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This month’s club is on a topic I admit I have not paid enough attention to.
We can use this information in our personal lives as well as our work lives.
Thank you Jeff for bringing the topic to us and volunteering to lead this month.Here are our articles for this month:
Polyphenols in cancer prevention: New insights (Review)Briguglio, G., Costa, C., Pollicino, M., Giambò, F., Catania, S., & Fenga, C. (2020). Polyphenols in cancer prevention: New insights (Review). International Journal of Functional Nutrition, 1, 9. https://doi.org/10.3892/ijfn.2020.9
Srimanta Patra, Biswajita Pradhan, Rabindra Nayak, Chhandashree Behera, Surajit Das, Samir Kumar Patra, Thomas Efferth, Mrutyunjay Jena, Sujit Kumar Bhutia,
Dietary polyphenols in chemoprevention and synergistic effect in cancer: Clinical evidences and molecular mechanisms of action, Phytomedicine, Volume 90,2021,153554,ISSN 0944-7113,https://doi.org/10.1016/j.phymed.2021.153554.I look forward to reading your comments.
Hey Everyone, as Renee said my name is Jeff I am one of the nurses in the outpatient JCRU. These articles are useful to everyone and not only those with a cancer diagnosis. Upon looking at the discussion page- it appears there are 4 articles but there are only 2 and for some reason the system duplicated them. The 1st article is lengthy, but it talks specifically about 8 different types of cancers and the effect diet can have on each of them.
1. What was the knowledge gained from the article? We all know that we have been told to eat more fruits and vegetables since we were young. These articles talk to the benefits of eating more of these foods and the polyphenols how they can reduce significance of certain types of cancers. I would not have thought that 30-35% of cancer cases were influenced by our diets. I was unaware that polyphenols could have a multi-faceted impact on the cell cycle. Before reading the articles, I did not have previous knowledge about platelet-activating factor. Zinc is recommended to promote for our patients to help with loss of taste, but how it in addition to folate, play a role DNA repair (zinc can be found in a lot of these fruits and vegetables as well). I have heard of the Mediterranean Diet and heard various health factoids about it, but I was unaware the prevalence of certain types of cancers was so significant (Prostate risk 20 fold greater coming to America for Asians). It is hard to believe that with as powerful as polyphenols are that our small intestine can only absorb 5-10% of the total intake. It was interesting that certain types of polyphenols (isoflavones in particular) may have hormone-related adverse effects on cancer.
2. Will the research/information in this article change or influence your practice? If so how? This information is valuable to everyone and not just those with a cancer diagnosis. I found these articles because I recently watched a documentary called “Gamechangers” from 2018 where it was professional athletes who ate a vegetarian (or vegan in some cases) diet and how their performance improved; and I was wondering the science behind it. I have started to implement dietary changes in my life already. The articles are valuable BUT hard to implement to our patients. Many of our patients already struggle to decide between paying bills or eating; and the foods rich in polyphenols are typically more expensive. Educating the patient will be helpful to where it may influence small dietary changes but hard to implement full scale dietary changes.
3. What other questions does the article raise about current practice? Why do isoflavones have hormone-related adverse effects? Why does our small intestine only absorb 10% ish of polyphenols and is there a way to improve that? What further testing needs to be done to promote turmeric or other supplement use? (Also hard to regulate because most supplements on the market are not regulated to quantity in each capsule/pill). Is there going to be changes where polyphenols are added as a supplement instead of us eating them naturally?
4. Do you agree/disagree with the conclusions of the author, why? I agree with the authors and that dietary changes could play a big role in cancer treatment (and for everyone to improve and potentially even prevent cancers). The diet high in polyphenols is often more expensive upfront but it can prove to cheaper long term.Hi all, my name is Chris Tornero, I am a RN in the OR at JOC (James West). This is my first time participating in the Martha Morehouse Journal Club, thank-you all for having me and let me just say the organization of this webpage is top notch.
1. What was the knowledge gained from the article?
I was not familiar with polyphenols before reviewing these articles so these articles were particularly interesting and informative to me. I find it very encouraging to see evidence that a change/improvement in diet can be so impactful in cancer outcomes and prevention. I was familiar with the Mediterranean Diet and its link to lowering risk factors in heart disease, so it is great to hear the same diet can help in oncology. I have always heard about antioxidants being healthy but didn’t fully understand their mechanism of action. It was very interesting to read about dietary polyphenols effect on apoptosis and autophagy in regards to anticancer pathways.2. Will the research/information in this article change or influence your practice? If so how?
Patients, friends and family will ask we what they can do to prevent cancer or what they can do in adjunct with their cancer treatment plan. I can now confidently say that adding at least 5 servings of fruits and vegetables a day is an effective way to help prevent and help combat cancer.3. What other questions does the article raise about current practice?
How can we help patients access fresh fruits and vegetables?
How can we we better prioritize diet as part of our patients treatment plan?4. Do you agree/disagree with the conclusions of the author, why?
I agree with the authors conclusions. Everyone should be eating more whole foods, fruits and vegetables. If 30-35% of cancer cases could be prevented and or positively influenced by our diet, promoting this diet should be at the for front of preventative medicine. To combat costs, gardening could be encouraged (if possible) and local resources like food collectives cold be utilized. More resources for obtaining fresh fruits and vegetables are definitely needed.Thank you Jeff for hosting and sharing these articles with the group. My name is Amber Davis and I work in Oncogeriatrics/Hematology Oncology at West Campus.
1. What was the knowledge gained from the article?
Cancer is the second leading cause of mortality, after cardiovascular disease. I was surprised to see that 30-35% of cancer cases are associated with dietary factors. The lower incidence of cancer in countries where the populations eating habits were low intakes of meat, moderate intake of dairy and alcohol, and the frequent consumption of fruit and vegetables. Natural compounds found in these diets can help modulate the cell cycle, remove anti-cancer agents, and exhibit chemo-preventative activity. There was also discussion of the Mediterranean diet. It was also interesting to read how these certain foods and supplements work. Also reading about how there is a 20 fold increase of developing prostate cancer for Asian immigrants to the U.S. is alarming.2. Will the research/information in this article change or influence your practice? If so how?
I think being able to give specific advice on food options/recommendations for patients and families is helpful. Being able to discuss the Mediterranean diet and specific fruits and vegetables for example: cherries, apples, broccoli, cabbage, tomatoes, berries, oranges, lemons, grapes, strawberries, black raspberries, etc. Unfortunately, the cost of these food items can be quite a reach for patients/families as they are going through costly treatments, loss/decrease of income, and for some access to food. Also for patients receiving treatment they may have altered taste and are losing weight. The taste and digestion of some of these foods may not sit well with the patients.3. What other questions does the article raise about current practice?
How can we implement healthy eating for the entire population, especially those individuals at risk? To be able to afford fresh produce and have access to fresh food can be difficult for some. I also was intrigued by the clinical trials that included curcumin, and I am wondering if additional clinical trials will be held to evaluate further effectiveness with chemotherapy and immunotherapies.4. Do you agree/disagree with the conclusions of the author, why?
I agree with consuming 5+ fruits and vegetables daily to lower cancer risk. The antioxidant and anti-inflammatory properties of these fruit and vegetable compounds need to be examined further to figure out a specific concentration of tested food and drink.Chris-I agree with your questions about how to help patients gain better access to fresh fruits and vegetables. Jeff-I hadn’t heard of having patients utilize zinc supplements to help with taste changes. That is helpful to konw!
Hi Everyone! My name is Trish and I am a triage nurse in the clinical call center. Thanks Jeff for hosting this month.
What a great topic! Welcome Chris, I agree this is a great journal club!1. What was the knowledge gained from the article? I have always heard that eating a diet full of colorful fruits and vegetables was healthy and prevented many health issues including heart disease and cancer. Now I understand the science of why. The polyphenols regulate molecular cell death pathways, reduce inflammation to help with cancer prevention and polyphenols increase the efficacy of anticancer medications by regulating tumor suppression genes. It was stunning to learn that as much as 30-35% of cancers can be prevented by our diets in the first article. The second article states that two-thirds of human-associated cancers could be prevented through applicable nutritional modifications and change in lifestyle. That is incredible to think that diet could be so preventative. I have known that the Mediterranean diet is recommended for heart healthy diets but didn’t realize it was also good cancer prevention as well.
2. Will the research/information in this article change or influence your practice? If so how? Patients cannot change their genetics or sometimes even their environmental exposures; however, they can prevent cancer with eating specific foods or help the traditional cancer treatments work more effectively to subdue the cancer they already have. A healthy diet can dramatically change how their body fights the inflammation and cell defense For example, carotene-rich fruits and vegetables, cruciferous vegetables and citrus food decrease the risk of cancer onset and phytonutrients from diverse colored vegetables and fruits can preventive cancer due to their strong antioxidant properties. Teaching that regularly eating polyphenols as food or food additives can be an additional way to fight cancer with anti-cancer drugs.
3. What other questions does the article raise about current practice? How can the oncology teams help patients incorporate polyphenols when the patient has a tight budget? What kind of social services can we offer our patient’s that have financial constraints? Would supplements be as effective as food as far as absorption if a patient is neutropenic and cannot eat fresh fruits and vegetables?Jeff, I was surprised at the multi-faceted way polyphenols worked in the cell cycle as well. It was interesting to see the science and research that eating healthy can be a game changer. As I nurse, it certainly hit a different way to see the research to prove what my mom and doctors always said growing up. It is unfortunate that it is so expensive to eat healthy knowing what this can do to the cancer prevention and how it helps with cancer remission. Not only is healthy eating expensive, some patients are restricted from eating fresh foods when they are neutropenic during treatment. It would be great to find a way to offer a supplement that can be better absorbed in the small intestines AND could be a covered benefit by insurance to increase compliance.
Chris, I noted too that the cancer rates in countries that eat less meat and dairy and more vegetarian are healthier in general. I was stunned that the Asian immigrants have a 20-fold increase of prostate cancer as well. What is most profound is that something so simple as eating the right foods can prevent and help cure cancer. We have a lot of work to do in research for supplements and education to the public and patients that even small changes can be beneficial.
Chris- welcome to this journal club!! You bring up good questions- I wish there was a better way to incorporate diets into our patients regimens. I think the change needs to start at an earlier level than prior to cancer diagnosis. I know we have Registered dietitians who can talk to patients about how to eat during cancer treatment, BUT as we know oftentimes patients don’t want to eat/ have taste changes/ don’t have the energy to eat/ or just can’t afford the healthy food options.
Amber- they encourage zinc to help with taste changes but from my experience such a small percentage of patients actually report it being helpful. I still encourage it for our patients but I give them a caveat that it doesn’t work for all patients.
Trish- The research was definitely eye opening as to the HOW polyphenols worked not just that they did work. Them impacting the cell cycle like that is impressive
Happy February! One month closer to spring! My name is Reena and I work at OSU East Endoscopy. Thanks, Jeff, for leading the journal club this month.
1. What is the knowledge gained from these articles? We hear all the time that diet can influence our health. I would say that working in endoscopy, it is apparent in many aspects. We hear of acid reflux, ulcerative colitis, Crohn’s disease, high incidence of polyps, etc. And many of these health conditions can be influenced by diet. It doesn’t surprise me that it can influence the direction of cells in cancer cell cycle. I listened to a podcast once that spoke of Americans following a more African diet and Africans following a more American diet and being able to see the changes in the colon lining after approximately one month.
2. Will the research/information in the articles change or influence my practice? In my practice I already speak with patients about their diet to help with constipation, diarrhea, acid reflux, bloating, etc. Now my education can be furthered by stating it can help in preventing cancer, including more than just colon cancer.
3. What other questions does the articles raise about current practice? I would say many of us have educated our patients on eating a healthy well-rounded diet and will continue to do so. I see some patients having a hard time buying some of the healthier options, but I have learned that there are many food banks in the Columbus area that anyone can go to pick up free items, this includes fresh fruit and vegetables.
4. Do I agree/disagree with the authors? I totally agree with the authors. Not only eating a healthy diet can improve your health, if it is showing that it can lessen the risk of some cancers, why wouldn’t we really try to pass this information on to our patient population?
Happy February everyone! My name is Amy, and I am nurse in medical oncology at the breast center. Thank you for sharing these articles Jeff! They were very informative and extremely interesting to read. I cannot get over that 30-35% of cancer cases are associated with dietary factors. Thats a pretty staggering number. I also did not know anything about polyphenols prior to reading these articles. I am very interested to talk to our pharmacists regarding these articles, as we typically ask patients to stop taking any antioxidants while undergoing chemotherapy so that they do not work against the chemo. More times than not, this is related to high concentrations in supplements, so the role of dietary polyphenols with chemo is intriguing.
I think these articles also highlight the importance of preventative care. In my role, we are always talking to patients after they’ve already been diagnosed, and so we talk a lot about nutrition and diet in the survivorship setting. This is obviously very beneficial to patients, but I think trying to help people see how important these diet changes can be in cancer prevention is extremely important too. I think these articles are a great example of how better access to preventative care could really help our society and make a positive impact. I definitely agree with the authors, anything we can do to decrease cancer risk is a great thing!Hello, My name is Patti and I work with Trish in Triage here at the James.
What was the knowledge gained from the article?
To be honest I was shocked to see that a healthy diet can prevent about 30% of carcinogenesis. I also found it eye opening that, chronic inflammation can put you at risk for cancer and even progression of existing cancer. It also surprised me to learn that antioxidant polyphenols play crucial role in the inhibition of inflammation. “A lower incidence of cancer has been observed in countries where eating habits involve a low intake of meat, moderate intake of dairy and alcohol, and the frequent consumption of fruit and vegetables rich in bioactive nutrients.” This contradicts what I was taught as a kid because it was stressed upon me to drink a lot of milk, and my major source of protein was red meat. We need better education to the general public.
Will the research/information in this article change or influence your practice? If so how?
I will recommend consuming more than five servings of vegetables and fruits in a day to diminish the risk of cancer initiation.
What other questions does the article raise about current practice?
Are supplements as effective as natural polyphenolic compounds found in fruits and vegetables?
Do you agree/disagree with the conclusions of the author, why?
I agree vegetables and fruits are potent disease preventive agents that help to combat cancer due to their strong antioxidant properties. However more research is needed to support the use of polyphenols in the treatment of cancer.As far as resources for our patients I know that Dr Clinton with GU med/onc had told me about the Garden of Hope a program for James patients and caregivers.
The mission of the Garden of Hope is to provide evidence-based nutritional information and education on the benefits of a plant-based diet. The 1.5-acre garden is located at the Waterman Agricultural and Natural Resources Laboratory on The Ohio State University campus. Registered participants for the two-year Garden of Hope program have the opportunity to harvest over 100 varieties of produce including vegetables, herbs, fruits, and edible flowers from June – October. During scheduled harvest sessions, staff is available to answer gardening and nutrition questions. Orientation is required for both cancer survivors and their caregivers to participate in the program.
Hello everyone! My name is Beth and I work in infusion on the fifth floor of the James. I appreciate Jeff for organizing this great topic.
1. Knowledge gained: I have known that a healthy diet of fruits and vegetables are important to maintain a healthy weight and ward off disease, but I did not understand the impact it could make, and the various mechanisms utilized in order to help the body stay healthy. I had not heard of polyphenols before, nor their antioxidant and anti-inflammatory properties.
2. Change or influence practice: The fact that 30-35% of cancer cases can be avoided by eating healthy is something everyone should be aware of. Patients diagnosed with cancer feel helpless and hopeless, however, incorporating more fruits and vegetables in their diet is something they can do, in addition to their treatments. It will help them feel like they have a little more control over what is happening to them.
3. Questions Raised: Which foods have the most polyphenols? Are there specific foods that fight specific cancers (one article touched on which polyphenols helped to combat certain cancers, but there were no specific foods listed that contain these properties)? How can we as providers come up with an information sheet for patients that will help them understand this information? How can we help make fresh fruits and vegetables accessible to all patients?
4. Do you agree or disagree? I am very much in agreement with these articles and am hoping I can implement change in nutrition in my own life and the lives of my loved ones. I hope to share the information I have learned with my patients too. Unfortunately, I think the people that could benefit most are young people that have time to make changes to their diets and lifestyles, where it will be most beneficial to their health. I hope there is more research in the bioavailability of these chemicals when administered as pure active principles, in order to target cancer more directly after diagnoses.Hello, my name is Jessica and I am a clinic nurse at The James at Outpatient Care New Albany.
What was the knowledge gained from the article?
Before reading these articles, I had never heard of “polyphenols” and their role in health. Growing up, I was always told to eat my fruits and vegetables because they were “good for you.” The reasons given were often basic, focusing on benefits like getting potassium and antioxidants. However, it was eye-opening to learn that certain fruits and vegetables might have specific protective effects, such as helping to prevent cancer. The article highlighted how polyphenols in these foods play a crucial role in cancer prevention, which was something I hadn’t considered before.
Will the research/information in this article change or influence your practice? If so how?
The research in these articles will certainly influence my practice. I now understand the importance of educating my GI/GU cancer patients about the potential role that fruits and vegetables, specifically those rich in polyphenols, can play in their health and cancer prevention. I can incorporate this knowledge into discussions with patients to emphasize dietary changes that may complement traditional treatments and improve overall well-being.
What other questions does the article raise about current practice?
One of the biggest concerns is how to ensure that patients, especially those from underserved communities, have access to fresh, nutrient-rich fruits and vegetables. How can healthcare professionals work with social work and case management teams to help patients obtain these foods?
Do you agree/disagree with the conclusions of the author, why?
I fully agree with the points made. I believe everyone should be encouraged to increase their intake of fruits and vegetables as part of a healthy diet. However, I also think more resources and support are needed to ensure that all individuals, regardless of their economic or social situation, have access to fresh produce. In my volunteer work at a local food pantry, I’ve seen firsthand that the supply of fresh fruits and vegetables is often limited, and what is available may not always be in the best condition.
Trish- I agree, the articles provided a deeper understanding of why a diet rich in colorful fruits and vegetables is crucial for preventing health issues like heart disease and cancer. It was shocking to discover that 30-35% of cancers could potentially be prevented through diet, with two-thirds of human-associated cancers being preventable through lifestyle and nutritional changes. I am also curious to what social servies are in place to help all patients have access to fresh produce.
Beth- I agree, there needs to be a simplified patient education page to breakdown “polyphenols” to patients that describes which fresh produce items would be best for each individual’s diet. Food intake is a modifiable risk factor for cancer, and it would be beneficial to help patients avoid diagnosis of cancer, if possible.
1. What was the knowledge gained from the article? Wow! I knew fruits and vegetables were good for you, but I had no idea polyphenols have been studied this extensively and can have such a powerful effect on cancer cells and their death or development. I was not surprised to read that polyphenols are not as effective when administered as solely their active component. I have seen headline after headline about various phytochemicals and their amazing attributes but their use as supplements does not duplicate these health attributes.
2. Will the research/information in this article change or influence your practice? If so how?
There isn’t a whole lot I can do to change my practice as far as polyphenols are concerned, besides promoting better dietary habits with patients. Dietary intake is already so challenging with patients that this is already a difficult and complex topic without an easy fix. Further complications in certain patients and cancer types create additional challenges, such as the need for nutrient-dense, high caloric small meals in the head and neck cancer population. I feel like we have been asking patients to increase their intake of fruits and vegetables for decades. Add to these concerns the number of fruit and vegetable recalls we see every year due to pathogen contamination and it further complicates the simple phrase: eat more vegetables. Many fruits and vegetables also have a higher cost than less healthy food alternatives, further limiting our patients’ ability to consume them in larger amounts.
3. What other questions does the article raise about current practice?
It’s unfortunate for me that the Mediterranean diet is associated with lower cancer rates and better health incomes, because I don’t like Mediterranean food. I do like Asian food, so I’ll have to hang my hopes on that.
4. Do you agree/disagree with the conclusions of the author, why?
Yes, polyphenols appear to have great promise in assisting with cancer prevention and even its treatment, but more research is warranted. I wonder if some amount of current research is limited because so much research is conducted by pharmaceutical companies, and courts have already ruled they cannot patent naturally occurring compounds and chemicals. If they cannot patent and profit from the study results, why would they conduct them in the first place? It also sounds like testing is difficult because most foods that contain them have relatively small amounts of polyphenols. The key here will be someone figuring
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