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    Comparing a Plant Based Olive Oil Diet to a Conventional Diet in Women Diagnosed with Invasive Breast Cancer After the Age of 50 for Improvement in Biomarkers and Weight Loss

    Scientific Abstract:
    Comparing a plant based olive oil diet to a conventional diet in women diagnosed with invasive breast cancer after the age of 50 for improvement in biomarkers and weight loss. Background: Diet and weight loss can influence biomarkers of breast cancer, such as blood levels of insulin, glucose, alpha tocopherol, carotenoids, lipids and oxidation. The diet recommended by the National Cancer Institute (NCI) lowers total fat and increases fruit, vegetable and grain consumpion. This lower fat, higher carbohydrate diet has the potential to increase insulin, glucose and lipid oxidation. The NCI diet allows meat, and published studies indicate meat can increase breast cancer risk. An alternative diet is plant based and moderate in fat, with the fat primarily from extra virgin olive (PBOO). Published studies indicate olive oil consumption is associated with a decrease in blood levels of insulin, glucose and lipid oxidation and breast cancer risk. The higher fat content could improve blood lipids and increase blood levels of carotenoids. Pilot data of the PI suggests the PBOO diet can produce greater weight loss than a conventional lower fat diet and improve some of the biomarkers of breast cancer. Thus, a PBOO diet may result in more improved biomarkers for breast cancer and better weight loss relative to the NCI diet. Hypotheses: Compared to the diet recommended by the NCI, a PBOO diet will result in: 1. more improved breast cancer biomarkers and significantly greater weight loss after 8 weeks; 2. more women will choose the PBOO diet for continued weight loss/ management; 3. women who choose to continue with the PBOO diet will have better weight loss/ management and biomarkers at 6 months of follow-up. Specific Aims: To compare the diet recommended by the NCI to a PBOO diet for: 1. improvement in some biomarkers for breast cancer; 2. 8 weeks of weight loss and 6 months of follow-up weight loss/management; and 3. acceptability of a PBOO diet for weight loss / management for women with breast cancer. Study design: Sixty women diagnosed with invasive breast cancer after the age 50, overweight but otherwise healthy will be studied. There will be two 8-week periods of weight loss, with random assignment to the order of the NCI diet and the PBOO diet. The NCI diet will emphasize fruits, vegetables and grains, total fat up to 30%, lean meat up to 6 oz/day with other fat from canola and other vegetable oils, but no olive oil. The PBOO diet will have a goal of at least 30% of energy from extra virgin olive oil and a total fat goal of 35-40%; meals will be plant based and meat restricted to poultry 6 oz/week and fish to 8 oz/week. Daily records of key foods and 3- day diet diaries during weeks 4 and 8 will assess diet compliance. Weekly meetings will provide nutrition and weight management education. After completing both diets, participants will select one of the diets for 6 months of follow-up with 2 meetings per month that will add information to help increase physical activity. Pedometers will be provided to monitor and increase activity. Anthropo- metric measures and fasting blood work pre and post each diet and after the 6 months of follow-up will be compared The blood will be analyzed for total and HDL cholesterol, HDL 2/3, triglycerides, LDL size and oxidation, insulin, glucose, c-reactive protein, alpha tocopherol, alpha- and beta- carotene and lycopene. Potential Outcomes and Benefits: Diet and weight loss can influence biomarkers of breast cancer, which has the potential to influence the prognosis of a woman with breast cancer. Yet, diet has not been adequately studied. The diet recommended has not been shown to improve cancer biomarkers or breast cancer survival and allows foods that might increase risk of recurrence. A PBOO contains foods with know health benefits and has been shown in pilot studies to result in greater weight loss and to improve some of the biomarkers of cancer. Thus, the PBOO diet has the potential to improve the overall health of women with breast cancer and decrease risk of recurrence.

    Lay Abstract:
    Comparing a plant based olive oil diet to a conventional diet in women diagnosed with invasive breast cancer after the age of 50 for improvement in biomarkers and weight loss. Diet can influence the blood levels of biomarkers for breast cancer such as blood fats, oxidation, insulin, glucose, vitamin E and carotenoids. The diet recommended by the National Cancer Institute (NCI) suggests eating less fat and increasing fruit, vegetable and whole grains, all carbohydrate foods. A lower fat higher carbohydrate diet has the potential to increase insulin, glucose, and blood fat oxidation and make blood fats less healthy, which all could adversely affect breast cancer risk. As dietary fat is needed to absorb caroten- oids in dark produce, a lower fat diet may not result in maximal blood levels of carotenoids. The NCI diet also allows meat daily and studies suggest meat can increase the risk of breast cancer. Being overweight can increase breast cancer recurrence and decrease survival. Low fat diets are recom- mended for weight loss as it is thought they help with weight loss. The PI of the proposed study completed 2 pilot studies comparing conventional lower fat diets to a plant based olive oil (PBOO) diet. Both pilot studies showed greater weight loss with the PBOO diet. One of the studies had blood samples and the PBOO diet produced lowered glucose and triglycerides. Thus, a PBOO diet may result in better weight loss and improvement in some breast cancer biomarkers relative to the diet currently recommended by the NCI. The proposed study will test if the PBOO diet of the pilot studies has the potential to improve the health and body weight of overweight women who have been diagnosed with breast cancer. The PBOO diet is moderate in fat, which would improve blood levels of insulin, glucose and blood fats and the higher fat content could increase blood levels of carotenoids. Extra virgin olive oil is the main fat as it has been shown to lower risk of breast cancer and can lower blood levels of insulin, glucose and blood fat oxidation and result in healthier levels of blood fats, which all could decrease risk of breast cancer. The higher plant, lower meat content is also healthier. The specific aims are to compare the diet that is recommended by the NCI to a PBOO diet for: 1. changes in some biomarkers for breast cancer; 2. weight after 8 weeks and 6 months of follow-up; and 3. acceptability for weight management. The proposed study is for 60 women diagnosed with invasive breast cancer after the age of 50 who are overweight but otherwise healthy. There will be two 8-weeks of weight loss, the NCI diet for one and the PBOO diet for the other. The NCI diet will emphasis fruits, vegetables and grains, lean meat up to 6 oz/day and total fat up to 30%. The PBOO diet will have a dietary fat goal of 35-40%, with at least 30% of calories from olive oil, meat restricted to 6oz/week of poultry, 8 oz/week of seafood and no red meat. Weekly meeting will be for nutrition and weight management education and reporting weight and health status. After completing both diets, participants will select one of the diets for 6 months of follow-up with 2 meetings per month. These meetings will add information to help increase physical activity. Pedometer will be provided to set goals and monitor activity. Results of body measures and blood samples before and after each diet and at the end of 6 months will be compared. Diet as a treatment for breast cancer is not well studied. The PI hopes the study results will open debate on diet recommendations for women with breast cancer and lead to diet recommendations that would best improve breast cancer prognosis. There are minimal risks and great potential health benefits to this study, as the PBOO diet contains foods with known health benefits and should result in a healthier body weight.