India is a developing country with one of the most diverse populations and diets in the world. Cancer rates in India are lower than those seen in Western countries, but are rising with increasing migration of the rural population to the cities, increase in life expectancy and changes in dietary habits and lifestyle. Trends, based on current and projected data indicate that countries face considerable challenges as under-nutrition evolves into over-nutrition as the community becomes developed.
Increase in cancer
The relationship between diet and health has been recognised throughout history. Previously, Indian immigrants in Western societies, after a generation, had a dramatic increase in incidence of cancer and other chronic diseases, such as coronary heart disease and diabetes, but now we see a similar pattern in the local population also. Urbanisation along with dietary changes, reduction in physical activity, and increasing obesity generally explains the trend. As a nation, we're getting fatter. Obesity and lack of physical activity are associated with increased risk at various cancer sites, including breast and endometrial cancer. Research has shown that many types of cancer are more common in people who are overweight or obese. This list includes two of the most common types of cancer — breast and bowel cancers, and three of the hardest to treat — pancreatic, oesophageal and gallbladder cancers.
Protecting the body
Whether we have a history of cancer in our family, or are currently battling the disease, lifestyle factors, including diet, can make a huge difference in helping us fight off cancer. By making smart food choices, we not only protect our health, but also boost our ability fight off cancer and other diseases. Avoiding cigarettes, limiting alcohol, reaching a healthy weight, and getting regular exercise are a great start to preventing cancer. But to best support our health, we also need to look at our eating habits. Without knowing it, we may be eating many foods that fuel cancer, while neglecting the powerful foods and nutrients that can protect us. For example, a daily serving of red or processed meat increases our risk of colorectal cancer by 21 per cent, whereas eating whole soy foods such as tofu or soy milk can help reduce the risk of breast cancer.
While there's no single food we can eat to prevent or fight cancer on its own, a balanced plant-based diet filled with a variety of vegetables, fruits, soy, nuts, whole grains, and beans can help lower our risk for many types of cancer. Plant-based foods are rich in nutrients that boost our immune system and help protect against cancer cells. Fruits and vegetables are the best sources of antioxidants such as beta-carotene, Vitamin C, Vitamin E, and selenium. Diets high in fruit may lower the risk of stomach and lung cancer.
Regional variations
As per the National Cancer Registry Programme of the Indian Council of Medical Research, there has been a lot of regional variation of incidence of cancer in India. Diet has a major role in the varying incidence of cancer. In Punjab, consumption of non-vegetarian food, especially red meat, has significantly increased in recent years. Also taking spicy foods on most of the days has become more regular in our daily households. A study carried out on the Indian diet has mentioned that consumption of very spicy foods, hot foods and beverages, high amounts of chilli, was positively associated with the risk of oesophageal cancer. Another western trend of consuming excessive alcohol, especially by females, has also shown a rise in incidence of breast cancer by approximately 7 per cent. Alcohol drinking increases the risk of cancers of the oral cavity, pharynx, larynx, oesophagus, and liver. An association is probable in the case of colon, rectal, and breast cancer. The risk of cancer is related to the amount of alcohol consumed. Alcohol drinking and tobacco smoking show an interactive effect on the risk of cancers of the head and neck.
An interesting study conducted by Dayanand Medical College, Ludhiana revealed that the prevalence of obesity was found to be 14.8 per cent in adolescent girls and heredity played no role. Again faulty dietary habits were found to be a major cause of weight gain. A number of sources, including the GLOBOCAN, suggest that there is a direct link between obesity and increase in cancer incidence and obesity-related cancer is a greater problem for women than men, largely due to endometrial (womb/uterus) and post-menopausal breast cancers. We Indians who were well known for roughage and a high-fibre diet are shifting to low or no-fibre western diet. Consumption of dietary fibre reduces the risk of colon cancer, breast and prostate cancer by absorbing and inactivating dietary estrogenic and androgenic cancer promoters.
Relying on superfoods
There are often stories in the media about specific foods or “anti-cancer diets” that are meant to be particularly good for us. But we shouldn't rely only on so-called “superfoods” or organic foods to reduce the risk of cancer. They cannot substitute for a general healthy, balanced diet. I think people can get a little too preoccupied with these theoretical connections when they would be better off focusing on better established ways of reducing their risk of cancer — weight loss, exercise, and a healthier diet. Here's an easy way to picture a healthy, protective diet. Every time you eat, aim to have two-thirds of your plate made up of healthy plant foods, like vegetables, fruits, whole grains and beans. Then have the remaining one-third, or less, made up of animal foods, preferably lean poultry, seafood, and very limited amounts of red meat. To add flavour, use moderate amounts of healthy oils, herbs, spices, citrus, and vinegars.
Heredity vs environment
Recent studies suggest that genes have a lesser role to play in cancer than diet and lifestyle. The American Institute of Cancer Research on its website has urged the western population to follow the New American plate (meals made up of 2/3 (or more) vegetables, fruits whole grains or beans and 1/3 (or less) animal protein) which is nothing but a staple traditional Indian plate, to decrease the alarming rise in incidence of cancer in the West. We should look back at our past and preserve the natural traditional Indian diet, which is rich in anti-cancer elements.
As a society, we Indians have one of the most interesting diets, with many unique dietary constituents like turmeric, a common household spice, that holds the promise of cancer prevention. Cancer-prevention efforts like diet and lifestyle changes can have enormous benefits for India. By reducing future disease burden we can save economic resources for needed improvements in societal infrastructure. As development and mechanisation continue into the 21st century, we should retain our rich traditions, of which the most important is the Indian diet. This will be the key point to slow down the increasing incidence of cancers in India. It is difficult to pin-point a single cause as cancer is caused by multiple factors. Therefore, a multi-pronged strategy to provide safe water supply, discouraging indiscriminate use of pesticides, tobacco and alcohol and adopting a healthy vegetarian diet is also recommended.
The writer is a surgical gastroenterologist with special interest in gastrointestinal oncology, at Fortis, Mohali
Pesticides & rising incidence of cancer in Punjab
A dietary survey of India has revealed that 65-70 per cent of total energy is drawn from carbohydrates, Based on the cancer registry data, it is estimated that there will be about 800,000 new cancers cases in India every year. Statistics released by the Punjab government in 2014 revealed that Punjab has over 90 cancer patients per 1 lakh population. This is much higher than the national average of 80 per lakh. The Malwa region, also known as the “cancer belt”, has the highest average of 136 cancer patients per 1lakh of population. Data over the last five years has shown that at least 18 people die of cancer each day in Punjab. Last year many reports in the media highlighted how Punjab, the country's food bowl, is in the throes of cancer. Indiscriminate use of pesticides is now being linked to the alarmingly high incidence of cancer in Punjab and has a major role to play in our diet.
Say yes to plant-based food
- Eating vegetables containing carotenoids, such as carrots and sprouts may reduce the risk of lung, mouth, pharynx, and larynx cancers.
- Diets high in non-starchy vegetables, such as broccoli, spinach, and beans, may help protect against stomach and esophageal cancer.
- Fruits like citrus and amla and vegetables like sweet potatoes and green leafy vegetables contains micronutrients such as Vitamin A and Vitamin C which have a protective influence in cancer of the lung, stomach cancer and several other sites.
- Foods high in lycopene, such as tomatoes, guava, and watermelon, may lower the risk of prostate cancer.
- Eating a diet high in fibre may help prevent colorectal cancer and other common digestive system cancers, including stomach, mouth, and pharynx. There is no fibre in meat, dairy, sugar, or “white” foods like white bread, white rice, and pastries.
- Drink plenty of water: Water is essential for fighting cancer. It stimulates the immune system, removes waste and toxins, and transports nutrients to all of your organs.
- For healthier meat choices, you don't need to cut out meat completely. Most people consume far more meat than is healthy. Try to keep the total amount of meat in your diet to no more than 15 per cent of your total calories. Red meat is high in saturated fat, so eat it sparingly
- Limit your consumption of salt. An intake of more than 2.4g sodium a day increases the risk of stomach cancer.