Nutritional Pearls: Reduce the Risk of Diabetes and Breast Cancer

Mary is a 40-year-old woman with a history of diabetes and breast cancer in her family. Her friend told her about a diet that can help reduce the risk of both diabetes and breast cancer. She thinks this is too good to be true and asks you if there is any research to support this and what kinds of foods are included in this diet.  

How would you advise your patient?

(Answer and discussion on next page)

Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients with evidence-based resources including special diets for coumadin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance.

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A dietary pattern associated with a lower risk of diabetes is also associated with a reduced risk of breast cancer. The diet is low in its overall glycemic index, low in trans-fat, sugar-sweetened beverages, and red or processed meat consumption, higher in cereal fiber, coffee, nuts, and fresh fruit, and with a higher ratio of polyunsaturated to saturated fats.

Researchers affiliated with Harvard Medical School and funded by grants from the National Institutes of Health as well as Susan G. Komen for the Cure® recently found that a dietary pattern associated with a lower risk of diabetes is also associated with a reduced risk of breast cancer.1

The Research

The research was performed using data gathered for the Nurses' Health Study (NHS) 1 and 2, both of which are large-scale, long-term prospective studies of female nurses. The studies began gathering data in 1976 and 1989, respectively, and include a total of over 238,000 participants. Every 2 years the participants in both studies respond to questionnaires regarding their health and medical history, and diet is assessed with a detailed food frequency questionnaire every 4 years.

In previous research using the same data, the authors of this study had identified a dietary pattern associated with an up to 40% lower risk of diabetes that they termed a Diabetes Risk Reduction Diet (DRRD): one that is lower in its overall glycemic index, lower in trans-fat, sugar-sweetened beverages, and red or processed meat consumption, higher in cereal fiber, coffee, nuts, and fresh fruit, and with a higher ratio of polyunsaturated to saturated fats.

Noting that insulin resistance, which is linked to type 2 diabetes, has also been linked to breast cancer, the authors wondered if a greater adherence to a DRRD might also reduce a woman's risk of breast cancer.

The researchers devised a scoring system that measured adherence to a DRRD, with scores ranging from 1 to 5 (lowest to highest risk) for each of the 9 dietary factors of a DRRD, with the lowest overall possible score being a 9 and the highest a 45.

Using the responses to the health surveys from the NHS 1 and 2  studies as well as medical information, the authors identified those women who developed breast cancer from the start of both studies to the end of 2016 (for the NHS 1) and 2017 (for the NHS 2). Those women who died before 1980 (in the NHS 1) and before 1991 (in the NHS 2) were excluded from their analysis, along with women who reported having cancer at the start of the studies or who provided implausible dietary information in their first surveys.

The Results

Comparing the DRRD score of those women who developed breast cancer with those who did not, the authors found that those with the highest DRRD score had a not-insignificant reduction in risk of breast cancer of 8% after taking into account multiple variables, including change in weight from age 18 years.

The risk of premenopausal breast cancer was cut by just 4%, but postmenopausal breast cancer risk was cut by 10%.

When the authors analyzed women who were overweight/obese and women of clinically normal weight separately, they found that the dietary association disappeared for women who were overweight/obese, but the inverse association still applied for women of normal weight.

What’s the Take Home?

It certainly isn't lost on me that the DRRD shares several elements with a Mediterranean-style diet, including less red and processed meats, higher intake of nuts, fruits, and cereal fiber (whole grains), and a higher ratio of unsaturated to saturated fats. Yet body weight also plays a role. The good news is that if you are working on your weight—or even if you're not—a Mediterranean-style diet is one that you can live with for the long term.

Reference:

1. Kang JH, Peng C, Rhee JJ, et al. Prospective study of a diabetes risk reduction diet and the risk of breast cancer. Am J Clin Nutr. 2020;112(6):1492-1503. https://doi.org/10.1093/ajcn/nqaa268