[MUSIC] Welcome to the University of Utah. My name is Doctor Tricia Petzold. I'm a family physician practicing integrative, functional and lifestyle medicine. Last year at the National Cancer Prevention Workshop, I introduced the course that we're teaching here at the University of Utah called Culinary Medicine. It's a graduate program where we work with nursing students, medical students, pharmacy students and social work students and other graduate students to really teach food as medicine and make it practical in the clinical setting. This year I'd like to expand on the collaboration happening at the University of Utah and introduce you to a researcher from the Huntsman Cancer Institute. Dr Mary played is an investigator at the Huntsman Cancer Institute and is doing research here on food and cancer prevention. I'm thrilled to be here with you Dr Clayton and we're here meeting in the teaching kitchen where I teach culinary medicine and where Dr Clayton's team is preparing a research project. Thank you for joining me and can you tell us more about your various hats you wear here at the university and what's happening here in the kitchen. >> Thank you so much for having me. I am an investigator in the Cancer Control and Population sciences program at the Huntsman Cancer Institute and then I have an appointment as an assistant professor in the department of nutrition and integrated physiology in the College of Health at the University of Utah. I am a nutrition and cancer epidemiologist but I started my career as a registered dietitian. My work studies the interface of diet with human metabolism and cancer. And today in the kitchen we're preparing some meals for the time span study. And this study came into being when I was made aware of some striking statistics that women who are native Hawaiian or Pacific Islander have four times the risk of developing cancer, end of the uterus or endometrial cancer compared with white women. And actually they have higher risk of other types of cancer as well. And this prompted me to think about why this is an issue here in Utah on the mainland but also nationwide in this particular population. One of the things that drives this type of cancer is metabolic health. So things like diabetes and risk factors for diabetes, high blood sugar levels, levels of obesity. And so these are things that we can intervene upon to prevent cancer of the uterus. And that prompted me to think about how can we use a diet approach to improve metabolic health in women who are native Hawaiian or Pacific Islander. And that's where the time span study was born. Really exciting research has started to emerge that is telling us that when we eat, might just be as important as what we eat for your metabolic health. So studies are showing that, regardless of what people eat if you can eat your calories in a shorter amount of time during the day with longer fasting overnight. That can have an impact on things like your blood pressure, your blood sugar levels, your cholesterol levels and even the health of the gut microbiome or the microbes that colonize your gut. And the important thing about this is that all of these pathways are important for cancer development. And especially cancer types like in the mutual cancer, other types of dietary research that have really focused on weight loss. It's very challenging and it's hard to stick to, especially in the long term. And so, we're trying to study is this approach feasible and can women stick to it and ultimately is it going to improve their metabolic health? So what we have going on here in the kitchen is we're preparing culturally tailored and culturally appropriate meals for women who are native Hawaiian or pacific islander here in Utah. In the time span study, what we're having women come in and do is we prepare these culturally tailored and delicious pacific inspired meals that we store as frozen meals and we provide lunch and dinner for eight weeks in total. For four weeks women can eat this nutritionally balanced meal plan whenever they want. So we're controlling their diet and we're not controlling the meal timing. And then they can spend a month going back to normal life then for another month, they're consuming the meals that we provide them, but they're eating all of their food within no more than ten hours during the day. So we're controlling the timing of when they're eating. And what we're hoping is that when we compare no meal timing versus meal timing control, that we'll see an improvement in metabolic health parameters, things like blood sugar and blood pressure. So the time span study really sits at the foundation of building scientific evidence. So we want to find out if this type of dietary plan is feasible, if people can do it if they can stick to it and if indeed it does improve their metabolic health. And ultimately we're hoping that this type of evidence will go towards building up evidence based dietary guidance at the population level, but also targeted towards specific communities that might have specific needs. I understand you to tackle many dietary and nutrition questions using a technology called metabolism mix. Can you explain that what that is to someone who doesn't do research? Absolutely. So Montevallo Mix is really a technology and it measures small chemicals in fluids and tissues. So, for example, in blood and even in tumor tissue, we can measure these small chemicals which we call metabolites and these are things that the size of, for example, simple sugars or the building blocks of protein, which is amino acids. So, really small. And we're applying this to dietary research in two major ways. So, first of all, as you're probably aware, especially, you know, with a lot of the patients that you see when you're talking about diet nutrition messages can be very confusing because you hear one thing one day and you hear another thing another day. And sometimes the answers to scientific questions, they evolve over time as the science evolves. And nutrition research is especially complex in particular because it's so difficult to measure diet. We're relying on questionnaires where we're asking people what they ate sometimes over the course of a year. And of course it's difficult to remember what we eat. And so we're using this technology to develop more objective ways of being able to measure what a person ate yesterday or last week or last month or even in the last several months or even the last year. So we're hoping that by developing these types of dietary biomarkers that we can have more precision and have better answers to diet and cancer questions. And then the second way we're using this technology is we can look at your body's metabolic response to a certain diet or dietary pattern. And so by looking at how diet influences metabolism and then how those metabolic effects are linked with cancer. We can pinpoint specific dietary prompts or dietary exposures and what's actually happening to increase or decrease cancer risk. And so that can help us to develop precision diets I guess for targeting cancer prevention, wow that's that's brilliant. Yeah, I certainly appreciate that recall. I I recall with patients even 24 hours what they've eaten. It's it's a challenge. So what a brilliant. That's an exciting. That's an exciting progress. What changes can policymakers advocate for based on your scientific research? The type of research that we're doing here at the University of Utah and the Huntsman Cancer Institute is really to address questions of does diet matter for cancer prevention and how can we optimize diet for cancer prevention? So ultimately, as as I mentioned, we want to build the scientific evidence for dietary guidance, but really we need to understand the size of the problem and when it comes to lifestyle, did you know that Up to 60% of certain cancer types could be prevented with a healthy lifestyle? I think this figure is underappreciated. So endometrial cancer which we're studying here with the time span study, for example, 60% of cases could be prevented if we could address obesity and in colorectal cancer, which is, it's a very diet driven cancer as well. And obesity driven cancer. Half of colorectal cancer cases could be prevented if we could promote living a healthy life. So that means healthy eating, achieving and maintaining a healthy weight and being physically active. So, understanding that yes, diet does matter for cancer prevention then what what can we do at the population level? And there are two major areas that I see as being, you know, obviously we have to look at it systemically, but two major areas that we could try to tackle right now. One is access. So food security, how do we get healthy food to be available to everybody? So, across communities, across age groups here in Utah, you know, we have a very rural population, sometimes they struggle with access to healthy food and so that's a real priority. Another level that we could target with policy is focusing on providing access to nutrition counseling. So, for example, I work with a lot of registered dietitians and being able to allow registered dietitians to get reimbursed for dietary counseling for nutrition education and health promotion would would be an incredible contribution to this cause and I'm sure that you have experience in this area as well. Yeah, those are great. Those are two great points. I can't knowing making that those profound numbers when you think about what you said, 50-60% of cancers could be prevented with access to the right food, the right lifestyle that that we know prevents cancer. When I think about in a clinical way, it's very empowering for me to keep talking about nutrition with my patients. But also when I think about how profound that is. When you compare reducing cancer rates by 50 to 60 from anyone even getting cancer to get getting cancer and being treated and reducing the recurrence rates by much lower percentage than that and having all the complications and costs of having to go through treatment of cancer. Yes, it would have an enormous public health public health impact on on cancer rates and on healthcare expenditure. What do you see as a as the biggest impact on cancer prevention from a policy standpoint? So some of the other policy areas that we can target is improving the quality of diet in institutions. So that could be schools and prisons, for example, also advertising for highly processed foods which tend to be high in sugar and high in fat and promote the obesity issue, which is a A risk factor for at least 13 cancer types. That's another area. And as I mentioned, you know, reinforcing the support for for health providers to be able to provide nutrition education policies that help to improve the quality of the food supply as well. So food production of foods that are less processed and making them more widely available across the community. Those are great actionable items. What do you see as you know, specifically what foods are most important to focus on for cancer prevention? That's an important question. And one that I'm sure a lot of people who are worried about cancer ask. And also of course people that are diagnosed with cancer. That's one of the first questions that they ask, what should I eat, Tell me what to eat, Tell me what supplements to take. But there's really no one magic bullet, it's an overall lifestyle change. It's an overall kind of wellness approach. And so the main cancer prevention recommendations that we can make is to really focus on a diet that's full of fruits and vegetables and whole grains and legumes as well while limiting processed foods so high in simple sugars and and added fats, limiting alcohol and also limiting red and processed meat. So kind of this focus on kind of more of a plant based type diet which is full of plant foods, so your body is exposed to the thousands of beneficial plant chemicals in terms of cancer prevention. But at the same time limiting things like red and processed meat. It's also a sustainable approach in terms of sustainability of the food supply. So that's another benefit. And it's also recommended not to focus on supplements to for cancer prevention, but rather to focus on whole foods. That's wonderful. That is inspiring for me to keep focusing on that clinically with the patients that I see. But the other issue that we have here in Utah and everywhere is accessibility. And could you speak a little bit about what we might be thinking about in terms of how to how to make this more accessible to people regardless of socioeconomic or or physical location in the country. I notice that the study you're doing right now is is really specific to to a group of people who likely have some hurdles barriers to access of of certain healthy foods. Yeah, absolutely. I can speak to that. Yes, this is the particular demographic that we're focusing this study on. So people in the native Hawaiian and pacific islander community. So research has been done to show that there are higher levels of food insecurity and also in rural areas. So that's definitely an issue. So with the with the covid pandemic, that's really bolstered mobile health interventions and access to mobile health, I guess. I'm hoping that that can have an impact and including possibly really developing the technology to be able to bring nutrition education out into the community and out into these rural areas. But I'm not an expert on that topic. And it's such an important question and it's really a challenge that that we do need to address. Well, thank you so much. Dr Clayton for being here at the cancer prevention workshop with us as a board member of Less Cancer. I feel like dr Clayton has left us with a lot of actual items and wonderful information. And I guess I have one final question. If you could leave this group with one most important idea to take away, what would that be? Absolutely the one key takeaway that I would like to really get across is that diet does matter for cancer prevention and let's give everybody equal access to healthy food. Wonderful. Well, thank you. And and and really the world that's what less cancers out there trying to do. And so it's because of things that you're doing here that lets us get this message out, So thanks so much.
