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E T WELL Dear supporter, Thank you for choosing World Cancer Research Fund's information booklet, Eat Well. By getting the balance right – focusing our diet on healthy foods and limiting the amount of unhealthy foods and drinks we have – we can get all the nutrients we need for good health and to reduce our risk of cancer. By eating well and being active, we can also keep our weight healthy. These healthy eating messages are also important for reducing our risk of heart disease, high blood pressure and Type 2 diabetes. As well as explaining the benefits of a healthy diet, this booklet contains practical advice on making small, sustainable and tasty changes to what you eat and drink. We hope you find this booklet interesting and informative. Help us spread our cancer prevention messages by sharing it with your family and friends. Yours faithfully, Marilyn Gentry Founder Contents 5 Reduce your cancer risk 6 Reshape your plate 8 5 A DAY 14 How you cook counts too 16 Think about what you drink 10 Cut down on red meat 12 Not all foods are equal 18 19 Cancer survivors Cancer Prevention Recommendations Eat well We have developed 10 Cancer Prevention Recommendations based on robust, up-to-date scientific research from around the world. This booklet focuses on the diet-related recommendations, explaining the importance of eating well for cancer prevention, and giving tips and advice to help you enjoy a healthy and delicious diet. Reduce your cancer risk Almost all of us are affected in one way or another by cancer, and the current statistic is that one in two people in the UK will develop cancer during their lifetime. But we are not powerless. Most of us know that smoking and too much sun exposure increase our risk of cancer, but did you know that other lifestyle choices also affect your cancer risk? By eating a healthy diet, being physically active and maintaining a healthy weight, about a third of the most common cancers could be prevented. That’s about 80,000 cases every year in the UK. There are no guarantees when it comes to cancer but scientific research shows that if you follow our Cancer Prevention Recommendations (the full list can be found on page 19) and choose not to smoke (or give up smoking), you will have the best chance of living a life free from the disease. Take simple steps… You don’t have to make extreme changes to your diet and lifestyle to help prevent cancer. By making small, sustainable changes to what you eat and drink, you can reduce your cancer risk. Regardless of your age and lifestyle, it is never too late to take steps towards a healthier you. Keep reading for lots of advice on how you can eat well. If you want to read more about our other recommendations, such as how to include more physical activity into your lifestyle, visit our website: www.wcrf-uk.org 5 Reshape your plate Looking at what is on your plate at meal times is a simple way to start checking if what you eat could be healthier. Reshaping your plate to include at least three-quarters of wholegrains, vegetables, fruit and pulses will help to provide your body with the nutrients it needs for good health. It can also help lower the calories in every meal and increase the fibre content. This means your meals will keep you feeling fuller for longer on fewer calories, which can help you maintain a healthy weight. Reshaping your plate might also help you to eat less red meat, which is a key step in helping to prevent bowel cancer. Healthy plate guide: 3/4 (or more) wholegrains, vegetables, fruit and pulses 1/4 (or less) meat, fish and other protein foods Meal examples: Mixed salad and wholemeal pasta, with grilled salmon fillet Steamed green vegetables, carrots and new potatoes, with baked chicken breast Vegetable and brown rice stir-fry, with tofu 6 Vegetables and plant foods Meat and other protein foods Vegetables and fruit – fresh, Red meat – eating no more than frozen, dried, and canned in water or natural juices all count towards your 5 A DAY Pulses – eg. lentils, peas and beans count towards your 5 A DAY Grains and cereals – eg. rice, oats, pasta, bread, cous cous and unsweetened breakfast cereals. Opt for wholegrain varieties, and limit highly processed foods, such as cakes and pastries, which can be high in fat, sugar or salt Starchy vegetables – eg. potatoes. Try to not add fat, like butter or cream, and opt for boiled or steamed rather than roasted or fried in oil 500g (cooked weight) a week and little, if any, processed meat will help to reduce your cancer risk (read more on pages 10–11) Poultry – eg. skinless chicken and turkey meat Non-oily fish – eg. cod and canned tuna (in spring water) Oily fish – eg. salmon, fresh tuna, trout, sardines and mackerel Eggs, dairy and dairy alternatives – eg. milk, yoghurt, cheese. Opt for reduced-fat, unsweetened varieties Nuts – eg. Brazil nuts and hazelnuts Meat-substitutes – eg. tofu, Quorn and pulses Why a plant-based diet can reduce your cancer risk Eating a diet rich in wholegrains, vegetables, fruit and pulses can help you stay a healthy weight, which is linked with a reduced risk of 11 cancers, making it one of the most important ways to reduce your cancer risk. Vegetables and fruit provide vitamins, minerals and other substances known as phytochemicals, which help protect cells in the body from damage that may lead to cancer. Different types of vegetables and fruit contain different phytochemicals, so it is best to eat a variety every day. Diets rich in fibre (eg. wholegrains, vegetables and fruit) have been shown to decrease the risk of bowel cancer. This may be because fibre helps to move food more quickly through the bowel. Keep reading for more information and advice on how to reshape your plate and reduce your cancer risk. 7 5 A DAY An important first step when reshaping your plate is to aim for at least five portions of vegetables, fruit and pulses a day. The 5 A DAY recommendation is based on the World Health Organization’s advice to eat at least 400g (equal to five 80g portions) of vegetables and fruit a day ‘to lower the risk of serious health problems, such as heart disease, stroke and some cancers'. What is a 5 A DAY portion? One portion weighs roughly 80g*, equivalent to: 3 heaped tablespoons of vegetables, like carrots 1 cereal bowl of salad leaves, like lettuce 3–4 heaped tablespoons of cooked or canned (in water) pulses, like beans, peas or lentils, or 1 tablespoon (30g) of dried pulses – pulses only count as one portion a day 1 medium whole fruit, like an apple 2 small whole fruits, like plums 1 slice of large fruit, like melon 1–2 handfuls of berries, like raspberries or blueberries * Fresh, cooked, frozen or canned (in water or fruit juice) all count. The following only count as one portion a day and as they can be quite high in sugar, it’s best not to have more than this: 1 heaped tablespoon (30g) of dried fruit, like sultanas or raisins 1 small glass (150ml) of unsweetened vegetable or fruit juice or smoothies What doesn’t count towards your 5 A DAY? Some starchy vegetables, like potatoes, yam, plantain or cassava Grains, like oats, quinoa or rice Anything fruit flavoured, or containing added sugar or salt, like jams or olives 8 Top tips for fitting in your 5 A DAY Stir in spinach. Add a large handful of fresh spinach to a piping hot bowl of soup or stew. The heat is enough to cook it and it doesn’t add to the washing up. Breakfast boost. Add chopped banana or berries to your cereal or porridge; slices of pear or nectarine to low-fat natural yoghurt; or try grilled mushrooms, tomatoes and spinach as part of a healthier cooked breakfast. Disguise your veg. If you’re cooking soups, sauces, chilli or stews from scratch, try chopping vegetables into very small pieces or blending them. Carrots, onions, mushrooms, swede, squash and peppers work well in Bolognese sauce. Beans and lentils can also be hidden in these foods. wap your normal S snack for a piece of fruit or vegetable sticks – keep biscuits, cakes, chocolate and crisps for occasional treats. Sunday roast. Instead of potatoes, try roasting sweet potatoes, squash or parsnips in a little oil. Unlike potatoes, they count towards your 5 A DAY. Visit local markets and learn what is in season. Seasonal fruits and vegetables tend to be tastier and you’ll experience the feel-good factor from supporting your local farmers. Fruity dessert. For a quick and easy pudding, try stewing or microwaving fruit like plums, apples (thinly sliced) or rhubarb with a sprinkle of cinnamon or drop of vanilla essence. Serve with low-fat natural yoghurt and toasted oats. Eat a rainbow. As different types of vegetables and fruit contain a different mix of nutrients, try to eat a variety of different coloured vegetables and fruit every day. 9 Cut down on red meat Meat, especially red meat, is often seen as the star of a meal but by reshaping your plate, you can reduce the amount you eat without going hungry. Not only can this lower the calories on your plate, but it can benefit your purse and reduce your cancer risk too. What is red meat? Red meat is beef, pork, lamb and goat. As red meat is a good source of nutrients, it can form part of a healthy, balanced diet, but we don’t need to eat it every day. Aim for less than 500g (cooked weight, which is about 700–750g raw weight) a week. Regularly eating more than this can increase your risk of bowel cancer. What is processed meat? Processed meat includes bacon, salami, chorizo, corned beef, pepperoni, pastrami, hot dogs and all types of ham. Meat is considered to be processed if it has been smoked, cured or had salt or chemical preservatives added to it rather than having just been cooked or reformed (like some sausages and burgers). We recommend avoiding processed meat because there is strong evidence that it is a cause of bowel and stomach cancer. It also tends to contain added salt, and be higher in fat and provide fewer nutrients than unprocessed red meat, making unprocessed red meat the better choice if you do eat red meat. 10 Red meat – how much a week? Here’s an example of how you could have four meals a week containing medium-sized portions of red meat and still stick to less than 500g (cooked weight): Spaghetti Bolognese with minced beef = 140g (about 200g raw weight) Small pork or lamb chop = 75g (about 110g raw weight) M edium steak = 145g (about 210g raw weight) Roast beef, pork or lamb (3 thin slices) = 90g (about 130g raw weight) What about other animal foods? FISH – We should aim to eat fish regularly, including at least two portions a week, one of which should be oily fish – such as salmon, fresh tuna, sardines and pilchards. POULTRY – Chicken and turkey are healthy alternatives to red meat. Reduce the fat content by removing the skin. EGGS – A good source of protein and can form part of a healthy diet when eaten in moderation. They are not linked to an increased risk of cancer. DAIRY FOODS – There is some evidence that milk may protect against bowel cancer, but not enough to make a recommendation about dairy foods. However, dairy foods are a good source of nutrients like calcium, which is important for bone health. Opt for lower fat options. GAME – Meats such as rabbit and venison have a different make-up to that of animals bred for meat, like beef. So we can’t assume they would have the same effects on cancer risk as red meat. There isn’t enough evidence to make specific recommendations. Top tips for cutting down on red and processed meat: Eating smaller portions (about the size of a deck of cards) means you can have red meat more often and stick within the 500g a week. Keep some days red meat-free. Enjoy a full English breakfast, but as an occasional treat. Try to cut back on the bacon and add more grilled mushrooms and tomatoes. Use alternatives to ham in your sandwiches. Try chicken, hard-boiled eggs, canned tuna (in spring water), or low-fat hummus or cream cheese. Swap beef mince for turkey or even Quorn mince. Even if you only swap half, you’ll cut calories and it's just as filling. Boost the flavour with onion, garlic, herbs and spices. Make red meat go further by adding beans, chickpeas, lentils or mushrooms to stews, chillies and pasta sauces. This can also lower the calories in your meals and adds towards your 5 A DAY. Cook with smoked paprika instead of chorizo for a flavour kick. 11 Not all foods are equal Managing your weight, long-term, is a balancing act: you need to balance the energy you put in – the calories from food and drinks – with the energy you burn through normal functions, such as your heart beating, and being active. Calories in foods The amount of calories (energy) that different foods and drinks contain can vary greatly. For example, there are 41 calories in 100g of carrot, but 100g of milk chocolate contains 530 calories – that’s 13 times more! The best way to keep your calories in check is to choose lower calorie foods, like vegetables and fruit, which contain a large amount of water that adds bulk but not calories. They also contain fibre, which helps keep us fuller for longer. High-calorie foods, like chocolate, crisps, biscuits, burgers and fried chicken, tend to be high in fat and/or sugars, and offer little in the way of vitamins, minerals and fibre. Eating a lot of these foods can contribute to weight gain, because even small amounts contain a lot of calories. Some high-calorie foods, like oily fish, cheese, nuts, seeds and avocado, contain good fats and nutrients, meaning they can be consumed in moderation as part of a healthy diet. A guide to calories: HIGH-CALORIE 12 Foods containing more than about 225 calories (kcal) per 100g. Examples: snack foods, like chocolate, crisps and biscuits; and foods that are high in fat like burgers, pastries, chips and other fried foods. MEDIUM-CALORIE Foods containing about 100–225 kcal per 100g. Examples: cooked brown rice and wholemeal pasta; wholemeal bread; lean meat; poultry; and fish. LOW-CALORIE Foods containing up to about 100 kcal per 100g. Examples: vegetables; fruit; and cooked pulses, like lentils and beans. Top tips for making healthier choices Read food labels Trim the fat Food labels include lots of useful information to help us make healthier choices. Use the front-of-pack traffic light label to see, at a glance, if a food is high, medium or low in fat, sugar and salt. You can also use food labels to compare calorie content and see how many servings are in a pack. Fat is high in calories. To cut down, try to: Choose lower fat dairy, like reduced-fat cheese, skimmed milk and low-fat natural yoghurt. Swap butter for reduced-fat spread. Avoid pastry. Opt for lower fat mayonnaise and salad dressings. Measure oil into a teaspoon, or use an oil spray. Use healthy cooking methods (see pages 14–15). Make realistic changes It is important to make changes that you can stick to. Take small steps to achieve your goal, such as: Eating half a chocolate bar with a piece of fruit if you’d normally eat a whole bar. Sharing your treats. Order one dessert or a side of chips to share. Use a smaller plate or bowl at mealtimes to reduce the amount you eat. Alternatively, try filling most of your plate with salad or steamed vegetables. Choose wholegrain varieties of breads, pasta, rice and unsweetened breakfast cereals. They are higher in fibre so will help you feel fuller for longer. 13 Cut down on salt Although the evidence linking added salt to stomach cancer has become less clear - partly because of the difficulty in measuring salt consumption – we cannot rule out the link, and eating too much salt is still a health concern. Therefore we recommend consuming no more than 6g of salt a day – that’s about one teaspoon. As well as not adding salt when you are cooking or at the table, it is a good idea to check food labels as foods like biscuits, soups and breakfast cereals may contain more salt than you expect. How you cook counts too The way we prepare and cook food is also important for cancer prevention. Here are some healthy options: Stir-frying is a healthy cooking method as the food is only cooked for a short time, so it retains its colour, flavour and nutrients. Plus, you only need a tiny amount of oil. Steaming is perfect for retaining vitamins as well as colour and texture when cooking fresh vegetables. Stovetop steamers are inexpensive to buy, or you can easily turn any saucepan into a steamer by using a metal colander and a saucepan lid. Baking and roasting generally need little or no oil. For example, chicken, fish and vegetables can be baked in greaseproof paper or foil parcels with a little water or reduced-salt stock. However, sometimes large amounts of oil or fat are used, such as when making roast potatoes. Try making healthier roast potatoes with parboiled new potatoes, baked in a small amount of spray oil. Dry-frying is done in a heavy- based, non-stick pan without adding any oil at all. The food cooks in its own liquid or fat, so this is an ideal way to cook oily fish such as salmon. This 14 method can also be used to brown meat and mince, so that you can drain off the fat before adding other ingredients. Microwaving is safe, and a good way of cooking vegetables and fruit as it doesn’t need much water which nutrients can be lost into. It also needs little, if any, oil for cooking. Always use microwave-safe cookware rather than metal trays, foil or Styrofoam. Grilling only needs the smallest amount of oil or marinade, if any, to prevent food from drying out. Chicken, chops, steaks, fish and some vegetables can all be grilled. Grilling also allows fat to run off the food. Poaching in water, stock or skimmed milk adds little or no fat at all and is a healthy method of cooking chicken, fish and eggs. Cooking oils Olive oil and vegetable oils, like sunflower and rapeseed oils, are healthy choices for cooking. You should always use an oil that is intended for cooking and avoid reusing oils. Avoid heating oils to their smoke point as, once they reach this temperature, their chemical structure can alter, though it is not clear whether this is linked to any health risks. If a recipe requires cooking at a high temperature then it might be best to use a vegetable oil, like rapeseed oil, which has a higher smoke point than olive oil. High temperatures Cooking foods at high temperatures does alter the make-up of foods, especially meat. However, there are only limited indications that eating burnt or charred foods increases the risk of any cancers. Dietary supplements What are they? Supplements contain: vitamins; minerals; other components of foods such as lycopene, found in tomatoes; herbs; and plant materials such as ginseng, garlic and green tea, sometimes in high doses. Supplements can be in pill, capsule, powder or liquid form. Do I need them? Despite the promises made by some manufacturers, we advise against taking supplements to reduce your cancer risk as the evidence is inconsistent. Instead, aim to meet your nutritional needs by eating a varied, healthy, balanced diet – for most people, this is enough. However, some groups may benefit from taking supplements, such as people who restrict their diet due to allergy or through choice; frail, older people with a poor appetite; women of childbearing age and new mothers; children under the age of five; people with darker skin; and those who are not exposed to much sun such as housebound people or people who cover their skin. People with bowel diseases, those who are being treated for cancer or who have survived cancer may not be able to absorb enough nutrients from their diet or to eat a normal diet, so may also benefit. In such cases, a doctor, dietitian or specialist nurse will be able to provide advice. 15 Think about what you drink Whether it’s a glass of wine with a meal, or a pint of beer at the end of a busy day, for many of us, drinking alcohol is a normal part of day-to-day life. And, while the immediate effects of drinking alcohol are obvious, we often don't think about the longer-term impact on our health. There is strong scientific evidence that drinking all types of alcoholic drinks can increase your risk of mouth and throat, oesophageal, breast, bowel, stomach and liver cancer. Alcohol is particularly harmful when combined with smoking for some cancer types. To reduce your cancer risk as much as possible, we recommend not drinking alcohol at all. If you do choose to drink alcohol, follow national guidelines. In the UK the recommendation is to drink no more than 14 units a week, which is roughly equal to seven drinks, spread over at least three days. Alcohol and weight gain Alcohol can be surprisingly high in calories and offers few of the healthy nutrients your body needs. A pint of beer or lager contains about 170 calories – similar to 3 chocolate chip cookies. A large (250ml) glass of wine contains about 190 calories – similar to a butter croissant. Cutting down on alcohol could help you to maintain a healthy weight, further reducing your cancer risk. 16 What is a drink? A drink contains about 10–15 grams of alcohol, so one drink is the same as: alf a pint H of normal strength beer, lager or cider (3–5% ABV*) One 25ml measure of spirits such as vodka or whisky (40% ABV*) One small (125ml) glass of wine (12–13% ABV*) * Alcohol by volume – the strength or amount of alcohol a drink contains Swap soft drinks It is easy to forget that soft drinks contain calories too. Evidence has shown that sugary drinks – such as cola, lemonade, flavoured milks and coffees, cordials and squashes like blackcurrant juice drink – can contribute to weight gain if consumed regularly or in large amounts. It is easy to drink a lot, as they don’t fill you up despite being quite high in calories. Natural fruit juice is a source of healthy nutrients but also contains a lot of sugar and has lost most of the fibre you’d get by eating the whole fruit so it is best not to drink more than one small glass (150ml) a day. Similarly, milk provides vital nutrients like calcium, but also contains calories, so opt for skimmed or semi-skimmed versions. Swapping sugary drinks for lower calorie alternatives like water, low-calorie soft drinks, or unsweetened tea and coffee with a small amount of milk can help you to keep a healthy weight. Top tips for savvy drinking: Opt for the smallest serving size. Avoid double measures of spirits. If you drink alcohol at home, try to pour small measures. Alternate between alcohol and water or low-calorie soft drinks. Dilute alcoholic drinks – ideally with a low-calorie mixer. For example, opt for a small wine spritzer with soda water rather than a large glass of wine. Swap sugary soft drinks for low- calorie versions, or better still, sparkling mineral water with a slice of lemon, lime or cucumber. Instead of a large glass of fruit juice, pour a small portion and dilute the juice with sparkling mineral water. Instead of sweet, frozen coffee drinks, try an iced Americano with a splash of milk. Swap chai tea lattes for a black tea with fresh mint leaves – you’ll be surprised how sweet it tastes. Rather than regular lattes, opt for skinny versions of less milky coffees like cappuccinos (without chocolate) or Americanos to cut the calories and sugar. 17 Cancer survivors More scientific studies are needed before we can fully understand the role of diet and lifestyle on cancer risk in cancer survivors. However, there is growing evidence that if you have had a cancer diagnosis, being a healthy weight may help to prevent you from getting cancer again, and improve survival, particularly following breast cancer. It is not uncommon to gain weight during cancer treatment. If this has happened to you, or if you were already overweight, a really positive step for your health could be to lose weight once your treatment has finished. A great place to start is by following the advice in this booklet about making simple, healthy changes to what you eat and drink. Eating a healthy diet and being physically active are both key for weight loss and keeping your weight healthy. If you are underweight or lost too much weight during your cancer treatment, you may need to boost your calorie intake to get back into the healthy weight range. If you find this difficult, it is important to speak to your doctor, dietitian or specialist nurse who will be able to give you advice on appropriate, healthy ways to gain weight. Current recommendation Based on the available evidence to date, we recommend that, after treatment, cancer survivors follow our Cancer Prevention Recommendations unless they are unable to do so or have been advised otherwise by a doctor, dietitian or specialist nurse. If your treatment included surgery on the digestive tract (including the bowel and stomach) or has affected what you can eat, you may benefit from taking dietary supplements. Speak to your doctor, dietitian or specialist nurse for advice. 18 Cancer Prevention Recommendations 1Be a healthy weight. Keep your weight as low as you can within the healthy range. 2Move more. Be physically active for at least 30 minutes every day, and sit less. 3Avoid high-calorie foods and sugary drinks. Limit high-calorie foods (particularly processed foods high in fat or added sugar, or low in fibre) and avoid sugary drinks. 4Enjoy more grains, veg, fruit and beans. Eat a wide variety of wholegrains, vegetables, fruit and pulses, such as beans. 5Limit red meat and avoid processed meat. Eat no more than 500g (cooked weight) a week of red meat, such as beef, pork and lamb. Eat little, if any, processed meat, such as ham and bacon. 6For cancer prevention, don’t drink alcohol. For cancer prevention, it’s best not to drink alcohol. If you do, limit alcoholic drinks and follow national guidelines. 7Eat less salt. Limit your salt intake to less than 6g (2.4g sodium) a day by adding less salt and eating less food processed with salt. 8For cancer prevention, don’t rely on supplements. Eat a healthy diet rather than relying on supplements to protect against cancer. Special Populations: 9If you can, breastfeed your baby. If you can, breastfeed your baby for six months before adding other liquids and foods. 10Cancer survivors should follow our Recommendations. After cancer treatment, the best advice is to follow the Cancer Prevention Recommendations. Check with your health professional. And, always remember – do not smoke or chew tobacco. 19 About World Cancer Research Fund We are the leading UK charity dedicated to the prevention of cancer. Our mission is to champion the latest and most authoritative scientific research from around the world on cancer prevention and survival through diet, weight and physical activity so that we can help people make informed lifestyle choices to reduce their cancer risk. Cancer currently affects one in two people in the UK but about a third of the most common cancers could be prevented by following our Cancer Prevention Recommendations. That’s around 80,000 cancer-free lives every year. The cornerstone of our research programme is our Continuous Update Project (CUP). It’s the world’s largest source of scientific research on cancer prevention and survival through diet, weight and physical activity. The CUP reviews new research findings to ensure our advice is always up-to-date. Find out more: www.wcrf-uk.org/our-research For the references used in this booklet or for tips and advice to reduce your cancer risk, please contact us on the details below. World Cancer Research Fund 22 Bedford Square, London WC1B 3HH Tel: 020 7343 4200 Email: [email protected] www.wcrf-uk.org twitter.com/wcrf_uk facebook.com/wcrfuk Blog Registered in London, England No: 2536180. Registered with the Charity Commission in England and Wales (Registered Charity No: 1000739). Registered Office: 22 Bedford Square, London WC1B 3HH. All information correct at time of print. © 2016 World Cancer Research Fund WEA8EW Next review date May 2019 cancer-prevention.org