Download GUIDELINES ON NUTRITION AND CANCER TREATMENT

GUIDELINES ON NUTRITION AND CANCER TREATMENT
Welcome to Track 3 of the Cancer Coping Kit where we discuss nutrition and offer
guidelines to manage your cancer. Good eating habits assist in fighting disease and
contribute to a healthy lifestyle.
What is poor nutrition?
Poor nutrition results from eating foods low in vitamins, minerals and fibre and high in
saturated fats and sugar. Combined with environmental and genetic factors, this can
contribute to the development of cancer. No particular food can cause or heal cancer. But,
if your diet lacks a sufficient intake of nutrients such as carbohydrates, proteins, fats,
vitamins, minerals and fibre over a period of time, malnutrition can result.
Why is it important for me to eat correctly?
A good diet is especially important during any illness as the body requires nutrients to fight
disease. To counteract the effects of treatments and to attempt to heal the body.
What are these nutrients?
They are proteins, carbohydrates, vitamins, minerals, fats, water and fibre. A balanced
eating plan provides all the nutrients in the correct amounts for the body to function at its
best.
Maintaining healthy eating habits can be difficult when you have cancer. The side effects
of treatments, emotional factors like depression and anxiety, or the metabolic changes that
cancer causes can play a role. If you are unable to follow this guideline, be gentle with
yourself. Eat whatever you can during this time. When you are feeling better you will find
this program easier to follow.
How can my treatment cause eating problems?
Chemotherapy, radiation and surgery are powerful treatments designed to kill cancer cells.
They also affect normal healthy cells and can cause conditions that may result in
nutritional or eating problems.
Surgery on or around the digestive tract may lessen the ability of the mouth, throat and
stomach to work properly. These areas may become sore and digestion will slow down.
Both chemotherapy and radiation therapy can cause sores in the mouth, nausea, vomiting,
changes in taste and appetite, diarrhoea and constipation. This affects your ability to eat
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and the body’s ability to absorb nutrients from food. Ways of dealing with this will be
discussed later in the program.
What is a well balanced eating plan?
It provides all the protein, carbohydrates, fats, vitamins, minerals, fibres and water that
your body needs to function properly. Each of these components fulfils a specific function
in the body. If you are deficient in one or more of them, your body may not be able to
protect, repair, rejuvenate and cleanse it’s self. This can leave you prone to disease,
infection and low energy levels. Let’s see how these 6 components contribute to your
nutritional status.
The first component is protein
Proteins are the building blocks of the body. Without a good supply the body is unable to
function, repair or replace damaged tissue properly.
Good sources of protein include fish, dry beans, peas, lentils, eggs, soya products, lean
chicken and beef. As a guideline eat two servings of protein per day.
What protein should I limit?
Limit or avoid protein foods high in saturated fats such as fatty meats, chicken with skin,
smoked and preserved processed meats such as polony, cold meats, and sausages. Full
cream dairy products also contain large amounts of animal fat.
What are carbohydrates?
Carbohydrates are the prime source of energy for all cells in the body. There are two types
of carbohydrates: fast releasing such as sugar, honey, sweets, bread and mielie meal. And
slow releasing such as vegetables, wholegrains, brown rice, oats, dry beans, lentils, dry
peas and fresh fruit. To achieve sustained energy levels throughout the day limit your
intake of fast releasing carbohydrates and eat small regular meals of slow releasing
carbohydrates. Mielie meal should be eaten in small portions, combined with a protein to
slow down digestion. Vary mielie meal with brown rice, samp, beans and mielie rice.
Limit your intake of sugar and refined foods such as white flour, white bread, pastries, pies
and pizza. Focus instead on wholegrains such as, mielies on the cob, coarse mielie meal,
brown rice and wholewheat bread. It is beneficial to eat three to five servings of vegetables
per day and two to four servings of fruit. It is best to eat fruit and vegetables as fresh and
raw as possible as they contain phyto nutrients that play an important role in keeping cells
healthy and can be protective against cancer development.
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What is fibre?
Not all of the carbohydrates and proteins that you eat will be digested, these are called
fibre. Fibre absorbs water and keeps bowel matter soft and easy to move. It cleans out the
bowel and removes waste before it can affect the body. Whole grains, vegetables, samp
mielie, mielie rice, fruits, nuts, seeds, lentils, beans and high fibre cereal are good sources
of fibre and need to be eaten daily to keep the body regular.
What happens if I don’t eat enough fibre?
The bowel will slow down and you may become constipated, with the waste remaining in
your body for too long.
Are vitamins and minerals important in my diet?
Vitamins and minerals have many functions and are vital for proper functioning of the
body. They protect the cells of the body. They keep the nervous system healthy. They
boost the immune system. They convert food into energy. They keep bones and teeth
strong. And they aid the healing process. Good sources of vitamins are nuts, fruits,
vegetables, seeds, dry beans and wholegrains.
Are fats necessary in a good diet?
Yes, not all fats are bad for you and there are some fats that your body needs to perform
properly. Monounsaturated and polyunsaturated fats are needed by your skin, nervous
system, immune system and circulatory system. They are also necessary to keep your cell
membranes healthy. Good sources are nuts, avocados, sunflower seeds, sesame seeds,
pumpkin seeds, olives, olive and sunflower oil and fish. Eat pilchards and sardines
frequently to ensure a good supply of monounsaturated fats. You may develop a dry skin if
you are deficient in these fats.
There are two types of fats to avoid: saturated fat and trans fatty acids. Limit your intake of
deep fried foods, poultry skin, full fat dairy products and cheeses, fast foods and fatty
bakery items, as well as snack foods such as chocolates and crisps as they contain
saturated fats. They can negatively affect your circulatory system and lower the oxygen
levels in your cells.
Trans fats are fats that have been processed and damaged by heat. They are hidden in
many foods and degrade your cell membrane, leaving your cells unable to absorb
nutrients. Foods to avoid are hard margarine, fried foods, biscuits, croissants, chips,
cakes, pancake mixes, doughnuts, and pastries. Check the label of products for the words
"hydrogenated" fats as these are trans fats and should be avoided.
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How should I cook my food?
The more food is heated the more the nutrients are destroyed. Eat vegetables as raw as
possible. There are a few exceptions such as tomatoes and carrots, where food value is
improved by heating. The best cooking methods to use are steaming, boiling or baking.
Where heat is kept as low possible for a short period of time. Cooking methods that
require high temperatures such as grilling, deep frying, roasting and braaing on coals
should be avoided; this converts good fats to trans fats. Where frying is unavoidable keep
the cooking period short such as stir frying.
Is it important for me to drink water?
Each day you lose between 1 and 2 litres of water through the skin, bowels, lungs and
urine as your body gets rid of wastes. It is important that you replace this water and keep
your body hydrated. Drink at least 6 – 8 glasses of water per day. Eating fruit and
vegetables is also an excellent way to replace fluid as they are composed of 90% water.
Limit your intake of tea, coffee and alcohol as they dehydrate you. Substitute with herbal,
ginger, fruit and rooibos teas. Fruit juices should be diluted with water as they are have
high sugar content.
Why do I need all of these types of food?
Imagine your body is a self-contained city and each cell is a person.
Carbohydrates
Everyone in your city needs a constant supply of energy to work and this comes from a
good supply of slow releasing carbohydrates.
Water
Each person also needs water to drink and keep clean. Without sufficient water your city
will become dehydrated and clogged with waste.
Vitamins and minerals
These provide the people of your city with armour and weapons to protect themselves, by
being able to fight off intruders.
Protein
When cells in your body die they need to be replaced with new ones. Protein is the
building block for new cells. You need a good supply to be able replenish and keep your
city at full strength.
Fibre
Your city needs a waste disposal system to get rid of waste and to keep the streets clean.
A good supply of fibre will do this.
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Fats
Criminals and bad elements must be kept out of your city to keep it running well.
Monounsaturated and polyunsaturated fats are necessary to keep your cell membrane
healthy and allow nutrients through, while eliminating waste.
Should I limit my intake of alcohol?
Yes, alcohol and cigarette smoking greatly increases the risk of developing cancer and
can hamper the healing process. Research indicates that all types of alcohol intake should
be limited. Daily intake for men should be no more than two drinks and for woman one
drink only – but consultation with your doctor is advisable.
To summarise, it is important to eat a wide variety of foods daily as no single food or food
group provides you with all the needed nutrients. To ensure optimum nutrition, select the
right quantity and type of food daily. Foods that are unprocessed and fresh will improve
your health and aid your ability to heal. Consult your doctor before attempting any radical
or extreme diet. They can affect the working of your body systems and impact negatively
on your health.
Let us now discuss ways in which you can be helped during treatment
You might find it difficult to eat according to recommended guidelines while you are
undergoing treatment. You will need to adjust your eating according to any problems that
you are experiencing. For example, loss of appetite can affect the amount you eat. Plan
menus in advance. Use time savers like ready made meals. Keep foods handy that need
little or no preparation. Take advantage of the times that you are feeling well to eat. Eat
foods with good nutritional value as the nutrients can be stored in your body for later use.
Is food preparation and storage important?
Yes, cancer treatment weakens your immune system. It is important that you avoid
infection and illness that may be caused by improperly stored or prepared foods. We
suggest the following
1. Wash all fruits and vegetables well
2. Wash your hands and all kitchen counters and utensils before preparing food.
3. Avoid raw meat, raw fish, raw eggs and shellfish.
Should I take vitamin supplements?
The best source of vitamins and minerals is food. You can’t completely replace the
nutrients in food with supplements. However, if your illness or treatment is preventing you
from eating healthily, supplements are a good insurance policy. Please consult your doctor
before taking any form of supplementation as it may affect your treatment.
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Are there any herbs that might help?
Fresh garlic is a natural anti-biotic that will help fight bacterial and viral infections. Peel a
small clove of garlic and swallow it whole to avoid the unpleasant taste or add it to soups
and stews.
Fresh herbs add flavour to food.
My mouth is very dry, is there anything that can help?
Some patients may have a significant loss of saliva due to their illness or treatment. Drink
as frequently as you are able to and suck ice cubes. You can also freeze a fruit juice in ice
trays to make flavoured ice cubes. Add a few drops of lemon juice to water to stimulate
saliva production and sip slowly. Apply Vaseline or Aloe Gel products to your lips to
prevent them from drying out and cracking. If this problem continues, please ask for
advice. Your Doctor may be able to prescribe other preparations.
What can I eat if my throat and mouth are sore?
This is a common side effect of treatment. Eat soft foods like yoghurt, oats and stews.
Sauces and gravies moisten foods, making them easier to swallow. Avoid food and drink
that is very hot. Allow it to cool first. You may try drinking through a straw.
Avoid rough or dry foods, such as toast, biscuits or raw vegetables. Acidic foods like
pineapple, citrus and tomatoes may be painful to eat or aggravate the problem. Keep your
mouth as healthy as possible at this time. Brush your teeth after each meal. If your
toothbrush is hurting you, use a child’s soft toothbrush. You might want to try a mouth
wash, ask your doctor to prescribe one that is not too strong for you. If you wear dentures,
soak them overnight in a cleansing solution. Treatment may cause your tongue to be
“coated”. Use a solution of one teaspoon of bicarbonate of soda dissolved in 0.5 litre water
to clean. Stop smoking as this can make the problem worse.
If you have difficulty in chewing or swallowing, a soft or liquid diet is recommended. It is
important that it is high in protein, energy, vitamins and minerals. Choose a good meal
replacement supplement.
Here are some general guidelines for a soft or liquid diet:
Chop up fish, eggs, chicken and well-cooked vegetables and moisten them with gravy or
stock. Ensure that all foods are very soft and chewed well before being swallowed.
Baby foods are useful as they are soft, come in small portions and require no preparation.
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I have lost my appetite, what do you recommend?
Eat whatever you feel like, when you can. Your appetite may be better in the mornings –
try to eat a little more at this time.
Eat little and often. Small meals with snacks like fruit in between. Experiment with different
flavours as your ability to taste might have changed. If you are unable to eat, substitute
meals with one or two glasses of high protein drinks to provide your body with much
needed protein and energy. Commercially prepared food supplements such as Ensure,
Complan, Nutrament T, Nutren or Buildup are available. Mix with water or milk. Ensure is
lactose free and is recommended if you have diarrhoea. Add fresh berries, mashed soft
fruit like banana, vanilla extract or juice for variety.
What can I do if I feel too tired to eat?
Many times friends would like to help but don’t know what to do. Asking them to do the
shopping and cooking not only gives you a break but gives them a chance to be
supportive. Protein drinks are good substitutes for a meal. They can be mixed with a fruit
juice, low fat or soya milk. Prepare and freeze meals on the days when you are feeling
better. Take regular rests or naps to restore your strength.
After eating a small amount of food I feel full, what do you suggest?
Eat small meals with snacks in between. Make sure that you chew your food thoroughly
and slowly before swallowing. Avoid greasy foods, fried foods and rich sauces that make
this problem worse. Limit your liquids at mealtimes and rather drink before or after your
meal. Drink pure fruit juices or meal replacement drinks and make mealtimes as relaxed
as possible.
I’m feeling nauseous, what do you recommend?
Nausea with or without vomiting is a common side effect of all the different treatments and
of the disease itself. It can prevent you from getting the vital nutrients that you need. Bland
foods are easier to tolerate when you are feeling nauseous. These include dry toast, low
fat yoghurt, sorbet, pretzels, boiled skinless chicken, clear liquids, soup and ice chips.
Greasy, fatty, fried, spicy or very sweet foods may contribute to your nausea.
Here is a list of ideas that may be helpful to deal with your nausea:
Let someone else prepare your meals and keep away from the smell of cooking.
Take a short walk before each meal to stimulate your appetite.
Eat in a room with good ventilation.
If you feel sick when you wake up, try and eat something dry, such as toast, preferably
before you get up.
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Do not drink with your meal. Wait ½ hour after meals before having a drink.
Eat small meals during the day. Eat and drink slowly to give your stomach time to adjust.
Cold foods and drinks are better for you when you are feeling nauseous than hot or warm
foods. Sip iced water or suck an ice cube.
Do not wear tight clothing.
Avoid lying flat after eating.
Rest while your meal settles.
Distract yourself when eating by listening to music, watching TV or chatting to friends.
If you are feeling nauseous, avoid your favourite foods as you may end up developing an
aversion to them. If nausea tends to occur during treatment, avoid eating 1-2 hours before
treatment starts. There may be certain foods, events or surroundings that trigger nausea.
Keep track of these triggers and make changes to your diet and schedule to avoid them.
Are there any remedies that can help with nausea?
Fresh or powdered ginger is effective in treating nausea. It can be used before or after
chemotherapy. Make a refreshing drink by grating a little ginger into water and placing in
the fridge, to sip throughout the day. Ginger tea and ginger ale may also be helpful in
controlling nausea. Mint is a good remedy for nausea and digestion. Make tea by putting
mint leaves in hot water and allow to cool before putting in the fridge. This can be sipped
throughout the day. If the nausea is debilitating, speak to your doctor so that he can
prescribe something that may help.
Is there anything I can do to stop vomiting?
Vomiting may occur with nausea. Often if the nausea is controlled, you will be able to
prevent vomiting. If vomiting is severe and lasts for more than 2 days your doctor should
be informed. This may lead to dehydration which can be life threatening.
Relaxation and breathing techniques are helpful to prevent or control vomiting. Find a quiet
area and lie down, relaxing as much as possible. Focus on your breathing and allow it to
deepen and slow down until you find a rhythmic pattern that calms you.
After an episode of vomiting do not eat or drink anything until vomiting has stopped. Once
vomiting is under control sip small amounts of clear liquids. Start with a teaspoon full every
10 minutes and gradually increase. If the vomiting remains under control you can start
sipping diluted fruit juices and clear soups to build up your strength. Eventually add soft
bland foods such as mashed potato.
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I am unable to taste the food, is there anything I can do?
People undergoing cancer treatment often experience changes in their taste and smell.
They may have a metallic taste in their mouths and an aversion to specific foods. If food
begins to taste different, here are a few ideas that may help to make it more palatable:
Eat the foods you like as often as possible.
Try different foods that are new and interesting to taste.
Enhance the flavour of foods by using more and stronger seasonings and herbs like
Lemon, Mint, Rosemary, Oregano, Basil and Tarragon.
Eat foods at room temperature, rather than hot.
Tea and coffee can be replaced with fruit juices and herbal teas.
What can help my constipation?
Sometimes the effects of your illness or its treatment may cause you to become
constipated. Changing your diet may help to alleviate this and prevent it happening again.
Consult your doctor before taking any laxatives as these may interfere with your treatment.
Drink plenty of fluids, at least 6 to 8 glasses a day. A warm drink first thing in the morning
may help. We recommend a glass of warm water with a little lemon juice added. Your diet
should include foods that are high in fibre, such as dry beans, lentils, fresh vegetables and
fruits. If you are able to exercise, a short walk helps the digestive tract to move. Prune
juice helps maintain regularity of the bowel and foods such as dried, stewed fruit, high fibre
cereal and paw-paw contribute to a healthy digestive tract.
A natural remedy for constipation.
Mix 1/4 cup of warm water with a tablespoon of prune juice. Add a few drops of fresh
lemon juice. Add 3-4 teaspoons of canola or olive oil and drink this mixture first thing in the
morning and last thing at night.
What can help my diarrhoea?
Diarrhoea needs to be monitored as it can lead to dehydration and you will not be
absorbing the necessary nutrients from food. If your diarrhoea lasts for more than two
days, contact your doctor. Avoid high fibre foods. Eat small frequent meals and drink
plenty of fluids to alleviate this problem. Eat foods and liquids high in salt and potassium,
such as clear soup, bananas, grated apple, marmite and mashed potato. Sachets of
rehydrate (available from your Chemist) or Lucozade are excellent to stop you from
dehydrating. Avoid milk and milk based products and replace with soya milk or yoghurt.
Our recommended remedy for diarrhoea is the following: boil white rice and drink the water
that the rice has cooked in as often as possible. Foods to eat are oats, steamed fish, rice,
mashed potato, mashed banana and grated apple.
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Now that we have covered the basic side effects that affect eating, let’s summarise:
Try to eat small meals as often as possible, avoid large heavy meals.
Include protein foods with low saturated fat content.
Eat lots of fruit and vegetables (Veggies should be eaten raw or lightly steamed).
If you lose more than 10% of your body weight, please tell your doctor.
Drink plenty of fluids especially water and diluted fruit juices. Limit the amount of tea and
coffee that you drink.
If the side effects of treatment are still causing problems, please talk to your doctor, or
nutritionist.
Don’t be influenced by everybody’s advice. People mean well, but remember you are in
control. You must decide on a program for yourself that fits in with your treatment, lifestyle
and follow up plan.
You may not always be able to stick to this plan. Eat as well as you can as often as you
can. Do not allow your diet to become a source of stress to you.
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