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Nutrition For pelvic radiotherapy Radiation Oncology Building 27 Salisbury Road Camperdown NSW 2050 p. 02 9515 8057 f. 02 9515 8070 Table of Contents I. Introduction ................................................................................................. 2 Important Notice II. Reduced Fibre Diet ..................................................................................... 3 Dietary Fibre Why I need a reduced residue diet? What foods do I need to avoid? Fluid Intake III. Food Guide .................................................................................................. 4 IV. Suggested Menu ......................................................................................... 7 Breakfast Morning tea Lunch Lunch Afternoon tea Dinner V. If you develop Diarrhoea ........................................................................... 8 If you develop watery diarrhoea If you develop constipation after treatment has finished Introduction The pelvic radiation treatment you are having may cause a change in bowel habits. It is normal to experience some symptoms and it may be necessary for you to change some of your eating patterns to minimise these symptoms. Symptoms usually occur 2-3 weeks into your treatment and may continue for a week or two after you have finished treatment. The symptoms vary from person to person and some people do not experience any problems. This guide contains information about the type of food you should avoid if you H[SHULHQFH GLVFRPIRUW RU GLDUUKRHD 5HPHPEHU \RX GRQ¶W QHHG WR DOWHU \RXU GLHWDU\ intake if you do not experience any symptoms. This guide will enable you to maintain an adequate dietary intake for the duration of your treatment and until the symptoms ease. It is important that you maintain your weight during your treatment. If you are overweight, do not try to lose weight until you have finished your treatment. Speak to your doctor or dietician about appropriate weight management. If you would like any further information please ask to see the dietician. Radiotherapy dietician: Mars (Tuesday am) Wendy (Thursday pm) Important Notice Information given within this document serves as a guideline only and should not replace health care professionals Reduced Fibre Diet Dietary Fibre Dietary fibre comes from plant sources such as fruits, vegetables, grains, dried beans or legumes, nuts and seeds. Although fibre is not digested by humans, it plays an active role in promoting the health of the bowel and in ensuring a regular bowel motion. Why I need a reduced residue diet? Pelvic irradiation can cause temporary inflammation of the lining of the bowel. This can make it difficult to tolerate certain foods because the intestine becomes more sensitive. The changes can vary from person to person, and the symptoms you could experience include bloating, increased flatus (wind), and sometimes diarrhoea. Fibre helps to normalise the bowel, and not all fibre-containing foods need to be avoided. Use the following list as a guide. A reduced residue diet may help you tolerate your treatment, but it is only temporary, until symptoms resolve. As your bowel habits return to normal, slowly introduce the foods you have been avoiding. It is suggested that you do this over a week. What foods do I need to avoid? Some foods can irritate the sensitive bowel. These foods include those containing fibrous structures that remain whole in the bowel, such as wholegrain cereals and skins of fruit and vegetables. Spices and fatty, oily foods can also irritate the bowel and need to be avoided. Refer to the list provided. Fluid Intake It is important to drink plenty of fluid, especially if you are experiencing diarrhoea. You should drink at least 6-8 glasses of fluid per day (such as water, milk, clear broth, cordials, soft drinks, sports drinks and jellies). Food Guide Breads and cereals FOODS ALLOWED FOODS TO AVOID Porridge, semolina, Weet Bix, Cornflakes, Special K, Rice bubbles Muesli and other cereals containing nuts and dried fruit. E.g. Sultana bran, Fibre Plus, Sustain, All bran White rice, white pasta Brown rice and wholemeal pasta White, fine wholemeal bread, Spaghetti with onions, rye bread, plain English pepper/chillies or other spicy muffins, crumpets, scones, seasonings Pikelets, cake, biscuits (e.g. Sao, plain salada, milk arrowroot) Coarse wholegrain bread Bread/rolls with poppy seeds, sesame seeds, caraway seeds Biscuits or cakes containing dried fruit seeds, nuts, coconut, whole grain crackers Milk and milk products Milk, yoghurt, cheese, ice cream (not containing nuts and seeds) Milk products containing fruit skins, nuts or seeds Meatfish, chicken, eggs and tofu Lean meat, chicken, fish, Fish canned in brine, Drain any oil from canned fish Gristly, fatty and fried meat Fried fish in batter Highly seasoned meats e.g. Curries/chilli-concarne, chinese, thai, Indian foods, pizza, meat pies, sausage rolls, pasties FOODS ALLOWED FOODS TO AVOID Vegetables Cooked and peeled vegetables including potatoes, pumpkin, carrots, tomatoes (seeded and skinned), flower of broccoli or cauliflower, zucchini, mushrooms, spinach, beetroot, tender lettuce, cooked asparagus spears, silver beet leaves Vegetable seeds and skins, onions, garlic, leeks, cabbage, celery, brussel sprouts, peas, tomato seeds and skins, radishes, olives, cucumber, sweet corn, peppers, French beans, green beans, avocados, broad beans, dried beans, split beans, lentils, chillies and pickled vegetables Fruit Soft stewed or canned fruits without skins and seeds, peeled fruit e.g. apples, pears, watermelon, honeydew melon, rockmelon, bananas, peaches, apricots, and other stone fruit, tinned fruit All fruit skins and seeds, pineapple figs, berry fruits, strawberries, passionfruit, kiwifruit, pomegranate, grapes, oranges, mandarins, grapefruit, dried fruit e.g. sultanas, raisins, dates and lemon peel Beverages Tea, small amounts of It is best to avoid alcohol or coffee, soft drinks, cordial, limit intake to small amounts milk, milo, strained fruit juice, vegetable juice Strong brewed coffee FOODS ALLOWED Desserts FOODS TO AVOID Soft puddings, jelly, custard, Desserts containing nuts, blancmange, ice cream and coconut, fruit skins or seeds, other milk puddings pastry, cake/muffins containing dried fruit or coconut Condiments, spreads, Honey, jam/jelly conserves, sauces and miscellaneous tomato puree, vegemite, marmite, plain chocolate (small amount), jelly beans, boiled sweets Jam and jelly conserves containing fruit seeds or skins Peanut butter Soups without peppers or spices Chocolate containing fruit and nuts Soups without cream Highly seasoned soups (mulligatawny, laksa), cream soups and broths containing unsuitable vegetables Pickles, wasabi, horseradish, popcorn, mustard, relish Nuts Suggested Menu Breakfast x Cornflakes with milk x x Strained fruit juice Poached egg on white toast or white rye toast with honey or vegemite Morning tea x x Cup of tea or coffee Plain biscuit (arrowroot), plain scone or a plain toasted English muffin with cheese Lunch x x White or rye bread sandwich with meat and cheese Peeled apple x Glass of strained orange juice Lunch x White or rye bread sandwich with meat and cheese x x Peeled apple Glass of strained orange juice Afternoon tea x Milk shake with banana and ice cream, plain biscuit/scone or yoghurt without fruit (vanilla) Dinner x Pumpkin soup x Grilled chicken fillet x Peeled and steamed potato x Broccoli OR x Pasta with tomato puree (no seeds) with allowed vegetables, stewed fruit and custard or plain tea cake If you develop Diarrhoea If you develop diarrhoea that is uncontrollable speak to your doctor. If you develop watery diarrhoea x Temporarily avoid large amounts of fruit and vegetables. x You may have diluted fruit juice, peeled pumpkin and potato. x Avoid cereals such as porridge and Weetbix, but you may have Rice bubbles, Special K or Cornflakes. x Use only white bread and avoid wholemeal products. x Avoid milk. Use soy milk or lactose-reduced milk e.g. Pauls Lactaid. Choose low fat yoghurt, and cheese and use very little fat in your cooking. x Eat small amounts often rather than 3 large meals e.g. 6 small nutritious snacks. Avoid very hot or very cold food and drinks as these may stimulate the bowel. If you develop constipation after treatment has finished x Drink at least 8 glasses of fluid per day. x Eat plenty of wholemeal cereals and plenty of fruit and vegetables (with the skins) everyday. You should aim for 3 servings of fruit and 5 servings of vegetables daily. Prunes and prune juice will help stimulate the bowel. x Eat regular meals and snacks x Try doing some light exercise, such as walking x Consult your doctor