Download Cancer Nutrition Resource Guide

Alice Schuler RD, LD 404.501.7520
DeKalb Medical Cancer Center
Cancer Center Web Site Nutrition Outline
Advice, Cautionary Tips and Menu Suggestions
A. Oncology Eating Tips
I.
During Cancer Treatment
a. Complementary and alternative medicine
b. Fatigue
c. Neutropenic diet
d. Losing your appetite
e. Olfactory (sense of smell) changes
f. Taste changes
g. Oral changes
h. Nausea with or without vomiting
i. Diarrhea
j. Adequate hydration
k. Constipation
l. Bowel obstruction
m. Hyperglycemia
n. Common interaction between food and medication
o. Unwanted weight gain
II.
After Cancer Treatment
a. Basic eating guidelines to assist with following AICR diet including
guidelines for cancer prevention
i. Eat a variety of foods
ii. The largest portion meals should come from vegetables
iii. Include high-fiber foods
iv. Match portion sizes to nutritional needs/What counts as one
serving?/How many servings are needed each day?
v. Excess calories
vi. Phytochemicals
vii. Diets high in salt
viii. Prepare and store food safely
ix. Supplements, herbals, and other botanical remedies
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Oncology Eating Tips
Even in the best of circumstances, the process of eating when living with cancer can
be difficult and a tremendous challenge every day. If you’ve had a recent diagnosis
or have been in treatment for some period of time, your diet can be a source of
great frustration. No diet can prevent all the unpleasant side effects of cancer
treatment; however, adequate nutrition is crucial for cancer patients and survivors.
The Cancer Center at DeKalb Medical has a Registered Dietitian on staff that provides
nutrition oncology counseling for cancer outpatients.
Our dietician can easily be reached by calling 404.501.5701 or 404.501.7520.
Appointments are scheduled during a time that is most convenient for you, even if
you are waiting for an appointment or for cancer treatment. Since nutrition is very
crucial during and after treatment, there is no fee for this service. That said, the
following are nutrition tips and helpful information by our Registered & Licensed
Dietitian, Alice Schuler. Call her if you have any questions!
Cancer treatment and subsequent malnutrition effects can depress the
function of the immune system. Consuming balanced meals with a variety of
fruits and vegetables, grains and adequate proteins is more important than ever.
However, uncontrolled side effects from some cancer treatments may change your
tolerance of certain foods. Thus, it is necessary to keep in mind that it is more
important to eat something rather than being so selective you may lose your
appetite while trying to make a decision about what to eat.
Although many different diet plans and/or menus can be recommended, it can be
especially helpful to look at several different plans, keeping in mind that the most
important aspect of plans and menus is to eat. In other words, diet plans will need to
be adjusted in terms of what you are capable of comfortably eating. The following is
a list of possible answers to common concerns with suggestions to help you plan
your meals and snacks.
Complementary and Alternative Medicine (CAM) can be appealing to those with
a recent diagnosis of cancer. Desiring the greatest assurance with the best results,
many patients want to consider every possible treatment. Use of CAM has increased
steadily during the past several decades. In 2005 it was reported that more than
90% of adults undergoing cancer treatment used some form of CAM. Prayer,
relaxation, and exercise are the most widely used forms of CAM. The most frequent
CAM therapies discussed are diets, massage, and herbal medicine.
According to the American Cancer Society, ―complementary therapies‖ are
supportive methods used to complement conventional evidence-based treatment,
such as using ginger for nausea. ―Alternative therapies‖ are treatments advertised as
cancer cures without evidence-based proof. When making decisions on treatment it
is important to approach the use of complementary and alternative medicine with
accurate, unbiased information.
To make appropriate and informed decisions about your treatment, every member of
your healthcare team needs to be aware of all the treatments you are considering.
Be careful not to get involved with a treatment program that is done ―in secret‖
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without your conventional health care team’s knowledge. Communication is essential
between you and your team.
Keep in mind that the government does not regulate all CAM practices. Also national
laws do not require companies to prove whether dietary supplements are safe and
effective before they sell them. To make an informed decision on a new treatment
method or product, thoroughly ask these key questions:
 Is the one delivering the treatment qualified and educated in the practice? When
a license is required, is their licensure documented?
 Has the practice or product been scientifically proven safe and effective? A clue
can be in knowing the number of subjects who participated in the testing. If only
a few subjects have been tested or there is a clear lack of clinical trials, then the
treatment should be viewed with caution.
 Can the CAM be used with conventional therapy? Are there any known
interactions between your current medication and this particular therapy? Again,
a tip-off for questionable treatment is when a program requires that it be done
―in secret‖ without involving your healthcare team.
 If a diet is recommended, does it eliminate certain foods or nutrients, and if so
what is its reasoning? In making an informed nutrition decision, keep in mind
that obtaining and maintaining optimal nutritional health requires a synergy of a
variety of foods. This has been scientifically proven to be essential, especially
long term. You need to ask yourself: What is the real cost of an expensive food
product or supplement in comparison to just a well-balanced diet?
 If a food product or supplement is recommended, does the protagonist or
manufacturer make unfounded claim(s)? Be aware that the quality and strength
of many supplements varies between bottles or brands. There are no guarantees
that dietary supplements actually contain what the labels report. Our national
laws do not require companies to prove whether dietary supplements are safe
and effective before they sell them. For example, a supplement may act as an
antioxidant, yet may also contain or degenerate into toxic by-products.
The National Center for Complementary and Alternative Medicine and the National
Cancer Institute at the National Institutes of Health can provide current information
about complementary or alternative treatments or products, including those being
tested in clinical trials: http://www.nccam.nih.gov
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Fatigue is a side effect of cancer and cancer treatment. There aren’t tests that have
been developed to measure fatigue, so your medical team needs to know if you are
experiencing it.
People who experience fatigue often say that they do not have any energy and talk
about feeling weak and tired. Many also say that at times they feel dizzy, sad and
have difficulty thinking and performing their daily routines. Proper nutrition and
hydration can help you maintain strength and energy, tolerate the side effects of
treatment, and quicken recovery. Even if you are unable to eat as much as you used
to, eating regularly can help you feel stronger and increase your energy. Starting a
daily routine with breakfast can help promote regular eating. Fortunately, breakfast
tends to be the ―best‖ meal in terms of ―feeling the best to eat the most‖ during
treatment. Therefore, eat the most when you first get up and aim towards eating
every few hours. For times when you do not feel like eating, keep commercially
prepared liquid nutritional supplements close at hand.
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Tips to help energize you:
Keep track of what makes you feel fatigued and what makes you feel better,
and adjust your activities accordingly. Include how often you become fatigued
and for how long; notify your medical team before you are incapacitated.
Try to rest when you feel the worst. Stay as active as possible when you feel
the best. Nap during the day and do your best to get quality sleep at night.
Ask your friends and family to stock your kitchen with easy-to-prepare and
easy-to-eat foods.
Make the most of each bite and swallow; choose foods and beverages that
are good sources of nutrition. Examples: (a) Peanut butter or cheese on toast
or crackers. (b) Add grated cheese to baked potatoes, vegetables, soups,
noodles, meat, and fruit. (c) Use milk for cooking in place of water for cereal
and cream soups. (d) Add cream sauce on vegetables and pasta. (d) Add
powdered milk to cream soups. (e) Add hard-cooked eggs (all eggs should be
well cooked to avoid the risk of harmful bacteria) to salads, casseroles, soups,
and vegetables. (f) Add leftover cooked meats to soups, casseroles, salads,
and omelets. (g) Dip: mix diced meat with sour cream and spices. (h)
Sprinkle seeds or nuts on desserts such as fruit, ice cream, pudding, and
custard. Also, sprinkle seeds or nuts on vegetables, salads, and pasta. (i) Add
peanut butter to a milkshake.
Dehydration can make you feel tired. Drink plenty of water and juice.
Commercially prepared liquid nutritional supplements or milkshakes may be
of assistance.
Eat small, frequent meals and snacks throughout the day.
Try eating foods that need less chewing, such as cottage cheese, eggs, fish,
or soft meats. Or for using a regular food such as spaghetti, put it in a
blender to puree it. Or just by chopping meat and vegetables into bite size
pieces and adding a sauce can make it easy enough to chew and swallow.
Here are suggestions to simplify menu planning:
1. Stretch one meal into several by varying cooking methods. For
example a microwave beef and vegetable dish eaten on one night can
later in the week be changed by making a hearty crockpot soup from
the leftovers. Other simple variations to stretching a meal into other
meals later in the week are:
a) When you have leftover cooked rice, add dried fruit and cinnamon,
or add celery with green onion and mushrooms, and warm on
stove or microwave by re-cooking the rice in chicken bullion
(optional- low sodium).
b) When you have leftover vegetables, add fresh grated ginger to
simmer in the cooking process. Ginger is noted for its mild distinct
flavor and for aiding digestion in times of nausea. A helpful tip is to
keep ginger in the freezer to be ready to grate whenever you need
it. And for another simple way to provide a different flavor to a
vegetable, add salsa or even lemon or lime juice just before
serving.
c) When you have leftover chicken, turkey or fish, bake or microwave
as usual, but include mustard and herbs, tomato puree (optional:
no-salt-added), or salsa. Baste in orange or tomato juice, or
chicken bouillon with a dash of thyme or cinnamon. And for a
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Mexican touch, spread plain lowfat yogurt on top with salsa before
cooking.
Poached Fish Recipe
Ingredients for 1 pound fish fillets or steaks: 2 cups water or skim milk, 3
tablespoons of lemon juice, 1 medium onion (sliced), 1 bay leaf, few whole cloves
or peppercorns (optional), and 1 pound fish fillets or steaks of your choice
Preparation: stir together water or skim milk, lemon juice, onion and seasonings
in a large skillet. Bring to a simmer. Add fish, cover, and adjust heat to maintain a
simmer. Cook 10 minutes per 1 inch of thickness at thickest part of fish, probably
5-10 minutes. Fish is done when it is opaque and flakes easily with a fork; do not
overcook it or it will become tough and dry. Lift fish from pan carefully with a wide
spatula. Serve hot with a sauce or just sprinkled with lemon juice, or can be chilled
and served in bite-size chunks tossed in a salad.
FYI: Poached Fish as the main entrée can be served over a bed of Brown Rice and
topped with Horseradish Sauce (recipe follows). On the side, steamed or
microwaved Green Beans or Broccoli would complete the menu.
Horseradish Sauce Recipe
This is a good sauce for fish, but can also be enjoyed as a creamy dip for raw
vegetables. The recipe below is for a mild flavor. For a hotter flavor just increase
the horseradish and/or hot pepper sauce to your specific taste preference.
Ingredients: 1 cup cottage cheese, 1-2 tablespoons of prepared horseradish,
¼ teaspoon dry mustard, 2 drops Worcestershire sauce, and ⅛ teaspoon hot
pepper sauce.
Preparation: Puree all ingredients together in a blender or food processor until
smooth and well blended. Serve immediately or refrigerate until 5-10 minutes
before serving. This can be stored up to 1 week in the refrigerator.
d) For salads, vary them by using different in-season vegetables. A no
lettuce salad can be made by using thawed frozen vegetables. Add
various cooked beans and lentils; if using canned versions, pour
them into a strainer and rinse to reduce sodium content and
improve flavor. For salad dressings experiment with different
flavored vinegars (balsamic, raspberry, or herbs). To be able to
make salads quickly, wash a few days worth of lettuce in advance.
Pat dry and store in plastic bags in the refrigerator.
2. By using the cook-ahead method, many foods can be prepared in
double batches, with the extra batch refrigerated or held frozen for
later use. This not only works for meats and soups but also rice, dried
beans, waffles, pancakes, muffins and quick-breads.
3. It is not necessary to burden yourself with trying to make many
different dishes; just choose one "focus" dish and fall back on ordinary
favorites for the rest of the meal. The meal will still stand out, even
though you have not slaved over it. For example, if you prepare
chicken with a special topping, serve plain rice or microwaved
potatoes. And steamed vegetables always goes well with pasta
together.
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Main Entrée Pasta Salad Recipe
This is a good recipe to use up the leftovers while increasing variety in menu. It is a
simple main dish salad that can use the extras from a previous night’s main course
combined with whatever vegetables you have.
Ingredients for one serving: 2-3 ounces of cooked meat (chicken, turkey, lean
beef, pork, fish or shrimp, 1 cup of variety of chopped raw vegetables, 1 cup
cooked pasta (linguine, small shells, or elbows), 2 tablespoons of vinaigrette-type
salad dressing or can use the vinaigrette salad dressing recipe below.
Optional add: ½ cup canned dried beans (kidney, garbanzo, black), and/or fruits
(strawberries, apricots, apples, pineapple, and orange sections)
Preparation: Mix ingredients in a bowl. You can add to this main entrée pasta
salad dish whole grain rolls or bread and you will have a complete meal.
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A Neutropenic Diet, also known as a Low Bacteria Diet, minimizes the risk of
infections for immunosuppressed persons. Immunosuppressed people are those who
have had recent surgery, a bone marrow transplant, and/or high doses of
chemotherapy or radiation therapy. They are at significant risk for infection because
their white blood cells or neutrophils, which happen to fight infection, are low. When
the presence of neutrophils drop below 1500/mm3 the condition is known as
neutropenia. Once a person becomes neutropenic, multiple strategies should be used
to minimize exposure to foreign bacteria. Eating foods that have not been prepared
using safe food handling practices often contain excessive bacteria, and this can
easily introduce food borne pathogen organisms into the gastrointestinal tract. This
can lead into an infection, also known as food poisoning. You may not be able to
fight off the infection if your immune system is weak, and then you may need to take
additional medication or stay in the hospital to control the infection.
If you experience neutropenia from a severely suppressed immune system as the
result of disease or chemotherapy, a Neutropenic diet might be beneficial. The diet
will generally vary among physicians and eliminates foods that may carry a greater
risk of infection. The diet includes eating healthy foods that must be prepared and
cooked in certain ways to keep the bacteria content low.
Bacteria are germs normally found in the home, on hands, or in the food itself. Good
hand washing and safe food preparation practices are necessary. Listed below are
foods and beverages associated with having high amounts of bacteria that can cause
infections. These may need to be eliminated during cancer treatment or if
experiencing neutropenia. Please clarify this with your physician or oncologist.
Foods limited or eliminated during neutropenia:
 Milk/milk products: unpasteurized milk, culture treated yogurt
 Meat/meat substitutes: raw or undercooked meats, cold cuts, cured
salami, cold smoked salmon, pickled fish, raw nuts or roasted nuts in the
shell, tempeh products
 Fruits and vegetables: unwashed raw fruit, vegetables and herbs, cold
salads
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Condiments/salad dressing: raw honey, salad dressing using raw egg
or aged cheese, commercial salsa, miso products
Beverages: well water (unless tested and found to be safe), cold-brewed
tea made with warm or cold water, fruit and vegetable juices that have
not been pasteurized
Other products: herbal supplements, uncooked brewer’s yeast
Safe food preparation practices:
 Purchasing: Do not purchase outdated products, dented or bulging cans,
torn boxes, or leaky plastic wrappers, cracked eggs, foods stored in large
bins, or taste food samples in grocery stores.
 Preparation: Place perishable foods in the refrigerator right away. Wash
hands before preparing foods. Wash fruits and vegetables completely
under running water before peeling or slicing. Cut away bruised areas. Use
separate cutting boards for meats and vegetables. Wash cans and bottles
with soap and water before opening.
 Cook foods: Cook meats until well done; there should be no pink color in
them (Using meat thermometer: red meat 165 degrees; poultry 180
degrees). Microwave cooking can leave cold areas prone to bacteria. When
cooking or heating in a microwave, turn the dish and stir often.
 Storing foods: As soon as possible place refrigerated foods below 40
degrees. Take them out only when it is time to eat them. Divide leftover
foods into small amounts and place them in small containers in the
refrigerator so that they can cool off quickly. Throw away unused food
that has been in the refrigerator two or three days. Do not reheat or eat
food that does not smell good, or has mold on it.
 Restaurants: Only eat at restaurants that are known to be clean. Avoid
foods from salad bars, deli counters, buffets, and places that sell foods
along the sidewalk. Avoid potlucks and food kept warm under warming
lights. Avoid yogurt and ice cream from soft-serve machines. Avoid
condiments such as ketchup from self-serve containers. Ask for condiment
packages.
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Losing your appetite may occur from the stress of the cancer experience or as a
side effect of the cancer treatment itself. Try eating small, frequent meals and
snacks. Ask your physician if an appetite stimulant might help. Try experimenting
with oral supplements such as Carnation’s Instant Breakfast, Boost, Ensure, or
milkshakes. To make mealtime easier and less stressful, simplify your meal
preparation with these tips:
 Add cheese or peanut butter to toast, crackers, steamed broccoli,
carrot/celery sticks, or apple slices.
 Add grated cheese or sour cream to baked potatoes, vegetables, soup,
noodles, meat, and fruit.
 Keep hard-cooked eggs in the refrigerator. Chop and add them to
casseroles, soups, vegetables and salads. Make a quick egg salad: Chop 2
hard-cooked eggs with a fork, and mix together adding to the egg mixture
1 Tbsp sweet relish, 1 tsp spicy mustard, 2 Tbsp salad dressing or
mayonnaise and sprinkle onion powder or salt, pepper and lemon juice.
Serve on toast, crackers, taco chips or bread sticks.
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Add leftover cooked meats, poultry, or fish to soups, casseroles, salads,
and omelets. Make a dip by mixing diced or shredded meat or poultry with
sour cream and spices.
Blend peanut butter in a smoothie or shake.
Add cooked beans, lentils, or peas to soups, casseroles, salads, or
vegetable dishes.
Energizing (High calorie) Recipes to use for snacks or
as additions to meals:
1. High Calorie & Protein Milk &/or Milkshake Recipe
Ingredients for 4 (1 cup) portions: one quart whole milk & ½ c nonfat dry milk
powder
Preparation: With a wire whip or electric mixer, mix the whole milk with the
nonfat dry milk until smooth and then chill to the temperature best tolerated.
Nutrient content for 1 cup portion: Calories- 200; Protein- 14 grams
For additional calories: make a milkshake by adding your favorite flavor of ice
cream
FYI: If lactose intolerant, substitute lactaid milk for whole milk. Nonfat dry milk is
already lactose reduced; therefore, you more than likely will tolerate it. However, if
you are still unable to tolerate to aid with digestion, you can take lactaid chewable
tablets that you can purchase over the counter.
2. High Calorie & Protein Jell-O Recipe
Ingredients for 4 (½ cup) portions: one 3- ounce package of Jell-O gelatin (any
flavor). One third cup dried powdered egg whites. (Look for powdered egg whites
found in the baking supply aisle or you can purchase the brand Just Whites online.)
It is necessary to use powdered egg whites and not liquid egg whites, because liquid
egg whites are uncooked providing a perfect environment for harboring infections.
Preparation: Prepare Jell-O according to package directions. Add 1/3 cup dried
powdered egg whites to warm gelatin mixture. Stir mixture gently until egg whites
are completely dissolved. This will take approximately 2 minutes. Then place this
gelatin mixture into a bowl and chill. It will take a few hours for the gelatin mixture
to solidify into a gel.
Nutrient content for half cup portion: Calories- 115; Protein- 9 grams
For additional calories: serve with whipped topping
3. High Calorie Sweet Potato Shake Recipe
Ingredients for 1- 12 oz. (1½ cup) portion: ½ cup mashed or pureed cooked
sweet potatoes, 8 oz. apricot nectar (chilled), 1 tablespoon applesauce,
2 tablespoons of honey, and ½ teaspoon of pure vanilla extract
Preparation: In blender or Cuisinart blend cooked sweet potato, honey, vanilla
extract, and applesauce until smooth. Then add slowly the chilled apricot nectar.
Nutrient content for 12 oz. (1½ cup) portion: Calories- 373; Protein- 2 grams
For additional calories: serve with whipped topping
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Flavoring Suggestions for Supplement Drinks (Ensure, Boost, etc.)
1. Chocolate flavor: Add one heaping teaspoon or more to taste. Example
brands: Hershey's Instant, Nestlé's Quik, Swiss Miss Sugar-Free,
Chocolate Milk Maker.
2. Vanilla, lemon, orange or almond flavors: Add a few drops to taste of
vanilla, almond, lemon, orange, or other extract. Different types and
brands vary in strength. These are available in the spice section of the
grocery store.
3. Coffee flavor: Add one level teaspoon instant coffee to a small amount of
supplement; add this mixture to the rest of the supplement and mix well.
Decaffeinated coffee can be used as well.
4. Mocha flavor: Add both instant coffee and chocolate flavorings.
5. Butterscotch flavor: Add 1 tsp butterscotch syrup or 1 Tbsp of
butterscotch powdered pudding mix.
6. Peanut butter flavor: If tolerating fat add 1 tsp of peanut butter to an 8-oz
cup of oral supplement formula and mix in a blender.
7. Variety of fruit flavors: Add dry powdered drink mix or gelatin mix
(regular or sugar free) of the flavor of your choice. One teaspoon of
powder drink or gelatin to 8 oz of oral supplement is usually enough.
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Olfactory (sense of smell) changes are associated with a decrease of appetite.
The following tips may help:
 Hot foods can give off strong smells that can alter your taste. Eating foods
that do not require cooking, such as peanut butter sandwiches, cheese
and crackers, milk and cereal, or oral supplements are easier to tolerate
when odors are offensive.
 Warm rooms tend to hold on to strong odors. Eat in an airy, scent-free
room.
 Beverages that have a scent are sometimes easier to drink when covered
with a lid or sipped through a straw.
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Taste changes are known to sometimes add an unpleasant bitter, salty, sweet or
metallic flavor. Dry mouth and reduced saliva production can contribute to taste
abnormalities. Try consuming moist foods and increase your intake of liquids. Any
food that’s too offensive, simply eliminate. If food is too sweet, try adding salt or
lemon; too salty, bitter or sour add sweetener or little bit of sugar. Day to day your
sense of taste can change. Experimenting with spices, marinades and different ways
of preparing meals can help.
Here are more tips for improving your sense of taste:
 Regularly rinse your mouth and brush your teeth—this can help keep your
mouth healthy, and food may taste better. To help clear your taste buds
before eating, you can rinse your mouth regularly with a solution of
1 quart water, ¾ teaspoon salt, and 1 teaspoon of baking soda. Avoid
mouth rinses that contain alcohol if your mouth is sore or irritated.
 Use sugar-free lemon drops, gums or mints to eliminate a bitter taste.
 To inhibit or reduce metallic taste use plastic utensils instead of stainless
flatware.
 Seasonings associated with overriding metallic taste are: onion, garlic,
chili powder, basil, oregano, rosemary, tarragon, barbecue sauce,
mustard, ketchup or mint.
 Tart foods--lemon wedges, citrus fruit, vinegar, or pickled foods--have
improved the flavors of food. This can be helpful if your throat is not sore
or irritated.
 Fresh veggies (when not neutropenic) or frozen vegetables may be more
appealing than canned.
 Include fruits and juices with your meals. These are usually easier to eat
and may perk up your taste and interest in other foods.
 Meat may just not taste right. If this happens, try other protein rich foods
such as chicken, turkey, eggs, milk products, soy milk, dried beans and
peas, tofu, and soy milk. Marinating and cooking meats in sweet juices,
fruit, wine, or acidic dressings may also help. Examples: cooking pork with
pineapple, chicken with a honey glaze or lean beef with Italian dressing.
 Blend fresh or canned fruit into shakes, ice cream, yogurt or oral
supplements (Ensure, Boost, etc.).
 Eat frozen fruit, such as grapes, mandarin orange slices, or melon balls.
Menu suggestions and recipes to use for taste
changes:
1. Pineapple Shake Recipe
Ingredients for 1 serving: ½ cup pineapple juice, 1 cup orange juice, 6 oz. yogurt,
and ½ cup or more of a liquid* of your choice to blend to the consistency you desire.
*Liquid suggestions: milk, soy milk, rice milk, Boost, Ensure, Boost Plus, or Ensure
Plus, or a generic version of one of these products.
Preparation: Place all ingredients into the blender. Blend all of the ingredients
together to desired consistency. Add additional liquid to the blender if needed to thin
out consistency for better blending.
Nutrient content for 1 serving: Calories- 440; Protein- 60 grams
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If mouth or throat is sore: substitute fruit nectars (apricot or mango) for
pineapple juice or orange juice.
2. Pineapple Salsa Recipe to accent any chicken, fish, or pork entrée
Ingredients for 4 servings: 1 (8-oz,) can pineapple chunks drained, 1 (11-oz.)
can mandarin oranges drained & chopped, 1 T. lemon juice, ¼ t. ground ginger,
1½ T. light brown sugar, 2 green onions chopped, 1 t. chopped jalapeno peppers,
and 1 T. cilantro.
Preparation: Place all ingredients into a sauce pan. Stir over medium heat for about
5 minutes. Serve hot or set aside in the refrigerator to serve cold depending on the
temperature desired.
Nutrient content for 1 serving (½ cup): Calories- 75; Protein- 1 grams
If mouth or throat is sore: omit pineapple, lemon juice and jalapeno peppers and
use 1 cup applesauce instead.
3. Cool Lime Dressing Recipe
Ingredients for ¾ cup: ½ cup plain yogurt, ¼ c. chopped cilantro, 2 T. lime juice,
and 2 T. canola oil.
Preparation: Mix in a bowl and store in refrigerator until serving.
Nutrient content for 1 serving (1 T.): Calories- 20; Protein- .25grams
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Oral changes such as dry mouth, sore mouth, and dysphagia (difficulty swallowing)
can occur during some cancer treatments. Simply put, this is due to some
chemotherapy drugs and radiation therapies that destroy rapidly dividing cancer
cells. Unfortunately, they can also destroy other rapidly dividing cells, such as those
in the digestive tract, starting in the mouth. Fortunately, after treatment these
diminished normal cells along our digestive tract, including our mouth, are replaced
with new cells, reviving our capabilities to eat and digest our food as before.
A healthy mouth is an important part of keeping you healthy during your cancer
treatment and recovery. Here are tips to help keep your mouth clean and healthy:
 See your dentist before you begin cancer treatment for thorough teeth
cleaning and check-up, especially if you are having any tooth pain.
 Brush your teeth with gentle pressure within 30 minutes of eating and at
bedtime. Use a soft toothbrush with fluoride. To soften toothbrush
bristles, you can soak the toothbrush in warm water for at least one
minute before brushing.
 Gently floss teeth and gums in an up and down motion at least once a day
after brushing.
 Rinse your mouth regularly. Homemade mouth rinse: Mix together:
1 teaspoon of baking soda, ¾ teaspoon of salt and quart of water. Avoid
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mouthwashes and mouth rinses that contain alcohol as they are
associated with causing irritation.
If dentures or dental plates are worn, clean with effervescent denture
cleaners and do not wear while sleeping, especially if they are ill-fitting.
To assist in prevention of dry lips, use petroleum jelly, lipstick, lip balm,
or cocoa butter.
To assist in preventing dry mouth at times try a water-based mouth
moisturizer.
Drink plenty of fluids throughout the day.
The mouth can become dry and/or saliva glands can become irritated and produce
less saliva or saliva that is thick, sticky, or stringy. Below are tips to assist you in
times of dry mouth or thick saliva:
 Drink lots of fluids throughout the day. This helps loosen secretions and
keeps your mouth moist. Dip or soak food in whatever you are drinking.
Add broth, soup, sauces, gravy, or margarine to moisten foods.
 Limit beverages with caffeine- such as coffee, tea, colas and cocoa- as
caffeine may cause dryness.
 Follow guidelines listed previously for healthy mouth care to keep your
mouth clean and lips moist.
 Unless you have a tender mouth, try thinning thick saliva secretions with
souring (lemonade) or sweet (cranberry) foods and beverages.
 To stimulate saliva suck on sugarless candy or chew on sugarless gum.
 Cold foods and beverages can be soothing, such as popsicles, fruit ices,
slushes, or ice chips. Try freezing fruit like grapes, melon balls, mandarin
orange slices and banana pieces.
 To moisten room air, use a frequently cleaned cool-mist humidifier,
especially at night.
 Ask your pharmacist about the following products that do not require a
prescription but could be behind the counter if not on display:
1. Biotene’s antibacterial toothpaste associated with reducing gum
inflammation or Biotene’s antibacterial chewing gum that
stimulates the production of saliva.
2. Oral moisturizers- Mouth Kote, Oral Balance, or Oral Moist – act as
sealers for moisture
3. Saliva substitutes: Xero-lube, Glandosane, or Salivart saliva
4. For times of mouth tenderness when it becomes too difficult to
even eat pureed foods, liquid meal replacements may be helpful.
Menu suggestions and recipes to use for dry mouth
1. Fruit Spritzer Recipe
Ingredients for 1 serving: 1 cup nectar (any flavor) and ½ cup club soda.
Preparation: In a glass combine juices. Stir to blend thoroughly. Chill. At serving
time, add ice.
Nutrient content for 1 serving: Calories-130 Protein- less than 1 gram
12
2. Easy Homemade Frozen Yogurt Recipe
Ingredients for 4 servings: 1 16-oz bag frozen fruit of your choice (example:
frozen unsweetened sliced peaches), 3 T. + 2 t. All-fruit spread (example: apricot),
and ½ c. vanilla nonfat yogurt.
Preparation: In a food processor or blender, combine all ingredients and blend until
smooth. Spoon into dessert dishes and serve immediately for a creamier texture or
place in freezer for 45 minutes for a lightly frozen sherbet texture. Stir gently and
serve immediately.
Nutrient content for 1 serving (½ cup): Calories- 100; Protein- 1 gram
For additional calories: use regular yogurt for nonfat yogurt
3. Flavored Ice Chips Recipe
Ingredients: liquid of your choice. Suggestions: fruit juice, nectars, or ginger ale.
Preparation: Place in ice trays and freeze. Once the ice cubes are frozen, serve as
cubes or place flavored ice cubes in a blender and blend for a fruit slush. Serve
crushed or as cubes.
Nutrient content: depends on the liquid you choose
Sometimes cancer and its treatment can make it hard to swallow requiring softer
consistencies of solids and/or thickening agents for liquids. An indication of difficulty
in swallowing can be if you cough or choke when you eat. Immediately report this to
your physician, especially if you also have a fever. A swallowing evaluation by a
speech therapist may become necessary. A speech therapist can provide
recommendations on appropriate consistencies of solids and liquids, as well as
provide practical techniques to assist in your eating and drinking when you have
difficulty swallowing. If you need thicker liquids to help you swallow, you can
purchase commercially prepared thickeners and follow the instructions on the label,
or try these thickening agent suggestions:
 To thicken liquid, make slurry by gradually adding less than a teaspoon at a
time of tapioca, flour, or cornstarch, stirring briskly over low heat and add
more tapioca, flour or cornstarch until the thickness you need is reached.
 To thicken soup you can add pureed vegetables; however, some vegetables
may alter the flavor of the soup. So instead, you may want to add dry infant
cereal or instant potatoes.
 To aid in swallowing products that crumble- cornbread, cakes, cookies- you
can add gelatin to make a slurried bread or cake. Mix until the gelatin
dissolves, 1 tablespoon of unflavored gelatin to 2 cups of liquid, and pour over
the crumbling product. Allow this to sit until the product is saturated. A soft
gel forms on the crumbling product, making it into a slurried bread or cake
which will provide assistance with swallowing.
 Softer moist consistencies of solids may be necessary to swallow. Uniform
consistency is best, as opposed to chunky soups and stews. Pureed meat,
vegetables and fruit (without seeds or skins) by adding gravy, syrups and
honey have made solids easier to swallow.
13
Menu suggestions and recipes for difficulty in
swallowing:
1. Basic Custard Recipe
Ingredients for 4 servings: 2 cups milk, 2 eggs, ¼ cup sugar, 1 ½ t. cornstarch,
1 t. vanilla, and a pinch of salt.
Preparation: In a medium saucepan, heat milk over medium-low heat until it just
begins to bubble at the edges. Do not boil. In a separate bowl beat eggs, and add
sugar and cornstarch and blend together. Add a little of the scalded mild to the egg
mixture, stirring well. Add this mixture to the rest of the scalded milk, stirring
constantly. Cook over low heat until the mixture coats a spoon. Remove from heat.
When cool add the salt and vanilla.
Nutrient content for 1 serving (½ cup): Calories- 150; Protein – 7 grams
For additional calories: This may be served by itself or over fruit or cake.
2. Basic Homemade Cream Soup Recipe
Ingredients for 4 servings: 2 cups lowfat milk, 2 T. flour, 2 T. melted margarine,
1 t. salt (optional), dash of pepper (optional), and ½ c. cooked vegetables of your
choice (examples: asparagus or broccoli)
Preparation: Mix milk, flour, melted margarine, and seasonings of your choice in a
blender. Once this is blended put in a saucepan, add ½ c. of cooked vegetables of
your choice and stir over medium to high heat until soup is thickened to your
likening.
Nutrient content for 1 serving (½ cup): Calories- 130; Protein- 5 grams
For additional calories: use whole milk or half-and half
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Nausea with or without vomiting – that queasy feeling in your stomach- has
been declared as the side effect that is the most bothersome while undergoing
chemotherapy or radiation therapy by many cancer survivors. Prescription
medication is often needed to control nausea from chemotherapy and/or radiation
therapy. Do not hesitate to ask for anti-nausea medication, and use it as prescribed.
Most anti-nausea medications require they be taken with food. It is also important to
keep your physician informed if your nausea continues; another medication may be
more effective. Other causes of nausea and vomiting: intense pain, fatigue, illness,
medications, and the stress and anxiety associated with coping with cancer. Nausea
from these causes has been managed using relaxation techniques or by changing the
diet.
Below are eating tips you may find helpful in controlling nausea:

An empty stomach has been associated with aggravating nausea. And
drinking liquids on an empty stomach can cause nausea. So, it is
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recommended to eat dry foods when you wake up and every few hours, such
as crackers, toast, or dry cereal. Try to take at least one or two bites of food
each hour to keep some food in your stomach.
Eating several small meals instead of three large meals may be tolerated
better.
If the smell of food makes you nauseous, avoid being around the preparation
of food. Allow someone else to prepare the meals, or consume meal
replacement oral supplements. Avoid foods or beverages that produce a
strong odor, such as boiling cabbage or coffee grinding and brewing. Try
getting some fresh air and wear loose clothing.
Hard candies can relieve nausea and get rid of the bad taste you may find in
your mouth. Another way to remove a bad taste is to rinse your mouth with a
mild solution of warm or cool water (1 quart) with 1 teaspoon of baking soda
and ¾ teaspoon of salt mixed together.
Avoid foods associated with aggravating nausea such as those that are very
sweet, spicy or fried. Bland foods served cool or room temperature may be
better tolerated.
If you are vomiting regularly, dehydration is a concern. Sip fruit juices, sports
drinks (Gatorade), uncarbonated sodas (a can of soda opened and allowed to
release its carbon dioxide). If you feel you cannot even tolerate water after a
bout of vomiting, rinse out your mouth with water or the solution noted
above, spit it out, and wait thirty minutes; then try to sip a clear liquid or
suck on ice chips.
Ginger from ginger ale, candied dried ginger or directly from the ginger root
(can be steeped with hot tea) has been noted to aid in digestion for
temporary periods. Note that ginger is contraindicated if on Coumadin
(warfarin) or calcium channel blocker medications because ginger can alter
the medication’s effects.
To avoid indigestion, limit activities; and if you recline, keep your head four
inches above your feet.
You may want to consider avoiding favorite foods when nauseated, to
decrease potential food aversions in the future.
15
Recipe suggestion for times of nausea:
Cantaloupe Half Stuffed with Chicken Salad Recipe
Ingredients for 4 servings: 7 T. fat-free mayonnaise-style salad dressing, 1 T.
+ 1 t. fresh lemon juice, 2 t. soy sauce (optional: low sodium soy sauce can be
used), 2 t. curry powder, 1 t. dry mustard, ½ t. hot red pepper flakes (optional)
salt to taste, ⅛ t. ground ginger, ⅛ t. ground nutmeg, 4 chicken breasts, ½ c.
sliced chestnuts, ¼ c. chopped red bell pepper, ¼ c. chopped scallion, and 2
5-inch cantaloupes, halved & seeded.
Preparation:
1. In a mixing bowl, combine salad dressing, lemon juice, soy sauce, curry,
dry mustard, red pepper flakes, salt, ginger, and nutmeg. Blend
thoroughly and set aside this marinade.
2. Remove the skin off of the chicken breasts. Wash and pat dry chicken
breasts, and then place chicken breasts in the mixing bowl with the
marinade.
3. Coat the chicken with the marinade and place in a roasting pan covering
the chicken with the rest of the marinade. Add bell pepper and scallion.
4. Cover the roasting pan and bake in the oven at 325 degrees until done.
5. Once the chicken is cooked, chill it (1 hour).
6. Chop the chilled cooked chicken into cube size pieces and place in mixing
bowl.
7. Add chopped water chestnuts to the chicken mixture and set aside in the
refrigerator.
8. At serving time, place one-fourth of chicken mixture in each cantaloupe
half and serve.
Nutrient content for 1 serving (½ cup): Calories- 350; Protein – 28 grams
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Diarrhea, two or more loose, watery stools a day can have many causes. Diarrhea
can be caused by the cancer itself or from its treatment- chemotherapy, radiation,
surgery, physical reaction to a diet or laxative regimen, antibiotic therapy, infectionor from the stress or anxiety related to being diagnosed with cancer and undergoing
cancer treatment. Gas, bloating, cramping, and diarrhea can last from 8 to 12 weeks
after therapy or may not develop for months. Every patient’s symptoms need to be
evaluated to determine if intravenous fluids or special medication should be
prescribed. Extended uncontrolled diarrhea with the absence of adequate fluid intake
can lead to dehydration, which is associated with fatigue and weakness. This can
lead to poor appetite and weight loss. It is important to inform your physician,
especially if it continues or your stools are accompanied by an unusual odor or color.
Possible solutions for resolving diarrhea:

Due to fluid loss with diarrhea, drink plenty of liquids. Drink at least one cup
of liquid after each loose bowel movement. Mild, clear, caffeine-free room
temperature liquids are usually better tolerated. Broths, soups, sports drinks,
and fruit juices can assist in replacing the electrolytes- sodium and
potassium- lost from persistent diarrhea. If unable to drink this amount of
liquid, add food that contains a significant portion of fluid, such as soup,
flavored ice pops, flavored ices, and gelatins. As you are increasing your
liquids keep in mind that drinking highly concentrated sugar beverages as in
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fruit juice cocktails, sodas, and sweetened teas are linked with causing loose
stools, better known as osmotic diarrhea; therefore, stick to broths or sugarfree beverages. Carbonated beverages may cause GI distress; if you feel
nauseous and desire a ginger ale soda, open the can and allow the
carbonation to escape for about 20 minutes before drinking.
To assist in slowing stool formation, add soluble fiber food sources- oats, oat
bran, barley, dried beans & peas, fruit (such as apples and oranges),
vegetables (such as carrots), psyllium (found in fortified cereals), pectin
(applesauce, bananas)- to meals or snacks at regular intervals throughout the
day. During the digestion process, soluble fiber foods prolong stomach
emptying time and release the breakdown of sugar more slowly. These foods
are especially good, because they just happen to be high in potassium, an
electrolyte lost from diarrhea and often in need of replacement. Increase your
consumption of high-sodium foods if diarrhea is severe. Commercially
prepared broths and soups are good sources of fluid and sodium.
To assist in decreasing the amount of stool elimination, limit consumption of
insoluble fiber food sources. Examples: whole wheat products, flaxseed, corn,
cauliflower, green beans and potato skins. Insoluble fiber foods assist in
pushing the bulk of the undigested mass through the intestines quickly.
If lactose intolerant, avoid food or beverages that contain milk. Sometimes
taking a lactase enzyme tablet prior to consuming milk products will eliminate
gas or diarrhea. You can purchase lactase enzyme tablets over the counter
from your local pharmacist, or purchase it already contained in the milk
(―lactaid milk‖).
To increase toleration, eat small-frequent meals and snacks throughout the
day, avoiding greasy, fried, spicy, high fat-sweet foods and alcohol or
caffeine.
Meals and snacks aimed at managing diarrhea by decreasing and slowing
down stool formation happen to be very limited in bulky whole grains, fruits
and vegetables. Consuming less whole grains, vegetables and fruit limits your
intake of vitamins and minerals. Therefore, you may need to add a multiple
vitamin and mineral supplement. Confirm this with your physician and
oncologist, as vitamin and mineral supplements are contraindicated during
some cancer treatments as they may block the cancer treatment’s
effectiveness.
Avoid sugar-free gum and candy made with sorbitol. The process of chewing
gum of any kind has been associated with gulping air that can lead to GI
distress. And sorbitol, a sweetener, ingested in excess amounts has been
associated with causing diarrhea.
With your physician or oncologist’s permission consider taking an antidiarrhea
medication. There are two types: bulk forming agents and antimotility agents.
Bulk forming agents resolve diarrhea by absorbing water from the intestine.
Antimotility agents stop peristalsis (cramping), prolonging the digestion
transit time.
Antidiarrheal medications with permission of physician:
1. Bulk forming agent: Psyllium (Metamucil, Citrucel)
Calcium polycarbophil (Fibercon)
Attapulgite (Kaopectate)
2. Antimotility agent: Loperamide (Imodium),
Diphenoxylate/atropine (Lomotil)

It is important to note that your physician needs to be informed of continuous
diarrhea or if stool(s) have an unusual odor or color.
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Antidiarrheal Menu Suggestion:
Breakfast: 1 cup oatmeal, 1 teaspoon margarine and brown sugar if
desired
1 scrambled egg
½ cup applesauce
Snack: 5 saltines and canned fruit
Lunch: Bean Burrito- large soft tortilla spread with ½ cup dried cooked
pinto beans*
Sliced tomato
½ c steamed carrots with 1 teaspoon margarine
1/3 c steamed rice with 1 teaspoon margarine
Dinner: 3 oz turkey
½ c mashed potatoes with 1 teaspoon margarine
Roll with cranberry spread (fruit spreads/jelly use pectin)
½ c peas with 1 teaspoon margarine
1 fresh orange
Evening Snack: oat bran cereal with soy milk
*add chopped garlic, onion, cilantro, salsa as tolerated
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Adequate hydration is important to feeling well. Diarrhea, vomiting or nausea can
affect hydration status. The loss of fluids from diarrhea and vomiting coupled with
nausea decreases the desire or ability to drink fluids adequately, and this can result
in dehydration.
Almost every human body function takes place in a watery medium. Water
transports nutrients and oxygen to body cells and carries waste products away. It
cushions joints and protects body organs and tissues. Water moistens your mouth,
eyes, and nose. Water is the primary part of every body fluid. Water, we can say, is
―our fluid for life.‖
To avoid dehydration and in order to sustain normal body function, our bodies need
an ongoing water supply. Fortunately, of all the nutrients in our diet, water is the
most available. Our main sources of water are from our drinking water and other
beverages, but we consume quite a bit of water in solid foods, too. Juicy fruits and
vegetables like oranges, berries, melon, tomatoes, and lettuce contain more than
90% water. Even grains, beans, and meat contain water.
How much water is needed depends on the amount of energy the body expends,
better known as calories burned. For every 1000 calories burned, 4 cups of water is
needed. Typically the average adult expends 2000 calories a day and, for this
reason, requires 8 cups of water a day. However, most people really need as much
as 12 cups of water daily because of additional factors, such as climate, physical
activity, and certain conditions such as chemotherapy, constipation, or fluid loss
through vomiting or diarrhea.
Normally, water intake and water loss balance out. If you consume more than you
need, your kidneys simply eliminate the excess. To see if you are drinking enough
fluid, check your urine. A small volume of dark-colored urine indicates that you are
18
not consuming enough fluid. Almost clear urine means you are drinking enough. As
another option, weigh yourself before and after expected fluid loss from vomiting or
diarrhea. For every pound of weight you lose, replace it with 2 cups of fluid.
Fluid
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Tips:
Drink fluids throughout the day, even when you do not feel thirsty.
Grab a water bottle and take it with you whenever you leave home.
Add liquids and foods containing a high concentration of fluid to your diet,
such as: soups, broth, popsicles, flavored ices and gelatins.
 Limit fluids associated with increasing fluid loss such as caffeinated products.
 If you have experienced diarrhea or vomiting, you need to replace sodium
and potassium losses. Sodium losses can be replaced by consuming high
sodium products such as broth, bouillon, sports drinks (Gatorade), saltines
and pretzels. Potassium losses can be replaced by consuming high potassium
products such as bananas, orange juice, tomato juice, melons, and potatoes.
Clear liquid nutritional supplements may be of assistance at this time. Your
physician, nurse, or dietitian may have samples and suggestions about which
supplements would be best for you. Talk to your physician about taking
medications to help control diarrhea or nausea and vomiting.
Recipe suggestions for times of diarrhea:
1. Zesty Cranberry Ginger Ale Recipe
Ingredients for 4 cups: 2 cups ginger ale and 2 cups cranberry juice
Preparation: Mix in a pitcher and chill. Serve over ice.
Nutrient content for ½ cup: Calories- 115; Protein – 0 grams
2. Homemade Sodium and Potassium Replacement Drink
Ingredients: 6 cups water, 1 t. salt, 1 t. baking soda, and ¾ c. frozen orange
concentrate.
Preparation: Mix in a pitcher and chill. Serve over ice.
Nutrient content for 1 cup: Calories- 58; Protein – 0 grams
For additional calories: add honey or corn syrup to taste.
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Constipation is having strained bowel movements or less bowel movements than
you are accustomed to. Insoluble and soluble fiber food sources promote regularity
and therefore prevent constipation. However, insoluble food sources are nature’s
natural sponge and broom for our digestive tract. By adding bulk and softness to our
stools, insoluble fiber foods act like a large sponge in our colon and sweep the waste
through the intestinal tract.
Insoluble fiber is found in whole wheat products, bran and many vegetables, such
as: cauliflower, green beans, and potatoes and includes the skins of fruits and root
vegetables. Try adding 1 or 2 tablespoons of wheat bran to your food, or drinking
warm prune juice 3 or 4 times a day. In order for insoluble fiber to do its job, there
needs to be adequate fluid. Insoluble fiber foods hold water which assists in moving
the waste through the digestive tract. Aim for at least 8 cups of liquids a day.
19
If adding fiber and fluids are not an option or has not resolved constipation, check
with your physician about following a daily bowel care program including the use of
stool softeners or laxatives. Cautions: 1) if ordered to follow a low fiber or lowresidue diet, these foods are not recommended; or 2) if you get full very quickly or
have trouble chewing or swallowing, these foods may not be recommended. Food
labels list fiber content as ―dietary fiber.‖ The general recommendation is to eat
between 25 and 35 grams of dietary fiber every day; however, the right amount of
fiber can be different for each person, depending on need and the ability to digest
fiber.
Along with constipation, abdominal gas has been voiced as a problem and should
disappear when bowel function returns to normal. If abdominal gas remains a
problem, limit drinks and foods that cause gas. It is important to note that the foods
and beverages that cause gas are individual. They can be: carbonated drinks,
broccoli, cabbage, cauliflower, cucumbers, dried beans, peas, and onions.
Techniques that may help reduce abdominal gas:
 When preparing dry beans, soak overnight, then discard the soaking water
and cook the beans in fresh water. The soaking water absorbs some of the
gas-producing carbohydrates.
 Cook dried beans thoroughly. Then they are more easily digested.
 Eliminate the gas from canned beans by draining off liquid and rinsing the
beans well.
 Swallowing air can also cause abdominal gas. To swallow less air, try not to
talk while eating, drink liquids without a straw, and avoid chewing gum.
 To help avoid or get rid of painful abdominal gas when eating foods that are
known to cause gas, take an over-the-counter supplement such as Beano, or
a product that contains simethicone.
High Fiber Recipes
Fruit and Bran: Mix together ¼ cup prune juice, ½ cup applesauce and
¾ cup bran cereal (wheat bran or 100% bran). This can be delicious
served on toast or as a side dish.
Gazpacho: Mix together 2 cans of tomato soup, 2 cans of water, 1
tablespoon of olive oil, 1 teaspoon of salt, a dash of hot sauce and a dash
of garlic powder. Then add 1 chopped medium onion; 1 peeled, seeded
and chopped cucumber; 1 peeled, seeded and chopped green pepper; and
1 large can or 2 fresh tomatoes peeled, seeded, and chopped to the
mixture. Chill and serve with chips or crackers. This makes 8 one cup
servings. Each serving contains 90 calories, 2 grams protein, and 3 grams
of dietary fiber. For even more fiber, do not peel or take out the seeds
from the vegetables.
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Bowel Obstruction can be due to the location of a cancer or from adhesions
from a previous surgery. Symptoms often include intense abdominal pain and
swelling sometimes accompanied with nausea and vomiting. If you have
concerns about pain or change in bowel habits contact your physician. If your
physician has informed you that you are at risk for bowel obstruction he (she)
may suggest you to follow a low-residue diet. A low-residue diet is the
opposite of a high fiber diet (whole-grain breads and cereals, nuts, and foods
20
that contain seeds, whole wheat, cracked wheat, rye or unpeeled fruit or
vegetables. Below are tips to reduce the chance of developing a bowel
obstruction:
 Choose breads, biscuits, soft buns, crackers, pasta, cereals, and other
grain products made with refined white flour.
 Drink at least 8 to 10 cups of clear noncaffeinated fluids a day;
drinking small amounts often and throughout the day.
 Avoid foods you know that are gas-producing for you. These foods can
be broccoli, cabbage, onions, pinto beans or other dried beans, melons
and carbonated beverages. Also an interesting note is gulping air by
chewing gum, sipping through a straw or eating foods too quickly can
also cause uncomfortable gas.
 You may develop temporarily lactose intolerance. Noted symptoms of
lactose intolerance are: gas, cramping and sometimes loose stools
followed by the ingestion of milk or milk products. If you suspect you
are lactose intolerant eat or drink smaller amounts of milk products at
meal or snack time. For example ½ cup milk or less is sometimes
better tolerated when other foods are ingested. Yogurt with live
cultures or lactaid milk is often better tolerated than milk or cheeses.
Keep in mind that if you are on a neutropenic diet yogurt with live
cultures is contraindicated.
Below is a table of suggested foods to eat to if at risk for bowel obstruction:
Food List
Suggested Foods to
Eat If at Risk for
Bowel Obstruction
Food That May Cause
Abdominal Distress
at Times of
Bowel Obstruction
High-protein foods
All meats and milk
Beans, peas and nuts
Bread, cereals, rice &
pasta
White bread, corn flakes,
cream of wheat, white rice
and pasta
Whole wheat breads, bran
cereals, granola, brown
rice, and wheat pasta.
Fruits and vegetables
Peeled fresh fruit,
bananas, canned fruit and
cooked vegetables
Beverages
Water, juice and
decaffeinated beverages
Apples, pears, prunes,
dried fruit, berries,
asparagus, sweet
potatoes, raw veggies and
salads
Coffee, cocoa, carbonated
beverages and alcohol
Desserts
Cake, cookies, pie,
sherbet, ice cream, and
pudding
Margarine, salad dressings
and vegetable oil
Miscellaneous
Desserts made with nuts,
seeds or dried fruit
Popcorn
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Hyperglycemia is high blood glucose level above 140mg/dL; also known as
―high blood sugars.‖ Normal blood glucose levels are between 70 and
110mg/dL at times of fasting (12 hours of not eating). When blood glucose
levels are high over a period of time it can lead to slow wound healing,
blurred vision, fatigue and more undesirable symptoms. Medications such as
diuretics, phenytoin, niacin, and high-dose glucocorticosteroids can cause an
increase in blood glucose levels. The condition usually corrects itself when the
right diet is followed, even though blood glucose levels may remain high. The
tips below can help keep blood glucose levels in more desirable ranges:
 Eat high protein food sources at each meal and consume snacks to
help stabilize blood glucose levels.
 Eat whole grains, rice, and cereals instead of refined flour and sugar.
 Eat 3 moderate meals and an evening snack of the same amount
every day.
 If light or moderate physical activity is recommended by your
physician, activity may help control blood glucose levels.
 While it may not completely fix hyperglycemia, it is important to note
that a healthy weight can help control blood glucose levels. Excess
weight and heredity influences occurrences of diabetes. During times
of cancer treatment, it is inappropriate to be on a weight loss plan;
however, it can be helpful to know not to purposely gain weight,
especially when not underweight.
 Limit intake of simple concentrated sugars such as: pastries, jams,
jellies, syrups, doughnuts, children’s sugary cereals, fruit in heavy
syrup, sugar-sweetened drinks, frosted cakes, rich desserts, and pies.
 Avoid regular sugar. For sweetening foods one can add sugar-free
artificial sweeteners that are located in most grocery stores. If you do
not desire to use artificial products, there is a sweetener made from an
herb, called Stevia, which is available in some health food stores.
Below is an example how one can eat to promote control of blood sugars:
Breakfast
Poached egg over whole wheat toast
3 tablespoons of raisins or ½ cup orange juice
½ cup bran flakes with ½ to 1 cup milk
Optional: Coffee or Green or Black tea
Water
Snack
3 graham crackers
1 cup sugar-free fruited yogurt
Lunch
1 cup lentil or split-pea soup
½ cup cole slaw
1 corn muffin
½ cup canned, juice-packed fruit
Optional: Coffee or Green or Black tea
Water
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Snack
Cheese and crackers
Dinner
1 chicken breast or thigh baked with Italian seasoning
1 baked sweet potato
½ cup creamed spinach
1 whole wheat dinner roll
½ cup applesauce
Optional: Coffee or Green or Black tea
Water
Snack
½ whole-wheat English muffin with apple butter
1 cup 1% or skim milk
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Common Interactions Between Food and Medication Prescription drugs and
over-the-counter products can often interact with certain foods. For specific
information on your particular medication, ask your physician or pharmacist. An
accurate evaluation involves a complete list of all medications, herbs and
supplements, taken alone as well as when taken when eating or drinking.
Combinations of medications, supplements, and foods can affect the absorption
rates of each group.
Another important variable pertaining to drug interactions is during the wearing
of a port for chemotherapy. Blood-thinning drugs such as coumadin may be
necessary. If so, eating foods high in vitamin K (such as dark leafy greens,
spinach, turnip greens, green tea, and cauliflower) can inhibit coumadin’s
effectiveness. Blood will clot faster and therefore may close up a port necessary
for chemotherapy. The key is to not avoid foods rich in vitamin K, but to eat
them in moderation and not make sudden changes in your dietary intake of
vitamin K.
Garlic pills are associated with thinning of the blood. If you are taking aspirin or
other blood thinning medication, consuming garlic supplements may thin your
blood too much. This is especially important to know before having surgery.
Before surgery, inform your physician of all medications, herbs, and supplements
including garlic pills, because the timing of your surgery may need to be
adjusted.
Pain relievers such as aspirin or ibuprofen may irritate your stomach, especially if
taken on an empty stomach. It is highly recommended to take pain relievers with
food, or a beverage with substance such as milk. It can also be beneficial to limit
other known stomach irritants you may consume, such as alcohol or caffeine.
Antacids containing aluminum need to be taken two to three hours before citrus
fruits. Citrus frits can increase the amount of aluminum absorbed, and decrease
bone-building calcium.
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Antibiotics need to be taken one or more hours before or after consuming dairy
products. Dairy products are high in calcium, and calcium can block the
absorption of tetracycline-based antibiotics.
These are only a few of the many drug and food interactions that may occur. It is
important to reiterate that your health professionals need to be aware of every
prescription, herb, and supplement that you are taking, along with the amount
and time of day you take them for your own optimal health.
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Unwanted weight gain can be a surprise when most people had thought a
diagnosis of cancer would lead to ―wasting away to nothing.‖ Some people have
actually gained weight during cancer treatment. Even though maintaining a
healthy weight is important for overall physical health and psychological wellbeing, unwanted weight gain may lead one to want to quickly lose the weight
they have gained. However, quick weight loss programs are strongly
discouraged. If you desire to lose weight, do not do it during treatment unless
your physician recommends it. Whether you gained weight during treatment or
were overweight at the start of treatment, planned healthy weight loss efforts
should start after treatment. Because body weight has been associated with a
role in the recurrence of some cancers, reaching and maintaining a healthy
weight is worth the hard work it may entail.
A healthy weight is defined as a body mass index (BMI) between 19 and 24. The
BMI is a measure of body weight fitness. Your physician or anyone on your
healthcare team can inform you of your BMI. If you have not weighed within your
recommended range within the last 10 years, your healthcare team can assist
you in identifying a reasonable body weight goal. Some degree of weight loss, as
little as 10% from your current weight, has been shown to improve health and
reduces the health risks of many chronic diseases.
To obtain a weight loss plan designed for your specific needs, schedule an
appointment with a Registered Dietitian. The Cancer Center at Dekalb Medical
Center’s Outpatient Services has a Registered Dietitian who specializes in
Oncology Nutrition and is certified in Weight Management. Services are at no cost
for cancer survivors. Call 404.501-7520 to schedule an appointment.
Below are some weight loss tips that include information about vitamins,
minerals, fiber, and phytochemicals that you may find helpful:
 Avoid skipping meals.
 Avoid selecting a high-calorie dessert in place of a whole meal.
 If possible, try to include light exercise such as walking three or more
times a week. (The Cancer Center at DeKalb Medical Center’s
outpatient services has a physical therapist who can individualize an
exercise plan for you. Call 404.501.5701 to schedule an appointment.
 To assist you in portion control and promote satisfaction, use a
smaller plate. To ensure accuracy, measure using measuring cups and
spoons for cereal, pasta, rice, nuts, peanut butter, salad dressing, and
other foods that are easy to overeat, and place the food in the bowls
and plates you typically use. Next time you will be able to simply eye
the portion and know if it is accurate.
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
To reinforce self-confidence, which promotes adherence to healthy
eating, change internal scripts that speak negatively with positive
ones. For example, after experiencing unconscious excess eating,
replace the negative self statement, ―I am bad for eating all those
chips,‖ with a more positive statement like, ―The extra chips I just ate
are not going to make or break me. It is how I am eating over the
long haul that counts.‖ When consciously eating, an example of a
positive internal script can be, ―More doesn’t taste better,‖ and allow a
5-second reminder before going back for seconds.
Keep a ―feelings‖ log. When you crave food or overeat, write down
your feeling. In the beginning it may be difficult to identify a feeling.
Just the word ―uncomfortable‖ can be enough. This opens the door to
learning cues leading to possible emotional overeating.
When non-physical hunger occurs, for instance after eating a balanced
meal, fill the time without filling your stomach by keeping busy. Down
time for many is a time for a snack, when actually a good use of time
would be to relax without the use of food. If unable to relax, get busy
doing anything. Physical exercise can be helpful.
Each day, aim for consuming 25 to 35 grams of fiber. This is
associated with decreasing the risk for cancer, heart disease,
constipation and excess weight. Fiber can be increased by substituting
whole grain for white refined grain products. Switch from a slice of
white bread (1g fiber) to whole wheat bread (2-3g); an ounce of corn
flakes (0g) to Raisin Bran (4g) or Fiber One or All Bran (13-15g); a
half cup of pasta (1g) to whole wheat pasta (3g); a flour tortilla (12g) to a whole wheat tortilla (5g). Also, switching saltines for whole
rye crackers (Ryevita or Wasa brand crackers) provides 8 times the
fiber and provides lignans which are associated with decreasing the
risk of breast or colon cancer. Vegetables and fruit, especially fresh,
are also high in fiber and, in addition, provide phytochemicals
associated with decreasing risks for cancer. Fresh fruit can be more
filling than juice. An 8 ounce cup of juice consists of 112-153 calories
and no fiber compared to 60 calories of one serving of fresh fruit with
3-4g fiber.
Aim for 3 or more vegetables a day. If you do not have time to wash
and chop vegetables, purchase pre-washed and chopped vegetables
or drink V8 or vegetable juice. You can double the vegetable power of
tomato sauce by throwing in a half cup frozen vegetables to a sauce.
Another way to increase vegetable consumption is using salsa for
more than just a dip. Salsa, a rich source of lycopene, an antioxidant
linked to protect against heart disease or cancer, can be added to
vegetables or bean soup, or mixed into brown rice or scrambled eggs.
Also, switching to sweet potatoes from white potatoes will provide less
calories and more vitamin A, associated with fighting against cancer
and heart disease. Using red pepper has 10 times the vitamin A and
twice the vitamin C content as green pepper.
You can increase absorption of iron from your meal by including a
vitamin C food source, easily accomplished by eating an orange,
tomato or a few strips of red pepper.
Replace butter on your toast with peanut butter. For the same
calories, peanut butter will keep you feeling full longer. Peanut butter
also provides protein and monounsaturated fat that is good for the
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heart, in contrast to zero protein and harmful saturated fat or transfat found in butter and margarine.
___________________________________________________________________
___________________________________________________________________
After Cancer Treatment
The previously discussed eating-related side effects are known to end after cancer
treatment. After treatment, most people gradually begin to feel better and are
interested in food again. If by chance any of these side effects persist, and especially
if weight loss occurs, contact your physician and see a Registered Dietitian trained in
oncology. After cancer treatment, you will want to eat healthy to regain and maintain
your strength, rebuild tissue, and to continue to feel well.
American Institute for Cancer Research (AICR) Guidelines for Cancer Prevention
state:
1. Choose a diet rich in a variety of plant-based foods.
2. Eat plenty of vegetables and fruits.
3. Maintain a healthy weight and be physically active.
4. Drink alcohol only in moderation, if at all.
5. Select foods low in fat and salt.
6. Prepare and store food safely.
And always remember…
Do not use tobacco in any form.
Below are basic eating guidelines to assist you in following AICR Diet and
Health Guidelines for Cancer Prevention:
 Eat a variety of foods. Concentrate daily on eating a variety of foods from all food
groups. After all, there is no magic potion that can guarantee cancer prevention.
No science-based reputable cancer research team has discovered a food or
formulated a nutrient formula that can provide all essential nutrients, replace all
other forms of nutrition, and prevent cancer. Since it is well known in the
scientific community that high doses of one nutrient can antagonize the
absorption of other nutrients, our most effective nutritive way to fight against
cancer is to eat a wide variety of foods. For every new season, try at least one
different fruit or vegetable that is new to you. Below are multicultural foods
found in you grocery stores you can try:
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Bread, Cereal, Rice, & Pasta
Cuisine
Preparation
Couscous
(pasta)
Moroccan
Serve hot with tomato sauce and
parmesan cheese, or serve cold
as a salad with raisins, mandarin
oranges, and spices.
Kasha
(buckwheat)
Eastern
European
Serve as a hot side dish with
chicken or beef. Mix with pasta.
Pozole
(corn)
Mexican
Soup served with diced onion,
shredded cabbage, and a lime
wedge.
Wonton Wrappers
(dough)
Chinese &
Vietnamese
Wrap thin strips of cooked lean
barbecue pork or chicken and
steamed shredded cabbage and
carrots in the thin wheat dough.
Vegetable
Jicama
Mexican
Slice in thin strips, and dip into
salsa or reduced fat dressing.
Can substitute with water
chestnuts.
Tomatillos
Mexican
Dice and boil with jalapeno
peppers for salsa. Dice and
combine with onions for an
omelet.
Shiitake Mushrooms
Japanese
Add raw to salads, sandwiches
or toss in stir-fry dishes.
Fruit
Cuisine
Preparation
Lychee
Chinese
Serve on top of frozen yogurt.
Kumquat
Chinese
Slice for fruit salad.
Papaya
Mexican &
Central American
Blend with pineapple for
tropical juices, dice and add
to salsas, or simmer in a
chutney recipe.
Plantain
Puerto Rican &
Central American
Cube and add to stews and
soup.
Mango
Caribbean
Slice for fruit salads, or
simmer in a chutney recipe.
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Meat, Poultry,
Fish, Dry Beans,
& Nuts
Veal, Lamb
Mediterranean
Marinate in Italian vinaigrette,
then grill.
Hummus
(mashed chickpeas)
Middle Eastern
Serve as a dip for raw veggies
or pita triangles.
Chorizo
(sausage)
Mexican
Slice in bite size pieces, add
to omelets or stews.
Tofu
Japanese
Slice for sir-fry dishes, or dice
for salads or soups.
Black Beans
Latin American
Use in place of red beans in
chili or soup, mash for
homemade refried beans, or
mix with rice.
Milk, Yogurt,
& Cheese
Plain yogurt
Middle Eastern
Top falafel sandwiches chickpea and vegetable stuffed
pita. Blend with mint as a
dip or dressing for cucumbers.
Goat Milk
Middle Eastern &
African
Drink goat milk plain. Make a
drink by mixing with juice. Use
in baking in place of cow’s
milk.
Ricotta Cheese

Italian
Use in lasagna or stuff in pasta
shells.
The largest portion of your meal should come from vegetables, followed by fruit.
Manufacturers have not been able to pharmaceutically duplicate the complete
nutritive values of fruits and vegetables so that all vitamin pills function and
respond in our bodies the same way as vegetables and fruits grown from the
earth.
Although vitamin and mineral content vary in each fruit and vegetable, they
contain the highest concentration in those of vibrant colors. Each of the vitamins
and minerals play a role in the normal everyday functioning of the human body
and assist in lowering the risks of some cancers, heart disease, and other health
problems. Fruits and vegetables are also good sources of complex carbohydrates
and fiber, and, unless fats are added, are low in fat and sodium. Try to eat at
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least 5 servings a day of vegetables and fruit. Include citrus fruits and dark-green
and deep-yellow vegetables.

Include high-fiber foods, such as whole grain breads and cereals, brown rice,
legumes (i.e., pinto beans, northern beans, lima beans, and peas), and oats.
Dietary fiber is theorized to decrease the risk for colon cancer by providing bulk
and holding moisture, allowing digested food to be transported down the
digestive tract quicker. For dietary fiber to work efficiently, adequate fluids need
to be consumed. The top ten high-fiber foods associated with decreasing risk for
cancer from their phytonutrients properties are: blueberries, raisins, broccoli,
spinach, sweet potatoes, pinto beans, lentils, pumpernickel bread, and oatmeal.
To increase fiber in your diet, try these tips:
1. Choose whole grain breads, crackers, or whole wheat flour instead of white
flour and plain crackers.
2. Choose whole grain cereals, especially bran, instead of plain or sugar-coated
cereals.
3. Choose whole grain spaghetti noodles or pasta instead of plain pasta.
4. Choose brown or wild rice instead of white rice.
5. Choose fresh fruit with skin when the skin can be eaten, instead of juice.
6. Choose raw, or steamed to lightly cooked vegetables.
7. Choose dried bean, peas, or lentil main entrees.
8. Sprinkle bran flakes on top of side dishes such as yogurt, cottage cheese,
applesauce, grits, or salad. Small amounts can be added to baked products
such as meatloaf or stuffing without noticeably changing the taste or texture.
9. Whenever increasing fiber, increase fluid intake. Aim for at least 8 glasses of
water a day.

Match portion sizes to your nutritional needs. American’s visual reference for
dietary guidelines is the much debated Food Pyramid. It was originally designed
to only emphasize ―adequate‖ nutrition. Adequate nutrition is no longer a threat
to America’s health. Overeating is now a very serious threat to the health of
many.
The scientific committee revising the dietary guidelines has been considering
changing the shape of the food pyramid to make it more useful for all consumers.
See (www.MyPyramid.gov). In order to decrease our health risk, Americans need
to be clear on how to eat at least half as much added sugar and solid fats. Added
sugars are simple carbohydrates we personally add to our food or are added in
the manufacturing process. Solid fats are saturated fats in meat or butter and
trans-fatty acids found in shortening. Health organizations for the past 20 years
have advised to ―cut the fat‖ for disease prevention.
Americans have followed these guidelines and bought and consumed ―low fat‖
products not realizing these products are actually higher in calories. Buying into
the commercials that low fat products are better for lower fat calories, consumers
did not realize that in changing the fat content often these products are actually
higher in total calories per serving. Not realizing this, consumers took it one step
further and increased the amount of servings of these so called low fat
manufactured products, eating them freely without counting the total calorie
content.
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What can Americans eat while consuming nutritious quality foods with lower
calories? Amazingly, it is a food readily available with fewer marketing schemes
employed for us to purchase them: fruit and vegetables.
For disease prevention, Americans have been recommended to eat more
vegetables and fruit. Americans need to eat four times more vibrant colored
vegetables than they are accustomed to, while eating less starchy vegetables like
potatoes. This can satisfy hunger with fewer calories and provide more vitamins
and minerals.
Plant-based vitamins and minerals are recognized for their continuing role in
helping to maintain a cancer-free life. Cancer-fighting agents added to
supplements have not produced the same cancer-fighting qualities found in
vegetables or fruit. Harvard researchers have found that adding daily exercise
and weight control to dietary guidelines has been beneficial, and also have
suggested adding exercise and weight control to the base of the food pyramid.
No matter the shape of the pyramid, the visual references alone will key in on the
needed serving size.
What counts as one serving?
Breads, Cereals, Rice and Pasta; the Grain Group: 1 slice of bread, ½ cup or
cooked rice or pasta, ½ cup cooked cereal, or 1 ounce of ready-to-eat cold cereal
(unsweetened).
Vegetables: ½ cup of cooked vegetables or 1 cup of raw vegetables.
Fruits: 1 piece of fruit or melon wedge, ½ cup of juice or canned fruit (canned in
fruit juice or water), or ¼ cup dried fruit.
Milk, Yogurt, and Cheese: 1 cup of milk or yogurt or 1½ -2 ounces of cheese.
Meat, Poultry, Fish, Eggs, Dried Beans and Nuts: 2-3 ounces of cooked lean
meat, poultry, or fish. (A 3-ounce cooked serving is about the size of an average
woman’s palm or the size of a deck of playing cards.) 1 egg is equivalent to 1
ounce of meat. 2 leveled tablespoons or 1 heaping tablespoon of peanut butter is
equivalent to 1 ounce of meat. ½ cup cooked dried beans (pinto, chick peas,
black beans) is equivalent to 1 ounce of meat.
Fats, Oils and Sweets: use sparingly. These are foods such as salad dressings,
cream, butter, margarine, sugars, soft drinks, alcoholic beverages, candies, and
sweet desserts. Some fats and sugars are already in the other food groups
mentioned above, such as cheese from the milk group, or french fries from the
vegetable group. Before purposely adding margarine, jam, or sugar to flavor your
foods, consider the additional fats and sugars that are already in the prepared
foods. Generally one serving is one teaspoon. Today’s packaged foods have
trustworthy food labels regulated by the U.S. government. In this way, you can
limit your fat content by aiming for no more than 10 grams of fat per 300 calorie
serving.
How many servings do you need each day? To answer this accurately you need to
have a Registered Dietitian assess your nutritional needs, but for an estimate
regarding a healthy average person, see below:
Women and some older adults: 6 grains, 3 or more vegetables, 2 fruits,
2-3 milks, and 5 ounces of meat.
Children, teen girls, active women, and most men: 9 grains, 4 or more
vegetables, 3 fruits, 2-3 milks, and 6 ounces of meat.
Teen boys and active men: 11 grains, 5 or more vegetables, 4 fruits,
2-3 milks, and 7 ounces meat.
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What would this look like on your dinner plate? The majority of the plate should
have vegetables and fruit with only a third of the plate holding the meat, the rest
holding grains.
What does a predominantly ―plant-based‖ menu look like?
Breakfast
1 cup whole grain cereal
½ cup nonfat or lowfat milk
1 cup strawberries
1 slice whole wheat toast
with
1 tsp. butter or margarine or 1 Tbsp. peanut butter
½ - 1 cup orange juice
Lunch
1 cup minestrone soup
4 whole grain crackers
Salad: 1 cup spinach leaves, 2 Tbsp. each of chopped carrots, cauliflower and
tomatoes, ½ cup kidney beans & 3 Tbsp. reduced-fat dressing
1 peach
2 oatmeal raisin cookies
1 cup nonfat milk
Dinner
Veggie and chicken fajitas with 1 whole wheat tortilla, 2 oz. chicken breast, &
¼ cup each stir-fried green pepper, red pepper and onion
¼ cup salsa
½ cup brown rice with black beans
½ cup raspberry frozen yogurt with 1 Tbsp. chocolate syrup
(calories:~1700; fiber:35grams)

Excess calories, regardless of the source, can lead to storing body fat, where
chemical carcinogens (cancer-causing agents) can accumulate. There has been
concern that high-fat diets are linked to an increased risk of colon, breast, and
prostate cancers, and many other diseases when actually it is probably excess
calories that are the culprit. Fat contributes over twice the amount of calories per
gram as carbohydrate or protein; therefore, it is easier to overeat and gain
unnecessary weight. While fat provides more calories for smaller serving sizes
than the other food groups, it also tends to be the lowest in nutrients. Fat has no
fiber and limited antioxidants (vitamin A, vitamin C, vitamin E and selenium)
associated with decreasing risk for cancer. During post treatment the best
nutritional advice is to consume meals low in fat and high in vitamins, minerals,
and dietary fiber. Keep in mind ―low in fat‖ does not mean zero fat. Fat, easy to
consume in many of our packaged foods, is necessary for absorbing the fatsoluble vitamins we ingest.
Absent-minded snacking can lead one to eat more calories than one realizes. To
choose satisfying, healthy snacks eat from two food groups, such as:
1. Whole grain cereal and milk.
2. Fruit smoothie (fruit or juice blended with milk or yogurt).
3. Yogurt and fresh fruit.
4. Pita bread and hummus (chickpea dip).
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5. Apple or pear slices topped with cheese.
6. Pita bread stuffed with lettuce, tomato, cucumber, and low
calorie dressing or a small serving of regular salad dressing.
7. Raw vegetables with cottage cheese or yogurt dip.
8. Hot-air popcorn and fresh fruit.
9. Quesadilla (soft tortilla and cheese).
10. Baked potato topped with salsa and a tablespoon of grated
cheese.
11. Tomato juice and broccoli florets.
12. Carrot sticks and 1 tablespoon or less of peanut butter.

Phytochemicals are just what they sound to be. ―Phyto‖ says what it does:
―fight-o‖, the root word for plant, and ―fight-o-chemicals‖ come from plants.
Many plant foods are in the process of being studied for protection against
cancer, heart disease, and other diseases. Phytochemicals can help prevent
cancer with their antioxidant abilities. Acting as antioxidants, phytochemicals can
dispose of the cell damaging by-products of processing oxygen. These byproducts, also known as free radicals, are brought on by environmental factors
such as smoking, pollution, too much sunlight, or infection. Phytochemicals can
prevent potential carcinogens (cancer-causing substances) from forming by
blocking or suppressing their development. Phytochemicals can protect us against
heart disease in how they influence blood pressure, blood clotting, and in
reducing the synthesis and absorption of cholesterol. All plant foods contain
phytochemicals in varying amounts. This means there is not one plant that
contains a miracle cure. Phytochemicals act in conjunction with other
phytochemicals, vitamins, minerals, fiber, hormones, and other compounds in
foods. The bottom line is to eat a wide variety of plant foods.
Examples of food sources with phytochemicals and possible linked benefits:
1) Berries have anthocyanides and ellagic acid that act as antioxidants,
protecting cells against cancer. Also rich in soluble fiber, berries are linked to
lowering cholesterol as well.
2) Chili Peppers have capsaicin which can act as an antioxidant interfering
with cancer development, and may prevent blood clotting.
3) Citrus Fruit contain flavones, acting as an antioxidant and may detoxify
cancer promoters and inhibit blood clotting.
4) Cruciferous Vegetables (cabbage, broccoli, turnips) contain indoles
associated with neutralizing carcinogens and interfering with tumor growth.
5) Flax contains lignans that are converted to a form of estrogen thought to
be protective in some cancers. Note: lignans are not in flaxseed oil.
6) Garlic Family (onions, chives, leeks) contain allycic sulfides associated
with lowering risks of cancer.
7) Herbs and Spices (rosemary, sage, thyme, oregano, ginger, cumin)
contain many phytochemicals, such as carnasol, phenols, curcumin, gingerols,
terpenoids, etc., associated with operating as an antioxidant fighting against
cancer.
8) Orange and yellow fruit/vegetables plus green leafy vegetables
contain carotenoids; lateen and zeaxanthin are linked with many anti-cancer
properties such as strengthening the immune system and reducing the risk of
macular degeneration of the eyes.
9) Legumes (lima beans, kidney beans, navy beans, lentils) contain
isoflavonoids, phytic acid, saponins, and phytosterols associated with
32
protecting against colon cancer. The soluble fiber content may lower blood
cholesterol as well.
10) Red Grapes contain flavonoids that may prevent damage to cells and
slow down tumor growth. Quercetin, a flavanoid, may benefit the heart.
11) Soy contains isoflavonoids and lignans that are converted to a kind of
Estrogen that is associated to being protective against some cancers.
Recently it has been recommended that people with estrogen-positive type
cancers limit intake of soy products. In other words, do not consume soy
products daily and when consumed, limit to one serving.
12) Tea contains flavonoids associated with neutralizing cell damaging free
radicals and possibly assists in lowering blood cholesterol.
13) Tomato products and in smaller amounts red peppers and pink-grapefruit
contain lycopene associated in fighting cancer in several ways. Tomato
products cooked or processed have higher levels of phytochemicals that are
mentioned the most in fighting prostate cancer.
14) Whole Grains (whole wheat, oats, barley) contain saponins and
terpenoids. Saponins are linked to neutralizing carcinogens in the intestine.
Terpenoids may help reduce heart and cancer risk. Dietary fiber in
whole grains contributes to lowering blood cholesterol and may reduce
colon cancer risk.

Diets high in salt (sodium) have been linked to stomach cancer. This included
salted foods as in processed foods. Even though stomach cancer is more
prevalent in countries related to their high consumption of salt-preserved foods,
Americans need to limit their salt intake to promote a healthy heart. To limit the
sodium content in your foods, choose fresh over processed foods whenever you
can. When you cannot cook from scratch, compare labels and select lower
sodium varieties of frozen dinners, canned soups and vegetables. Rinse canned
beans to wash away some of the sodium. For rice mixes, use only part of the
seasoning packet if at all. Aim for no more than 800 milligrams of sodium per
entrée. Experiment with herbs and spices. Herbs and spices can provide flavor
without the risks associated with salt, and they give the added bonus of
containing phytochemicals. Below is an herb chart you can start using to find
your favorite combinations:
Seasoning
Basil
Chives
Thyme
Dill
Rosemary
Oregano
Tarragon
Sage
Goes Well With…
Fish, poultry, soups, tomatoes, eggplant,
zucchini
Fish, soups, salad dressings, baked
potatoes, steamed vegetables
Seafood, poultry, dried beans, green
beans, tomatoes, mushrooms, summer
squash, onions
Fish, yogurt sauces, rice dishes, soups
Chicken, roasted potatoes, marinades,
breads, rice, peas, turnips
Tomato dishes/sauces, salad dressings,
soups, beans, corn, cabbage
Fish, chicken, salad greens, soups,
mushrooms, asparagus
Fish, poultry, stuffing, soups, Brussel
sprouts, carrots, winter squash
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
Drink alcohol only in moderation, if at all. Alcohol is linked to increasing the risk
for cancers of the mouth, pharynx, esophagus, liver, colon, rectum and breast. If
smoking is included, the risk for cancer is even higher. Another reason not to
drink alcohol is its association with high blood pressure, stroke, heart disease,
birth defects, osteoporosis, accidents, violence and suicide.
In contrast, there has been evidence that consuming alcohol moderately may
protect against heart disease. However, if you do not drink alcohol, this is not a
good reason to start because there are other, more healthful ways to lower your
heart disease risk. If you do drink alcohol, drink it in moderation. Moderation
means women should have no more than one drink a day, and men should have
no more than two drinks daily. One drink is equivalent to 12 oz. beer, 5 oz. wine,
or 1.5 oz. of 80-proof liquor.

Prepare and store food safely. During the preparation of meat, cancer promoting
substances called heterocyclic amines (HCAs) and polycyclic aromatic
hydrocarbons (PAHs) can be produced. Cooking meat at high temperatures,
especially over open flame, produces HCAs on the surface of meat. Muscle meats
like beef, chicken or fish provide the greatest risk of forming HCAs when grilled.
PAHs are formed when fat drippings have contact with fire producing smoke. The
smoke and flames that rise up onto the food leave behind PAH carcinogens.
Eating meat cooked by grilling, barbecuing, broiling or pan frying possibly
increases the risks of stomach, colon, and rectal cancer. When cooking meats,
use lower heat options like baking, poaching, stewing, roasting and microwaving.
When you desire cookouts on the grill, follow these safer guidelines:
1. Grill vegetables and fruit instead of meat. Try grilling vegetables,
quesadillas, veggie burgers, or fruit kebobs.
2. Choose lean meats when grilling. Trim away any visible fat. This reduces
fire formation caused by fat drippings forming HCAs & PAHs. Keep meat
juices from dripping into the fire any way you can, such as: use aluminum
foil or do not place meat directly over the coals, flip meats with a spatula
or tongs instead of a fork, do not squirt starter fluid into the coals while
meats are cooking, and keep a spray water bottle handy to quell any fire
flare-ups that do occur.
3. For 10 minutes or more, marinade meat in an oil-free sauce that has a
strong acidic content, such as lemon juice or balsamic vinegar. Research
has demonstrated that as much as 90% of the HCAs are prevented from
forming when meat is marinated for at least 10 minutes before grilling.
4. Pre-cook meats. The shorter time the meat stays over an open flame the
less cancer risk there is. Cook your meat in the oven or microwave until
almost done, then finish cooking on the grill for the grilling flavor you
want.
5. Cut away and discard any burnt or charred parts of the meat before
eating.
Regarding safely storing food, improper storing known by its rancid smell of
peanuts and grains can produce aflatoxins, a cancer promoter. Consuming
aflatoxins alone does not cause one to have cancer. Due to strict food and
safety guidelines in America, this has been a rare occurrence and is hardly
worth mentioning.
34

Supplements , herbal, and other botanical remedies are regulated differently than
pharmaceuticals. According to current laws and regulations, herbal and botanical
remedies and other dietary supplements can enter the marketplace without the
Food and Drug Administration’s (FDA) approval. It is the burden of the FDA with
its limited budget to remove a dangerous dietary supplement from the
marketplace. Currently, dosages of herbal remedies are not standardized, so
dosages vary among products, and many of their claims are backed with limited
scientific evidence. Vitamins and minerals have recommended intakes listed
providing safe dosage as ―Dietary Reference Intakes.‖ There are no
recommendations or safe dosage limits existing for herbals, other botanicals, and
other nonnutrient supplements. The National Institutes of Health’s Office of
Dietary Supplements provides advice on many botanicals. It is important to note
that caution should be used when using any botanical supplements because
many can contain active ingredients that can cause dangerous side effects,
interfere with prescription medications (along with supplements including herbs),
and can even lead to death. It is vital to let your physician known every pill,
herb, and/or supplement you ingest.
Questions frequently asked regarding supplements include:
1. Can vitamin and mineral supplements make up for unhealthy food
choices? Answer: No, dietary supplement(s) can replace ongoing
inadequate eating habits. Only a varied and balanced eating pattern can
provide optimal health. A daily multivitamin & mineral supplement is
helpful when one is limited to a variety or a balance of foods on a regular
basis.
2. Can vitamins or minerals give extra energy? Answer: Energy is supplied
by calories. Calorie sources come from carbohydrates, protein, and fat.
We cannot boost our energy by taking vitamins or minerals. Vitamin B is
often misunderstood as something that produces energy. Actually vitamin
B helps cells produce energy from carbohydrate, protein, and fat food
sources.
3. Do vitamins marketed for easing emotional stress work? Answer:
Emotional stress does not change our needs for nutrition. Any claim(s)
that promotes dietary supplements for stress relief are misleading.
4. Can people who smoke or drink excessively protect themselves from the
associated harmful effects by taking vitamin supplements? Answer: Taking
a vitamin pill or multivitamin & mineral supplement(s) cannot block the
harmful effects of smoking or excessive alcohol use. Smoking does
increase the body’s need for vitamin C, and drinking alcohol does interfere
with the absorption of some vitamins and minerals. However, additional
nutritional needs can be met by making appropriate food choices.
5. Can taking a large quantity of vitamins A, C, and/or E prevent cancer?
Answer: There is no scientific evidence that proves that taking
supplements with a higher dosage of vitamins or minerals prevents
cancer.
6. Can I take vitamin and mineral supplements safely? Answer: All dietary
supplements, including herbs, need to be approved by your physician.
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