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PAT I E N T
I N F O R M AT I O N
G U I D E
Guide to
Good Nutrition
AMERICA’S FIRST COMPREHENSIVE CANCER CENTER
25019 (12/11)
- Notes Good Nutrition
Good nutrition is always important while you are receiving cancer treatment. Adequate
daily intake of calories, protein, vitamins and minerals is needed to promote healing and
aid in minimizing side effects. If you would like to speak with a registered dietitian, ask
your doctor or nurse to arrange this for you. Here are some recommendations to
promote good nutrition:
• Drink 2 or more cups of milk daily. Cheese, cottage cheese, ice cream or
yogurt may be substituted. If you are unable to drink milk, you will likely need
Vitamin D and possibly a calcium supplement. Some patients may be advised
to use low fat dairy products such as 1% milk and low fat yogurt.
• Eat at least 6-8 ounces of meat, fish or poultry every day or its equivalent in
eggs, cheese or beans.
• Eat at least 3-4 servings of fruit each day. Juice may be substituted.
• Eat at least 3-4 servings of vegetables daily. Try to incorporate a dark green or
dark yellow vegetable.
• Eat at least 6-8 servings of grain or bread daily. These might include cereal,
rice, pasta, oatmeal or sandwich bread.
• Include fats and sugars in moderation unless directed otherwise by a member
of your healthcare team.
• To increase calories, protein, vitamins and minerals, nourishing snacks or liquid
supplements, such as Carnation® Instant Breakfast, Boost,® or Ensure,® may be
added between or along with meals.
• Drink plenty of fluids: 6-8 glasses each day, if possible, (1.5-2 quarts).
• Utilize fortified milk powder or whey protein when making such food products as
puddings, creamed sauces, mashed potatoes, breakfast batters. (See Adding
Protein to Your Diet).
You might prefer to eat 5 or 6 smaller meals rather than the 2 or 3 larger meals usually
eaten each day. If cooking smells are unpleasant, try cool or chilled foods which have
less aroma. Remember to eat slowly and chew your foods well. A pleasant atmosphere
or meals enjoyed with friends or family often help stimulate the appetite. Enjoy desserts
because you need the calories and carbohydrates. Recommendations for this may be
individualized based on your current health status and history including those with
diabetes. Your dietitian can provide additional recommendations or assistance in helping
you meet your nutrition and/or diet therapy goals.
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Planning Meals:
Healthy Eating Strategies
A Sample High-Calorie Menu
Everyone should make an effort to make healthy food choices to promote good health.
When you are feeling well, and have not been ordered by a physician to restrict your
diet for any medical reason, you should focus on making food and beverage choices
that align with the 2010 Dietary Guidelines for Americans. These guidelines include:
The following sample menu is based on 3 meals and 3 snacks per day. It will provide
approximately 3000 calories per day.
• fresh or canned fruit
Breakfast:
• 4 ounces of orange juice
• avoiding oversized portions
• choosing low-fat dairy products
• 1 cup cereal with banana
• choosing foods low in sodium
• 8 ounces whole milk
• eating plenty of fruits, vegetables and whole grains
• drinking water instead of sugary drinks
You should aim to make daily food and beverage choices within your calorie goals to
maintain or achieve a healthy weight. Visit the website ChooseMyPlate.gov to learn
more about the 2010 Dietary Guidelines, get a personalized eating plan, learn about
healthy eating tips, or get weight loss information.
• 8 ounces of whole milk (white or
chocolate)
Afternoon Snack:
• milkshake and 2 cookies or cottage
cheese and fruit
• 1 scrambled egg
• 1 slice toast with 2 teaspoons
butter, peanut butter, margarine
or jam
Dinner:
• mixed green salad with dressing
(add nuts, cooked egg, olives or
cheese as desired)
Morning Snack:
• Fresh or canned fruit or a
Nutritional Supplement such as
Boost® or Ensure®
• spaghetti with sauce, meatballs and
grated cheese
• 2 slices French bread with garlic
butter
Lunch:
• Sandwich on a bun with meat
and/or cheese, lettuce, tomato and
mayonnaise (may use tuna fish or
peanut butter and jelly if meat is
bothersome)
Dessert: sherbet
Evening Snack: (choose 1 or 2)
(1) 1 ounce cheese and crackers
(2) 12 ounces lemonade
• potato salad
For an additional 300-500 calories, add any of these foods:
• 1/2 cup hummus with pita chips and some raw vegetable slices
• 3 oz. tuna mixed with 2 Tbsp. mayonnaise on 2 slices wheat bread
• 3 tablespoons of peanut butter on celery sticks
• 3 oz. cheese with 12 whole grain crackers
• 6 ounces of fruit yogurt with 1/2 cup granola
2
15
• Vitamin C (ascorbic acid) is found in various fruits and vegetables as well as
cereals, beef, poultry and fish.
• Vitamin E, a fat soluble vitamin, can be found in almonds, nuts, broccoli, and
oils such as wheat germ, safflower, corn and soybean.
American Institute for Cancer Research
Recommendations for Cancer Prevention
VITAMIN, MINERAL, HERBAL SUPPLEMENTS
The supplement industry has experienced such growth in recent years and it is
becoming quite common for the general public to take dietary supplements.
Therefore, the importance of informing your physician of supplements you are taking
cannot be stressed enough. It is of utmost importance to give a detailed dietary
history, while making mention of any supplements, vitamins, minerals, and herbs you
may be taking, as they may potentially interact with your treatment plan. Despite
supplements being “natural,” many of them including your herbs have medicinal
properties. It is usually NOT recommended to take over-the-counter supplements,
herbals or antioxidants during your therapy.
The food and beverage choices you make each day can affect your chances of
developing cancer during your lifetime. If you are a cancer survivor, these choices can
affect your chances of having a cancer recurrence, or developing a new cancer.
Making healthy eating choices, staying physically active, and maintaining or achieving
a healthy weight can help reduce your risk of cancer developing or recurring. The
AICR guidelines you should aim to follow are:
1. Be as lean as possible without becoming underweight.
2. Be physically active for at least 30 minutes every day.
3. Avoid sugary drinks. Limit consumption of energy-dense foods (particularly
processed foods high in added sugar, or low in fiber, or high in fat).
4. Eat more of a variety of vegetables, fruits, whole grains, and legumes such as
beans.
5. Limit consumption of red meats (such as beef, pork, and lamb) and avoid
processed meats.
6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
7. Limit consumption of salty foods and foods processed with salt (sodium).
8. Don’t use supplements to protect against cancer.
Special Population Recommendations
9. It is best for mothers to breastfeed exclusively for up to 6 months and then
add other liquids and foods.
10. After treatment, cancer survivors should follow the recommendations for
cancer prevention.
And always remember –
Do not smoke or chew tobacco.
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3
• Do not cross-contaminate. Use separate knives and cutting boards for your
meat and vegetables.
Cancer and Weight Loss
• Thaw your meat in the refrigerator instead of the countertop.
• Do not consume raw or undercooked meat, fish, eggs or poultry.
Most cancer patients lose weight because they do not eat as much as their body
needs during treatment to rebuild normal tissue because of tumor, the effects of
surgery, radiation, or chemotherapy. When you eat less, your body uses its own stored
fat, protein, and other nutrients for energy. Not enough food intake and nutrition intake
may cause these problems:
• Loss of lean muscle mass
• Increased susceptibility to infection
• Delayed wound healing
• Lowered tolerance to therapy
• Fatigue and lack of energy
Therefore, you will need to evaluate or have your intake evaluated by a dietitian to
determine the adequacy of your calorie, protein, nutrient intake.
ANTIOXIDANTS
You hear a lot about antioxidants these days and studies continue to be conducted to
look at the role they may play in cancer prevention. Antioxidants neutralize the free
radicals which cause cell damage. By preventing or minimizing this damage, it is
theorized that antioxidants may then inhibit some types of cancer formation. It should
be noted, however, that according to the National Cancer Institute, the information
obtained from these studies is still inconsistent.
There is no scientific evidence that dietary supplements or herbal remedies can cure
cancer or prevent its recurrence. It is usually not recommended that one supplement
with pharmacological antioxidants (over the counter supplements) be used, but
rather concentrate on obtaining them naturally by eating a wide variety of fruits,
vegetables, and whole grains. The following list identifies which foods contain various
types of antioxidants.
Which Foods are Rich in Antioxidants?
BLOATING/FULLNESS AND WEIGHT LOSS
Discomfort from bloating or fullness after meals is common during cancer therapy,
and is usually caused by:
• Decreased exercise
Antioxidants can be found in large quantities in fruits and vegetables, and in smaller
amounts in nuts, grains and some meats, poultry and fish.
• Beta-Carotene can be found in sweet potatoes, carrots, cantaloupe, squash,
apricots, pumpkin, and mangos. It may also be found in green leafy vegetables
including collard greens, spinach and kale.
• Gulping air while eating
• Eating gas-producing foods (cabbage, beans or onions, etc.) or high fat foods
• Lutein is also found in green, leafy vegetables such as collard greens, spinach,
and kale.
• Slowed movement of food through the G.I. tract due to gastric surgery,
chemotherapy, radiation therapy or medications
• Lycopene is found in red and pink pigmented foods such as tomatoes,
watermelon, guava, papaya, apricots, pink grapefruit and blood oranges.
The discomfort from these feelings often causes you to reduce your food intake and
results in weight loss and muscle wasting. Since adequate nutrition plays such an
important role in your treatment and healing process, you are encouraged to do
whatever you can to control these feelings.
4
• Selenium is not an antioxidant in the strictest sense but rather a part of the
antioxidant enzymes. It can be found in Brazil nuts, beef, tuna, turkey, chicken,
pasta, rice and eggs.
• Vitamin A is found in liver, sweet potatoes, carrots, milk, egg yolks and
mozzarella cheese.
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SUGGESTIONS TO MINIMIZE WEIGHT LOSS;
ENSURE GOOD NUTRITION
Tips for Reducing Bloating/Fullness
• Chew foods more slowly to avoid becoming too full too quickly.
• Take advantage of your up times by eating more when you feel well. You may want
to prepare meals you can freeze for days when you don't feel like preparing
anything.
• Eat small frequent meals. Try 5 or 6 small meals instead of 3 large meals.
Attempt to eat every 2 to 3 hours if possible.
• Concentrate on the foods that appeal to you and avoid those that don’t.
• Avoid high fat foods (e.g., deep fat fried foods, oils, butter, shortening) and
foods that cause gas formation.
• Try to eat breakfast. Many cancer patients find that they feel better early in the
day and can tolerate a meal when they feel rested.
• Avoid or limit high fiber fruits and vegetables, corn and bran cereals.
• Increase the number of times you choose to eat. Small frequent meals are
especially helpful if a large meal is unappealing or if you tend to fill up quickly.
• If red meat doesn't taste right, cook chicken, turkey or fish. You may tolerate
cold meats better. Other substitutions that are good sources of protein are
eggs, dairy products, peanut butter, cheese, yogurt, hummus, lentils or beans.
• Drink less during the meal. Drink 30-45 minutes before or after eating.
• Avoid carbonated beverages (gas producing) and chewing gum (stimulates the
stomach). Try ginger tea as an additional remedy for gastric stimulation.
• Stop eating when you feel uncomfortable. Take a walk to increase circulation
and to help release any gas.
• Cold foods or foods at room temperature often taste better.
• Salty or tart foods such as cranberry juice, orange juice, pickles, lemon juice
and vinegar may enhance flavor.
• Avoid drinking liquids at meals. Limit your intake of non-nutritious beverages
like coffee and tea which add few nutrients but fill you up and reduce your
appetite.
• To stimulate your appetite, concentrate on making your meals an enjoyable
experience with an attractive setting, good company, varied eating places, and
enjoyable music.
• Utilize prepared foods and side dishes sold at your local grocery store to
minimize your cooking time and to conserve your energy.
• Stock your refrigerator and pantry with prepared or easy to prepare foods, and
foods you are currently able to eat.
LOSS OF APPETITE
Loss of appetite is common in cancer patients due to treatment (radiation or
chemotherapy), illness, fatigue, pain, depression, or any combination of these. Good
nutrition is an essential part of your recovery. You require additional protein and
calories to build new tissue. Maintaining adequate food intake prevents weight loss
and lack of energy, and improves your tolerance to the cancer treatment. Therefore,
you are encouraged to do whatever you can to stimulate your appetite.
Suggestions to Improve Appetite
A balanced diet of nutritious foods is essential to provide the protein, vitamins,
minerals, and other elements needed to keep your body functioning normally. If you
are not feeling particularly hungry, try these tips.
• Eat small meals more often.
PRACTICE FOOD SAFETY
• Your immune system may become weakened while undergoing treatment.
Therefore, it is important to remember food safety and to put it into practice on
a daily basis.
• Be sure to thoroughly wash all of your fresh fruits and vegetables, including the
skins of melons.
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• Snack between meals and at bedtime. Make the snack high-calorie and highprotein for more benefit with a smaller amount. Examples are sandwiches,
milkshakes, cheese and crackers, peanut butter and jelly on toast, cereal with
whole milk.
• Light exercise for 10-15 minutes before you eat will help stimulate your
appetite.
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• Concentrate on making your meal more enjoyable: attractive settings, pleasant
music, good company.
• Adjust the seasonings and flavorings in your food to accommodate taste changes.
The following are recipes for a high calorie drink and a high calorie milkshake which
will add a good amount of calories and protein to your current intake. You can divide it
up into 6-8 oz. portions and drink 2-4 times daily depending on your intake of other
foods to help you meet your calorie and protein needs.
• Avoid foods or beverages that have an overpowering aroma. Try cool or cold
selections such a cottage cheese and fruit plate or a chef salad with meat,
nuts, cheese and/or eggs.
• Rely on your favorite foods when your appetite is diminished.
• Prepare foods that are pleasing to your sense of smell and taste to stimulate
appetite.
HigH Calorie drink
(Yield 24 oz.)
• Talk to your doctor about medications that may help relieve these symptoms.
- 1 c. vanilla ice cream
HigH Calorie
Homemade milksHake
(Yield 10 oz.)
- 12 oz. whole milk
- 1 c. vanilla ice cream
- ⁄2 c. vanilla whey protein powder
- 4 oz. whole milk
- 1 T. honey
- 1⁄4 c. vanilla whey protein powder
- 1 T. canola oil
- 1 T. canola oil
1
NAUSEA AND VOMITING
Nausea and vomiting are two undesirable side effects you may experience while
undergoing treatment. It may be intermittent and temporary, however, over a long
period of time it can have a negative impact on your nutritional status since your
intake may be diminished. Following are some tips which may assist you in dealing
with these side effects.
900 Kcal | 56 gr. Protein
585 Kcal | 28.5 gr. Protein
73.9 gr. Carbohydrates | 43.4 gr. Fat
41 gr. Carbohydrates | 34 gr. Fat
• Be sure to take your anti-nausea medication as prescribed by your doctor.
• Experiment with a clear liquid diet using such liquids as apple juice, cranberry
juice, lemonade, broth, ginger ale, lemon lime soda, popsicles, gelatin, tea or
colas.
• Try carbohydrate foods such as crackers, toast, hot or cold cereal, rice, pasta,
noodles, pudding or tapioca.
• Try drinking a nutritional supplement such as Boost,® Ensure,® Carnation®
Instant Breakfast (prepare with skim or 1% milk), or Isopure Plus®.
• Try to maintain your fluid intake by drinking a variety of fluids including water
and salty fluids like broth. You may need to drink 1⁄2 to 1 cup fluid after a
vomiting episode.
**Any modifications made to these ingredients or amounts will affect nutritional values**
• For a lower fat version substitute 1% or skim milk for whole milk or fat free frozen
yogurt for the ice cream.
• For a low lactose version substitute lactaid, soy, rice or almond milk in place of the
whole milk and sherbet in place of the ice cream.
• If the product is too sweet you can substitute plain whey protein in place of the vanilla.
• Any of the following can be added to offer some flavor variety:
• Fruit of your choice, fresh, frozen or canned
• Do not lie down flat for at least two hours after eating.
• ½ tsp. Flavoring extract
• Small, frequent meals may be tolerated better with emphasis on foods that are
working well for you.
• 1 Package instant coffee (dissolved in 1 tbsp. hot water)
• Experiment with various foods to see which foods work the best for you.
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• Peanut butter
Note: Some of the suggested milkshake additions may be contraindicated if you are on a therapeutic diet
11
• Canned salmon and sardines can conveniently add to your protein intake
at or between meals.
• Use peanut butter on crackers or celery, waffles or pancakes, muffins, hot
breads and biscuits.
• Add chopped nuts to cereals, cakes, cookies, quick bread recipes, topping for
ice-cream or pudding; mix with yogurt or cottage cheese.
Adding Calories to Your Diet
• Just one teaspoon of butter or vegetable oil adds 45 calories. Mix it into hot
foods such as soups, vegetables, potatoes, cooked cereal and rice. Serve hot
breads. When the butter melts, add more.
• Mayonnaise has 100 calories per tablespoon, almost twice as much as salad
dressing (e.g., Miracle Whip®). Use it with salads, eggs and sandwiches.
• Use peanut butter which has protein and calories (90 calories per tablespoon)
to spread on apples, pears, bananas, or celery. Add it to a sandwich with jelly
or cream cheese.
• Avoid highly spiced or highly seasoned foods or those high in aromas. Instead,
experiment with seasoning using mild herbs such as parsley, basil, salt, pepper,
lemon or sugar to enhance sweetness, if needed.
• Avoid fried and fatty foods.
• Avoid high fiber grain, fruit and vegetable sources.
• You may wish to avoid eating immediately before or after your chemotherapy
treatment if you tend to have nausea and/or vomiting.
• Your tastes may change throughout treatment so never force yourself to eat a
particular food, but rather concentrate on the foods you have a desire to eat.
MOUTH PAIN, DRY MOUTH OR DYSPHAGIA (Difficulty Swallowing)
• Experiment with different textures of foods, making them softer and easier to
chew and to swallow. Some soft foods include mashed potatoes, cottage
cheese, scrambled eggs, puddings, gelatins.
• Spread toast with butter, honey or jam. Add butter and cream cheese to bagels.
• Use your blender to puree cooked vegetables, to make soups, smoothies or milk
shakes. Use high calorie ingredients such as ice cream, peanut butter, whole milk,
yogurt, and fortifying these foods with dry powdered milk or instant breakfast mix.
• Butter, sour cream or yogurt can be used to add flavor and calories to cooked
vegetables such as potatoes, beans, carrots or squash.
• To moisten foods, add extra gravy, butter, margarine and sauces or cream
soups to the foods.
• Sour cream or yogurt is also good as dip for fresh vegetables. Sour cream can
be added to gravies.
• Avoid highly fibrous, coarse and rough foods such as raw fruits, vegetables and
bran products.
• Heavy cream (whipping cream) has about 60 calories per tablespoon and can
be added to mashed potatoes, pies, fruit, pudding, hot chocolate, gelatin or
other desserts.
• Avoid very dry foods such as crackers and toast. If you wish to have these
foods, soak them in gravy, soup or milk before eating to soften the foods.
• Nuts, dried fruits, buttered popcorn, crackers, cheese, granola, milk-shakes, ice
cream and popsicles made from juice are good high calorie snacks.
• Add raisins, dates or chopped nuts with brown sugar to hot or cold cereal for a
snack.
• Have an evening snack. Try such foods as sandwiches, peanut butter, cold
pizza, cheese and crackers, milkshakes or hot chocolate.
• Chilled foods are sometimes tolerated better such as flavored ice, ice-cream,
sherbet or sorbet, puddings, yogurt, milkshakes.
• Acidic foods such as tomatoes and citrus fruits such as orange juice or
cranberry juice may be bothersome.
• Try sucking on ice chips, popsicles or hard candy, or chew gum.
• Speak to your doctor about numbing agents such as lozenges or sprays or
moistening agents such as “artificial saliva” or aloe vera beverages, which can
help you to better tolerate meals.
• Sipping liquids throughout your meal may help relieve a dry mouth.
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7
CONSTIPATION
INCREASING PROTEIN AND CALORIE INTAKE
You may experience constipation related to various medications which may be
prescribed for you during your cancer treatment.
You should eat foods that are high in protein and calories because you may need
more than normal amounts during illness, treatment, and recovery. Doctors and
researchers have found that cancer patients who maintain their weight and eat well
(diets high in protein and calories) during their treatment tolerate side effects of
their therapy better.
Following are some tips which may assist in the management of constipation.
• Increase your daily fiber intake by eating more fruits, vegetables, whole grain
products, beans, nuts, dried fruit, such as raisins and prunes. A dietitian will
gladly guide you with the adjustment to your diet that is appropriate for you.
• Choose fresh fruits, canned fruit, or fruit juice, such as apple or prune.
• Remember to increase your fluid intake while increasing your fiber intake,
especially, grain fiber. You may also wish to add high water content foods such
as cantaloupe, honeydew melon, grapes, watermelon, manderin oranges or
fruit and jello combinations.
• Increase your physical activity on a daily basis as you are able, even if it is 10
minutes at a time (per doctor’s recommendations).
• Take your medications for constipation as prescribed for you.
• You can increase calories and protein by selecting cheese and saltine crackers,
peanut butter on graham crackers or bread, cottage cheese, eggs, yogurt,
pudding and custard, milkshakes, casseroles, cream soups (over rice, pasta or
mashed potato), granola, cereals, nuts, muffins, bread, rolls, cereal / milk,
pizza, pitas and sandwiches.
You can increase calories by adding these foods when cooking: butter and margarine,
whipped cream, milk and cheese, cottage cheese, ricotta cheese, cream cheese, sour
cream, salad dressings or other dips and spreads, honey or jams; also, try adding
bread, rice and pasta to meat and vegetable dishes.
• Try drinking hot beverages, such as tea or coffee.
Adding Protein to Your Diet
DIARRHEA
• Avoid raw vegetables and fruits. Select cooked or canned vegetables and fruits
and reduce the total quantity of fruit and vegetables eaten. Select more ripe
bananas and applesauce during the week.
• When eating grains and cereals, select refined products such as white bread,
white rice, pasta, pretzels, or crackers. Avoid high fiber cereals and whole
wheat bread or breads and rolls having seeds. Increase intake of oat cereals,
seedless rye bread, barley cereal such as Post Grape Nuts Flakes.
• Also avoid chocolate, high-fat desserts, spicy foods and fried foods.
• Be sure to replace the fluid which you lose in diarrhea by consuming adequate
fluids throughout the day.
• You may need to increase intake of potassium and sodium. Ask to see a
dietitian who will show you how these minerals can be increased in your diet,
and not worsen the diarrhea.
• Milk contains lactose, a sugar in milk. It may be a factor in aggravating the
diarrhea. Lactose-free milk is widely available today and you may need to use
lactose-free milk or increase intake of yogurt, with active cultures, until the
diarrhea significantly decreases.
• Be sure to take your prescribed medications per your doctor.
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• Skim milk powder adds protein. Mix 2 tablespoons of dry skim milk powder per
cup of milk (2 tablespoons = 3 grams protein); pour the fortified milk over cold
cereal, blend it into hot cereal; add 2 tablespoons per cup of flour to breads or
any baked products; add it to scrambled eggs, soups, gravies, ground meat
products (meatballs, meatloaf, hamburger), casseroles or desserts.
• Whey protein is another option to add to foods and beverages for additional
protein. Amount of protein yield may vary by brand.
• Consider using evaporated milk to mix into cream soup, on sauces, macaroni
and cheese (2 tablespoons = 2 grams protein).
• Add milk or half-and-half instead of all water for making cereals, instant cocoa,
puddings and canned soups or homemade soups or stews.
• Add diced or ground meat to soups and casseroles.
• Add grated cheese or chunks of cheese to sauces, vegetables, soups, salads,
omelets and casseroles.
• Add tuna to your vegetable salad or pasta salad.
• Hard cook a few extra eggs for between-meal-eating, for egg salad
sandwiches, or addition to vegetable, pasta or potato salad.
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