Eat Well, Feel Well: Fighting Cancer with Nutrition

Eat well, feel well

Fighting cancer with nutrition

Adéle van der Merwe & Jeske Wellmann

Registered Dietitians SA

Tafelberg

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INTRODUCTION

Nutrition plays a vital role throughout our lives. It lays important foundations in the womb and gives us vital building blocks during periods of rapid growth from infancy and through the teenage years. In adulthood, proper nutrition helps to maintain a strong immune system, provides us with energy and other vital nutrients for the day-to-day functions of our body, and can help to prevent and manage many diseases. Good nutrition has also been proved to help prevent most major cancers. And even during illness, nutrition continues to play an essential role in treatment of the disease and the eventual outcome. Scientific studies have demonstrated time and again that a good nutritional state during illness, including cancer, can help keep energy levels up, prevent weight and muscle loss, and improve immune functions. People who have a poor nutritional status have a higher risk of developing infections. Some studies have even shown that cancer treatments such as chemotherapy are not well tolerated and are in fact often stopped early in undernourished patients.

Although good nutrition is essential during illness and cancer therapy, there are several reasons why it is difficult to follow a healthy diet. Most people feel overwhelmed and confused when trying to find out what they should be eating – suddenly every well-meaning family member, friend or colleague becomes an expert on nutrition. And trying to separate sound information from myths on the internet is nearly impossible. Then there are the supplements, herbs and other ‘miracle’ remedies – which will help and which will do more harm.

The aim of this book is to provide sound, evidence-based guidelines on what to eat during this stressful time. We will also give practical advice on what to eat to help manage some of the side effects often associated with cancer therapy. The information provided was accurate at the time of publication.

In addition, we look in detail at some of the most common cancers and what to eat when diagnosed with one of them, depending on what treatment is being used.

Seeing a loved one undergo cancer treatment is also an emotional, stressful time for family and friends. One of the ways of caring for and showing our support for the cancer sufferer is to provide food, but doing this can also be a challenging task, as many people are unsure what to cook. To help, this book is filled with tasty and healthful recipes that are also easy to prepare.

If you would like more information on what to eat, or if you need more support with your diet, contact your registered dietitian.

Please refer to the list at the back of the book for resources and organisations to consult for more information on other aspects of cancer and its treatment, besides nutrition, which is discussed here.

Medical information has been used with the kind permission of the Canadian Cancer Society. Please visit www.cancer.ca and www.cansa.org.za for more information on cancer types and treatment.

Everyone is an individual, so it is advisable to contact your registered dietitian and/or doctor to make sure that the treatment outlined here won’t interfere with your current medical treatment.

THE ROLE OF NUTRITION DURING CANCER TREATMENT

The link between diet and cancer is complex and difficult to unravel. This is because our diet is made up of lots of different foods and nutrients, and is also influenced by our lifestyle. For example, people who smoke often tend to eat less fruit and vegetables and may drink more alcohol. All of these factors affect our risk of developing cancer.

A poor diet and unhealthy lifestyle significantly increase a person’s risk of developing cancer. According to the Cancer Association of South Africa (CANSA), the following factors increase cancer risk by:

•5%: consuming too much alcohol

•15%: being overweight and not getting enough exercise

•20–25%: using tobacco and tobacco products

In fact, experts estimate that the risk of developing cancer can be reduced by 30% by following a healthy lifestyle.

We know that diet and nutrition can either promote cancer or help prevent it. However, scientists need to conduct very large studies to see which specific foods protect us from cancer and which may cause it. Many such studies are underway and their results are already providing us with firmer answers. For now, we know about the general types of foods that can help to keep us healthy. And we know that a balanced diet will help to maintain a healthy body weight, which can in itself reduce the risk of developing many types of cancer.

Cancer cells take a long time to develop, which means that the diet when the cancer first develops or when it is promoted is most important, and not when cancer is actually diagnosed. Therefore, studies on diet and the development of cancer look at populations and their diet over several years to determine possible links.

What is the benefit of good nutrition during cancer treatment?

Good nutrition is especially important if you have cancer because both the illness and its treatments can change the way you eat. Cancer and cancer treatments can also affect the way your body tolerates certain foods and uses nutrients.

The nutritional needs of people with cancer vary from person to person. Your registered dietitian can help you identify your nutrition goals and plan ways to help you meet them.

Eating well while you are being treated for cancer may help you:

•Feel better.

•Keep up your strength and energy levels.

•Maintain your weight and your body’s store of nutrients.

•Better tolerate treatment-related side effects.

•Lower your risk of infection.

•Heal and recover faster.

Eating well means eating a variety of foods that will give your body the nutrients needed to help fight cancer. These nutrients include the macronutrients – protein, carbohydrates and fat, and micronutrients – vitamins, minerals, antioxidants and phytonutrients, as well as water.

Nutrients that make up balanced diet

1. Protein

We need protein for growth, to repair body tissue and to keep our immune system healthy. When your body doesn’t get enough protein, it starts breaking down your own muscle. This means it will take longer to recover from illness and can increase your risk of infection. Protein needs often increase in people with cancer due to surgery, chemotherapy or radiation therapy, and therefore sufficient amounts of protein are needed to help heal tissue and fight infection.

Good sources of protein include fish, poultry, lean red meat, eggs, low-fat dairy products, dried beans, peas and lentils, and soya foods.

2. Carbohydrates

Carbohydrates are the body’s major source of energy and give the body the fuel it needs for physical activity, brain power and proper organ functioning. The best sources of carbohydrates are whole grains, fruits and vegetables. These foods also supply much-needed vitamins and minerals, fibre and phytonutrients to the cells of the body for optimum immune function.

Whole grains or foods made from them contain all the essential parts and naturally occurring nutrients of the entire grain seed. Whole grains are found in cereals, bread, flour and crackers such as Provitas®. When choosing a whole-grain product, look for the words whole grain, stone ground, whole ground, whole-wheat flour, whole-oat flour or whole-rye flour.

Fibre is the part of plant foods that the body cannot digest. There are two types of fibre: insoluble fibre, which helps to move food waste out of the body quickly and prevents constipation; and soluble fibre, which binds with water in the stool to keep stools soft and is also helpful in dealing with diarrhoea by absorbing excess water in the intestines. Soluble fibre also plays a role in regulating blood glucose levels and reducing cholesterol.

Other sources of carbohydrates are potatoes, rice, pasta, cereals, corn, bread and legumes. Sugar (found in desserts, confectionery and sugary drinks) can supply carbohydrates, but provide very little in the way of vitamins, minerals or phytonutrients.

3. Fats

Fats play an important role in nutrition. Fats and oils are made up of fatty acids and serve as a rich source of energy for the body. The body breaks down fats and uses them to store energy, insulate body tissues and transport certain vitamins through the blood.

You may have heard that some fats are better for you than others. When considering the effects of fat on your heart and cholesterol level (as well as cancer risk), choose monounsaturated and polyunsaturated fats rather than saturated fats, trans fats or hydrogenated fats.

Monounsaturated fats are found mainly in vegetable oils like olive, canola and peanut oils, nuts and nut butters.

Polyunsaturated fats (omega-6 and omega-3) are found mainly in vegetable oils like safflower, sunflower, corn and flaxseed. They are also the main fats found in seafood.

Saturated fats are mainly found in animal sources such as meat and poultry, whole or reduced-fat milk, cheese and butter. Some vegetable oils, like coconut, palm kernel oil and palm oil, are also saturated. Saturated fats can raise cholesterol and increase your risk for developing heart disease as well as cancer.

Trans-fatty acids (hydrogenated fats) are formed when vegetable oils are heated to a very high temperature for an extended time. Sources of trans fats include snack foods and baked goods made using partially hydrogenated vegetable oil or vegetable shortening. Trans fats are also found in deep-fried foods such as takeaway foods. Because trans fats can increase your risk for heart disease and cancer, try to eliminate them from your diet.

4. Vitamins and minerals

The body needs small amounts of several vitamins and minerals to help it function properly. Most are found naturally in food and they help the body use the energy (calories) found in food. They are also sold as supplements in pill and liquid forms.

Someone who eats a nutritionally balanced diet usually gets plenty of vitamins and minerals. However, it can be difficult to eat a nutritionally balanced diet when you are being treated for cancer, especially if you have treatment-related side effects that last a long time. In such a case, your doctor or registered dietitian may suggest a daily multivitamin-and- mineral supplement.

If you are thinking about taking a vitamin or mineral supplement, be sure to discuss this with your doctor first. Some people with cancer take large quantities of vitamins, minerals and other dietary supplements to try to boost their immune system or even destroy cancer cells. But some of these substances can be harmful, especially when taken in large doses. In fact, large doses of certain vitamins and minerals may make chemotherapy and radiation therapy less effective or even more toxic .

If your oncologist agrees to your taking a vitamin-mineral supplement during cancer treatment, choose one with no more than 100% of the Daily Recommended Intake (DRI) of vitamins and minerals and without iron (unless your doctor thinks you need iron). Also choose a reputable brand.

5. Antioxidants

Antioxidants include vitamins A, vitamin C and vitamin E, selenium and zinc, as well as some enzymes that absorb and attach to free radicals, preventing them from attacking normal cells.

If you want to take in more antioxidants, registered dietitians recommend eating a variety of fruits and vegetables, which are good sources. Taking large doses of antioxidant supplements or vitamin-enhanced foods or liquids is usually not recommended while receiving chemo or radiation therapy. Talk to your doctor about the best time to take antioxidant supplements.

6. Phytonutrients

Phytonutrients, or phytochemicals, are plant compounds like carotenoids (in carrots), lycopene (in tomatoes), resveratrol (in red wine) and phytosterols (in whole grains) that are thought to have health-protecting qualities. They are found in plant products such as fruits, vegetables and teas. Pill or supplement forms of phytochemicals have not been shown to be as helpful as eating the foods that contain them naturally.

7. Water

h, as the cells of the body need water to function. If you do not take in enough fluids or if you lose fluids through vomiting or diarrhoea, you can become dehydrated (your body doesn’t have as much fluid as it needs). If this happens, the fluids and minerals that help keep your body working can become dangerously out of balance.

Although you get some water from the foods you eat, you need to drink about 6–8 glasses of liquid each day to be sure you are properly hydrated. These could include water, rooibos and herbal teas, cold drinks and fruit juice. Regular tea and coffee contain caffeine, which may aggravate dehydration. You may need extra fluids if you are vomiting or have diarrhoea. Keep in mind that all liquids (soups, milk, and even ice cream and jelly) count towards your fluid intake.

8. Herbs

Herbs have been used to treat diseases for hundreds of years, with mixed results. Today, herbs are found in many products, such as pills, liquid extracts, teas and ointments. Many of these products are harmless and safe to use, but others can cause severe and harmful side effects. Some may even interfere with proven cancer treatments, including chemo and radiation therapy, and recovery from surgery. If you are thinking about using products containing herbs, consult your oncologist or registered dietitian first.

Herbs that are used in cooking to flavour food, such as rosemary and thyme, are safe to use.

SAFETY CONSIDERATIONS

Many people believe that if a pill or supplement is available in stores, it’s safe and it works. However, at present there is no legislation in South Africa to ensure that supplements contain what the labels claim they do, that they have the claimed effects on the body, or even that they are safe.

Tell your healthcare team about any over-the-counter products or supplements you are using or thinking of using. Take the packaging to your doctor to talk about the dose and be sure that the ingredients do not interfere with your health or cancer treatment.

Some other safety tips:

•Ask your doctor or registered dietitian for reliable information on dietary supplements.

•Check the product labels for both the quantity and concentration of active ingredients in each product.

•Stop taking the product and call your doctor right away if you have any side effects, such as wheezing, itching, numbness or tingling in your limbs.

HOW MUCH SHOULD I EAT?

  ¹/2 of the plate: salad and vegetables

  ¹/4 of the plate: starch (portion size is a fist).

  ¹/4 of the plate: protein and dairy (protein portion size is the size of your palm)

  a controlled portion of fat

   fruit as a snack

Each meal must consist of a starch, a protein, a fat, and vegetables and/or fruit. So, for example, breakfast might be muesli, yoghurt and fruit, or an omelette with mushrooms, baby marrows and a slice of whole-wheat toast.

Because of the side effects of therapy and cancer itself, it may be difficult to eat three substantial meals a day and most recommendations are to eat small amounts regularly. Your portion sizes will be smaller than the suggested plate model for healthy people, and you might eat off a small side plate, but the proportion of nutrients on the plate should stay the same.

If you are losing weight, you will need extra calories to supplement your diet. For ways to increase the protein and calorie content of your diet, have a look