Nutrition and Breast Cancer

An informative presentation about all all aspects of Nutrition and

Cancer

By Angela D’AmoreMount Hospital Dieititan

                                           

Overview Risk factorsCommon treatment and nutritional side effectsHealthy eating guidelinesUnproven diets/therapiesChanges in weightAvoiding refluxBowel careFluid and hydrationLow bacteria dietsummary

Cancer risk factorsObesityPhysical activityConsume a healthy diet with an

emphasis on plant sourcesProcessed meats and red meats

(for colon cancer)Alcohol

Common treatment nutritional side effects Breast cancer chemo

  Nausea and Vomiting

Diarrhoea Sore mouth

Reduced appetite

Taste changes

Reduced immunity

Florouracil (5FU)    

Epirubicin      

Cyclophosphamide 

     

Doxirubicin    

Taxotere  

FEC  

methotrexate    

Paxiaxol (Taxol)    

Other side effects

• Gastrointestinal: bloating, constipation– Cells as rapidly turning over in the gut and

chemo affects these• Weight changes

– Weight gain: more breast and prostate– Weight loss: more lung, bowel, pancreatic

Controlling side effects• Medications I.e Nausea &

Vomiting, Diarrhoea etc• Gels for mouth ulcers• Diet I.e reduced Nausea, improve

taste of food, reduce pain with mouth ulcers

• www.macmillan.org.uk

Healthy eating guidelines Maintaining adequate Nutrition and food intake

during chemotherapy is optimal to minimise deficiency and optimise your immune system

Nutrition recommendations for cancer patients are designed to help the patient cope with the effects of the cancer and its treatment

No special foods or diets have been scientifically proven to cure or prevent cancer

Diet Myths and Cancer• What have you been told or read

about Nutrition and Cancer?

Unproven diets/therapiesLow Dairy Diets

Calcium is an important nutrient for bone health and provides protein for muscle strength

Protective effect in colorectal cancer shown (with calcium supplements

No significant association between dairy and breast/ovarian cancer

Other Diet and cancer “Myths”

Myth 1: Large amounts of protein can cause the cancer to return not true.

Protein is much needed to help with healing of the muscles and to prevent them from wasting. No need to be excessive but avoiding protein may be damaging

Myth 2, Juicing is a better way to consume vegetables Not true

Certain vegetables like tomatoes require heat and oil for our body to absorb the 'lycopene' (active ingredient) that is needed. Juicing also removes fibre and pulp that we need for good bowel movements.

Diet & Cancer myths cont…

Myth 3, Becoming a vegetarian will improve chances of recovery

Drastic diet changes are not recommended nor will they do anything to reduce cancer progression/treatment tolerance

Myth 4, Relatives and blood related families have the best answers

They may have gone through the process but always check with your doctor or dietitian the evidence/truth behind the suggestions

Diet & Cancer myths cont…

Myth 5, Losing weight is a good thing It is very common to lose a bit of weight during

cancer treatments. Weight loss is expected during such events. But if there is a significant or big drop of weight, please consult your doctor about it. Losing a lot of weight at a time is a sign of another underlying problem

Other nutrients/foodsSoy

Rich in Phyto-estrogens which mimic oestrogen in the body

High consumption of soy foods may lower the risk of breast and prostate cancer (but only slightly)

Existing or previous Breast cancer patients should avoid consuming large volumes of soy or phyo-estrogen supplements

Low Sugar Diets• Sugar does not feed

cancer cells• Although all cells, including

cancer cells, use glucose (blood sugar) for energy, sugar does not speed tumor growth. In turn, removing sugar from your diet will not slow tumor growth.

• Balanced diet with some sugars is best

Vitamin Supplements etc Supplements= specific isolated nutrients Nutrients from food work together to more

protective effect than supplements High doses of some vitamins I.e Vit C can

increase risk of Lung cancer in smokers Antioxidants- Vitamin A (beta carotene)

supplements can increase risk of certain cancers Vitamin supplements can interfere/interact with

the chemo Herbs/homeopathic remedies- can interfere as

well, contact Oncologist if unsure

Factors that indicate “Fad diet”• Does it exclude one of the 5 food groups?• Does it include large amounts of fruit, vegetables

or their juices?• Does it limit cooked foods or cooking methods

allowed?• Does it limit protein foods like meat, chicken or fish?• Is it causing you to lose weight?• Include large amount of supplements• Cost you in time and money

Weight Management• A high BMI (Body Mass Index) = inc risk

of breast cancer development• If overweight to start you may gain

weight during treatment (menopause, steroid sensitivity etc)

• If your appetite fluctuates don’t overcompensate your food intake when you feel well

• Hormone therapy may cause inc weight gain

Changes in Weight• Weight loss of > 10% in 1 month

- Is not desirable even if you are overweight (BMI > 25)

- Research shows that any weight loss incurred is muscle mass not as fat mass

- This makes you less active/weak/dec function and energy levels

- Aim to maintain weight through healthy eating and high protein diet

- May need protein supplements, talk to Dietitian and individual consult may be required

Changes in Weight• Weight gain

- Research shows that breast cancer patients who gain weight throughout chemo are still losing muscle.

- Some of the weight gain is fluid- healthy balanced eating to promote fat loss

not muscle loss- Eat small, regular, low fat, high protein meals- If you are overweight tor obese, start looking

at your lifestyle habits seriously after your treatment and aim to lose slowly and healthily

Diet Post Chemo• Chemo increases the risk of reflux

– Reduce intake of Orange juice

• Lemon• Lemonade• Grapefruit juice• Cranberry juice• Tomato

For a few days post chemo treatment

Diet Post Chemo• Drink lots of water and nutritious fluids• Soup, Juice, milk, Milkshakes etc

Bowel Changes

• Can alternate between constipation and diarrhoea

• Diarrhoea– Stick to LOW FIBRE FOODS– White breads, pasta, rice, refined cereals– Fruits without skins, bananas, limited vegies– Can have “soluble fibre” – helps form

stools/adds bulk I.e psyllium husks, Benefibre powder.

Bowel Changes

• Constipation– Can reduce appetite– Definition – Increase fibrous foods: fruits (dried

especially), vegetables, all grains to be wholemeal/wholegrain I.e pasta, rice, bread and cereal

– Fibre supplement I.e Psyllium Husks, Benefibre

– DRINK! Fluid intake is important- 1-1.5 LITRE WATER + other fluids

Other things• Thrush or bout of Diarrhoea = take

1 serving yakult daily for 10 days

• Drink lots of fluid afterDiarrhoea even more than Rec 2 L/day

Protein • Adequate protein helps reduce muscle

wastage and improve energy• Include a source at each meal- at least

50g per day• Requirement: 0.75 multiply by your

weight= number of grams pf protein needed per day (may be too high, minimum 50g/day)

Sources • Protein content of common foods: • Beef, chicken, 90g cked= 20g• Tuna, ½ cup 15g• ½ cup legumes= 7-8 g• Cheese- cheddar, 2 slices= 6g• Cheese, ricotta, ½ cup= 5g• Milk, 1 cup= 8g• Yoghurt, 100g= 5g• Egg, 1= 6g• Nuts, 2 tbs= 6g• Cereals, ½ cup 1-2 g • Pasta, rice, per ½ cup= 2 g

Meal Plan to meet Ptn requirements

• Breakfast: Cereal- Muesli with nuts,½ cup (6g) + ½ cup milk (4g) = 10g• Morning tea: Milky coffee (1 cup milk) = 8g• Lunch 1 tin flavoured tuna (13g) + 2 wholegrain crackers (1g)= 14g• Afternoon tea 100g Yoghurt = 5g• Dinner 60g cooked meat, chicken, fish + vegies (0) = 15g• Supper fruit (0) + 100g lite custard = 5g

= 54g total

Low Bacteria Diet• When your levels of neutrophils, a type of white blood

cells, become too low• Neutrophils defend against infections

– Mild - ANC of 1000-1500 cells per mm3. – Moderate - ANC between 500 - 1000 cells per mm3. – Severe - ANC falls below 500 per mm3

• Following a low bacteria diet is the only thing you can do to manage• Usually transient and comes and goes between chemo cycles

Low Bacteria Diet• Foods low in bacteria must be eaten whilst your

white cell count is low• Avoid

– Raw meats or processed meats (inc smoked salmon)– Fresh or moudly cheeses (cream and hard cheese is

fine)– Salad bars, buffets etc. – all food much be freshly prepared!– Soft serve/milkshakes– Products with raw eggs– Unpasteurized products

Summary1) Don’t exclude food groups2) Don’t overload one type of food I.e

pomegranate3) Don’t replace fruit with juices, have juices after

meals4) Ok to eat cooked foods but reduce deep frying5) Protein is important for muscle turnover and

repair6) Watch mega doses of vitamins/minerals7) CONSULT A QUALIFIED DIETITIAN

Questions?