Nutrition During and After Cancer

Carol Schimmer RD, LDKlemens Ast and Lindsey Warren ARAMARK Dietetic InternsDecember 20, 2011

Objectives Nutrition goals for cancer patients Nutrition strategies for common side

effects of cancer and cancer treatment

Food safety Nutrition for cancer prevention Phytochemicals and where in the diet

they can be found Resources for information and recipes

Nutrition Goals #1 goal is to prevent weight loss Increased calorie needs Protein intake is essential during all stages of cancer

Best choices for protein: Fish, lean poultry, eggs, low-fat meat, non-fat/low-fat dairy

products, nuts, seeds, and legumes. Avoid anemia

Best sources: beef or chicken, fortified whole grains, nuts, seeds, dried fruit, and black strap molasses.

Vitamin C help absorption (lemon juice, vinegar, citrus fruits)

Food can help improve signs, symptoms, and side effects. Patient specific

Nutrition strategies for Nausea and Vomiting

Prevent dehydration Sip on clear liquids throughout the day Examples: water, lemonade, clear juices, sports drinks.

6-8 small meals/day Choose soft bland foods on day of treatment

Chicken noodle soup - Bread Hot cereal - Rice

Use hard candy or gum Nibble on dry foods

Crackers Pretzels Dry cereal

Rinse mouth with baking soda and salt rinse (1tsp of salt and baking soda in a 1qt of water)

Avoid: Strong odor foods Sweet, fried and spicy foods Eating in warm rooms or near odors.

Nutrition Strategies for Poor Appetite

Eat small, nutrient dense meals all day. Drink fluids between meals Be as physically active as possible

Stimulates appetite Maintains strength

Eat large meals at the beginning of the day. Commercial supplements:

Ensure, boost, glucerna

Nutrient-dense foods Foods with a lot of vitamins and minerals.

Fruits, vegetables, whole grains, and low-fat proteins and dairy.

Examples: Oatmeal, quinoa Avocado, berries, pomegranate, oranges Chicken/turkey, peanut butter, nuts, and beans Skim/low-fat: milk, cottage cheese, yogurt

Nutrition Strategies forConstipation Increase fiber in your diet

Gradually increase Increase fluids Best sources: Vegetables, fresh or dried fruits, whole

grains Prunes or prune juice Stick to a schedule Limit gas causing foods

Beans, cabbage family vegetables, large amounts of refined sugar and corn syrup.

Increase physical activity Drink hot beverages

Nutrition Strategies for Diarrhea

Drink extra fluids and replace electrolytes Broth, Gatorade, Pedialyte

Avoid high fiber foods until diarrhea improves, then add fiber back gradually. Nuts, seeds, whole grains, legumes, raw fruits

and vegetables Limit intake of milk products Avoid high fat foods, sugar alcohol, alcohol,

and caffeine. Increase soluble fiber

Rice, banana, canned fruit, oatmeal, rice Avoid gassy foods and carbonated drinks May want to increase foods with potassium

Bananas, potatoes with the skin, fruit juices

Strategies for Aversions to foods or flavors

Clear palate before eating by brushing teeth. Metallic taste

Use plastic utensils Ginger ale, lemon, and mint can mask Add flavoring to food suck on hard candy Try chilled, frozen, sweet, or tart foods.

Decreased ability to taste salt and sugar Add other seasonings, sauces, or more salt or

sugar

Food Safety

Clean strategies: Wash hands, cooking surfaces, and

produce thoroughly before cooking and eating.

Be careful when handling raw meat and eggs Keep separate from ready to eat

foods Clean all surfaces that they may

come in contact with Cook thoroughly

Do not undercook Use thermometers

Chill or freeze leftovers promptly Cook raw foods like fruits and

vegetables

Foods to Avoid for Risk of Infection Hotdogs, luncheon, deli meats Raw (Unpasteurized) milk Soft cheeses

Feta, queso blanco, queso fresco, brie, camembert cheeses, blue veined cheeses.

Soft-boiled or “over-easy” eggs Cold salads made at the store

Ham salad, chicken salad, egg salad, tuna/seafood salad.

Other Useful Strategies

Cold foods may be better tolerated Examples: Carbonated beverages, ices,

gelatin, watermelons, grapes, peeled cucumbers, cold meat platters, ice cream, salted nuts, shakes, puddings, and custards.

Nutrition After Cancer 9.5 million persons in the US are cancer

survivors Set and achieve life-long goals regarding:

Appropriate weight Healthful diet Staying Physically active

American Cancer Society Eat a variety of healthful foods,

with an emphasis on plant sources

Choose whole grain Limit consumption of red meats,

especially those high in fat. Maintain healthy weight throughout

life Balance intake with physical activity Lose weight if currently overweight or

obese Adopt a physically active lifestyle

Suggested: 30 minutes moderate activity >5 days/week

Best: 45min moderate/vigorous activity on >5 days/week

Limit Alcohol intake No more than 1 drink/day for women

and 2 for men.

PhytochemicalsColor Phytochemical Food

Red Lycopene Tomatoes, pink grape fruit, watermelon

Red/purple Anthocyanins, polyphenols

Berries, grapes, red wine, prunes

Orange Alpha, beta-carotene Carrots, mangoes, pumpkin

Orange/yellow Flavonoids Cantalope, peaches, oranges, papaya, nectarines

Yellow/green Lutein, zeaxanthin Spinach, avocado, honeydew, collard and turnip greens.

Green Sulforaphanes, indoles Cabbage, broccoli, brussel sprouts, cauliflower, bok choy, turnips, collard greens

White/green Allyl sulphides Leeks, onions, garlics, chives

Good Resources for More Information

Cancer prevention and control http://www.cdc.gov/cancer/

Cancer Research and Prevention http://www.preventcancer.org

Complementary Treatments for Cancer http://nccam.nih.gov/health/cancer

Patient Advocate Foundation http://patientadvocate.org

Wellness Community http://www.thewellnesscommunity.org/

Recipe Resources

The Cancer Project http://cancerproject.org/

recipes/

American Institute for Cancer Research http://www.cancerrd.com

QUESTIONS???

Resources Escott-stump S. Nutrition and Diagnosis-

Related Care. 7th ed. 2012: 731-798. Mahan LK, Escott-Stump S. Krause's Food &

Nutrition Therapy.12th ed. St. Louis, MI: Elsevier; 2008. 

Brown J et al. Nutrition and Physical activity during and after cancer treatment: an american cancer society guide for informed choices. Cancer J Clin. 2003: 268-291.