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Survivorship sur⋅vi⋅vor⋅ship

Nutrition & Health Guidelines for Cancer Survivors Helping you work towards improving physical and mental well being to live a healthy, balanced lifestyle.

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Forward To the Patient and Family

This booklet is for people who have been diagnosed with cancer. Nutrition plays a vital role in a healthy lifestyle post-cancer treatment. A healthy lifestyle can:

• Lower your risk for heart disease and other chronic conditions • Increase your energy • Improve your mood and outlook

Understanding Nutrition Research

Research in the health field is ongoing. Because of its changing nature, you may hear conflicting advice and/or information about what to do. This handout was created based on thorough research from credible sources, and is meant to serve as a safe tool to guide your everyday decisions. Cancer survivors are at a higher risk for:

• A second type of cancer • Osteoporosis • Obesity • Heart disease • Diabetes mellitus • Trouble performing daily activities

Therefore, cancer survivors are strongly encouraged to make lifestyle changes for improved health. The guidelines in this booklet offer overall health benefits to prevent disease and improve outlook. If you have any questions about the information in this booklet, please ask your health care team.

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Making Healthy Lifestyle Choices

Changing habits takes time—it is not an overnight process. You will first need to figure out the areas that need some improvement. To help you get started, take the following American Cancer Society (ACS) Nutrition & Activity Quiz. It is also available on their website at www.cancer.org.

1. Check “Yes” or “No” next to each question. 2. Add up your “Yes” responses. 3. Look up your score in the “Scoring” section.

Scoring:

0 – 4 “Yes” Answers You eat a diet high in fat and low in plant-based foods. Try to eat more fruits, vegetables, whole-grains, and legumes. Work on increasing your physical activity.

5 – 8 “Yes” Answers You are off to a great start for healthier living. Look at your “No” responses to help make goals for improvement.

9 – 12 “Yes” Answers You follow healthy eating and lifestyle habits. Keep looking for new ways to improve or maintain your current lifestyle.

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Setting Your Goals American Institute for Cancer Research

Now that you have a better idea of your strengths and weaknesses, the next step is to set goals. Goals are an important motivational tool for making effective and lasting changes. They should be Specific, Measureable, Attainable, Relevant, and Time-bound, or SMART. (For example, “I will eat 5 fruits and vegetable servings everyday” is more powerful than “I will eat more healthily.”) Work on 1-2 goals at a time to easily track progress.

American Institute for Cancer Research (AICR) Recommendations

The AICR has compiled a list of eight recommendations for cancer prevention, backed by research and evidence (also available on their website at www.aicr.org).

1. Be as lean as possible within your normal body weight range (aim for a body mass index between 21-23).

2. Be physically active for at least 30 minutes every day. 3. Avoid sugary drinks (i.e. juices and sodas). Limit energy-dense foods. 4. Eat a variety of vegetables, fruits, whole grains and legumes such as beans. 5. Limit consumption of red meats (i.e. beef, pork and lamb) and avoid processed

meats. 6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women per day. 7. Limit consumption of salty foods and foods processed with salt (sodium). 8. Don’t use supplements to protect against cancer.

Try to incorporate these into your long-term health goals.

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+ Stay Physically Active

Physical activity is just as crucial as good nutrition to stay healthy. Benefits include:

! Prevention against disease. ! Improved heart and lung health,

with a lowered risk of a heart attack.

! Weight loss if overweight, and maintenance of a healthy body weight.

! Increased energy, endurance, strength and flexibility.

! Reduced stress, anxiety, and fatigue

! Better overall emotional well-being.

! Normal bowel function maintenance.

What kind of physical activity do I need?

It is a good idea to incorporate both aerobic exercise and weight training into your physical activity routine.

Moderate exercise, such as a brisk walk, is best. Start with shorter sessions (10 – 15 minutes) at a relaxed pace to avoid injury. Over time, increase the length and intensity of your activity.

Some research shows that high-intensity exercise weakens the immune system. If your doctor advises you to exercise, start slowly.

How do I start?

" Take the stairs instead of the elevator. " Park at the far side of the parking lot. " Walk a few laps around the store

before you begin to shop. " Invest in a stationary bike or jump

rope to exercise while watching TV.

Tips for Success

" Schedule exercise on your calendar to reserve time for this important activity.

" Find an exercise partner to help you stick with your program and to keep you company.

" Warm up and cool down at low intensity for five to ten minutes. Remember to stretch after your cool down.

Always talk to your doctor before beginning an exercise program.

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Aerobic Exercise

Aerobic exercise makes the heart and lungs work harder. It moves oxygen through the blood and burns calories to help you maintain a healthy weight. As your strength and stamina improve, do moderate to vigorous physical activity for at least 30 minutes on most days. This improves fitness, heart, and lung health. See the chart below for information on certain activities.

Weight Training Lifting weights can increase the size and strength of muscles, and also increases your metabolism. Perform weight training every other day. Your muscles need 3-4 days to recover, so work on different muscle groups throughout the week. Muscle weighs more than fat, so gaining muscle may cause a slight weight gain. With your doctor’s approval, talk to a personal trainer for a weight-training program.

Always ask your doctor before starting an exercise program. Be cautious if you have:

• Severe anemia: Stop exercise until the anemia has improved, but continue normal activities.

• A compromised immune system: Avoid public gyms and places until white blood cell counts improve.

• A stem cell transplant: Avoid gyms and public places for one year after the transplant. • Severe fatigue: Try to do 10 minutes of stretching exercises daily. • Radiation burn: Avoid swimming pools. • Indwelling catheters: Avoid water or other microbial exposures. Avoid weight training of

the muscles in the catheter area. • Significant peripheral neuropathy: Try stretching and floor exercises, or ride a

stationary recumbent bicycle. You may be less able to do exercises that use the affected limbs due to weakness, limited feeling or loss of balance.

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Maintain a Healthy Weight There are several ways to find your healthy body weight. Here are some simple methods:

" The HAMWI Formula for Ideal Body Weight Women:

For the first 5 feet of height, add 100 lbs. For every inch above 5 feet, add 5 lbs. i.e., a 5 foot 4 inch woman should weigh 100 lbs + 4 in(5lbs) = 120lbs +/- 10%

Men: For the first 5 feet of height, add 106 lbs. For every inch above 5 feet, add 6 lbs. I.e. a 5 foot 10 inch man should weigh 106 lbs + 10 in(6lbs) = 166 lbs +/- 10%

" Body Mass Index (BMI) BMI is a measurement that takes height and weight into consideration. It is measured in kilograms divided by height (in meters squared). A healthy BMI is between 18.5 – 25 kg/m2.

Limit Alcohol Intake

If you do not drink alcohol, do not start. Alcoholic drinks are high in calories while having little to no nutritional benefit. Consuming too much alcohol can cause:

• Cirrhosis of the liver • Obesity • Heart Disease • Liver cancer and cancers of the gastrointestinal tract.

Alcohol is also linked to breast cancer and colorectal cancer. Studies show increased risk of all types of cancer and other chronic diseases.

A serving of alcohol is: • 5 ounces of wine • 12 ounces of beer • 1.5 ounces of liquor

Men should have two servings or less per day. Women should have one serving or less per day.

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Fruits and Vegetables • Eat five to nine servings of fruits and vegetables every day. • One serving = o ½ cup cooked or 1 cup raw vegetable o 1 small piece of fruit (tennis-ball sized), 1 cup fruit, or ½ cup

dried fruit • Shoot for the rainbow. The variety of colors in fruits and

vegetables are indicative of the different nutrients they each offer.

Grains • Aim for 6-8 servings per day. One serving =

o 1 slice bread o 1 cup cold cereal o ½ cup cooked pasta, rice, or cereal

• Choose whole grains rather than processed/refined grains (such as white bread and pasta).

• Whole grains include whole-wheat flour, bulgur, oatmeal, and brown rice and are a good source of fiber.

Proteins • Eat 5-6 servings per day, or about the size of 2 decks of cards. • One serving =

o 1 ounce of meat, poultry or fish o ¼ cup cooked beans o 1 egg o ½ ounce nuts or seeds; 1 tablespoon of peanut butter

• Choose lean animal protein sources like poultry or seafood, and limit red meats

Fats • Limit fat intake to 20-35% of your daily calories. • Choose healthy fats, including omega-e fatty acids,

monounsaturated fat, and polyunsaturated fat. The best food sources are:

o Olive oil, canola oil, avocado, nuts and seeds, salmon, and flax

• Avoid trans fats, which are converted to cholesterol in the body.

Eating a Healthy Diet Variety is the key to healthy eating. Your diet should emphasize plant-based foods including fruits, vegetables, whole grains, and legumes with a moderate amount of protein. The following guidelines for good nutrition will help you get an idea of what and how much to eat.

The Power of Antioxidants Free radicals are unstable, damaged molecules that can come from pollution, radiation, sunlight, cigarette smoke, alcohol, aging, and injury/trauma. Free radicals harm healthy cells—including DNA. If DNA is damaged, it can develop into cancer. Antioxidants protect our body’s cells from free radicals. They are naturally found in foods from plant sources, especially colorful fruits and vegetables. The three main antioxidants are beta-carotene, vitamin C, and vitamin E.

Beta-carotene

Sources: apricots, cantaloupe, carrots, mangoes, peaches, asparagus, broccoli, spinach, Beets, turnips, sweet potato

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Vitamin E blocks the formation of cancer and may also help to reduce tumor size.

Sources: corn, soybean and safflower oil, wheat germ, nuts and seeds

For a majority of these foods, you will get the most benefits eating them raw or lightly steamed. Aim to eat a wide variety of fruits and vegetables which naturally have many other nutrients that boost health. Ask your physician or dietitian about multivitamins if you can’t get enough antioxidants from food sources.

Some other antioxidants include: Zinc

Sources: Oysters, red meat, poultry, beans, nuts, seafood, whole grains, dairy products Selenium

Sources: Tuna, beef, poultry, fortified breads

Vitamin C protects cells from damage by free radicals. It captures the free radical and neutralizes it. Vitamin C is also helps to restore vitamin E’s antioxidant properties:

Sources: berries, kiwi, mango, orange, peppers, tomatoes

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Changing habits takes time—it is not an overnight process. You will first need to figure out the areas that need some improvement. To help you get started, take the following American Cancer Society (ACS) Nutrition & Activity Quiz. It is also available on their website at www.cancer.org.

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Scoring:

0 – 4 “Yes” Answers You eat a diet high in fat and low in plant-based foods. Try to eat more fruits, vegetables, whole-grains, and legumes. Work on increasing your physical activity.

5 – 8 “Yes” Answers You are off to a great start for healthier living. Look at your “No” responses to help make goals for improvement.

9 – 12 “Yes” Answers You follow healthy eating and lifestyle habits. Keep looking for new ways to improve or maintain your current lifestyle.

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American Cancer Society (ACS) Nutrition & Activity Quiz.

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