Cancer & Nutrition

Nutrition During and After Cancer Treatment:

A Guide for Informed Choices by Cancer Survivors From the American Cancer Society — May/June 2001

QUESTIONS ABOUT COMMON SYMPTOMS

Are there foods that will help with dry mouth and swallowing problems?

Sugarless gums, especially those that are citrus flavored, can improve saliva formation. Frequent sipping of water and mouth sprays can also help. Select foods high in moisture, or add sauces, gravies, or oils to your meals. High-calorie shakes and blenderized drinks can also help. Canned nutritional supplement beverages can be useful, but there are many alternatives. Any food can be pureed, mashed, blended, or mixed to be softer and easier to swallow. Adding liquids to foods, and using foods such as eggs, custards, dairy products, cheese, fruits, soft-cooked vegetables, and soft meats, can help with swallowing problems.

Are there foods that will help my loss of appetite and nausea?

Loss of appetite and nausea are commonly experienced after cancer treatment. Taste perceptions  can often change during treatment. Adding or increasing spices and condiments to meals might be needed temporarily to increase food appeal. Experiment with spices and flavoring often, as tastes may change. Try to eat small, more frequent meals and snacks. In some instances, medications can be very helpful to reduce nausea. There are also medications that can help to stimulate appetite. Ask your health-care provider if those might be right for you.

What can I do to reduce fatigue?

Fatigue can be reduced by nutrition and physical activity. Often, cancer survivors become fatigued because they do not eat enough, do not drink enough fluids, or do not exercise enough. Starting slowly with an exercise regimen, even if only for a few minutes a day, can help to restore energy. The frequency and duration of a simple activity like walking can be steadily increased. Do not hesitate to tell your health-care providers about your fatigue. There may be specific medical treatments that can help.

Should I be concerned about unintentional weight loss?

Weight loss often occurs in the early stages of cancer treatment and recovery. Continued weight loss should be avoided. Weight loss can be minimized by adequate dietary intake. Use of between-meal snacks and foods that are good sources of calories, fat, and protein can help.

Should I intentionally lose weight?

After the treatment phase, those who are overweight can benefit from modest, slow weight loss. It is not essential for those who are overweight to come down to normal weight levels. There are substantial benefits from stopping weight gain and beginning weight loss, even if that process is slow.

Should I be concerned about weight gain?

Weight gain is often unavoidable during treatment with some chemotherapy protocols. After treatment, and during recovery, a program of regular physical activity and healthy food choices can usually stop the pattern of weight gain and lead to slow, controlled weight loss.

Is there a diet to help improve anemia?

Anemia is common during and after cancer treatment, as it can result from blood loss, chemotherapy, and/or radiation therapy, or from cancer itself. A balanced diet can help support the body's repair system for producing new blood cells. Iron supplements should be taken only after consulting with your health-care provider. Extra iron is useful to correct iron deficiency, but it is not helpful for other conditions, and it can cause digestive system side effects. In addition to these strategies, do not hesitate to ask your doctor about medical treatments that may help.

What is a good way for women to protect their bone strength?

Bone strength can be reduced after menopause, whether it is a natural menopause or one that has been induced by cancer therapy. Bone density can be easily measured to determine the need for treatment. Estrogens can increase bone strength, but they may be unwise for women who have had estrogen-responsive breast or endometrial cancers, or who are at high risk for breast cancer. Other methods of increasing bone strength (calcium, vitamin D, prescription medications, and exercise) can also be effective.

What is a good way to control the symptoms of menopause?

Estrogens can reduce menopausal symptoms but may be inadvisable for women who have had estrogen-responsive breast cancer, endometrial cancer, who are at high risk for breast cancer, or have had complications that can be worsened by estrogens, such as blood clots. Other methods of controlling menopausal symptoms include regular exercise, healthy eating, avoiding caffeine, reducing alcohol use, stress reduction, and prescription medications that do not contain estrogens. Many dietary supplements taken to manage symptoms of menopause contain estrogens, so health-care providers should be consulted before their use.

Is there a good diet for the treatment of lymphedema?

Lymphedema is swelling in the arm or leg following cancer surgery or radiation. It is caused by a blockage of flow of the lymph fluid. Although a high-protein, low-sodium diet has been recommended by some, there is no scientific evidence of benefit with this diet in the treatment of lymphedema. It is instead advisable to seek out specific physical or massage therapy programs designed to treat lymphedema.

PHYSICAL ACTIVITY

Is regular exercise useful after a diagnosis of cancer?

Moderate exercise reduces fatigue and increases a sense of well-being during active treatment and can speed recovery. Whether it will reduce the chances of cancer recurrence or slow cancer growth is unknown. The benefits of regular exercise for weight control and cardiovascular health are other good reasons to be physically active.

How do I select an exercise program that is right for me?

The right exercise program is one that starts slowly, and progressively increases in duration and intensity as you are able. Your muscles will tell you when you need to slow down and rest. Strength, flexibility, and aerobic fitness are all important features of an effective exercise program.

DIETARY SUPPLEMENTS

Should I supplement my diet with vitamins and minerals?

The best source of vitamins and minerals is food. During illness and recovery, dietary intake may not be optimal, so a vitamin and mineral supplement may be needed. The best choice is a balanced multivitamin/mineral supplement containing as much as 100% of the “Daily Value” of most nutrients (formerly known as the “RDA”). Some people believe that if a little bit of nutrient is good for you, then a lot must be better. There is no scientific evidence to support that idea. In fact, high doses of nutrients can have harmful effects. Be sure to discuss vitamin and mineral supplement use with your health-care provider.

Can I get the nutritional equivalent of fruits and vegetables in a pill?

No. Many hundreds of healthful compounds are found in fruits and vegetables. The small amount of dried powder contained in pills that are represented as being equivalent to fruits and vegetables includes only a small fraction of the levels contained in the whole foods.

Should I take antioxidants?

It is not a good idea to take “mega-doses” of vitamin or mineral, including the antioxidant nutrients, at any time. High doses of antioxidants may interfere with the effectiveness of chemotherapy and radiation therapy, so be sure to discuss your use of supplements with your health-care provider. Fruits and vegetables are the best sources for naturally occurring antioxidants.

Should I take supplements containing beta-carotene?

Supplements containing 5 mg or less of beta-carotene are unlikely to be harmful, as this is similar to the levels available from foods. However, higher dose supplements should be avoided because studies have shown that higher doses may actually increase risk for certain cancers such as lung cancer.

Should I take soy supplements?

Although soy is a good source of protein, large amounts of soy protein (as are found in most soy pills or powders) could increase cancer risk in ways that are not yet understood. Phytochemicals, naturally occurring plant chemicals (iso-flavones) that are present in soy, may affect the way cancer cells grow. While there is reason to believe that these effects might be beneficial, especially for prostate cancer, there is also a possibility that high doses of soy might act in the same way as estrogens to increase the growth of estrogen-responsive cancers, such as breast or endometrial cancer. Breast and endometrial cancer survivors should therefore not take high doses of soy without first consulting with their health-care providers.

How do I know that alternative or complementary methods are safe for me?

Study all sources of information, but beware of testimonials or information that come only from those who are selling a product. Also be sure to tell your health-care providers about the methods you wish to use, so they may advise you about any particular interaction that might occur with conventional therapy. It is also best to remember, if it sounds too good to be true, it most likely is not true.

FOODS AND DIETS

How do I select a diet that is right for me?

Start with the Food Guide Pyramid and the American Cancer Society Cancer Prevention Guidelines. If you are having problems with particular foods, many others in that same food group can be substitutes. Special problems might require consultation with a registered dietitian or nutritionist.

How many servings of fruits and vegetables should I eat every day?

Although everyone should eat at least five servings of fruits and vegetables each day, during cancer therapy it may be difficult. Nevertheless, by incorporating balanced meals with nutritious snacks, and drinking juices, eating up to 10 servings of fruits and vegetables per day is quite possible, and may be beneficial.

Can I get the same nutritional value from frozen and canned fruits and vegetables?

Yes. In fact, frozen foods are often more nutritious than fresh foods because they are usually picked ripe and quickly frozen. Canning can reduce some of the nutrients, but the nutritional value of canned fruits and vegetables is often equivalent to those that are fresh.

Should I be juicing my fruits and vegetables?

Juicing is not necessary, but can add variety to the diet and is a good way to consume fruits and vegetables, especially if there are difficulties with chewing or swallowing. Juicing also improves the absorption of some of the nutrients in fruits and vegetables. If you buy commercially juiced products, avoid those that have not been pasteurized.

Should I be concerned about pesticides in my foods?

There is no evidence that the low levels of pesticide residues found in fruits and vegetables affect cancer growth. Pesticides can be toxic, but only in very high doses, such as those to which agricultural workers are exposed when handling chemicals. To reduce exposure to pesticides, thoroughly wash all fruits and vegetables.

How do I avoid becoming ill from contaminated foods?

Wash all foods thoroughly; do not allow meats and dairy products to stay at room temperature; thoroughly cook all meats, poultry, and seafood; and do not drink unpasteurized commercial beverages.

How much water should I drink?

Try to drink at least eight cups of water each day. Many symptoms of fatigue, lightheadedness, and nausea can be due to dehydration.

Should I drink alcohol?

There are some heart disease benefits from low levels of alcohol (one to two drinks per day), but cancer benefits are not likely. In fact, these same levels of alcohol seem to increase breast cancer risk. Breast cancer and head and neck cancer survivors should consider avoiding the frequent use of alcohol.

Should I limit my caffeine intake?

Although many heart problems can be better controlled without caffeine, and sleep disturbances are less common, caffeine will have no adverse impact on cancer.

Should I eat high-fiber foods?

Yes. Fiber from whole grains and from high-fiber cereals can improve bowel function and help to decrease heart disease risk, but fiber has not been shown to reduce cancer risk in studies conducted to date. Other high-fiber foods, such as beans, are good meat substitutes. Fruits and vegetables are good choices for their fiber content, as well as for the many other nutrients they contain. Fiber supplements do not contain the beneficial vitamins and other substances found in fruits and vegetables.

Should I reduce my fat intake?

While consuming a diet that is low in fat has been shown to help reduce the risk of heart disease, the possible benefit for prevention of cancer recurrence is yet unproven. During cancer treatment, adding moderate amounts of fats and fat-containing foods can help to improve calorie intake. After treatment, cancer survivors should eat a diet that minimizes high-fat foods and animal fats for optimal heart health.

Should I avoid refined sugar?

Refined sugars do not seem to adversely affect cancer, but they can cause fatigue due to fluctuating blood sugar levels, and they do not contain the same level of nutritional value as sugars naturally present in whole foods. It is therefore wise to limit intake of refined sugars (including brown sugar) in favor of more nutritious goods.

Should I become a vegetarian?

It is not necessary to eliminate meat from the diet after cancer, but reducing red meat intake (and other sources of saturated fats) can reduce one's risk of heart disease, and may also reduce risk for colon and prostate cancers. A vegetarian diet can be quite healthy if it is carefully planned. Diets that include lean meats in small to moderate amounts can be healthy as well.

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