Nutrition and Cancer. Special diets. What is a healthy diet?

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1 Nutrition and Cancer The staff at New Mexico Cancer Center wishes to support your nutritional needs during your treatment. Your personal dietary goals will vary based on the type of treatment you receive, the duration of your treatment, and your nutritional status at the beginning of your treatment. Some patients do not experience any nutritional problems during their treatments, some experience only a few minor issues, and a small group will require significant nutritional support or guidance. Depending on your needs, dietary recommendations will be made that best ensure your nutritional health. Special diets If you were eating well and maintaining your normal weight before you start treatment, you do not need a special diet. However, dietary changes designed to maintain your pretreatment weight might be necessary if you lost weight before you were diagnosed or if you lose a significant amount of weight during treatment, or if you experience difficulty eating. If you do develop diet related issues, talk to your physician or call our triage nurse. We do not want you to lose weight even if you were overweight before you started treatment. Cancer, and the methods used to treat cancer, can be debilitating, and weight loss under these conditions can result in a patient s feeling weak, tired, or just not right. Therefore, weight loss is not advised during cancer treatment. What is a healthy diet? A healthy diet supplies all of the calories, protein, vitamins, minerals, and fluid you need to maintain a healthy weight, and ensure proper function of your gastrointestinal tract. Of all nutrients, water is the most important. Water makes up over half of our body weight, allows for the transport of nutrients to our cells, allows for the excretion of waste products from our bodies, and ensures the smooth function of all of our organ systems. The U.S Dietary Guidelines recommend that Americans drink between 64 ounces and 80 ounces of

2 fluid each day. It may sound like a daunting task, but we can all achieve this by drinking 4 ounces of liquid for every hour that we are awake. Then there is the question of fueling our bodies. Our body prefers to run on a type of sugar called glucose, which our intestinal systems supply by breaking down the sugars and starches we eat. Sugar is found in fruit, table sugar and sweets, milk and milk products, and many baked or processed foods. Starches include foods like bread, cereal, rice, pasta, other grain products, potatoes, and winter squashes. Your body does not know the difference between glucose that comes from starch and glucose that comes from sugar, so you should eat whatever types of these foods that appeal to you. Your body breaks down all starches to sugar and it is not necessary to avoid simple sugars like candy. Feel free to try the candy that has been set out for patients in various locations throughout the cancer center. It is a myth that eating sweets will make some cancers grow faster. The structural parts of our bodies are based on protein. Some protein can be found in starches and vegetables, but complete protein sources include animal products like meat, poultry, fish, eggs, milk, and milk products. You should try to eat at least two servings of protein per day. A serving size of meat, fish, or poultry is 3 ounces, which is roughly the size of one deck of cards. A serving of milk is one cup, and a serving of eggs is two large eggs. Vitamins and minerals needed to repair, replace, and fuel our cells are found in many different foods, but some are more abundant in certain types of food. In general, the foods that are unprocessed contain the most nutrients. Examples include fresh meat, chicken, fish, milk, vegetables, fruit, and whole grains. During the 1930, there were many persons who developed nutrient deficiencies in the U.S as a result of the depression. In order to help prevent nutrient deficiencies, the US began the enrichment and fortification of food during the 1940s. At that time, the US began fortifying all grain products with the B-

3 vitamins, thiamin, riboflavin and niacin as well as iron. These nutrients are often lost during processing. Since this time, the grain enrichments laws ensure that most rice, pasta, cooked cereals in the have been enriched. Then in 1996, a lack of folic acid was linked to neural tube defects in newborns, folate was also added to grains. The grain enrichment laws ensure that most rice, pasta, cooked cereals, and breads sold in the U.S. have been enriched. The Food Guide Pyramid guidelines recommended that all persons eat a minimum of six servings from the grain group daily. However, whole grains are recommended over refined and enriched products because of their link to a reduction in cancer, cardiovascular disease and overall health. Fiber is also much more abundant in whole grain foods than processed grain foods, so whole grains are preferable for healthy individuals. However, depending on your illness, and its treatment, you may actually be advised to avoid whole grains while under our care. Iron, although added to most grain products, is not well absorbed from these foods and will probably need to be supplied by other foods in your diet. Meat, fish, or poultry are the best sources of dietary iron. If you do not wish to eat these foods, and you are found to be iron deficient, you should ask your physician if an iron supplement might be appropriate during your treatment. Fresh, frozen, or dried fruits and vegetables offer plentiful levels of vitamins and minerals, while canned fruits and vegetables are less abundant sources of these nutrients because of the high temperatures used in the canning process. The adult goals for fruits and vegetables are at least three servings of vegetables per day, and at least two servings of fruit per day. One-half-cup of most vegetables equals one serving size. One cup of fruit equals one serving for most fruits. Milk is such a good source of protein, sugar, vitamins, and minerals, that it has its own food group. If you are able to drink milk, or eat milk products, they are important nutrient sources in your diet. If you cannot drink milk, or eat milk products, the dietitian can suggest other foods, or supplements, that supply these valuable nutrients.

4 Just Plain Calories The most concentrated form of calories available in your diet comes from fat. Good sources include butter, margarine, oils, whole milk, meat, and poultry. You should not avoid these foods unless advised to do so by your physician. In addition to being an excellent source of calories, fats also supply us with the fat-soluble vitamins A, D, E, and K. Some patients need more fat in their diets during cancer treatment in order to maintain their pre-illness weights. Consider this a plus! The New Mexico Cancer Center may be the only doctor s office you ever visit where you will not be criticized for eating a hot fudge sundae! Nutrition and Cancer Research According to the National Cancer Institute, nutrition guidelines for cancer prevention may help cancer survivors prevent the development of a second cancer. The relationship between diet and cancer continues to be studied, but the strongest link between diet and cancer prevention is the relationship between a diet high in fruits and vegetables and whole grains and a reduced risk of lung, prostate, breast, and gastro-intestinal cancers. For this reason, the National Cancer Institute is a primary supporter of the Eat 5 to 9 a Day Program to promote increased intake of fruits and vegetables among Americans. Frequently asked questions What if I am already on a physician recommended diet? You should discuss this with your physician and the dietician here at New Mexico Cancer Center. He or she may wish you to continue on this diet while you are being treated; or prefer that you stop while you are a patient here. The patients who most often need to continue on their previous diets are diabetics, and patients with pre-existing digestive problems.

5 Can I continue to take the vitamin, mineral and herbal supplements that I took before treatment? Nutritional supplements are another matter that you should cover with your doctor. Some supplements, particularly herbal supplements, can interfere with the treatments that you receive in our facility. What are the most common diet related problems of cancer therapy? The most common problems are constipation or diarrhea, while patients taking certain medications and/or receiving chemotherapy sometimes experience nausea or vomiting. Patients who receive head and neck radiation, or radiation to part of the intestinal tract, have other issues that can lead to difficulty tolerating certain foods. Should any of these problems affect you, they need to be addressed individually. You should inform your treatment nurse, or the center s telephone nurses, if you experience any of the intestinal problems mentioned above. The nurses may be able to help you immediately, or they may refer the problem to someone else. Either way, telling a staff nurse about your side effects is the quickest way to find the right solution to your problem. Keeping track of the foods you eat The food pyramid is an excellent guide to the number of servings of each food group needed by adults. If you have no digestive problems, try to select unprocessed foods to ensure that you receive adequate amounts of fiber, and recently discovered compounds called phytonutrients, which are not found in processed foods.

6 What foods are in the grain group? Any food made from wheat, rice, oats, cornmeal, barley or another cereal grain is a grain product. Bread, pasta, oatmeal, breakfast cereals, tortillas, and grits are examples of grain products. Grains are divided into 2 subgroups, whole grains and refined grains. Whole grains contain the entire grain kernel -- the bran, germ, and endosperm. Examples include: whole-wheat flour bulgur (cracked wheat) oatmeal whole cornmeal brown rice Refined grains have been milled, a process that removes the bran and germ. This is done to give grains a finer texture and improve their shelf life, but it also removes dietary fiber, iron, and many B vitamins. Some examples of refined grain products are: white flour degermed cornmeal white bread white rice Most refined grains are enriched. This means certain B vitamins (thiamin, riboflavin, niacin, folic acid) and iron are added back after processing. Fiber is not added back to enriched grains. Check the ingredient list on refined grain products to make sure that the word enriched is included in the grain name. Some food products are made from mixtures of whole grains and refined grains.

7 What foods are in the vegetable group? Any vegetable or 100% vegetable juice counts as a member of the vegetable group. Vegetables may be raw or cooked; fresh, frozen, canned, or dried/dehydrated; and may be whole, cut-up, or mashed. Vegetables are organized into 5 subgroups, based on their nutrient content. What foods are in the fruit group? Any fruit or 100% fruit juice counts as part of the fruit group. Fruits may be fresh, canned, frozen, or dried, and may be whole, cut-up, or pureed. What foods are included in the milk, yogurt, and cheese group? All fluid milk products and many foods made from milk are considered part of this food group. Foods made from milk that retain their calcium content are part of the group, while foods made from milk that have little to no calcium, such as cream cheese, cream, and butter, are not. The US Department of Agriculture normally recommends that milk group choices should be fat-free or low-fat. This does not hold true for cancer patients, who may need the extra calories provided by high fat foods. You should not limit your fat intake unless you weight rises above you pre-illness weight. What foods are included in the meat, poultry, fish, dry beans, eggs, and nuts (meat & beans) group?

8 All foods made from meat, poultry, fish, dry beans or peas, eggs, nuts, and seeds are considered part of this group. Dry beans and peas are part of this group as well as the vegetable group. As with milk products, the USDA recommends that most meat and poultry choices should be lean or low-fat. Fish, nuts, and seeds contain healthy oils. However, we do not recommend that you avoid high fat foods unless your weight rises above your pre-illness weight. What are oils? Oils are fats that are liquid at room temperature, like the vegetable oils used in cooking. Oils come from many different plants and from fish. Some common oils are: canola oil corn oil cottonseed oil olive oil safflower oil soybean oil sunflower oil Most oils are high in monounsaturated or polyunsaturated fats, and low in saturated fats. Oils from plant sources (vegetable and nut oils) do not contain any cholesterol. In fact, no foods from plants sources contain cholesterol. A few plant oils, however, including coconut oil and palm kernel oil, are high in saturated fats and for nutritional purposes should be considered solid fats. Solid fats are fats that are solid at room temperature, like butter and shortening. Solid fats come from many animal foods and can be made from vegetable oils through a process called hydrogenation. Some common solid fats are:

9 butter beef fat (tallow, suet) chicken fat pork fat (lard) stick margarine shortening Information on the Food Pyramid is from the USDA website:

10 Recipes Cancer.gov recipe The following recipe have been taken the National Cancer Institutes web site regarding nutrition: Fortified Milk Used to increase the nutrient content of milk for patients who have difficulty maintaining their weight 1 quart whole milk 1 cup nonfat instant dry milk 1. Pour liquid milk into a deep bowl. 2. Add dry milk and beat slowly with beater until dry milk is dissolved 3. Refrigerate and serve cold. 4. Note: If it tastes too strong, start with 1/2 cup of dry milk powder and gradually work up to 1 cup. Nutrient Content : 200 calories with 14 grams of protein per cup (whole milk contains 150 calories with 8 grams of protein per cup) Banana Milkshake 1 whole ripe banana, sliced Vanilla extract (few drops) 1 cup milk 1. Place all ingredients into a blender. 2. Blend at high speed until smooth. If made with 2% milk: Calories per serving: 226 calories and 9 grams of Protein per serving If made with whole milk: Calories per serving: 255 calories and 9 grams of Protein / serving

11 If made with fortified milk: 315 calories with 15 grams of Protein per serving Fruit and Cream 1 cup whole milk 1 cup vanilla ice cream or frozen yogurt 1 cup canned fruit (heavy syrup), including juice (peaches, apricots, pears) Almond or vanilla extract to taste 1. Blend ingredients and chill well before serving. If made with ice cream: 302 calories and 7 grams of protein per serving If made with frozen yogurt: 268 calories and 9 grams protein per serving Lactose-Free Double Chocolate Pudding 2 squares baking chocolate (1 oz each) 1 cup lactose-free milk (Lactaid) 1 tbsp cornstarch 1/4 cup granulated sugar 1 tsp vanilla extract 1. Melt chocolate in small pan or on foil. 2. Measure cornstarch and sugar into saucepan. 3. Add part of the liquid and stir until cornstarch dissolves. 4. Add the remainder of the liquid. 5. Cook over medium heat until warm. 6. Stir in chocolate until mixture is thick and comes to a boil. 7. Remove from heat. 8. Blend in vanilla and cool.

12 Eat 5 to 9 a day recipes The following recipes have been taken from the Eat 5 to 9 a Day Program which is sponsored by the U.S. Department of Health and Human Services, the National Institutes of Health, and the National Cancer Institute. In some cases, recommendations for recipes changes have been made in order to prevent weight loss in our patient s. Those without a need to increase their calorie or protein intake should not modify the recipes. You can find more information on the 5 to 9 a day program at the website Striped Fruit Cup Ingredients 1 8-ounce container low-fat lemon, orange, vanilla or banana yogurt 5 medium strawberries, diced 2 kiwi, peeled and sliced lengthwise 3 ounces sliced honeydew (or about 1/2 cup cubed) 3 ounces sliced cantaloupe (or about 1/2 cup cubed) 1 mango, peeled, pitted and sliced into strips 1 papaya, peeled, seeded and sliced lengthwise 3 ounces sliced watermelon (or about 1/2 cup cubed) Juice of 1 lemon or 2 limes Preparation Time: < 30 minutes Directions Empty the yogurt into a small serving bowl. Gently stir in strawberries. Place the dip in the center of a large round plate or platter. "Stripe" the fruit slices around the bowl of dip. Squeeze lemon or lime juice over the fruit. Serve with tongs, a spoon for the dip, and individual plates. Serves: 4 people 2.5 fruit servings per serving *Add vanilla yogurt to increase the calorie and protein levels of this recipe

13 Lentils and Rice Ingredients 1 tablespoon extra virgin olive oil 2 large onions, peeled and sliced (4 cups) 4 cups low-sodium chicken or vegetable broth 1 cup lentils, dry, washed (2 cups cooked) 1/2 cup long grain white rice 1/4 teaspoon salt 1/4 teaspoon pepper 2 tablespoons chopped cilantro Preparation Time: :30 min -1 hour Directions Heat the broth in a saucepan. Add the lentils and simmer 20 minutes. While the lentils are cooking, heat the oil in a large high-sided skillet on medium high. Saute the onions until golden brown. Take half the onions out of the pan and set aside. Add the remaining onions, rice, salt, and pepper to the simmering lentils. Cover and bring to a boil. Reduce the heat and cook very slowly about 20 minutes or until the lentils and rice are tender. Serve in a bowl topped with the reserved onions and chopped cilantro. Serves: 4 people 3 vegetable servings per serving * add butter or margarine to increase the caloric level of this recipe Fruit Slush Ingredients 3 cups frozen fruit (such as frozen strawberries, blueberries, raspberries, or melon) 1 teaspoon vanilla extract 1 cup fat free milk or non-fat plain yogurt

14 Sweetener as needed: about 1-3 tablespoons sugar or the equivalent in artificial sweetener Preparation Time: < 30 minutes Directions Blend first three ingredients until smooth. Sweeten to taste. Serves: 4 people 1 fruit servings per serving * Use whole milk or regular vanilla yogurt and all of the sugar you like to increase the caloric content of this recipe Mock Frozen "Peach" Daiquiri Ingredients 1 cup juice packed canned peaches 1 Tbsp. fresh lemon juice 2 Tbsp. frozen pink lemonade concentrate 1 cup crushed ice Preparation Time: < 30 minutes Directions Chill peaches in freezer until very cold. Add to blender container with pink lemonade concentrate, lemon juice, and crushed ice. Puree until smooth. Pour into glasses. Serves: 2 people 1 fruit serving per serving * add milk or half & half to increase the caloric content of this recipe Baked Apple Slices Ingredients 2 oranges 2 tablespoons honey 1/4 teaspoon ground cinnamon

15 1/4 teaspoon ground cloves 3 Granny Smith apples, peeled, cored, and cut in 1/2-inch slices 5 tablespoons raisins 1/4 cup chopped walnuts, divided 1/4 cup low-fat vanilla yogurt Preparation Time: 30 minutes to 1 hour Directions Preheat the oven to 500 degrees F. Grate the zest of one of the oranges and set aside. Squeeze the juice from both oranges into a small bowl. Stir the honey, cinnamon, cloves, and half the zest into the juice. Lay half the apple slices in a glass-baking dish. Scatter the raisins and 2 tablespoons of the walnuts on top. Pour on half the juice mixture and top with the remaining apples and juice. Combine the remaining 2 tablespoons walnuts with the orange zest and scatter over the top. Cover lightly with foil and bake 30 minutes or until the apples are soft and the juices, bubbly. Serve warm or cold with a dollop of low-fat vanilla yogurt. Serves: 4 people 1 fruit serving per serving * Dot the top of the mixture with butter or margarine before baking in order to add calories Pumpkin Cheesecake Pudding Ingredients 1 packet unflavored gelatin 1/2 cup cold water 3 cups canned pureed pumpkin or frozen winter squash 3/4 cup brown sugar 1 1/2 cups lowfat cottage cheese 1/2 teaspoon cinnamon

16 1/2 teaspoon ground ginger 1/4 teaspoon ground cloves 3/4 cup lowfat plain yogurt Preparation Time: 0:30-1 hours Directions Soften the gelatin in the cold water in a small saucepan for 1 minute. Turn the heat to medium high and heat to dissolve completely. Pour the pumpkin, brown sugar, cottage cheese, cinnamon, ginger, and cloves into a food processor. Blend until smooth. Stir in the yogurt and pour into six individual custard cups. Chill in the refrigerator until set. Serves: 6 people 1 fruit serving per serving * use regular cottage cheese and yogurt, and substitute whole milk for water, in order to increase the caloric content of this recipe