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American Cancer Society Complete Guide to Nutrition for Cancer Survivors
Eating Well, Staying Well During and After Cancer
By Barbara L. Grant, Abby S. Bloch, Kathryn K. Hamilton, Cynthia A. Thomson
American Cancer Society / Health PromotionsCopyright © 2010 American Cancer Society
All rights reserved.
EATING WELL IS AN IMPORTANT PART OF A HEALTHY LIFESTYLE. But what is meant by "eating well"? Eating well is simply eating a balance of foods to help optimize your health. Along with avoiding tobacco, keeping a healthy weight, being physically active, and limiting the alcohol you drink, eating well helps your body stay strong before, during, and after cancer treatment.
Eating well is essential for people with cancer. Getting the foods and nutrients you need will help you be in the best health as you face the challenge of cancer and cancer treatment. In fact, several nutrients may actually slow the growth of some types of cancer. Cancer treatment lowers the body's immune response and can put you at greater risk for infection. Good nutrition can counteract these effects by boosting immune response and helping maintain healthful tissues and cells. Getting the nutrients you need also will help your body heal after the stress of therapy. More people are living long lives after cancer treatment, and eating a balanced, healthy diet and being physically active helps provide a solid foundation for a healthy life.
What Is a Healthy Diet?
Before treatment, your goal is to stay strong so treatment can have the most positive effects possible. As you prepare for treatment, talk to your health care team about whether and how your diet will need to change. The best place to start is to follow established guidelines for overall good health. The American Cancer Society publishes guidelines on nutrition and physical activity for cancer prevention to advise health care professionals and the public about making positive choices for their health (see page 4). These guidelines are consistent with those of the American Heart Association and the American Diabetes Association for the prevention of coronary heart disease and diabetes, as well as for general health promotion. They represent the most current scientific evidence related to dietary and activity patterns and cancer risk. These principles are also cited by the American Cancer Society Expert Committee report, Nutrition and Physical Activity During and After Cancer Treatment: A Guide for Informed Choices.
WHAT IS A SURVIVOR?
The word "survivor" can have many different meanings. Some people use the word to refer to anyone who has received a cancer diagnosis. Some people use it when referring to a person who has completed cancer treatment. And still others call a person a survivor if he or she has lived several years past a cancer diagnosis. The American Cancer Society believes that each individual has the right to define her or her own cancer experience, and considers a cancer survivor to be any person who chooses to define himself or herself that way.
American Cancer Society Guidelines for Cancer Prevention
Maintain a healthy weight throughout life.
* Balance caloric intake with physical activity.
* Avoid excessive weight gain throughout the life cycle.
* Achieve and maintain a healthy weight if currently overweight or obese.
Adopt a physically active lifestyle.
* Adults: Engage in at least thirty minutes of moderate-to-vigorous physical activity, above usual activities, on five or more days of the week. Forty-five to sixty minutes of intentional physical activity is preferable.
* Children and adolescents: Engage in at least sixty minutes of moderate-to-vigorous physical activity at least five days per week.
Consume a healthy diet, with an emphasis on plant sources.
* Choose foods and beverages in amounts that help achieve and maintain a healthy weight.
* Eat at least five servings of a variety of vegetables and fruits each day.
* Choose whole grains in preference to processed (refined) grains.
* Limit consumption of processed and red meats.
If you drink alcoholic beverages, limit consumption.
* Drink no more than one drink per day for women or two per day for men.
In general, these guidelines can be the basis for a nourishing diet throughout the cancer experience, with the counsel of your health care team. Remember, however, that your needs and abilities may be different during cancer treatment. For example, during cancer treatment you may need to consult with a registered dietitian to reach your goal weight. Your goal weight during treatment may be different from your goal after treatment. Staying active during treatment may be different from what one would expect after treatment. To meet activity goals, you might consider participating in planned exercise programs such as exercise and yoga classes, as well as adding physical activity into your daily life. Try to move more, sit less, go up and down stairs, and do household chores and yard work.
Maintaining a Healthy Weight
The way to achieve and maintain a healthy body weight is to balance food and drink intake with physical activity. Being overweight or obese is clearly linked with an increased risk for several types of cancer, such as breast, endometrial, prostate, pancreatic, and colorectal cancer. Some studies have shown a link between losing weight and lowering the risk for certain types of cancer, such as breast, endometrial, prostate, pancreatic, and colorectal cancer.
However, it is difficult to generalize about maintaining weight during cancer treatment. During treatment, goals for nutrition and weight are based on your specific needs or weight management issues. For example, if you are underweight and preparing for an intensive type of cancer treatment (such as chemotherapy and radiation therapy given at the same time), you may be more likely to experience significant treatment-related weight loss. People receiving this type of treatment will most likely be advised by their health care team to gain weight by eating high-protein, nutrient- and calorie-dense foods.
Most people are advised to maintain their current body weight during cancer treatment. There is some evidence that gaining weight during cancer treatment can have unfavorable effects on cancer outcomes. And weight gain during or after treatment can contribute to the risk of cancer, as well as other obesity-related problems such as diabetes, hypertension, or heart disease. If you are overweight or obese, your doctor may advise you to lose weight before surgery — if there is time for you to do so safely. See chapter 8 for specific tips and suggestions for maintaining a healthy body weight before, during, and after your cancer treatment.
YOUR HEALTH CARE TEAM
The term "health care team" can represent different things to different people. Depending on where you live or where you seek medical care, your "team" may be quite different from the care providers your family or friends may have had at different cancer treatment facilities. For example, if you are undergoing cancer treatment at a large metropolitan medical center or a community cancer center, your care may be provided by a large "team" of health care professionals such as doctors (e.g., surgeons, medical oncologists, and radiation oncologists), nurse practitioners, nurses, registered dietitians, pharmacists, social workers, therapists, and counselors. If you are receiving cancer treatment in a doctor's office or clinic, however, your "team" may be made up of only your doctor and a nurse. Throughout your cancer treatment, be sure to talk to your health care team about your questions and concerns.
Adopting a Physically Active Lifestyle
Scientific evidence indicates that physical activity can decrease the risk for several types of cancer. Taking part in physical activity can also be a great opportunity to spend time with a friend, spouse, or child. There is also evidence that physical activity is safe and possible while you are undergoing cancer treatment, and in some cases, can help to alleviate some of the side effects of treatment. Studies have shown that regular physical activity can reduce anxiety and depression, improve mood, boost self-esteem, and lessen nausea and pain. While most people who are fatigued do not feel like being physically active, current studies show this is exactly what is needed — people undergoing cancer treatment who are fatigued and get more physical activity can actually reduce their fatigue substantially.
Even among breast cancer survivors who are at risk for or who have been diagnosed with treatment-related lymphedema, new studies show that engaging in physical activity is not a problem and may actually lessen lymphedema symptoms. Exercise during treatment is discussed further in chapters 8, 9, 10, and 13. Talk to your health care team about the level of activity that is right for you.
Consuming a Healthy Diet
Vegetables and Fruits
It is reasonable for most people with cancer to follow dietary recommendations for eating five or more servings of vegetables and fruits daily. Many vegetables and fruits, such as baby carrots, grapes, cherry tomatoes, and bananas, can be eaten on the spot, with minimal preparation. Fresh produce should always be well washed with water before eating to remove any surface dirt and bacteria, especially if you are going to eat the skin. The skin of vegetables and fruits contains fiber and is rich in healthy compounds known as phytochemicals (see page 68). In addition, for most vegetables and fruits, the nutrients are better preserved if the produce is fresh and raw. Purchasing produce twice a week and using local farmer's markets can help to ensure freshness, or you could be adventurous and plant a small garden. In addition, cooking can reduce nutrient content, as some vitamins are leached into cooking water; when you do cook vegetables, minimize the amount of water used and the cooking time as much as possible.
A whole grain contains the germ (the sprout of a new plant), endosperm (the seed's source of energy), and bran (the outer layer) of a grain or seed. Whole grains provide complex carbohydrates (starches), which help provide energy, fiber (the part of plant foods that the body cannot digest), and vitamins and minerals such as folate. Whole grain foods differ in nutrient content, but all whole grain foods provide more vitamins, minerals, fiber, and other protective substances than refined grains. Refined grains such as bleached (white) flour have the bran and germ removed during milling and therefore lack many of the nutrients found in whole grains, including B vitamins, iron, zinc, phytochemicals, vitamin E, and fiber. A regular intake of fiber-rich foods such as whole grains (as well as many vegetables and fruits) helps maintain proper bowel function.
Whole grains provide foods with darker, richer color and heavier weight and texture. In the United States, people eat on average only half a serving of whole grains a day, which means we miss out on much of the folate, selenium, and other nutrients in them. Brown rice, millet, quinoa, kasha (buckwheat), barley, whole wheat pasta, and bulgur are good sources of whole grains. Between 15 and 20 percent of cereals contain whole grain as a main ingredient.
Dietary fiber includes a wide variety of plant carbohydrates that are not digested by humans. Fiber can be soluble (dissolvable in water), such as oat bran, or insoluble (not dissolvable in water), such as wheat bran or cellulose. Soluble fiber helps reduce blood cholesterol, thereby lowering the risk of coronary heart disease. Good sources of fiber are beans, vegetables, whole grains, and fruits.
WHAT COUNTS AS A SERVING?
Here's how the United States Department of Agriculture (USDA) defines a serving of fruit or vegetables:
1 medium piece of fruit or !½ cup fruit
½ cup of 100 percent juice
¼ cup dried fruit
½ cup raw non-leafy or cooked vegetables
1 cup raw leafy vegetables (such as lettuce)
½ cup cooked beans or peas (such as lentils, pinto beans, and kidney beans)
There is no solid scientific evidence that eating fiber reduces the risk of developing cancer, but eating fiber-rich whole grains is still recommended because they contain other substances beyond fiber alone that may help prevent cancer and because they have other health benefits.
WHAT IS FIBER?
Fiber refers to the parts of plant foods that the body cannot digest. Fiber is most abundant in whole grains and gives them their dark color, heavy feel, and great nutrient content. Fiber can also be found in vegetables, fruits, nuts, seeds, and beans. The amount of whole grains and fiber you need depends on your age, gender, and amount of physical activity. Currently, the recommendation is that healthy adults should try to eat at least twenty-five grams of fiber daily. One way to increase fiber is buying whole grain products whenever possible, such as brown rice instead of white rice, whole grain pasta instead of egg noodles, and old-fashioned rolled oats instead of instant oatmeal. Most people will need to work up to this level slowly over time because gas or bloating can occur with abrupt increases in fiber intake. A supplement such as Beano that contains natural enzymes can help to decrease the digestive problems that can occur after eating these foods.
Fiber is classified as either soluble or insoluble, which refers to whether it dissolves in water (is soluble) or not. Both types are important to health. Soluble fiber is found in oats, legumes, barley, apples, berries, and carrots, and it helps reduce the amount of cholesterol in your blood and may help control blood sugar and insulin levels. Insoluble fiber is found in whole grains, bran, some vegetables and fruits, and seeds, and it promotes normal, regular bowel movements.
Fiber also can be consumed as a supplement, but food sources are considered the best sources for fiber. Fiber supplements are known as functional fibers and are generally manufactured from dietary sources (for example, chitin from crab and lobster shells, fructans from chicory and onions, beta glucans from oats and barley, guar gum from guar beans, and psyllium from psyllium seed). Whereas supplements are considered an easy way to get adequate fiber each day, there is little data on the role of supplemental fiber products in cancer prevention. Fiber is best obtained from beans, whole grains, vegetables, and fruits, rather than from supplements.
Benefits of Whole Grains
Many of the carbohydrates eaten in the United States are sugars and refined starches, which have little to no fiber and do not do the body much good. Whole grains, however, contain many more nutrients than refined grains and provide several health benefits:
They help maintain a healthy body and weight. The high fiber content of many whole grains may help you feel full with fewer calories.
Fiber-containing foods, when eaten with adequate water or other fluids, promote proper bowel function.
These foods may help you live a longer life. A study of thirty-five thousand women showed that those who ate at least one serving of whole grains a day lived longer than women who ate few or no whole grains.
There are some simple ways to incorporate more whole grains into your diet:
Eat whole grain bread, bagels, and English muffins instead of white, and choose plain oatmeal over low-fiber, sugary cereals.
Add whole grains such as barley or whole wheat pasta to your soup.
Try whole grain crackers (such as wheat, rye, pumpernickel, etc.) as a snack.
Choose whole wheat flour over refined white flour. (Whole wheat flour contains nutrients that can spoil and should be stored in the refrigerator.)
Experiment with bulgur, millet, quinoa, and pearl barley.
Look for foods with whole grain listed as the first ingredient, and try to choose unprocessed foods — foods that have not been altered from their original states. Processed foods include frozen dinners, many canned or boxed "convenience" foods, processed meats (such as lunch meats, bologna, hot dogs, and sausage), and packaged cakes, cookies, and snack foods.
Also note the following when selecting foods:
"Multigrain," "seven grain," and "made with whole grain" labels do not mean a food is whole grain. Only whole grain foods may be labeled as "whole grain."
The Nutrition Facts panel lists how much fiber a serving of food contains. Although two grams or more of fiber per serving qualifies a food as whole grain, selecting foods with more than four grams per serving is advised.
A claim can be made that a food is a "good source" of fiber if it provides 10 percent (two and a half grams) of the Daily Value (twenty-five grams) of fiber per serving. Foods can be called "high in fiber," "rich in fiber," or an "excellent source of fiber" if they contain 20 percent (five grams) of the Daily Value of fiber per serving.
Excerpted from American Cancer Society Complete Guide to Nutrition for Cancer Survivors by Barbara L. Grant, Abby S. Bloch, Kathryn K. Hamilton, Cynthia A. Thomson. Copyright © 2010 American Cancer Society. Excerpted by permission of American Cancer Society / Health Promotions.
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