Nutrition+for+the+Person+With+Cancer

Nutrition for the Person With Cancer During Treatment: A Guide for Patients and Families Nutrition is an important part of cancer treatment. Eating the right kinds of foods before, during, and after treatment can help you feel better and stay stronger. Chances are, if you are reading this booklet either you or someone you care about is going through cancer treatment. The American Cancer Society has prepared this guide to help you and your loved ones cope with treatment side effects that might affect how well you can eat. Not everyone has nutrition-related side effects, but this guide will help you address them if and when they come up. You don’t have to read straight through all of the information here. You can just read the sections you need and use the information that applies to you. The information in this guide is not meant to replace the advice of a medical professional. If you have any questions or concerns, you should talk to a doctor, nurse, or dietitian about your nutritional needs. A registered dietitian (RD) can be one of your best sources of information about your diet. If you are going to meet with a dietitian, be sure to write down your questions before your meeting so you won’t forget anything. And be sure to ask the dietitian to repeat or explain anything that is not clear. If you have questions about something in this guide, the dietitian can give you a more detailed explanation. For a more detailed discussion of nutrition before, during, and after cancer treatment, please see our book called The American Cancer Society Complete Guide to Nutrition for Cancer Survivors: Eating Well, Staying Well During and After Cancer. For more information or to find a registered dietitian, contact the American Dietetic Association (see the “To learn more” section). Benefits of good nutrition Good nutrition is especially important if you have cancer because both the illness and its treatments can change the way you eat. Cancer and cancer treatments can also affect the way your body tolerates certain foods and uses nutrients. The nutrient needs of people with cancer vary from person to person. Your doctor, nurses, and a registered dietitian can help you identify your nutrition goals and plan ways to help you meet them. Eating well while you are being treated for cancer might help you: • Feel better. • Keep up your strength and energy. • Maintain your weight and your body’s store of nutrients. • Better tolerate treatment-related side effects. • Lower your risk of infection. • Heal and recover faster. Eating well means eating a variety of foods that will give your body the nutrients needed to help fight cancer. These nutrients include protein, carbohydrates, fat, water, vitamins, and minerals. Nutrients Proteins We need protein for growth, to repair body tissue, and to keep our immune systems healthy. When your body doesn’t get enough protein, it might break down muscle for the fuel it needs. This makes it take longer to recover from illness and can lower resistance to infection. People with cancer often need more protein than usual. After surgery, chemotherapy, or radiation therapy, extra protein is usually needed to heal tissues and help fight infection. Good sources of protein include fish, poultry, lean red meat, eggs, low-fat dairy products, nuts and nut butters, dried beans, peas and lentils, and soy foods. Fats Fats play an important role in nutrition. Fats and oils are made of fatty acids and serve as a rich source of energy for the body. The body breaks down fats and uses them to store energy, insulate body tissues, and transport some types of vitamins through the blood. You may have heard that some fats are better for you than others. When considering the effects of fats on your heart and cholesterol level, choose monounsaturated and polyunsaturated fats more often than saturated fats or trans fats. • Monounsaturated fats are found mainly in vegetable oils like olive, canola, and peanut oils. • Polyunsaturated fats are found mainly in vegetable oils like safflower, sunflower, corn, and flaxseed. They are also the main fats found in seafood. • Saturated fats are mainly found in animal sources like meat and poultry, whole or reduced-fat milk, cheese, and butter. Some vegetable oils like coconut, palm kernel oil, and palm oil are saturated. Saturated fats can raise cholesterol and increase your risk for heart disease. Less than 10% of your calories should come from saturated fat. • Trans-fatty acids are formed when vegetable oils are processed into margarine or shortening. Sources of trans fats include snack foods and baked goods made with partially hydrogenated vegetable oil or vegetable shortening. Trans fats also are found naturally in some animal products, like dairy products. Trans fats can raise bad cholesterol and lower good cholesterol; try to eliminate them from your diet. Carbohydrates Carbohydrates are the body’s major source of energy. Carbohydrates give the body the fuel it needs for physical activity and proper organ function. The best sources of carbohydrates – fruits, vegetables, and whole grains – also supply needed vitamins and minerals, fiber, and phytonutrients to the body’s cells. Whole grains or foods made from them contain all the essential parts and naturally occurring nutrients of the entire grain seed. Whole grains are found in cereals, breads, flours, and crackers. Some whole grains, such as quinoa, brown rice, or barley, can be used as side dishes or part of an entree. When choosing a whole-grain product, look for the words “whole grain,” “stone ground,” “whole ground,” “whole-wheat flour,” “whole-oat flour,” or “whole-rye flour.” Fiber is the part of plant foods that the body cannot digest. There are 2 types of fiber. Insoluble fiber helps to move food waste out of the body quickly, and soluble fiber binds with water in the stool to help keep stool soft. Other sources of carbohydrates include bread, potatoes, rice, spaghetti, pasta, cereals, corn, peas, and beans. Sweets (desserts, candy, and drinks with sugar) can supply carbohydrates, but provide very little in the way of vitamins, minerals, or phytonutrients. Water Water and liquids or fluids are vital to health. All body cells need water to function. If you do not take in enough fluids or if you lose fluids through vomiting or diarrhea, you can become dehydrated (your body doesn’t have as much fluid as it should). If this happens, the fluids and minerals that help keep your body working can become dangerously out of balance. You do get some water from the foods you eat, but a person should drink about eight 8-ounce glasses of liquid each day to be sure that all the body cells get the fluid they need. You may need extra fluids if you are vomiting or have diarrhea. Keep in mind that all liquids (soups, milk, even ice cream and gelatin) count toward your fluid goals. Vitamins and minerals The body needs small amounts of vitamins and minerals to help it function properly. Most are found naturally in foods. They are also sold as supplements in pill and liquid form. They help the body use the energy (calories) found in foods. A person who eats a balanced diet with enough calories and protein usually gets plenty of vitamins and minerals. But it can be hard to eat a balanced diet when you are being treated for cancer, especially if you have treatment side effects that last for a long time. In this case, your doctor or dietitian may suggest a daily multivitamin and mineral supplement. If you are thinking of taking a vitamin or supplement, be sure to discuss this with your doctor first. Some people with cancer take large amounts of vitamins, minerals, and other dietary supplements to try to boost their immune system or even destroy cancer cells. But some of these substances can be harmful, especially when taken in large doses. In fact, large doses of some vitamins and minerals may make chemotherapy and radiation therapy less effective. If your oncologist says it is OK for you to take a vitamin during treatment, it may be best to choose a supplement with no more than 100% of the Daily Value (DV) of vitamins and minerals and one without iron (unless your doctor thinks you need iron). Antioxidants Antioxidants include vitamins A, C, and E; selenium, and zinc; and some enzymes that absorb and attach to free radicals, preventing them from attacking normal cells. If you want to take in more antioxidants, health experts recommend eating a variety of fruits and vegetables, which are good sources of antioxidants. Taking large doses of antioxidant supplements or vitamin-enhanced foods or liquids is usually not recommended while getting chemo or radiation therapy. Talk with your doctor to find out the best time to take antioxidant supplements. Phytonutrients Phytonutrients or phytochemicals are plant compounds like carotenoids, lycopene, resveratrol, and phytosterols that are thought to have health-protecting qualities. They are found in plant products such as fruits, vegetables, and teas. Pill or supplement forms of phytochemicals have not been shown to be as helpful as eating the foods that contain them. Herbs Herbs have been used to treat disease for hundreds of years, with mixed results. Today, herbs are found in many products, like pills, liquid extracts, teas, and ointments. Many of these products are harmless and safe to use, but others can cause severe and harmful side effects. Some may even interfere with proven cancer treatments, including chemo, radiation therapy, and recovery from surgery. If you are interested in using products containing herbs, talk about it with your oncologist or nurse first. Safety considerations Many people believe that if they find a pill or supplement in stores, it is safe and it works. The Food and Drug Administration (FDA) put out rules in 2007 to help ensure that supplements contain what their labels claim they do, but the supplement’s safety and its effects on the body are not addressed by any FDA rules. The FDA does not make manufacturers of these products print possible side effects on their labels. And the FDA cannot pull a dietary supplement or herbal product from the market unless it can prove that the product is unsafe. Tell your health care team about any over-the-counter products or supplements you are using or are thinking about using. Take the bottle(s) to your doctor to talk about the dose, and be sure that the ingredients do not interfere with your health or cancer treatments. Some other safety tips: • Ask your doctor or nurses for reliable information on dietary supplements. • Check the product labels for both the quantity and concentration of active ingredients contained in each product. • Stop taking the product and call your doctor right away if you have side effects, like wheezing, itching, numbness, or tingling in your limbs. If you would like to learn more about a vitamin, mineral, herb, or supplement, call us at 1-800-227-2345 or visit our Web site at www.cancer.org. Cancer and cancer treatment affect nutrition When you are healthy, eating enough food to get the nutrients and calories you need is not usually a problem. In fact, most nutrition guidelines stress eating lots of vegetables, fruits, and whole-grain products; limiting the amount of red meat you eat, especially those that are processed or high in fat; cutting back on fat, sugar, alcohol, and salt; and staying at a healthy weight. But when you are being treated for cancer, these things can be hard to do, especially if you have side effects or just don’t feel well. So, you might need to change your diet to help build up your strength and withstand the effects of your cancer and its treatment. This may mean eating things that are not normally recommended when you are in good health. For instance, you may need high-fat, high- calorie foods to keep up your weight, or thick, cool foods like ice cream or milk shakes because sores in your mouth and throat are making it hard to eat anything. The type of cancer, your treatment, and any side effects you have must be considered when you are trying to figure out the best ways to get the nutrition your body needs. When your cancer was first diagnosed, your doctor talked with you about a treatment plan. This may have meant surgery, radiation therapy, chemotherapy, hormone therapy, biologic therapy (immunotherapy), or some combination of treatments. All of these treatments kill cancer cells. But in the process some healthy cells are also damaged. This damage is what causes cancer treatment side effects. Some of the more common side effects that can affect your ability to eat are: • Loss of appetite (anorexia) • Sore mouth or throat • Dry mouth • Dental and gum problems • Changes in taste or smell • Nausea • Vomiting • Diarrhea • Constipation • Feeling very tired all the time (fatigue) • Depression You might or might not have any of these side effects. Many factors determine whether you will have any side effects and how bad they will be. These factors include the type of cancer you have, the part of the body affected, the type and length of your treatment, and the dose of treatment. Many side effects can be controlled, and most go away over time after treatment ends. Talk with your doctor or nurse about your chances of having side effects and what can be done to help control them. After your treatment starts, tell your cancer care team about any side effects that are not being controlled. Let them know if the medicines they have given you to control side effects do not work, so that others can be used. Before treatment begins Until you begin treatment, you won’t know exactly what, if any, side effects you may have or how you will feel. One way to prepare is to look at your treatment as a time to focus on yourself and on getting well. Here are some other ways to get ready. Make plans now You can reduce your anxiety about treatment and side effects by taking action now. Talk to your treatment team about the things that worry you. Learn as much as you can about the cancer and your treatment plan. Planning how you will cope with possible side effects can make you feel more in control and ready for the changes that may come. Many people have few or no side effects that keep them from eating. Even if you have side effects, they may be mild, and you may be able to manage them with drugs or simple diet changes. Most side effects go away after cancer treatment ends. Here are some tips to help you get ready for treatment: • Stock your pantry and freezer with your favorite foods so you won’t need to shop as often. Include foods you know you can eat even when you are sick. • Cook in advance, and freeze foods in meal-sized portions. • Talk to your friends or family members about ways they can help with shopping and cooking, or ask a friend or family member to take over those jobs for you. • Talk to your doctor, nurse, or a registered dietitian about any concerns you have about eating well. They can help you manage side effects like constipation or nausea. For more information on coping, see the “To learn more” section and/or call your American Cancer Society at 1-800-227-2345. Once treatment starts Eat well Your body needs a healthy diet to function at its best. This is even more important if you have cancer. With a healthy diet, you’ll go into treatment with reserves to help keep up your strength, prevent body tissue from breaking down, rebuild tissue, and maintain your defenses against infection. People who eat well are better able to cope with side effects of treatment. And you may even be able to handle higher doses of certain drugs. In fact, some cancer treatments work better in people who are well-nourished and are getting enough calories and protein. • Don’t be afraid to try new foods. Some things you may never have liked before may taste good during treatment. • Choose different plant-based foods. Try eating dried beans and peas instead of meat at a few meals each week. • Try to eat at least 5 colorful servings of fruits and vegetables a day, including citrus fruits and dark-green and deep-yellow vegetables. Colorful vegetables and fruits and plant-based foods contain natural health-promoting substances called phytochemicals. • Limit high-fat foods, especially those from animal sources. Choose lower-fat milk and dairy products. Reduce the amount of fat in your meals by choosing a lower-fat cooking method like baking or broiling. • Try to stay at a healthy weight, and stay physically active. Small weight fluctuations during treatment are normal. • Limit the amount of salt-cured, smoked, and pickled foods you eat. If you cannot do any of the above during this time, do not worry about it. Help is available if or when you need it. Sometimes diet changes are needed to get the extra fluids, protein, and calories you need. Tell your doctor, nurse, or dietitian about any problems you have. Snack as needed During cancer treatment your body often needs extra calories and protein to help you maintain your weight and heal as quickly as possible. If you are losing weight, snacks can help you meet those needs, keep up your strength and energy level, and help you feel better. During treatment you may have to rely on snacks that are less healthy sources of calories to meet your needs. Keep in mind that this is just for a short while – once side effects go away you can return to a more healthy diet. To make it easier to add snacks to your daily routine, try the following: • Eat small snacks throughout the day. • Keep a variety of protein-rich snacks on hand that are easy to prepare and eat. These include yogurt, cereal and milk, half a sandwich, a bowl of hearty soup, and cheese and crackers. • Avoid snacks that may make any treatment-related side effects worse. If you have diarrhea, for example, avoid popcorn and raw fruits and vegetables. If you have a sore throat, do not eat dry, coarse snacks or acidic foods. • If you are able to eat normally and maintain your weight without snacks, then do not include them. Examples of quick-and-easy snacks Angel food cake Gelatin Popcorn, pretzels Cereal (hot or cold) Granola or trail mix Puddings, custards Cheese Homemade milk shakes and drinks Sandwiches such as egg salad, grilled cheese, or peanut butter Cookies Ice cream, sherbet, and frozen yogurt Soups (broth based or hearty) Crackers Juices Sports drinks Dips made with cheese, beans, yogurt, and peanut butter Milk Vegetables (raw, cooked, juices) Eggnog (pasteurized) Muffins Yogurt (low fat or Greek) Fruit (fresh, frozen, canned, dried) Nuts, seeds, and nut butters Tips to increase calories and protein • Eat several small, frequent snacks throughout the day, rather than 3 large meals. • Eat your favorite foods at any time of the day. For example, eat breakfast foods for dinner if they appeal to you. • Eat every few hours. Don’t wait until you feel hungry. • Eat your biggest meal when you feel hungriest. For example, if you are most hungry in the morning, make breakfast your biggest meal. • Try to eat high-calorie, high-protein foods at each meal and snack. • Exercise lightly or take a walk before meals to increase your appetite. • Drink high-calorie, high-protein beverages like milk shakes and canned liquid supplements. • Drink most of your fluids between meals instead of with meals. Drinking fluid with meals can make you feel too full. • Try homemade or commercially prepared nutrition bars and puddings. High-protein foods* Milk products Eat cheese on toast or with cracke