Nutrition and Breast Cancer An informative presentation about all all aspects of Nutrition and Cancer By Angela D’Amore Mount Hospital Dieititan Overview Risk factors Common treatment and nutritional side effects Healthy eating guidelines Unproven diets/therapies Changes in weight Avoiding reflux Bowel care Fluid and hydration Low bacteria diet summary Cancer risk factors Obesity Physical activity Consume a healthy diet with an emphasis on plant sources Processed meats and red meats (for colon cancer) Alcohol Common treatment nutritional side effects Breast cancer chemo Nausea and Vomiting Florouracil (5FU) Epirubicin Diarrhoea Sore mouth Reduced appetite Cyclophosphamide Doxirubicin Taxotere FEC Tast e chan ges Reduced immunity methotrexate Paxiaxol (Taxol) Other side effects • Gastrointestinal: bloating, constipation – Cells as rapidly turning over in the gut and chemo affects these • Weight changes – Weight gain: more breast and prostate – Weight loss: more lung, bowel, pancreatic Controlling side effects • Medications I.e Nausea & Vomiting, Diarrhoea etc • Gels for mouth ulcers • Diet I.e reduced Nausea, improve taste of food, reduce pain with mouth ulcers • www.macmillan.org.uk Healthy eating guidelines Maintaining adequate Nutrition and food intake during chemotherapy is optimal to minimise deficiency and optimise your immune system Nutrition recommendations for cancer patients are designed to help the patient cope with the effects of the cancer and its treatment No special foods or diets have been scientifically proven to cure or prevent cancer Diet Myths and Cancer • What have you been told or read about Nutrition and Cancer? Unproven diets/therapies Low Dairy Diets Calcium is an important nutrient for bone health and provides protein for muscle strength Protective effect in colorectal cancer shown (with calcium supplements No significant association between dairy and breast/ovarian cancer Other Diet and cancer “Myths” Myth 1: Large amounts of protein can cause the cancer to return not true. Protein is much needed to help with healing of the muscles and to prevent them from wasting. No need to be excessive but avoiding protein may be damaging Myth 2, Juicing is a better way to consume vegetables Not true Certain vegetables like tomatoes require heat and oil for our body to absorb the 'lycopene' (active ingredient) that is needed. Juicing also removes fibre and pulp that we need for good bowel movements. Diet & Cancer myths cont… Myth 3, Becoming a vegetarian will improve chances of recovery Drastic diet changes are not recommended nor will they do anything to reduce cancer progression/treatment tolerance Myth 4, Relatives and blood related families have the best answers They may have gone through the process but always check with your doctor or dietitian the evidence/truth behind the suggestions Diet & Cancer myths cont… Myth 5, Losing weight is a good thing It is very common to lose a bit of weight during cancer treatments. Weight loss is expected during such events. But if there is a significant or big drop of weight, please consult your doctor about it. Losing a lot of weight at a time is a sign of another underlying problem Other nutrients/foods Soy Rich in Phyto-estrogens which mimic oestrogen in the body High consumption of soy foods may lower the risk of breast and prostate cancer (but only slightly) Existing or previous Breast cancer patients should avoid consuming large volumes of soy or phyo-estrogen supplements Low Sugar Diets • Sugar does not feed cancer cells • Although all cells, including cancer cells, use glucose (blood sugar) for energy, sugar does not speed tumor growth. In turn, removing sugar from your diet will not slow tumor growth. • Balanced diet with some sugars is best Vitamin Supplements etc Supplements= specific isolated nutrients Nutrients from food work together to more protective effect than supplements High doses of some vitamins I.e Vit C can increase risk of Lung cancer in smokers Antioxidants- Vitamin A (beta carotene) supplements can increase risk of certain cancers Vitamin supplements can interfere/interact with the chemo Herbs/homeopathic remedies- can interfere as well, contact Oncologist if unsure Factors that indicate “Fad diet” • Does it exclude one of the 5 food groups? • Does it include large amounts of fruit, vegetables or their juices? • Does it limit cooked foods or cooking methods allowed? • Does it limit protein foods like meat, chicken or fish? • Is it causing you to lose weight? • Include large amount of supplements • Cost you in time and money Weight Management • A high BMI (Body Mass Index) = inc risk of breast cancer development • If overweight to start you may gain weight during treatment (menopause, steroid sensitivity etc) • If your appetite fluctuates don’t overcompensate your food intake when you feel well • Hormone therapy may cause inc weight gain Changes in Weight • Weight loss of > 10% in 1 month - Is not desirable even if you are overweight (BMI > 25) - Research shows that any weight loss incurred is muscle mass not as fat mass - This makes you less active/weak/dec function and energy levels - Aim to maintain weight through healthy eating and high protein diet - May need protein supplements, talk to Dietitian and individual consult may be required Changes in Weight • Weight gain - Research shows that breast cancer patients who gain weight throughout chemo are still losing muscle. - Some of the weight gain is fluid - healthy balanced eating to promote fat loss not muscle loss - Eat small, regular, low fat, high protein meals - If you are overweight tor obese, start looking at your lifestyle habits seriously after your treatment and aim to lose slowly and healthily Diet Post Chemo • Chemo increases the risk of reflux – Reduce intake of Orange juice • Lemon • Lemonade • Grapefruit juice • Cranberry juice • Tomato For a few days post chemo treatment Diet Post Chemo • Drink lots of water and nutritious fluids • Soup, Juice, milk, Milkshakes etc Bowel Changes • Can alternate between constipation and diarrhoea • Diarrhoea – – – – Stick to LOW FIBRE FOODS White breads, pasta, rice, refined cereals Fruits without skins, bananas, limited vegies Can have “soluble fibre” – helps form stools/adds bulk I.e psyllium husks, Benefibre powder. Bowel Changes • Constipation – Can reduce appetite – Definition – Increase fibrous foods: fruits (dried especially), vegetables, all grains to be wholemeal/wholegrain I.e pasta, rice, bread and cereal – Fibre supplement I.e Psyllium Husks, Benefibre – DRINK! Fluid intake is important- 1-1.5 LITRE WATER + other fluids Other things • Thrush or bout of Diarrhoea = take 1 serving yakult daily for 10 days • Drink lots of fluid after Diarrhoea even more than Rec 2 L/day Protein • Adequate protein helps reduce muscle wastage and improve energy • Include a source at each meal- at least 50g per day • Requirement: 0.75 multiply by your weight= number of grams pf protein needed per day (may be too high, minimum 50g/day) Sources • • • • • • • • • • • • Protein content of common foods: Beef, chicken, 90g cked= Tuna, ½ cup ½ cup legumes= Cheese- cheddar, 2 slices= Cheese, ricotta, ½ cup= Milk, 1 cup= Yoghurt, 100g= Egg, 1= Nuts, 2 tbs= Cereals, ½ cup Pasta, rice, per ½ cup= 20g 15g 7-8 g 6g 5g 8g 5g 6g 6g 1-2 g 2g Meal Plan to meet Ptn requirements • • • • • • Breakfast: Cereal- Muesli with nuts,½ cup (6g) + ½ cup milk (4g) = 10g Morning tea: Milky coffee (1 cup milk) = 8g Lunch 1 tin flavoured tuna (13g) + 2 wholegrain crackers (1g)= 14g Afternoon tea 100g Yoghurt = 5g Dinner 60g cooked meat, chicken, fish + vegies (0) = 15g Supper fruit (0) + 100g lite custard = 5g = 54g total Low Bacteria Diet • When your levels of neutrophils, a type of white blood cells, become too low • Neutrophils defend against infections – Mild - ANC of 1000-1500 cells per mm3. – Moderate - ANC between 500 - 1000 cells per mm3. – Severe - ANC falls below 500 per mm3 • Following a low bacteria diet is the only thing you can do to manage • Usually transient and comes Low Bacteria Diet • Foods low in bacteria must be eaten whilst your white cell count is low • Avoid – Raw meats or processed meats (inc smoked salmon) – Fresh or moudly cheeses (cream and hard cheese is fine) – Salad bars, buffets etc. – all food much be freshly prepared! – Soft serve/milkshakes – Products with raw eggs – Unpasteurized products Summary 1) Don’t exclude food groups 2) Don’t overload one type of food I.e pomegranate 3) Don’t replace fruit with juices, have juices after meals 4) Ok to eat cooked foods but reduce deep frying 5) Protein is important for muscle turnover and repair 6) Watch mega doses of vitamins/minerals 7) CONSULT A QUALIFIED DIETITIAN Questions?