You Have Cancer - Now, What Should You Eat?

[Guest guest]

July 6, 2004

PERSONAL HEALTH

For Survivors of Cancer, All Calories Are Not Equal

By JANE E. BRODY

After her third battle with cancer, Dyer decided she needed

something more than surgery and chemotherapy to keep the disease at

bay. During treatment, she ate whatever she could tolerate to get the

calories her body needed. But afterward, her goal was to use diet to

minimize the risk of recurrence.

She searched the scientific literature for guidance and developed a

plan based, she recognized, on " very little clinical science " but on

the best science available.

She increased her exercise; reduced her alcohol intake; avoided

saturated fats in animal foods and the trans and hydrogenated fats in

processed foods; switched to olive and canola oils; gave up red meats

and poultry but ate more soy foods, fatty fish and eggs, rich in

omega-3 fatty acids; doubled her fiber intake through whole grains,

legumes and nine or more servings a day of fruits and vegetables;

replaced diet sodas with tomato and orange juice, and green tea;

stuck to low-fat dairy products; and added nuts and flax seeds to her

diet.

She describes her plan, including what to do when eating out, in a

book, " A Dietitian's Cancer Story " (Swan Press, $15.95), and offers

two weeks of menus and recipes on her Web site, www.cancerrd.com.

Part of the sales of the book benefit the American Institute for

Cancer Research. The book can be ordered through the institute at

(800) 843-8114.

Also helpful on the subject is the American Cancer Society's

publication " Nutrition for the Person With Cancer: A Guide for

Patients and Families, " available by calling (800) ACS-2345.

Will Ms. Dyer's approach help keep her free of cancer? So far she has

been healthy. And the diet will lower her risk of heart disease.

A diagnosis of cancer is a wake-up call for many people. Hoping to

maximize their chances of survival, however, many patients turn to

strange diets, supplements and herbal remedies with little or no

scientific evidence to establish their worth. Some may be harmful.

To help health care providers and their patients make the best

choices based on the best available evidence, three years ago the

American Cancer Society published in the journal CA a guide on

nutrition during and after cancer treatment. It was designed to help

the more than 1.2 million people who each year receive cancer

diagnoses and the more than nine million Americans who have thus far

survived cancer. The article is online (caonline.amcancersoc .org) or

can be found in the May/June 2001 issue.

In addition to the nutritional advantages gained from the suggested

dietary measures, making improvements in living habits has important

psychological benefits by helping patients regain a sense of control

over their lives.

During Treatment

Current approaches to cancer treatment - surgery, radiation and

chemotherapy - may not only change a person's nutritional needs but

also interfere with the ability to consume, digest, absorb and

assimilate food. In most cases, cancer treatment increases a person's

caloric needs while making it more challenging to meet them.

Small, frequent meals and snacks and foods that are easy to chew,

swallow, digest and absorb - and that are appealing - are

recommended, even if they are high in calories or fat. This is not a

time to try to lose weight or worry about how healthful foods might

be. Meeting one's caloric needs is the primary goal; during

treatment, it is often helpful to add beverages like Ensure or Boost

as temporary aids.

Cancer patients are also urged to engage in light, regular physical

activity to counter fatigue; to stimulate appetite and digestion; to

prevent constipation; to maintain energy and muscle mass; to provide

relaxation; and to reduce stress.

But the cancer society's experts warn against consuming high levels

of certain supplements that may do more harm than good. Folic acid,

for example, can interfere with the action of some chemotherapeutic

drugs, like methotrexate, that act as folic acid antagonists. And

high doses of antioxidants, like vitamins C and E, which patients

sometimes take in hope of protecting normal cells, may reduce the

effectiveness of therapies that work by causing oxidative damage to

cancer cells.

The experts recommend as a prudent approach during treatment " not to

exceed the upper limits of the Dietary Reference Intakes for vitamin

supplements and to avoid other nutritional supplements that contain

antioxidant compounds. "

Cancer treatment often suppresses immune responses, and so it is also

important to pay particular attention to food safety. Do not eat raw

fish or undercooked meats and poultry or drink unpasteurized juices;

rinse all fruits and vegetables; and protect foods eaten uncooked

from the drippings or utensils used on raw meats, poultry and

seafood.

Once active treatment ends, the goal is to rebuild muscle strength

and correct problems like anemia that may have been caused by

treatment. Again, this is not a time to diet; the emphasis should be

on eating healthful foods.

Although daily exercise may not prevent recurrence or slow the

progression of cancer, the experts note that it can " reduce anxiety

and depression, improve mood, improve self-esteem and reduce symptoms

of fatigue, nausea, pain and diarrhea. "

Eating for Good Health

The cancer society experts say, " There is no evidence to support

fasting as a healthy practice during cancer treatment or beyond. "

Vegetarian diets and macrobiotic diets based on whole grains, fruits

and vegetables, beans, fermented soy products, nuts, seeds and

teas " can be consistent with a healthy diet " as long as consumers are

careful to take in enough calories and essential nutrients.

But the experts found " no data to support the claim that a

macrobiotic diet reduces cancer incidence or recurrence " any more

than the less restricted regimen the society recommends, which

includes animal protein foods in moderation.

Although a one-a-day type of multivitamin-mineral supplement can help

compensate for nutrient shortfalls, the experts advise against doses

above the recommended intake for any nutrient. " There is no evidence

that any nutritional supplement can reproduce the apparent benefits

of a diet high in vegetables and fruits, " the experts say.

Alcohol is best avoided or consumed in moderation - at most a drink a

day for women, two for men - since it is associated with an increased

risk of breast, lung and digestive cancers. Purple grape juice helps

protect against heart disease. Teas are all right for cancer

survivors, as long as they are made from plants that are ordinarily

used for foods or beverages. Caffeine is all right, too; it has no

link to cancer.

The jury is still out on the benefits and risks of estrogen-rich soy

foods for survivors of breast and prostate cancers, though they are

not believed to be hazardous when consumed in moderation, say, at one

meal a day. But breast cancer survivors should avoid supplements of

soy concentrates and isoflavones.

High-fat diets, in general, are not advisable for cancer survivors,

or for anyone. In place of animal-derived fats and polyunsaturates,

some experts recommend monounsaturates like olive and canola oils and

the fats in avocados, nuts and fish, which have been associated with

protection against cancer and heart disease. Foods high in sugars may

have no adverse effect on cancer, but they have limited nutrient

value and often supplant more healthful foods.

As Ms. Dyer discovered, until there is evidence to the contrary,

eating lots of fruits and vegetables and whole grains rich in

potentially protective fiber and phytochemicals should be the goal

for all cancer survivors. In fact, for everyone.