Carolyn's Cancer Lectures

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Nutrition During Treatment

Nutrition During Treatment

    If you have been diagnosed with cancer, one of the most important things for you to consider as part of your whole treatment regimen is nutrition. Eating a healthy diet can make a big difference in the success of your treatment. One simple rule of thumb is to maintain a steady body weight throughout treatment as much as possible. This means neither gaining too much, nor losing too much weight (fluctuations of more than, say, 5lb per week).
    • Before Treatment:

      Surgery
      Eat a low fat (less than 25% calories), high protein (8-10 oz lean meat, chicken or turkey for example) diet the day before surgery. Supplement with a broad spectrum multi-vitamin and mineral with 100% RDA. Additionally, 500 mg vitamin C with bioflavonoids every 8 hours may be beneficial to healing. Stop supplements of vitamin E, vitamin K, evening primrose, borage or fish oils supplements 1 week before surgery as these can cause thinning of the blood.

      Radiation
      No special diet.

      Chemotherapy
      Eat low fat, high carbohydrate diet the day before chemotherapy. Supplement with multivitamin and mineral giving 100% RDA.

    • During Treatment - Expedient Diet:

      Surgery
      As per surgeon's protocol.

      Radiation
      Extra carbohydrate calories for energy

      Chemotherapy
      Avoid eating your favorite foods within 24 hrs of treatment to avoid negative associations with them at a later time. Eat low fat (less than 3 tablespoons or 40 grams fat/oil per day), high carbohydrate (mainly complex carbohydrate (starch) from grains, fruits and vegetables) diet with small quantities of good quality protein. White meat chicken, fish and eggs are easy to digest. Protein powder-based (soy or whey) smoothies are also good ways to add in extra protein.

    • After Treatment:

      Surgery
      High protein diet (8-10 oz lean meat, poultry, fish or 2-3 eggs) Regular supplements as above. Antioxidant supplement including 400 IU vitamin E and 500 mg vitamin C per day.

      Radiation
      High protein and energy diet. Lactose-free and relatively low in simple sugars (sucrose, honey) to avoid intestinal discomfort.

      Chemotherapy
      Small, frequent meals of easy to digest foods such as fish, chicken, rice, baked potato, banana, apple sauce. Stimulate appetite with ginger ale. If weight drops rapidly add Energy Drinks (see recipes) or meal replacement type products. Avoid lactose as above.

    Specific Chemotherapy Agents and Nutrition

    Asparaginase, Elspar Drink extra fluids. Consume extra calories.
    Bleomycin, Blenoxane Bland foods.
    Busulfan, Myleran Drink extra fluids. Eat foods rich in B vitamins.
    Carmustine, BiCNU Bland foods, avocado.
    Chlorambucil, Leukeran Drink extra fluids. Bland foods, avocado.
    Cisplatin and carboplatin Avoid purine rich foods (liver, caviar, sardines, anchovies). Eat plenty of magnesium, potassium and zinc rich foods (whole grains and nuts). Drink extra fluids.
    Cladribine, 2-CdA, Leustatin General dietary advice.
    Cyclophosmide, Cytoxan Drink extra fluids. Don't cut back on salt or sodium containing foods. Avoid alcohol. Eat bland and low fat foods.
    Cytarabine, Ara-C, Cytosar-U Drink extra fluids. Bland foods, avocado.
    Dacarbazine,DITC-Dome Drink extra fluids. Bland foods, avocado.
    Daunorubicin, Cerubine Drink extra fluids. Eat foods rich in B vitamins particularly riboflavin (milk, lean meat, egg yolks, wheat germ).
    Doxorubicin, Adriamycin Drink extra fluids. Eat foods rich in B vitamins particularly riboflavin (see above).
    Etoposide, VePesid, VP-16 Bland foods, avocado.
    Fludarabine, Fludara-IV Drink extra fluids.
    Hydroxyurea, Hydrea Drink extra fluids.
    Idarubicin, Idamycin Drink extra fluids.
    Ifosfamide, Ifex Drink extra fluids.
    Lomustine, CeeNU Bland foods, avocado.
    Mechlorethamine, Mustargen Drink extra fluids. Restrict simple sugars.
    Melphalan, Alkeran Drink extra fluids.
    Mercaptopurine, Purinethol Drink extra fluids, avoid alcohol. Avoid foods rich in purines (anchovies, kidneys, liver, meat extracts, sardines, beans and lentils). Eat foods rich in B vitamins like wheat germ.
    Methotrexate, Mexate Drink extra fluids, avoid alcohol, bland diet. Eat foods that produce an alkaline urine to assist excretion (almonds, milk, fruits and vegetables except cranberries, plums, corn and lentils).
    Mitomycin, Mutamycin Drink extra fluids, bland diet, avocado. Eat foods rich in folate (green, leafy vegetables, citrus fruits) and foods rich in calcium (dairy foods, broccoli)
    Mitoxantrone, Novantrone Drink extra fluids (discolored urine)
    Pentostatin, Nipent Bland foods, avocado.
    Procarbazine, Matulane Avoid tyramine containing foods (aged cheeses, yogurt, raisins, eggplant, canned figs, salami, sour cream, avocados, bananas, soy sauce, lima beans, tenderized meats, etc. - ask for a list from doctor). Maintain tyramine free diet for 14 days after treatment ceases. No alcohol.
    Tamoxifen, Nolvadex Avoid high fat foods. Exercise regularly to minimize possible weight gain side effect. Eat foods rich in calcium and magnesium (dairy foods, broccoli, nuts and seeds).
    Thioguanine, Tabloid High fiber diet.
    Vinblastine, Velban Drink extra fluids.
    Vincristine, Oncovin Drink extra fluids, bland diet, avocado.

    New Anti-Cancer Agents

     

    Interferon-recombinant Intron, Roferon Drink extra fluids, bland diet, avocado.

    Drugs used with Chemotherapy

     

    Dexamethasone, Decadron Low salt, high potassium diet (avocado, bananas, citrus fruits, most vegetables).Adequate chromium in diet (whole grains, brewer's yeast)
    Prednisone, Deltasone, Meticorten, Orasen Low salt, high potassium diet. No alcohol. Adequate chromium in diet (see above).
    Mesna, Mesnex Plenty of fluids.

    If your oncologist is using combinations of the above medications modify the advice so that you retain the most important parts. Remember to involve him or her in your nutrition plan.

    Many chemotherapy regimens affect your blood cell count. If not contraindicated, a hematinic (blood building) supplement may be recommended. Check with your oncologist.

    Nutritional Suggestions for Immunotherapies

    1. Acetaminophen
      Eat plenty of foods rich in vitamins B, e.g. wheat germ as this may deplete liver levels of B vitamins niacin, thiamin and pyridoxine.
    2. Allopurinol (5FU)
      Avoid purine rich foods, e.g. anchovies, sardines, liver or other organ meats.
    3. Benadryl
      Eat a diet that forms acidic urine. This means more meat, beans, cranberries and plums or prunes.
    4. Busulfan
      Drink plenty of fluids. No special protocol.
    5. Corticosteroids
      Eat chromium rich foods, e.g. wheat germ or supplement with no more than 200 micrograms of chromium GTF (glucose tolerance factor) or polynicotinate daily. Avoid candies and sweets and focus on starchy foods. Drink plenty of fluids.
    6. Interferons and other cytokines
      General immune supportive diet rich in fruits and vegetables. Cooked foods may be recommended for part of the treatment period to minimize bacterial content.
    7. Mesna
      Drink plenty of fluids.

    Radiation Treatment and Nutrition

    Radiation may affect your taste buds so that food may taste bitter or you may have a metallic taste in your mouth. Try marinating meats for better flavor. Cold foods may be more palatable than hot. Use herbs such as thyme, tarragon, mint, basil for added flavor. Try adding sauces such as apple sauce, yogurt dressings, salad dressings to make food more easy to chew. Snack on protein powder milk shakes (especially those made with soy or whey protein which contain anticarcinogens genistein, daidzein and the protease inhibitor, Bowman-Birk. Ensure or other canned elemental diets are also useful standby's - look for the newer versions suitable for radiation enteritis or other chronic diarrhea situations, e.g. Boost or Resolve. For maximum effects radiation treatment should not be combined with high dose supplements of anti-oxidants (beta carotene, vitamins C and E or glutathione). The amounts found in a normal mixed diet will not interfere with treatment.

    To counteract gastrointestinal problems, take additional B complex vitamins as 9 tablets of brewer's yeast per day, or in a supplement. 4 fl oz of Aloe Vera juice can also be a soothing drink. Avoid milk and milk products as lactose intolerance may develop. Yogurt which uses a live culture may be tolerated well. You can use Lactaid milk and the Lactaid drops to minimize discomfort with dairy products. Ensure and similar meal replacement drinks are lactose free.

    Other Nutritional Ideas

    • Garlic
      Allicin (allythio sulfinic allyl ester) is a weak anti-cancer agent found in garlic. Recognized as early as 1550 BC as a treatment for cancer.
    • Pycnogenol
      This powerful antioxidant is found in grape seeds and from an extract of pine trees. Anyone with alcohol related liver damage should not take this or megadoses of beta carotene for the same reasons. Vitamins A (as beta carotene and other carotenoids) and C Foods rich in these vitamins provide anti-oxidant and anti-carcinogenic activity. Examples are cantaloupe, mangos, kiwi fruits, oranges and carrots.
    • Coenzyme Q10
      This is another antioxidant that can be beneficial during treatment. 50-150 mg per day as directed by your nutrition professional.

    Many treatments for cancer can leave you feeling "low energy". Food may taste bland and unintere-sting. Here are some recipes to stimulate your appetite and give energy in a natural way:

     

    Fruit Shake
      1 cup plain low fat yogurt
      1 ripe banana
      few drops vanilla extract
      1 teaspoon honey
      1 teaspoon coconut (optional)
    Combine ingredients in a blender. The banana may be replaced with frozen strawberries, raspberries, half a papaya or mango, or a few chunks of pineapple.

     

    Fruit Juice Smoothie
      2 cups apple juice
      1 ripe banana
      1/2 cup fresh or frozen strawberries
      1/2 cup pineapple juice
    Combine ingredients in a blender. Add ice if wished. Sip slowly with a straw.

     

    Energy Drink (Dry Mix)
      1 cup peeled almonds
      1 cup sesame seeds
      2 tablespoons protein powder (soy or whey)
    Combine ingredients in a blender and blend until fine. This mix can be refrigerated for up to two weeks in a sealed jar. Blend with 8 fl oz of chilled Fresh Mix and drink as a meal enhancer or replacement. Use protein powder alone if other ingredients not available.

     

    Energy Drink (Fresh Mix)
      1 ripe banana
      1 cup fruit juice (apple, cranberry, or similar)
      1/2 cup mineral water
      honey to taste (optional)
    Combine ingredients with 1 tablespoon of the dry mix in a blender. Sip slowly. Remember you can add fresh berries to give canned products (Ensure, etc.) additional "life".

    Some Important Reminders

    1. Eat small amounts of food frequently (every couple of hours), rather than big meals. You may find your appetite is best in the morning so have a good breakfast.
    2. Drink plenty of fluids (about 10-12 cups per day) use water, clear soups and juices.
    3. Imagine your digestion is like that of a young child. You'll need small quantities at one time of easily digested foods. Small jars of weaning baby food may be helpful as ready-to-eat supplemental snack meals. Protein shakes are good too.
    4. Microwaving or moist cooking fruits and vegetables improves digestibility.
    5. If fruits upset your stomach, use juices instead.
    6. Experiment with different foods in small amounts - Everyone's digestion is unique.


    HERBS AND SURGERY WARNINGS

    The American Medical Association recently issued the following warnings about herbs that should be discontinued prior to surgery:

    Herb Discontinue Period Prior to Surgery
    Ephedra At least 24 hours before surgery
    Garlic At least 7 days before surgery
    Ginkgo At least 36 hours before surgery
    Ginseng At least 7 days before surgery
    Kava At least 24 hours before surgery
    St. John's Wort At least 5 days before surgery
    Valerian Taper off several weeks before surgery. Suddenly stopping can cause withdrawal problems.



    TELL YOUR MEDICAL TEAM ABOUT ANY SUPPLEMENTS YOU ARE TAKING.