The Nutrition Handbook

THREE STAGES IN A CYCLE OF NUTRITION AND CANCER

Nutrition During Treatment

• 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

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

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:

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:

JAMA July, 7, 2001

TELL YOUR MEDICAL TEAM ABOUT ANY SUPPLEMENTS YOU ARE TAKING.