Nutrition For Breast Cancer Patients - From imaginis.com - http://imaginis.com/breasthealth/nutrition.asp

Maintaining a well-balanced diet during breast cancer treatment can help patients better cope with side effects, regain strength, and rebuild tissues damaged by cancer.  However, some patients may find it difficult to eat well during treatment due to certain side effects (such as nausea or diarrhea) or the emotional burden a diagnosis of breast cancer can bring.  This section discusses the importance of maintaining a healthy diet during breast cancer treatment and offers suggestions on how to cope with side effects of treatment that may affect a patient’s eating habits.

Common side effects of breast cancer treatment that may affect eating include:

• Loss of Appetite
• Nausea
• Vomiting
• Dry Mouth
• Diarrhea
• Constipation
• Weight Gain or Loss

Eat Well During Breast Cancer Treatment

The National Cancer Institute and the American Cancer Society recommend maintaining a varied diet during cancer treatment.  A varied diet includes daily servings of fruits and vegetables, proteins, grains, and dairy products.  Each person’s diet should be to modified to fit her personal needs.  For instance, if a certain breast cancer treatment causes diarrhea, a patient may want to temporarily reduce her intake of high-fiber foods (such as vegetables, fruits, cereals, and whole grains).  Breast cancer patients should talk to their physicians, nurses, or registered dietitians about maintaining proper nutrition during treatment.  Certain foods, vitamins, or minerals may interfere with cancer treatment.  

A varied diet provides several nutritional benefits:

• Fruits: Good sources of vitamin C.  Fruits are usually low in calories and fat.
• Vegetables: Excellent sources of fiber and vitamins (A and C).  Deep-yellow or dark-green vegetables are rich in vitamin A.
• Proteins: May provide protein, iron, zinc, and B vitamins.   Meats, beans, nuts, and seeds provide these benefits.  Some seeds, like almonds, are good sources of vitamin E.
• Dairy products: Milk and cheese provide calcium, protein, and vitamin B12.
• Grains:  Breads, pasta, rice, and cereals provide carbohydrates and B vitamins.  Carbohydrates are an important source of energy. 

The following are suggestions for maintaining a well-balanced diet while experiencing side effects of breast cancer treatment.  Patients may want to try a variety of different suggestions or talk to a registered dietitian for more tips that may help during treatment.

Loss of Appetite

Loss of appetite can occur from a variety of breast cancer treatments, including chemotherapy, radiation therapy, and several drug therapies including Aromasin. Loss of appetite may also result from other side effects such as nausea or vomiting or from the emotional burden of breast cancer. 

Suggestions for coping:

• Eat several small meals instead of three regular meals.
• Stock up on a variety of foods.
• Try different settings when eating – the dining room, kitchen, with background music, watching television – anything that makes eating more appealing

Nausea

Nausea can be a side effect of surgery, chemotherapy, radiation, drug therapies, or other aspects of breast cancer.  Nearly 50% of patients experienced nausea and vomiting during their first treatment with the drug, Herceptin. 

Suggestions for coping:

• Ask a physician about medications called antiemetics that help control nausea
• Eating toast, crackers, yogurt, oatmeal, skinned chicken (not fried), and ice chips may help ease nausea.
• Eat foods slowly and in small amounts.
• Drink plenty of fluids but avoid drinks during meals because they may cause a bloated feeling.
• Avoid eating right before treatment if treatment causes nausea.
• Try cool foods.  Warm foods may worsen nausea.
• Keep track of what foods can increase nausea, and try to avoid those if possible.

Vomiting

Vomiting often follows nausea.  Often, if a patient can control nausea, she can prevent vomiting.   Vomiting is a common side effect of chemotherapy, and drug treatment with Herceptin or Arimidex (generic name, anastrozole).  

Suggestions for coping:

• Ask a physician about medications called antiemetics that help control nausea and vomiting.
• Do not eat or drink until vomiting is under control.
• Talk to a physician about trying a full-liquid diet until the vomiting has subsided and regular food can be kept down.     

Dry Mouth

Dry mouth is a side effect that can be associated with several breast cancer drugs or other treatments.  When a patient has dry mouth, foods may be more difficult to chew or swallow.  

Suggestions for coping:

• Take small sips of water every few minutes to help moisten the mouth.
• Eat sweet foods or drinks such as lemonade to help the mouth produce more saliva.
• Eat moist foods with sauces or gravies to make swallowing easier.
• Talk to a physician about other options to treat dry mouth.

Diarrhea

Chemotherapy, drug therapies, or other breast cancer treatments as well as coping with the stress of breast cancer may cause diarrhea.  Patients with severe diarrhea (lasting more than a few days) should contact their physician immediately.  Patients with diarrhea can lose valuable vitamins and nutrients and become dehydrated.   Diarrhea is a common side effect of several breast cancer drugs, including Herceptin, Arimidex, and Ellence.

Suggestions for coping:

• Drink plenty of liquids and drink beverages at room temperature.
• Eat several small meals rather than three large ones.
• Try low-fiber foods such as rice, noodles, yogurt, bananas, lean beef, skinned turkey or chicken, etc.
• Avoid fried foods, raw and high-fiber vegetables, and fruits. 

Constipation

Some drugs used to treat breast cancer (such as Herceptin) may cause constipation.  Constipation may also occur if there is a lack of bulk or fluids in the diet.  

Suggestions for coping:

• Drink plenty of liquids.
• Eat high-fiber foods (such as cereals or pastas), fresh fruits and vegetables, and whole grain products.
• Exercise if the physician recommends it.
• Talk to a physician about medications to ease constipation. 

Weight Gain or Weight Loss

 Some cancer patients find that they gain or lose weight during treatment from certain drug therapies or stress. Patients should talk to their physicians if they experience any significant weight fluctuation during treatment.  Weight gain during cancer treatment could be due to water retention or other effects of treatment rather than an increased caloric intake.  An attempt to lose weight during treatment could cause increased health problems in some patients.  Diuretics can usually be prescribed to reduce excess water in the body. 

Weight loss is a possible side effect of tamoxifen. The drug Aromasin has been shown to increase or decrease appetite in some patients.  Weight gain or loss may also occur from the stress of breast cancer treatment. 

From - http://www.cancersupportivecare.com - http://www.cancersupportivecare.com/diet.html

Nourish Thyself
by Bernadette Festa, MS, RD

Why Does My Food Taste Different

Question:
Since I started chemotherapy, food just doesn't taste the same, is there anything that I can do?

Answer:
It's not uncommon to have taste changes with chemotherapy and some types of radiation therapy. People may experience changes in smell as well as taste perception. Both smell receptor and taste bud cells are rapidly dividing cells. Many cancer chemotherapy agents act by killing off rapidly dividing cells, including these receptor cells. We tend to be more sensitive to metallic and bitter tastes, but not to sweet tastes. Bitter and metallic tastes are intensified possibly causing food aversions whereas sweet tastes tend to be tolerated well. Metallic and bitter tastes are usually perceived in foods such as meat (from the amino acids) and flavors like soy sauce.

Here are some tips to enhance the taste of food while undergoing therapy:

• Sweeten the food that you eat with healthy alternatives such as fruit juices, fruit sauces or dessert baby food.
• Use fruit sauces to accompany meats
• Serve fruit nectars with meals.
• Enhance the flavor of meat, chicken or fish by marinating with fruit juice or sweet wine. Serve with a fruit sauce as papaya, mango, applesauce or sweetened cranberry sauce.
• Try colder foods to eliminate smells; cold foods can be good sources of protein and calories, can help if you have mouth sores (mucositis) and act as a local anesthetic.

Try some of these delicious cold sources of protein:

• Cottage cheese with pineapple or your favorite fruit
• Fruited tofu - mash tofu then add a banana and berries for a festive treat
• Vanilla yogurt with bananas or your favorite fruit
• Shakes with milk or soymilk

What Diet for Low White Blood Cell Count

Question:
I've been told that I have a low white blood cell count and that I should avoid raw fruits and vegetables. Why do I need to do this and is there any other foods that I should avoid?

Answer:
Your immune system will not be as strong when your white cell count is low, a condition called neutropenia. Neutropenia can occur during or shortly after chemotherapy or radiation therapy. So, during this time, while your body's immune system may not have the ability to fight infection and foreign substances, it is important to take precautions with food to lessen your exposure to infection-causing organisms. Some people will only need to avoid raw fruits and vegetables while others may need a stricter approach. Check with your medical team to determine the best eating plan for this time.

Here are some tips and suggestions:

• Eating Out
   
  • Avoid Sushi, raw fish, smoked fish
  • Avoid salad bars, delicatessens, buffets and smorgasbords, potlucks, sidewalk vendors
  • Fast Foods - ask that food be prepared fresh
  • Use only single-serving condiment packages; avoid self-serve bulk condiment containers
  • Avoid free food samples

   

• Grocery Shopping
   
  • Use fresh meats, poultry and seafood with packaging dates only. If they are out of date, do not purchase.
  • Check ``Sell By'' and ``Use by'' dates.
  • Inspect cans for any damage, swelling, rust, or denting, choose intact cans only.
  • Do not purchase cracked or unrefrigerated eggs
  • Select unblemished fruits and vegetables, buy them with a skin which can be peeled as oranges, bananas, winter squash.
  • Don't use foods from self-service bins, as bulk foods
  • Purchase frozen and refrigerated foods last
  • Store groceries promptly

   

• Foods to Avoid
   
  • Raw and undercooked meat, fish, sushi, shellfish, poultry, eggs
  • Cold, smoked fish (salmon) and lox
  • Any food which contain raw eggs
  • Unpasteurized juices, milk, cheese, yogurt, and honey
  • Miso products
  • Soft-serve ice cream, milkshakes, and frozen yogurt from yogurt machines
  • All moldy and out-dated food products
  • Aged or moldy cheeses as certain sharp cheeses, blue cheese
  • All raw vegetable sprouts such as alfalfa and mung beans
  • Herbal preparations

   

• Use Food Safety Strategies
   
  • Always wash hands with warm soapy water, for 15 seconds, before and after preparing food and before eating
  • Use separate cutting boards for meat and vegetables
  • Thaw meat, fish, or poultry in the refrigerator. Use defrosted foods right away; do not refreeze.
  • Never leave perishable food out of the refrigerator for more than two hours. Dishes containing egg, cream or mayonnaise should not be left out of the refrigerator for more than one hour.
  • Cook eggs until the white are completely hard and the yolks begin to thicken
  • Wash the tops of cans and the can opener before using
  • Cook meats until well-done and no remaining pink
  • Never taste food that looks or smells strange
  • Always wash fruits and vegetables under running water before peeling and/or cutting.

These recommendations have been adapted from patient guidelines provided at the Fred Hutchinson Cancer Research Center.

You can schedule an individual appointment with Bernadette Festa, MS, RD , by calling the Cancer Supportive Care Program at Stanford Center for Integrative Medicine,Phone: (650) 498-5566. Fax: (650) 498-5640

What Foods Should I Eat After Finishing Treatment

Question
I've just finished chemotherapy treatment, feel very weak and have been told that my red blood cell level (Hemoglobin and Hematocrit), is low, what foods/supplements should I be eating to feel better and to be healthier.

Answer
Low hemoglobin and hematocrit are common after treatment. It is important to give your body nutrients that it needs during this time to provide the foundation to build your red blood cells. Iron and Vitamin B12 can help. The meat group (beef, chicken and fish) is especially high in these nutrients. Have about 3-4 oz of lean meat at both lunch and dinner daily. Other things that can help is cooking in cast-iron pots which contribute iron to the diet. Having a Vitamin C food source at meals will also boost iron consumption from the vegetable and bean group. So, have a small glass of orange juice, or a fruit such as an orange, grapefruit, melon, tangerine or raw bell pepper with your meals. The amount of iron in a multi-vitamin should be adequate for your needs, I wouldn't encourage supplemental iron unless your doctor recommends it. As your blood count goes up you will start to feel better and have more energy. The lifespan of a red blood cell (RBC) is about 120 days, therefore it may take up to 3 months to see your red blood cell level return to normal range.

The main goal at this time is to give your body adequate calories and protein that it needs. In the long-term, you want to aim for more fruits and vegetables and a more vegetarian-like diet. However right now, you may find that your digestion is sensitive so go slowly in increasing the fruit, vegetable and legume (bean) group. The decision to take additional antioxidants (Vitamin C, E, beta-carotene and selenium )is a personal one. Check with your medical team if you plan on using these to ensure safety after your chemotherapy or radiation treatment.

How do I choose a multi-vitamin

Question:
How do I choose a multi-vitamin?

Answer:
It is always best to meet your needs through proper food choices however it may not always be possible if you have had

• Loss of appetite, taste or smell
• Surgery to the head and neck areas with swallowing difficulty
• Cancer of the digestive tract
• Impaired digestion or absorption of nutrients
• Low calorie intake, especially under 1200 calories per day

Reading the Label
Check the daily value. The Daily Value (DV) is a government standard that specifies the minimum daily requirements to prevent deficiency disease in healthy people. The DV is based on an intake of a least 2,000 calories per day.

Look for "USP" on a label. This specifies that the supplement meets the standards of the U.S. Pharmacopoeia.

Read specialized formulas (those for women, men, seniors, etc.) carefully. Claims aren't regulated; each company sets its own standards. For example, "women's" formulas have additional calcium, but may lack the DV for Vitamin D, which is a helper for calcium absorption.

Check the expiration date!

Look for 100% of the Daily Value for Vitamins B1 (thiamin), B2 (riboflavin), niacin, Vitamin B6, B12, C, D, E, and folic acid. If you do intend to have additional supplementation of the antioxidants such as Vitamin C or E it may be advantageous to take these separately. Most of the multi-vitamins do not provide adequate supplemental amounts of these.

Check the Serving Size
In some instances you have need to swallow up to six tablets daily to get the requirements listed on the label.

Skip the iron in a multi-vitamin
For cancer patients, it is advisable to ask your medical team about whether or not you should take iron in a multi-vitamin. Usually, unless you have iron-deficient anemia, are at risk of anemia, or have had recent surgery, your may not desire to take additional iron. Iron supplements can also cause constipation and you will need to increase your fiber and fluid intake.

Additional tips
It is advisable to take the vitamin with food to assist with absorption. MVI's as a rule, work better when taken with food. Determine which is the best form for you to take. Supplements are available in liquid form as well as chewable tablets for those with problems swallowing.

If you are presently on chemotherapy or radiation therapy or awaiting surgery, always check with your medical team before taking any supplement.

From http://www.cancersupportivecare.com - http://www.cancersupportivecare.com/nutrition.html

Nutrition
Bernadette Festa, MS,RD; Pat Kearney RD; Ernest Rosenbaum, MD

Good nutrition is needed for general good health and is particularly important when you are ill. During this time, it is important to give your body the proteins, fats, carbohydrates, vitamins and minerals it needs for energy, repair of normal tissue, and to keep your immune system strong to fight disease. Food is not only something to delight the taste but is an essential ingredient in the fight against disease. It is as important as your medicine or medical therapy (e.g., surgery, radiotherapy, or chemotherapy). Because of your illness or treatments, you may not be able to eat in the same way as before. You might find that your pleasurable experiences around eating are affected.

During illness, you will be more attuned to the smell, taste and texture of foods. As your senses will be acute, it is important to savor and enjoy foods now more than ever. However, you may find that your tastes have changed and you are turned off by foods that you once enjoyed (food aversions). Allow your memory of the enjoyment to encourage you to seek these foods as well as to develop a taste for new foods.

Think of yourself as an explorer. Sample small portions of foods previously eaten, try new tastes and note the reaction your body and spirit have to them. Even an explorer needs a map to chart unknown territory. With the help of a registered dietitian you can learn to explore alternative tastes and foods. Classes and counseling sessions have been set up at Stanford and we are in the process of setting these up at the Mt. Zion campus of UCSF. Dietitians Bernadette Festa, MS, RD, and Patricia Kearny, RD can address your personalized needs. The goal of our class and counseling is to provide current information which will help you maintain or improve your nutritional status and help you better fight your illness.

You may have no, one, or more symptoms from therapy. Everyone is different and there is no set pattern. The bright side is that most cancer survivors do not have these problems for very long after therapy has been completed, and some may not have any eating problems at all.

Loss of Appetite - A Common Problem

You may not be able to rely on your hunger mechanism as a signal to eat. Many problems as pain, nausea, vomiting and diarrhea or a sore or dry mouth may make eating difficult and cause you to loss interest in eating. Depression, stress and anxiety also cause a loss of appetite. As appetite may no longer motivate you, now you need a planned approach.

• Eat by the clock rather than hunger mechanism. Eat because it is 9:00am, noon, 3:00pm or 6:00pm or whatever your studied daily pattern becomes. Snack between meals - choose high calorie puddings, shakes, high calorie and protein drink supplements, sandwiches, avocados, nuts
• If you miss or delay a meal for a test or therapy bring a snack of nuts, dried fruit, or cheese and crackers. Check with your dietitian if these foods fit into your medical diet.

  Remember, you probably will not be hungry!

• Choose high calorie foods at this time. Use cream soups, cooked cereals and vegetables with added butter or margarine, add nut butters to bread, use extra olive oil in salads.

  Remember, you need the calories.
  If you're concerned about a higher fat diet because of high cholesterol or heart disease, talk with your dietitian and choose better fats such as avocados, oils and nuts

• Plan your daily menu in advance
  plan the time that you will eat.
  Have the food available, you may want to portion out snacks and keep in the refrigerator in ziplock bags so that it is really easy for you.
  Make a list of your favorite foods and beverages and prepare a shopping list.
  Having the food in the house and a menu makes it so much easier!
• Enjoy help in preparing your meals A friend or relative is often happy to help out by preparing food for you. Home aid in preparing meals or delivered meals are available in many communities. Some grocery stores have shopping services that may be accessed through your computer. You are very important - ask for help when you need it, and ideally before you anticipate that you will need it.
• When you are feeling better, Fix several portions of your favorite foods and freeze them. Then you won't have to think about what to fix! It lessens the problem about thinking about what to eat when your appetite may be poor or you do not feel like cooking.
• Make food visually appealing- eye appeal is often the first step in eating. Attractive colors, garnishes as parsley, lemon wedges, olives, cherry tomatoes, Help to enliven the appetite and ready one for eating.
• Appeal to your sense of smell Tap into your sense of well-being that smells can stimulate. Haven't you smelled bread baking and suddenly become hungry in the past. Remember the cravings that the smell of chocolate have brought on in the past.
• If you find that you are overwhelmed by smells at this time, stay away from the kitchen, and have someone else prepare the cooking.
• Make your mealtimes pleasant your mealtime atmosphere is important to make you feel like eating. Set the table, add candles or wine, if permitted. Whenever possible eat with family, friends. Or if you are alone, turn on the radio, Television or music for company.
• Study friends who are overweight - notice that they eat when preoccupied with TV or reading or music. They also may have snacks in sight and put into desk drawers. Do the same. Realize that you need the calories at this time.

Nausea and Vomiting

Nausea is a frequent side effect of cancer treatment or the cancer itself.
 

• Pay close attention to when it happens, and if possible try to modify your mealtimes
• Pay close attention to any psychological causes. Mr. So and so gets nauseous whenever he passes a restaurant a block away from where he was receiving his treatment and actually vomited once when he passed it.
• A visualization program helped him- ask your doctor or program coordinator. Try it -don't hesitate. You could be feeling better sooner.
• If nausea is extreme or severe speak with your doctor or nurse about it, medication can help.
  Here are some practical tips for lessening Nausea:
   
• Keep crackers, dry bread at your bedside for early morning nausea
• Eat small amounts of food often- take clear, cool foods and chilled drinks at first, especially apple and cranberry juices, fruit drinks as Gatorade, ginger ale and 7-Up, room temperature chamomile or peppermint tea.
• Eat and drink slowly- use a straw for beverages to reduce the smell.
• Try bland, soft foods as peaches, mashed potatoes.
• Popsicles, salty foods (salads, olives,) soda crackers and toast are often well tolerated.
• Consider avoiding your favorite foods right now as you may start to associate these foods with treatment, nausea and vomiting and develop a strong aversion to them.
  
  What to do for Vomiting:
  
   
• try only tiny sips of liquids as juices, ginger ale or 7-Up, lukewarm miso broth, or herbal teas
• start out with clear liquids then proceed to heartier more nutrient packed ones.
• Try softer, more bland foods until you feel better as pureed soups, smoothies, fruit nectars, yogurts, well-cooked cereals thinned with milk or soy, mashed cooked potatoes and vegetables, pasta with egg and grating cheese
• Drink and eat potassium-rich foods
• Drink lots of room temperature liquids to help prevent dehydration.

Diarrhea

Diarrhea may be due to many causes. You may get it because of chemotherapy, radiation therapy to the lower abdomen, malabsorption or sometimes antibiotics can cause diarrhea. It can also develop because of an intolerance to milk or difficulty in absorbing fats. Whatever the cause, diarrhea can be uncomfortable and embarrassing and causes you to lose vitamins, minerals and water.

• Try to find a pattern for the diarrhea.
• Speak with your health professional to try and determine the cause and get the proper treatment.
• Drink lots of room-temperature liquids to help prevent dehydration as fruit drinks, Gatorade, ginger ale, peach or apricot nectar, water, weak teas. Limit caffeinated beverages.
• Allow carbonated beverages to lose their fizz or stir them before you drink them.
• Have more potassium foods as orange juice, tomato juice, bananas, potatoes
• Try the BRAT diet - bananas, rice, applesauce, tea and toast, try a well-baked apple without the skin
• Try frequent, small meals
• Avoid fiber foods for now
• Try breads made from refined flour without seeds or nuts, limit raw
• Vegetables and salads right now as well as most fruits. - Do return to your higher fiber foods, fruits and vegetables once the diarrhea subsides (check with your dietitian and doctor first!)
• Have spicy or highly seasoned foods only as tolerated.

Constipation

Constipation may be caused by some chemotherapy medications as Vincristine, Vinblastine. Other drugs as morphine and codeine may contribute.

What you can do

• add more fiber and bulk to your diet
• try beans as kidney and chick peas, lentils, fresh fruit and vegetables, dried fruit, IF your not used to eating a lot of fiber slowly increase your intake as you may Initially have increased flatulence, gas. Soaking beans first in water and discarding the water may help to reduce flatulence from this group.
• eat bran cereals or shredded wheat, foods made with whole grains as bulgur, wheat berries
• plan your diet and when you will get your fiber intake in.
• Add unprocessed wheat bran to hot cereals and yogurt.
• REMEMBER to drink plenty of liquids. You need more fluid when you have more fiber for fiber to work effectively.
• Reduce your caffeine intake as caffeine may promote constipation by causing you to loose fluids.

When Foods Taste or Smell Funny

You may notice a metallic or bitter taste in your mouth or that foods just don't taste as good. This can occur during certain cancer treatments, especially during or after chemotherapy or if you have received radiation therapy to the neck and mouth area.

When foods taste too bitter

• add sweet fruits to meals
• add honey or sweetener to foods and drinks
• eat meat cold or at room temperature
• try meat substitutes or blandly prepared chicken and fish; mild cheeses, eggs, dairy products, soy drinks or tofu or bean dishes.
• Marinate foods in wine, italian dressing, lemon juice, or low sodium soy sauce.

When foods taste ``off''

• drinking water, tea, ginger ale or fruit juices mixed with club soda may remove some of the strange tastes from your mouth.
• try cold or room temperature foods which may taste better
• try chilled soups, starches as potatoes, rice and plain pasta, cold sandwiches.
• Do not add butter, margarine or other fatty substances to these foods.
• choose bland foods as eggs, mild cheeses, cereals, puddings and custards, rice, jicama, peanut butter instead of foods with more distinctive flavors.

Generally

Eating in relaxed and pleasant surroundings may help reduce problems with Taste blindness. -Flavorings such as herbs, spices or food seasonings may help. Acidic foods such as grapefruit may stimulate taste buds (but avoid them if they irritate your mouth).

Chewing or Swallowing Difficulties

Soreness and tenderness in the mouth and throat are not uncommon. If your swallowing difficulties are minor the following suggestions may help. You May need to work with a swallowing therapist or consider alternative methods of feeding if you have severe problems.

• Eat frequent small meals and snacks to ensure that you are getting enough calories.
• Choose soft foods or foods that can be cooked until tender, choose higher calorie foods that we have already discussed.
• Cut foods into -sized pieces or grind them so that less chewing is required.
• Many people find liquid supplements helpful or shakes that can be made in your blender.
• Some people will need to use a blender to puree the foods your family is eating. Remember to add high calorie liquids to blenderize this as gravy, milk, cream, broth may be used instead of water.
• Try very soft or thick liquid foods puree or blenderize potatoes, carrots, and other vegetables and soups, as well as meats.
• Dunk bread or other baked goods in your beverage
• Drink generous amounts of nutritious liquids with meals.
• Be adventurous - try new sauces, gravies, different oils on foods to make swallowing easier.
• Have some baby food on hand for something quick and tasty.

Weight Gain

Gaining weight may be due to chemotherapy, prescribed steroids as prednisone, or fluid retention. Steroids may change your metabolism or the way your body uses calories and may also increase your appetite.

While you are being treated for cancer this is not the time to go on a strict weight loss program as your body requires nourishment.

• You may switch to a lower fat diet (less butter, margarine, oil, lean meats only)
• A low sodium diet may be needed if you are retaining water. Its not enough just to avoid adding salt to your diet.
• Avoid canned goods and prepared food items as flavored rices and grains, and frozen dinners.
• Look at food labels and note the amount of sodium on the label.
• Discuss this with your dietitian.

Summary

Remember -

-The times when you are weak and do not feel like eating are the times when you need the energy, protein and protective factors from foods most.

DO

• Plan your meals
• Prepare a shopping list
• Prepare foods and meals when you are feeling better
• Have a positive attitude
• Remember, that during this time, you may be eating differently. If while under treatment the need for energy temporarily overrides other needs that this is OK. Remember that after treatment you have time to adjust your diet.
• Realize that this symptom may only be temporary and a few days, weeks or months from now you will be focusing on only the joy you are receiving from life.
• Lastly, Bon appetit!

Herbs and Supplements

We are always asked questions regarding the use of herbs and supplements. Keep in mind that herbs are not regulated in the US. There are no standards so formulations vary in potency and recommended dosages. Always seek a diagnosis from a physician before taking herbs, especially for serious conditions and inform your medical team of herbs you are taking so a crosscheck can be made for contraindications of use with other prescription medications.

Some of the most common questions for supplements are on selenium, garlic, carotenoids and isoflavones.

Selenium - Researchers currently advise against supplements until they can prove anti-cancer benefits as well as decide on the amount to optimize health without toxicity. It is believed that an amount of 200 micrograms a day is probably safe. Some food superstars are brazil nuts (4), 436 micrograms (mcg), 3.5 ounces of light tuna -50 mcg., 3.5 oz. Pork sirloin - 52 mcg., 1 cup cooked pasta - 30 mcg. IF you are taking supplemental selenium and are undergoing radiation, be sure to speak with your dietitian or medical team about possible interactions.

Garlic: growing research suggests garlic and its allium cousins are effective cancer fighters but the American Cancer Society for one is hesitant to endorse garlic, citing too little evidence as yet. Garlic supplements can lower blood sugar so this is not recommended for diabetics on medications. People with a clotting disorder or on blood thinners need to check with their physician before using supplements. Most nutritionists will recommend using both raw and cooked garlic in your diet instead of supplements.

Carotenoids: research results have been mixed and there are possible risks of single carotenoid supplementation. Consumption of foods rather than supplements, particularly vegetables and fruits that contain other protective substances is preferred, eating at least 5 to 9 servings per day. Lycopene, another powerful carotenoid antioxidant has been listed in recent ketchup ads as a cancer prevention food. Be aware that label comparisons are shown per ounce not per serving. One study found a daily consumption of 40 milligrams (mgs) did boost blood levels of carotenoids. Some rich food sources include - cup of tomato sauce - 23 mgs., 6 oz. Vegetable juice- 18 mgs., 8 oz. Tomato soup - 12 mgs.,

2 tablespoons ketchup - 6 mgs and 1 medium tomato 4 mg.

Isoflavones: These phytoestrogens are found in soy foods. Benefits are thought to be increased by as little as one serving of soy food per day. Eating soy foods is still preferable to using supplements and as a protein source and can replace animal saturated fat. Some rich food sources are l cup soy milk - 70mgs,1 oz. soy nuts - 40 mgs, 1/2 cup of tofu - 40 mgs, 1/2 cup of cooked soybeans - 35 mgs. Recent research suggests that if you have estrogen positive or hormone positive breast cancer that you should avoid taking in large amounts of soy products.Generally a few servings per week are acceptable.

Most of the questions we receive on herbs are on the following four: ginger, bilberry, milk thistle and saw palmetto. Here is a brief pro and con review.

Ginger ( zingifer officials)- May be useful for nausea and indigestion and may work by promoting secretion of saliva and digestive juices, neutralizing stomach acid and toxins, increasing tone and movement in intestines. There are capsules available or try 2 cups of tea using l teaspoon (tsp) fresh ginger or 1 1/2 tsp. powdered ginger. Excessive amounts may cause heartburn. Do not use for postoperative nausea as it may prolong bleeding or with combinations of other blood thinners.

Bilberry: (vaccinium Myrtillus) may be useful for simple diarrhea. There are capsules however it may be easier to make a tea using 1 tablespoon (tbl) of dried berries per cup. Do not use the leaves and fresh berries as they may have a laxative effect. Bilberry may prolong blood coagulation so caution is advised if taking other blood-thinning agents, like aspirin.

Milk thistle: (silybum Marianum) May be useful for chronic inflammatory diseases of the liver such as cirrhosis or hepatitis. Liver conditions require a physician's care. Milk thistle may work by acting on cell membranes to prevent toxins from entering the liver. Acts as an antioxidant. If you take: use seed extracts standardized to at least 70% silymarin at daily dose of 200 to 400 mgs. Teas are not effective because silymarin is not water soluble. It may have a mild laxative effect and is a possible allergen for those sensitive to ragweed.

Saw Palmetto (serenoa repens) may be useful for early non-cancerous prostate enlargement. May lessen symptoms but does not reduce prostate size. May work by counteracting androgenic hormones and fighting inflammation. If you take it: the usual dose is 320 mgs.dried fruit extract in 1 to 2 doses. Teas are of little value because few of the active ingredients are water soluble. Large amounts may cause diarrhea. Prostate enlargement requires physician care and there is some concern that the herb may cause inaccurate readings on prostate-specific antigen (PSA) tests.

Home