Enjoying your food again after treatment

with relaxation, food & exercise

life

Depending on the stage of your treatment not all of these may apply at the moment

But with any ‘condition’ – the more health promoting activities that one can do, within the constraints of the treatment, the better for our health

WCRF / AICR report 2007; 8 main recommendations

1. Be as lean as possible within normal range of body weight

2. Be physically active as part of everyday life 3. Limit consumption of energy dense foods4. Eat mostly foods of plant origin5. Limit intake of red meat & avoid processed meat6. Limit alcohol containing drinks7. Limit consumption of salt, avoid mouldy grains,

pulses8. Aim to meet nutritional needs through diet alone

World Cancer Research Fund report (2007) 8 main recommendations:

Body Weight includes fat, muscle and water

1. ‘Be as lean as possible within normal range of body weight’avoid weight gain and increases of waist circumference through adulthood

Pros of body fat:1. Provides

cushioning for our bones

2. Keeps us warm

3. Provides energy store when we can’t eat (and stops breaking down muscle)

Cons of body fat:

Convincing evidence risk cancer in men (colorectal) &in women post menopause (breast)

Also risk diabetes, high blood pressure and heart disease

What do you feel is a good weight (well weight) for you?

Measure weight / BMI (body mass index) at present

Are you under or overweight? If under: try to eat more and also increase exercise

/ activity to promote muscle building If over: (and not due more chemo / radiotherapy)

refer to Eatwell plate and increase exercise/ activity

Weight plan

Walk at least 30 min/d: (10,000 steps) every day(increasing to 1hr/d of moderate activity)

Limit sedentary activities eg TV watching Think of ways to include activity in your daily routine: walk to

the shops? Use exercise bike / hand weights whilst watching TV?

2. Be physically active as part of everyday life:

Pros: Heart Disease & Diabetes:

- lowers blood pressure - helps weight-loss (body fat, central fat)

- improve cholesterol & glucose levels –

Mental health - reduced risk of depression and dementia - Increased positive emotional well-being - improves response to stress

Physical Activity Convincing evidence that

most physically active people have lower risk of developing colo-rectal cancer

Probable evidence that risk of post menopausal breast and endometrial cancer is reduced

Limited evidence that there is risk reduction for lung, pancreas, pre-menopausal breast cancers

Convincing evidence that it prevents weight gain, overweight, obesity

CONS

Nordic walking New age Kurling Tai Chi Exercise on prescription

AGE UK

1. Avoid sugary drinks, 2. Consume ‘fast food’ sparingly (if at all)3. For colorectal cancer there is some suggestion

that fatty foods (animal fats) and sugary foods increase risk

What is Energy density ?

225-275 calories (kcal) per 100gAverage energy density of diets to be lowered

towards 125kcal per 100g

3. Limit consumption of energy dense foods,

‘Guess the energy density’ game?

25

260

40

560305 or

215

416

The lower the energy density, the bigger the portion

Food ED = 2.3 Food ED = 0.52

Prof B Rolls

600g/d of non-starchy vegetables & fruits What does this look like…

25g /d of fibre from cereals & pulses

Eat relatively unprocessed cereals and or pulses with every meal

Limit refined starchy foods

4. Eat mostly foods of plant origin:

Each portion

contains 2g of fibre

15 fold range in incidence through out the world

highest risk in US, N Europe, NZ, Australia lowest rates in rural Africa, India, China

low meat and fat intake , high plant food intake; vegetable and starchy staples (fibre)

Migrants from these areas quickly acquire the same rate of cancer as the host population

Colorectal cancer

Low residue diet (adhesions, narrowing of gut)

Wind, diarrhoea, constipation, sore bottom

Any issues having lots of fruit & veg post surgery?

Doctors often have their patients follow a low-residue diet the first weeks after any abdominal surgery.

This includes only foods that are easily digested and don't leave much waste behind,

When going back to foods you have not eaten since surgery, try one new food a day. Keep a food and symptom log.  if they seem to cause symptoms, try them again in 2-3

weeks.  Log results.  Eventually you should be able to have a full and varied diet. 

Low residue diet

Foods and drinks that may cause loose stools:

Drinks: apple juice prune juice beer , wine milk Hot beverages

Tea & coffee

Vegetables & Fruit baked beans green beans spinach cabbage broccoli raw fruit

highly spiced foods, chocolate, liquorice

May be helped by; Apple sauce, Peanut butter, Bananas, Rice / pasta / potatoes, Tapioca, marshmallows, pretzels, Boiled milkDrink plenty; bouillon(salty drink), ginger ale, Weak tea

Wind

fish melons Milk nuts carbonated beverages Sweets Alcohol; beer

asparagus cabbage family ,

brussels, broccoli, cauliflower

dried beans and peas , baked beans

onions , radishes, cucumbers

Eat regularly; missing meals can use gas build upAvoid swallowing air; relax, take your time and don’t talk with your mouth fullAvoid chewing gum or drinking through a straw

These foods may cause more gas to form;

•  certain raw fruits and vegetables (e.g., oranges, apples, coleslaw, celery and corn)

•  popcorn •  Chinese/oriental vegetables •  nuts •  coconut •  dried fruits (e.g. raisins, figs) •  food with seeds •  spicy foods

FOODS WHICH MAY CONTRIBUTE TO ANAL IRRITATION

Relieving diarrhoea

May be caused by; Very large meals Spicy meals Soup baked beans / Dried

beans Beer Hot beverages chocolate, liquorice,

prune juice Red wine

May be helped by: Apple sauce Peanut butter Bananas Rice / pasta / potatoes Tapioca marshmallows, pretzels Boiled milk Drink plenty; bouillon,

ginger ale, Weak tea

‘It took about 6 months for me to eat fresh fruits and vegetables without them speeding through my system.  It takes time for the body to slow down.  Some foods work better than others, peanut butter made me worse as did applesauce, however others have had great results with them.  Keep a food log.  Try new foods, if they don't work, try them again in 2-3 weeks.  Log results.  Eventually you should be able to have a full and varied diet.  I live on fresh fruits and vegetables now but it took a while to achieve this.  As for weight loss you can try bulking up by using powders or drinking high calorie shake drinks.  They make them dairy-free so you should be able to tolerate them’.

‘I had the reversal ileostomy 10 weeks ago just like Cathy and I eat everything’.

‘Certain foods like salad and chinese do go through a bit quicker, and curry and chilli do cause some bottom burning for a day or so, but I still eat them. I take 10ml of immodium syrup before bed but thats all’.

Reintroducing foods…

Increase liquids Eat high fibre foods; fruit (chew well), veg – raw &

cooked, Wholemeal breads and cereals (oatmeal, wheat

flakes, branflakes) Coffee, chocolate, lemon juice, liquorice, prune

juice Exercise Make sure you aren’t taking too many ‘Imodiums’

Relieving constipation

No more than 18oz (500g) cooked red meat /week (e.g. 150g three times a week)

Eat very little, if any, processed meat ‘Salting, smoking & curing to make processed

meats are a probable cause of some cancers (colorectal, stomach)’

Use of nitrates as a preservative

Many processed foods are also high in fat, trans fats, refined starch which increase risk of heart disease

‘Processes’ such as freezing steaming, drying – are not a problem

5. Limit intake of red meat & avoid processed meat:

What can I have instead?

Sandwiches / snack meals; Egg Fish (tinned in water, oil

& drained) Hummus Fresh chicken, turkey

slices Small portion cheese or

lower fat cheeses Salad

Main meal; Chicken Turkey Fish Pottage! (vegetable

and bean / lentil stew); onion / leek / parsnip / carrot – stock, herbs, spices (tumeric, garlic)

6. Limit alcoholic drinks:

No more than 2 drinks /d for man and 1 drink/d for women (10-15g alcohol)

1 unit = 8g = 10ml of pure alcohol

A drink = ½ pint normal strength

beer (3-5%) One shot, 25ml spirits

(40%) One small glass (125ml

wine (12-13%) Baileys: 100ml

Convincing evidence that alcohol increases risk of cancer of mouth, oesophagus, throat, breast, bowel (in men)

Probably increases risk of liver cancer and bowel (in women)

Other Cons: lots of calories

Pros: reduces heart disease in men over 40 and women (post menopausal)

Top tips to keeping alcohol intake within guidelines

Order smallest measure Alternate with soft

drinks Dilute with low calorie

drinks eg spritzer Keep a few nights

alcohol free Don’t drink alcohol if

you are thirsty (rehydrate first)

7. Limit consumption of salt, avoid mouldy grains, pulses

• Avoid salt preserved, salted or salty foods

• Aim for Less than 6g salt/day

• Or 2400mg sodium

• Sources of sodium: processed food 75-80%, cooking & on food 15-20%, fresh food 10%

Baked beans ½ tin: 2.7g (45% GDA)

Can Soup: 2.4g (40% GDA)

Bacon (2 rashers): 2.4g (40% GDA)

Bread (2 slices): 0.8g (14% GDA)

Egg (60g): 0.2g (4% GDA)

Roast Chicken (50g); 1% GDA

Sodium – practical advice

avoid adding salt at the table reduce salt used in cooking – use other

flavourings; herbs, spices, pepper, lemon juice, garlic, stock

choose lower salt/ sodium versions where available, e.g. bread, beans, tinned vegetables

cut down on salty processed foods, e.g. sauces, soups, flavoured noodles

cut down on salty snack foods, e.g. crisps & nuts limit cured foods (e.g. bacon & ham), foods packed

in brine (pickles, olives, fish) and condiments use fresh, frozen or canned ‘no added salt’

vegetables choose fresh or frozen plain meat, fish & poultry

8. Aim to meet nutritional needs through diet alone

• Dietary supplements are not recommended for cancer prevention

Cons: may promote cancer at certain stages (folate, vitamin A, iron)

Pros: may reduce risk at certain stages, folate, carotene, vitamin D

Selenium, vitamin D, calcium, folate; may be protective

Calcium: low fat dairy, nuts, pulses, edible bones in fish

Selenium: brazil nuts, fish, offal

Vitamin D: oily fish, liver, egg, fortified marg & cereals, sunlight

Folate: green vegetables, pulses, nuts, seeds, fortified cereals

Lots of food from plant sources, including fruits, vegetables, potatoes, breads and grains, pulses, beans, nuts, and seeds.

A variety of minimally processed, seasonally fresh, and locally grown foods.

Olive oil , rapeseed? as the principal fat, replacing other fats and oils.

Low saturated fat intake Red meat consumed a few times per month. low to moderate amounts of cheese and yogurt daily fish (oily fish) and poultry Up to 4 eggs per week.

Fresh fruit as the typical daily dessert; Moderate consumption of wine, normally with meals,

Mediterranean diet

FRUIT & VEGETABLES

MEAT, FISH, EGGS, BEANS

MILK & DAIRY FOODS

FOODS & DRINKS HIGH IN FAT AND/OR SUGAR

BREAD, RICE, POTATOES, PASTA

Breast Cancer Stress Management and Relaxation Training Programme

(B-SMART)

Based on evidence of psychosocial factors that are related to positive adaptation

OptimismBenefit findingSocial supportAnxiety reduction

Combines Cognitive Behavioural Therapy and relaxation techniques

Techniques to minimise physical tension and anxiety producing thoughts

Provides training in: anxiety-reduction skills awareness of sources of

stress and indicators of stress

noticing and replacing negative thoughts

cognitive and interpersonal coping skills

The programme

Goal to improve ways in which people manage stressors and maintains social support networks

Improved immune functioning

Increased benefit finding and decreased depression

Most effective for women low in optimism

Summary

Eat a balanced and varied diet. i.e. food choices from all food groups Add foods to your diet gradually to see how your body

responds.

Keep Active  Relax; Think about how you manage stress and improve

response Speak to a dietitian if you have any specific diet concerns  

Convincing Probable Limited but suggestive

Alcohol (men) High intake red & processed meat

Alcohol women Non starchy vegFruits Fish

Physical activity Food containing fibre Garlic Milk Calcium

Cheese Fat/Animal fat intake Food containing Fe Sugar intake Cantonese style (fermented) salted fish

Body fatness Abdominal fatness

Foods containing folate Foods containing Se Foods containing Vit D

Dietary risk factors in colorectal cancer: risk risk

Extra slides

Probiotics: protective bacteria

Definitions; 1. Live micro-organisms which when administered

in adequate amounts confer health benefits on the host (WHO / FAO 2002)

They must remain viable during their passage through the GIT

Usually representative of species present in infants; Lactobacillus, Bifidobacterium, yeast Saccharomyces boulardii

Safe; by virtue of their long use in fermented diary products

Protective bacteria Ferment dietary fibres & complex starches in

food in the colon resulting in: short chain fatty acids; electrolyte uptake in the

large intestine (sodium, potassium…) energy provider for colon cells (gases H2, CO2, CH4), also some vitamins B12, K may alleviate symptoms of lactase intolerance Reduce inflammation Improve Bile salt metabolism; Probiotic associated with decreased reduction in

rate of progression of colon cancer

Foods that may cause gas and odour:

Alcohol; beer carbonated beverages

Eggs; meringues

fish strong flavored cheeses spiced foods fatty foods (pastries/deep

fried foods)

melons asparagus cabbage family , brussels,

broccoli cauliflower dried beans and peas ,

baked beans radishes pickles onions Cucumbers mustard

buttermilk, parsley and yogurt may reduce the odour

Phyto-oestrogens: chemicals in plants similar to oestrogens; as they compete with endogenous oestrogens the end result is anti oestrogenic found in soya, linseed, also in cereals, legumes,

veg; insufficient evidence that they are protective against breast cancer

Antioxidants: C,E carotenoids and selenium – prevent oxidation and DNA damage; not enough evidence that increasing intake would decrease risk of breast cancer

Other specific nutrients

Breast Cancer WCRF 2007Convincing Probable Limited

suggestiveBody fatness (pom) Physical Act (pom) Total fat (pom)

Alcohol (both) Adult weight gain (pom)

Physical Act (pre)

Adult attained height (post) Lactation (both)

Abdominal fatness (pom) Adult attained height (pre)

Pom; post menopause, pre: premenopause

Increases risk decreases risk

Sites for absorption of nutrients

9 litres of fluid pass through the duodenum each day of which only 1.5L reaches the colon

stomach duodenum jejunum ileum Ascending colon

minerals Water sol vits

sugars

Vits A & D Bile salts Water, sodium, potassium, vits

Fats Vit B12

Water & sodium

Amino acids