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