NUTRITION AFTER CANCER TREATMENT

Nutrition is an important component of care for people impacted by cancer. Eating the right types and amount of food improves quality of life, reduces side effects of treatment and also reduces the risk of developing other chronic conditions.

As long as the patient has no ongoing complications, nutritional recommendations for cancer survivors are the same as for anyone wanting to improve their health. If there are ongoing complications or eating difficulties, then a referral to an Accredited Practising Dietitian (Registered Dietitian) is recommended. The following key strategies have been associated with decreased risk of developing cancer and lifestyle conditions. There is currently limited data around diet and cancer recurrence.

1. Healthy and balanced eating.

A varied diet including lots of vegetables, fruit, legumes, spices as well as whole grains appear the healthiest. When it comes to recommending meal selections, the Australian Dietary Guidelines and ESPEN guidelines recommend that cancer survivors:

Eat at least 2 pieces of fruit (1 whole item e.g., apple or several smaller items e.g., plums) and 5 serves of vegetables (1/2 cup cooked or 1 cup salad) every day. Frozen items are fine to include regularly.

Choose healthy fats, including omega-3 fatty acids, such as those found in fish and algae. The best vegan source of omega 3 fatty acids is algae, but other sources include walnuts, chia and flaxseeds. Recommend proteins that are low in saturated fat, such as fish, lean meats, eggs, dairy or legume alternatives, nuts, seeds and legumes. The topic of soy for those with oestrogen receptor positive cancers can be confusing because of the conflicting evidence. Generally, it appears that regular soy consumption can reduce the risk of developing cancers. Two to three serves of soy foods a week appears to be fine but soy and isoflavone supplements are not recommended. Suggest healthy sources of carbohydrates for sustained energy such as vegetables, fruit, legumes, and whole grains.

2. Weight management is important.

Weight gain or loss is common during anti-cancer therapy. It is recommended to keep body weight within a healthy level. For cancer survivors who need to:

• Gain weight, this will likely involve coming up with ways to make food

more appealing, modifying the texture, fortifying the nutrient content or adding extra sauces to make it easier to eat. A referral to a qualified dietitian can help with techniques to gain weight safely.

• Lose weight, gradual weight loss is more sustainable and will help prevent the weight loss roller coaster. Aim for no more than 2 pounds change in weight (about 1 kilogram) a week. Recommendations should include a reduced calorie plan which is balanced with exercise. Easy ways to cut calories include cutting out or decreasing alcohol, sweetened beverages, snacks like chocolate and chips, milk in teas and coffees and include more nonstarchy vegies like salads and shredded carrot, zucchini and cabbage to form the basic meals. Legumes like lentils and chickpeas are a great option as they help fill you up without too many calories. Eating can seem overwhelming to a cancer survivor if they need to lose a lot of weight, especially if they have been using food and/or alcohol to help them cope. It’s best to take it slowly and stick to a feasible healthy lifestyle plan. There are plenty of good apps around including MyFitnessPal which help with monitoring and accountability.

3. Gut – Brain Connection.

What we think about can worsen gastro symptoms, just as what we eat can influence mood, food cravings and how well we sleep. Including good sources of prebiotics (fibres that the good bacteria feed on) daily is important. Prebiotic sources include legumes, vegetables, fruits and wholegrains which can be found in the healthy plan recommended above. Probiotics are the good bacteria themselves and are found in yogurt and fermented foods like kombucha and pickled vegetables.

Nutritional requirements for cancer survivors are the same as for anyone wanting to improve their health.

The importance of mindful eating should not be ignored. A lot of the eating that we do is emotional eating. Mindful eating can help us eat less, with more satisfaction. Slow down the eating process and appreciate the colours, taste and textures of food.

Summary.

Eating well is a key supportive strategy for people after cancer treatment. Not only is healthy eating associated with decreased risk of developing certain cancers but also decreased risk of developing other lifestyle diseases. Eating the right type and amounts of certain foods helps improve quality of life and can provide the patient with a sense of control over their lifestyle. Mindful eating helps to manage comfort eating and assists with gradual and sustained weight loss.

Dr Liz Isenring helps people to be healthy via evidence-based nutrition. She is Director of LINC Nutrition, Adjunct Honorary Professor at Bond University, international speaker, author of over 150 peer-reviewed scientific papers and received over 4 million dollars in research support. Dr Liz has been on the board of the Maggie Beer Foundation, Dietitian Connection, MASCC and AuSPEN. Dr Liz may be contacted via her website.