Nutrition During Breast Cancer

1. Nutrition During Breast Cancer www.angelfood.org SadiaShaukat Sodexo Dietetic Intern 2012 “When life kicks you, let it kick you forward”. Kay Yow

2. Nutrition and breast cancer risk • Diet is linked to about 30-40% of all cancers • Diet alone can’t “cause” or “cure” cancer • Findings suggest that physical activity, a healthy diet and healthy weight can help reduce the risk of breast cancer or cancer coming back

3. Eat well during treatment Never been more important than it is now • Help keep you strong • Help your body rebuild tissue that has been damaged • Help your body deal with side effects of treatment • Help your body fight off infection • Affect immune system, mood and energy level

4. Eat well during treatment Never been more important than it is now • Some treatments work better in people who eat enough calories and protein • Maintaining healthy weight • Eating healthy and regular physical activity can reduce the risk of RECURRENCE

5. Healthy Eating???? • Eat variety of foods • Eat nutrient dense food • Include all food groups • Fruit and Vegetables • Whole grain • Meat and Beans • Milk and Dairy • Fats and Oils

6. Food Groups- Fruit and Vegetables • AICR recommend 5 ser/day to reduce the risk • Variety is key to add different nutrients • Good source of fiber, vitamin C & A • Low in calories and fats • Minimum 5 servings of fruits & vegetables per day with physical activity 30 min daily (like brisk walking)can reduces the risk of recurrence by approximately 50%

7. Food Groups- Grain • USDA recommends at least 3oz whole grain • AIC and ACS recommend whole grain over refined • Read label- 1st ingredient “whole grain” or ‘whole” • Bread 2-3gm/slice • Cereal 6gm or more per serving • Provides energy • Good source of Vit B

8. Food Groups- meat • Provides energy, protein, iron, zinc & vit B • Protein required to repair & rebuild tissues • Maintain a healthy immune system • 1 ½ ser/day of red meat may increase the risk of breast cancer • Include lean meats, beans, nuts and seeds • 1 egg equals one serving of meat

9. Food Groups- Milk and dairy • 3 cups per day • Provide Calcium, protein, Vit D & B12

10. Food Groups- Fats and oils • Study on 2,500 BC survivors who consumed 20% cal. From fat revealed reduced risk of recurrence to 42%, particularly in women with ER –ve (WINS) • Diet high in fat tends to be high in fats that may contribute to obesity • Obesity increases the risk of recurrence • Consume as few trans fats as possible

11. *recommendations are based on 2,000 calories per day

12. Treatment side effects related to diet • Loss of appetite • Eat smaller meals throughout the day • Eat whatever sounds good to you even if it is not the most healthy • Have variety of foods available • Change in taste & smell • Try foods that are tart, like lemon pudding or strong seasonings like oregano & rosemary • Avoid strong smelling meats like beef. Try chicken turkey or eggs • Inquire if someone can cook for you • Try plastic utensils if metallic taste bothers you

13. Treatment side effects related to diet • Sore mouth and throat • Eat softer foods such as mashed potatoes, mac & cheese, milk shakes, puddings or apple sauce • Eat foods at room temperature • Dry mouth • Sip water every few minutes • Suck on hard candy and eat popsicles or fruit juice • Add gravy, broth & sauce to your food • Include fruits like lemons, oranges, lime or grape fruit

14. Treatment side effects related to diet • Diarrhea • Get plenty of fluid. Water, broth & grape juice • Eat foods low in fiber • Small meals through out the day • Nausea & Vomiting • Eat more bland foods such as toast, crackers, oatmeal, clear liquids • Avoid greasy and spicy foods • Take meds with food if allowed

15. Treatment side effects related to diet • Constipation • Plenty of fluid everyday • Eat high fiber foods such as whole grain breads, fresh fruits & vegs • Physical activity • Risk of steroid induced diabetes • Avoid all concentrated sweets such as regular soda, candies, juices, cookies & cakes

16. Treatment side effects related to diet • Weight gain • Medicines, low activity or high calories • Study at John Hopkins found that for every 11 lbs gained the risk of dying from BC increased by 14% • Increases the risk of recurrence • Limit the amount of calories • Avoid items that provide extra calories • Be physically active as much as possible

17. Treatment side effects related to diet • Weight Loss • Eat Variety of healthy foods throughout the treatment • Talk to your Dr. if you notice changes • If you have lost weight and/or trying to prevent further weight loss, increase the calorie content of what you eating by: • Using milk instead of water for soups and cooked cereals • Adding butter, salad dressing & oils to vegetables • Extra protein can be added to soups by slicing cooked egg white into the soup

18. Fluid • Ensure adequate hydration and electrolyte balance • Prevent dehydration and hypovolemia • Fluid requirement is 30-35 ml/kg/day • Sign of dehydration • Fatigue • Acute wt loss • Poor skin turgor • Dry oral mucosa • Dark or strong smelling urine • Decreased urine output

19. alcohol • Studies found link between alcohol intake & risk of some cancers • Alcohol intake also affect the risk of developing new cancer in cancer survivors • It can ↑ the levels of estrogen which can ↑the risk of recurrence of ER+ breast cancer • Among breast cancer survivors research found both harmful and benefit • Avoid to prevent interaction with treatment • Irritating to survivors with oral mucositis

20. Flax seeds • Excellent source of vitamins, mineral, fiber & omega-3 fatty acids • Animal studies suggest that flaxseeds reduces the growth of tumor & potentiate the effect of treatments such as tamoxifen • Study on 32 women with breast cancer assigned to flaxseed-supplemented diet prior to surgery had significantly lower tumor proliferation • A study indicates that 25g flaxseed reduced tumor growth in patients with breast cancer • More research needed

21. Soy products • Plant-based protein it contains phytoestrogens & isoflavones • Consuming modest amount of soy before reaching adulthood can reduce the risk of breast cancer • Controversial for women diagnosed with hormone sensitive cancers • ER+ or ER- tumors (ask your Dr.) • ACS advises breast cancer survivors to limit soy to no more than 3 ser/day • Avoid soy supplements

22. Organic foods • Organic • grown without pesticides & genetic modification • Meat, poultry, eggs, dairy products from animals that are not given antibiotics or growth hormones • May be more helpful because: • Reduce exposure to agriculture chemicals • Nutrients composition may be better • No research to support that such foods can reduce cancer incidence, recurrence or progression

23. Dietary supplement • No dietary supplement treats or cures cancer • Talk to your Dr. before adding MV supplement; some may interfere with your treatment • Consume vitamins & minerals from food • AICR encourages all including cancer survivors not to use dietary supplements • In some cases supplement required depending on diagnosis

24. Food safety • Survivors are more susceptible of developing infections • Especially during treatment related to immunosuppression • Avoid foods that may contain unsafe levels of pathogenic microorganisms • General food safety practice: • Wash hands before eating • Thoroughly wash raw fruits and vegetables • Keep foods at proper temps • Use special care in handling raw meat, fish and poultry • Avoid raw honey, raw unpasteurized milk & unpasteurized juices

25. Tips • Don’t think that you have to dramatically change your diet in 1 day • Take it slowly and ease yourself into healthy eating and cooking • Try small, frequent meals & snacks throughout the day • Focus on foods that require little handling, preparation or effort to eat • Keep ready to serve & easy-to-prepare foods available to take advantage of times when you feel like eating. Examples: puddings, peanut butter, tuna, cereal bars, trail mix, cheese & crackers, eggs.

26. Tips • Some research suggests that frying, broiling or grilling particularly meats high in fat, at very high temperatures creates chemical that are carcinogenic. • ACS recommend to limit the consumption of processed & red meats • Discourages the practice of cooking these and other higher fat sources of protein at high temperatures • No evidence available regarding these effects on cancer recurrence & progression

27. Tips • If the smell of food makes you nauseous, stay out of the room where food preparation is being done • Take only small portions on the plate and go back for second • Pain medications should be taken approximately 1 ½ hour before meal time to minimize interference with food intake • Allow friends and family to prepare meals for you • Don’t hesitate to accept their offers of help with shopping & meal preparation • Take advantages of times you feel well • If you are physically able try to be more active

28. Question??? "I'm here today because I refused to be unhappy. I took a chance". Wanda Sykes www.beliefnet.com/Health/Womens-Health

29. Resources "A Dietitian's Cancer Story" by Diana Dyer. http://www.cancerrd.com/ “Cancer Lifeline Cookbook” by Kimberly Mathai & Ginny Smith 2004 http://www.cookinglight.com/ http://www.cancer.org/ http://www.aicr.org/