NUTRITION DURING BREAST

CANCERSadia Shaukat

Sodexo Dietetic Intern 2012

“When life kicks you, let it kick you forward”. Kay Yow

www.angelfood.org

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

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

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

HEALTHY EATING???? Eat variety of foods Eat nutrient dense food Include all food groups

Fruit and VegetablesWhole grainMeat and BeansMilk and DairyFats and Oils

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%

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

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

FOOD GROUPS- MILK AND DAIRY 3 cups per day Provide Calcium, protein, Vit D & B12

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

Food group Amount per day

examples

Grains 6 ounces 1 ounce is:• ½ c hot cereal• 1c cold cereal• ½ c rice• ½ c pasta• 1 slice bread

Vegetables 2 ½ cup 1 cup raw, cooked or juice2 cups leafy vegetables

Fruits 2 cups 1 cup raw, cooked or 100% juice½ cup dried fruitAvoid fruits with added syrup

Milk 3 cups 1 cup milk, yogurt or soymilk1 ½ oz natural & 2 oz processed cheese choose low fat

Meat & beans 5 ½ ounces 1 ounce is: • 1 oz of lean meat, fish or poultry• 1 egg• 1 Tbsp peanut butter• ½ oz nuts or seeds• ¼ cup beans or peas

*recommendations are based on 2,000 calories per day

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

QUESTION???

"I'm here today because I refused to be unhappy. I took a chance". Wanda Sykes

www.beliefnet.com/Health/Womens-Health

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/