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NUTRITION - Eat a Rainbow Sarah Todd Senior Dietitian St Mary’s Hospital

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NUTRITION - Eat a Rainbow. Sarah Todd Senior Dietitian St Mary’s Hospital. TOPICS. Super foods? – Pomegranates Tomatoes 2. Side effects of Hormone treatment – Weight gain, Metabolic rate 3. Radiotherapy – Side effects. Pomegranates. - PowerPoint PPT Presentation

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Page 1: NUTRITION  - Eat a Rainbow

NUTRITION - Eat a Rainbow

Sarah ToddSenior Dietitian

St Mary’s Hospital

Page 2: NUTRITION  - Eat a Rainbow

1. Super foods? – Pomegranates Tomatoes

2. Side effects of Hormone treatment – Weight gain, Metabolic rate

3. Radiotherapy – Side effects

TOPICS

Page 3: NUTRITION  - Eat a Rainbow

Pomegranates

The fruit is comprised of peel (pericarp), seeds, and aril (outer layer surrounding the seeds).

The peel makes up 50% of the fruit and contains a number of bioactive compounds, including phenolics, flavonoids, and ellagitannins, and minerals such as potassium, magnesium, and sodium.

Arils are mainly composed of water and also contain phenolics and flavonoids.

Page 4: NUTRITION  - Eat a Rainbow

How Many Seeds??!!

• A pomegranate can contain 200 – 1400 seeds depending on size (that’s a lot to pick up with a pin!!)

• The seed or Arils is what is consumed, the taste can sometimes be sour from the acidic tannins found in the arils.

• This is what the juice is made from, a glass of pomegranate juice is made from more than one fruit.

• What about Mixed juice drinks – they contain added water and less pomegranate juice but some do contain other healthy berries.

Page 5: NUTRITION  - Eat a Rainbow

Pomegranate JuicesPOM100% Pomegranate Juice from concentrate

Innocent Pomegranate smoothie

67 Pressed Red & White Grapes, 2 Mashed Bananas , 1 Squeezed Oranges, 1 Pressed Pomegranates 14% , 96 Crushed Blueberries 3.5% ,56 Peeled Acai Berries 2% ,And a squeeze of Lemon

Tesco Pomegranate juice drink

Pomegranate Juice From Concentrate (32%)

Tropicana Trop 50 Pomegranate& Blueberry Juice Pomegranate Juice (2.5%)

Pomegreat Pomegranate Juice Drink

Fruit Juices from Concentrate 33% (Pomegranate 30%, Aronia Berries)

Sainsbury Pomegranate

& Blueberry Juice Drink

Pomegranate Juice From Concentrate (25%

PomeGreat 100% Pomegranate

Page 6: NUTRITION  - Eat a Rainbow

Are they as super as they claim?• Antioxidant benefits – from phenolics, flavonoids, and

ellagitannins– Antioxidants mop up excess Free Radicals, which are produced by

the body as it protects itself from outside invaders, like bacteria, If free radicals get out of control, they can damage normal cells and tissues.

• May help prevent the clogging up of the artery walls - due to Polyphenols, such as tannins and flavonols – which are actually found in many fruit and veg.

• Small studies have shown they may suppress tumour growth and lower Prostate Specific Antigen (PSA) levels BUT more larger clinical trials are need.

• In these studies the participants consumed 8oz pomegranate juice a day

Page 7: NUTRITION  - Eat a Rainbow

• In studies the equivalent of a large glass a day was consumed – so not excessive

• Pomegranate juice is higher in natural sugars and energy (Kcal), a possible concern if you have diabetes or are trying to control weight.

• Perhaps spilt into 2 smaller glasses and take with food.

• In 8oz (220ml) there are 150Kcals compared to 77Kcal in Orange Juice and 30Kcal in Tomato juice

• May impact on how some medication is broken down in the body (e.g. Statins, Warfarin) – best speak to your doctor/pharmacist.

• Overall –it is just a fruit with no negative effects if taken in moderation.

Any Harm??

Page 8: NUTRITION  - Eat a Rainbow

• Other Antioxidant rich foods:• Blueberries• Goji Berries• Strawberries• Cranberries• Bilberries

–Super berries??

The potential benefits are from the antioxidants

Also:Tomatoes, green tea and all fruit and veg!

Page 9: NUTRITION  - Eat a Rainbow

Lycopene

• Gives fruit and vegetables the ‘red’ colour• Antioxidant properties• Sources: Tomatoes, guava, watermelon, papaya, pink

grapefruit, apricots• Lycopene best absorbed from cooked vegetables and fruits,

also aided by a small amount of fat (e.g. pasta mixed with tomato sauce and drizzle olive oil)

• Evidence that Lycopene in fruit and veg probably protects against Prostate cancer. Inconclusive evidence that it helps slow progression – but doesn’t harm.

Page 10: NUTRITION  - Eat a Rainbow

Ways to include Lycopene in your diet

• Mix sun-dried tomatoes into bread dough or add them to a sandwich or salad.

• Have Pasta with a tomato sauce • For a refreshing start to your day, enjoy a pink grapefruit.• Reach for tomato juice to quench your thirst.• Make a quick bruschetta by toasting baguette slices and

lightly brushing with olive oil. Top with canned, diced tomatoes and a sprinkling of basil.

• Have a few dried apricots as a snack or chop and sprinkle on your cereal

• Have watermelon or papaya as a fruity pudding– (….with cream or ice-cream)

Page 11: NUTRITION  - Eat a Rainbow

Summary• Pomegranate and Tomatoes (Lycopene rich

foods) may be beneficial• Overall aim for a diet rich in antioxidants

– By eating more fruit and vegetables (5 a day (at least))

– Snack on fresh/dried fruit or add to cereal, have a glass of fruit juice a day, have a fruity pudding and have veg / salad with your meals

– Eat a rainbow though…• This message is the basis of healthy eating

Page 12: NUTRITION  - Eat a Rainbow

Hormone treatment

• Hormone treatment for prostate cancer can cause weight gain and tiredness. In turn these symptoms may make you less active, which may make weight gain worse.

• May be a loss of muscle mass due to lower testosterone levels and an increase in the amount of body fat, so you may have a change to your body shape.

• Some studies show that the weight gain stabilises after first year of treatment (?)

Page 13: NUTRITION  - Eat a Rainbow

Controlling weight is never easy

• We have no other tools than trying to:–Maintain a healthy diet–Be active

•Exercise can help to maintain muscle strength, especially resistance exercise such as swimming

•Aim for 30mins exercise 5 days a week (but during treatment just do what you can)

•Don’t have to join a gym – take a walk, ride a bike, go swimming, take the stairs in shops rather than escalator, speak to a healthcare professional regarding chair based exercises if needed

Page 14: NUTRITION  - Eat a Rainbow

Metabolism• Metabolic system?• We all need a certain amount of energy to maintain life –

Basel metabolic rate

• If you have a high percentage of body fat you are more likely to store fat more easily, giving a lower metabolic rate

• As people get older they naturally lose muscle mass which reduces metabolic rate slightly

• Exercise is the way to combat this – especially strength exercises to maintain muscle mass.

• If you lose weight too quickly via ‘fad diets’ you lose muscle mass, which lowers your metabolic rate.

• It can be ‘tricked’ by if you become more active and burn off more energy.

Page 15: NUTRITION  - Eat a Rainbow

Healthy Eating• Foods Groups

– Starchy carbohydrate – bread, rice, pasta, potato etc

– Fruit and vegetables (fresh, dried, frozen, canned)– Dairy – milk, cheese, yoghurt– Meat, fish, pulses, eggs, nuts – Protein group– Foods containing fats and sugars When looking at a plate of food – ½ should be

vegetables or salad, a ¼ starchy carbohydrate and a ¼ protein containing foods.

• Regular meals – don’t skip breakfast

Page 16: NUTRITION  - Eat a Rainbow

Healthy eating

• Eat 5 a day fruit and veg (remember the rainbow)• Chose high fibre carbohydrates (e.g. wholegrain bread,

eat skin on potatoes, wholegrain cereal)• Remove all visible fat from meat and limit fat used in

cooking• Replace some meat with beans/pulses (if able) to

increase dietary fibre. Lower fat cheeses (e.g. Edam), choose low fat soft

cheese even as an alternative to butter/marg on bread. • Limit high energy snacks and puddings (e.g. biscuits,

cake, gateaux's, ‘stodgy’ puddings)• Watch alcohol intake (A 250ml glass of wine contains

250Kcals)

Page 17: NUTRITION  - Eat a Rainbow

Fat Facts• Different types:• Saturated animal fat – bad for your heart• Unsaturated (Vegetable) fats

– Polyunsaturated – e.g. sunflower oil rich Omega 6– Fish Oils – Omega 3 – Anti – Inflammatory

– Monounsaturated – e.g. olive oil healthier fat for you heart

Bottom line – all contain same Kcals -

1 tablespoon oil = 100Kcal (Equivalent to 3 rich tea biscuits or a crumpet)

Page 18: NUTRITION  - Eat a Rainbow

Watch those extra’s

• Naan bread ( a large Naan contains 400Kcal compared to 550 in an average curry and rice. – meal total 950Kcal)

• Garlic bread (3 small slices contain ½ Kcals of a portion of lasagne – meal total 750 Kcal)

• Crisps – can vary from 80Kcal – 200Kcal per packet• A portion of sticky toffee pudding and custard has same

Kcal content as an average meal• 4 chocolate coated biscuits has same Kcal content as a

ham sandwich

Page 19: NUTRITION  - Eat a Rainbow

Radiotherapy

• Causes tiredness• Can irritate your bowel leading to soreness and /

or diarrhoea (reported 80% of patients having radiotherapy to pelvis region have stomach upsets

• Stomach cramps• Can cause inflammation of your bladder• Can make blood vessel fragile leading to blood

on passing stools or urine

Page 20: NUTRITION  - Eat a Rainbow

Dietary changes may help

• Drink plenty – aim 8 -10 cups of fluid a day

• If you have diarrhoea – speak to your doctor regarding medication to help.– A Low Fibre diet may help some individuals – no evidence

that routine reduction helps alleviate incidence or severity

– Lactose – Some people feel that milk/lactose makes the diarrhoea worse but the enzyme that breaks down lactose is Lactase, found in high in small bowel – Radiation is highest further down.

Page 21: NUTRITION  - Eat a Rainbow

Low Fibre Diet• Breakfast cereals: Cornflakes, Rice Krispies, Coco Pops, Special K • Bread, flour, pasta & rice: White: bread, rolls, pitta, chapatti,

crumpets, white rice, white pasta, cornflour, sago, tapioca, semolina, couscous

• Biscuits, cakes, crackers: Biscuits made with white flour: Rich Tea, Nice, Ginger Nuts, Shortbread, Custard Creams, Jaffa Cakes, Plain cake e.g. sponge cake, plain scones , White crackers or crispbreads e.g. Cream crackers,

• Fruit : Tinned, stewed or fresh fruit without skins or seeds: peeled apples, pears or peaches, melon, ripe bananas

Fruit juice without ‘bits’

• Vegetables: Well-cooked vegetables e.g. carrots, Swede, parsnip, beetroot, cauliflower and broccoli floretsPotatoes without skins

Page 22: NUTRITION  - Eat a Rainbow

• All Meat, fish, eggs, dairy products are ok.• Only follow this diet whilst the symptoms of

diarrhoea may still be present.• Re-introduce fibre slowly back into your diet

• Other foods that can aggravate diarrhoea:– Caffeine drinks: tea, coffee, cola (use decaf versions,

herbal teas)– Alcohol– Sugar-free products containing Sorbitol eg chewing gum– Fruit juice (limit to one small glass (150ml) per day)– Spicy foods– Fried foods

Page 23: NUTRITION  - Eat a Rainbow

Eating during radiotherapy•Common side effects:•Poor appetite, Nausea, tiredness, low mood•Travelling to treatment centres can worsen above symptoms•Result – reduced oral intake –

• Little and often approach, have energy dense snacks, Puddings after meal or in between as snacks, Add fats to foods (e.g. butter in mash potato, cheese sauce on veg, parsley sauce with fish, roasted veg in oil), Grate cheese onto meals, have milky drinks, Full fat diary products

Page 24: NUTRITION  - Eat a Rainbow

Summary• Pomegranates may slow progression of tumour but further

studies needed

• Cooked/sun dried tomatoes good source of Lycopene - an antioxidant

• Aim to eat 5 portions of different fruit and veg (a rainbow) to have an antioxidants rich diet (include tomatoes + Pomegranates as part of a healthy diet).

• A healthy lifestyle helps control weight gain – but it is difficult

• Symptoms of diarrhoea can be helped with a low fibre diet• If your appetite is poor due to treatment then a ‘little and

often’ approach to eating is needed with energy dense foods.

• If you require specific individual dietary support speak to your doctor regarding referral to a Dietitian