Transcript Nutrition and Breast Cancer - Breast Cancer Research Centre WA

Nutrition and Breast Cancer
An informative presentation
about all all aspects of Nutrition
and Cancer
By Angela D’Amore
Mount Hospital Dieititan
Overview
 Risk factors
Common treatment and nutritional side
effects
Healthy eating guidelines
Unproven diets/therapies
Changes in weight
Avoiding reflux
Bowel care
Fluid and hydration
Low bacteria diet
summary
Cancer risk factors
Obesity
Physical activity
Consume a healthy diet with an
emphasis on plant sources
Processed meats and red meats (for
colon cancer)
Alcohol
Common treatment nutritional side effects
Breast cancer chemo
Nausea and
Vomiting
Florouracil (5FU)
Epirubicin
Diarrhoea
Sore
mouth
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Reduced
appetite
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Cyclophosphamide
Doxirubicin
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Taxotere
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FEC
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Tast
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chan
ges
Reduced
immunity
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methotrexate
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Paxiaxol (Taxol)
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Other side effects
• Gastrointestinal: bloating, constipation
– Cells as rapidly turning over in the gut and
chemo affects these
• Weight changes
– Weight gain: more breast and prostate
– Weight loss: more lung, bowel, pancreatic
Controlling side effects
• Medications I.e Nausea & Vomiting,
Diarrhoea etc
• Gels for mouth ulcers
• Diet I.e reduced Nausea, improve
taste of food, reduce pain with
mouth ulcers
• www.macmillan.org.uk
Healthy eating guidelines
 Maintaining adequate Nutrition and food intake
during chemotherapy is optimal to minimise
deficiency and optimise your immune system
 Nutrition recommendations for cancer patients
are designed to help the patient cope with the
effects of the cancer and its treatment
 No special foods or diets have been scientifically
proven to cure or prevent cancer
Diet Myths and Cancer
• What have you been told or read
about Nutrition and Cancer?
Unproven diets/therapies
Low Dairy Diets
Calcium is an important nutrient for
bone health and provides protein for
muscle strength
Protective effect in colorectal cancer
shown (with calcium supplements
No significant association between
dairy and breast/ovarian cancer
Other Diet and cancer
“Myths”
Myth 1: Large amounts of protein can cause the
cancer to return not true.
Protein is much needed to help with healing of the muscles
and to prevent them from wasting. No need to be
excessive but avoiding protein may be damaging
Myth 2, Juicing is a better way to consume
vegetables Not true
Certain vegetables like tomatoes require heat and oil for our
body to absorb the 'lycopene' (active ingredient) that is
needed. Juicing also removes fibre and pulp that we need
for good bowel movements.
Diet & Cancer myths cont…
Myth 3, Becoming a vegetarian will improve
chances of recovery
Drastic diet changes are not recommended nor
will they do anything to reduce cancer
progression/treatment tolerance
Myth 4, Relatives and blood related families
have the best answers
They may have gone through the process but
always check with your doctor or dietitian the
evidence/truth behind the suggestions
Diet & Cancer myths cont…
Myth 5, Losing weight is a good thing
It is very common to lose a bit of weight during
cancer treatments. Weight loss is expected
during such events. But if there is a significant or
big drop of weight, please consult your doctor
about it. Losing a lot of weight at a time is a sign
of another underlying problem
Other nutrients/foods
Soy
Rich in Phyto-estrogens which mimic
oestrogen in the body
High consumption of soy foods may lower the
risk of breast and prostate cancer (but only
slightly)
Existing or previous Breast cancer patients
should avoid consuming large volumes of soy
or phyo-estrogen supplements
Low Sugar Diets
• Sugar does not feed
cancer cells
• Although all cells, including
cancer cells, use glucose
(blood sugar) for energy,
sugar does not speed tumor
growth. In turn, removing
sugar from your diet will not
slow tumor growth.
• Balanced diet with some
sugars is best
Vitamin Supplements etc
 Supplements= specific isolated nutrients
 Nutrients from food work together to more
protective effect than supplements
 High doses of some vitamins I.e Vit C can
increase risk of Lung cancer in smokers
 Antioxidants- Vitamin A (beta carotene)
supplements can increase risk of certain cancers
 Vitamin supplements can interfere/interact with
the chemo
 Herbs/homeopathic remedies- can interfere as
well, contact Oncologist if unsure
Factors that indicate “Fad
diet”
• Does it exclude one of the 5 food groups?
• Does it include large amounts of fruit,
vegetables or their juices?
• Does it limit cooked foods or cooking
methods allowed?
• Does it limit protein foods like meat,
chicken or fish?
• Is it causing you to lose weight?
• Include large amount of supplements
• Cost you in time and money
Weight Management
• A high BMI (Body Mass Index) = inc risk of
breast cancer development
• If overweight to start you may gain
weight during treatment (menopause,
steroid sensitivity etc)
• If your appetite fluctuates don’t
overcompensate your food intake when
you feel well
• Hormone therapy may cause inc weight
gain
Changes in Weight
• Weight loss of > 10% in 1 month
- Is not desirable even if you are overweight
(BMI > 25)
- Research shows that any weight loss incurred
is muscle mass not as fat mass
- This makes you less active/weak/dec function
and energy levels
- Aim to maintain weight through healthy
eating and high protein diet
- May need protein supplements, talk to
Dietitian and individual consult may be
required
Changes in Weight
• Weight gain
- Research shows that breast cancer patients
who gain weight throughout chemo are still
losing muscle.
- Some of the weight gain is fluid
- healthy balanced eating to promote fat loss
not muscle loss
- Eat small, regular, low fat, high protein meals
- If you are overweight tor obese, start looking
at your lifestyle habits seriously after your
treatment and aim to lose slowly and healthily
Diet Post Chemo
• Chemo increases the risk of reflux
– Reduce intake of
 Orange juice
• Lemon
• Lemonade
• Grapefruit juice
• Cranberry juice
• Tomato
For a few days post chemo treatment
Diet Post Chemo
• Drink lots of water and nutritious fluids
• Soup, Juice, milk, Milkshakes etc
Bowel Changes
• Can alternate between constipation and
diarrhoea
• Diarrhoea
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Stick to LOW FIBRE FOODS
White breads, pasta, rice, refined cereals
Fruits without skins, bananas, limited vegies
Can have “soluble fibre” – helps form
stools/adds bulk I.e psyllium husks, Benefibre
powder.
Bowel Changes
• Constipation
– Can reduce appetite
– Definition
– Increase fibrous foods: fruits (dried especially),
vegetables, all grains to be
wholemeal/wholegrain I.e pasta, rice, bread
and cereal
– Fibre supplement I.e Psyllium Husks, Benefibre
– DRINK! Fluid intake is important- 1-1.5 LITRE
WATER + other fluids
Other things
• Thrush or bout of Diarrhoea = take 1
serving yakult daily for 10 days
• Drink lots of fluid after
Diarrhoea even more than
Rec 2 L/day
Protein
• Adequate protein helps reduce muscle
wastage and improve energy
• Include a source at each meal- at least
50g per day
• Requirement: 0.75 multiply by your
weight= number of grams pf protein
needed per day (may be too high,
minimum 50g/day)
Sources
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Protein content of common foods:
Beef, chicken, 90g cked=
Tuna, ½ cup
½ cup legumes=
Cheese- cheddar, 2 slices=
Cheese, ricotta, ½ cup=
Milk, 1 cup=
Yoghurt, 100g=
Egg, 1=
Nuts, 2 tbs=
Cereals, ½ cup
Pasta, rice, per ½ cup=
20g
15g
7-8 g
6g
5g
8g
5g
6g
6g
1-2 g
2g
Meal Plan to meet Ptn
requirements
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Breakfast: Cereal- Muesli with nuts,½ cup (6g) + ½ cup milk (4g) = 10g
Morning tea: Milky coffee (1 cup milk)
= 8g
Lunch 1 tin flavoured tuna (13g) + 2 wholegrain crackers (1g)= 14g
Afternoon tea 100g Yoghurt
= 5g
Dinner
60g cooked meat, chicken, fish + vegies (0)
= 15g
Supper
fruit (0) + 100g lite custard
= 5g
= 54g total
Low Bacteria Diet
• When your levels of neutrophils, a type of
white blood cells, become too low
• Neutrophils defend against infections
– Mild - ANC of 1000-1500 cells per mm3.
– Moderate - ANC between 500 - 1000 cells per
mm3.
– Severe - ANC falls below 500 per mm3
• Following a low bacteria diet
is the only thing you can do
to manage
• Usually transient and comes
Low Bacteria Diet
• Foods low in bacteria must be eaten whilst
your white cell count is low
• Avoid
– Raw meats or processed meats (inc smoked
salmon)
– Fresh or moudly cheeses (cream and hard cheese
is fine)
– Salad bars, buffets etc.
– all food much be freshly prepared!
– Soft serve/milkshakes
– Products with raw eggs
– Unpasteurized products
Summary
1) Don’t exclude food groups
2) Don’t overload one type of food I.e
pomegranate
3) Don’t replace fruit with juices, have juices
after meals
4) Ok to eat cooked foods but reduce deep
frying
5) Protein is important for muscle turnover and
repair
6) Watch mega doses of vitamins/minerals
7) CONSULT A QUALIFIED DIETITIAN
Questions?