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Nutrition Services

Ask the Nutritionist Archive

Ask the Nutritionist enables you to ask the Dana Farber/Brigham and Women's Cancer Care Nutrition Department general questions about nutrition during and after cancer treatment. This archive includes answers to questions posed so far.


Optimal Diet

Q: Hello. You may not be able to answer this, but I thought asking couldn't hurt. My mom recently underwent the Whipple procedure for pancreatic cancer. The doctors say she is doing remarkably well, however, she's barely 100 lbs and can't seem to keep food in her long enough to pull any of the nutrients from them. She is only two months out, and we are told her eating will be trial-and-error and to just stick to giving her six small meals a day. Are there any foods that would be essential for her to try and eat — foods in which she'll get the most nutrition and won't cause her horrible gas pains or diarrhea? She's a vegetarian, but does eat fish. White fish sits well, but salmon (because it's so fatty) doesn't. She can't eat green vegetables because they are so hard to digest, yet they contain the iron she needs for energy. She's so tired all the time. She can't digest fat, so that won't help her put on weight. Her sugar is all over the place so we don't want her to eat too many carbohydrates. I'm just looking for a little guidance or some suggestions, if possible. Any insight would help.

Kind regards,
Kyle
Boston, MA

A: It sounds like your mom could benefit from some diet modifications to help her symptoms and promote weight gain since her surgery. We recommend that your mother speak with her doctor about a prescription for digestive enzymes. Many of the digestive problems you describe, such as diarrhea and mal-absorption of nutrients, could be helped by using prescription digestive enzymes. These enzymes are usually taken with meals and snacks to help the body break down food and increase the amount of nutrients being absorbed. They will particularly help with fat digestion and absorption. Because she is not eating much fat now, she may be deficient in fat-soluble vitamins, such as vitamin D. Your mother should ask to have her vitamin D levels checked with a blood test called "25 OH D."

As far as diet recommendations go, your mother should be eating protein, fruits and vegetables, and complex carbohydrates. These kinds of foods will help promote healing and help her feel better. Diarrhea and gas pains can be caused by foods that contain too much fat or too much fiber, and making different diet choices may help prevent or treat these problems.

Protein is essential for your mother to try and eat. Vegetarians sometimes have a hard time getting enough protein, but there are ways to get protein into her diet without causing gas pains or diarrhea. Eggs are a great source of protein and a good source of iron. They also should not cause diarrhea or gas pains. Depending on the type of vegetarian your mother is, eggs may be a great addition to her diet. For protein, she should continue eating white fish and should try small amounts of tofu and smooth/creamy peanut butter. These are both protein sources that won't cause diarrhea. Sometimes lactose found in dairy products may cause diarrhea, so trying out products such as soy milk, rice milk, almond milk, and low -fat yogurt without fruit will provide some protein.

The kinds of fruits that are easiest to digest are cooked or peeled and do not have skins or seeds. These include applesauce, ripe bananas, fresh melon, canned peaches, oranges and fruit cocktail in "lite" or natural syrup. The kinds of vegetables that are recommended are cooked vegetables with the skins and seeds removed, such as winter squash, sweet potatoes, baked potatoes, green beans, carrots, beets, asparagus tips, peeled summer squash or zucchini. These vegetables are easy to digest. Cooked asparagus tips and green beans are also are a fair source of iron.

Most cereals are fortified with iron. Your mother should try eating a small portion of low-fiber cereals such as Cheerios, Rice Krispies or Corn Flakes. Just make sure to check the labels for iron fortification and low fiber (should be less that 3g of fiber per serving). Some pastas are also fortified with iron. She may also need an iron supplement and should speak with her doctor about checking her blood iron levels. To prevent diarrhea and gas, stick to boiled, enriched noodles or pastas instead of whole wheat pastas. Adding cereals and pastas to your mother's diet may also help with her fatigue. These carbohydrates will keep her energy up and small portions eaten frequently will not spike her blood glucose.

The best way to eat all this food is in small frequent meals. Eating too much at once will cause too much food to be "dumped" into the small intestine and the food will move very quickly causing her diarrhea and gas pains. Small meals will move more easily through the GI tract and allow for more digestion to occur, which can result in better absorption of nutrients. Eating slowly and chewing foods thoroughly will also help her prevent this "dumping" from happening.

Finally, we recommend you ask your mother's doctor for a referral so she can see a Registered Dietitian who will create a personalized diet plan for her.

Q: What kind of frying oil is heart-healthy? I've read that canola is one kind of oil low in saturated fat, but it doesn't have a high smoke point. So what oil is the healthiest to use with at least a 325-degree smoke point? Thank you.

Scott G
Newark, DE

A: You can use canola oil to cook at higher temperatures: its smoke point is 350 degrees. Canola oil is low in saturated fat and contains omega-3 and monounsaturated fats. Omega-3 fats can reduce inflammation and possibly reduce the risk of cancer and heart disease. Canola oil is also cholesterol-free and trans-fat free. Because you write that it's not your favorite form of oil for frying, you may prefer using it when you cook using other methods.

Extra virgin olive oil is one of the healthiest oils, but it is not recommended for cooking at high temperatures. Heating it at such high levels will result in oxidation or creation of free-radicals that can contribute to inflammation in the body and cell damage associated with increased cancer risk. Olive oil that is not extra virgin or virgin can be used at slightly higher temperatures. Like canola oil, olive oil has the health benefit of being low in saturated fats. In addition, olive oil has much more monounsaturated fat than canola oil, which can reduce LDLs (the "bad" cholesterol) and increase HDLs (the "good" cholesterol).

We recommend that you consume fried foods in moderation. If you like cooking with oil, we would suggest two healthier methods: sautéing and stir-frying. Using either canola oil or olive oil, you can make a delicious stir-fry that includes your favorite vegetables and meats. We suggest a recipe for a vegetable stir-fry we have in our recipe archive. You can also make a fajita-style stir fry with peppers, onions, tomatoes, chicken and jalapeños. Serve it on a whole wheat tortilla and you've got a meal that provides vitamins, minerals, phytonutrients and healthy fats.

Q: I noticed that shellfish (shrimp is my main concern) are not on the lean protein list — where do they fit in or are they not good for a colorectal cancer diet?

Suellen
Attleboro, MA

A: Shellfish, such as shrimp, do provide many important nutrients such as protein, iron, niacin, zinc, vitamin B12 and selenium. Shrimp are considered a lean protein. Four large shrimp provide 4.6g of protein with only 22 calories and only .2g of total fat.

A low fiber residue diet is sometimes recommended for someone with colorectal cancer, because the colon may be obstructed due to the cancer. Low-fiber residue diets are also recommended for people who have diverticulitis, bowel surgery and stenosis. This type of diet reduces that amount of indigestible foods, such as fiber, and reduces the bulk of food that is being eaten. It will prevent blockages from forming in the intestine and large amount of bulk or gas and may relieve some discomforts like abdominal pain and cramping. Unfortunately, shrimp and other shellfish are one protein source that may cause discomfort because of their texture.

If you are at risk for obstruction, you may be able to eat shrimp in moderation. Just be sure to chew it very well. This will break down the texture and possibly make it a little easier for your body to digest. If you have recently had a bowel obstruction, you should talk to you doctor before trying to include shrimp in your diet. Try boiling, poaching or adding them to soup: these types of preparation can make the texture less tough and a little easier to digest in comparison to grilling or sautéing.

Q: My mother has breast cancer and I have been trying to come up with a weekly diet plan for her. Could you send me an idea of what I should be feeding her daily?

RBB
Roseville, CA

A: Protein, fruits and vegetables are all highly recommended in a diet for a patient with cancer. Please refer to this "Ask the Nutritionist" question and answer for more information on a diet for someone with breast cancer.

Soy products are a concern for many breast cancer patients. Foods that come from soybeans are a great source of protein, but soy contains isoflavones which exert a weak estrogen-like effect on the body. Isoflavones are plant-based nutrients and can be referred to as a source of phytoestrogens. Isoflavones have been found to have a protective effect on the development of certain types of cancer like prostate, breast, colon and bladder cancer. However, after the diagnosis of Estrogen Receptor Positive breast cancer, there are controversies surrounding consumption of soy foods. It is still unknown whether or not excessive consumption of soy isoflavones may fuel the growth of estrogen-dependent breast cancer cells. Current research suggests that it is prudent for women to avoid soy isoflavone supplements and highly concentrated foods, such as foods made with textured vegetable protein and soy protein isolate found in many protein powders and nutrition bars, because of the high concentration of isoflavones. However, whole soy foods, like soymilk, edamame and tofu, may still be consumed in moderation several times per week. Foods with soy in the name, that do not have any phytoestrogen activity and are safe to eat include: soybean oil, soy sauce and foods made with soy lecithin.

Preliminary research suggests that adequate vitamin D intake may help prevent and slow the progression of breast cancer. Up to 800-1,000 IU of vitamin D per day will help prevent deficiency and provide an important nutrient for bone health. Unfortunately, there are not many food sources that offer enough vitamin D to maintain healthy blood levels, especially for those who live in northern regions of the country. Some good food sources of vitamin D are one cup of milk or fortified soy/rice beverages (100 IU), 3 oz. of canned tuna (200 IU), 3 oz. of salmon (425 IU), 3 oz. of pink salmon (530 IU), and 3 oz. of canned sardines (250 IU). If you are not a fish person, try packets of Quaker Nutrition for Women oats, which offers 140 IU of vitamin D. Some other excellent sources of vitamin D include one tablespoon of cod liver oil (1,360 IU) and 3 oz. of herring (1,384 IU).

The skin is often able to make enough vitamin D usually in the months between April and October in the northeast. 15-20 minutes of sun exposure, without sunscreen on, between 9:00 a.m. and 3:00 p.m. (the best exposure is at mid-day) can cause your skin to synthesize enough vitamin D for your body. Remember, however, that there is risk associated with too much sun exposure, so keep your time in the sunlight limited to 15-20 minutes.

Depending on the treatment that your mother is receiving, she may be able to handle some foods better than others. However, a well-balanced diet with protein, fruits and vegetables, and healthy fats is the recommended diet for someone diagnosed with breast cancer. Please also check out our recipes archive for great ideas for healthy meals and cancer-related health tips associated with each recipe.

Q: Does eating plenty of nuts raised your cholesterol?

CF
Boston, Mass.

A: Nuts are a great addition to any diet. They are full of protein, fiber, healthy fats and other nutrients. The fats that are found in nuts are mostly monounsaturated fats, which do not raise your blood's cholesterol levels. Nuts are also cholesterol free. However, nuts can be high in calories, so stick to smaller servings to receive the optimal health benefits. Just a serving of 1 1/2 ounces of nuts a day can reduce your chance of heart disease when it is paired with a diet that is low in fat and cholesterol.

Nuts also contain phytonutrients. These are nutrients that are found in natural foods and have properties that can reduce your cancer risk. Pecans and walnuts contain ellagic acid, which is a cancer-fighting phytonutrient. Many other nuts contain phytic acid, which may reduce cancer risk and may help control blood sugar, cholesterol and triglycerides. Walnuts also contain omega-3 fatty acids, which may protect against or help reduce the development of cancer.

Overall, nuts provide many health benefits when eaten in moderation and as part of a balanced diet. They can be sprinkled onto salads and parfaits for a little extra crunch. They can be used as a coating or topping for chicken, fish or vegetables. Also, just a plain handful of nuts can make for a healthy snack.

Information found from the American Dietetic Association.

Q: What is a recommended diet after a bi-lateral mastectomy with reconstructive surgery using her own body tissue? I'll be visiting/assisting a post-op friend approximately 2 weeks after her surgery and want to prepare meals that enhance recovery. Or send me to a Web site that will answer this for me. Thanks.

dd
Moosup, CT

A: By two weeks after your friend's surgery, she should be able to return to her normal eating patterns again. A diet that will help her heal and keep her healthy should contain protein, fruits and vegetables, healthy fats, and carbohydrates.

It is important your friend is getting enough protein during her recovery period. Protein will help the growth and repair of all cells in the body, including muscles and hormones. Some good protein choices are poultry, fish, lean meat, cheese, eggs, low-fat dairy products, and beans. So far, there is no correlation between growth hormones in meat and dairy with harming the cancer recovery process. If you or your friend is worried about trace residual hormones, you can make the personal choice to buy organic meats and dairy.

Other foods that will help your friend heal are fruits and vegetables. Fruits and vegetables are full of vitamins, minerals and phytonutrients, which are all essential to aid healing in the body. The best way to include all of these vitamins, minerals, and phytonutrients is to eat a wide variety of fruits and vegetables. Just remember to wash produce thoroughly. If you choose to buy organic produce to avoid pesticide exposure, choose organic fruits and vegetable that have a thin skin, such as strawberries. Thick-skinned fruits like bananas are less likely to have high pesticides residue on them, and you don't ingest the skin of these types of fruits, anyway. The Environmental Working Group Web site has a complete list of the types of fruits and vegetables that have higher and lower pesticide residue exposure.

Eating a variety of fruits and vegetables will also supply your friend with carbohydrates that will give her energy to combat fatigue that may occur after surgery and that will help her heal. It is important to serve her complex carbohydrates, including whole grain pastas, whole grain bread, brown rice, potatoes, and sweet potatoes.

Healthy fats should be included regularly in a well-balanced diet. These healthy fats will also help your friend heal. Monounsaturated and omega-3 fats are the best choices. They are found in fish, olive oil, nuts and nut butters, ground flax seed, wheat germ, and avocado. Monounsaturated and omega-3 fats have been shown to improve immune function, decrease inflammation in the body and prove beneficial to heart health. Fats that should be avoided are saturated fast and trans-fats. Trans-fats can raise bad LDL cholesterol levels and are not beneficial to helping your friend heal. These kinds of fats are found in butter and margarine, deep-fried foods, and the oils in processed foods. Anything in the ingredients list that says partially-hydrogenated or hydrogenated oils indicates there are trans-fats in that food.

Keeping up a well-balanced diet after surgery will help your friend heal the fastest and help her start feeling healthy again.

Q: What are the benefits of omega-3 fats and what foods are the healthiest sources of omega-3?

Anonymous

A: Omega-3 fats are increasingly recommended to be added to maintain a healthy diet, but many people do not know what they are or how to get the best sources of these beneficial fats.

Omega-3 fats can reduce the risk of heart disease and high blood pressure, prevent blood clots, and encourage healthy brain development in children. In cancer patients, preliminary research suggests that diets that include omega-3s may protect against the development of cancer, reduce inflammation, help prevent muscle loss associated with cancer treatment, and may increase the potency of certain chemotherapy drugs.

While there are various food sources of omega-3 fats, different sources provide different levels of the "active" substances that help reduce inflammation. There is Alpha-linolenic acid (ALA), and the more metabolically active eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA).

Fatty fish, such as sardines, mackerel, salmon, swordfish, herring and tuna steaks are good sources of omega-3 fats. These types of fish are rich sources of the more metabolically active EPA and DHA and don't have to be converted from ALA. This is why fish is the preferred omega-3 source. Eggs and grass-fed beef are weaker sources of omega-3 fats.

Plant seed oils like flax (linseed), hemp, pumpkin, and walnut are all sources of ALA. Less than 10% of these oils are converted to EPA and DHA in the body, though. But for people who avoid fish, it is encouraged to include flaxseeds, hemp seeds, pumpkin seeds or walnuts on a daily basis to get omega-3 fats into their diet.

Fish oil capsules are also a useful way to get a consistent amount of omega-3 fats if dietary fish intake is inconsistent. Fish oil capsules should provide at least 500 mg combined of EPA/DHA per capsule. There are also "fish-free" omega-3 capsules that are sourced from sea algae for vegetarians. A doctor or dietitian can recommend a specific amount of omega-3 in pill form.

Q: Please outline a good diet for [a person with] metastatic liver cancer.

C.C. Harris
North Yarmouth, ME

A: It is recommended for cancer survivors to follow a plant-based diet with adequate protein and fluids. Please see our Optimal Diet section at the top of this page for more detail.

With regard to metastatic liver cancer, there are likely additional dietary recommendations based on any digestive symptoms you may be experiencing. Also, there may be further recommendations depending on your specific treatment plan.

Please review the archived questions on this page or the Alleviating Side-Effects section for more advice and to learn about diet modifications for issues such as diarrhea or fat intolerance.

Dietary recommendations are unique to each patient and the current context of their cancer treatment. The best course of action would be to schedule a consultation with a Registered Dietitian who could meet with you one-on-one to give you a personalized diet plan.

Q: My sister has 4th stage bone cancer. She is 51. Her Oncologist told her to eat whatever she wants for caloric intake – pizza, Chinese, etc. I gave her some GNC Super Supreme Foods to take for general health. It is a freeze-dried mix of 170 fruits and veggies. She asked was it ok, and he told her it is a $50 billion industry and would not help her cancer. I'm concerned and disappointed. She is taking nothing for nutrition.

C.C. Harris
Killeen, TX

A: GNC Super Supreme Foods may be used safely as a dietary supplement by a healthy individual. However, the current research shows that high-dose antioxidant supplements, including powders, may be contraindicated with chemotherapy drugs and radiation therapy. High-dose antioxidants have been shown to significantly hinder the effectiveness of these cancer therapies. Rather, your sister should take a standard multivitamin during treatment.

Your goal of encouraging your sister to include nutrient-rich foods in her diet is both correct and advisable. However, your sister's oncologist is also correct. The supplement you mention has no proven effect to prevent or fight cancer or any other diseases. Dietary supplements in this country are not regulated and are a multi-billion-dollar industry.

What we would recommend is following a diet that is high in healthy calories, protein, and phytonutrients. Antioxidants that naturally occur in foods and are consumed in usual dietary amounts are not only safe during cancer treatment, but also strongly advised. Antioxidants are a class of phytonutrients. Phytonutrients are found in plant-based foods and may prevent cancer as well as provide other health benefits, including promotion of cancer survivorship and immune support. Phytonutrients/fiber sources include fruits, vegetables, whole grains, and spices.

Eating fast food and other high-calorie, high-fat meals may cause a weight gain in healthy individuals. However, someone who is undergoing cancer treatment could benefit following a healthy diet that may boost the immune system, rebuild healthy cells between treatments, and help with weight maintenance/gain that is primarily lean body mass vs. body fat. Healthy fat sources include: Olive oil, canola oil, flax oil, avocado, seeds, and nuts.

Achieving adequate nutritional status through diet will also promote faster recovery with fewer infections and/or complications, spare protein for other uses in the body, and prevent weight loss during healing.

We encourage everyone who is undergoing cancer treatment to meet with a Registered Dietitian one-on-one to develop an eating and vitamin/supplement plan that is individualized based on the patient's goals and needs, and that may take into account side effects of treatment and other diseases the patient may be treated for.

Q: I was recently diagnosed with LMS of the uterus. I had a total hysterectomy. All the diets I have been reading about only tell you to have greens/vegetables. WHAT can I eat???? Can you suggest a menu for me, please?

Dianne
Conroe, TX

A: We recommend following a diet that is rich in fiber, phytonutrients, and healthy fats.

Fruits, vegetables, beans, and grains are excellent sources of fiber and phytonutrients. Fiber helps you feel full for a longer period of time. Phytonutrients are natural components found in plant-based foods that give plants their rich pigments as well as their distinctive taste and smell. There are thousands of phytonutrients that may strengthen the immune system and help prevent cancer as well as provide other health benefits, including promotion of cancer survivorship.

Healthy fats such as olive, flax, and canola are very good for your heart health, and are also sources of additional calories. Nuts and seeds are also sources of healthy fats.

Your goal is to aim for 5-10 servings of colorful fruits and vegetables and about five servings of grain every day.

What Counts as a Serving?

One serving is equal to:

  • 1 cup leafy greens, berries or melon chunks
  • 1/2 cup for all other fruits and vegetables
  • 1 medium fruit/vegetable (i.e. apple, orange)
  • 1/4 cup dried fruit
  • 3/4 cup juice

Here are some suggestions for a menu:

Breakfast (Choose one from each of the following three options)
  • 1 cup cereal/1 whole wheat bagel/1 whole wheat toast
  • 1 cup lowfat milk/1 cup lowfat plain yogurt/1 Tbsp light cream cheese
  • 1/2 pink grapefruit/1 small pear/ 1 small apple/1/2 box raisins
Snacks
  • 1-2 graham crackers with 2 Tbsp peanut butter
  • 10 Kashi TLC crackers with 1 string cheese
  • 10 medium grapes
  • 1 cup popcorn, air popped
  • 10 almonds
  • Kashi 7 grain bar
Fluids (at least 8 (8 oz) cups per day)
  • Choose mostly water; sparingly opt for 100% juice (cranberry, apple, orange).
Dinner
  • Meat: choose mostly chicken and turkey, baked or broiled
  • Fish: the best is baked/grilled
  • Salad: Every time you make a green salad add about 1 Tbsp of a healthy oil: olive, flax, canola; sprinkle about 1 Tbsp of sunflower seeds or pumpkin seeds
  • Vegetables: Fresh or frozen, steamed or stir fried with canola oil

You can find more healthy food ideas in our Recipe Archive.

We encourage you to meet with a Registered Dietitian one-on-one if you are interested in getting personalized menu options based on your food likes and dislikes, whether you want to maintain, lose or gain weight, or if you have any other questions related to diet.

Q: My 70-year-old mother has recently undergone colorectal surgery to remove a portion of her sigmoid colon. She is recovering in the hospital, and is on liquids now. Doctors will be sending her home soon and I need to have some meals prepared for her. Can you give me any suggestions? I have read that such patients should eat less but more frequently, and avoid high-fiber diets. Is that true?

Anonymous

A: You are right: Patients who have undergone recent bowel surgery should follow a special diet that will decrease the work their bodies must do to digest food. The goal is to avoid stretching the area where the bowel has been reattached, and to help decrease gas production (a common side-effect after surgery) that can be uncomfortable. This special diet is a temporary way of eating and a doctor will advance the diet to include other items when it is appropriate.

Start with clear liquids (i.e. juice, gelatin, clear broths, tea, etc.) that are necessary to assess the resected bowel's function. If these items are tolerated by the patient, slowly advancing her to a diet that is low in fiber and fat will allow for adequate nutrition while reducing stress on the gut during digestion. Use the list below for specific suggestions for her special diet:

  • Beverages: Staying hydrated is important following surgery. Stick to fruit and vegetable juices without pulp, water, and Gatorade. Avoid caffeinated beverages, prune juice, and other drinks with dietary fiber.
  • Dairy Products: Because the gut may produce fewer enzymes for milk digestion after surgery, limit dairy to 2 servings (2 cups) daily, as tolerated. Lactaid tablets may be necessary for intolerance. Choose low-fat or fat-free products. Avoid full-fat dairy and cream-based soups.
  • Grains, Breads, and Cereals: Fiber in whole grains, breads and cereals will cause slower movement of food through the gut, resulting in irritation. Select white bread, pasta, crackers, and refined cereals (i.e. cornflakes, Cream of Wheat) when preparing meals.
  • Fruits and Vegetables: Choose canned and cooked fruits and vegetables without the skin. Raw cantaloupe, melon, watermelon and bananas are okay; other raw fruits are too fibrous for the gut to break down effectively following surgery.
  • Meats and Meat Alternatives: Protein is important for healing. Look for tender/skinless chicken and turkey, white fish, and lean cuts of meat (remove visible fat). Avoid fried foods as well as luncheon meats that are high in fat. Eggs (not fried), egg substitutes, and tofu are also excellent sources of protein.
  • Miscellaneous: Cook with non-stick sprays or use moist cooking methods (boiling, braising) instead of using oils or butters. Choose low-fat condiments and seasonings, as tolerated.

Preparing smaller, more frequent meals with the above foods will be easier to digest than three larger ones. Meeting with a registered dietitian is always recommended to maximize intake based on individual needs.

Q: What foods can I eat to gain weight pre-breast surgery and chemo if I also have ulcerative colitis and am not eating wheat or dairy? I am very thin and have been told I need to gain weight before the surgery and treatment for breast cancer.

AMG
Newton, Mass.

A: Crohn's disease and ulcerative colitis are chronic digestive disorders commonly referred to as Inflammatory Bowel Disease (IBD). Ulcerative colitis primarily affects the large intestine. Although diet cannot prevent or cure IBD, maintaining an adequate caloric intake and a generally balanced diet between acute flare-ups is essential for replacing nutrient losses, promoting healing, and improving your tolerance for medications. An acute flare-up is a time when you are extra sensitive to the symptoms of your disorder. Food choices at this time should be based on individual preferences and tolerances. However, during an acute flare-up your diet may be modified to minimize symptoms and maximize comfort.

You are correct in avoiding wheat and dairy. Limiting fiber and milk or milk products may also help in minimizing symptoms. You may better tolerate small, frequent meals (5-6 times a day). Eat slowly and chew well so there is less work for your digestive system. Remember to drink plenty of fluids to replace any fluid lost through diarrhea and vomiting. Aim for at least 8 (8 oz.) cups per day.

Adequate calories can help to keep energy levels up and body processes running smoothly. Eating enough will also help to prevent weight loss during healing, spare protein for other uses, and promote faster recovery with fewer infections and/or complications.

The recommendations below are a starting point. We encourage you to meet with a Registered Dietitian one-on-one to develop an eating plan that suits your specific needs and nutritional goals.

Here are some recommendations for foods to boost calorie intake in healthful ways:

  • Peanut/Almond/Cashew butter: Spread on grains, baked goods, fruit, or veggies.
  • Avocado: Make guacamole or put slices of avocado on sandwiches or salads.
  • Beans: Add to salads or entrees, mix into soups, or combine with cheese and make nachos.
  • Bean dips/Hummus: Use as a veggie dip, add to nachos or baked potatoes, or dip into with pita bread or tortilla chips .
  • Eggs: Add chopped hard-boiled eggs to salads, dressings, casseroles, or other entrees; beat eggs into mashed potatoes, veggie purees, and sauces; add to custards, pudding, baked goods, or breakfast food; or fry or cook for a meal.
  • Oil: Stick to olive and canola oil. Use when stir frying or as a dip for bread; add to pasta or rice; cook all foods in oil; use as a salad dressing; add to cake or bread mixes; and try pesto sauce
  • Flaxseed Oil: Add to flavored yogurts and frappes; mix in with salad dressings.

In addition to following the above recommendation, you can also sip on higher calorie fluids such as juices (try cranberry, grape, and nectars), and commercial nutritional supplements (e.g., Boost, Ensure). In addition, try higher calorie soups like split pea, tomato bisque, chowders, cream soups, and chili.

Q: How do people lose weight on fruit and vegetable diet? And why?

Theresa
Arcadia, CA

A: Fruits and vegetables are very good sources of fiber that help you feel full for a longer period of time because they are digested slowly in your stomach. They are usually lower in calories than other foods such as meats, poultry, breads, and desserts because they are naturally low in fat, including saturated fat and cholesterol. That is why the consumption of fruits and vegetables is usually recommended for people who want to maintain or lose weight. There are a lot of other health benefits of following a diet that is rich in fruits and vegetables. Fruits and vegetable are full of vitamins, minerals, and phytonutrients that are essential for health.

The goal is to aim for 5-10 servings of colorful fruits and vegetables every day.

What Counts as a Serving?
One serving is equal to:

  • 1 cup of leafy greens, berries or melon chunks
  • 1/2 cup for all other fruits and vegetables
  • 1 medium fruit/vegetable (i.e. apple, orange)
  • 1/4 cup dried fruit
  • 3/4 cup juice

Phytonutrients are natural compounds found in plant-based foods that give plants their rich pigment as well as their distinctive taste and smell. They are essentially the plant's immune system and offer protection to humans as well. There are thousands of phytonutrients that may help prevent cancer as well as provide other health benefits.

We encourage you to meet with a Registered Dietitian one-on-one if you are interested in losing weight or if you have any other questions related to fruits/vegetable intake.

Q: Since my breast cancer diagnosis and treatment, I have reduced my alcohol intake so that I drink only an occasional glass of red wine. I like to substitute it with de- alcoholized red wine, which is available from Trader Joe's and a few other places. Is there any health benefit from these "wines"?

CSG
Newton, Mass.

A: It is a good idea for breast cancer survivor to limit intake of red wine and all alcoholic beverages.

The difference between a regular red wine and an alcohol-free one is only in the alcohol content. The primary benefits of wine drinking are related to the phytonutrients that are present in this type of alcoholic beverage. Phytonutrients are present in both regular red wine and alcohol-free red wine, as well as in 100% red/purple grape juice.

Phytonutrients are natural compounds found in plant-based foods that give plants their rich pigment as well as their distinctive taste and smell. They are essentially the plant's immune system and offer protection to humans as well. There are thousands of phytonutrients that may help prevent cancer as well as provide other health benefits, including promotion of cancer survivorship.

Phytonutrients that are present in red wine come from red or concord grapes. Resveratrol is an example of a phytonutrient with some anticancer properties, found in the skin of red grapes. Research shows that it can inhibit cancer formation in different ways. Resveratrol stops DNA damage, improves DNA repair, slows down tumor growth and slows cell transformation from a normal to a cancerous state.

Q: My wife's advanced ovarian cancer (with partial bowel obstruction) has created the need for high-protein, no-fiber snacks. Suggestions?

JJH
Shoreview, MN

A: A partial bowel obstruction is fairly common in those with ovarian cancer and means that part of the intestines are blocked, thus reducing the amount of digested food and gas that can pass through the system. When this happens, it is best to eat small frequent meals and to avoid foods that result in gas and bulk in the intestines. This means that avoiding fiber-rich foods such as whole grains and raw fruits and vegetables is essential for a patient's comfort and proper bowel function. The amount of fiber restriction depends on the severity of the obstruction. It is important to try to continue to eat fruits and vegetables. However, they must be low fiber/low residue, which typically means they should be cooked, canned, and/or free of skins and seeds. Pair the choices below for a well-balanced snack.

Some examples of high-protein, low-fiber snacks appropriate for most partial bowel obstructions:

  • Yogurt, particularly Greek yogurt
  • Cheese with white bread or crackers
  • Smooth nut butter with white bread or crackers
  • Smoothies made with pulp-free fruit juice, yogurt, and whey protein powder
  • Drinkable yogurt
  • A hard-boiled egg
  • Smooth oatmeal or cream of wheat made with milk instead of water
  • Canned tuna on white bread or crackers

For more protein-rich snack ideas, visit the Recipe Archive

To maintain intake of phytonutrient rich fruits and vegetables, add these low fiber/low residue options to the snack ideas above:

  • Cooked vegetables such as carrots, winter squash, sweet potato (without skin), or pureed cauliflower
  • Canned fruits in natural juice
  • Peeled apple or applesauce
  • Ripe bananas
  • Mashed avocado
  • Honeydew, cantaloupe, or watermelon, with all seeds removed
  • 100% fruit/vegetable juice without the pulp

Q: My doctor says I am losing white blood cells and protein through my kidneys. I am on antibiotics and have regular blood tests. But what should I be eating. What diet do I follow?

Anonymous

A: It sounds like more information is needed to provide you with an in-depth answer to your question and that meeting with a Registered Dietitian to develop an individualized diet plan would be of benefit to you. Here are some general guidelines that are essential for maintaining healthy blood cells and kidneys.

Protein is a necessary component of the diet that is needed for the proper growth and repair of all body cells, including red blood cells, white blood cells, muscles, and hormones. Protein ensures that your body functions properly and is comprised of amino acids, some of which our body cannot make and must obtain from diet. This makes it important for us to eat protein-rich foods on a daily basis. However, if you are losing protein through your kidneys, you should make an appointment with a dietitian for an individually tailored strategy on protein consumption.

Examples of healthy protein sources in some common foods include:

  • Chicken
  • Turkey
  • Fish (examples: chunk lite tuna, salmon, haddock, and trout)
  • Beef
  • Pork
  • Cooked beans
  • Cheese
  • Eggs
  • Milk and soy milk
  • Nuts (examples: almonds, walnuts, cashews).

Hydration is another essential component necessary to keep your kidneys and your entire body at optimal health. Water is important in a number of ways:

  • It regulates body temperature
  • Cushions and protects vital organs
  • Aids in the digestive system
  • Makes up 75% of all muscle tissue in the body
  • On a cellular level, it transports nutrients and excretes waste

To keep all vital organs functioning optimally, a person should consume the amount of water excreted or lost from the body. You can obtain water by drinking beverages or eating foods like fruits and vegetables. The amount of water needed each day varies from person to person, so please speak with your dietitian to find out the optimal amount for you.

The use of prebiotics or probiotics is useful if you're experiencing antibiotic-associated diarrhea. Prebiotics and probiotics are beneficial bacteria found in various foods that can restore the balance of bacteria in your digestive tract. Probiotic bacteria like lactobacilli are naturally found in fermented foods like yogurt. If you choose to try a supplement, the recommendation would be for Lactobacillus GG (Culturelle) at 1 pill a day starting 72 hours after starting the antibiotics (if possible) and continuing through the course of antibiotics. Always speak with your physician before starting a supplement regimen.

Q: I'm 15 years old and about 173 cm [5 feet, 8 inches]. I'm tall for my age and I'm also very skinny. I weigh about 44kg [97 lbs]. This is because I have a fast metabolism. I do not feel comfortable with myself and I feel really awkward when I'm around other girls and don't fit in. I would like a diet plan to gain weight healthily.

Becki
Age 15

A: There are a number of reasons why it's possible to experience changes in metabolism and/or problems with weight gain. It is not uncommon during cancer treatment or adolescence and at times of growth and development. Having trouble with maintaining a healthy weight can be frustrating and challenging. Here are some tips that will hopefully ease some of the difficulty and confusion surrounding this important topic.

Eating enough calories is crucial for preventing weight loss during healing from treatment, for promoting a fast recovery, and to fuel growth and development. A person can accomplish this by eating calorie-dense and nutrient-rich foods.

Here are some healthy foods you can eat to increase calories and gain weight:

  • Incorporating nuts and seeds into your diet is a heart healthy way to increase calories and aim for weight gain. Try adding nuts (walnuts, almonds, peanuts, pistachios, etc.) to baked goods, breads, cereal, pancakes, salads, and ice cream or yogurts. ( 1/4 cup serving = 170 calories)
  • Trail mix or granola bars with dried fruits and/or cranberries or raisins are a calorie-dense option that can be eaten as a snack or added to cereals and yogurts. ( 1/4 cup serving/bar = 120 calories)
  • Try frying or cooking eggs for a meal. Add chopped hard boiled eggs to salads, dressings, and casseroles, or beat eggs into sauces, custards, and baked goods. (1 large egg = 90 calories)
  • Olive and canola oil can be mixed into sauces, used as salad dressing, and added to yogurt frappes or smoothies as a great calorie boost that contains essential fatty acids that your body needs. You can also use oil to cook when stir-frying vegetables. (1 tbsp = 120 calories)
  • Try adding beans to soups, salads, or entrees.
  • Try adding peanut butter as a spread to whole grain breads or eat it with fruits like bananas and apples for a healthy snack (2 tablespoons = 190 calories)
  • Add cheese, bean spreads or hummus to vegetables (1 oz. or 1/8 cup cheese = 100 calories; 1/4 cup hummus/bean spread = 100 calories)

Here are some strategies you can try for healthy weight gain:

  • Eat small, frequent meals and snacks every couple of hours throughout the day.
  • Use small plates for meals opposed to full size dinner plates.
  • Try not to snack too close to meal times to avoid feelings of fullness.
  • Do try to eat your favorite foods more often.
  • Limit fluids to a minimum at meals but make sure to drink fluids between meals.
  • Keep high-calorie snacks on hand at your house and bring these snacks with you when on the go.
  • Drink high-calorie fluids/100% juices (orange juice, blueberry juice, V8, cranberry juice, milk) or a commercial nutritional supplement such as Ensure, Carnation Instant Breakfast, or Boost.

Q: My father-in-law has cancer, recently had one kidney removed, and suffers from severe diabetes. He has lost so much weight (well over 100 lbs.), but his sugar is staying sky high (has topped 600) and his calcium level is extreme, too. What on earth can we feed him that will not exacerbate one of these issues? He loves milk & cottage cheese with fresh fruit. Of course the first two are calcium-filled dairy and the peaches send his sugar skyrocketing. He stays nauseous and all too often he simply refuses to eat. We have tried all we know and need help. The hospital dietician says that any food is better than no food at this point. Is there any advice that you can give us?

Anonymous

A: You are facing quite the challenge. The first priority in helping your father-in-law to eat may be to control his level of nausea.

The following are some nutritional strategies for managing nausea:

  • Try eating or drinking ginger in the form of ginger tea, ginger ale, crystallized ginger, ginger chews, or fresh ginger root tea
  • Drink lemonade or lemon water
  • Smell a fresh lemon when odors are causing nausea
  • Eat a small portion of potato chips (4-5 chips) to calm the stomach, then wait 10 minutes before eating a healthy, bland snack or small meal
  • Make the room comfortable in which you are eating (control the temperature and air circulation; make sure the room is free of odors that may cause nausea)

Your father-in-law may want to discuss options for anti-nausea medications with his physician if nutritional strategies are not successful.

Eating small, frequent meals throughout the day is another important strategy for control of both nausea and blood sugar levels. Try suggesting a small portion of baked chicken breast, cold cereal with rice or soy milk, Cream of Wheat or chicken noodle soup.

Speaking with a dietitian who specializes in nutrition for renal (kidney) disease may be very beneficial for you and your father-in-law. They will be able to offer more specific suggestions regarding type of foods that are appropriate for him given his high blood-calcium level.

Q: My boyfriend was diagnosed a few years ago with chronic lymphocytic leukemia (early stages) and was told he had nothing to worry about at the present time. He had some blood work done this week and asked his doctor what he can do to help this out. His doctor said "I don't know." Can you give any suggestions as to what he should or shouldn't have in his diet, etc. that might help him fight his CLL? I would greatly appreciate any assistance – including suggesting other places he can turn for answers.

Noreen
Dedham, MA

A: It is recommended that cancer survivors follow the same diet guidelines as those for cancer prevention: A predominately plant-based diet with plenty of fruits and vegetables, whole grains, lean sources of protein, and omega-3 fatty acids.

Eating 5-10, 1/2 cup servings of fruits and vegetables each day may be particularly important in fighting CLL because these foods contain phytonutrients. Phytonutrients are compounds found in plants which are essentially the plants' own immune system. When consumed, they may have powerful health benefits for humans as well. For example, laboratory studies have shown that resveratrol, a phytonutrient found in the skin of red and purple grapes, may block the development and progression of leukemia cells. While this effect has not been proven in humans, it certainly won't hurt to eat a serving of grapes most days. Phytonutrients are concentrated in the color of plants, so aim to include a variety of different colored fruits and vegetables (green, yellow, orange, blue, red, etc) in your diet for the greatest potential health benefit.

Additional sources of phytonutrients include whole grains, flax seeds, green tea, and a number of spices, including garlic, ginger, turmeric, and parsley. In fact, a compound in garlic known as diallyl disulfide has been shown to kill leukemia cells in laboratory studies. Again, the effect has not been proven in humans, but adding a few extra teaspoons of minced garlic to your favorite pasta recipe will boost flavor and may help fight CLL.

For more information about phytonutrients and the role they play in fighting cancer, read this article from InteliHealth by Dana Farber nutritionist Anne Chiavacci, MS, MA, RD, LDN.

For more information about a healthy diet for cancer survivorship check out the Optimal Diet Plan and for some tasty, healthy recipe ideas, browse our Recipe Archive.

Q: Which important dietary elements are not provided by beans? I'm considering going on a mostly-bean diet - not to lose weight, but for convenience and budget-related reasons.

Adam
Chicago

A: There are benefits to eating beans as part of a balanced diet. Beans are high in fiber and a good source of protein. Most contain up to 20% protein and only 2-3% fat. They contain no cholesterol and provide the body with essential B vitamins and iron. In addition, beans are high in carbohydrates, which are used to provide the body with energy. However, beans should be incorporated into a balanced plant-based diet rich in fruits and vegetables, whole grains, lean protein, and omega-3 fatty acids. Phytonutrients are important compounds with anti-cancer properties found only within plant-based foods. These compounds are essential for providing energy and benefiting immune function. In addition, there are naturally occurring vitamins and minerals found within a variety of plant-based foods and whole grains that cannot be obtained from eating a diet of only beans.

One half-cup of cooked beans (baked, kidney, black, lentils, lima, refried, etc.) contains 9 grams of protein. Protein in the diet is essential for the growth, repair, and proper functioning of all cells in your body. Three ounces of cooked chicken or turkey contains 27 grams of protein. An alternative protein source is fish: 3 oz. of fish (salmon, haddock, etc.) contains 21 grams of protein. This means that by including fish in your diet, you would not have to eat as many cups of beans to meet your daily protein requirement. Also, by consuming fish like salmon, you will be consuming essential omega-3 fatty acids that are necessary for maintaining optimal health.

Q: My wife is 42 years old and last year she was diagnosed with thyroid cancer and her entire thyroid gland was removed. We'd like to find out what type of diet is best for her post-gland-removal period. For example, sugar is bad for her and a large intake of veggies is good for her. Fast food is completely out. Could you please indicate the useful nutritional chart for her daily diet?

Fariborz Farzaneh
Laguna Niguel, CA

A: The optimal diet post-thyroid gland removal should minimize processed foods and include rich amounts of plant-based foods such as fruits, vegetables, whole grains, lean protein sources, and omega-3 fatty acids. Eating a well balanced, plant-based diet is the recommendation for all cancer survivors. Plant-based foods contain naturally occurring compounds called phytonutrients which are beneficial to immune function. It is important to consume a variety of fruits and vegetables of varying colors. The different pigments represent different types of phytonutrients contained within plant-based foods essential for your health.

Yes, you are correct: A high intake of vegetables in the diet is good for you. Increasing vegetable intake is beneficial by providing essential nutrients, vitamins, and minerals that your body needs. Non-cruciferous and non-starchy vegetables are associated with decreased risk of thyroid cancer. One example of these are leafy greens such lettuce or spinach. Aim for 5 to 10 servings of fruits and vegetables a day. A serving for most fruits and vegetables counts as ½ cup and 1 cup for leafy greens, berries, and melon.

Increasing consumption of fruits and vegetables can replace the processed and refined foods in the diet that tend to be high in sugars and inadvertently lead to unhealthy weight gain and insulin resistance. However, foods with naturally occurring sugars such as fruits should not be restricted because these foods also contain cancer-fighting nutrients that provide energy and protection from disease. In addition it is important to remain physically active to maintain a healthy weight and minimize weight gain after thyroid removal.

Q: My husband was recently diagnosed with very advanced (stage IV) and very aggressive prostate cancer. He has evolved from a high protein diet (including a significant amount of red meat) to a modified vegan diet (he will eat fish). Is this a good idea? What do you recommend for someone who is 60 years old and very healthy in all other regards, except for his prostate cancer?

AKL
Salem, MA

A: There are advantages and disadvantages to a vegan diet (excluding all animal products) for any person.

Advantages: Limiting your options forces you to be more conscious of your food choices, and ultimately include more plant foods such as fruits, vegetables, whole grains, soy, nuts, and beans in your diet. Studies show that plant-based diets provide important antioxidants and phytonutrients that work together to reduce the risk of developing various types of cancer and help to support the immune system.

Disadvantages: It limits the amount of protein you get in your diet. Protein is an important part of any well-balanced diet, and it is particularly important for cancer patients because it is needed to repair damaged cells and help your body recover and maintain a healthy weight. This diet can also be quite restrictive on a person's vitamin D intake, as this nutrient is found primarily in fortified dairy and fatty fish, such as salmon, mackerel and tuna. Vitamin D deficiency is common in northern parts of the United States, particularly in the winter months when our skin cannot make the vitamin from the sun.

What does this mean for someone fighting prostate cancer?

Bottom line: No one needs to adopt a vegan diet to eat well. Start with 5-10 servings of fruits and vegetables every day, and combine that with lean protein (fish, poultry, legumes, beans, nuts, nut butters, and low-fat dairy), healthy fats, and whole grains, and you're on your way to building a strong immune system and a healthy body. In regards to vitamin D, you can ask your doctor to check your husband's blood levels with the 25-OH vitamin D test. That being said, be sure he is getting enough: typically 1,000 International Units (IUs) per day and no more than 2,000IU.

Q: According to the diabetic food exchange list Choose Your Foods, 1 1/2 cups of cooked veggies are equivalent to 1 carbohydrate. Could this be counted as vegetables also?

DB
Bush, Louisiana

A: Yes, you are correct that many foods can "count" as more than one category. The American Diabetes Association now uses the Carbohydrate Counting system in place of the diabetic food exchange list. This new system allows for greater flexibility in choosing foods. A carbohydrate serving equals 15 grams of carbohydrate. This includes 1 slice of bread (1 oz), 1 small piece of fruit, cup oatmeal, cup of starchy vegetable (black beans, corn, peas).

A food such as peas would be considered both a vegetable and a carbohydrate. Peas and black beans also contain protein, another important nutrient, so could fall into that category as well. Many foods straddle a few "food categories," making them good choices in a balanced diet.

Q: Several years ago my mother-in-law was in a clinical trial for bladder cancer. She remains cancer-free, but as a result of the radiation she has developed abdominal adhesions and what I believe to be radiation enteritis. She had surgery to remove an intestinal blockage but is in excruciating pain and is unable to gain any weight. Doctors tell her to live with the pain and eat anything she wants. I've been researching and think a low-density diet might help and wanted to see if there any guidelines she might be able to follow. Also, do you think a trip to see one of your nutritionists might help?

Anne
Westwood, Massachusetts

A: Thank you for your question. It is possible to help reduce pain associated with digestion or the lingering effects of cancer therapy, such as radiation enteritis or abdominal adhesions, by making a few changes to the diet. You have hit on a key concept that may help your mother-in-law: following a low fiber/low residue diet.

A fiber and residue-restricted diet is one that contains minimal amounts of the indigestible portion of foods, such as seeds, nuts, raw fruits and vegetables with seeds and skin, milk, and the connective tissue of meats.

For those who have a decreased area for food to pass through, decreased bulk and volume of stools is essential for eliminating pain and potential for obstruction. You do not need to eliminate all of these foods, but it may be helpful to limit the amount eaten for one to two weeks, then gradually reintroduce one new food a day to determine if any are contributing to pain.

Some people can become lactose intolerant from this type of cancer treatment and therefore it may help to choose lactose-free dairy products, including soy, almond or rice milk. It is not necessary to eliminate all fruits and vegetables from the diet as these contain many important, healthy nutrients. Instead, try to remove the seeds when possible and consider cutting or peeling the skin.

It sounds like your mother-in-law could benefit from designing a personalized eating plan with one of our Registered Dietitians. Please call (617) 632-3006 to schedule an appointment.

Q: Bill wants to keep his fat intake down to 30% or less. He currently takes in 3000 calories. What is the maximum amount of fat grams he should be consuming?

JS
Baldwin City, Kansas

A: To calculate the number of grams of fat you should eat based on a goal of 30% of 3000 calories, follow this equation:

3000 calories x .30 = 900 calories from fat
900 calories/9 grams of fat per calorie = 100 grams of fat total for the day.

3000 calories is greater than what is generally recommended for healthy weight maintenance; however, some cancer patients require more energy or calories to help meet their increased needs, especially during treatment, to prevent unwanted weight loss and malnutrition. It is always best to meet with a dietitian who specializes in oncology to determine your individual calorie needs.

Q: I have a question regarding soy products and breast cancer. I was diagnosed a year ago with DCIS, ER/PR+. I have read that people with this type of breast cancer should not consume products containing soy protein isolate. Is the same true for products with soy lecithin?

B.A.
Harford, Conn.

A: The relationship between soy intake and cancer is a topic that has been studied extensively. However, to date, the results have been inconclusive as to whether consumption of soy products, particularly excessive intake of isoflavones, can stimulate the growth of ER+ tumors.

Soy is naturally rich in isoflavoves, a phytoestrogen, that can bind to estrogen receptors (ER) and create weak estrogen-like effects. Chemical components of soy isoflavones have non-hormonal properties that have been associated in numerous prostate and breast cancer studies with decreased cancer cell growth. The majority of studies showing a benefit to soy intake have used "whole soy" products such as soy milk, tofu, soy nuts, tempeh, and edamame, which are all healthful, lean protein sources. Moderate consumption of foods high in phytoestrogens is unlikely to have any adverse effects, such as 2-3 servings per week. What should be avoided are soy products that are concentrated sources of phytoestrogen such as dietary supplements, pills, powders, and soy-based protein bars, as you mentioned in your question.

Soy lecithin, extracted from soy-bean oil, is often used in numerous foods, like chocolate to help keep ingredients emulsified. Many food labels will list a soy-based emulsifier like lecithin. The amounts are generally minute and don't contribute a substantial level of phytoestrogens. Products with soy lecithin do not need to be avoided because they have such minor amounts.

Q: Should breast cancer survivors avoid soy milk? I'm an 11-year survivor and I love soy milk in my coffee.

Janet
Somerville, Massachusetts

A: It is not necessary for breast cancer survivors to avoid all types of soy foods. Research suggests that survivors with an estrogen receptor-positive breast cancer limit their consumption of soy foods, especially the more concentrated forms. Avoid foods made from soy protein powder, soy protein isolate, isolated soy protein (read the ingredient list to look for these). These forms of soy are often found in nutrition bars, soy protein powder, many high protein breads and cereals and vegetarian "meat-less" options, such as certain brands of veggie burgers or soy hot dogs.

Natural soy foods such as soy milk, edamame, tempeh, miso, and tofu can be safely consumed a few times a week (2-3 servings/week is the general recommendation). Foods such as soybean oil, soy sauce and soy lecithin do not contain any phytoestrogen and need not be limited or avoided.

Q: My husband has Stage IV pancreatic cancer and is receiving Gemzar, Cisplatin and pancreatic enzymes. His normal weight before biliary-enteric bypass surgery six months ago was 138 lbs. He is now 118 lbs. We have spoken with a GI physician in addition to our oncologist and internist. Some, but not all, of his stools indicate that he is not digesting fat and sometimes the stools are so large they indicate that he is not utilizing the food he is eating. Sometimes he is ravenous, and sometimes he has a modest appetite. Without adding much volume, are there additives (low-fat, high-protein) — powders or such — that I can add to eggs, or to mashed potatoes, or whatever you suggest, that might help him gain weight?

Liz
Chicago, Ill.

A: When trying to gain weight, increase the total amount of calories in your day. In other words, an increase in food or calorically dense foods will add on the pounds. In a case where there is fat malabsorption and subsequent large and loose stools, it is best to minimize (but not eliminate) the amount of fat in the diet.

High-fat foods to limit or avoid:

  • fried foods
  • fatty meats (meat with gristle, skin of poultry, prime rib)
  • oils, butter, margarine or regular salad dressing
  • nuts and nut butters
  • full-fat milk products
  • bakery products such as croissants and pastries

Ways to increase calories on a low-fat diet:

  • Small, frequent meals: 3 meals and 3 snacks a day.
  • Keep fluids to a minimum at meal times, but don't forget to drink between meals.
  • Add dried milk powder, whey or soy protein powder to foods (mashed potatoes, eggs, soups).
  • Consider high-carbohydrate and easy-to-digest foods such as: baked potato, Cream of Wheat, dry toast, rice, pasta, saltine crackers, animal crackers, and pretzels.
  • Snack on dried fruit and add to pancakes, grains, cereals, yogurt, chicken or vegetable salad. Cook in muffins, chicken or pork entrees.
  • Sip on higher calorie fluids such as juices (try cranberry, grape and nectars), milk, homemade smoothies (examples below), and commercial nutritional supplements (ex: Ensure or Boost).

Low-fat homemade smoothie recipes

Fruit Yogurt Smoothie

1 cup fruit puree, from fresh, canned, or frozen fruit
6 ice cubes
1 cup low-fat yogurt
2% milk

Place all ingredients in blender and work until frothy. Add milk to desired consistency.

Calories: 259; Protein: 20.7 gm

Apricot Ice Cream Smoothie

3 ice cubes
2-3 ripe apricots, halved, seeded, and sliced
2 scoops low-fat vanilla ice cream or frozen yogurt
1 cup apricot nectar
Low-fat milk
2 Tbsp low-fat yogurt

Put the ice cubes in a blender and blend to a snow. Add the apricot slices, ice cream, and apricot nectar. Blend until frothing and creamy, adding enough milk or water to make the blades run. Put the mixture into a glass, swirl in the cream or yogurt, if using, and serve with a spoon.

Calories: 338; Protein: 5.7 gm

Peach Shake

1 canned peach half
3 tablespoons dry milk powder
1/4 cup milk
1/2 package vanilla instant breakfast beverage mix (about 2 Tbsp)
1 cup low-fat vanilla ice cream

Place all ingredients in blender and blend well.

Calories: 300; Protein: 11 gm

Q: Is Stevia sweetener beneficial for weight loss? Does it have any connection with cancer?

Veronica
Worcester, Massachusetts

A: Stevia, an herb native to Central and South America, is widely grown for its sweet leaves. It is virtually calorie-free and up to 300 times as sweet as sugar, which makes it appealing as a natural alternative to both sugar and artificial sweeteners. If used sparingly (one to two tablespoons per day in coffee or tea, for example), it will most likely not result in harmful health effects. By replacing one to two tablespoons of table sugar with stevia, you will decrease your daily calorie intake by 90 calories. While a reduction of 90 calories is a good start, it is likely not a sufficient calorie reduction to result in weight loss. It is recommended you meet with a Registered Dietitian who can help you understand your individual weight goals and assist you in designing a healthful eating plan to promote weight loss.

When stevia is metabolized, it is broken down into various compounds. Research in laboratory animals has shown some of these compounds to be mutagenic, meaning they can cause changes in a cell's genetic material (DNA). It remains unclear if this occurs in humans; therefore, the widespread human consumption of stevia is currently not recommended. If used sparingly; however (one to two tablespoons per day in coffee or tea, for example), it will most likely not result in harmful health effects.

Q: I have Chronic Obstructive Pulmonary Disease (COPD) and one lung that does not work very well. I also have a mycobacterium lung disease that the doctors have been treating for a year. Because I am on oxygen 24 hours a day, I can do very little. I am 5 feet, 8 inches tall and weigh 87 pounds. I eat a lot, but doctors say I am probably burning 2500 to 3000 calories a day just for my body to metabolize my medicines and keep me going. I need help in finding meal plans and ingredients to gain weight.

Brenda
Corpus Christi, Texas

A: For some diseases like COPD and cancer, patients' calorie requirements are increased because their bodies require more energy to function and heal. Meeting these increased calorie needs can help:

  • Provide you with greater energy and endurance;
  • Maintain strength;
  • Better withstand the effects of medical treatment and stress;
  • Promote faster recovery from surgery and illness;
  • Lead to fewer infections and medical complications;
  • Prevent weight loss;
  • Spare the protein in your muscles from being broken down for energy.

Here are some healthy suggestions for gaining weight:

  • Add calories to fruits by layering with granola and baking, dipping in nut butters, or baking in pies and turnovers. You can also add to milkshakes or commercial nutritional supplements.
  • Add calories to salads by adding salad dressings, seeds, avocados, and/or olives.
  • Eat small meals and snacks every couple of hours throughout the day.
  • Keep fluids to a minimum at mealtimes, but don't forget to drink between meals.
  • Try higher-calorie soups like split pea, tomato bisque, chowders, cream soups, and chili.
  • Eat nuts and seeds for snacks. Add chopped/ground nuts to bread, baked goods, salads, pancakes, cereal, and ice cream.
  • Use peanut/almond/cashew butter on grains, baked goods, fruit, or veggies.
  • Use bean dips or hummus as a veggie dip. Add to nachos or baked potatoes, or dip pita bread or tortilla chips.
  • Add chopped, hard-boiled eggs to salads, dressings, casseroles, and other entrees. Beat eggs into mashed potatoes, veggie purees, and sauces. Add to custards, pudding, baked goods, or breakfast foods. Fry or cook for a meal.
  • Use olive or canola oil when stir frying or as a dip for bread. Cook all food in oil or add to pasta, rice, cake or bread mixes. Use oil as a salad dressing. Try pesto sauce.
  • Add flaxseed oil to flavored yogurts and frappes. Mix in with salad dressings.

Q: I am a fan of frozen grapes as a snack. I am also a breast cancer survivor. I understand that there is some research behind grapes and cancer prevention? What are the studies saying about grapes and cancer prevention? Myth or fact?

Nancy
Glenwood, Colorado

A: Grapes contain a polyphenolic compound known as resveratrol. Resveratrol first gained scientific attention in 1992 when it was discovered in red wine, leading researchers to question if this compound could explain the "French paradox" — the low incidence of heart disease among the French people, who eat a relatively high-fat diet. More recently, resveratrol has regained the attention of the scientific community as an anti-cancer compound.

Laboratory research has shown high-dose reseveratrol to inhibit the rapid cell division of a variety of human cancer cell lines, including those from breast, prostate, stomach, colon, pancreatic, and thyroid cancers. Although the laboratory data is promising, studies in humans suggest that even very high dietary intakes of resveratrol may not be sufficient to result in most of the protective effects demonstrated in cell culture studies. In other words, it would be difficult to consume enough food sources of reseveratrol to benefit from its anti-cancer properties.

It is important to note, however, that these studies are looking at one compound in isolation. Most foods contain hundreds if not thousands of bioactive compounds, which most likely work in harmony with one another to promote health. Therefore, as a general rule of thumb, it is important to eat a balanced diet, high in colorful fruits and vegetables including grapes, in order to obtain the maximum benefit from these health promoting compounds.

Q: What is the best way to lose weight, especially belly fat, brought on by very high doses of prednisone taken during chemotherapy?

V.G
Worcester, Massachusetts

A: Weight gain during prednisone therapy is common. In general, the weight gain is due to a combination of factors including fluid retention, increased calorie consumption, and decreased physical activity.

When taking prednisone, the body will hold onto extra sodium, (salt) and it will release extra potassium. Together this causes the body to retain fluid, which can result in weight gain. Decreasing the amount of sodium in your diet by limiting the use of table salt and decreasing the amount of processed foods in your diet, as well as increasing the consumption of potassium-rich foods (i.e. bananas, cantaloupe, kiwi, etc.) can help prevent fluid retention.

Increased calorie consumption is also common when taking prednisone, as the drug can result in an increase in appetite. Some tips to avoid gaining weight include: eating smaller meals more frequently (i.e. six small meals vs. three large meals), eating whole grains instead of refined carbohydrates, and eating protein with all meals/snacks. Keeping a food journal (including type of food, amount consumed, and method of preparation) can help keep track of total calories consumed each day. Meeting with a Registered Dietitian who can help you understand your individual weight goals and assist you in designing a healthful eating plan is highly recommended.

In addition to a healthful eating plan, exercise is necessary to help prevent weight gain and to help promote weight loss. It is recommended you meet with your doctor to develop an exercise plan that accommodates your lifestyle and medical condition.

Q: I'm a cancer survivor and would like guidance on healthy nutrition. In Malaysia, our diet is based on rice and oily food, which I avoid.

Ruhaizan
Selangor, Malaysia

A: The World Cancer Research Fund and American Institute for Cancer Research's report, published in 2007, outlined ten recommendations for cancer prevention. The last recommendation for cancer survivors was simply to follow the recommendations for cancer prevention.

  1. Body Fatness: Be as lean as possible within the normal range of body weight.
  2. Physical Activity: Be physically active as part of everyday life.
  3. Foods and Drinks That Promote Weight Gain: Limit consumption of energy-dense foods. Avoid sugary drinks.
  4. Plant Foods: Eat Mostly foods of plant origin.
  5. Animal Foods: Limit intake of red meat and avoid processed meat.
  6. Alcoholic Drinks: Limit alcoholic drinks.
  7. Preservation, Processing, Preparation: Limit consumption of salt. Avoid mouldy cereals (grains) or pulses (legumes).
  8. Dietary Supplements: Aim to meet nutritional needs through diet alone.
  9. Breastfeeding: Mothers to breastfeed; children to be breastfed.
  10. Cancer Survivors: Follow the recommendations for cancer prevention.

You will be able to follow these diet recommendations for cancer survivors while still enjoying traditional Malaysian foods influenced by Malay, Indian, Chinese and Nyonya cuisines. Focus on eating lean protein sources such as fish and chicken. Rice does not need to be avoided, just watch the portion size. Choose an abundant variety of tropical fruits and vegetables such as mangoes, lychee, chilies, bean sprouts and onions. All these foods can be nutritiously and deliciously prepared with an array of spices and herbs used in Malaysian cooking such as turmeric, ginger and curries. Additionally, it would be recommended to limit the amount of fried foods and coconut milk consumed, as these foods are higher in saturated fat and the preparation of frying can promote free radicals.

Additional information:

Q: A month ago I was diagnosed with kidney cancer. I underwent partial nephrectomy. Because the cancer was caught in early stage, I don't need any further treatment. I would greatly appreciate your advice with regards to diet and prevention.

G.A.
New York, N.Y.

A: Prior to surgery you may have been asked to follow a specific diet. After surgery, you can resume a normal diet. We would recommend eating a well-balanced diet of fruits and vegetables, whole-grains, and a moderate amount of protein, meaning you no longer need to restrict or eat high amounts of protein. Protein foods include meat, poultry, pork, fish, eggs, nuts, beans and soy foods.

Stay hydrated by drinking plenty of water. A good indicator of your hydration status is the color of your urine; the lighter the color the better. If you were restricting calcium and potassium prior to surgery, you can reintroduce those restricted foods back into your diet. Continue to follow a lower-sodium diet, especially if you have a preexisting medical condition that requires you to restrict the amount of salt in your diet. Finally, taking a multivitamin every day will make sure you are getting the recommended amounts of vitamins and minerals. For more individual recommendations, we suggest you meet with a Registered Dietitian.

Q: My 76-year-old mother has a pancreatic cancer that can't be surgically removed. What is the best diet for someone with this disease?

Ana
Ponta Delgada, Portugal

A: Eating a plant-based diet is recommended for all cancer survivors. This means choosing healthy, minimally processed foods high in plant products including:

  • Fruits and vegetables in varying colors (red, orange/yellow, dark green, blue/purple, and white, such as garlic or cauliflower);
  • Protein such as beans, lentils, nuts, and seeds;
  • Whole grains such as brown rice, quinoa, barley, oats, whole wheat breads, and pastas.

It is also important to maintain adequate hydration with water and natural fruit juices. In general, we also recommend a standard multivitamin (without iron).

With pancreatic cancers, blood sugar control might be affected. Choosing plant- based sources of carbohydrates such as fruits, vegetables and whole grains is preferred over foods that include high-fructose corn syrup or a significant amount of table sugar. Eating smaller meals, more frequently during the day, is another important strategy. Be sure to include a protein source with all of your meals and snacks to help blood sugar control as well as boost energy levels. Good sources of protein include beans, fish, nuts, and eggs.

We encourage you to meet with a registered dietitian or other qualified nutrition professional in your area to help provide more individualized recommendations.

Q: I have stage IIIC HER2-positive breast cancer. Because it is a protein-based cancer, should I restrict all proteins to make sure that I do not feed the cancer?

Mindy
Portland, N.Y.

A: Your question brings up an intriguing point. HER2 is a gene that may influence cancer growth and aggressiveness in certain types of breast cancers. While genes are made up of protein-based building blocks, there is no research to suggest that restricting all forms of protein may help to fight cancer. Protein is essential for the body to function properly and is necessary for the growth and repair of all cells. Protein is made up of amino acid building blocks, some of which cannot be made by your body, meaning they must come from diet. Adequate dietary protein becomes more important for strength and healing during cancer treatment because your body is working hard to repair and rebuild. Most immune cells that help your body fight cancer are made up of proteins.

After diagnosis of breast cancer, however, data on consumption of soy protein is controversial. This issue is specifically relevant to women with ER+ breast cancer. The research is inconclusive as to whether excessive consumption of soy isoflavones may help the growth of estrogen-dependent breast cancer cells. It may be sensible for women with breast cancer to avoid isoflavone or soy supplements (pills, powders). However, soy foods (soy milk, tofu, soy nuts, tempeh, edamame) may be consumed in moderation (1 serving) 2-3 times per week.

For all cancer survivors it is recommended to choose plant-based proteins such as beans and nuts as well as lean sources of protein such as fish, chicken, eggs, and turkey. Red meat should be eaten in moderation (once/week according to the American Cancer Society guidelines).

Q: I realize that not all calories are created equal, but could you please explain it to me? For example, what is the difference if one ate 800 calories a day from fruit/sugars etc., versus from 800 calories of foods fried in trans fat free oil. Would one still gain weight if they ate 400 calories worth of ice cream (which is loaded with fats and sugar) instead of 800 calories of regular savory foods (such as pizza, pasta)?

S.P.
Los Angeles, Calif.

A: You highlight a very confusing issue to the American public. The answer to your question is yes and no (see how confusing this is!). Let's try to make sense of this together.

Weight management is a key concern for cancer prevention and survivorship. One philosophy on weight management is that although fats, protein, and carbohydrates are processed differently in the body, at the end of the day, regardless of the form consumed, you will have equal amounts of calories consumed. The problem with this ideology is that although you may have two equal amounts of calories, depending on the composition, you may gain health-promoting benefits with one scenario, and disease-promoting factors with the other option.

Let's take a look at your example:
Eight-hundred calories worth of fruit: the fruit will have lots of fiber, vitamins, and phytonutrients. The fiber keeps your digestive tract healthy (i.e. regular bowel movements); the vitamins play an important role in many metabolic pathways that affect your energy and basic body functions, while the phytonutrients may aid in preventing cancer and other chronic illness such as high blood pressure.

Eight-hundred calories worth of fried food (i.e. doughnuts or French fries): The fried food will have very few nutrients such as vitamins, and the high fat content may have negative effects on the body, such as promoting acid-reflux and clogging your arteries. Most fried foods are low in fiber, therefore if eaten regularly, you may experience constipation.

Furthermore, fiber is known to help regulate hunger and fullness. You can eat a much larger volume of food when it has high fiber and water content, such as fruit. Due to its high water and fiber content, the 800 calories worth of fruit would equate to approximately 3-4 large bowls. Because fat is so high in calories, 800 calories of fried foods would equate to approximately 8.5 oz. of French fries (~1.5 large McDonald's French fries). You're getting quite a bit more food with the fruit option (and many more healthy benefits). You will likely still feel hungry after eating the French fries, in part due to its smaller volume. Because of this, it is easier to overeat. Choosing plant-based foods can help with weight management, in part because you get to eat a greater quantity of food, and you can more readily pick up on your body's signals that it is full.

If you compare 400 calories of ice cream to 800 calories of pizza, the lower-calorie item will contribute less to your overall daily caloric requirements than the higher-calorie option. But neither is a great choice, because both are loaded with unhealthy fats and high calories (meaning you can't eat much of it, and it may contribute or create health problems over the long term if it's a regular habit due to the saturated fat content). If I had to choose, I would pick the pizza and modify it to be healthier: whole-wheat crust, half the cheese, and lots of vegetables piled on top. Ideally you want to focus on fruits, vegetables, low-fat dairy products and other lean sources of protein, and whole grains as the source for most of your daily nutrition and choose ice cream and French fries in very small quantities, much less often.

Q: I have stage IV lung cancer, and I'm wondering if you have any experience with nutrition benefits for lung cancer patients. Also, there is some literature regarding the benefits of pomegranate juice for lung cancer patients.

D.N.K.
Portland, Maine

A: Consuming a plant-based diet that includes fruits such as pomegranate is advised for all cancer survivors, including those with lung cancer. The dark or rich color of a fruit or vegetable is a good indicator of its health promoting content. Choosing a variety is recommended to get as many phytonutrients as possible. Phytonutrients are plant-based compounds that are beneficial in terms of immune function, energy level and anti-cancer properties. Making sure to eat enough in general to prevent weight loss, especially in a small, frequent meal pattern that includes a source of protein, can be helpful in keeping the immune system strong and energy levels high for patients with lung cancer. Lean protein sources such as fish, eggs, dairy, chicken, turkey, red meat, nuts, seeds and beans are all examples of healthful protein-rich foods.

Vitamin D is another important nutrient, and many people with lung cancer who live in New England are deficient. Your doctor can order a blood test, 25 (OH) D, to determine if you are deficient. A qualified nutritionist can help you create the proper supplementation plan based on your blood test results.

View video on Vitamin D

I would encourage you to meet individually with a licensed nutritionist who specializes in oncology to create a food and supplement plan to best fit your needs. If you are a Dana-Farber patient, please contact us to schedule an appointment or speak with your oncologist.

Q: I have early myelodysplasmia and would like to know the best foods, or diet, to slow the disease. I am currently on just vitamins.

Bill
Marietta, Ohio

A: Eating a plant-based, balanced diet, being physically active and maintaining a healthy weight is recommended for all cancer survivors as well as to help prevent cancers and reduce a person's risk for cancer progression. Plant-based foods such as fruits, vegetables, whole grains, legumes and spices/seasonings contain phytonutrients. Phytonutrients, (Phyto is Greek for plant), are natural compounds that give plants their color, flavor, smell and texture. Phytonutrients are the immune system of a plant. They protect plants from disease, and they can protect you too.

There are as many as 2,000 known phytonutrients. Just one serving of vegetable or fruit may possess more than 100 different types. Phytonutrients work best when eaten together in whole foods, so they can function as a team. This is one reason why getting these nutrients from foods is the best approach. Vitamins may be helpful to fill in the missing pieces from one's diet, but can not replace or replicate the naturally occurring, health-promoting properties of plants.

Please refer to the Optimal Diet Plan for more information and helpful tips. Also, check out the Recipe Archive for easy, tasty, cancer-fighting meal and snack ideas.

Most of your cancer fighting nutrients can come from your diet. We would recommend you speak with a local registered dietitian, as well as your physician, to review your current vitamin regimen.

For more on phytonutrients and their anti-cancer actions, please read this article by one of our staff dietitians.

Q: The Dana-Farber e-News story about brown fat was interesting, but did not mention which foods contain brown fat and which foods contain white fat. I would really like to know the difference so I could eat healthier.

Harry

A: Wouldn't it be great if we could eat a type of food that would rev up our metabolism?

The Dana-Farber e-News story, Scientists find brown fat master switch, describes a type of fat tissue in mice that is being studied in the lab. The brown fat described in the article refers to animal tissue rather than a type of fatty acid for human consumption.

The research described is currently in the animal phase of discovery and will need to be further studied in animals and then in humans to determine if there is a viable intervention for obesity in people.

For now, to help increase resting metabolism and promote maintenance of a healthy weight, physical activity is your best bet. Specifically, combining cardiovascular exercise, such as walking, biking or swimming, with resistance exercise, such as weight lifting, push-ups or power yoga can help to increase a person's lean body mass as well as decrease fat mass. Increasing lean body mass will help raise a person's metabolism both at rest and during activity. It's also important to eat a balanced, plant-based diet rich in fruits, vegetables, whole grains, lean protein, healthful fats such as extra-virgin olive oil or avocado, and plenty of water.

Q: I am a 28-year-old survivor of Hodgkin's Lymphoma. I underwent both chemotherapy and radiation. What diet/foods should I strive to include to help keep myself healthy for a long time to come?

Mark
Brookline, Mass.

A: The optimal diet for cancer survivors is a plant-based diet, that includes a balance of fruits, vegetables, whole grains, lean protein foods and foods rich in Omega-3 fatty acids. Strive for 5 to 10 servings of fruits and vegetables each day (a serving is 1/2 cup for most fruits and veggies, 1 cup for leafy greens, melon and berries). Be sure to eat at least 3 meals a day, and include walking and other forms of physical activity in your daily life.

For more tips on making nutrient-packed, healthful meals, see our Optimal Diet Plan and Recipe Archive.

Q: I am on Xeloda as well as blood pressure meds. My potassium level is low, despite Klor-Con. I eat bananas a few days a week, but get tired of them. I drink orange juice every day and have a few baked potatoes a week. What else will help?

Nancy
Syracuse, N.Y.

A: Potassium is a mineral that helps muscles and nerves work properly. This is especially important with the heart muscle. You can balance the potassium in your blood by choosing certain foods.

Fruits and vegetables are the best food sources of potassium. Here are some healthy, high-potassium foods you could choose:

  • Acorn squash
  • artichoke, boiled
  • avocado
  • baked beans
  • banana
  • broccoli
  • butternut squash
  • cantaloupe
  • chick peas or garbanzo beans
  • dates
  • dried fruit
  • honeydew melon
  • pomegranate
  • potatoes
  • raisins
  • tamarinds
  • tomato paste or sauce
  • water chestnuts
  • winter squash

Q: My son is completing 15 sessions of radiation therapy for a parotid gland tumor that was removed three months ago. He has one radiation session left. His mouth is currently so sore that he cannot eat comfortably. He is using the oral wound rinse provided to him. I've also stocked his dorm refrigerator with pudding, yogurt, JELL-O, mac and cheese (all soft foods) and bought him Ensure with vitamin and mineral supplements. He has no interest in eating right now as it hurts too much. How soon will the sore mouth subside and how do I get him to take SOMETHING in until his mouth feels better? I'm desperate. He's an 18-year-old athlete who is very active and needs some caloric support.

Kelly
Athol, Mass.

A: You are on the right track! Moist, soft foods are the best choices for nourishment when someone has a sore mouth from treatment. Fortifying the amount of nutrients in these foods can also help make small portions count for more nutrition. Some basic tips for helping your son get more nutrition to promote healing and recovery, include:

  • Eat small amounts, more often
  • Get on an eating and drinking schedule
  • Drink your nutrition: make smoothies, frappes and other high calorie/high protein drinks
  • Choose room temperature foods and beverages
  • Fortify foods with more calories and protein
    • Blend canola oil into shakes
    • Add olive oil during and after cooking to vegetables, grains and potatoes
    • Make oatmeal or cream of wheat with milk instead of water
    • Add gravy, sauce and sour cream to foods
    • Add dry milk powder to mac and cheese, mashed potatoes, soups and other foods for additional protein
    • Blend silken tofu into smoothies, shakes and soups for protein
    • Stir together 2 tablespoons of creamy peanut butter and 1 tablespoon of canola oil to make a dressing-like consistency and stir it into yogurt, hot cereal, or soak soft bread in it
    • Try moist, soft foods like shepards pie, quiche, puree soups and chowders, mac and cheese, avocado, banana, scrambled eggs, mashed potatoes (add gravy), pasta with alfredo sauce, custard, pudding, cheesecake (without the crust)

Q: My 24-year-old son has been diagnosed with melanoma of the pancreas, liver, spleen and lungs. We are trying to fix healthy and beneficial meals for him before and during treatment. Is watermelon any good for him? Also, what can we use instead of whey protein powder?

G.M.
Portland, Maine

A: Yes, watermelon is an excellent source of phytonutrients and fluid. One cup of watermelon provides a 1/2 cup or 4 ounces of water.

Protein powders are one way to increase the amount of protein in foods and beverages. Getting enough protein is important to help with immune function, healing and overall energy levels during treatment. Most protein powders on the market are either Whey- or Soy-based. Whey protein powders come from a milk protein while Soy protein powders are derived from soy protein. Both come unflavored or in flavors such as vanilla or chocolate. The unflavored powders can be added to foods such as soups, squash, mashed potatoes, oatmeal, cream of wheat and scrambled eggs, in addition to smoothies and frappes.

Nuts, natural nut butters, beans, hummus, fish, lean meat, poultry, eggs, dairy products and some whole grains such as quinoa are also good sources of protein.

For more tips on making nutrient-packed, healthful meals, see our Optimal Diet Plan and Recipe Archive.


Alleviating Side Effects

Q: My 44-year-old brother started a clinical trial of Folfox and Cetuximab two weeks ago. This past week he's had terrible mouth and tongue sores. He was given a prescription mouth wash that didn't help much, and is now starting on another. Can you tell us a little more about them? Can anything be done to avoid these? Will they last the entire six months of chemo? I understand it's the 5FU doing this – it's really miserable!
Thank You – your site has been extremely helpful.

Debbie
Gilford, NH

Mouth and tongue sores are an inflammatory response to the chemotherapy treatment. There are many ways you can try to alleviate the discomfort and pain associated with mouth sores during chemotherapy. These mouth sores may or may not last for the entire duration of chemotherapy.

Rinses and healthy oral hygiene may help reduce the onset and length of time the mouth sores are present. Studies have shown that a glutamine mouth swish and swallow may help decrease the length of time and severity of mouth sores. Glutamine is a type of amino acid (a building block of protein) that can help to feed the cells lining the intestinal tract and has been shown to be "conditionally essential" during certain times of stress, such as chemotherapy. Research has demonstrated that glutamine supplementation for cancer patients is both safe and may also be effective.

Pure L-Glutamine powder can be found in many supplement/vitamin stores and some pharmacies. Try to find a pure powder with no fillers in the ingredients. It is important to have your brother check with his doctor before starting a new type of mouth rinse, such as glutamine. A basic mouth rinse made of one tablespoon baking soda to one quart water will also help to remove food and germs and keep the mouth clean. It is important to rinse the mouth to reduce bacteria.

There are certain types of foods that can be eaten that will not irritate the mouth or tongue sores and may help alleviate your brother's pain. Eating foods that are high in protein and calories will help the healing process. Eating soft and bland food such as scrambled eggs, creamed soups, and cooked cereals will provide protein and nutrients and will be easier to eat. Also, pureeing or liquefying foods and drinking them through a straw, to avoid the sores, may also make food easier to eat. Hot foods may irritate mouth sores, so try to serve foods lukewarm or cold. Cold foods can sometimes alleviate the pain of mouth sores. Foods like Italian ice (particularly watermelon flavor), ice cream, sorbet, sherbet and pudding may also be soothing.

Some foods to avoid are citrus fruits and fruit juice as well as tomato sauce or juice. These are very acidic and may irritate mouth sores. Spices or seasonings such as pepper, chili powder, cloves, nutmeg, salsa, and horseradish may also be irritating and painful to eat. Avoid some raw vegetables, granola, toast, crackers and other rough, course, or dry foods. Tobacco and alcohol may exacerbate mouth sores, so it is also good to avoid these.

Your brother should experiment with different foods to find out which are the most soothing for him. He should start his trials with water, Italian ices (not lemon), sherbet and warm broth. After those, he can progress to yogurts, puddings and fruit purees. After those, he can try soft, solid foods like mashed potatoes, macaroni and cheese and oatmeal. Just remember he should avoid spices and very acidic foods.

Q: My husband was diagnosed with Multiple Myeloma Aug 7 2009. His Velcade/Dexamethasone/Liposomal Doxil chemotherapy clinical trial was stopped at the end of the 28 days cycle because the tumor at his C7 grew [and] also more lytic lesions [were] found. The doctor prescribed 10 consecutive days of focus radiation (throat area-C7) which resulted in extreme throat pain about 12 days after the radiation ended. Because he could hardly swallow his saliva, my husband ate only sorbet, ice cream and Ensure. His throat is better now and he is taking mostly soups (vegetable soups with chicken/pork/beef). He has just finished the first cycle on the new chemotherapy regimen (Revlimid/Dexamethasone/Velcade + Aloxi) and once-a-month Zometa. He is constipated [and] gassy most of the time. When he moves his bowels, it is a few round hard stools. Sometimes after that he has diarrhea. There is no in between. How can we address this problem? We are also very concerned that he is loosing muscle mass [and] especially that continued muscle atrophy will cause other damages, especially to the heart muscle. What can I do about this, in terms of his food intake, exercise, etc.? Thank you.

K.O.
Potomac, MD

One way of managing constipation and diarrhea is to add soluble fiber to the diet. This fiber will help move food through the GI tract to battle constipation. Soluble fiber may also alleviate the diarrhea because it will help to form soft stools. Soluble fiber can be found in whole grain products like oat-based whole grain crackers, cereals and breads, oatmeal, beans and fresh or frozen fruits and vegetables. You may want to try removing seeds and skins from fruits and vegetables and cooking vegetables to make them easier to swallow and digest. Seeing that your husband may have a hard time swallowing some of these foods, you may also want to try Benefiber. Benefiber is an over-the-counter supplement that provides soluble fiber to the diet to alleviate constipation. It is dissolvable in any liquid, hot or cold, and it is tasteless but can be bought in a variety of flavors.

Adequate water intake is very important in managing constipation and diarrhea. It will help alleviate constipation and it will replenish water loss that occurs during diarrhea. We recommend 8-10 glasses of water and fluids per day.. With increased diarrhea, you may want to increase the liquid intake. For more tips on symptom management, read our "managing side effects" information.

To avoid muscle atrophy, your husband should be eating enough calories and protein. These calories will provide the body with energy so it does not have to break down muscle for energy. Eating small, frequent meals will help his diarrhea and constipation, but if the meals are higher in calories, it will help him to avoid losing muscle mass. Seeing that your husband is eating mostly soups, try higher calorie ones like split pea, tomato bisque or chili. When increasing fluid intake, choose some high-calorie drinks, such as fruit juices, frappés, milk or commercially prepared supplements like Ensure. Just beware of foods very high in fats, such as fried food, as this may increase diarrhea. To restore some muscle loss, higher protein foods, such as meats, poultry, eggs, and fish, would also be a good addition to your husband's diet. For exercise to restore muscle loss, walking would be the best choice. It will keep his muscles active but not put too much strain on them.

Also, because your husband is on Zometa we recommend talking to his doctor about checking his vitamin D level. If he finds that his vitamin D is low, he may require a supplement.

Q: I need a dietician / nutritionist to help a friend. My friend had a gastric bypass 10 years ago, and 7 years ago he was diagnosed with colon cancer. It [the cancer] has spread and he now is at stage 4 and losing weight like crazy. He is being seen elsewhere and the oncologist says: Eat what you can. The bypass is presenting problems because as he loses weight his stomach gets smaller.

Gary
Boston, MA

A: There are many similarities between a diet recommended for a patient with cancer who is losing weight and a patient who had a gastric bypass. The main priority is getting nutrition and calories into the body. Adequate calories will help keep the patient's energy level up and keep the body processes running smoothly. It will also help the body heal and promote faster recovery with fewer infections and complications.

One of the best tips to increase calorie intake is to eat small frequent meals every few hours throughout the day. This will be effective especially for gastric bypass patients. Because the stomach is reduced in size, a small meal will allow for easy digestion and movement through that gastrointestinal (GI) tract. It is important to include protein in each small meal. This protein will help your body rebuild body tissue and it will help the body stay strong through cancer treatments.

Some great ways to add protein to small frequent meals include incorporating nuts into your diet: add them to any breads or baked goods, throw them into salads and cereal, or sprinkle them on top of ice cream. You can also add beans to salads or entrees or put them into soups for a great addition of protein. Beans also make a great ingredient in dips for vegetables or tortilla chips. Another option is to include eggs: they can be hard-boiled, chopped and added to salads, dressings, casseroles or other entrees. They also make a great breakfast whether they are fried or hard-boiled.

Healthy fats are also a good way to increase calorie intake so the body will break down that fat instead of muscle when it needs energy. Avocados contain healthy fats and can be made into dip or sliced and put on a sandwich. When cooking, use olive oil or canola oil when stir-frying, preparing pasta or rice, or making a salad dressing. Nuts also contain healthy fats. Try using peanut, almond or cashew butter on toast or crackers.

Tell your friend to remember to eat well when his appetite is better or he feels well enough to, and keep high-calorie foods readily available for him to snack on, especially when he is away from the house. Keeping fluid at a minimum during mealtime is best because it will increase the bulk of food that he is able to eat. It is very important to stay hydrated by drinking liquids between meals. These liquids can consist of higher calories drinks like 100% fruit juices, milk or frappes. Commercial nutrition supplements, like Ensure or Boost, can also increase an individual's calorie intake. Finally, stock up on his favorite foods: relying on one's favorite food is a great way to stimulate the appetite.

Q: My friend was diagnosed with anal cancer. I want to cook for her. She is starting chemo & radiation treatments this week. What kinds of foods/meals would help her? What foods will help her heal?

Amy
Syracuse, NY

A: Radiation treatments to the lower abdominal or pelvic region and certain types of chemotherapy may cause diarrhea.

When cooking for your friend, keep these tips in mind:

  • Small, frequent meals are easier to digest and absorb
  • Low fiber and low fat foods are also easier to digest
  • Caffeine, found in coffee, soda and regular tea, can worsen diarrhea
  • Lactose is difficult to digest and may worsen diarrhea; try lactose-free dairy products such as Lactaid®, soy milk or rice milk.
  • Some foods, like oatmeal, pasta, rice, bananas and applesauce, may thicken stool and decrease diarrhea. These foods should be added gradually.
  • Fluid and electrolytes can be lost when a patient has diarrhea and should be replenished with caffeine-free liquids, including water, Gatorade®, Pedialyte, or broth. Patients should try to drink these between meals instead of with meals.

Types of food that will help your friend heal are foods that contain protein and phytonutrients and are easy to digest. The best protein choices for your friend would be lean proteins such as chicken or turkey without skin, tender and lean beef or lamb, eggs, tofu, low-fat cheese or peanut butter. These protein-rich foods should not increase diarrhea.

The phytonutrients that will help your friend heal can be found in fruits and vegetables. Fruit and vegetables that are cooked or canned and do not have skins or seeds are easiest to digest and will not cause diarrhea. This includes cooked or canned peaches, pineapple, orange, or fruit cocktail. Some good vegetable choices would be tomato sauce or puree and cooked or canned vegetables, such as asparagus tips, peeled summer squash, mushrooms, peeled white or sweet potato, spinach or carrots.

Here is a suggestion for a dinner that you can cook for your friend that would be satisfying and nutritious for her:

Dinner

Baked, boiled or broiled chicken breast cooked with 1 teaspoon olive oil

Peeled and cooked sweet potato or summer squash with 1 tablespoon light, trans-fat free margarine on top

Cooked spinach

Dessert

Angel food cake served with sorbet or with canned or cooked peaches

Q: I have had systemic candidiasis for 20 years and have found it to be a very tricky ailment in treating. When it is particularly bad it manifests as tinea versicolor on my skin. My main desire is to rid myself of the ailment – especially the versicolor – without losing weight. When I follow nutritionally suggested protocols I have weight loss, catabolism, bad body aches and brain fog. This Herxheimer Response simply doesn't work for me. Is there any way to rid myself of the candidiasis overgrowth, get back into balance and do this without losing lean body mass?

JA
Tampa, FL

A: Candida infection usually occurs in people with long-term administration of antibiotics, decreased immunity, and organ or stem cell transplantation. The population most susceptible to fungal infections include HIV/AIDS and cancer patients.

People at risk for fungal/yeast infections or currently with the condition should maintain a healthy population of beneficial bacteria in the gut, which may reduce the risk of infection.

Studies have shown that yogurt and probiotics should be consumed daily, including yogurt enriched with Lactobacillus acidophilus to increase levels of friendly bacteria in the gut and vagina. Also taking one teaspoon (4 g) of fructooligosaccharides daily may help in the proliferation of bifido bacteria in the gut.

Other nutrients may be used to reduce the risk of infection because they may attack the organisms directly responsible for the infection or enhance the immune response to fight it. These include the following:

  • Goldenseal – Barberine found in the goldenseal may inhibit growth of some organisms
  • Lactoferrin – Part of the whey protein may produce an immune defense against bacteria, yeasts, and intestinal parasites
  • Tea tree oil – May have some antifungal properties and may be used in treatment of dermatologic Candida infection and paronychia
  • Essential oils – Oils including clove, cayenne, oregano have been shown to reduce fungal load and number of colony count in animal studies. There are no studies in humans to confirm protective effect of using these kinds of oils.
  • Garlic – May inhibit the growth of Candida due to its extract content
  • Boric acid – May cure fungal infections

Before trying the above nutrients please contact your physician regarding dosing, side effects, and any possible nutrient-drug interactions.

Regarding maintaining lean body mass: Try following a diet high in protein, healthy fats, and phytonutrients. Eggs, lean meat (including chicken and turkey), fish, cheese, and hummus are examples of foods that are high in protein. Healthy fat can be found in olive oil, canola oil, flax seed oil, avocado, nuts, and seeds. Fruits, vegetables, beans, whole grains, and spices are excellent sources of phytonutrients that play a role in preventing cancer and provide other health benefits.

Q: A year out of treatment, I seemed to be doing well (pancreatic cancer) except for spasms in my stomach, loose stools - now I am experiencing constipation, horrible gas or as the ultrasound showed, air in my liver, resulting in 24 hours of stomach aches, sleepless nights, gas, and the constant feeling of hunger. I am about to see my GI doctor, but wanted to find a nutritionist who handles my specific needs. I am continuing to lose weight, which is very disturbing. What should my next step be? Thank you for any help you can suggest.

Edie Rosen
Bloomfield, CT

A: GI disturbances are common with pancreatic cancer. However, the management of these symptoms can be a unique process. In order to decrease gas, we recommend you to:

  • Avoid using a straw
  • Avoid chewing with your mouth open or eating quickly
  • Avoid chewing gum
  • Avoid carbonated beverages and beer
  • Use Beano when eating gas-producing produce (broccoli, cauliflower, onions, Brussels sprouts, corn, cucumber, cabbage, leeks, radishes, peppers, kohlrabi, turnips, asparagus) and beans (baked beans, soybeans, lentils, split peas, kidney beans, garbanzo beans, lima beans, navy beans)
  • Use Lactaid or Dairy Ease to aid in digestion of dairy products, or choose soy or rice milk instead

Gentle tips for managing constipation include:

  • Eat foods or beverages that are warmed, including prune juice
  • Drink plenty of fluids
  • Eat regular meals at same time daily.
  • Eat whole grain breads. Try oatmeal bread which his helpful for both constipation and diarrhea
  • Choose whole grain cereals such as oatmeal and oat based cold cereals
  • Increase intake of fruits and vegetables, particularly cooked vegetables and fruits such as apples, pears and melons (these types are less likely to induce diarrhea)

Eating small, frequent meals will help with these symptoms, as well as your weight loss. Also try adding healthy calories, including foods like avocado, hummus and nut butters.

For generalized tips for healthy eating with pancreatic cancer, please refer to our Diet for pancreatic cancer patient.

Making an appointment with a nutritionist to have a personalized assessment of your diet and symptoms would the most helpful, long-term option in your case.

Q: I am currently undergoing treatment for ovarian cancer, [stage] IIIC. One of my side effects has been vagus nerve damage, specifically gastroparesis. I have been told to stay away from anything high in fat [or] fiber and stick with soft foods, etc. My question is: Besides adding protein powders to my food, puddings, smoothies, and yogurt, what can I eat that will help me gain back some of the weight that I've lost? I'm becoming malnourished because I'm not absorbing nutrients from my food and anything that I eat causes pain. I am also having problems with my blood sugar because of delayed digestion from the gastroparesis. I love fruits and vegetables but I have been warned to stay away because of the possibility of forming bezoars. The nausea from chemo is not helping either.

Anonymous

A: Gastroparesis is delayed gastric emptying: The stomach takes too long to empty its contents. It is a digestive disorder that occurs when the nerves that control the movement of your stomach and intestines are damaged and, consequently, food lingers in the stomach for too long. Signs and symptoms include nausea, vomiting, heartburn, early fullness when eating, abdominal bloating and discomfort, and weight loss. If food remains in the stomach for long periods of time, bezoars may form (solid masses of undigested materials), which lead to pain, nausea, and blockages in the digestive tract.

You are correct in avoiding high-fat foods and high-fiber fresh fruits and vegetables. Consuming protein powders, smoothies, and yogurt, etc., is great. However, there are a number of other options that you can incorporate into your diet to increase your calories and not exacerbate your symptoms. The recommendations below are a starting point. I encourage you to meet with a Registered Dietitian one-on-one to develop an eating plan that suits your specific needs and nutritional goals.

  • Choose low fiber options such as white or refined pastas, breads, cereals and crackers.
  • Canned and cooked fruits and vegetables may also be included, as they are easier to digest. High fiber foods (whole grains, legumes, fresh fruits and vegetables, etc.) are difficult to digest and are also more likely to form bezoars.
  • Choose low fat dairy products and lean meats. Because fat slows the movement of food from the stomach, aim to eat less than 40 grams of fat per day, spread out between meals.
  • Prepare foods by broiling, baking, poaching, or steaming.
  • Avoid high-fat foods, including fried food, desserts, bakery goods, and creamy salad dressings.
  • Consuming 4-6 mini meals of these types of foods instead of three large meals may be easier for you to digest. Eat slowly and chew well so there is less work in the stomach for digestion. Sit up after eating and avoid exercise or activity for one hour after meals.
  • Finally, try to drink fluids separately from meals and snacks, so you don't fill up on fluids alone.

Q: What can I do about flagging energy after chemotherapy? It seems to last too long afterwards.

Myrna
Las Vegas, NV

A: Although it may seem counterintuitive, the best strategy to fight fatigue is to get moving. Research shows that physical activity following chemotherapy can actually boost energy levels and make you feel better. Walking is a great way to incorporate physical activity since it doesn't require anything besides a decent pair of shoes. A ten-minute walk around the block each morning may be the key to feeling less tired and having more energy throughout your day.

It is also important to eat enough calories, especially calories from protein, to help you regain your strength. Try a handful of nuts or a scoop of cottage cheese as a snack, and be sure to include a portion of lean protein (fish, chicken, tofu, eggs) at meals. Other foods that are good sources of protein include cheese, dairy products, nuts/nut butters, and beans.

Finally, drink plenty of fluids to ensure that you are adequately hydrated. If you get tired of drinking plain water, try adding a little lemon or lime juice, or cucumber slices. In addition to drinking water, eating fruits, vegetables, and soups will help you meet your fluid needs.

To find out your exact protein and fluid needs, please speak with a registered dietitian.

Q: Although I am an RD (essentially retired, and have not worked in clinical setting for over 30 years), I am definitely not "up" on dietetic oncology (though I was the first dietitian to work at Dana Farber, from 1974-77).

I have a friend who is suffering from hepatic cancer, for which even the most radical treatments have not worked. She has been told that she needs to eat more protein. Needless to say, she has no appetite, but will take liquids. I've been encouraging fruit slushies to which I suggested her husband add powdered Vivonex (see how old my knowledge is).

Do you have any suggestions for protein supplements, and/or meds that might improve appetite?

I also suggested that her family contact a dietitian at Massachusetts General Hospital, where she's being treated, but she's never been seen by one during any treatment or hospitalization. So, I am acting like a clinical nutrition consultant — and I need advice that is more up-to-date than I have.

LB
Peabody, Massachusetts

A: Thank you for your excellent question and it's always nice to hear from a colleague. I agree that your friend should meet with a nutritionist where she's being treated. The RDs in oncology at MGH are excellent; their number is (617) 724-4144.

We recommend a pattern of a small, frequent meals, with four to six small meals a day, high in calories, protein and other nutrients, to help promote appetite and adequate overall nutrition for energy level and immune support.

Protein shakes or smoothies are often a helpful way of reaching these goals. The protein powders we recommend most often include whey or soy protein powder, which can be found at a variety of health food stores and grocery or drug stores. We also like Resurgex protein powder, which is 350 calories for 15 grams of protein and contains phytonutrients. Resurgex also comes in ready-to-drink form.

Adding 1 tablespoon of canola oil to homemade smoothies is another way to increase calories in a healthful manner (120 calories per tablespoon). Canola oil will not change the texture or flavor of the shake. There are some tasty smoothie and other recipes on our web site in the Recipe Archive section.

Other tips for boosting total calories without increasing the volume of food include using healthful fats such as olive oil; nut butters (peanut, almond, sunflower seed, etc.); pesto, snacking on nuts/trail mix/granola; and using whole-milk dairy products. You'll find more tips in our section on managing side effects.

There are a few medications that physicians recommend, including Megace and Marinol. Your friend should speak with her doctor to see if any appetite-stimulating medications are right for her.

Q: I am a multiple myeloma patient and have peripheral neuropathy as a result of both the myeloma and chemotherapy. I have been told that B vitamins may help with both my current symptoms and with any future chemotherapy. What dose of these vitamins is safe? Are there other nutritional supplements that can help?

J.M.
Richmond, Calif.

A: Peripheral neuropathy, a side effect of certain chemotherapy drugs, is a condition that causes numbness and tingling in your hands and feet. The exact mechanism of this chemotherapy-induced neuropathy is unknown. Supplementation may help alleviate symptoms of neuropathy.

Vitamin B6 is known to help diabetic neuropathy and may help manage chemotherapy-induced neuropathy symptoms when taken in a safe dose. Taking 50 to 100 mg of B6 daily is safe and may be effective. If you are taking a multivitamin and/or B Complex, check the amount of B6, so that you do not go above 100 mg total per day.

Glutamine has been suggested to help chemotherapy-induced neuropathy, especially from Taxol. Taking 30g/day, as 15 grams twice daily, of Pure L-Glutamine Powder is considered safe for cancer patients. Try to find a powder without other "fillers" in the ingredient list.

Alpha-Lipoic-Acid (ALA) seems to reduce symptoms of peripheral neuropathy in diabetic patients, and may help with symptoms of chemotherapy-induced neuropathy. Taking 300 mg twice daily or 600 mg daily is considered a safe dose. Symptom improvement is seen within 3-5 weeks. ALA is an antioxidant, and when used in combination with radiation treatment, it may reduce effectiveness of the cancer therapy. ALA can be used for up to 4 weeks safely. For long-term use, please speak with your physician and dietitian.

An alterative therapy to oral supplementation is acupuncture. Emerging evidence supports acupuncture as effective in reducing chronic pain associated with cancer.

When considering supplementation, it is important to meet with a Registered Dietitian for an individualized dietary supplement plan.

Q: My father-in-law has been diagnosed with lymphoma. So far he has had one chemotherapy treatment. He had to be admitted to the hospital and denied chemotherapy due to the fact that he is not eating. He now has a feeding tube in his nose, but he is still losing weight. His complaint is that everything tastes like metal. He has no appetite and says it hurts to swallow. Are there any tricks to make food not have the metallic taste?

J.N.

A: Thank you for your detailed question. This is a very important topic for anyone taking care of a loved one going through cancer treatment. You pose several different nutritional challenges that often come along with cancer and treatment. People going through treatment may face one or more of these challenges at a time, which can understandably impede their ability to eat well and keep their weight up. It can be a frustrating experience for everyone involved. Here are some tips that may help.

Taste changes can be different for every patient as they are affected differently by their illness and treatments. Some strategies to try are:

To give foods more flavor:

  • Season foods with tart flavors such as lemon wedges, citrus fruits, lemonade, cranberry juice, vinegar, and pickled foods. (If you have a sore mouth or throat, these foods should be avoided.)
  • Try flavoring foods with onion, garlic, chili powder, basil, oregano, rosemary, tarragon, barbecue sauce, mustard, ketchup, or mint.
  • Marinated and cooked meats are often better tasting. Try sweet juices, fruits, acidic dressings, or wine (e.g. try sweet and sour pork with pineapple, chicken with honey glaze, and London Broil in Italian dressing).

To hide strange or metallic tastes:

  • Rinse your mouth with tea, ginger ale, salted water, or water with baking soda before eating to help clear your taste buds.
  • Chew on lemon drops, mints, or gum to help get rid of bad or off-tastes that linger after eating.
  • Cold dishes that contain meat may taste more appealing than hot meals with this ingredient.

Some other tips to help food taste better:

  • Try serving foods cold or at room temperature, since hot foods produce stronger smells and flavors.
  • If foods taste metallic, use plastic utensils and dishes when possible.
  • If nutrition supplement appeal is an issue, try pouring them out of the can and serve chilled or over ice.

Here are some ways to increase calories:

When appetite is low, it is important to make everything you eat count. It's OK to have small portions. Try to pick "nutrient-dense" foods and drinks (see tips below) and be encouraging. Eating more often will help make up for having less food at each meal or snack.

Tips:

  • Eat small meals and snacks every couple of hours throughout the day.
  • Eat well during times when your appetite is better.
  • Keep high-calorie foods handy at home and in your car.
  • Add calories to vegetables by stir frying in canola or olive oil, or serving with a cheese sauce or sprinkle cheese on top.
  • Add calories to salads by adding salad dressings, nuts, seeds, avocados and/or olives.
  • Spread toast, crackers and fruit with peanut butter.
  • Keep fluids to a minimum at mealtimes but don't forget to drink between meals.
  • Try higher-calorie soups like split pea, tomato bisque, chowders, cream soups, and chili.
  • Sip on higher-calorie fluids such as juices (try cranberry, grape and nectars), milk, frappes, and commercial nutritional supplements.
  • Blend 1 tablespoon of canola oil in frappes or commercially prepared supplements (Boost/Ensure).

Additional information:

Q: Is it safe to lose weight during treatment with breast cancer? If so, what is a safe amount?

Andrea
Bangor, Maine

A: Weight gain during breast cancer treatment is very common and certainly an unwanted side effect. Weight gain after diagnosis of early stage breast cancer is actually a risk factor for recurrence. Maintaining a healthy weight during treatment and beyond is recommended for all breast cancer survivors.

To answer your question, yes it is safe and advisable for many women to lose weight during breast cancer treatment. Most breast cancer patients hear that they should not lose weight during treatment. They also hear that if they are overweight, weight loss is very important for survivorship.

What should one do? Meet with a Registered Dietitian who can help you understand your individual weight goals and assist you in designing a healthful eating plan. It is possible to eat all the important nutrients for maintaining health, yet at the same time promote a very gradual, medically appropriate weight loss, even during treatment. There is not a uniform approach to this delicate situation, which speaks to the importance of meeting with a qualified professional who can help to guide you through your treatment.

It would certainly be detrimental to focus on treatment as a weight loss tool, although for many overweight cancer patients this has appeal. Rather, focus more on daily exercise and consuming ample amounts of healthful foods like fruits, vegetables, whole grains, lean proteins, and low-fat dairy products that will provide important nutrients and may contribute to gradual, appropriate weight loss if a person is overweight without compromising the immune system.

Q: Why am I so tired? I was working out 40-60 minutes a day. I'm hypoglycemic, so I basically don't eat sugar. I eat mainly salads for lunch with some protein. At 2 p.m. everyday I need a nap.

Chris
Hillsborough, NJ

A: It sounds like you could benefit from optimizing your balance of energy in, energy out and rest. Your lethargy in the afternoon could be from a number of things that are interconnected. Here are some things you could consider:

  1. Limiting sugar intake is very healthy, but you may have an overall inadequate carbohydrate intake. Carbohydrates are the body's primary fuel and our muscles need carbohydrates to replenish what's used up during exercise. Choosing low glycemic index (previously known as complex) carbohydrates would be a healthful choice. Look for fruits and 100% whole grain products with at least 3 grams of fiber per serving.
  2. Be sure to eat breakfast and an afternoon snack everyday and include a protein source. For example:
    • whole grain toast with natural nut butter and banana
    • 2 eggs with 2 slices whole grain bread
    • steel-cut oatmeal made with 1% milk or soy milk, add berries, 1 tablespoon ground flaxseed or wheat germ
    • piece of fruit with trail mix
  3. Lack of adequate hydration — If you divide your body weight in half, this is approximately your daily fluid requirement in ounces. You'll need additional fluid for each workout, depending on how much you sweat. If you exercise for at least an hour or are sweating a lot, be sure to drink an electrolyte-rich fluid.
  4. Overtraining — When someone is working out at a higher intensity on a daily basis, especially coupled with restricted food intake, the body goes into a state of stress. This leads to an inefficient system and hinders muscle gain and weight loss. It also produces an immunosuppressive effect, making someone more susceptible to illness. It can also make a person extremely tired. Try taking a day off a week, varying the type of exercises you're doing and also including a mind-body workout such as yoga. Strive to get at least 8 hours of sleep each night.

Q: I have active but stable multiple myeloma and am on temporary "vacation" from Revlimid until my white cells recover. I'm currently taking prescribed doses of potassium (10mg daily), Vitamin D (8000 units once weekly) and magnesium (240 mg daily). What do you recommend I add to a healthy diet to boost red and white counts being depleted by Revlimid?

JSH
North Truro, Mass.

A: It sounds like you are on your way to helping replenish nutrients that have been reduced during the course of your treatment. It is also important to get enough protein to help rebuild blood cells. Good sources of protein include lean meat and poultry, fish, eggs, low-fat dairy products like milk and yogurt, soy foods, nuts, nut butters, beans, and hummus. To find out your exact protein needs, please speak with a registered dietitian.

Balancing activity with good quality sleep and rest can help rebuild red and white blood cells as well as overall immunity.

Research suggests that acupuncture may help with white blood cell count recovery between chemotherapy treatments. The Zakim Center for Integrative Therapies at Dana-Farber provides acupuncture services.

Q: I have been recently diagnosed with multiple myeloma, and in addition, I am being treated for diabetes. I am currently being treated with Dexamethasone and will start on REVLIMID/Dexamethasone at the end of the month. When using Dexamethasone, my glucose readings go out of sight. I found that exercise (walking 30 minutes three times a day) seems to reduce the glucose swings. I was considering shifting to a low-carbohydrate diet to reduce the generation of glucose during this time. Is this diet shift a wise decision?

Deb
Warwick, R.I.

A: Several factors can affect your blood sugars: diet, exercise, stress, hormones, infection, and medications. Dexamethasone is a type of steroid, a side effect of which is high blood sugar. If your blood sugars are normally controlled, the addition of this drug can cause your blood glucose readings to spiral out-of-control.

Carbohydrates are our body's primary source of energy. If we do not get enough energy from carbohydrates, our body breaks down muscle to produce energy. Eating a well-balance diet with a moderate amount of healthful carbohydrates will help keep blood sugars in control while providing you with energy. Healthful carbohydrates-- like whole wheat bread, brown rice, whole wheat pasta, and whole grain cereals — have fiber and less impact on blood sugars. Also, spread your intake of carbohydrates evenly throughout the day and keep in mind serving size to help regulate blood sugar levels.

  • 1 slice of bread
  • 1/2 English muffin
  • 1/2 cup of cereal
  • 1/3 cup of rice (white or brown)
  • 1/2 small potato
  • 1/2 beans

Exercise is another important component in controlling blood sugars. When muscles are working during physical activity, blood sugar (glucose) is pulled into your muscle, lowering your circulating blood glucose. If you are type 2 diabetic, exercise can also increase insulin sensitivity and make insulin even more effective at regulating your blood sugar. Exercise is important for weight management and overall fitness. Always talk with your physician before beginning any physical activity.

For more individual guidelines, meet with a Registered Dietitian who can assess your current diet and provide appropriate recommendations. To schedule an appointment at Dana Farber, please call (617) 632-3006. If your blood sugars continue to be high, schedule an appointment with your physician.


Current Controversies

Q: I am interested in your expert opinion on a nutritional beverage called MonaVie. It is a nutritional fruit juice that boasts the equivalent of 13 servings of high-antioxidant fruits in the recommended daily serving. Is this beneficial for those undergoing treatment for cancer or for helping the body to prevent the development of cancers?

KD
Dartmouth, MA

A. The nutritional beverage MonaVie claims to protect against free radials and offer key nutrients for optimal health. It contains high concentrations of a variety of "power" fruits that the maker of MonaVie claims have the highest amounts of antioxidants. However, there is no current scientific evidence of the benefits of such high concentrations or of how much of these antioxidants get absorbed into the body.

For a healthy adult, MonaVie is no more effective at preventing the development of cancers than a plant-based diet. At this time, there is no scientific evidence to suggest it is even as good as a plant-based diet, physical activity and weight management will be in terms of prevention. This drink contains ingredients that are safe when eaten in normal amounts that are found in food. However, there have been no scientific studies of the safety of those ingredients when they are consumed in more concentrated amounts like the ones found in this beverage.

While there is no harm in drinking MonaVie for a healthy adult, there may be some adverse reactions when it is taken by those who are undergoing cancer therapy or who take certain medications. Most cancer patients in treatment should avoid MonaVie. Certain ingredients in the beverage can actually interfere with chemotherapy or radiation treatments, making these therapies less effective or even causing a patient harm. Please view our Nutrition Services section to learn more about nutrition during cancer treatment. A plant-based diet provides many of the vitamins, minerals and antioxidants that can safely help the body heal during cancer treatment and protect the body against cancer.

When eating a plant-based diet, it is important to get a variety of colorful fruits and vegetables on a daily basis. Each different color of fruit or vegetable contains a different kind of phytonutrient that can help to strengthen the immune system and may help to fight or prevent cancer. Foods like ground flax seeds, teas, ginger, beans or legumes, nuts, and whole grains also provide phytonutrients. Please check out our recipe archive to find delicious, colorful recipes that provide lots of these cancer-fighting nutrients in safe, healthy and food-based amounts.

Q: Is it safe to do the Budwig diet along with chemotherapy?

Tammy
Taunton, MA

The Budwig diet is an example of an Alternative Diet and is not recommended for cancer patients during treatment. It is based out of a complementary medicine center in Europe. The main focus of the Budwig diet is organic cottage cheese and flaxseed oil. The diet recommends blending these two ingredients together and eating them two times a day. Meals consist of raw, organic fruits and vegetables and drinking a lot of water and fruit or vegetable juices. The diet also recommends cutting out all fats, meats, sugars, carbohydrates and dairy. The diet includes options of light exercise, if you are not too weak, and enemas using hot water and coffee.

While aspects of this diet are healthy, other aspects are considered harmful, especially during chemotherapy. Flaxseed oil contains omega-3 fats, a very healthful nutrient. In cancer patients, preliminary research suggests that diets that include omega-3s may protect against the development of cancer, reduce inflammation, help prevent muscle loss associated with cancer treatment, and may increase the potency of certain chemotherapy drugs. The high amounts of fresh organic fruits and vegetables also provide many phytonutrients in the diet.

However, this diet is extremely limited in protein and adequate calories. During chemotherapy, it is important to give your body adequate protein to prevent muscle wasting and maintain a healthy immune system. Your body also needs enough carbohydrates and healthy fats to meet daily energy and nutrient needs. During chemotherapy, you may also be suffering from side-effects, including diarrhea, nausea, appetite loss and change of taste. An extremely limited diet, such as this, may not be helpful when managing these side-effects. Also, coffee enemas are not recommended, because they carry a high risk for infection.

Adding variety to your diet and being able to eat what makes your body feel better, especially during chemotherapy, is important for health and wellness. You can however, add the flaxseed oil and cottage cheese mixture as a healthy part of your overall diet. It would make a great breakfast with some fruit added to it. Another point you can take away from the Budwig diet is the amount vegetables and fruits in your diet. A plant-based diet in combination with adequate lean proteins such as chicken or fish and whole grains will keep your energy levels up and help your body heal.

For more healthy eating ideas, visit our recipe archive and our information on optimal diets for cancer survivors.

Q: Hello. I've read in a few places that putting milk in your tea will lower the antioxidant count …. Well, I was wondering would the same thing happen if I ate some sort of dairy [product] when I was drinking tea? Like, if I was drinking tea and eating cheese on crackers. If it does, how long do I have to wait before/after until I can drink tea and get the maximum amount of antioxidants? Thanks for any help.

Pam
Fairfax, VA

A: There have been many research studies about this particular topic. Does adding milk to tea reduce the amount of antioxidants your body can absorb? The research studies have used blood samples taken after consumption of tea alone and then after having tea with milk. They have all been unanimous in their results that the addition of milk to tea did not have an effect on antioxidant blood levels after consumption. From these results, there is most likely also no effect on how well your body can absorb antioxidants from tea when consumed at the same time as you eat cheese.

The antioxidants that are found in teas are catechins and flavonoids. These are antioxidants that may help protect against heart disease and certain kinds of cancers. Green tea tends to have a much higher concentration of these antioxidants and also contains a type of catechin called "EGCG." EGCG has the highest anti-cancer fighting properties.

To get an optimum amount of antioxidants from green tea, try to consume about 3 cups a day. Also, the longer you let your tea brew, the higher it will be in antioxidants. Allow for an 8-10 minute brewing time.

Q: Do you recommend eating sprouted grains as part of a balanced diet? Currently, I sprout organic grains such as wheat and quinoa myself and eat them with fruit and soy milk for breakfast. Recently, a friend spoke with a well-known herbalist who categorically recommended against eating sprouts. She claimed that sprouts contain carcinogenic compounds.

Chris
Hartford, Connecticut

A: There is no scientific evidence demonstrating that sprouted grains contain carcinogens, or cancer-promoting compounds. In fact, most research supports the benefit of sprouted grains. Sprouting grains may help to improve bioavailability — the ability of the body to absorb immune-supportive minerals and trace elements such as selenium. Quinoa, buckwheat, and wheat seem to have the greatest ability to increase their nutrient content by sprouting as compared to other grains.

Q: Are natural sugars like honey and sugars in dried and fresh fruit harmful? I have a sweet tooth, so I need to cut out chocolate, etc., but I love toast with honey and juices, dried fruit, etc. Should I have to cut these out, too, because it's also harmful like refined sugars?

Monica
Northampton, England

A: Naturally occurring sugars found in fruit and honey are more healthful than processed, refined sugars. Dried fruit is a great source of vitamins and fiber. Combining protein with natural sugars is advantageous for blood sugar stability and also to help decrease some of the negative aspects of sugar intake such as dramatic shifts in energy levels or increase in insulin secretion. Of course it's important to use any sweetener in moderation, but a natural form, including dark chocolate, is the best choice and does not need to be totally eradicated from the diet.

Q: The question of sugar and white flour always comes up. Does sugar feed cancer cells? Am I harming myself and encouraging a recurrence if I eat sugar?

Kathy
Ludington, Mich.

A: The notion that sugar feeds cancer is widespread in the public press. To cut to the chase: it's not that simple. There is not a 1:1 ratio or direct link between eating a bite of sugar and the resulting growth of a certain number of cancer cells. "Sugar" is a term often used to represent dozens of important, natural chemical structures that exist in our bodies. However, most of us hear the word sugar and think of the white form of table sugar.

Unfortunately, the typical American diet is high in many processed and refined foods, including sugar and white flour. Replacing these foods with healthy forms of carbohydrates such as fruits and whole grains is advised for people who have had cancer. However, being fearful of or restricting intake of certain foods that contain natural sugars is not necessary or healthful.

Here is an example: Should cancer survivors avoid eating oranges because they have natural sugar? For comparison's sake let's consider that one medium orange contains 12 grams of sugar and a small donut contains 10 grams of sugar. The difference is that the orange also contains fiber and phytonutrients, both of which may play a role in fighting cancer, whereas the donut is just 200 empty calories, devoid of any potential nutritional benefit. Eliminating foods that contain sugar, such as fruits, is not wise for cancer survivors as this limits intake of cancer-fighting nutrients that are important for energy and overall health.

In fact, many cancer patients are lead to believe that they must follow a restricted sugar diet for fear of causing cancer growth in themselves if they do not adhere. This fear and rigidity often promotes a very stressful experience. The stress will actually lead to an increase in blood sugar as well as compromised immunity. These negative health effects are actually the exact opposite of the purported benefit of such a plan.

There may be a connection, however, between a diet high in refined, processed foods combined with a sedentary lifestyle that may lead a person to become overweight and eventually experience insulin resistance. Insulin resistance can cause an increase in blood levels of insulin and related compounds that may act as growth factors. The connection between body weight, insulin levels and cancer survivorship is currently being researched. In the meantime, becoming more physically active, striving to maintain a healthy weight and eating a plant-based diet including substituting refined sugars and white flour with whole grains and other unprocessed carbohydrates can all help to keep insulin levels in check and promote cancer survivorship.

Q: What are your thoughts on grapefruit and breast cancer?

MG
Boulder, Colo.

A: To date, only one large study has looked at the link between the consumption of grapefruit and breast cancer risk. It is hard to make conclusive recommendations based on just one study; however, the results are compelling and deserve attention. Here is a summary of the research report from the University of Southern California and the University of Hawaii.

Grapefruit juice has been found to interact with more than 60 percent of orally administered drugs. Drinking just 6 ounces can cause a dramatic increase of the drug's concentration in your blood. One example is the interaction of grapefruit with cholesterol lowering medications including Zocor, Mevacor and Lipitor. As alarming as this may sound, grapefruit is the only plant food so far found to have this strong of effect on medication metabolism. Other fruits and vegetables do not have a cause for concern.

A recent study by the same authors found that oestrogen levels in the blood were about 30-percent higher in post-menopausal women with natural loss of periods and who were consuming the equivalent of 1/4 grapefruit per day or more. The biological theory is if grapefruit can increase circulating levels of oestrogen in the body, then the regular intake of grapefruit would increase the risk for breast cancer in women.

This study looked at 46,080 post-menopausal women. Of these women, 1657 were diagnosed with breast cancer in the study time period. Whole grapefruit was consumed by 50 percent of the population and 7 percent consumed the equivalent of 1/4 grapefruit or more per day. Relative risk for the intake of 1/4 grapefruit or more per day was significantly associated with a 30-percent increase in breast cancer.

The researchers from this study suggest that it is biologically possible for grapefruit consumption to increase the risk of breast cancer. This study found a correlation of grapefruit intake and increased breast cancer risk, but more studies with greater comprehensive measures of grapefruit and grapefruit juice intake should be completed before final judgment is made.

Resource:
KR Monroe, SP Murphy, LN Kolonel and MC Pike. Prospective study of grapefruit intake and risk of breast cancer in post-menopausal women: the Multiethnic Cohort Study. British Journal of Cancer. 10 July 2007; 1-6.

Q: My tumor is extremely estrogen sensitive. I've been reading that there is quite a bit of estrogen in meat and dairy products, so I now avoid them. Soy is reputed to behave like estrogen, so I am avoiding soy, although there is some question about whether or not soy may actually be helpful.

There is even more conflicting evidence about other plant-based estrogens (phytoestrogens). There seems to be no way to know if phytoestrogens will help or hurt. I am particularly interested in your opinion about ground flaxseed. Is this something I should avoid, or is there no way to know, or is it something I should try to eat?

Valerie
Worcester, Mass.

A: A tremendous amount of controversy exists over the role of dietary plant-based or phytoestrogens in women with a history of estrogen-receptor positive breast cancer.

To first address your question on dairy and red meat: while there is no conclusive evidence that hormones in meat or dairy contribute to breast cancer risk, it makes sense to choose a low-fat version of these foods and to keep red meat intake to 4-6 ounces per week at most. Hormones are fat soluble so choosing a low-fat variety can help to reduce any potential exposure. Furthermore, weight gain and high body weight are correlated with risk for breast cancer recurrence, so choosing lower fat dairy and animal protein is helpful in this regard as well. You may also consider organic, low-fat dairy and meat.

In terms of soy-based foods and phyto- or plant-based estrogens, the data is unclear. Here at Dana-Farber, we recommend that women with a history of estrogen-positive breast cancer consume 2-3 servings of natural, whole soy foods per week to keep intake at a "moderate" level. You may choose to avoid soy altogether, however soy is a good source of protein, calcium, iron and other nutrients, so it need not be completely eradicated from the diet if you were already accustomed to eating soy. One does not need to begin eating soy, but can choose to do so in moderation without concern of harm.

Natural soy foods (i.e. tofu, edamame, soy nuts, soy milk) are the best choices because they have a lower concentration of phytoestrogen, as compared to concentrated soy foods containing ingredients such as Soy Protein Isolate (i.e. soy protein powder, most nutrition or protein bars, soy-based or vegetarian "meats"). Please avoid all soy-based dietary supplements such as those promoted to ease menopause symptoms.

Ground flax seed is a healthy source of Omega-3 fats and, when consumed at 1-2 tablespoons per day, does not pose any risk to breast cancer survivors.

Eating a plant-based diet, engaging in daily physical activity such as walking, limiting or avoiding alcohol, getting enough sleep and incorporating stress reducing behaviors into your life are the best way to promote health as a breast cancer survivor.

Q: How can I detoxify to clean out my system from chemotherapy?


A: There are many "detox" products sold on the internet. Some are dangerous and can increase a person's risk for infection, especially colonic, enema-based products.

A healthy way to help your liver naturally detoxify is to eat cruciferous vegetables. These include: broccoli, cauliflower, cabbage, Brussels sprouts, kale, watercress, and radish. The American Institute for Cancer Research recommends cancer survivors choose 5-7 servings per week from this category. A serving is one cup for leafy greens such as kale and a half-cup for the other vegetables listed. These foods can help your body produce enzymes, which aid in detoxification. These foods are safe to consume during and after cancer treatment.

Always speak with your physician and nutritionist before beginning a vitamin, herb or dietary supplement regimen.

Q: I was very surprised when I read the Fruit Salsa recipe for this month's Recipe of the month. One of the ingredients is known to have what is believed to be carcinogens in it...butter flavored cooking spray. Is the info I've read and been told incorrect?

P.V.S.
Hampton, N.H.

A: There has been no reliable scientific evidence suggesting that butter or olive oil spray used for cooking contains carcinogens. However, if you are concerned, I would highly suggest using an oil-spray pump. You can purchase this at any gourmet cooking store, and it works very similarly to a store-bought version (i.e. Pam), but also has key differences. The first difference is that you are able to fill the container with any oil of your choice. Secondly, you manually pump air into the cylinder which causes an increased internal pressure. Upon pushing the button, the pressure is released and oil is expelled onto the pan or food surface. There is no aerosol or artificial chemicals. This handy tool is a very healthy way of applying small amounts of fresh oil to foods.

Q: Can nutrition be used as a treatment for a blood disorder/cancer, instead of using chemo or oral medication such as Gleevec?

M.C.
Galesburg, Ill.

A: As a dietitian, I would love to say that nutrition is the primary treatment for blood disorder/cancer, but I cannot. Though there are many miracle stories out there that claim cancer was alleviated by "XYZ" diet, scientific evidence simply has not shown any nutrition regimen to be an effective treatment for curing cancer.

With that said, your daily food choices do play a significant, supporting role in aiding your immune system, maintaining muscle mass integrity, preventing cancer recurrence, and mitigating treatment side effects. Depending on how you react to chemotherapy (oral or infusion), I would recommend that during your treatment, focus on healthful, high-calorie foods, such as nuts, seeds, olive oil, avocado, and protein rich foods, in order to prevent your body from using its reserves for fuel which leads to muscle loss, fatigue and weakens the immune system.

Post-treatment, in general, is an excellent time to also focus on high-nutrient foods such as whole grains, fruits, vegetables, lean proteins, and healthy oils. I would also recommend you schedule an appointment with a registered dietitian who specializes in oncology, at every phase throughout your cancer journey, in order to optimize your daily nutrient intake and troubleshoot for problems.

Q: I have been trying to follow the Eat Right for Your Blood Type diet and have been reading PH Miracle regarding acidity/alkalinity. Do either of these hold any credibility in your view?

Sharon
Bangor, Maine

A: Your question brings up a very important issue for cancer survivors and the public at large: how do you sift through diets promoted in the media to figure out which have scientific merit and which are in fact distorted or misleading?

The old adage, "if it sounds too good to be true, it probably is," might be a good mindset to have when evaluating diets and supplements marketed towards cancer patients. There are over 10 million cancer survivors living in the U.S. In the current environment of an unregulated dietary supplement industry, companies can target sales messages that tap into the vulnerability of those affected by cancer and their loved ones. Buyer beware is a good strategy to keep in mind before beginning a supplement or diet regimen. We always encourage patients or their caregivers to speak with their nutritionist and/or physician to address any concerns about the merit or feasibility of following a "cancer-fighting" diet or supplement regimen.

Both of these diets you inquired about are examples of eating plans that boast exaggerated health claims. While there are certainly healthful foods included in these diets, there are also unnecessary recommendations to avoid certain foods and food groups. In fact, neither the Blood Type Diet nor the Alkaline Diet have scientific evidence to support the purported health benefits made by advocates of these plans. The Blood Type Diet and Acid/Alkaline Diet lack what we refer to as biologic plausibility. In other words, given the medical community's understanding of how the body works, these diets don't make sense. Without well designed, human research studies showing that these diets actually do what they say they can, qualified dietitians, nutritionists and other health care professionals can not recommend either of these diets to their patients.

For more information specifically on the Acid/Alkaline diet, please refer to an article published by one of our Dana-Farber nutritionists on the Intelihealth web site: Alkaline Diets and Cancer: Fact or Fiction?

Supplements

Q: Is L-Glutamine safe and potentially effective in alleviating peripheral neuropathy caused by Velcade? I am being treated for multiple myeloma and am heading towards a stem cell transplant.

JKD
Menlo Park, CA

A: Glutamine is an amino acid that is being studied for its role in helping to reduce the severity of peripheral neuropathy during chemotherapy. The symptoms of neuropathy include numbness, tingling, muscle weakness and mouth sores. Only certain patients receiving chemotherapy experience these symptoms.

Thus far, Glutamine has been shown to be safe and possibly effective in lessening the symptoms of neuropathy. At this point, research has only been done on taxol, paclitaxel and oxaliplatin chemotherapies. The results back Glutamine's role in alleviating neuropathy. It is possible that the amino acid could be beneficial during Velcade treatment as well. The usual dose is 15 grams of L-Glutamine powder, taken twice a day.

Glutamine is one of the building blocks of protein made by the body. It helps heal and maintain muscle cells, the immune system and the digestive tract. During certain times of stress that include surgery, trauma and chemotherapy, it becomes "conditionally essential": the body cannot produce enough of the amino acid to keep up with its needs.

Please check with your physician before beginning any new dietary supplement.

Q: Yesterday, I had a lumpectomy at BWH [Brigham and Women's Hospital] to treat DCIS. I will have 6 weeks of radiation, once my body heals. Then take tamoxifin for 5 years. Currently I take 10 mg of Lexapro, 1 multi-vitamin, and 2400 mg of omega 3 fish oil. Please advise if this okay now that I am being treated for breast cancer. I read certain minerals and vitamins are not recommended.

Also, how can I attend a nutrition seminar?

Brenda
South Dartmouth, MA

A: A standard multi-vitamin and fish oil are safe to take two weeks after surgery and during radiation as well as when you begin tamoxifen. Check to be sure your multi-vitamin contains approximately 100% of the daily recommended intake (DRI); many have increased the levels of anti-oxidants and other components, which would not be recommended during treatment. You may also want to add Calcium and Vitamin D supplementation. Speak with your doctor and consider scheduling an appointment to see a Dana-Farber Registered Dietitian by calling (617) 632-3006.

Please see our seminar section for information on upcoming seminars and cooking classes.

Q: Do you recommend any supplement for gum recession? I did not have an issue with this until getting chemo treatment. Is CoQ10 recommended? If so, in what dosage? Thank you.

VG
Worcester, MA

A: Preliminary evidence suggests that taking Coenzyme Q-10 (CoQ10) orally may be helpful for treating periodontal or gum disease, while topical use of this supplement has been found to be ineffective. The safest dose is 100-200 mg per day, divided into 2 or 3 doses.

Use Coenzyme Q-10 with caution because it might lower blood pressure. It can have additive effects with medications used for hypertension. Theoretically, Coenzyme Q-10 might interfere with blood pressure control during and after surgical procedures. Patients should discontinue Coenzyme Q-10 at least two weeks before elective surgical procedures. CoQ10 is also considered an antioxidant and should be avoided during radiation therapy and some chemotherapy.

Nutritional supplements such as phosphorus, magnesium, calcium, vitamin B complex and vitamin C are sometimes prescribed for prevention of decay and repair of gum tissue.

We encourage you to meet with a Registered Dietitian one-on-one to develop an eating plan for your condition and current intake and answer any questions you may have regarding recommended dosing of the above nutritional supplements.

Also, we recommend talking to your oncologist/dental care provider before trying any new treatments.

Q: Is it recommended to take a Biotin supplement, when in remission, for hair loss/brittle nails as a result of chemo? If so, what is the dosage? What are some other recommendations for hair/nail health?

VG
Worcester, MA

A: Orally, biotin is effective for treating biotin deficiency associated with long-term parenteral/intravenous nutrition, malnutrition, and rapid weight loss. There is some preliminary evidence that it may be helpful for hair loss, brittle nails, diabetes and peripheral neuropathy.

The adequate intake (AI) for biotin is 30 mcg per day for adults over 18 years.

Hair growth depends partly on vitamin intake in your diet. The most important vitamins necessary for hair growth are: vitamin A (produces healthy sebum in the scalp), vitamin C (antioxidant), vitamin E (improves scalp circulation), Biotin (produces Keratin), Inositol (keeps hair follicles healthy), Niacin (promotes scalp circulation) and pantothenic acid, vitamin B6 and vitamin B12 (prevent graying and hair loss). The most common food-based sources of these vitamins are: citrus fruits, green vegetables, fruits like pineapple, strawberries, kiwi, potatoes, green peppers, vegetable oils, soybean, raw seeds, dried beans, wheat germ oil, brewer's yeast, whole grains, eggs, rice, milk, fish, turkey, chicken and lean red meat.

To improve nail growth, your diet should be rich in foods with the above vitamins, but also include vitamin D, iron, calcium, and zinc. You can find all these vitamins/minerals in dairy products, lean chicken and turkey, red meat, kidney beans, and rice, as well as a multivitamin.

We encourage you to meet with a Registered Dietitian one on one if you interested in maintaining/gaining weight after your treatment or if you have any other questions related to supplement/vitamin intake.

Q: I was diagnosed with stage 1 >90% er+ pr+ breast cancer. I have been drinking a lot of green tea because I have heard of many health benefits and I enjoy it. I have now read that green tea may contradict tamoxifen. Is this true? Should I avoid green tea?

CBC
Wilmette, IL

A: The current research in mice indicates that green tea may actually improve the effects of tamoxifen for breast cancer treatment, not contradict it. The evidence shows that the combination of green tea and tamoxifen may be more potent than either drug alone in suppressing breast cancer growth, in animal models. Whether this benefit translates to humans is uncertain, as studies have not yet tested this hypothesis in humans. There are no significant drug interactions or contraindications with tamoxifen and green tea, when the tea is consumed in reasonable amounts (2-3 cups/day maximum), based on current evidence-based literature.

You should continue to drink green tea, but choose a decaffeinated one more often.

Q: Is drinking kombucha tea healthy for a breast cancer survivor taking Letrizole? Does it have any possible health benefits or is it hype?

Suzanne
Newburyport, MA

A: There is insufficient reliable scientific information about the effectiveness of kombucha tea.

It can be used for strengthening of the immune system and metabolism and to help hair re-growth. To avoid lead poisoning, it should not be prepared in a lead-glazed ceramic container.

There are some adverse reactions that might be associated with drinking kombucha tea. Orally, use of kombucha tea can cause stomach problems, yeast infections, allergic reactions, jaundice, nausea, vomiting, and head and neck pain.

It is also worth mentioning that fermented tea contains alcohol. So, it may be contraindicated with prescribed medications. Also, limiting alcohol intake is important for breast cancer survivors.

It is recommended that you contact your physician or oncologist before buying this kind of tea. It may pose some health risks associated in its interaction with Letrozole and other medications you may be taking.

Q: I am a cancer survivor and it was recommended by one of the Dana-Farber nutritionists to take a vitamin D supplement. At my annual physical with my family doctor, I requested a blood test to see what my vitamin D level is. I am 44 years old. What blood level of vitamin D is beneficial to cancer survivors? The test he ordered is for 25 hydroxyvitamin D. Is this the correct test?

Chris Mulcahy
Hartford, CT

A: Excellent question. Recent research suggests that having adequate vitamin D levels may both reduce the risk of developing cancer and provide benefits for cancer survivorship. Our skin can make vitamin D from the sun, but the amount produced is affected by a number of factors including skin color and sunscreen, as well as geographical like the amount of sunlight, cloud cover, and smog there are where you live. There are also limited dietary sources of vitamin D, including salmon, tuna, cod liver oil, and fortified dairy. For most people living in New England, especially during the sun-deprived winter, supplementation is usually recommended.

Yes, the test that your doctor ordered for 25(OH)vitamin D is the best indicator of vitamin D status. The level of 25(OH)vitamin D in the blood is a reflection of the vitamin D produced by your skin, as well as the amount consumed from food or supplements.

Our understanding of vitamin D is still evolving, but studies suggest that the optimal level of 25 (OH) vitamin D for cancer survivors is between 40-60 ng/mL. The general amount of supplementation currently recommended is a total of 1000 International Units per day. If your blood level is less than 30 ng/mL, it is recommended that you start at a total supplemental dose of 2000 IU per day. Check the amounts of vitamin D in other supplements you may already be taking, such as multivitamin or calcium, to see how much additional vitamin D you may need to reach the total daily recommended intake based on your blood level. Levels of 25(OH) vitamin D should be rechecked 8-12 weeks after beginning supplementation. If necessary, your dose should be adjusted accordingly to reach the serum level goal of approximately 50 ng/mL.

Speaking to your physician or a registered dietitian is recommended before starting any supplements. We would also advise you follow up with your Dana-Farber nutritionist to help guide you on the proper amount of supplementation and for an evaluation of your blood tests.

Q: As a nutrition student, I know that taking vitamin supplements should be part of our dietary lifestyle. However, I've heard so many times — even from doctors — that vitamins may lead to weight gain. Is that right?

Lia
Glendale, CA

A: No, there is no scientific evidence demonstrating that vitamin supplements promote weight gain. That being said, it is still better to get the vitamins and minerals that you need from whole foods rather than from supplements. Taking a daily multivitamin is a good safety net and is encouraged, but eating a balanced diet is the best method for ensuring your nutritional needs are being met.

Q: My friend is beginning treatment for metastases to her liver and bones. The primary cancer was breast three years ago. She is on Avastin and Gemstar and is HER+. She thinks she needs a multivitamin without folic acid. Is this true? Where can we find such a vitamin?

K.M.T
Ludington, Mich.

A: Xeloda, Avastin and Gemzar do not require a multivitamin without folic acid. Folic acid is a B vitamin needed in the body for the development of new healthy cells. Folic Acid, also known as folate, can be obtained through food (vegetables, fruits, whole grains, fortified cereals) or a dietary supplement. The daily recommendation for folic acid is 400 mcg.

In the majority of the population it is safe and beneficial to take a multivitamin. The multivitamin should have close to 100% of the RDA (recommended dietary allowance) of vitamins and minerals. For those over 50 and postmenopausal women, multivitamins without iron are advised.

Q: I do not eat any seafood whatsoever. What can I substitute for the fish? Is there a supplement I should take due to no fish in my diet?

Courtland
Orangevale, Calif.

A: Fish are of particular benefit for two main reasons. First, they are a great source of protein, and second, they provide Omega-3 fatty acids, a polyunsaturated fat, which is currently receiving attention for anti-inflammatory properties. If your diet does not include fish, I would recommend consuming alternative sources of protein (chicken, turkey, pork, cheese, eggs, tofu, tempeh, beans, nuts, quinoa, etc), and taking an Omega-3 fatty acid supplement.

Omega-3 supplements come in a variety of forms, ranging from vegan capsules to liquid fish oil. When reading the label on the supplement, make sure that the combined amount of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) equals a minimum of 500 mg (exp. 300 mg EPA and 200 mg DHA).

Look for supplements approved for purity and content, indicated on the bottle by a USP or NSF symbol. Many reputable products can be found at your local grocery store of health food store.

Q: Do you recommend any probiotic supplements or foods with probiotics when having diarrhea/constipation with chemotherapy?

Julie
Gardner, Mass.

A: Probiotics are "friendly bacteria" that help restore the balance between friendly bacteria and harmful bacteria in the gut. Recent research has shown probiotics to be effective in decreasing the severity of diarrhea often associated with chemotherapy/radiation. When choosing a source of probiotics, either as food source or as a supplement, it is important to select a strain of bacteria that has been tested and shown to have beneficial effects, such as Lactobacillus and bifidobacterium strains. Yogurts with live cultures are a good source of probiotics, as well as supplements such as Culturelle or New-Chapter All-Flora. These and other probiotic products can be found at your local pharmacy or grocery store.

Q: I am a Dana-Farber patient with ALL Leukemia. I am 38 and started treatment in early July 2007 and am currently in complete remission. I receive chemotherapy every 2 weeks (PEG Asparaginese) and every 3 weeks I receive vincristine, steroids, dexamethasone and some other typical chemos). My question is, is it safe for me to drink Kombucha? It seems to have really helped me with digestion. My stomach does not ache as much, no nausea or vomiting, etc., but I am wondering if it might interfere with the treatment. I am also asking my doctor, but wanted a nutritionist's opinion as well on Kombucha and its benefits or possible side effects.

Michael
Salem, Mass.

A: Kombucha is a medley of fungi, bacteria, tea, caffeine, and sugar. It is classified as a detoxification agent and an immune system strengthener. However, there is little scientific evidence supporting the efficacy of this product. With this limited research, it appears that Kombucha does not react with food and only reacts with the drug, Disulfiram. However, some potential, adverse effects are nausea, vomiting, liver damage, yeast infection, irritability, nervousness, metabolic acidosis, and hypersensitivity reactions.

The liver typically plays a key role in eliminating chemotherapy drugs from your system. There was one case of Kombucha affecting the functionality of an individual's liver. I would suggest that your physician periodically check your liver function tests. The Kombucha "mushroom" consists of yeast and bacteria, therefore, you may want to discontinue if you are currently experiencing any type of oral thrush and/or urinary tract infections. In addition, it may increase levels of uric acid in the blood, which may contribute to any existing issues with gout. Make sure your doctor is routinely checking your uric acid levels in the blood. Though you mentioned that it has improved some of your gastrointestinal symptoms, I would certainly pay close attention to your body for any new developments, particularly if you're diabetic (due to the sugar content).

The daily intake of Kombucha should not exceed 8 ounces. Kombucha tea should be stored in anything other than ceramic or lead crystal (due to its high acid content), at room temperature, away from heat, moisture, and direct light.

Q: Could you please tell me what herbs and other supplements should be avoided while taking Zometa?

GCR
Amesbury, Mass.

A: In our current unregulated dietary supplement market, it is very important to inquire about potential contraindications with medications, or drug-herb/vitamin interactions.

Each person should develop an individually tailored dietary supplement plan based on their current diet, medical treatment and history, working with a registered dietitian or licensed nutritionist with specialized training in this area.

Specific to Zometa, there are no known herb/supplement interactions with this medication, because it is given intravenously. However, the area of dietary supplements and medication interactions has not been well studied. You should always speak with your doctor before taking any dietary supplement while undergoing cancer treatment or taking any other prescribed or over-the-counter medications.

Q: I am going in for surgery for a lumpectomy. I currently take in a lot of Omega-3 fatty acids through my diet (i.e. salmon three times per week, 1 tablespoon ground flaxseed every morning, walnuts, leafy greens). I have heard that Omega-3 is a blood thinner and wondered if I should leave any of these out of my diet before surgery.

Wendy
Charlton, Mass.

A: You have identified an important consideration when preparing for surgery. The American Society of Anesthesiologists notes that certain herbal or supplement products can interfere with anesthesia. Some can contribute to blood thinning and risk of bleeding, while others may raise blood pressure.

The most important thing you can do is inform your physician of all medications, prescription and over-the-counter, as well as all vitamins, minerals, herbs and other dietary supplements you are currently taking.

It is recommended that patients stop taking blood thinning and other dietary supplements which can impact blood pressure two weeks prior to their surgery. These include but are not limited to: Vitamin E, Fish Oil/Omega-3, Garlic, American Ginseng, Gingko, Evening Primrose Oil, Ginger, Feverfew, Licorice, Valerian Root, Echinacea, and Goldenseal.

However, you do NOT need to curtail your consumption of Omega-3-rich foods as long as they are consumed in usual amounts. The amount you noted is excellent in terms of gaining adequate amounts of this important nutrient through your diet, and are not what we would consider excessive.

Herbal and Dietary Supplement Use and Anesthesia (PDF)

Q: My urologist said that my rising PSA indicates a recurrence of prostate cancer after a radical prostatectomy. My PSA number indicates a non-aggressive cancer because of its low doubling rate of 2 years. I am in my early 70s.

My questions are: Can someone like me overindulge in antioxidants and is my level of antioxidants helping me relative to my prostate cancer? Each day I eat at least 6 servings of fruit, 1 or 2 veggies, 2 tablespoons each of wheat germ and ground flaxseed, 2 cups green tea, at least 2 servings per day of whole grains, a Centrum Silver multivitamin and olive oil in a lot of our meals.

J. S.
Newton, Mass.

A: Eating a plant-based diet is an excellent tool to help promote cancer survivorship in men living with prostate cancer. There is also research to support maintaining or achieving a healthy weight if one is overweight or obese. Maintaining a healthy weight may help to delay the onset of a recurrence or reduce the aggressiveness of a tumor should cancer return.

In terms of antioxidants, you seem to be consuming the recommended amount of plant-based foods: 7-10 servings per day, many of which contain antioxidants. Consuming antioxidants from foods does not pose any health risk.

There is some data to support specific antioxidants in helping to slow progression of prostate cancer, such as: selenium and lycopene. Selenium can be found in foods such as Brazil nuts, sunflower seeds and salmon.

Lycopene is one of the carotenoids and is found in foods with a deep red or orange pigment, such as tomatoes and watermelon. In order for Lycopene to be adequately absorbed, the tomato should be cooked and consumed with some healthful fat, as it is a fat-soluble nutrient (i.e. tomato sauce with extra virgin olive oil).

Green Tea is another antioxidant currently being investigated.

Additional research shows the benefit of physical activity and integrative therapies for persons with prostate cancer, including Qi Gong and Reiki therapy. These services are available at Dana-Farber Cancer Institute through the Leonard P. Zakim Center for Integrative Therapies.

A nutritionist specializing in oncology could evaluate and recommend which, if any, supplements may be beneficial and which you should avoid, as well as help you revise or tailor a food plan based on the most up-to-date research. Please contact us to schedule an appointment or speak with your oncologist.

Q: I attended "Fighting Cancer With Your Fork." Patients taking blood thinners were advised against taking Omega-3 fish oil supplements. Does the same warning hold true for flaxseed oil, a source of vegetable-based Omega 3s?

JSH
North Truro, Mass.

A: Thanks for attending our lecture series, "Fighting Cancer with Your Fork."

High doses, over 3000 mg EPA/DHA, of fish oil can contribute to blood thinning, especially in patients who take daily, therapeutic doses of blood thinning medication such as Coumadin. Flaxseed oil has a moderate risk of contributing to blood thinning in higher doses in those who take blood thinning medications. Men should use caution with flaxseed oil as there is some controversy regarding this supplement and prostate cancer. Eating 1-2 tablespoons of ground flaxseed is a safe way to obtain this plant-based Omega-3 for men and women.

Patients should speak with their physician and nutritionist before beginning any dietary supplement regimen. Fish oil and other supplements with blood thinning potential should be stopped prior to surgery.

Please refer to our Nutrition Seminars section for more details about upcoming events.

Nutritionist vs. Dietitian

The terms "nutritionist" and "dietitian" are often used interchangeably. All dietitians can also refer to themselves as nutritionists, but not all nutritionists are dietitians. At Dana-Farber, all of our nutrition professionals are nationally credentialed as Registered Dietitians (RD) and also licensed through the state of Massachusetts (LDN). The RD credential signifies that the clinician has completed academic and accredited internship experience, successfully passed the national credentialing exam, and maintains ongoing continuing education/professional development in accordance with the national Commission on Dietetic Registration.

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