Nutrition plays a vital role in overall health, especially for individuals battling cancer. Understanding the importance of a well-structured diet and making informed food choices can significantly impact treatment outcomes and quality of life. People with cancer often need to follow diets that are different from what we think of as healthy.
Nutritional Needs During Cancer Treatment
When you have cancer, though, you may need extra protein and calories. To eat enough protein and calories, your diet may need to include more meat, fish, eggs, dairy, fats, and plant-based proteins than someone without cancer. A registered dietitian can help make sure you get the right amount of protein and calories during and after cancer treatment. During treatment, you may be tired and not feel well. Being tired can make it harder to grocery shop, cook, and eat. Keep easy-to-digest snacks on hand for when you feel sick.
Both cancer and cancer treatments may cause side effects that affect your taste, smell, appetite, and ability to eat enough food or absorb the nutrients from food. This can lead to malnutrition. People with certain cancers are more likely to have problems eating. These cancers include those that affect your digestive system directly, such as cancers of the head and neck, esophagus, stomach, pancreas, liver, or colon. When malnutrition is not managed in people having cancer treatment, it can lead to cancer cachexia. Cancer cachexia is a wasting syndrome that can cause weakness, weight loss, and fat and muscle loss.
Cancer Treatment and Its Impact on Nutrition
Cancer treatments like chemotherapy, hormone therapy, immunotherapy, and radiation therapy can significantly impact a patient's nutritional status.
Chemotherapy
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. But these drugs may also kill healthy cells that grow and divide quickly, such as cells in the mouth and digestive tract. If you are on chemotherapy, you may have a high risk of infection, including from food (foodborne illness). That is because chemotherapy can reduce the number of your white blood cells, which fight infection.
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Hormone Therapy
Hormone therapy may be used to slow or stop cancers that rely on hormones to grow, like breast, ovarian, and prostate cancer. Hormone therapy adds, blocks, or removes these hormones.
Immunotherapy
Immunotherapy uses your immune system to fight cancer. Immunotherapy may cause fatigue, which can lead to a poor appetite.
Radiation Therapy
Radiation therapy to any part of your digestive system has side effects that cause eating problems. Most of the side effects begin 2 to 3 weeks after radiation therapy begins and go away a few weeks after it is finished. But some side effects can last for months or years after treatment ends. Fatigue, which can lead to a poor appetite, is a common side effect of radiation therapy.
People who have a stem cell transplant have special nutrition needs. If you have a stem cell transplant, you have a high risk of infection, including from food (foodborne illness). That is because treatment given before your transplant reduces the number of your white blood cells, which fight infection. After a stem cell transplant, you are also at risk of acute or chronic graft-versus-host disease (GVHD).
Surgery is a common part of cancer treatment. Surgery that removes all or part of certain organs can affect your ability to eat and digest food. After any surgery, your body needs extra energy and nutrients to heal wounds, fight infection, and recover.
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Targeted therapy is a type of cancer treatment that targets proteins that control how cancer cells grow, divide, and spread. Other problems might include taste changes and a dry or sore mouth.
Some cancer treatments make it easier for you to get sick from contaminated food. Some cancer treatments can weaken your immune system. This makes it harder for you to fight infections, including foodborne illnesses. So, you need to take special care in the way you handle and prepare food during your cancer treatment. Keep foods at safe temperatures, scrub raw vegetables and fruits, and be careful to use separate utensils, plates, and cutting boards when preparing meats and produce.
If you are at risk of poor nutrition or malnutrition, your doctor will refer you to a registered dietitian. Based on this information, the registered dietitian will create a nutrition care plan. Drink most of your fluids between meals, not during meals. If you continue to struggle to eat and keep up your weight, you and your treatment team can discuss other nutrition support options. You may also take medicines that increase appetite.
Managing Common Side Effects Through Diet
Cancer treatments often come with unpleasant side effects that can make eating challenging. Modifying your diet can help manage these symptoms.
Nausea and Vomiting
Nausea is when you feel sick to your stomach, as if you have the urge to throw up. Vomiting is when you throw up. Nausea and vomiting are common side effects of cancer treatments, including chemotherapy and radiation therapy. When you vomit, you may become dehydrated and lose a lot of electrolytes. Electrolytes are minerals, such as potassium, sodium, and calcium that help balance body fluids and support your heart, nerve, and muscle functions.
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Dry Mouth
Dry mouth occurs when you have less saliva than you used to. Having less saliva can make it harder to talk, chew, and swallow food. Chemotherapy and radiation therapy to the head or neck can damage the glands that make saliva.
Mouth Sores
Cancer treatments can harm fast-growing cells in your mouth. Radiation therapy to the head or neck, chemotherapy, and immunotherapy can cause mouth sores (little cuts or ulcers in your mouth) and tender gums. Dental problems or mouth infections, such as thrush, can also make your mouth sore. Eat foods cold or at room temperature. Rinse your mouth three to four times a day. Talk to your doctor about medicine to numb your mouth.
Sore Throat (Esophagitis)
Chemotherapy and radiation therapy to the head and neck can make the lining of your throat inflamed and sore, a problem called esophagitis. It may feel as if you have a lump in your throat or that your chest or throat is burning. You may also have trouble swallowing. Some types of chemotherapy and radiation to the head and neck can harm fast-growing cells, such as those in the lining of your throat. Sit upright and bend your head slightly forward when you eat or drink.
Taste and Smell Changes
Cancer and its treatment can cause changes in taste or smell that can make it hard to eat. Cancer treatment, dental problems, or the cancer itself can cause changes in your sense of taste or smell. Food may have less taste or certain foods (like meat) may be bitter or taste like metal. Although there is no way to prevent these problems, there are things you can do to manage them. Try low-sodium or sodium-free seasoning products, like Mrs. Add water and ice to dilute sweet juices. Use marinades on meats to add flavor. Do not buy prepackaged food in metal containers, such as canned beans.
Nutrition Support Options
Sometimes, despite your best efforts, you may not be able to eat enough to stay strong. If this happens, nutrition support through a feeding tube may be a good option. Nutrition support helps if you cannot eat or digest enough food to stay nourished.
Enteral Nutrition
Enteral nutrition gives you nutrients in liquid form through a tube that is placed into the stomach or small intestine. A nasogastric tube is inserted through the nose and down the throat into the stomach or small intestine. A gastrostomy tube is inserted into the stomach, or a jejunostomy tube is inserted into the small intestine through an opening made on the outside of the abdomen. The type of formula used is based on your specific nutritional needs. Some people can still eat by mouth when using enteral nutrition.
Parenteral Nutrition
Parenteral nutrition is used when you cannot take food by mouth or use a feeding tube. Parenteral feeding does not use the stomach or intestines to digest food. Nutrients are given to you directly into the blood through a catheter inserted into a vein. As with enteral feeding, some people can eat by mouth when using parenteral nutrition. A central venous catheter is placed beneath your skin and into a large vein in the upper chest. The catheter is put in place by a surgeon. A peripheral venous catheter is a thin, flexible tube that is inserted into a vein. A peripheral venous catheter is placed into your vein in the arm. A peripheral venous catheter is put in place by trained medical staff.
Nutrition at the End of Life
If you are nearing the end of life, the goal is to provide the best possible quality of life and control symptoms that cause discomfort. People at the end of life often do not feel much hunger at all and may want very little food. Sips of water, ice chips, and mouth care can help with thirst. Food and fluids should not be forced on someone who is at the end of life. You and your loved ones have the right to make informed decisions. Your religious and cultural preferences may affect your decisions.
General Dietary Recommendations for Cancer Prevention
The healthiest eating is mostly based on plant foods like vegetables, fruits, whole grains, beans, and nuts/seeds. They also include healthy protein sources, such as beans, fish, or poultry, while limiting red and processed meats. Studies have shown that these dietary patterns are linked to a lower risk of cancer, certain other diseases, and early death.
Vegetables and Fruits
Vegetables (including beans) and fruits are full of vitamins, minerals, fiber, and other substances that may help prevent cancer. Eating vegetables and fruits may also control weight, since they are low in calories, high in fiber, and have lots of water.
Whole Grains
Whole grains keep all parts of the original grain, so they have more fiber and nutrients than refined (or processed) grains. These include things such as whole wheat, brown or wild rice, oats, and corn. Studies show that eating whole grains might lower the risk of colorectal cancer. Dietary fiber is found in plant foods such as beans, whole grains, fruits, vegetables, nuts, and seeds. Eating these foods may help prevent excess body weight, which can lower the risk of cancer. Studies of fiber supplements like psyllium fiber and wheat bran fiber havenât been shown to reduce colon polyps.
Red and Processed Meats
Processed meat has been cured, smoked, salted, or fermented to improve or preserve ï¬avor. Examples include bacon, sausage, hot dogs, and deli meats. Evidence that red and processed meats increase cancer risk has existed for decades, and many health organizations recommend limiting or avoiding these foods. In 2015, the International Agency for Research on Cancer (IARC) classified processed meat as âcarcinogenic [cancer-causing] to humansâ (Group 1) and red meat as âprobably carcinogenic to humansâ (Group 2A), based on evidence that they increase the risk for colorectal cancer. It isnât known if there is a safe level of red or processed meat to eat. Because of this, the ACS recommends eating more protein from fish, poultry, and beans instead of red meat.
Added Sugars and Ultra-Processed Foods
Added sugars and other high-calorie sweeteners (such as high-fructose corn syrup) are often used in sugar-sweetened beverages and energy-dense foods (for example, traditional âfast foodâ or ultra-processed foods (or UPFs). The health impact of UPFs (also called highly processed foods) is an area of increasing concern. Some processing, like peeling, cutting, or freezing vegetables and fruit, can make food safer, easier to use, and tastier. These highly processed foods are usually high in fat, sugar, refined grains, and salt. Studies have linked them to health problems, including weight gain. More research is needed to understand the impact on cancer risk.
Calcium, Dairy, and Vitamin D
Some research has linked diets high in calcium and dairy products to a lower risk of colorectal cancer, and possibly breast cancer as well. But some studies have also suggested that calcium and dairy products might increase prostate cancer risk. Vitamin D, made by the body when the skin is exposed to ultraviolet (UV) rays, helps keep bones and the immune system healthy. You can also get it from foods like fatty fish, some mushrooms, fortified foods (milk, orange juices, cereals) or from supplements. Some studies suggest vitamin D might lower cancer risk, particularly colorectal cancer. Most Americans donât get enough vitamin D in their diets, and many have low blood levels. While research continues on vitamin D and cancer risk, avoiding low vitamin D levels is recommended.
Dietary Supplements
Dietary supplements include vitamins, minerals, amino acids, herbs/botanicals, and other ingredients. While dietary supplements can provide some benefit, they also have risks. Dietary supplements are not regulated the same way as medicines are. Eating a diet rich in vegetables, fruits, and other plant foods may lower cancer risk, but thereâs little consistent evidence that dietary supplements do the same. Some high-dose supplements containing nutrients such as beta-carotene and vitamins A and E may actually increase the risk of some cancers. Vegetables and fruits contain many different compounds that probably work together to have healthful effects. Some supplements claim to provide the same nutrition as vegetables and fruits, but they usually contain only a small fraction of what whole foods provide. Food is the best source of vitamins, minerals, and other important food components.
Top 10 Cancer-Fighting Foods
Foods that fight cancer include fruits, vegetables, legumes, whole grains, fish and fermented foods. Found abundantly in the Mediterranean diet, these foods contain several protective compounds that work together to lower cancer risk. Some help regulate hormones, such as estrogen. Others slow cancer cell growth or block inflammation. Many lower the risk of damage to healthy cells caused by antioxidants, but most people remain unaware of these benefits. This lack of awareness has resulted in a very SAD diet for most Americans. The standard American diet (SAD), a term used to describe the nutrient content of the food Americans typically eat, has long been believed to contribute to the health challenges experienced in the United States, including cancer. According to the American Institute for Cancer Research, only 8% of the standard American diet consists of protective foods. Although no single food can stop cancer, consistently including a variety of cancer-fighting foods as part of a healthy diet is key to reducing risk. Choose these foods in their whole form, as whole foods contain more nutrients than processed. Our list of top 10 cancer-fighting foods includes foods that comprise the popular Mediterranean diet, long known to improve health outcomes as a whole food, plant-forward healthy eating pattern. Because the Mediterranean diet is flexible, you can tailor it to your needs and get various nutrients that work together to help your body.
- Berries: Berries are among the healthiest foods you can eat. Their vitamins, fiber and antioxidants, such as anthocyanins, ellagic acid and resveratrol, can ward off cancer in our digestive tract. The magic likely resides in their blue, purple and red pigments. Delicious alone or as a snack or dessert.
- Cruciferous Vegetables: These foods include broccoli, cauliflower, bok choy, cabbage and Brussels sprouts. The name comes from the Latin âcruciferae,â meaning "cross-bearing" because the four petals on the leaves resemble a cross. While diverse in color and shape, they share several nutritional benefits and are the only foods containing the cancer-fighting compound indole-3-carbinol. Frequently eating these foods is associated with a lower risk of many cancers.
- Fish: Fish contains high levels of nutrients and protein, particularly oily fish, such as salmon, tuna and anchovies. One of the highest food sources of omega-3 fatty acids, fish combats inflammation and protects against breast and colorectal cancer. Need help with how to cook it? Marinate or season to add flavor and bake, broil, steam or sear on the stovetop. Eat hot or add avocado and greens for a cold salad.
- Nuts: According to the American Institute for Cancer Research, all nuts, especially walnuts, have cancer-fighting properties. A great source of fiber and healthy fats, nuts can be eaten as a snack, sprinkled on cereal or added to a salad.
- Legumes: The American Cancer Society recommends legumes and beans as one of the most important food groups for prevention. Rich in vitamins, minerals, protein and fiber, they are among the most inexpensive cancer-fighting foods. Plant chemicals known as flavonoids in the outer bean layer are strong antioxidants. Cheap, healthy, versatile and delicious, legumes are a food staple worldwide, available dry and canned.
- Dark chocolate: Eating dark chocolate with high cocoa content can deliver fiber, antioxidants and minerals that may lower the risk of certain cancers. Chocolate comes from the cacao tree's plant seed, the cocoa bean, and is a good source of polyphenols and flavanols, which are rocket fuel for healthy gut bacteria. Of course, dark chocolate is still candy and is best consumed in moderation. Have a square or two after dinner and try to savor the complexity of flavors it provides.
- Whole grains: Whole grains such as rolled oats, brown rice and 100% whole wheat bread contain protective antioxidants as Vitamin E, lignans, phytic acid and fiber. Eating whole grains reduces the risk of at least 18 types of cancer, and each 10-gram increase in dietary fiber from this food group is linked with a 7% reduction in colorectal cancer risk.
- Leafy greens: Carotenoids found in leafy vegetables such as spinach and kale act as antioxidants to boost the bodyâs own defenses to fight breast, bladder and lung cancer. Most Americans shy away from dark, leafy greens because they are bitter. To balance the bitterness, massage your greens to break up the fibers. Wonderful for salads, kale won't wilt for days, making it great for packing ahead.
- Fermented foods: Cultured or fermented foods provide probiotics, healthy bacteria that improve immune function and protect against cancer. These good bacteria can bind and destroy potential carcinogens, which may be especially effective in preventing colorectal cancer. Don't like yogurt? Try something new, such as kefir, kombucha, kimchi or tempeh.
- Garlic: Classified as a vegetable, cultures have long used garlic both for cooking and medicine. A root vegetable, garlic contains allicin, a protective sulfur compound that inhibits cancer progression. Eating garlic frequently lowers the risk of colorectal cancer but is also being studied for its role in reducing other cancers. When cooking with garlic, wait 15 minutes after you crush or chop garlic before heating to release the active ingredients.
Sample Meal Plan
Ready to add more cancer-fighting foods to your diet? Food is a personal choice, but the first step to making healthier choices consistently over time is keeping the menu simple. You don't need a long list of ingredients to make a healthy, delicious meal full of cancer-fighting nutrients. Planning can go a long way to make a plant-forward meal easy to prepare, affordable and unapologetically delicious.
- Breakfast: Homemade yogurt parfait with strawberries, nuts and low-fat plain yogurt
- Lunch: Kale, tomato, avocado and chickpea salad with vinaigrette
- Dinner: Halibut over brown rice with roasted vegetables and garlic.
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