A healthy diet offers numerous advantages for individuals who have completed cancer treatment, aiding in regaining strength and energy, improving overall well-being, and reducing the risk of other health problems. The American Cancer Society has a Nutrition and Physical Activity Guideline for Cancer Survivors. This article provides a comprehensive guide to dietary recommendations for cancer survivors, emphasizing the importance of a balanced, plant-based approach.
The Importance of a Healthy Diet After Cancer Treatment
Once cancer treatment is complete, it's natural to consider how to best support your health. A healthy diet after treatment can assist in regaining strength and energy, improving overall well-being, and potentially lowering the risk of cancer recurrence or developing a second cancer. It is important to maintain a healthy weight and increase muscle mass through a combination of a healthy diet and physical activity. However, before making significant dietary changes, it is essential to consult with your cancer care team, as some individuals may experience difficulties such as trouble swallowing or dry mouth.
"Cancer is a teachable moment and an opportunity to work with cancer patients when it comes to nutrition," says Dawn Mussallem, D.O., a Mayo Clinic general internal medicine physician and cancer survivorship specialist. "I find that living a healthy lifestyle focused on nutrition and physical activity during and after a cancer diagnosis can be empowering and give patients control over their disease. It can also improve cancer outcomes, reduce the risk of secondary cancers, and improve quality of life during and after cancer."
Key Components of a Cancer Survivor Diet
The healthiest dietary approach emphasizes plant-based foods such as vegetables, fruits, whole grains, beans, and nuts/seeds. It also includes healthy protein sources like beans, fish, or poultry, while limiting red and processed meats. Studies have consistently linked these dietary patterns to a reduced risk of cancer, other diseases, and early death.
Fruits and Vegetables: A Colorful Cornucopia of Health
Fruits and vegetables are vital sources of fiber, essential vitamins, minerals, and phytonutrients. Phytonutrients are responsible for the vibrant colors in fruits and vegetables. For example, tomatoes get their vibrant red hue from the potent phytonutrient lycopene. And the deep purple stains left on your fingers after eating blueberries are from a group of phytonutrients called anthocyanins.
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Eating vegetables and fruits may also control weight, since they are low in calories, high in fiber, and have lots of water.
Whole Grains: The Foundation of Sustained Energy
Grains are an important part of a healthy diet. Whole grains contain three parts: the bran, germ and endosperm, which are rich in nutrients. When grains are refined to make products such as white bread, white pasta and white rice, some of these parts are removed - along with their nutrients.
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.
Protein: The Building Block of Healthy Cells
Protein is an essential nutrient that acts as a building block of healthy cells. Eating plant-based proteins is a great way to up your protein intake without the unhealthy saturated fats found in red meats. As a bonus, many plant proteins have essential vitamins, minerals and fiber. Lean meats are another great source of protein.
Dairy: A Source of Protein, Calcium, and Vitamin D
Dairy is rich in protein, calcium and vitamin D. Fermented dairy (such as yogurt or kefir) also provides gut-friendly probiotics. In moderation, low-fat or nonfat dairy can be part of a healthy diet for survivors of cancer survivors.
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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.
Berries: A Daily Dose of Antioxidants
"I give this as homework to all my patients: Have a half-cup to one cup of berries, not just twice a week, but every day. They're rich in fiber, antioxidants such as vitamin C, and phytochemicals, and they're enjoyable," says Dr. Mussallem. "The Nurse's Health Study findings showed that breast cancer survivors who had two servings of berries per week demonstrated a 25% improved breast cancer-specific survival," adds Dr. Mussallem.
When fresh berries are not easy to find or they are not cost-effective, Dr. Mussallem suggests buying frozen ones.
Foods to Limit or Avoid
While some foods (like vegetables) can help prevent disease, others have been associated with greater risk of heart disease, diabetes or cancer.
Processed Meats: A Known Carcinogen
Processed meats are those that have been preserved, most commonly through salting, curing, fermenting or smoking. Processed meats are carcinogens, meaning that they can cause cancer. Specifically, processed meats increase your risk of developing both colorectal cancer and stomach cancer. The link between processed meats and cancer is strong. The World Health Organization is just as confident about the link between processed meats and cancer as it is about the link between cigarettes and cancer. That’s not to say that a single slice of bacon will give you cancer, but you should not eat these foods routinely.
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"Processed meats are a Group 1 carcinogen. They are in the same class as cigarettes. When it comes to carcinogens, I don't think it is appropriate for me to counsel my patients toward moderation," says Dr. Mussallem.
Red Meat: Limit Consumption
"Evidence suggests that red meat is a probable carcinogen, so it is best to limit red meat as much as possible. Red meat includes beef, pork and lamb.
In 2015, the International Agency for Research on Cancer (IARC) classified processed meat as “carcinogenic [cancer-causing] to humans” (Group 1) and red meat as “probably carcinogenic to humans” (Group 2A), based on evidence that they increase the risk for colorectal cancer.
Because of this, the ACS recommends eating more protein from fish, poultry, and beans instead of red meat.
Fast Food and Ultraprocessed Foods: Empty Calories and Unhealthy Fats
Fast food and ultraprocessed foods are tempting - for both their convenience and taste. A processed food is any food that has been changed from its natural form. Some foods, such as sliced carrots, are minimally processed, while others, like potato chips, are highly processed. Many ultraprocessed foods lack fiber and vitamins and are high in unhealthy saturated fats, starches and sugars. When possible, try to stick with foods that are less processed.
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 “fast food” or ultra-processed foods (or UPFs). 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.
Sugar-Sweetened Beverages: Avoid Empty Calories
Most - if not all - of these drinks offer no nutritional benefit, meaning they provide nothing but extra calories and sugar. Cut back on drinks sweetened with sugar.
The trouble with fruit juice and other highly processed drinks is that they are low in nutritional value and high in concentrated, sugary calories. "When it comes to juices, you're stripping away some of the most vital benefits of fruit, and that's the fiber. Eat the whole fruit. Don't waste your money on the juice," says Dr. Mussallem. The same can be said for soda and other sugary sports drinks, which can contribute to obesity and excess weight.
Alcohol: Minimize or Eliminate
Does alcohol provide any benefit? In the past, red wine was thought to be good for the heart, but we now know the evidence for that is quite weak.
"Alcohol is also a carcinogen. The best recommendation we can give to patients for cancer prevention, or following a cancer diagnosis, is to just avoid it. There isn't a health benefit when it comes to alcohol consumption," says Dr. Mussallem. "The more you drink, the more risk there is. Patients will ask, 'How much is reasonable if I'm going to have a little bit of alcohol socially?' What is important is that we talk to our patients about standard drink sizes," she says. "Patients are shocked when I share that 5 ounces of wine equals one drink, and 12 ounces of a regular beer or 1.5 ounces of an 80-proof liquor would be equivalent to one standard drink.
Saturated Fats: Consume in Moderation
Saturated fats are fats that are solid at room temperature. They are found in butter; lard; fat-containing milk, yogurt and cheese; and meats, and they should be consumed in moderation. "The Women's Health Initiative study, after a 19.6-year follow-up, showed that a low-fat diet helped to reduce breast cancer mortality," says Dr. Mussallem. "When saturated fat is reduced in men with prostate cancer, there's a reduced risk of recurrence. The Physicians Health Study investigated dietary patterns after a prostate cancer diagnosis.
Dietary Supplements: Proceed with Caution
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 there’s 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.
"A recent survey reported that over 70% of cancer survivors take dietary supplements. But dietary supplements aren't recommended for cancer prevention or in the cancer survivorship setting," says Dr. Mussallem. "There are a lot of false claims out there. Cancer patients are a good target for this $32-billion industry. There are multiple studies that show that some supplements can actually cause harm," says Dr. Mussallem.
Food is the best source of vitamins, minerals, and other important food components. 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.
Practical Tips for Implementing Dietary Changes
Eating a healthy diet can be hard. You may be nauseated or not feel hungry. You may notice changes in the way some foods taste, especially if you're taking certain medicines. For many people with cancer, their caregivers, and their loved ones, balancing the need to eat differently with the demands of the rest of the household may feel overwhelming. People may be busy or on different schedules. Not everyone may agree with a new, healthier approach to eating.
Remember that cancer survivorship is a marathon - not a sprint. Start small and stay consistent before overhauling your entire diet. Make one or two improvements (for instance, more servings of vegetables, fewer alcoholic drinks) and commit to those for several weeks before moving on to your next goal. Quite simply, the food you eat affects how you feel.
Here are some steps you can take to overcome challenges:
- Keep track of what you eat.
- Try to eat meals at the same time every day.
- Try healthier versions of your favorite recipes.
- When you're able to eat more foods, try to fill half your plate with fruit and vegetables.
- If you can afford it, go out to eat or order pickup or delivery service from a local restaurant.
- Look for meal delivery programs in your area.
- Order your groceries online.
- Ask for help. Can someone in your household take over or help with cooking? Is a friend or neighbor willing to pick things up when they go out?
- Start a vegetable garden. It's a great way to get outside, get some physical activity, and involve the whole family.
- Consider replacing a meat-based meal with a vegetarian one a few days a week.
Seeking Professional Guidance
When you visit your doctor, ask for healthy eating advice. First, think about your goals. Do you want to feel more energetic? Are any side effects bothering you? Write down questions as you think of them. Your oncologist or primary care doctor may be able to refer you to a nutritionist or dietician. You can also check with the social services division of area hospitals and health departments.
If you have trouble figuring out how to eat healthier, ask to meet with a registered dietitian (RD).
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