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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: 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 4 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.

You may also want to check out the Gonzalez regimen which is an alternative approach to pancreatic cancer treatment that has been studied at the U.S. National Cancer Institute. It is not a proven therapy, nor is it approved by the U.S. Food and Drug Administration; however, it may be of interest to you.

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. 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: 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. 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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