Diet and nutrition - Aoife Gorham

NUTRITION & NUTRITION & BREAST CANCERBREAST CANCER

AOIFE GORHAMAOIFE GORHAMSENIOR DIETITIANSENIOR DIETITIAN

2929thth Sept 2012 Sept 2012

Nutrition Is Good MedicineNutrition Is Good Medicine

While a healthy diet can help prevent While a healthy diet can help prevent cancer, if you are loosing weight because cancer, if you are loosing weight because of your cancer or treatment, the diet you of your cancer or treatment, the diet you should be following may be very different should be following may be very different to usual healthy eating advice.to usual healthy eating advice.

Speak with your dietitian/doctor if your Speak with your dietitian/doctor if your loosing weight.loosing weight.

Causes of Poor Nutrition Pre & Causes of Poor Nutrition Pre & Post Treatment.Post Treatment.

- Sore or dry mouth- Sore or dry mouth

- Disturbances of taste & smell- Disturbances of taste & smell

- Changes in odour perception- Changes in odour perception

- Mood- Mood

Sore Mouth or ThroatSore Mouth or Throat Side effect of treatment.Side effect of treatment.

Usually starts to improve some time after your Usually starts to improve some time after your treatment finishes.treatment finishes.

It may be difficult to eat your usual foods.It may be difficult to eat your usual foods.

Discuss with your doctor / nurse about mouth Discuss with your doctor / nurse about mouth care and pre-meal pain control.care and pre-meal pain control.

Eat little & oftenEat little & often

Choose soft moist foods.Choose soft moist foods.

Sore Mouth or ThroatSore Mouth or Throat Chop, mince, mash or liquidise your foodsChop, mince, mash or liquidise your foods

Drink plenty of nourishing drinks.Drink plenty of nourishing drinks.

Take care with the following foods and drinks- as Take care with the following foods and drinks- as the may worsen a sore mouth or throat.the may worsen a sore mouth or throat.

- Very hot food and drinks, allow to cool a little Very hot food and drinks, allow to cool a little before you eat/drink them.before you eat/drink them.

- Salty or spicy foods e.g. packet or tinned soup, Salty or spicy foods e.g. packet or tinned soup, curry, chilli and vinegar curry, chilli and vinegar

Sore Mouth or ThroatSore Mouth or Throat

Rough or dry foods e.g. toast, crisps, raw Rough or dry foods e.g. toast, crisps, raw vegetables or biscuitsvegetables or biscuits

Acidic fruit drinks such as orange, Acidic fruit drinks such as orange, pineapple or tomato juice.pineapple or tomato juice.

Alcohol, especially spirits e.g. whiskey, Alcohol, especially spirits e.g. whiskey, brandy, vodka.brandy, vodka.

Dry MouthDry Mouth Your medication or treatment may reduce Your medication or treatment may reduce

the flow of saliva.the flow of saliva. Can cause taste disturbances.Can cause taste disturbances.

Saliva is needed to keep your mouth moist Saliva is needed to keep your mouth moist and protect against tooth decay.and protect against tooth decay.

You may be recommended an artificial You may be recommended an artificial saliva spray /gel if you suffer with a dry saliva spray /gel if you suffer with a dry mouth.mouth.

Dry MouthDry Mouth Helpful Hints:Helpful Hints:

1)1) Drink oftenDrink often

2)2) Fizzy drinks may make your mouth feel Fizzy drinks may make your mouth feel fresher.fresher.

3)3) Try sucking on ice cubes or ice popsTry sucking on ice cubes or ice pops

4)4) Sugar free gum, boiled sweets or Sugar free gum, boiled sweets or pastilles may help saliva flow.pastilles may help saliva flow.

Dry MouthDry Mouth

5) Eat soft, moist foods.5) Eat soft, moist foods.

6) Avoid chocolate, pastry and freshly baked 6) Avoid chocolate, pastry and freshly baked bread .bread .

7) Use lip balm on dry lips7) Use lip balm on dry lips

Taste ChangesTaste Changes

4 basic tastes: sweetness, bitterness, 4 basic tastes: sweetness, bitterness, saltiness, and umani (the savouriness of saltiness, and umani (the savouriness of protein).protein).

Taste changes depend on tumour site.Taste changes depend on tumour site. Head and neck cancer patients report Head and neck cancer patients report

more complaints of taste acuity.more complaints of taste acuity. 88.8% for one taste; 66.7% for more than 88.8% for one taste; 66.7% for more than

one taste compared with breast 21% or one taste compared with breast 21% or lung cancer 23-25%.lung cancer 23-25%.

Taste ChangesTaste Changes Taste sensitivity decreases in most cases Taste sensitivity decreases in most cases

after chemo/ RT due to destructive effects after chemo/ RT due to destructive effects on sensory organs & tissues associated on sensory organs & tissues associated with taste and smell.with taste and smell.

Common taste changes are metallic or Common taste changes are metallic or bitter taste or after taste.bitter taste or after taste.

If food tastes metallic: Eat your food cold or at room temperature.

Chicken and fish tend to taste less metallic than red meat.

Marinate (soak) meat or chicken and fish in red wine, soya sauce, sweet fruit juices or lemon juice to help mask the metallic taste

Use plastic cutlery.

If food tastes too sweet

Add a pinch of salt to reduce the sweet taste.

Add salt to custard and milk puddings.

Eat savoury snacks instead of sweet ones. Try crisps, crackers, cheese or nuts.

If foods taste too salty

Don’t eat salty foods. Add a pinch of sugar to your food to

reduce the salty taste. You can add sugar to soups, sauces, stews or gravy.

Snack on sweet foods instead of savoury ones, such as cakes, chocolate, sweets or biscuits.

If foods taste bland or you have no taste

Add flavour to your food with sauces such as mustard, ketchup, mint, soy sauce, barbecue sauce or curry sauce.

Use seasonings and herbs to flavour your food, such as salt or pepper, fresh herbs or spices, garlic or lemon.

Use more seasoning than you would normally. Try sour foods such as lemon juice, fruit or fruit

juices, sour boiled sweets, sour cream or sweet and sour sauce, to stimulate your taste buds.

General tips

Eat foods that taste good to you.

Experiment with different flavours.

Take good care of your mouth – brush your teeth and tongue with a soft toothbrush and use mouthwash.

General TipsGeneral Tips Don’t stick to a small number of foods, try new

ones. Food you didn’t like before may taste better now.

Re-try foods every 2-3 weeks as the taste may have returned to normal.

Tea and coffee may taste very different so try other drinks such as fruit teas, cocoa, Ovaltine, Horlicks or Complan.

Suck on pineapple chunks before meals.

Nausea & Vomiting Can be a side effect to treatment or due to

the cancer itself.

Speak with your doctor about an anti-sickness tablet.

Eat little and often (6-8 small meals per day) rather than 3 main meals per day.

Avoid fried, spicy or very sugary foods as may make nausea worse.

Nausea & Vomiting Choose foods that don’t have a strong

smell.

Fresh air.

Don’t lie down for up to an hour after eating but if you need to rest, ensure head is elevated about 2 x pillows high.

Constipation can make nausea worse.

Nausea & Vomiting Avoid dehydration, aim 8-10 glasses of

fluid daily.

Drink a glass of fluid each time you vomit.

Rinse you mouth before eating.

Fizzy drink may help relieve nausea e.g. lemonade, ginger ale or soda water sipped slowly through a straw.

Diarrhoea Can be caused by your treatment or

medication or an infection. Drink plenty of fluids Eat little and often e.g. snack on cereal

Rice Krispies or cornflakes, toast, rice pudding, custards, yoghurts, cheese and crackers.

Avoid fizzy drinks, chewing gum, beans, peas, cabbage.

Diarrhoea

Avoid foods that contain sorbitol (artificial sweetener

Probitotics – eat 1-2 Bio or live yoghurts drinks as part of your diet unless your white blood count is low. Ask you doctor or dietitian if you are unsure.

Constipation You illness, chemotherapy or medication can

make you constipated.

You may need to get you doctor to prescribe you a laxative.

Eat regular meals

Include a high fibre at each meal

Drink plenty of fluids

Constipation

If you have been very constipated you may get watery stools passing through the solid stool. This is called ‘overflow’ diarrhoea. If you develop diarrhoea after being constipated talk to your doctor or nurse.

Fatigue Ask family or friend to help with shopping/

cooking Cook extra portions of food and freeze or

use ready meals for time when you are too tired to cook .

Have a nutritional drink when you don’t feel like cooking

Eat small portions but more often as you may need to rest after a meal.

Fatigue Try exercising when you can. Research shows

exercise may actually help you feel less tired.

Have a bed time snack e.g. hot milk

Avoid drinks that contain caffeine and chocolate a few hours before bed.

Don’t drink alcohol near bed time as it tends to cause a broken sleep pattern.

Nutritional Supplements

A Nutritional supplement is a drink packed with energy, protein, vitamins and minerals to help and you meet your nutritional requirements with diet.

Specific supplements can be used as a sole source of nutrition if you are not tolerating diet.

Nutritional supplement are best taken as a snack in between your meals as they are not intended to replace your meals but to act as a ‘top up’.

Nutritional Supplements Can be consumed warm or chilled. Range of flavours available They have to be consume within 24 hours

once opened and follow storage instructions.

Can be store in a cool, dry place away from radiators and direct sunlight.

Nutritional Supplements

Your dietitian/ doctor will advise you if you need to commence them and for how long.

Nutritional supplements are available on prescription and are dispensed by a pharmacy.

Cover under the medical card / Long Term Illness / Drug Payment Scheme.

Nutrition is Good MedicineNutrition is Good Medicine

It is important for those with cancer or who have It is important for those with cancer or who have had cancer to take care of themselves. Taking had cancer to take care of themselves. Taking care of yourself includes:care of yourself includes:

Being a healthy weightBeing a healthy weight Being Physical ActivityBeing Physical Activity Following the Healthy Eating Guidelines/ Food Following the Healthy Eating Guidelines/ Food

Pyramid ( if weight stable)Pyramid ( if weight stable) Being aware of complimentary/ alternative diets Being aware of complimentary/ alternative diets

and Supplementsand Supplements

Facts About being a Healthy Facts About being a Healthy Weight.Weight.

Being overweight can lead to heart Being overweight can lead to heart disease, type 2 diabetes and some disease, type 2 diabetes and some cancers.cancers.

Its a good idea to weight yourself once per Its a good idea to weight yourself once per month and to measure your waist every month and to measure your waist every few weeks.few weeks.

Facts About being a Healthy Facts About being a Healthy Weight.Weight.

Waist Measurement should be:Waist Measurement should be: Less than 80 cm or 32 inches in womenLess than 80 cm or 32 inches in women

Less than 94 cm or 37 inches in men.Less than 94 cm or 37 inches in men.

49% of Irish men and 70% of Irish women 49% of Irish men and 70% of Irish women exceed the above waist measurements.exceed the above waist measurements.

Weight & BMIWeight & BMI

Body Mass Index (BMI):Body Mass Index (BMI):

Weight (kg)Weight (kg)Height (mHeight (m22))

Normal BMI = 18.5 -25 kg/mNormal BMI = 18.5 -25 kg/m22

Underweight = <18.5 kg/mUnderweight = <18.5 kg/m2 2

Overweight = >25 kg/mOverweight = >25 kg/m22

Obese = >30 kg/mObese = >30 kg/m22

Weight & BMIWeight & BMI

Old Food PyramidOld Food Pyramid

New Food PyramidNew Food Pyramid

Maximum 1

Choose any 2

Choose any 2

Choose any 3

Choose any 5 +

Choose any 6 +

Healthy Eating GuidelinesHealthy Eating Guidelines Enjoy your foodEnjoy your food

Eat a variety of different foodsEat a variety of different foods

Eat the right amount to be a healthy weightEat the right amount to be a healthy weight

Eat plenty of foods rich in starch & fibreEat plenty of foods rich in starch & fibre

Eat 5 or more portions of fruit and vegetables Eat 5 or more portions of fruit and vegetables per dayper day

Healthy Eating GuidelinesHealthy Eating Guidelines Reduce intake of high fat foodsReduce intake of high fat foods

Don’t eat more than 500g (18oq) of red meat Don’t eat more than 500g (18oq) of red meat (cooked) a week. A standard portion is 60g (cooked) a week. A standard portion is 60g (2oz) cooked meat. Choose leaner cuts of meat.(2oz) cooked meat. Choose leaner cuts of meat.

Reduce intake of salt and salty foodsReduce intake of salt and salty foods

Reduce intake of sugar and sugary drinksReduce intake of sugar and sugary drinks

If you drink alcohol, drink sensiblyIf you drink alcohol, drink sensibly

Healthy Eating Guidelines

You do not need a vitamin/ mineral supplement if you have a balance diet. Only take one if you doctor/ dietitian advises you to.

Be physically active.

Breads, Cereals & potatoes Breads, Cereals & potatoes

Choose any 6 or more servings each day if you are active.

Provide energy.

Choose wholemeal / wholegrain versions where possible.

WHAT IS A Serving??WHAT IS A Serving?? Pitta Pocket/ 1x tortilla wrap/ small bagel/ small scone/ small French roll

2 Serving

4 dessertspoons of a High fibre cereal without sugar/ honey/chocolate coating e.g. Bran flakes

1 Serving

1 x slice of Brown sliced Bread or wholegrain soda bread

1 Serving

3 dessertspoons ofDry Porridge oats

1 Serving

2-3 Crackers or crispbreads

1 Serving

WHAT IS A Serving??WHAT IS A Serving??2 x Breakfast Cereal Wheat or oat Biscuits

1 Serving

1 x medium or 2 x small potatoes

1 Serving

2 x Dessertspoons mash potato

1 Serving

3 x dessertspoons or ½ cup boiled pasta/rice/noodles (25g uncooked)

1 serving

3 x dessertspoons of Muesli without honey coating

1 serving

Breads, Cereals & potatoes (6)Breads, Cereals & potatoes (6) Evidence is mounting that eating Evidence is mounting that eating

wholegrain regularly as part of a healthy wholegrain regularly as part of a healthy diet and lifestyle may help to reduce the diet and lifestyle may help to reduce the risk of many common diseases e.g. heart risk of many common diseases e.g. heart disease, Type 2 diabetes and some forms disease, Type 2 diabetes and some forms of cancer.of cancer.

Wholegrain may also help in maintaining a Wholegrain may also help in maintaining a healthy body weight over time.healthy body weight over time.

How can I increase my intake of How can I increase my intake of wholegrain?wholegrain?

When choosing foods from the starchy When choosing foods from the starchy group replace refined cereal foods with group replace refined cereal foods with wholegrain varieties. Wheat ,oats, rye, wholegrain varieties. Wheat ,oats, rye, rice and oats are the most commonly rice and oats are the most commonly available cereals in the wholegrain form.available cereals in the wholegrain form.

Look for the word “whole” before the name Look for the word “whole” before the name of the cereal e.g. whole wheat pasta.of the cereal e.g. whole wheat pasta.

Aim to have at least half your servings per Aim to have at least half your servings per day as wholegrain.day as wholegrain.

Fruit & Vegetables (5)Fruit & Vegetables (5)

Eating more fruit and vegetables could significantly Eating more fruit and vegetables could significantly reduce the risk of many chronic diseases, including, reduce the risk of many chronic diseases, including, high blood pressure, cardiovascular diseases and high blood pressure, cardiovascular diseases and some cancers.some cancers.

Good source of vitamins, minerals, fibre and are low Good source of vitamins, minerals, fibre and are low in calories.in calories.

Including more fruit and vegetables reduces the Including more fruit and vegetables reduces the overall calorie density, which helps us maintain a overall calorie density, which helps us maintain a healthier weight.healthier weight.

Fruit & VegetablesFruit & Vegetables

Plant foods are an important of antioxidants, nutrients vitamin A, C, E, B carotene, Trace minerals as Selenium and zinc.

These are proposed to have a protective against the initiation phase of breast cancer.

Principle source of fibre which is thought to reduce circulating estrogen concentration in blood.

Fruit & Vegetables (5)Fruit & Vegetables (5)

Fresh, frozen, canned, juiced or dried Fresh, frozen, canned, juiced or dried fruits and vegetables all count in the diet.fruits and vegetables all count in the diet.

Potatoes are a carbohydrate and are Potatoes are a carbohydrate and are therefore included in the bread and therefore included in the bread and cereals food group.cereals food group.

You should aim to eat a minimum of five You should aim to eat a minimum of five portions of a variety of fruit and vegetables portions of a variety of fruit and vegetables each day.each day.

Quick guide to fruit and vegetable Quick guide to fruit and vegetable portionsportions

FruitFruit PortionPortion

Medium sized fruit e.g. Medium sized fruit e.g. apple ,banana, pearapple ,banana, pear

11

Small sized fruit e.g. plum, Small sized fruit e.g. plum, Satsuma, kiwiSatsuma, kiwi

22

Large fruit e.g. grapefruitLarge fruit e.g. grapefruit HalfHalf

Dried fruit e.g. raisins, currants, Dried fruit e.g. raisins, currants, sultanas, mixed fruitsultanas, mixed fruit

1 tbsp.1 tbsp.

Quick guide to fruit and Quick guide to fruit and vegetable portionsvegetable portions

Berries, grapes or cherries

10-12

Cooked fresh fruit, fruit tinned in own juice or frozen fruit.

4 x dessertspoons

Unsweetened fruit juice or a smoothie made only from fruit or vegetables

100ml ( small glass)


VegetablesVegetables PortionPortion

Broccoli spearsBroccoli spears

Cauliflower FloretsCauliflower Florets

Cabbage, spinach, green beansCabbage, spinach, green beans

22

88

4 heaped 4 heaped tbsp.tbsp.

Cooked vegetables e.g. steamed, Cooked vegetables e.g. steamed, boiled, microwaveboiled, microwave

4 4 dessertspoondessertspoonss

Canned & frozen vegetables is Canned & frozen vegetables is roughly the same as a fresh portionroughly the same as a fresh portion

4 4 dessertspoondessertspoonss


VegetablesVegetables PortionPortion

Bowl of saladBowl of salad 11

Bowl homemade vegetable Bowl homemade vegetable soupsoup

11

Pulses and beans e.g. kidney, Pulses and beans e.g. kidney, butter beans, chick peas. butter beans, chick peas. Remember these only count as Remember these only count as one of your five a day portions!one of your five a day portions!

3 heaped tbsp.3 heaped tbsp.

Milk & Dairy Foods Choose any 3 servings each day.

Important source of protein and calcium which are essential for healthy bones and teeth.

Milk & Dairy Foods

One Portion is:-

Milk 200ml (1/3 Pint)

Low fat soft cheese 50g (2oz)

Yoghurt 1 pot (125ml)

Cottage cheese 75g (3 oz)

Hard Cheese (edam/ Cheddar)

25g (1oz)

Milk & Dairy Foods

Yoghurt drink 200ml

Low fat soft cheese 50g

Cheese Triangles 2 portions

One Portion is:-

Meat, Poultry, Fish, Eggs, Beans, Peas, Lentils

Choose any 2 servings per day.

These foods provide protein, which is essential for cell growth, repair and immunity.

They are also important sources of minerals such as Iron.


Don’t eat more than 500g (18oz) of red Don’t eat more than 500g (18oz) of red meat (cooked) a week.meat (cooked) a week.


One Portion is:-

Cooked Lean meat/ Poultry

50-75g

Cooked oily fish or white fish.

100g

Eggs 2

Cooked beans/peas 6 dessertspoons.

Unsalted Nuts 40g


One Portion is:

Soya or tofu 100g

Hummus 125g

Reduced Fat Spreads & OilsReduced Fat Spreads & OilsChoose any 2 servings per day.

Provide essential fats but these are only needed in small amounts.

Choose low fat and reduced fat spreads and oils e.g. Rapeseed or olive oil (monounsaturated) instead of hard margarine, oil or butter.

Reduced Fat Spreads & OilsReduced Fat Spreads & Oils

One Portion is:

Low fat spread/reduced fat spread

1 heaped tsp. (should cover 2 x slices of bread)

Full fat spreads Less than 1 heaped tsp.(should cover 3 x slices of bread)

Foods & Drinks high in Fat, Foods & Drinks high in Fat, Sugar & Salt.Sugar & Salt.

There are no recommendations for this There are no recommendations for this group because they are no essential.group because they are no essential.

Limit what you eat from to no more than 1 Limit what you eat from to no more than 1 serving per day and ideally not everyday.serving per day and ideally not everyday.

Reduce Intake of High Fat FoodsReduce Intake of High Fat Foods While all types of fats are high in calories, While all types of fats are high in calories,

some fats can also raise cholesterol some fats can also raise cholesterol levels. The main problematic fat is levels. The main problematic fat is saturated fat, found in fatty meat, dairy saturated fat, found in fatty meat, dairy foods, cakes and pastries and palm oil.foods, cakes and pastries and palm oil.

Some easy ways of reducing your intake Some easy ways of reducing your intake of this unhealthy fat include:of this unhealthy fat include:

Change to reduced-fat dairy products e.g. Change to reduced-fat dairy products e.g. semi-skimmed milksemi-skimmed milk

Reduce intake of high fat foodsReduce intake of high fat foods

Use soft spreads made from vegetable oil, Use soft spreads made from vegetable oil, such as rapeseed or olive oil, rather than such as rapeseed or olive oil, rather than choosing butter and use sparingly.choosing butter and use sparingly.

Trim the visible fat from meat and the skin Trim the visible fat from meat and the skin from chickenfrom chicken

Limit your intake of fried fast food, meat Limit your intake of fried fast food, meat products such as sausages, pies and products such as sausages, pies and streaky baconstreaky bacon

Go for snacks which are low in saturated Go for snacks which are low in saturated fat such as fruits, breads, nuts, seeds, low fat such as fruits, breads, nuts, seeds, low fat yoghurt, vegetables and cereals.fat yoghurt, vegetables and cereals.

Reduce intake of high fat foodsReduce intake of high fat foods

EPIC Norfolk Cohort (13,000 Females) showed the women who ate more than 45g saturated fat per day were twice as likely to get breast cancer than those who ate less than 12g saturated fat per day.

Monounsaturated fats and omega 3 polyunsaturated fats appear to be protective while saturated fats, trans fats and omega 6 polyunsaturated fats seemingly increase risk.

Omega – 3 fatty acidsOmega – 3 fatty acids

Main source is oily fish/ seafood.Main source is oily fish/ seafood. Tuna (Fresh)Tuna (Fresh) SalmonSalmon HerringHerring PilchardsPilchards MackerelMackerel Trout (rainbow)Trout (rainbow) ShrimpShrimp crabcrab

Omega – 3 fatty acidsOmega – 3 fatty acids

Benefits of eating oily fish:Benefits of eating oily fish:

1.1. Lower risk of heart and blood vessel Lower risk of heart and blood vessel disease.disease.

2.2. Maintenance of healthy joints.Maintenance of healthy joints.

To get the most benefit adults are advised To get the most benefit adults are advised to eat 2 portions of fish per week ( 140g), to eat 2 portions of fish per week ( 140g), one of which should be oily.one of which should be oily.

Stanols & SterolsStanols & Sterols

Occur naturally in foods such as Occur naturally in foods such as vegetables, nuts seeds, cereals, legumes, vegetables, nuts seeds, cereals, legumes, olive & peanut oils.olive & peanut oils.

Estimated we consume 150-400mg per Estimated we consume 150-400mg per day of naturally occurring stanols and day of naturally occurring stanols and sterols, but an average dietary intake at sterols, but an average dietary intake at this level has little effect on cholesterol this level has little effect on cholesterol levels.levels.

Stanols & SterolsStanols & Sterols

They work by reducing cholesterol They work by reducing cholesterol absorption from the gut.absorption from the gut.

Both have similar effect on cholesterolBoth have similar effect on cholesterol A healthy diet, regular exercise in A healthy diet, regular exercise in

combination with plant stanols and sterols combination with plant stanols and sterols can help reduce total cholesterol and LDL can help reduce total cholesterol and LDL cholesterol (bad cholesterol) by 10-20%cholesterol (bad cholesterol) by 10-20%

Recommend a intake of 2 – 3g per day for Recommend a intake of 2 – 3g per day for those with raised cholesterol.those with raised cholesterol.

Stanols & sterolsStanols & sterols

ProductProduct Package sizePackage size VarietiesVarietiesBenecol Yoghurt Benecol Yoghurt DrinkDrink

Flora Pro-activ Flora Pro-activ probiotic yoghurt probiotic yoghurt drinkdrink

Danone Danacol Danone Danacol yoghurt Drinkyoghurt Drink

70g70g

100g100g

100g (1.6g sterols per 100g (1.6g sterols per bottle)bottle)

Plain, light, strawberryPlain, light, strawberry

Original, strawberry, Original, strawberry, orangeorange

Original, strawberryOriginal, strawberry

SaltSalt

Eating too much salt can increase your risk of Eating too much salt can increase your risk of developing high blood pressure.developing high blood pressure.

The average salt intake is currently 9.5g a day, The average salt intake is currently 9.5g a day, we should be having much less than this.we should be having much less than this.

The recommended salt intake is 6g per day The recommended salt intake is 6g per day about 1 tsp.about 1 tsp.

75-80% of salt we eat is already added to the 75-80% of salt we eat is already added to the food we buy.food we buy.

Reducing your intake of salty processed foods is Reducing your intake of salty processed foods is an important part of a healthy diet.an important part of a healthy diet.

SaltSalt

Use herbs and spices in cooking instead Use herbs and spices in cooking instead of salt.of salt.

Try not to add extra salt at the table.Try not to add extra salt at the table. Cut right down on salty processed foods Cut right down on salty processed foods

and ready meals.and ready meals. Check out food labels for salt content and Check out food labels for salt content and

choose lower salt options.choose lower salt options.

FOOD LABELSFOOD LABELSIngredient listingIngredient listing A lists of the product’s ingredients is A lists of the product’s ingredients is

required by law. required by law. This listing tells you what was used to This listing tells you what was used to

make the product. make the product. The ingredients are listed in descending The ingredients are listed in descending

order, so the ingredient that was used in order, so the ingredient that was used in the greatest amount will appear first on the greatest amount will appear first on the list, all the way through to the last the list, all the way through to the last ingredient which was used least in the ingredient which was used least in the product. product.

Foods Labels

Nutrition labelsNutrition labels Nutritional labelling is any information Nutritional labelling is any information

appearing on food labels relating to the amount appearing on food labels relating to the amount of calories (energy) and nutrients contained in of calories (energy) and nutrients contained in the product. the product.

Nutrition labels can help you make healthy food Nutrition labels can help you make healthy food choices as you can compare the nutrition choices as you can compare the nutrition information on similar products. information on similar products.

Guideline Daily Amount is nutrition information Guideline Daily Amount is nutrition information that is presented on the front of pack.that is presented on the front of pack.

Some tips for reading Food Labels

Sugar can be listed as: sucrose, maltose, honey, palm sugar, hydrolysed starch, syrup and invert sugar.

Reduced fat products likely to still be high in fat.

Salt may be listed as sodium, to convert sodium into salt just multiply by 2.5.

A Guide to Food Labels

A Lot per 100g A Little per 100g

15g of total sugars 5g or less of total sugars

20g of fat

5g of saturated fat

3g of fat

1.5g or less of saturated fat

3g of fibre 0.5 of fibre

1.5g of salt

0.6g of sodium

0.3g of salt

0.1g of sodium

Old Alcohol GuidelinesOld Alcohol Guidelines

RECOMMENDATIONS:RECOMMENDATIONS: WOMEN 1 UNITS PER DAYWOMEN 1 UNITS PER DAY MEN 2 UNITS PER DAYMEN 2 UNITS PER DAY ALSO HAVE A FEW ALCOHOL FREE ALSO HAVE A FEW ALCOHOL FREE

DAYS IN A WEEKDAYS IN A WEEK CONSULT WITH YOUR DOCTOR IF IT CONSULT WITH YOUR DOCTOR IF IT

IS SAFE FOR YOU TO DRINK ALSOHOL IS SAFE FOR YOU TO DRINK ALSOHOL DURING YOU TREATMENT.DURING YOU TREATMENT.

NEW ALCOHOL GUIDELNESNEW ALCOHOL GUIDELNES

For low risk drinking the weekly limits are:For low risk drinking the weekly limits are: Up to 11 standard drinks per week for Up to 11 standard drinks per week for

women.women. Up to 17 standard drinks per week for Up to 17 standard drinks per week for

men.men. Do not take more than 5 standard drinks in Do not take more than 5 standard drinks in

one sitting.one sitting. Have 3 alcohol free days during the week.Have 3 alcohol free days during the week.

Unit Guide

100ml Glass of wine 1 unit

35ml Spirit 1 ½ units

½ pint 1 unit

Complementary, Alternative Diets & Complementary, Alternative Diets & SupplementsSupplements

Have become very popular, with information Have become very popular, with information available on the internet, in books, through the available on the internet, in books, through the media.media.

There is no scientific evidence to support any of There is no scientific evidence to support any of these diets cure or prevent cancer recurring.these diets cure or prevent cancer recurring.

In some cases they are harmful.In some cases they are harmful.

Always discuss with your doctor/ dietitianAlways discuss with your doctor/ dietitian

What are Complementary & What are Complementary & Alternative DietsAlternative Diets

A complementary diet is one you follow A complementary diet is one you follow while you have medical treatment.while you have medical treatment.

An alternative diet is instead of the An alternative diet is instead of the recommended medical treatment.recommended medical treatment.

Health professional do not recommend Health professional do not recommend any of these diets.any of these diets.

Complementary & Alternative Diets May leave out Complementary & Alternative Diets May leave out one or more of the following:-one or more of the following:-

Dairy foods e.g. milk, yoghurts, cheese.Dairy foods e.g. milk, yoghurts, cheese.

Main source of calcium.Main source of calcium.

Calcium is needed for healthy bones and to Calcium is needed for healthy bones and to prevent osteoporosis.prevent osteoporosis.

Very important in women after menopause.Very important in women after menopause.

If you diet is not rich in calcium you may need a If you diet is not rich in calcium you may need a calcium supplement.calcium supplement.

Red meat, Poultry, eggsRed meat, Poultry, eggs

Good source of protein. Protein repairs your Good source of protein. Protein repairs your body, particularly after cancer treatment.body, particularly after cancer treatment.

Iron is important for healthy blood cells.Iron is important for healthy blood cells.

Red meat is the best dietary source of iron.Red meat is the best dietary source of iron.

If your diet is not rich in iron you may need a If your diet is not rich in iron you may need a supplement.supplement.

sugarsugar

No evidence to support sugar “feeds a No evidence to support sugar “feeds a tumour”.tumour”.

Sugar is present in many foods and gives Sugar is present in many foods and gives you energy.you energy.

Bristol dietBristol diet

Basically dairy freeBasically dairy free

Also avoid red meat, salt & sugar.Also avoid red meat, salt & sugar.

Eat lots of fruit and vegetables.Eat lots of fruit and vegetables.

Gerson DietGerson Diet Avoid nearly all animal products and all Avoid nearly all animal products and all

fats and oils except flaxseed oil.fats and oils except flaxseed oil. All foods to be fresh and organic.All foods to be fresh and organic. No processed, preserved, canned, bottled, No processed, preserved, canned, bottled,

boxed or frozen foods.boxed or frozen foods. No salt allowed.No salt allowed. Avoid sources of toxicity e.g. tobacco. Avoid sources of toxicity e.g. tobacco.

Alcohol, fluoride, pesticides, food chemical Alcohol, fluoride, pesticides, food chemical and all medicines.and all medicines.

Macrobiotic DietMacrobiotic Diet Completely vegan ( no dairy products of Completely vegan ( no dairy products of

meat allowed)meat allowed) Promotes organic whole grains e.g. brown Promotes organic whole grains e.g. brown

rice, oats & buckwheat, organic fruit & veg, rice, oats & buckwheat, organic fruit & veg, soups made with vegetables, seaweed, soups made with vegetables, seaweed, beans, chickpeas lentils and fermented beans, chickpeas lentils and fermented soy.soy.

Allowed small helpings of nuts, seeds & Allowed small helpings of nuts, seeds & pickled vegetables.pickled vegetables.

Macrobiotic DietMacrobiotic Diet Only eat when hungry and chew food for a long-Only eat when hungry and chew food for a long-

time until it become liquid in your mouth.time until it become liquid in your mouth. Drink only when thirsty & only allowed water or Drink only when thirsty & only allowed water or

non-flavoured decaffeinated tea.non-flavoured decaffeinated tea. Food is prepared and cooked in a certain way. Food is prepared and cooked in a certain way.

Avoiding microwaves or cooking with electricity.Avoiding microwaves or cooking with electricity. No vitamin/mineral supplements allowed.No vitamin/mineral supplements allowed. No processed foods with artificial colours, No processed foods with artificial colours,

flavours, preservatives.flavours, preservatives.

Soy Evidence: Research in the role of soy/soy

foods in breast cancer is inconsistent For breast cancer survivors, the evidence

suggests neither benefits nor harmful effects when soy is eaten in moderate amounts as part of a healthy diet

Moderate amount = approx 25g/day (4g in soy yoghurt, 7g in 200ml glass of soy milk, 10g in 200g/7oz portion tofu)

Soy Safety: Higher doses of soy may have an

oestrogen-like effect and higher levels of oestrogens increase the risk of progression of post-menopausal and oestrogen-receptor positive breast cancer

Breast cancer survivors should avoid the high concentrations of soy found in soy powders/supplements - AICR

Soy

Safety: Soy can interact with thyroid hormone medications – do not take thyroid medications within 2-3 hours of eating soy

No conclusive evidence to show that soy interacts with tamoxifen

Other Benefits: No conclusive evidence that soy can help reduce hot flushes (NCI)

Vegetarian Diets

Evidence: No evidence to show that vegetarian diets prevent or reduce risk of recurrence of breast cancer

Safety: Safe to consume vegetarian diet that provides all food groups and essential nutrients

Other Benefits: Elements of vegetarian diet protective against heart disease e.g. low in animal fat, high in fruit & vegetables

Dairy Foods

Evidence: Research does NOT support a link between consumption of dairy foods and increased risk of breast cancer.

Animal studies have shown that dairy foods may have a protective effect against breast cancer – human studies needed.

Dairy Foods

Safety: Safe to consume as part of a healthy balanced diet.

Other Benefits: important for maintaining bone health / prevention of osteoporosis.

Green Tea Evidence: No evidence to show that green tea

reduces risk of recurrence of breast cancer - results from human studies are not consistent

Safety: Safe non – toxic drink **

3 – 10 cups per day

Contains caffeine Other Benefits: may offer protection against

some bacterial infections

**Very high amounts of green tea components (usually associated with over dosage of green tea supplements) have been shown interact with drugs that affect blood clotting such as aspirin.

Antioxidants

Vitamins A, C and E Sources – fruit and vegetables Evidence: High intakes of supplements not

advisable as research is conflicting regarding role in cancer

Safety: Not recommended to take > 100% of RDA

Anti-oxidants from fruit & vegetables not harmful Other Benefits: protect against heart disease

Echinacea Evidence: No evidence to show that Echinacea reduces

risk of recurrence of breast cancer Safety: Safe to use continuously for < 3 weeks Should not be taken by:

- diabetics- individuals with impaired liver

function or autoimmune diseases e.g. TB, MS, rheumatoid arthritis

- if taking immunosuppressant medications

Should not be taken by those with cancer of immune system e.g. leukaemia, lymphoma

Other Benefits: Stimulates immune system

Aloe vera

Evidence: No evidence to show that aloe vera reduces risk of recurrence of breast cancer

Safety: Should not be taken orally as oral aloe vera intake is known to slow down or reduce absorption of nutrients and drugs

Other Benefits: Topical application is beneficial in treating radiation dermatitis, post-surgical scars, cuts, burns, sunburn

Check with your radiation therapist / breast care nurse before using

Ginseng

Evidence: no conclusive evidence at present to show that ginseng reduces risk of recurrence of breast cancer

Safety: Should not be taken by individuals with high blood pressure, anxiety disorder and in those taking oestrogen or steroids

Other Benefits: may boost immune function and aid treatment of fatigue, weak evidence that ginseng may reduce hot flushes

Co-enzyme Q10

Evidence: No evidence to show that it reduces risk of recurrence of breast cancer

Safety: may make some chemotherapy drugs/ radiotherapy less effective

Should not be taken if taking anti-coagulants e.g. Warfarin

Other Benefits: may be beneficial in heart disease/ heart failure

Supplements and Tamoxifen

The following supplements interact with Tamoxifen :

- St John’s Wort- Black Cohosh- Dong Quai

If considering taking the above supplements, please consult your doctor first

Diet, Supplements and Menopause

Ensure adequate calcium intake Follow low-fat diet to reduce risk of heart

disease Physical activity may reduce hot flushes Evening primrose oil not recommended for hot

flushes Dong Quai – little evidence to support it’s safety Black Cohosh not recommended as may

damage liver

Organic FoodsOrganic Foods

Tend to be more expensive.Tend to be more expensive.

Have same nutrients as non- organic food. Have same nutrients as non- organic food. There is no harm choosing organic but has There is no harm choosing organic but has no known benefits.no known benefits.

Vitamins, Minerals & other Vitamins, Minerals & other supplementssupplements

If your diet is not healthy and varied you may If your diet is not healthy and varied you may need a multivitamin/mineral supplement.need a multivitamin/mineral supplement.

Multivitamin/mineral supplement, should not Multivitamin/mineral supplement, should not contain more than 100% RDA for vitamins & contain more than 100% RDA for vitamins & minerals.minerals.

Mega dosing on multivitamin/mineral Mega dosing on multivitamin/mineral supplements can have harmful side effects.supplements can have harmful side effects.

Always discuss with your dietitian / doctor before Always discuss with your dietitian / doctor before taking a c0-enzyme/ herbal supplement as it can taking a c0-enzyme/ herbal supplement as it can interfere with your treatment.interfere with your treatment.

AICR GuidelinesAICR Guidelines

1.1. Choose a variety of fruit and vegetablesChoose a variety of fruit and vegetables2.2. Limit intake of red meat to less than 3oz/dayLimit intake of red meat to less than 3oz/day3.3. Decrease the amount of fatty food in especially those Decrease the amount of fatty food in especially those

from animal and decrease total fat intakefrom animal and decrease total fat intake4.4. Eat less salty foods and less salt in cooking, use herbs Eat less salty foods and less salt in cooking, use herbs

and spices insteadand spices instead5.5. Limit alcohol to less than 2 drinks a day for men and one Limit alcohol to less than 2 drinks a day for men and one

for women for women 6.6. Do not eat charred meat often, nor cured and smoked Do not eat charred meat often, nor cured and smoked

meatsmeats7.7. Avoid being overweightAvoid being overweight8.8. Take 1 hour brisk walk or similar dailyTake 1 hour brisk walk or similar daily

Myth or Fact

1) Organic foods are better for you.

Myth or Fact

1) FALSE. Nearly all foods can be healthy once you eat them as part of a balance diet.

2) Processed foods are less nutritious and not as good as fresh foods.

Myth or Fact

. – FALSE. As part of a balance diet processed foods can be healthy. Processed foods may keep most of their goodness.

3) Large doses of vitamins can prevent or cure many diseases.

Myth or Fact– FALSE. There is no scientific evidence for

this and large doses may be dangerous.

4) Sugar feeds cancer and you should avoid it .

Myth or Fact

FALSE. Sugar if found in may foods and gives the body energy as part of a balance diet.

Useful WebsitesUseful Websites

National Cancer Institute:National Cancer Institute: www.cancer.govwww.cancer.gov

American Institute of Cancer ResearchAmerican Institute of Cancer Research www.aicr.orgwww.aicr.org

Macmillan Cancerline (UK)Macmillan Cancerline (UK)www.macmillan.org.ukwww.macmillan.org.uk

Useful Websites

Irish Nutrition and Dietetic Institutewww.indi.ie

Irish Cancer Societywww.cancer.ie

Irish Hospice Foundation www.hospice-foundation.ie

Diet and nutrition - Aoife Gorham

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