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Survivorship: Nutrition and Healthy Living Guidelines for Cancer Survivorship

Survivorship: Nutrition and Healthy Living Guidelines for Cancer Survivorship 1

Nutrition and Healthy Living Guidelines for Cancer Survivorship Table of contents To the patient and family......................................................................................................................................................4 Understand nutrition research............................................................................................................................... 4 Asses your diet and lifestyle .................................................................................................................................5 Goal setting........................................................................................................................................................................6 American Cancer Society guidelines...............................................................................................................................6 Eat healthy foods........................................................................................................................................ 6 Animal protein...................................................................................................................................................................7 ....Other considerations for your diet...................................................................................................................................7 Adopt a physically active lifestyle........................................................................................................................................7 How much exercise do I need?........................................................................................................................................8 Strength training...............................................................................................................................................................8 Tips for success.................................................................................................................................................................9 Maintain a healthy weight throughout life.........................................................................................................................9 Body mass index...............................................................................................................................................................9 Waist size......................................................................................................................................................................... 10 Weight loss.......................................................................................................................................................................... 10 Limit alcohol........................................................................................................................................................................ 11 What is a serving of alcohol?......................................................................................................................................... 11 Make the best choices.........................................................................................................................................................12 How to read food labels.................................................................................................................................................12 Cancer fighters in food...................................................................................................................................................13 Phytochemicals.................................................................................................................................................................... 14 Should I take vitamins, minerals, antioxidants or herbal products?.............................................................................. 14 How do I choose a multivitamin?..................................................................................................................................15 How can I be sure of a supplement’s quality? .............................................................................................................15 Understanding soy..............................................................................................................................................................16 Tips for adding soy to your diet.....................................................................................................................................16 Special considerations........................................................................................................................................................17 Menu 1..................................................................................................................................................................................17 Menu 2..................................................................................................................................................................................18 Try new recipes.................................................................................................................................................................... 19 Breakfast.......................................................................................................................................................................... 19 Appetizers........................................................................................................................................................................ 19 Salad dressings...............................................................................................................................................................20 Vegetables and grains....................................................................................................................................................20 Desserts...........................................................................................................................................................................22 Resources.............................................................................................................................................................................24 Appendix..............................................................................................................................................................................26

Survivorship: Nutrition and Healthy Living Guidelines for Cancer Survivorship 3

To the patient and family This booklet is for people who have been diagnosed with cancer. If you have any questions about the information in this booklet, please ask your health care team. A healthy lifestyle is important after cancer treatment. A healthy lifestyle can:

• • • •

Reduce your risk of cancer (new or recurrence) Help you lower your risk for heart disease Give you more energy Lessen feelings of sadness and improve your mood

Understand nutrition research With ongoing research, we are starting to see more specific guidelines for cancer survivors. This book will discuss these lifestyle choices that can help reduce risk for cancer. Current evidence-based recommendations will be provided when available. Most experts agree that survivors should eat a diet for cancer prevention. This may help prevent a cancer from coming back or a another type of cancer. There are many reasons why this makes sense: • Even though you have finished treatment, you may still have tiny, undetected cancer cells in your body. • You may have a higher risk of: – a second type of cancer; – osteoporosis; – obesity; 4 MD Anderson Cancer Center

• • •

– heart disease; – diabetes; and – problems with being able to perform daily activities. Nutrition and lifestyle changes for cancer prevention are similar to the guidelines for general good health and well-being. They offer overall health benefits in preventing disease. Certain foods have been shown to contain nutrients which may help fight cancer. Excess weight has been shown to increase the risk for certain cancers, including colorectal, breast (postmenopausal), endometrial, esophageal, pancreatic, gall bladder, kidney and liver. Eating healthy foods is one way to help avoid excess weight.

Assess your diet and lifestyle Take it one step at a time. Do not try to change your current eating habits in one day. To get started, take the following American Cancer Society Nutrition and Activity Quiz. It is also at www.cancer.org 1. Check “Yes” or “No” next to each question. 2. Add up your “Yes” Responses. 3. Look up your score in the “Scoring” section. Yes

No

I eat at least 2½ cups of vegetables and fruits every day. I eat whole-grain bread, pasta and cereal instead of refined grain products. I try to choose foods low in calories and fat. I rarely eat red meat or processed meat like bacon, hot dogs and sausage. I take it easy on high-calorie, baked goods, such as pies, cakes, cookies, sweet rolls and doughnuts. I rarely add butter, margarine, oil, sour cream or mayonnaise to foods when I’m cooking or at the table. I rarely (less than twice a week) eat fried foods. I try to stay at a healthy weight. I get at least 150 minutes (2.5 hours) of moderate or 75 minutes (1 hour and 15 minutes) of vigorous physical activity throughout each week. I usually take the stairs instead of waiting for an elevator. I try to spend most of my free time being active, instead of watching TV or sitting at the computer. I never, or only occasionally, drink alcohol. Scoring: 0-4 “Yes” Answers: Diet alert!

Your diet may be too high in calories and fat and too low in plant foods like vegetables, fruits and grains. Look at your eating habits and find ways to make some changes. 5-8 “Yes” Answers: Not bad! You’re halfway there.

You are making a great start for smart living. Look at your “No” answers to help set goals for improvement. 9-12 “Yes” Answers: Good for you! You’re living smart!

Keep up the good habits. Continue to look for ways in increase or maintain your current lifestyle. Survivorship: Nutrition and Healthy Living Guidelines for Cancer Survivorship 5

Goal setting The next step is to make one goal. Use the results from the quiz above as a place to start. See the guidelines below to think about different changes you can make to live healthier. The goal can be small, however make sure it is specific. As time goes on, you can set more goals. This book will teach you some of the important changes you can make to be healthier. Some examples of goals are: “I will add ¼ cup of dried fruit to my cereal every morning to eat more fruit every day.”

“I will eat one meatless meal each week to limit the amount of animal protein I eat.”

“I will walk 30 minutes three days a week to get more exercise.”

American Cancer Society guidelines The American Cancer Society sets guidelines that teach people how to lower cancer risk. You can use these as a guide to help you set your goals. The guidelines are:

• • • •

Eat a variety of healthy foods, with an emphasis on plant sources. Adopt a physically active lifestyle. Maintain a healthy weight throughout life. If you drink alcoholic beverages, limit your intake.

It is important to have support from your school, workplace and community. For example:

• • •

Ask for healthy meal and snack choices at school or work. Support retailers and restaurants that serve healthy options. Help make your community an easier place to enjoy physical activities, including walking and bike riding.

Eat healthy foods Plant-based foods are a healthy choice and you should aim to include more of these foods in your diet. Plants give vitamins, minerals, antioxidants, phytochemicals and fiber. Each of these are essential to good health. Examples of plant-based foods include: • Vegetables • Fruits • Beans, peas and soy beans • Whole-grain breads and pasta • Nuts and seeds • Canola oil and olive oil When adding plant-based foods to your meals, try to fill 2/3 of your plate with these foods. • Aim for at least 2 1/2 cups of vegetables and fruits in your diet per day. – Eat vegetables and fruits at each meal. – Snack on vegetables and fruits. – Limit French fries, chips and other fried vegetable choices. 6 MD Anderson Cancer Center

• • •

– Choose vegetables and fruits that are fresh, frozen or canned with no salt added. Choose whole grains, rather than processed (refined) white flour or white rice. – Eat at least 25 grams of fiber per day. Good sources of fiber include bran cereals, wheat germ, wheat bran, fruits, vegetables, 100 percent whole grains, beans, soy beans, nuts and seeds. Many plant based foods are a good source of protein. These include beans, lentils, seeds and nuts. Use these to make a “meatless” meal once or twice a week.

Animal protein Most people need about 6 ounces of animal protein daily. Choose lean cuts of chicken, turkey, fish, pork and beef. Try to limit red meat (such as beef, pork and lamb) to no more than 3 ounces per day. Other forms of animal protein include: • Milk, yogurt and cheese • Eggs • Venison and wild game If you choose to include animal protein;

• • •

Limit red meats (beef, pork, lamb, goat, etc.), and avoid processed meats, which are cured, smoked or preserved. This includes lunch meat. The American Institute of Cancer Research (AIRC) recommends limiting red meat to less than 18 ounces per week to reduce the risk of cancer. This would be the same as eating a 3-ounce portion (about the size of a deck of cards), six days a week. Choose fish, poultry, and beans in place of beef, pork and lamb. Use low-fat cooking methods. Stir fry, bake, roast, broil and boil. Do not fry meats. Fill your plate with less than one-third animal protein.

Other considerations for your diet • • • • •

Limit “empty calories,” which are foods with calories but few vitamins, minerals or protein. Avoid sweetened cereals, sweetened juices, soft drinks, pastries, candy and other sugars. Avoid fried foods and foods prepared with a lot of oils and fats. Avoid trans fats. These are fats that are harmful to your body. Check the nutrition label to ensure the foods do not have trans fats. Add whole soy food to your diet in moderation. (See page 16 to learn more.)

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Adopt a physically active lifestyle Exercise has many benefits. It:

• • • • • • •

Reduces risk of cancer Improves your overall health Improves your heart and lung health and lowers risk of heart disease Helps you lose weight and maintain your weight Increases your energy, endurance, strength and flexibility Lessens the effects of stress, anxiety and fatigue and gives you emotional well-being Helps you maintain normal bowel function

Always ask your doctor before starting an exercise program. Some late effects of cancer and its treatment may limit exercise.

How much exercise do I need? You should strive for moderate or vigorous physical activity most days of the week. Moderate and vigorous describe how hard it is for you to do the activity. During moderate activity, you should be a little out of breath and feel your heart beating a little faster. During vigorous activity, you should be breathing more rapidly and only able to speak a few words at a time. Based on your ability and goals, try to get either:

• • •

150 minutes of moderate activity each week, 75 minutes of vigorous physical activity, or A combination of both vigorous and moderate activity.

Start slow with shorter sessions (10-15 minutes) at a relaxed pace to avoid injury. Then over time, increase the frequency, length and intensity of your activity. You can reach the total minutes through different types of exercise. For example, you could walk briskly for 30 minutes, five days a week. (This would be 150 minutes of moderate activity.) You could also swim laps or play basketball for 25 minutes, three days a week. (This would be 75 minutes of vigorous activity.) The table below gives examples of moderate and vigorous activity.

Moderate activity

Vigorous activity

Brisk walking (17-minute mile)

Fast walking (12-minute mile)

Dancing

Running

Slow swimming

Fast bicycling

Golfing

Basketball

Gardening

Swimming laps

Strength training Strength training is exercise that provides resistance against a force. It can help you build lean body weight, build bone density to help prevent osteoporosis, and strengthen muscles. Include strength training at least two days per week. You could: 8 MD Anderson Cancer Center

• Lift free weights or dumbbells to do a bicep curl. • Use weight machines to do leg presses. • Move your legs by doing walking lunges.

Easy ways to be more active • Use the stairs instead of the elevator. • Park at the far edge of the parking lot. •

Walk a few laps around the store

before you begin to shop. bicycle, and peddle while watching

TV. •

Walk, jog or jump rope in place.

Increase your steps by taking a

longer route.

• Schedule exercise on your calendar to reserve time in your day. • Find an exercise partner to help you stay with your program and keep you company

• Purchase a new or used stationary

Tips for success

• Warm up and cool down for five minutes. Remember to stretch after both your warm up and cool down. • You may need to increase activity and eat fewer calories to lose weight. Speak to a dietitian for a personal plan for weight loss.

Maintain a healthy weight throughout life Be as lean as possible within the normal body range throughout life for healthy living. Reduce your cancer risk by maintaining a healthy weight. Total body fat and visceral fat, the fat around your waist, have been shown to increase the risk for certain cancers. These include colorectal, breast (postmenopausal), endometrial, esophageal, pancreatic, gallbladder, kidney and liver. Body mass index and the size of your waist are two important numbers. If they are high, you may be at higher risk for certain cancers and other health problems.

Body mass index (BMI) Body mass index, or BMI, measures a person’s weight in relation to height. As BMI increases, so does your risk for some cancers. To find your BMI, refer to the chart on page 26. Then review the table below.

BMI weight status Below 18.5 Underweight 18.5 – 24.9 Normal 25 – 29.9 Overweight 30 and above Obese

My BMI is _________________________

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Waist size Waist circumference, or the size around your waist, measures the fat around your waist. People with large waists or an increase in waist size over time are at higher risk for some cancers. To find your waist size, follow these steps. 1. Face a mirror and find the top of your hipbone. 2. Wrap a tape measure around your waist, just above your hipbone. The tape should be snug, but not pressing into the skin. 3. Exhale, and record the measurement in inches. Health Risk

Men

Women

Low Health Risk

40 inches or less

35 inches or less

High Health Risk

More than 40 inches More than 35 inches

My waist size __________________

Weight loss One way to reduce the risk of cancer is by maintaining a healthy body weight. Talk with your doctor or dietitian to find out if you are at a healthy weight. If you are not at healthy weight, follow these steps: 1. Set a goal. Make this goal sensible and include a deadline. For example, if you need to lose weight, you could start with a goal of 10 percent weight loss in six months. Do not lose weight too quickly. Slow, consistent weight loss is healthy. Eating 300 to 500 fewer calories per day can result in a weight loss of 1 to 2 pounds per week. Anything more may be unhealthy. 2. Focus on eating balanced, healthier foods. Increase the amount of vegetables and fruits you eat. 3. Get and stay active. Start with 10 to 15 minutes of walking each day and increase over time. Work your way up to 150 minutes per week (30 minutes a day, five days a week). 4. Make lifestyle changes.

Limit the times you go out to eat.

Involve your family and friends in being active.

Plan your meals, and schedule time for exercise.

Make your health and weight loss goal a priority.

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Limit alcohol Alcohol and the link to cancer risk needs more research. We do know that drinking alcohol and smoking cigarettes adds to cancer risk. We also know that the more alcohol you drink, the greater chance you have of getting cancer and other types of disease. Alcoholic drinks are high in calories with limited nutritional benefit. In other words, they are “empty calories.” Drinking alcohol can increase the risk of some cancers. Too much alcohol may increase the risk of:

Liver cancer

• Cancers of the gastrointestinal tract system, such as colorectal cancer and cancer of the mouth and esophagus

Breast cancer

Heart disease

• Obesity

Cirrhosis of the liver

What is a serving of alcohol? If you do not drink alcohol, don’t start. Men should have no more than two servings or less per day. Women should have no more than one serving or less per day. Instead, try fruit smoothies, green tea, herbal teas or alcohol-free cocktails. If you do choose to drink, know the serving size so you can keep track of the amount.

A serving of alcohol is either: • 5 ounces of wine • 12 ounces of beer • 1 ½ ounces of liquor

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Make the best choices How to read food labels A Nutrition Facts panel (or food label) is on almost all processed foods, cooked meats and prepared foods. Some raw food like “raw chicken breast” and fresh fruits and vegetables do not have a label. Reading a food label can be hard. Use these tips to help:

• Know that g=gram and mg=milligram.

• Look at the serving size. It may be more or less than what you expect. Serving sizes are based on what is normally eaten. • Look at the left side of the label. It tells you the calories, fat, cholesterol, sodium, total carbohydrates and protein. Know your goals for each.

• Check the percent daily value on the right.

This is based on a 2000-calorie diet. Your diet may not be the same and you would need to adjust the percentages.

Nutrition Facts Serving size 1 cup (228g) Servings per container 2

1

Serving size

2

Amount of calories

3

Limit these nutrients

4

Get enough of these nutrients

5

Percent (%) Daily Value

6

Footnote with daily values (DVs)

Amount per serving

Calories 250

Calories from Fat 110 % Daily Value* Total Fat 12g 18% Saturated Fat 3 g 15% Trans Fat 3g Cholesterol 30mg 10% Sodium 470mg 20% Total Carbohydrate 13g 10% Dietary Fiber 0g 0% Sugars 5g Proteins 5g Vitamin A Vitamin C Calcium Iron

4% 2% 20% 4%

*Percent Daily Values are based on a 2,000-calorie diet. Your daily values may be higher or lower depending on your calorie needs.

Total Fat Sat Fat Cholesterol Sodium Total carbohydrate Daily Fiber

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Calories

2,000

2,500

Less than Less than Less than Less than

65g 20g 300mg 2,400mg 375g 25g

80g 25g 300mg 2,400mg 375g 30 g

Cancer fighters in food Phytochemicals are found in plant sources of food. They play a vital role in a healthy diet. Phyto is Greek for “plant.” Phytochemicals are plant chemicals that promote health. They are found in fruits, vegetables, legumes, nuts, seeds, whole grains, herbs and spices. They add to the smell, color and flavor of the plant. Phytochemicals play a major role in reducing cancer risk. We are still learning more about how they fight cancer. Early research hints that they may be a frontline defense. Antioxidants are one type of phytochemical. Antioxidants protect cells from damage that can turn into cancer. Damage can come from: • Aging

• Cigarettes

• Pollution

• Herbicides

• Radiation

• Alcohol

• Sunlight

• Injury

The best way to get phytochemicals in your diet is to eat plant-based foods. The table on page 14 lists examples of phytochemicals and the foods that have them. The key is to eat a mix or “rainbow” of colored fruit and vegetables.

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Phytochemicals Phytochemical Potential benefits • Carontenoids • Carotenoids act as antioxidants; may slow growth of certain Dark leafy greens (lutein, zeaxanthin) types of cancer cells (breast, skin, lung, stomach); may improve (spinach, kale, • Flavonoids immune response romaine lettuce, • Fiber collard greens) • Fiber may reduce the risk of colorectal cancer • Folate • Ellagic acid • Act as antioxidant Berries (strawberries, • Flavonoids raspberries, • Anthocyanosides • Slows the reproduction of cancer cells blueberries) • Vitamin C • Inhibits the development of some cancers • Fiber • Act as antioxidant Broccoli and • Indoles Food

cruciferous vegetables • Isothiocyanates (Brussels sprouts, • Beta-carotene cabbage, cauliflower) • Potassium

Legumes (dry beans, peas, lentils)

• Inositol • Protease inhibitors • Sterois

Tomatoes

• Lycopene

Apples (with skin)

• Quercetin • Flavonoids • Vitamin C • Fiber

• Helps repair damaged DNA

• Block the activity of hormones that impact the development of some cancer • Inhibit cancer cell growth • Prevent tumors from releasing compounds that can destroy nearby healthy cells • Lessen inflammation (which may support cancer growth) • Antioxidant • May protect against prostate cancer • Anti-inflammatory • Antioxidant

For more information and other examples of cancer fighters in your food, please view the American Institute for Cancer Research website at www.aicr.org/foods-that-fight-cancer.

Should I take vitamins, minerals, antioxidants or herbal products? You may not need to take vitamins, minerals, antioxidants or herbal products. It is best to make healthy food choices and eat a plant-based diet. Some research has found that taking supplements may not provide the same health benefit as eating the whole foods. In some cases, taking high doses of some supplements can be harmful. Supplements may also interfere with prescriptions, over-the-counter medicines and chemotherapy. Talk to your health care team about any questions or supplements you are taking. If you are taking blood-thinning medicine, this is especially important. 14 MD Anderson Cancer Center

In most cases, the body is better able to use nutrients from food than from supplements. If you wish to take a supplement:

Talk to your dietitian and care team. They can help you review all options.

Track your diet to see how much of a nutrient you get from food.

If you need a supplement, a daily multivitamin may be best. Take it as written on the label.

How do I choose a multivitamin? Choose a multivitamin with no more than 100 percent daily value of the nutrients that are listed on the label. This information is on the right side of the nutrition label. Avoid multivitamins that have herbal products. Herbal ingredients may interact with other prescription or overthe-counter medicine. A multivitamin should not take the place of nutrients found in a healthy, well-balanced diet. How can I be sure of a supplement’s quality? Unlike food, the U.S. government does not review the safety of dietary supplements. This includes all vitamins, minerals and herbal products. Therefore, it is best to use dietary supplements that are reviewed by an independent third party organization like the United States Pharmocopeia or ConsumerLab.com. • United States Pharmocopeia (USP) www.uspverified.org To receive the USP Verified seal of approval on a product label, the supplement manufacturer must volunteer to participate in the program. The product is then tested for quality, purity, and potency. Mnay brand and generic supplements are USP Verified. • ConsumerLab.com (CL) www.ConsumerLab.com ConsumerLab performs independent reviews of dietary supplements and publishes this information on the website. However, this information is only available to subscribers. Brands that meet the CL standards may carry the CL seal of approval on their label. There is not enough research data to say if herbal supplements are safe or useful. Herbs vary from region to region and from each other. It is hard to know if herbal supplements are all the same. Evidence suggests that too much may increase cancer risk. Talk with your health care team before taking these.

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Understanding soy Soy is a plant that is common in the Asian diet. Soy-derived foods, such as tofu, soy milk and soy powder, provide a number of nutrients. Currently, most experts agree that moderate amounts (one to two servings per day) of soy is safe and possibly helpful for cancer survivors, including breast cancer survivors. However, do not eat large amounts of soy, such as soy powders or isoflavone supplements. Speak to your doctor or dietitian to learn more about soy. Soy is a good source of fiber, protein and phytochemicals. The phytochemicals found in soy have: •

Antioxidant properties

Protein inhibitors, which are enzymes that change cell division

Limits blood supply to the tumors

As an excellent source of protein, soy can be a good choice in place of meat.

Tips for adding whole soy to your diet Common soy products include: •

Soy milk: This non-dairy liquid is fortified with calcium and often vitamins A and D. Choose a low-fat or non-fat type. Use this to substitute for milk in any recipe, or drink it plain.

Tofu : This varies in texture from extra firm to soft or silken. Extra firm tofu is dense and holds well for stir-frying or grilling. Soft or silken tofu is ideal for blending in soups, or added to pureed or blended dishes.

o Tip : When the recipe calls for sour cream, use half tofu and half sour cream. o Remember to keep tofu refrigerated. It is perishable, so always check the expiration date.

o Freeze tofu for up to five months.

Soy nuts: These baked mature soybeans are usually seasoned. They have a nutty flavor, similar to a roasted peanut. Try them as a snack.

Edamame: These boiled or steamed green soybeans are eaten straight out of the pod. (Squeeze out the bean with your fingers or teeth and throw away the pod.) They can also be purchased already shelled. Eat them as a snack.

What is a serving of soy: • 1 cup of soy milk • ½ cup cooked soy beans • 1/3 cup soy nuts • 1/3 cup of tofu

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Special considerations Do you have another chronic health problem, such as diabetes, heart disease, liver disease or kidney disease? You can still live a healthy, enjoyable life. In addition to these guidelines, monitor your carbohydrate, protein, salt and fat intake. Seek advice from a registered dietitian to help you improve your health. Registered dietitians are licensed specialists. Their extensive education and training prepare them to make unique care plans for patients during treatment and recovery. To find a dietitian, visit the Academy of Nutrition and Dietetics at : www.eatright.org. Click on Find a Dietitian. If you would like to schedule an appointment with your dietitian at MD Anderson, please call Clinical Nutrition at 713-563-5167.

Menu 1 Breakfast

Snack

½ -1 cup cooked oatmeal

6 ounces V-8® juice

1 slice whole-wheat toast

6 ounces low-fat yogurt

¾ cup blueberries

1 cup raw broccoli and cauliflower

8 ounces 1 percent milk 1 teaspoon butter 1 teaspoon jelly 1 cup hot green tea

Lunch

Dinner 1 cup whole-wheat spaghetti noodles with 1 cup marinara sauce made with lean ground turkey Garden salad: mixed green lettuce, carrots, tomatoes and cucumber

Sandwich:

Balsamic vinaigrette salad dressing (See recipe on page 21.)

2 slices whole-grain bread

½ cup cooked Italian green beans

2 ounces sliced turkey breast

Breadstick

1 ounce low-fat cheese slice

12 ounces iced green tea

Lettuce, pickle, tomato and/or onion

1 teaspoon mayonnaise

Snack/Dessert

1 teaspoon mustard

Apple berry salsa with cinnamon chips (See recipe on page 23.)

1 ¼ cup strawberries 1 cup carrot and celery sticks 12 ounces iced green tea

Survivorship: Nutrition and Healthy Living Guidelines for Cancer Survivorship 17

Menu 2 Breakfast

Snack

Whole-wheat waffle topped with partially thawed frozen mixed berries (See recipe on page 20.)

Peach cubes topped with low-fat raspberry yogurt

8 ounces 1 percent milk 1 scrambled egg or Âź cup scrambled egg whites

Dinner 3-4 ounces salmon

Lunch

1 cup brown rice with snow peas (See recipe on page 22.)

1 cup tomato soup

Baked squash casserole (See recipe on page 22.)

Grilled chicken salad: mixed lettuce greens, grated Spinach salad carrots, tomato slices, cantaloupe cubes, cucumber slices, chopped bell pepper, 3-4 ounces grilled chicken, Snack/Dessert 1 ounce feta cheese Fruit smoothie (See recipe on page 20.) Raspberry vinaigrette dressing Whole-wheat roll

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Try new recipes Breakfast Whole-wheat pancakes

Prepare any pancake recipe, substituting whole-wheat flour for ½ or all of the white flour. Also, substitute soy milk for the milk. Fruit smoothie (1 serving)

6 ounces plain low fat yogurt 1–1 ½ cups fresh fruit 1 teaspoon sugar or artificial sweetener 6-8 ice cubes Blend ingredients in a blender until smooth.

Appetizers Onion dip

Greek spinach melts (12 servings)

1 cup soft or silken style low-fat tofu

1 package whole-wheat English muffins

½ cup green onions

1 package (9 ounces) frozen chopped spinach, thawed and drained

1 cup low-fat or non-fat sour cream

1 Roma tomato, chopped

1 envelope dry onion soup mix 1 tablespoon Tabasco® Green Pepper Sauce

¼ cup onion, chopped 1 clove garlic, pressed

1. Stir tofu and green onions together until creamy.

½ cup crumbled Feta cheese

2. Stir in the other ingredients.

¼ cup silken tofu

3. Chill for two hours before serving.

¼ cup light sour cream ½ teaspoon dried dill ¼ teaspoon salt 1. Preheat oven to 350 degrees. 2. Slice English muffins in half and place on a baking sheet. Place in the oven for 2-3 minutes to toast slightly. 3. Combine all other ingredients in a mixing bowl. 4. Spread each muffin slice with the spinach mixture. 5. Bake 10-12 minutes or until heated through. Serve immediately.

Survivorship: Nutrition and Healthy Living Guidelines for Cancer Survivorship 19

Salad dressings

Vegetables and grains

Creamy salad dressing

Substitute silken style tofu for mayonnaise in any recipe.

Broccoli salad (6 servings)

1 bunch fresh broccoli Balsamic vinaigrette salad dressing

1 cup balsamic vinegar ¼ cup olive oil 2 tablespoons Italian seasoning 2-4 garlic gloves, crushed Combine all ingredients.

1 small red onion, chopped ¹/³ cup raisins 1 cup seedless grapes, sliced ½ cup low-fat mayonnaise or soy mayonnaise 2 tablespoons sugar 1 tablespoons vinegar

½ cup non-fat plain yogurt

1. Cut broccoli florets into small pieces. Peel stems and cut into small pieces. Place in a bowl.

½ cup low-fat sour cream or soy-based sour cream

2. Add onion, raisins, grapes.

2 tablespoons cilantro, minced

3. In separate bowl, combine mayonnaise, sugar and vinegar.

Creamy herb dressing

½ teaspoon lemon pepper 1 green onion with top, minced ½ teaspoon honey or sugar 1. Using a hand beater, whip together yogurt and sour cream. 2. Stir in the remaining ingredients. 3. Keep refrigerated. Yogurt dressing

1 cup low-fat yogurt 1 package buttermilk salad dressing 2 tablespoons lemon juice ¹/³ cup skim milk or soy milk 1. Combine yogurt and salad dressing mix. 2. Stir in lemon juice. 3. Add milk. 4. Refrigerate until chilled.

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4. Add dressing to broccoli mixture. Refrigerate for three hours. 5. Stir once before serving.

Baked squash casserole (8 servings)

Brown rice with snow peas (8 servings)

2 yellow squash, sliced

1 ½ cups brown rice, uncooked

2 zucchini, sliced

2 chicken bouillon cubes

2 fresh tomatoes, sliced

3 cups water

1 large onion, sliced

½ cup chopped onion

1 green bell pepper, cut into strips

¹/³ cup chopped celery

Parmesan cheese, grated

¼ cup chopped parsley

Olive oil spray

¼ cup chopped green pepper

Salt and pepper

1 sliced carrot 4 tablespoons olive oil, divided

1. Preheat oven to 350 degrees.

½ pound fresh mushrooms, sliced

2. Spray bottom of 9” by 13” pan with olive oil.

1 can water chestnuts (8 ounces)

3. Layer on bottom of the pan: yellow squash, 1 tomato, ½ onion, ½ green pepper.

1 bag frozen snow pea pods (7 ounces)

4. Lightly sprinkle with salt and pepper. 5. Sprinkle with Parmesan cheese. 6. Layer zucchini, 1 tomato, ½ onion and ½ green pepper. 7. Lightly sprinkle with salt and pepper. 8. Top with Parmesan cheese. 9. Bake 1 hour.

Nonstick spray 1. Preheat oven to 350 degrees. 2. Place rice, bouillon cubes and water in a saucepan and cook according to package instructions. 3. Sauté onion, celery, parsley, green pepper and carrot in 2 tablespoons oil until tender. 4. Sauté mushrooms in 2 tablespoons olive oil for five minutes. 5. Combine cooked rice, vegetables, water chestnuts and pea pods and toss together. 6. Spray a 2-quart casserole dish with nonstick spray. 7. Spoon rice mixture into the casserole dish. 8. Cover and bake 15-20 minutes.

Survivorship: Nutrition and Healthy Living Guidelines for Cancer Survivorship 21

Quinoa cranberry salad

Desserts

1 cup quinoa 1/2 cup cranberries

Reduced-fat banana pudding (8 servings)

1 sliced red pepper

1 large box fat-free instant vanilla pudding (fat-free, sugar-free may be used, if desired)

1/4 cup chopped fresh parsley 1 lime juice 1. Preheat oven and broil red peppers for 10 min (or until skin chars slightly). Slice to thin pieces.

1 cup vanilla flavored low-fat soy milk 1 container fat-free whipped topping 2-3 sliced bananas

2. Boil quinoa with 2 1/2 cups of water and add salt to taste. Drain quinoa carefully after cooking.

½-ž box reduced-fat vanilla wafers

3. Mix quinoa, cranberries, roasted red peppers, fresh parsley, lime juice and salt.

5. Beat together pudding and soy milk until thick.

4. Serve, or chill overnight in the refrigerator to enhance flavor.

6. Fold in whipped topping, and refrigerate for five minutes. 7. In large serving bowl, layer twice as follows: vanilla wafers, bananas and pudding mix. Top with vanilla wafers. 8. Refrigerate until ready to serve.

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Apple berry salsa with cinnamon chips

Berry crisp (8 servings)

Salsa (8 servings, ¼ cup each):

4 ½ cup berries (Choose any you like.)

2 medium Granny Smith apples, chopped (do not peel)

2 tablespoons Splenda

1 cup strawberries, sliced

1 cup oats

1 kiwi, peeled and chopped

1 cup whole-wheat flour

2 teaspoons orange zest

¾ cup brown sugar (or ½ cup brown sugar and ¼ cup Splenda)

¼ cup orange juice

1 teaspoon cinnamon

2 tablespoons packed brown sugar

½ cup butter

2 tablespoons apple jelly 1. Preheat oven to 350 degrees◦. Combine all ingredients in bowl and serve with cinnamon chips. Cinnamon Chips (16 servings, 4 wedges each): 7” whole-wheat tortillas 1 tablespoon sugar (or substitute Splenda® if desired) ½ teaspoon ground cinnamon 1. Preheat oven to 400 degrees.

3. In bowl, combine flour, oats, brown sugar and cinnamon. Cut in butter with fork until crumbly. 4. Sprinkle mixture on top of the berries. 5. Bake about 30 minutes. The fruit will be bubbly, and the topping will be golden brown. Fruity soy shake (2 servings)

2. Lightly spray tortillas with water. 3. Combine sugar and cinnamon, and sprinkle over tortillas. 4. Cut each tortilla into eight wedges.

1 cup vanilla soy milk or skim milk, chilled 5 ounces soft or silken tofu, chilled 2 cups fresh or frozen fruit of your choice 2-3 tablespoons honey

5. Place wedges on baking sheet. 6. Bake 8-10 minutes, until lightly browned and crisp. 7. Cool on baking rack.

2. In 8” by 8” or 9” by 9” pan, place berries and sprinkle with Splenda.

½ teaspoon vanilla extract Combine all ingredients in a blender and process until smooth.

Survivorship: Nutrition and Healthy Living Guidelines for Cancer Survivorship 23

Resources American Cancer Society

800-ACS-2345 (800-227-2345) www.cancer.org The American Cancer Society provides information on nutrition during and after treatment, how to handle side effects and much more. In the website search field, type “nutrition” to find information. Type “cooking smart” to find tips on healthy cooking, shopping lists and more. American Dietetic Association (ADA)

www.eatright.org 800-877-1600 The ADA is the nation’s largest organization of food and nutrition professionals. This website provides objective food and nutrition information for optimal nutrition, health and well-being. Although partially restricted to ADA members, you may search for healthy lifestyle tips, use online tools, read brochures and reading lists and link to other nutrition resources. American Institute for Cancer Research (AICR)

800-843-8114 http://aicr.org The AICR funds research on diet and cancer prevention and educates the public about the results. This site contains valuable research-based information. Click on the “Subscribe” tab at the top of the page to subscribe to a free e-newsletter and weekly healthy recipes. National Cancer Institute (NCI)

800-422-6237 http://www.cancer.gov For more information about nutrition and cancer survivorship, call the National Cancer Institute’s Cancer Information Service. A trained cancer information specialist will answer your questions. Type “nutrition” in the search field to read “Nutrition in Cancer Care (PDQ®).” National Institutes of Health – Office of Dietary Supplements

301-496-4000 http://dietary-supplements.info.nih.gov Click on the “Health Information” tab to find information on dietary, vitamin, mineral and herbal supplements. This link includes Federal Drug Administration (FDA) warnings and false advertising claims filed by the Federal Trade Commission (FTC). The Department of Agriculture’s Food Consumption Database is also available. Nutrition Data

www.nutritiondata.com In addition to tools like the Daily Needs Calculator and the Nutrient Search Tool, Nutrition Data gives a complete nutrient analysis for any food or recipe and helps you select foods that best match your dietary needs.

24 MD Anderson Cancer Center

Nutrition.gov

www.nutrition.gov This website provides access to government information on food and nutrition. Find reliable information on healthy eating, physical activity and food safety. Specialized nutrition information is also provided for life stages: infants, children, teens, women, men and seniors. MD Anderson Cancer Center

https://atthetable.mdanderson.org/ @TheTable is an online cookbook with nutritious, family-friendly recipes for a healthy lifestyle. A dietitian from the Children’s Cancer Hospital has reviewed these recipes.

Books Eating Well Through Cancer: Easy Recipes & Recommendations During and After Treatment by Holly Clegg, 2006. Everything Cancer-Fighting Cookbook by Carolyn Katzin, 2011. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective by the World Cancer Research Fund and the American Institute for Cancer Research, 2007. Foods to Fight Cancer: Essential Foods to Help Prevent Cancer by Richard Beliveau, 2007. Present Knowledge in Nutrition by John Erdman, 2012. The Cancer-Fighting Kitchen: Nourishing Big-Flavor Recipes for Cancer Treatment and Recovery by Rebecca Katz, 2009. The New Mayo Clinic Cookbook forward by Nelson Hensrud, 2012. The Survivor’s Handbook: Eating Right for Cancer Survival by Neal Barnard, 2006. What to Eat During Cancer Treatment: 100 Great-Tasting Family-Friendly Recipes to Help You Cope by Jeanne Besser, 2009. The Essential Cancer Treatment Nutrition Guide and Cookbook by Jean LaMantia, 2012. Betty Crocker’s Living with Cancer Cookbook, 2011. The New American Plate Cookbook: Recipes for a Healthy Weight and a Healthy Life, by American Institute for Cancer Research, 2005. American Cancer Society Complete Guide to Nutrition for Cancer Survivors: Eating Well, Staying Well During and After Cancer by Abby S. Bloch (Editor) , Barbara Grant (Editor) , Kathryn K. Hamilton (Editor), Cynthia Thompson, 2010.

Journal articles American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer with Healthy Food Choices and Physical Activity in CA: A Cancer Journal for Clinicians, volume 56, page 254, 2006. Nutrition and Physical Activity Guidelines for Cancer Survivors in CA: A Cancer Journal for Clinicians, 2012, volume 62, pages 242-274. Available at: http://onlinelibrary.wiley.com/doi/10.3322/caac.21142/pdf

Survivorship: Nutrition and Healthy Living Guidelines for Cancer Survivorship 25

26 MD Anderson Cancer Center 35

36

37

38

144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302 310 318 325 333 340 348 355 363 371 378 386 393 401 408

148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 280 287 295 303 311 319 326 334 342 350 358 365 373 381 389 396 404 412 420

152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 287 295 303 311 319 327 335 343 351 359 367 375 383 391 399 407 415 423 431

156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328 336 344 353 361 369 377 385 394 402 410 418 426 435 443

74

75

76

Source: Adapted from Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report.

99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 198 203 208 212 217 222 227 232 237 242 247 252 257 262 267

73

54

140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 265 272 279 287 294 302 309 316 324 331 338 346 353 361 368 375 383 390 397

53

72

52

136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 257 265 272 279 286 293 301 308 315 322 329 338 343 351 358 365 372 379 386

51

71

50

132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278 285 292 299 306 313 320 327 334 341 348 355 362 369 376

49

70

48

128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236 243 250 257 263 270 277 284 291 297 304 311 318 324 331 338 345 351 358 365

47

69

46

125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230 236 243 249 256 262 269 276 282 289 295 302 308 315 322 328 335 341 348 354

45

68

44

121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 230 236 242 249 255 261 268 274 280 287 293 299 306 312 319 325 331 338 344

42 43

67

41

118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 223 229 235 241 247 253 260 266 272 278 284 291 297 303 309 315 322 328 334

40

66

39

114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240 246 252 258 264 270 276 282 288 294 300 306 312 318 324

Body Weight (pounds)

34

65

33

110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232 238 244 250 256 262 267 273 279 285 291 296 302 308 314

32

64

31

107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 203 208 214 220 225 231 237 242 248 254 259 265 270 278 282 287 293 299 304

30

63

29

104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 196 202 207 213 218 224 229 235 240 246 251 256 262 267 273 278 284 289 295

28

62

27

100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211 217 222 227 232 238 243 248 254 259 264 269 275 280 285

26

61

25

97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 184 189 194 199 204 209 215 220 225 230 235 240 245 250 255 261 266 271 276

24

60

23

94

22

59

21

Extreme Obesity

96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 172 177 181 186 191 196 201 205 210 215 220 224 229 234 239 244 248 253 258

20

Obese

91

19

Overweight

58

Height (inches)

BMI

Normal

Body Mass Index Table

Appendix

Notes

Survivorship: Nutrition and Healthy Living Guidelines for Cancer Survivorship 27

Produced by the Patient Education Office in collaboration with the Office of Cancer Survivorship and Clinical Nutrition. This material has been provided due to generous funding from the Holiday Letter Program.

28 MD Anderson Cancer Center

gr | kg| 3.14 | 5K


Survivorship: Nutrition and Healthy Living Guidelines for Cancer Survivorship