The Havenâ€™s Guide To Healthy Eating
Breast Cancer Support Centres
I spoke to the (Haven) nutritionist and I’ve stuck to what she told me ever since. I found eating well could have a really big impact. I felt a lot stronger and my friends were coming round and saying, ‘You’ve just had chemo but you look fantastic.’
About The Haven The Haven is a unique charity that supports anyone affected by breast cancer, either from our three Haven centres in London, Hereford and Leeds, over the phone or via our website. Our services are free of charge.
Debbie, Haven Visitor
How we can help you
We provide a wide range of therapies to help you cope with the physical and emotional effects of breast cancer and its treatment. Our specialist cancer nurses and experts in emotional support, complementary therapies, nutrition, exercise and stress-reduction, provide a tailor-made programme of supportive care to help you cope better. As healthy eating is a key part of our support programme, this booklet has been designed by our Haven nutritional therapists to help you eat well with, and beyond, breast cancer.
What’s inside this booklet Introduction 2 Eating healthily as part of a wider support programme 4 How to maximise the benefits of a healthy diet 4 Metabolic changes in cancer 5 The Haven’s healthy eating suggestions 6 Some answers to frequently asked questions 18 Putting it altogether 24
Introduction This booklet outlines our nutritional recommendations and explains the reasoning behind them. These recommendations are backed up by the most up-to-date research evidence. If you would like to skip the background information and focus only on our recommendations, please go straight to the section that describes our healthy eating plate on page 6.
Eating a healthy diet after you have been diagnosed with breast cancer can bring many benefits. Healthy eating can have a positive impact on physical wellbeing such as:
By reading this short section alone you will be able to follow our healthy eating recommendations.
• Helping you to maintain a healthy weight which could reduce the risk of the disease recurring. • Ensuring good nourishment during treatment which can reduce the risk of side effects and complications. • Optimising your nutrient intake in the long-term which will provide support to your immune system and reduce the risk of linked conditions such as osteoporosis (fragile bone disease).
Healthy eating also boosts mental and emotional wellbeing by supporting the health of the brain and nervous system and by giving you a sense of control and positive involvement.
• At each meal try to fill half your plate with vegetables and fruit. • Always try to include some protein (animal products or pulses) in each meal. • It’s important to include some healthy fats (nuts, seeds, oily fish, vegetable oils or a little animal fat) in each meal. • It’s good to choose whole grain products but only fill up to 20% of your plate with grains or potatoes (starchy carbohydrates) at any meal. • As much as possible try to avoid sugary and fatty foods that have been processed. • Keep yourself well hydrated by drinking plenty of water or herbal teas. • Try to minimise your alcohol consumption. These benefits are increasingly confirmed in research findings as the publication of studies exploring this subject grows. We want to support you in finding a healthy diet that is easy to adopt in your life. This diet is based on fresh foods in their natural state for maximum flavour and benefit.
Eating healthily as part of a wider support programme
Metabolic changes in cancer
Eating a balanced, nutritious diet is a vital aspect of any programme intending to restore or improve health. However you should not consider nutrition on its own. Our health depends on other factors, such as exercise, time to relax and enjoying ourselves, which when combined with a healthy diet, can provide you with the greatest chance of achieving health and wellbeing.
Scientists have known for many decades that changes in the body’s metabolic processes occur in cancer. Some of these changes occur within the cancer cells themselves and some are more widespread in our normal cells and tissues. One of the key changes within cancer cells is an alteration in the way energy is produced from the sugar called glucose. This results in the cancer cells requiring more glucose than normal cells to produce the same amount of energy.
How to maximise the benefits of a healthy diet Our comprehensive healthy eating plan looks not only at the types of foods you are eating but also the way in which you are eating them. Many of us live busy, hectic lives and mealtimes are often squeezed into short periods of time or eaten while juggling other tasks. By design, our digestive system slows when we are under stress to allow the body to divert energy to the systems required to deal with the cause of the stress. For this reason, eating when under stress can result in indigestion, bloating and abdominal pain. To experience the full healing benefits of food, try to make mealtimes a priority. By doing this it will allow enough time for the food to be eaten in a relaxed manner. Where you eat is also important and should ideally be calming, away from work or chores. If mealtimes are shared, arguments and heated discussions are best avoided.
Research shows that cancer cells take up more glucose than normal cells. This has led to the suggestion that foods which promote high glucose levels, in particular sugar and refined grains (grains that have been significantly modified from their natural composition usually through the removal of the bran and germ) may encourage cancer growth. This theory has been investigated by researchers, although not very extensively, and at this time the results are mixed and inconclusive. But there is growing evidence that we should reduce or avoid dietary sugars and refined grains and here we explain why. A diet high in processed sugar and refined grains increases the risk of unhealthy weight gain, possibly leading to obesity. It also increases the chances of your body developing a resistance to insulin. Insulin is a hormone required to control blood glucose levels.
Metabolic syndrome, which increases the chances of developing diseases such as diabetes, heart disease and cancer is known to be linked to our diet and lifestyle. Apart from a high consumption of refined grains and sugars, other associated dietary factors include high amounts of unhealthy fats, in particular ‘damaged fats’ found in heavily processed foods, and a low consumption of fresh vegetables and fruit. A problem linked to Metabolic Syndrome is impaired immune function. A healthy immune system will respond to tissue trauma or injury by producing an acute inflammatory reaction that will die down once the problem is resolved. Chronic inflammation, on the other hand, may occur on a long-term basis and can be a sign of immune disturbance. Like Metabolic Syndrome, chronic inflammation has associations with poor food choices, such as a diet high in sugar and unhealthy fats and has links with certain diseases. The relationship between cancer and chronic inflammation has been known about for more than a century. The body’s systems are very closely interlinked and changes within one will impact on the functioning of other systems. Changes in our metabolism and alterations to our immune system can result in disturbances within the endocrine (hormone) system. As an example, high levels of insulin are known to interfere with the normal metabolism of oestrogen, one of the main hormones associated with breast cancer.
The Haven’s healthy eating suggestions
Balancing different types of food Try to balance the food on your plate at each meal. Breakfast can be challenging as we often rely on bread and cereal. Get some help from our Healthy Eating Ideas booklet. At times when finding balance at each meal is not possible, then try and achieve the nutritional balance over the whole day. When it comes to vegetables and fruit in each meal, a wide variety of colours will ensure a variety of different nutrients.
(a single cupped handful) — Fruit can be eaten raw or cooked. For a mix of beneficial nutrients and to add interest, include a wide variety of different types.
30% Vegetables (2 cupped handfuls) — Vegetables can be eaten raw or cooked. For a mix of beneficial nutrients and to add interest, include a wide variety of different types.
20% starchy carbohydrates (a single cupped handful) — Whole grains and potatoes are very important to include but should not be eaten in excess due to their high level of starch which can be converted to glucose and may lead to weight gain.
(a single cupped handful) — Include meat, fish, eggs and dairy products. Also include pulses which contain plant proteins.
(2 tablespoons) — Foods rich in healthy fat include nuts, seeds, vegetable oils and animal fats such as butter. Certain protein foods are also high in fats such as some cuts of red meat, full-fat dairy products and oily fish. When these form part of a meal, extra fat is not necessarily required.
Foods to enjoy at every meal Vegetables and fruit
Such as a variety of vegetables and fruits of many different colours. You can include salad leaves as well as cooked vegetables.
Such as brown rice, oats, rye, barley, millet, whole wheat. Potatoes also fall into this group as they are high in starch. Quinoa, technically a seed, is also high in protein.
Why Why • They contain lots of healthy nutrients and can be eaten at each meal and as snacks. • They contain phytochemicals (healthy chemicals found in plants) which can have antioxidant activity which means they can reduce the actions of damaging particles known as ‘free radicals’. • Many have anti-inflammatory actions and are alkalising which are good for our health. • Some have been shown to possess anti-cancer activity. We suggest Eat eight portions (a portion is a single cupped handful) of vegetables and fruit a day. Try to make about six of these vegetables and two fruit because fruit has a larger sugar content. You may like to eat the two fruit portions as snacks. Include a wide variety of both but eat tropical and dried fruits in moderation.
• Whole grains contain a range of vitamins and minerals such as the B vitamins, magnesium and zinc, as well as essential fats. • They are a good source of fibre which aids digestion and helps eliminate waste materials, including excess oestrogen. • They provide starch which the body converts to energy and (because they are unrefined) the energy is released slowly. This occurs particularly when they are combined with protein and fat in a meal. We suggest Eat one portion (a single cupped handful) of cooked whole grains or potatoes at each meal.
Protein Such as meat, fish, eggs and dairy, or in non-animal products like beans, peas and lentils (pulses), although they also contain high levels of starch. Nuts, seeds and quinoa contain a significant amount of plant protein. Why • It is important that people recovering from illness consume the right levels of protein in their diet as it is one of the fundamental nutrients which can help repair the body. • Protein helps to regulate blood glucose levels when it is included in a meal containing carbohydrates. We suggest Eat one portion (a single cupped handful) of protein at each meal. If you wish to minimise animal products include plenty of pulses. Further guidance on which animal products to choose is included later in this booklet.
Foods to enjoy at every meal—continued Healthy (unprocessed) fats
Herbs and spices
Such as oily fish (e.g. sardines, mackerel or salmon), plant sources including green leafy vegetables, nuts and seeds, nut and seed butters, cold pressed or ‘extra virgin’ vegetables oils or butter. Oily fish is a superior source but plant sources can provide small amounts if you don’t eat fish.
Such as ginger, garlic and turmeric and other garden herbs like mint, parsley, rosemary and chives. Why
Why • Fat is another fundamental nutrient with many important functions such as forming a large part of the membrane that surrounds every cell. • Particularly important are the omega 3 and omega 6 fats which are essential for life and can’t be made by the body, meaning they have to be provided by your diet. • Omega 3 fats, found in oily fish, green leafy vegetables and flax seeds should be particularly highlighted in your diet as they tend to be in shorter supply than the omega 6 fats. A low intake can undermine health and promote chronic inflammation. We suggest Eat approximately two tablespoons of healthy (unprocessed) fats with each meal in the form of cold pressed or ‘extra virgin’ vegetables oils, nuts and seeds, nut or seed butters, or butter. Sometimes the fat will be included in the animal products that make up the protein part of the meal, for example oily fish, red meat or dairy, so extra will not be needed.
• Like vegetables and fruit, herbs and spices are packed full of phytochemicals with powerful antioxidant and anti-inflammatory actions. • Research studies have highlighted the benefits of certain herbs and spices, examples being ginger, garlic and turmeric for people affected by cancer including breast cancer. We suggest You include a variety of herbs and spices in your diet daily to enhance flavour as well as benefitting your health.
Water Including herbal teas and fresh vegetable juices. Why • Drinking water regularly throughout the day is the best way to stay well hydrated. • Being well hydrated can help with appetite regulation and a healthy digestive system with good elimination. • Drinking enough supports your general energy level and your ability to concentrate. We suggest Drink around 1.5 to 2 litres of fluid per day, more if the weather is hot, if you are physically active, experiencing hot flushes or night sweats. Try to reduce or avoid caffeine and alcohol and minimise sugary drinks including fruit juice. If you wish to purify your water you can use a jug filter or have a filter system plumbed in to your drinking water supply at home. For more details on filters speak to one of our nutritional therapists.
Foods to enjoy in smaller amounts Red meat Why
• Red meat is a rich source of B vitamins and minerals, in particular iron. • There is evidence that consuming large amounts of red and processed meats may increase the risk of certain types of cancer e.g. bowel cancer, however, there is no clear link between red meat and breast cancer. • Certain types of red meat have relatively high saturated fat levels and in large amounts they could increase risk of unhealthy weight gain and obesity.
• Eat dairy in moderation and as part of a varied diet. • If dairy foods upset your digestive system you should avoid them or you may like to try sheep or goat milk products which can be easier to digest. • A small amount of full-fat dairy has more beneficial nutrients than the lower fat products. However, we appreciate that many people may prefer not to use full-fat milk. If this is the case, we suggest semi-skimmed milk to avoid the total removal of the beneficial fat-soluble vitamins. • Choose the best quality dairy products you can find. Organic products are higher in quality, but we recognise that not everyone has access to, or can, afford them. • For more information on dairy, see page 18 or discuss this with your Haven nutritional therapist.
We suggest Eat red meat no more than 1-2 times per week. Ideally choose unprocessed meat and buy the best quality and affordable cuts that are available, preferably organic. To save money on meat, choose cheaper cuts such as chicken thighs rather than chicken breast.
Dairy Why • Milk and milk products are a source of protein, healthy fats and a range of vitamins and minerals, particularly vitamin A (retinol), calcium and iodine. • Evidence that high dairy intake can cause breast cancer is inconsistent and inconclusive and it remains a topic of intense scientific debate. • Some people find that dairy foods can upset their digestion and this may be a particular problem following chemotherapy treatment. • When the immune system is lowered during chemotherapy for breast cancer, there is a small risk of developing listeria (a serious bacterial infection) so it may be wise to avoid unpasteurised cheeses, blue-veined and soft cheeses at this time. • Uncommonly, there is a risk with certain types of chemotherapy that your immune system can become severely weakened. If this is the case, you may be advised by your hospital doctor to follow a more restricted diet to ensure that your already weakened immune system is not compromised further.
Soya Such as soya beans, tofu, tempeh or miso. Why • Soya beans are a source of fibre, vitamins, minerals and also phytoestrogens. • Phytoestrogens are plant compounds that may reduce the potentially harmful action of the body’s own oestrogen. • We may eat significant amounts of soya due to its presence in many processed foods and the popularity of soya products such as milk and yoghurt as alternatives to dairy foods. • There are concerns that soya phytochemicals can disrupt the absorption of important nutrients into the body, these are termed ‘anti-nutrients’; traditional processing techniques remove some of the anti-nutrients. We suggest If soya based produce is normally a part of your diet then choose the traditional soya foods such as tofu, miso and tempeh which tend to contain lower levels of the anti-nutrients. Evidence shows that food sources of phytoestrogens, such as soya, are not a risk factor for cancer. However, in the interests of variety and lowering intake of anti-nutrients, it is suggested that you consume no more than three portions of soya products (3 cupped handfuls) per week.
Foods to avoid Alcohol
Refined grains and sugars
Such as white flour, white rice and sugar.
• Evidence has clearly shown that alcohol increases the risk of breast cancer and may also increase the risk of the disease recurring. • While some alcoholic drinks like red wine contain healthy antioxidants (substances that may protect cells from the damage caused by unstable molecules known as free radicals) you can get a high level of antioxidants from a diet rich in vegetables and fruit without consuming alcoholic drinks. • Many people find alcohol helps them to relax, particularly at social events. In moderation, the possible psychological benefits on these occasions can have a positive impact on your health.
We suggest If you do drink alcohol, have it as a special treat rather than on a regular basis. It is suggested that all alcohol is avoided during treatment with chemotherapy and radiotherapy as it can add further stress to an already taxed body coping with intensive treatment.
• They are much less nutritious than whole grains having had their fibre removed along with other nutrients such as vitamins, minerals and essential fats. • When we eat refined grains and sugars, our blood sugar will fluctuate more easily resulting in unhealthy instability. We suggest Try using fruit as the main sweetener rather than sugar. Honey and similar syrups also affect blood sugar, so keep these to a minimum. You may like to try stevia (a plant sugar) that is healthier than regular sugar. It can be bought in granules, powder and liquid.
Foods to avoid—continued Processed (unhealthy) fats
Barbequed or ‘burnt’ foods
Such as fats found in processed foods like low-fat spreads, crisps, chips, mayonnaise, sweets and commercially-produced baked goods like biscuits and cakes.
Why A diet containing frequent amounts of barbequed or ‘burnt’ foods may increase some cancer risk. However, there is no evidence linking these foods with breast cancer.
Why Processing means they are likely to have become damaged in terms of their nutrient value. One group of processed fats is the ‘trans fats’ which have been shown to be harmful to health. We suggest Fatty and processed food should be avoided. Do not heat oils to high temperatures when cooking and when possible add oils later in the cooking process to add flavour. The most stable fats for cooking are those with the lowest polyunsaturated fat content such as olive oil, coconut oil, palm oil and butter. Coconut oil, palm oil and animal fats, such as butter, are high in saturated fats so should be used in moderation, however butter is far preferable to any type of margarine or low-fat spread which all contain processed fats. For more details on fats, see page 18.
Processed meats These meats are those that have been smoked, salted or cured as a method of preservation, e.g. bacon, pate, salami, sausages and hamburgers. Why A high intake of these foods may increase the risk of certain cancers such as bowel cancer, but the evidence is not convincing for breast cancer. We suggest Use smoked, cured or salted meat or fish no more than one to two times a week. Avoid heavily processed meats as much as possible.
We suggest Cook meat and other foods without burning them. This includes toast.
Salt Why Essential minerals, such as sodium and chloride, are found in salt, but too much can be unhealthy. There is a lot of salt in processed foods. A diet naturally low in salt comes from fresh, unprocessed foods. We suggest Use rock or sea salt rather than table salt and use sparingly in cooking and at the table. Try other flavour enhancers like herbs, spices, lemon juice or zest, onions or garlic. Seaweed can also add flavour and its regular inclusion in the diet is recommended. It is a rich source of iodine – an essential mineral for health that is commonly deficient in the modern diet.
Coffee and caffeinated drinks Such as coffee, cocoa, some soft drinks, sports and energy drinks. Teas have less caffeine than coffee so can be drunk in moderation. Why Stress hormones and blood sugar may increase if large amounts of caffeine are consumed. We suggest Keep your tea and coffee intake to one or two cups a day and less in times of stress. Try alternatives such as herbal teas or coffee substitutes made from dandelion root or barley.
Some answers to frequently asked questions In the media, there is a lot written about which foods and drinks to avoid or introduce to your diet if you are diagnosed with breast cancer. Often these reports will offer conflicting viewpoints leading to some confusion. To help guide you through this maze we have answered some frequently asked questions which can be backed up by research evidence.
amounts of full-fat dairy products rather than choosing low-fat dairy products which have been further processed and have had beneficial nutrients, such as fat-soluble vitamins, removed. Some people find that dairy products cause digestive problems particularly following chemotherapy. In these situations dairy foods should be avoided.
Should fatty foods be avoided with cancer? Fatty foods should not be avoided with cancer but it is important to choose foods that contain healthy fats and minimise unhealthy processed fats. Some fats are essential for health and must be obtained from food; these are the polyunsaturated omega 3 and omega 6 fats. We recommend healthy fats from nuts and seeds, cold pressed or ‘extra virgin’ vegetable oils, oily fish and green leafy vegetables. Ensure that you have lots of foods rich in omega 3 fats, especially oily fish, due to the relative deficiency of these nutrients in the average British diet.
Where will I get the calcium and iodine I need if I avoid dairy products? If you decide to completely eliminate all dairy foods it is still possible to obtain sufficient calcium from the diet. To do this, ensure that you eat the following foods regularly:
Another group of fats are those that are saturated. Rich sources include red meat, fullfat dairy products, coconut oil and palm oil. There is some evidence to suggest that a high intake of saturated animal fats may increase the risk of breast cancer but the findings are mixed and inconclusive. Saturated fats have been naturally present in our diet since we evolved as humans and do not need to be avoided, but they should be eaten in moderate amounts. The group of fats to be avoided as much as possible are the processed (unhealthy) fats. They are the same basic compounds as the healthy polyunsaturated fats but with one difference - they have been chemically altered through heavy processing. These processed fats are found in processed fatty foods such as margarines and low-fat spreads, crisps, chips, pastries, biscuits and cakes and they have only appeared in our diet relatively recently. Research suggests that these fats can be very damaging to health and may increase cancer risk. We do not encourage the use of processed, low-fat foods which often contain extra sugar, starches and other additives. For information about fat in dairy products, please see page 12 and the section below. I have heard that I should avoid dairy products if I have cancer; is that true? There is conflicting evidence about dairy consumption if you have breast cancer. Some studies suggest that dairy can provide protection against breast cancer while other research indicates an increased risk of breast cancer from a high intake of dairy. So it is not clear to what extent dairy foods should be included in the diet of people with breast cancer. The best and most recent research suggests that it is not necessary to avoid dairy products but we feel it is important to choose the best quality products available. Ideally milk would be organic and non-homogenised and come from grass-fed cows. This type of milk is available from some supermarkets, health food shops and specialist suppliers. It is preferable to eat moderate
• Small fish such as sardines including the bones. • Dark green leafy vegetables such as watercress, cabbage, spinach, kale, spring greens, broccoli and parsley. • Pulses such as lentils, peas and beans. • Nuts and seeds, especially pumpkin seeds, sesame seeds (also available as tahini), sprouted alfalfa, almonds and walnuts. Please note that adequate vitamin D is required for good calcium absorption. To find out more about the benefits of vitamin D, see page 22 in this booklet. The mineral iodine is essential for health in many ways including normal thyroid function. The thyroid gland controls how quickly the body uses energy, makes proteins and is essential to other hormones. Growing evidence suggests that sufficient iodine in the diet may be important for breast health. Other than seaweed, dairy foods are the main source of iodine in our diet. Fish, seafood and eggs also contain significant amounts of iodine. A daily kelp supplement is another good way to ensure adequate iodine intake. I have heard that I should be a vegetarian or vegan; would this be a good idea? Although we would encourage people to eat a plant-based diet we would not recommend avoiding animal products. Our bodies are designed to thrive on plants and animals as food and the animal products provide us with many essential nutrients, some of which can be difficult to obtain in optimal amounts from plants. Examples include vitamin B12, iron, vitamin D and the essential omega 3 fats.
Some answers to frequently asked questions How can I maintain steady blood glucose levels? Blood glucose levels naturally fluctuate during the day due to food intake and changes in hormone levels. However, it appears that keeping the blood glucose levels relatively steady will help to promote good health. The following tips will help you to avoid large fluctuations in blood glucose: • Avoid refined grains and added sugar, syrups or honey as much as possible. Fruit should be the main source of sweetness in the diet. • Limit starchy carbohydrates (potatoes and whole grains) to no more than 20% of a meal. • Include some protein and healthy fat in every meal and snack. • Eat at regular times and don’t skip meals. Have small snacks between meals if you feel hungry. • Limit caffeine intake. • Limit alcohol intake. • Reduce stress where possible and give yourself time to relax and unwind. Should I buy organic foods? Organic foods have the double advantage of having lower levels of potentially harmful chemical residues and, according to recent research, they may have higher levels of beneficial nutrients. Organic foods tend to be more expensive than conventional produce and not so widely available. For this reason it is important to stress that it is preferable to eat an abundance and wide variety of whole foods, whether organic or not, rather than limiting the food range due to the cost or availability of organic produce. It is also important to be aware that not all organic standards are equal. The largest UK certification body, the Soil Association, has some of the strictest standards and we would recommend choosing Soil Association certified produce whenever possible. An increasing number of farmers markets and box schemes supply organic produce and often the quality is superior and more reasonably priced than supermarket produce. Do I need to follow an alkaline diet? It appears that the body’s tissues function best when in a slightly alkaline state. Our diet can influence the acid-alkaline levels of the tissues and the foods with the greatest alkaline-forming effect are vegetables and fruit. This does not mean we should avoid all other foods with less alkaline-forming effects as the acid-alkaline impact is only one consideration of food and we would not be well nourished if we lived exclusively on vegetables and fruit. A plant-based diet containing a moderate level of animal products and free from refined, processed foods is very supportive to acid-alkaline balance. It is important to be aware that other lifestyle factors influence the acid-alkaline levels of the tissues and emotional stress may have a greater impact than the foods we eat.
Should I be including cancer superfoods in my diet? From time to time media stories highlight the benefits of certain foods for those with cancer. Examples include green tea, soya products, blueberries, turmeric and dark chocolate. The stories result from positive research involving these foods which are given the prestigious branding ‘superfood’. The trouble with the concept of superfoods is that the decision of which foods to label this way is based on the food research that happens to have been picked up by the media at any particular time. In reality we are designed to eat a variety of whole, unprocessed foods and all such foods have benefits for health. The real power of a healthy diet comes from combining many different foods. So while it is a good idea to include the so-called superfoods in the diet, it is not beneficial to emphasise them over and above other healthy foods. Most foods, even the healthiest ones, have some negative aspects; the sugar in dark chocolate, the caffeine in green tea and the anti-nutrients in soya. But when they are included in the context of a healthy balanced diet the negative aspects are counterbalanced by the properties of other foods. Is it a good idea to make my own fresh juices? Freshly made juices can be a great way of boosting levels of the valuable nutrients found in vegetables and fruit. Because the process of juicing removes the fibrous portion of the plant and fibre is important for health, juicing should generally be used to supplement the diet rather than be a replacement for whole vegetables and fruit. Removing the fibre results in faster absorption of nutrients as well as sugars so we recommend juices containing mainly vegetables rather than fruit which will be too sweet. Freshly made vegetables juices are also very cleansing for the body. For more details on juicing speak to one of our nutritional therapists. If I eat well do I need to take supplements? Ideally the best balance of all the nutrients required would be obtained by eating a healthy, balanced diet. However this does not always happen. This can be as a result of poor food choices or nutrient absorption. It is worth noting that nutrient levels have been declining in our healthiest foods over the past few decades due to intensive farming practices. Or it could be due to a state of health requiring extra nutrients. Examples relating to this second point include an increased need for iron with anaemia or calcium and vitamin D with osteoporosis. Mild deficiencies of vitamins and minerals are relatively common and although foods would ideally be used to remedy the situation, sometimes supplements can do the job more quickly and efficiently. There are times when those with cancer have an increased need for a wide range of nutrients especially if weight loss becomes a problem or oral intake of food becomes difficult. In these situations nutritional supplements can be essential. We would always recommend speaking to a nutritionally qualified health professional before taking nutritional supplements.
Some answers to frequently asked questions How can I reach and maintain a healthy weight? Some of the strongest research regarding diet and breast cancer relates to weight. It is very clear that being overweight or obese increases the risk of breast cancer and also increases the risk of the disease recurring. Also women with breast cancer who are obese have poorer survival rates than women with breast cancer who are not obese. The negative impact of carrying extra weight can result in metabolic changes such as greater levels of inflammation and a rise in oestrogen levels which occur as fat tissue stores increase. If you wish to lose weight we would not recommend crash dieting which could lead to health problems. Instead we recommend you follow a healthy diet as outlined in this booklet and ideally speak to a nutritionally qualified health professional for further guidance. Weight loss can be a problem for some people with cancer and in such cases extra calories, protein and other nutrients may be required. Calorie dense foods that we recommend include nuts and seeds, oily fish, avocados and coconut milk. We do not recommend foods containing processed fats or sugar. If you are having difficulty maintaining a healthy weight it is important to seek support from one of our nutritional therapists. What else can I do to support my health and wellbeing? It has been clearly demonstrated that regular physical activity is beneficial for cancer survivors. A 2011 report published by the cancer charity Macmillan recommended that cancer survivors should undertake 2.5 hours of moderate intensity physical activity per week and stated that being active to the recommended levels could reduce the risk of breast cancer recurring by 40%. If you are unable to manage this amount of physical activity, start with gentle activities such as light gardening or walking for a few minutes per day and build up gradually. Physical activity supports bone and muscle strength, energy levels and psychological health as well as helping to maintain healthy weight. In the last few years it has become apparent that a very important cancer-protective nutrient is vitamin D. It has also become very clear that many people are deficient in this nutrient. While it is possible to get some vitamin D from our food, the richest sources being oily fish, beef liver and egg yolks, we get most of our vitamin D through exposure to sunlight. With people increasingly using sun creams and avoiding exposure to sunlight for fear of burning or skin cancers, our main source of vitamin D is under threat. Research shows that while it is not good to let your skin burn in the sun, regular moderate exposure to sunlight is protective against cancer. To reduce risk of skin burning, choose early morning or evening or short spells of exposure to sunlight e.g. five minutes three times per day.
Our world has become increasingly polluted and every day we are exposed to a whole host of chemicals that are foreign to the body. Many of these can upset the delicate balance of hormones in the body. To help the body cope with high levels of chemicals it is important that we are able to efficiently break down and eliminate them. This requires that our bodies are working efficiently. The diet recommended in this booklet can help to ensure this, as can regular gentle exercise and drinking plenty of water. Certain nutritional supplements and herbs can enhance healthy detoxification but it is recommended that you seek the advice of a nutritionally qualified health professional before taking such products. Should phytoestrogens be avoided with breast cancer? Phytoestrogens are often called plant oestrogens since they contain compounds that exert weak biological effects on animals, similar to the hormone oestrogen. As oestrogen can encourage the growth of breast cancer cells it may seem obvious that phytoestrogens should be avoided if you have breast cancer. But, the story is not that simple. Phytoestrogens have the ability to bind to the body’s oestrogen receptors and prevent the body’s own oestrogen from binding to those receptors. As phytoestrogens have a much weaker oestrogen effect than the body’s own version of this hormone, the end result is a lowering of the oestrogen response. Research studies have shown that Asian women consuming regular amounts of phytoestrogen-rich foods, from an early age had a decreased risk of breast cancer. The same protective effect has not been shown for women living in the West eating soya products in adulthood. Dietary phytoestrogens certainly don’t seem to be a risk factor for cancer and so do not need to be avoided. Actually they would be difficult to avoid if you are consuming a plant-based diet. Apart from soya, other sources of phytoestrogens include certain pulses, seeds, grains and vegetables. Please note that soya products are not recommended in large amounts due to their action of blocking the absorption of some nutrients as discussed earlier on page 13 of this document.
Putting it all together
If you feel you would like to make some changes to your diet after reading this booklet there are some important points that will help you do this: •
eep it simple — just do things gradually in your own time. This will enable changes to be K sustained over a longer period.
et support — speak to one of our nutritional therapists who will be able to offer you guidance G and support as you make your dietary changes. Seek support and encouragement from friends and family and ask for their help on practical issues such as shopping and food preparation. Also contact us for details on our healthy eating talks and healthy cookery courses.
The advice (given by the Haven nutritionist) has really helped me to focus on eating the right type of foods and balancing my blood sugar. It’s a very sensible and achievable attitude towards healthy eating which I will be able to continue with on my own. Haven Visitor
T he enjoyment of food — eating is one of life’s great pleasures and following a healthy diet can be enjoyable. By incorporating a wide variety of interesting, healthy foods, this type of diet will bring many benefits to the way you feel, which will be a great pleasure in itself. Of course many people like to treat themselves to foods that would be regarded as less than healthy. If you are eating well for the majority of the time there is room to indulge yourself with the foods you love. If you choose to treat yourself in this way, do not feel guilty or cross with yourself. Instead see it as doing your body a great service as the psychological benefits you experience will reap physical rewards.
Finally, our Healthy Eating Ideas booklet can help you use this guidance to cook healthy nutritional meals at home. If you would like to talk to one of our nutritional therapists about anything in this booklet, please contact your nearest Haven. Contact details are on the back cover.
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www.thehaven.org.uk The Haven is the working name of Breast Cancer Haven. Registered Charity No. 1061726. Issue date: October 2012. Review date October 2014. Version 1.
This booklet outlines our nutritional recommendations and explains the reasoning behind them. These recommendations are backed up by the mos...