Cancer and Nutrition

A cancer diagnosis closely affects all aspects of your life, including your priorities, family life, and overall appearance. While you're learning about cancer, its treatments, and many related topics, you may not think much about how you should be eating based on your illness. However, the way you eat during cancer treatment is much more important than your eating habits during other periods of your life. You can read the article where specialists at Anadolu Health Center provide information on cancer and nutrition.

During and After Your Treatment, Proper and Balanced Nutrition:

• Helps you feel better
• Keeps you strong and energetic
• Maintains your weight and the nutrients stored in your body
• Helps you tolerate complications caused by treatment
• Reduces your risk of infection
• Assists in quick recovery and getting back to your routine

Various studies have shown that individuals who are well-nourished during cancer treatment are more resistant to side effects from treatments such as chemotherapy, radiotherapy, surgery, and biological therapies. Well-nourished individuals can even tolerate higher doses of medications.

Nutrition in Cancer

When it comes to how cancer patients should eat, unfortunately, everyone claims to have the “information.” However, the problem you may face is that everyone gives different advice, and you don't know what to do or who to trust. Every day, you hear different things from the internet, radio, TV, newspapers, or your friends, and it leaves you confused. Some of the things you hear are correct, but unfortunately, most of them consist of misinformation. However, since you don't know which advice to follow, you cannot distinguish between right and wrong.

There is No Fixed Nutrition Program for Cancer Patients
The nutrition program, or in other words, selecting the right foods to ensure adequate and balanced nutrition, varies from person to person. Especially in cancer patients, nutrition changes based on the type and severity of side effects caused by the treatments being applied. For example, in cases of swallowing difficulties caused by the treatment, nutrient-dense liquid foods are recommended. We will examine various nutrition practices related to potential side effects in this section.

Just as the nutrition program changes depending on side effects, it also varies depending on the type of cancer. We hope to clear all the questions you may have on this topic in this section.

What is Healthy Nutrition?

We all know that a healthy life is possible through healthy eating. But what do we mean by healthy nutrition? Healthy nutrition is defined as the adequate intake and proper use of the nutrients necessary for growth, development, and long-term healthy and productive living. Being physically active, maintaining a healthy weight, not smoking, limiting alcohol consumption as much as possible, and eating healthy are key factors for keeping your body strong and dynamic.

Healthy nutrition is particularly important for cancer patients. Consuming the necessary nutrients such as proteins, carbohydrates, fats, vitamins, and minerals will help you fight the disease. Many people continue to live for many years after cancer treatment. Therefore, healthy eating and staying physically active are crucial for leading a more dynamic and healthy life in the future.

How Should You Eat Before Treatment?

The primary goal before treatment is to stay strong so that the treatment can have the most positive impact. Just as there is no standard nutrition plan in every phase of cancer treatment, there is no standard nutrition approach before treatment. However, the focus during this period should be on the person’s weight and the type of treatment to be applied. Regardless of the situation, maintaining an ideal weight is essential for the effectiveness of the treatment. Individuals who are underweight should aim to reach their ideal weight before starting treatment. Chemotherapy and radiotherapy can lead to certain side effects that may negatively affect nutrition, which we will discuss in detail in this section. Therefore, it is crucial for individuals to gain weight and reach their ideal weight before treatment begins.

For individuals considering surgery, weight is also important. Your surgeon may recommend weight loss to improve the success of the surgery. However, the most important point to emphasize is that nutrition therapy should be personalized. Every patient who needs to gain or lose weight should follow a program under expert supervision. Unfortunately, today there are thousands of different diets available on various websites or in newspapers. Remember, a nutrition program should be tailored to an individual’s age, gender, activity level, health issues, and physiological needs. Diets published in newspapers or websites are generalizations and can especially put individuals with health problems at risk.

So, the question we frequently encounter, and the one that may be on your mind but you haven’t found a clear answer to, is:

How should cancer patients eat?

The concept of nutrition, which is crucial for cancer patients, is not much different from the nutrition approach for other people. The key is for the individual to maintain adequate and balanced nutrition in relation to the side effects caused by the treatment.

Here are a few healthy nutrition suggestions that can be given to individuals before treatment:

• Eat at least 5 servings of different colored vegetables and fruits per day.
• Prefer whole grain products (such as whole wheat) instead of processed grain products.
• Reduce the consumption of processed and fatty meats.
• Increase your protein intake.
• To minimize the harmful effects of chemotherapy, drink at least 2 liters of water, especially during treatment.
• Avoid foods high in sugar and fat with little nutritional value.

Balance Your Diet

Diversifying your diet is the key rule to meeting your nutritional needs (vitamins, minerals, carbohydrates, fats, proteins) in the most balanced way. Meeting the nutritional needs of the body is even more important for cancer patients.

You may be directed by those around you or some healthcare professionals to take the necessary nutrients in pill form. However, keep in mind that there is a significant difference between getting nutrients from natural foods and from supplements. A balanced diet helps the body by providing the necessary nutrients, positively impacting health. On the other hand, some antioxidant supplements like vitamin E, vitamin C, and folic acid can interfere with the effects of certain chemotherapy drugs and radiation therapy. Therefore, if you plan to use a multivitamin/mineral supplement, it is important to seek guidance from a healthcare professional specialized in this area.

Proteins

Carbohydrates

Does Sugar Feed Cancer Cells?

People who consume high amounts of sugar and sugary foods often miss out on nutrient-dense foods. The nutritional value of sugar and sugary foods is extremely low.

Your primary goals during treatment should be to maintain sufficient calorie and nutrient intake, stay energetic, and maintain your ideal weight. If you are losing weight and unable to consume enough calories, including high-calorie foods like sugar in your daily meals may help you gain weight. However, if your weight is already ideal or increasing towards obesity, consumption of sugar and sugary foods should be avoided.

Sugar does not directly cause cancer, nor does it promote cancer cell growth. Therefore, sugar is not recommended for cancer patients not because it feeds cancer cells, but because it has no nutritional value.

Fats

Vitamins

Minerals

Water

Water is the second most important element for human life after oxygen. While a person can survive without food for weeks, they can only survive a few days without water. Vomiting and diarrhea, which can develop due to cancer treatments, cause additional loss of water from the body. For this reason, drinking 8-10 cups of water per day can prevent dehydration. Additionally, drinking water during chemotherapy is crucial to minimize the harmful effects of chemotherapy drugs on the body. Drinking water helps remove chemotherapy drugs from the body after they have done their job without causing harm.

Functions of water in the body:

• Digestion, absorption, and transport of nutrients from the food we eat
• Functioning of cells, tissues, organs, and systems
• Removal of harmful metabolic byproducts
• Regulation of body temperature
• Lubrication of joints
• Support for various biochemical processes

An average adult loses about 10 cups of water per day, and this lost water needs to be replaced. Even though we might think other drinks contribute to our fluid intake, beverages like tea and coffee are actually diuretics, which lead to water loss. Therefore, tea and coffee consumption should be limited, and the body's fluid needs should be met with water. Drinking 8-10 cups of water per day will meet your fluid requirements.

Does What You Eat Benefit You or Harm You?

Many cancer patients believe that certain foods can treat cancer, which leads them to frequently consume specific foods or herbal mixtures. However, the impact of these practices on health is not well understood. Unfortunately, no food has the ability to destroy cancer cells. Some foods may positively influence side effects caused by treatment, and others may reduce the risk of developing cancer. The goal of nutrition in cancer patients is to meet the body's energy and nutrient needs, creating a stronger, more energetic immune system that can better combat side effects and infections. It is not possible, under any circumstances, to destroy cancer cells with food or starve them by avoiding certain foods.

You may have heard the terms "alternative" and "complementary" medicine in the context of cancer diagnosis, prevention, and treatment. But do you know how safe these methods are?

Proven treatments are those that have been found to be safe and effective through rigorous research. After studies, the treatments or medications to be used are approved by the FDA (Food and Drug Administration). First, clinical trials are conducted to determine if a treatment or medication is safe and effective for humans. Before the medication is used on humans, studies are done in laboratories and on animals. Once the treatment is confirmed to be safe, its effect is evaluated on patients. If the treatment is effective in patients, the FDA may approve its use.

The term "complementary" refers to treatments that are applied in addition to proven therapies. An example of this is meditation to reduce stress. Complementary therapies are not intended to cure the disease but may be used to improve symptoms and overall well-being.

Alternative methods, on the other hand, are described as treatments that cure cancer. However, these methods have either not been proven effective due to lack of research or have been found to be ineffective. If you are receiving alternative treatment instead of proven therapies, you may risk harm due to the use of inappropriate or ineffective treatments.

Side Effects That May Negatively Affect Your Nutrition During Treatment

During treatment, your main focus should be on fighting cancer. Healthy eating will help you stay strong during this battle while ensuring that your body gets the necessary nutrients. However, during treatment, certain side effects may negatively affect your nutrition. Even though healthcare professionals provide information about the treatment and potential side effects beforehand, these effects vary from person to person. Some patients may not experience any side effects, while others may experience specific ones more intensely. Many factors influence what kind of side effects you may experience and how severe they will be. These factors include the type of cancer, the area being treated, the type and length of treatment, and the dosage.

Prepare Yourself for Treatment

Until you start treatment, you cannot be sure whether it will have an effect on you or how it will affect you if it does. The best way to prepare for treatment is to think of the process as "focusing on yourself and your recovery."

Here are a few ways to prepare:

Think Positively:
By adopting a positive attitude, you can reduce your anxiety about possible complications from treatment by discussing your feelings and becoming more knowledgeable about cancer and the treatment. As a result, being prepared for potential complications will help you feel more in control and maintain your motivation for the treatment.

The potential complications from treatment often affect eating in a minimal way, or not at all. Even if a complication arises that interferes with your eating, they tend to be mild and many disappear after cancer treatment. There are also medications available to control potential complications.

Healthy Diet

A healthy diet is essential for optimal body function. If you follow a healthy diet during treatment, you will maintain your strength, prevent the breakdown of body tissues, renew your tissues, and continue to build resistance to infections. People who eat a healthy diet are always more successful at coping with the potential complications of treatment. In fact, some cancer treatments are more effective in individuals who are adequately and balancedly nourished.

Cancer Treatments and Nutrition

Surgery

Surgery is defined as the removal of cancer cells and the surrounding tissue from the body. After surgery, treatment can be supported with chemotherapy and/or radiotherapy, and in some cases, radiotherapy and/or chemotherapy can be applied before surgery to shrink the tumor. Based on various tests, your oncologist will determine what treatment plan to follow. After surgery, your protein and calorie requirements increase for wound healing. Many people experience pain and weakness after surgery, making it difficult to meet their nutritional needs. If any part of organs such as the mouth, esophagus, stomach, small and large intestines is removed through surgery, the body’s ability to utilize necessary nutrients may change. Before surgery, if you are taking any vitamin supplements that affect red blood cells or thin the blood (such as B6, folic acid, B12, vitamin E, vitamin K, omega-3, garlic, ginger), it is recommended to stop them.

The post-surgery diet should be planned in three stages:
In the first stage, easy-to-digest liquid foods should be preferred. If you have nausea, vomiting, or diarrhea, you may tolerate liquid foods better than solid foods. The liquid foods in this stage provide about 500 calories per day and do not overburden your intestines. These foods include water, lemonade, clear tea, strained fruit juices, and strained vegetable soups. Since this diet will not meet your needs for a long period, unless otherwise stated, you can move to the second stage on the second day after surgery.

In the second stage, in addition to the foods in the first stage, you can include rice pilaf, all kinds of fruit juices, pudding, white bread, grilled meat, chicken, fish, and milk. Foods with fiber, such as bulgur pilaf, legumes, and whole wheat bread, should be avoided as they are harder to digest. Additionally, vegetables that cause gas, such as cauliflower and cabbage, should not be consumed.

The third stage includes a normal diet.

Post-Surgery Recommendations:

• Ensure your food and drinks are easy to digest and low in fat. Since high-fiber foods are harder to digest, avoid them for a while.
• Avoid gas-producing foods (such as legumes, cauliflower, radishes, etc.).
• Increase your fluid intake to prevent dehydration.
• Increase your meal frequency by eating small meals throughout the day.
• Don’t wait to feel hungry; eat at the times you have planned for meals and avoid skipping meals.
• Try to return to your daily activities as soon as possible under the supervision of health personnel. Avoid being overly dependent on bed rest.
• Proteins are essential for rebuilding your strength and forming new cells. Therefore, you may increase the consumption of eggs, meat, and dairy products.
• Ensure you are getting enough vitamin C, iron, calcium, magnesium, and potassium after surgery.

Radiotherapy

Chemotherapy

Immunotherapy

Hormone Therapy

Certain hormones, particularly in cancers such as breast and prostate cancer, can cause cancer to develop and progress. Hormone therapy aims to block the production or activity of these hormones, either through medications or by surgically removing the hormone-producing glands. Hormone therapy can kill cancer cells or slow their growth.
Some hormone therapies may lead to fluid retention, increased appetite, and weight gain, while others may cause mild nausea and fatigue. Cancer patients undergoing hormone therapy are advised to seek help from a nutritionist to maintain their ideal weight.
To manage the side effects of hormone therapy:

• Reduce the amount of salt you add to food to prevent fluid retention and avoid keeping a salt shaker on the table.
• Since hormone therapy may increase your appetite, avoid excessive calorie intake, stay active, and maintain your weight.
• Ask your doctor and dietitian if hormone therapy will affect your calcium intake or bone density.
• Soy and soy products are sources of phytoestrogens, which behave like the natural estrogen hormone in the human body. You can consult your dietitian for more information about these products.
• Remember that the side effects of hormone therapy are temporary and will only last during the treatment period.

Weight Management in Treated Patients

Why is Weight So Important?

Weight Loss:

Weight loss can occur due to several factors:

• Pressure from tumors in the stomach or abdominal area,
• Treatments for head and neck cancers,
• Loss of appetite due to psychological reasons like depression,
• Cancer treatments, such as surgery, which can cause weight loss for weeks, or immunotherapy, which may cause severe weight loss,
• Side effects from treatments like nausea and vomiting.
  Weight loss can lead to fatigue, weakness, and a weakened immune system, making you more susceptible to infections. If a drop in immune system components is observed in blood tests before chemotherapy sessions, chemotherapy may be delayed. Healthy individuals who maintain a proper weight through adequate and balanced nutrition have a lower risk of such complications.

Coping with Weight Loss

Weight loss results from inadequate food intake due to lack of appetite. If you experience weight loss during your treatment, try to eat small portions every one to two hours. It will be helpful to keep high-calorie and high-protein foods in your refrigerator to consume whenever you feel hungry.
Keep the following tips in mind:
Some cancer patients may not like the taste of fats and fatty foods. In these cases, you should consume high-protein, low-fat foods such as fat-free or low-fat yogurt, cheese, eggs, and lean meat.
To increase your calorie intake, you can consume 100% fruit and vegetable juices and dried fruits.
Engaging in light physical activity can help reduce stress and improve your appetite.
Here are a few practical tips to help combat your loss of appetite:

• Eat your favorite high-calorie foods.
• Try to eat small amounts frequently.
• Avoid drinking liquids during meals, as they may cause bloating.
• Try eating in a pleasant setting with your family or loved ones.
• Avoid entering the kitchen while food is being prepared, as food odors may suppress your appetite.
• Do 5-10 minutes of exercise at least half an hour before meals, as this can help stimulate your appetite.
• Try to stay away from stress during meals.
• Serving your food more aesthetically may increase your appetite. Remember, "A good meal is first enjoyed by the eyes, then by the nose, and finally by the mouth."
• Use times when you feel good to have a hearty meal. Many people have a better appetite in the morning because they feel more rested.
• Avoid eating immediately after treatment.
• If possible, try eating before bedtime. This will not affect your appetite for the next meal.
• Avoid foods that require excessive chewing, as they can lead to less food intake.
  If you experience any of the following symptoms, consult your doctor:
• Nausea
• Unable to eat for one or more days
• Weight loss of 2.5 kg or more
• Pain while eating
• Difficulty urinating for an entire day
• No bowel movements for two days or more
• Strong-smelling or dark yellow irregular urine
• Vomiting episodes lasting more than 24 hours

Weight Gain

Coping with Weight Gain

Should Cancer Patients Follow a Weight Loss Diet?

When people hear "diet," they usually think of starving, which is often the result of low-calorie, quick weight loss diets seen in newspapers, magazines, and online. However, these types of diets negatively affect health. Cancer patients can follow a weight loss diet, but it must be done with great care. The primary goal for cancer patients is to meet their calorie and nutrient requirements while maintaining body strength. Therefore, cancer patients should seek advice from a nutritionist if they wish to lose weight.

Practical Tips to Maintain or Lose Weight

• Do not skip meals; aim for six meals a day, including three main meals and three snacks.
• Reduce sugar and sweets intake.
• Increase fiber intake (unless otherwise specified).
• Increase vegetable and fruit consumption.
• Choose low-fat foods.
• Increase fluid intake.
• Do not add extra fat to vegetable dishes containing meat.
• Prefer white meat over red meat.
• Instead of frying, use steaming, baking, boiling, and grilling methods.
• Be sure to engage in physical activity, including daily activities (such as climbing stairs, washing the car, etc.).
• Develop a habit of reading food labels.

Fatigue During Treatment and Its Causes

Fatigue is one of the most common side effects of cancer treatment, affecting nine out of ten patients.
Fatigue is different from the tiredness that comes from the regular hustle of daily life. Here are some symptoms of fatigue:

• Feeling as though you have no energy
• Sleeping more than usual
• Not wanting to do normal activities
• Not caring about your personal appearance
• Still feeling tired after sleep
• Difficulty concentrating
• Reduced sexual desire
• Being irritable and impatient
  In some people, fatigue may resolve after treatment, while in others, it can last for several months. Fatigue caused by treatment can isolate you from many daily activities.

Constipation
Changes in eating habits, fatigue, medications, and decreased physical activity can contribute to constipation. In cancer patients, constipation can be a symptom of the disease itself, but treatments can also cause constipation. Dehydration (fluid loss) and insufficient food intake can also cause constipation.
Medications for pain, anxiety and depression, antacids, diuretics (water pills), iron and calcium supplements, sleep medications, or general anesthesia can lead to constipation. Some chemotherapy drugs, especially in older individuals or those eating a low-fiber diet, can cause constipation.

Preventing Constipation

• Ensure that you consume fiber-rich foods such as legumes, whole grain products, whole wheat bread, whole wheat pasta, and dried fruits.
• Increase fiber intake by consuming fruits and vegetables that can be eaten with their skins, after thoroughly washing them.
• Drink plenty of liquids, especially warm ones (8-10 glasses).
• Try to be more active.
• Try to eat at the same times every day.
• Use the laxatives prescribed by your doctor.

If you experience any of the following, consult your doctor:

• If you are unable to go to the toilet for three days
• If you see blood in the anal area or stool
• If you are unable to go to the toilet within two days after using a laxative
• In cases of persistent cramps or vomiting