Ask the Nutritionist: Your breast cancer questions answered!

Q: I was diagnosed with her 2+ breast cancer, stage III, in 2009. I just completed treatment (last Herceptin last month). I have begun to switch to a plant-based diet but still eat a little chicken and fish. I have to avoid soy. I am intrigued by the vegan diet outlined in Kris Carr’s new book, Crazy Sexy Diet (she is also the author of Crazy Sexy Cancer). As long as I avoid tofu and focus on other proteins like beans, etc., is the vegan approach alright to try? I can pretty readily give up chicken and fish, but want to be sure it is okay. Thanks.

CU
Hartford, CT

Kris Carr’s book Crazy Sexy Diet has been getting a lot of press lately, so I am very glad you asked this question. It is something other patients are probably wondering about as well.

At Dana Farber, we recommend a plant-based diet and eating animal products in moderation.

A vegan approach that centers on whole foods, using limited processed soy products, is certainly alright to try, if you are healthy.

You may need to supplement certain vitamins such as B12, which can be difficult to obtain on a vegan diet, although possible through fortified foods such as nutritional yeast and many brands of almond milk.

It is also important to avoid getting stuck in “black and white” thinking: all foods are either “good or bad.” Good and bad foods don’t exist; better choices do.

The book also recommends adding in a green juice daily and eating only organic food. If you have the time and money to make those changes, they will not be detrimental to your health. However, no rigorous scientific studies have proven that taking a food-based supplement will increase your health, and these are often quite expensive and can interfere with certain medications or cancer treatments.

Ms. Carr also talks a lot about blood pH and alkalinity. We recommend that you read this response by a Dana Farber Registered Dietician before following Ms. Carr’s advice.

If you are already enjoying a primarily plant-based diet, we recommend that you continue with this healthy eating pattern. Eliminating chicken and fish while adding in more plant-based proteins including sounds like a perfectly healthy plan. We recommended adding these plant-based proteins: whole grains, lentils, beans, hummus, nuts and seeds.

Also, be mindful to supplement or seek fortified foods as needed.

We encourage you to work with a registered dietitian to determine what your body needs, and how you can work the foods you love into your diet, while getting an appropriate amount of energy.

It is important that you are not restricting your diet to a level that you are no longer able to maintain a healthy weight, which some people may find challenging when they are on a vegan diet.

For patients in active treatment we strongly recommend they speak with a dietitian before adopting a vegan diet to be sure all their nutrient needs are met at a time when they are at risk for developing malnutrition.

If you are a Dana-Farber patient, please schedule an appointment with one of our nutritionists at (617) 632-3006.

Q: I am currently receiving Lupron and Zomeda as well as taking Tamoxifen. I am very active and work out regularly. I eat healthy. I am having trouble maintaining my weight and am gaining weight, especially in my mid-section. Is there some food that I can focus on that will help me be able to fight this?

Cindy
Medford, MA

A: It is wonderful to hear that you are working out and eating healthfully, which are two very important parts of cancer survival. Now we just need to work on consuming an adequate amount of calories to maintain your healthy weight.

Maintaining a healthy weight throughout cancer treatment increases the chance of survival after cancer diagnosis. It is safe to lose is one to two pounds of weight per week.

Losing weight gradually is the best way to shed fat without losing muscle. You can do this by eating 500 fewer calories a day, burning 500 more calories per day, or doing a combination of both.

You can make small changes in your diet to avoid that weight gain. To feel full, eat smaller meals more frequently (i.e. six small meals vs. three large meals), consume whole grains instead of refined carbohydrates, and include a serving of protein with all of your meals and snacks.

By eating fruits and vegetables, you also feel full for a longer period of time because these foods are digested slowly in your stomach.

Fruits and vegetables are low in calories but full of fiber and phytonutrients, both of which will help prevent cancer while keeping you at a steady weight. Aim for 5-10 servings of colorful fruits and vegetables every day.

Safe, smart swaps to reduce your calorie intake

This chart offers a few suggestions to trim calories. Mix and match and choose what works best for you:

Instead of: Choose:
Fruit juice Whole fruit
Baked or fried potato Steamed green vegetables or carrots
Flavored yogurt Plain yogurt with fresh or frozen fruit
Mayonnaise Mustard
Creamy salad dressings Vinaigrette or Balsamic Vinegar
Creamy soups Tomato- or broth-based soups
A large bagel 2 slices of whole grain toast
1 cup mac ‘n cheese or alfredo pasta 1 cup pasta with marinara sauce
Whole or 2% milk 1% or skim milk
70% or 85% lean ground beef 90 or 93% lean ground beef or turkey
T-bone steak, porterhouse steak, top loin steak, prime rib, “Prime” cuts Eye of round roast or steak, round steak, chuck shoulder roast or steak, top sirloin steak, tenderloin steak/filet mignon, “Choice” or “Select” cuts
Fried, breaded, or battered meat, poultry, or seafood entrée Baked, grilled, or broiled entrée

Balance Your Plate

Planning balanced meals and snacks can help you feel satisfied and help you consume a healthful variety of foods.

Aim for generous portions of fruits and vegetables so you feel full from the fiber and get the cancer-fighting benefits of phytonutrients.

Pair protein sources with your starches for long-lasting energy.

“Friendly fats,” such as nuts, avocadoes, and vegetable oils, are a heart-healthy addition in small amounts.

View our advice on how to balance your plate.

Mindful Eating

Mindful eating is being present for the sensations of tasting, swallowing, and breathing while eating.

Scientists are evaluating the complex role of the mind-body connection in eating behavior.

Multitasking while eating can interfere with critical signals from the digestive system to the brain, which can lead to overeating.

Here are some simple first steps to eating mindfully:

  • sit at the kitchen table
  • eat without watching television, working at the computer, or reading the newspaper
  • eat slowly and chew thoroughly
  • put your fork down between bites
  • use your less dominant hand
  • notice the color, texture, and flavor of your food
  • begin a meal with a breathing exercise, prayer, or meditation.

We also recommend you meet with a Registered Dietitian, who can help you understand your individual weight goals and assist you in designing a healthful eating plan.

To schedule an appointment with a Dana-Farber nutritionist, please call (617) 632-3006.

Q: I liked the Nutrition Tip with the November 2010 Recipe of the Month that highlighted butternut squash because it was high in carotenes. What are some other foods that are high in carotenes? Should I be worried about absorption in cooked vs. raw vegetables?

Anonymous

A. We’re glad you like the recipe and nutrition tip we featured in the November 2010 newsletter.

Here is a list of some other healthy foods that are high in carotenes:

  • Carrots
  • Sweet potatoes
  • Spinach
  • Kale
  • Collard greens
  • Tomatoes
  • Pumpkin
  • Apricots
  • Cantaloupe
  • Broccoli

While all of these vegetables are delicious and healthy eaten raw, by steaming them, you can improve the availability of their carotenoids.

For example, once a tomato is cooked at a high temperature, your body will absorb more of the lycopene (a carotenoid) in it.

Lightly steaming broccoli, carrots, and spinach with a small amount of water improves your body’s ability to absorb the carotenoids in those foods.

Carotenoids are fat soluble, so you also can increase their absorption by eating them along with a small amount of heart-healthy oil, nuts, seeds, or avocados.

 

Q: Are Eggland’s Best Eggs safe to eat if I have had breast cancer? They feed soybean meal to their hens. Thanks.

Chris
Delmar, NY

A: You raise a very interesting question. Before we address the egg topic, I should clear up some misconceptions about soy and breast cancer.

It is not necessary for breast cancer survivors to avoid all types of soy foods.

Research suggests that survivors with an estrogen receptor-positive breast cancer should limit their consumption of soy foods, especially the more concentrated forms.

Avoid foods made from soy protein powder, soy protein isolate, and isolated soy protein (read the ingredient list to look for these). These forms of soy are often found in nutrition bars, soy protein powder, many high-protein breads and cereals, and vegetarian “meat-less” options, including certain brands of veggie burgers or soy hot dogs.

Natural soy foods such as soy milk, edamame, tempeh, miso, and tofu can be safely consumed a few times a week (3-4 servings per week is the general recommendation).

Foods such as soybean oil, soy sauce, and soy lecithin do not contain any phytoestrogen, so you do not need to avoid or limit consuming them.

Back to your question: chickens are sometimes fed soybean meal in large egg farms. The eggs have been found to have soy isoflavones, a type of phytoestrogen, in them. However, the amount is very low and unlikely to cause any harm.

Should you choose to avoid these kinds of eggs, we suggest you buy eggs from a farmer’s market and talk directly to the supplier about the hens’ diet. You may also find soy-free eggs in specialty grocery stores, such as Whole Foods.

Q. Do you know where I can get a suggested daily menu for someone who is going through chemotherapy?

Tommy

A: Balanced nutrition is a very important part of cancer treatment, as well as survivorship and prevention.

A healthful diet can help rebuild your body’s cells and energy level, especially if you are receiving chemotherapy or radiation treatment.

Since every patient is unique and has their own sets of needs, we encourage you to talk to our nutrition experts while receiving your care at Dana-Farber Cancer Institute.

We encourage everyone who is undergoing cancer treatment to meet with a Registered Dietitian one-on-one to develop an individualized eating and vitamin/supplement plan. This plan should meet a particular patient’s goals and needs, while taking into account side effects of treatment and other diseases for which a patient is receiving care.

The Registered Dietitians (RDs) at Dana-Farber are nutritionists with special training in the areas of oncology and integrative nutrition. Their work is based on scientifically sound nutrition therapies.

Working with other members of your healthcare team, your nutritionist will help you design a practical eating plan to meet your individual needs with special attention to your beliefs and cultural values.

Until you meet with an RD, we recommend that all our patients follow the Optimal Diet Plan for cancer, and eat a primarily plant-based diet.

Our website has an entire recipe section full of delicious and nutritious meals for you to choose from in planning your meals.

Q: It is my understanding that chemotherapy weakens the immune system. When receiving chemo, which diet is better to lean toward (especially if you know you will be going through a bone marrow transplant in the future): the optimal diet for survivors or the low bacterial diet? For instance, one has fresh fruits, while the other wants you to cook the fruit first. Secondly, the low bacteria diet only allows certain brands of bottled water. Is it better to just drink Aquafina or Dasani during chemotherapy? Third, is it better to follow the 24 hour rule on leftovers? How much of the low bacteria diet should be used?

LRM
Portland, CT

A: Thank you for your great questions.

A low bacteria diet is recommended for the first 100 days following a Bone Marrow Transplant.

Since you are currently undergoing chemotherapy, and are not in that window of post-transplant, you do not have to stick to a very low bacterial diet. Instead, it is important to maintain basic food safety principles, and follow the optimal diet.

To answer your more specific questions: fresh fruit is fine to eat while undergoing chemotherapy, and an important part of a healthy diet. Be sure to always wash fruit and vegetables before eating them.

For bottled water, we recommend post-transplant patients drink Aquafina or Dasani, which are filtered tap waters. Otherwise, any bottled water is fine to drink during chemotherapy.

In terms of food safety, most leftovers can be kept refrigerated for 3 to 4 days. Check out these charts for information on how long to keep leftovers and the temperatures and times to cook food.

Check out our Optimal Diet Plan section for more information.

We also recommend that you meet with a Registered Dietitian who will help you design a practical eating plan to meet your individual needs.

Q: I had a bone marrow stem cell transplant at Dana-Farber and I would like to know what the best diet and food are to keep me healthy. All the info I received was what not to eat. I am at my 120th day after the transplant. I feel pretty good. My weight is constant.

Charles
North Attleboro, MA

A: We are so glad to hear that you are feeling well and are at a steady weight 120 days post-transplant.

Because you have passed the 100 day mark, you no longer have to be as strict with the low-bacteria diet that was previously recommended to you.

Check with your doctor or nurse practitioner to be sure there are no additional dietary restrictions you need to follow. Occasionally these arise if someone has complications post-transplant.

We recommend the optimal diet for cancer survivors, a plant-based diet that includes a balance of fruits, vegetables, whole grains, lean proteins, and foods rich in omega-3 fatty acids.

Strive for 5 to 10 servings of fruits and vegetables each day (a serving is 1/2 cup for most fruits and veggies and 1 cup for leafy greens, melon, and berries).

Be sure to eat at least 3 meals a day, and include walking and other forms of physical activity in your daily life.

For more tips on making nutrient-packed, healthful meals, see our Optimal Diet Plan and recipe archive.

We also recommend making an appointment with a Registered Dietitian, who can make a personalized assessment of your diet and symptoms and create a meal plan that will be the most helpful, long-term option for you.

Q. I was diagnosed with breast cancer in 12/07. I was wondering if decaffeinated coffee is bad for me. I did not receive chemo and am on Tamoxifen.

Julie
Reading, MA

A: There is no evidence that coffee, either caffeinated or decaffeinated, consumed in moderation, is bad for you.

Research is inconsistent about whether or not coffee increases risk of breast cancer, but the positive relation is only with very high consumption.

If you enjoy a cup of decaf coffee every day, we would not recommend that you stop.

Q: I have hormone positive, ER+ PR+,Stage 1, Ductal Carcinoma In Situ Breast Cancer. Should I avoid completely eating peanuts, peanut butter, lima beans, avocados, almonds and sweet basil? Any other foods that I absolutely should never eat?

Carolyn
Atlanta, GA

A: Many patients who have been diagnosed with cancer, or are undergoing treatment, often have questions about specific foods to avoid or include in their diet.

There is a tremendous amount of information about cancer and diet that is easily accessed on the Web or in popular magazines. Unfortunately, this information is not always accurate.

The type of question you’re asking would be best answered in a discussion with a registered dietitian during a one-on-one consultation. Registered dietitians can provide individualized recommendations using evidenced-based medicine for diet and cancer.

Often, articles that are found in popular health magazines or through the Internet do not use a rigorous process to determine if they are reliable or based on scientific evidence.

It is very important to bring any questions to a qualified health professional, such as a registered dietician. To schedule an appointment with a Dana-Farber nutrition team member, please contact us.

Q: Is it advisable to eliminate grapefruit from the diet after having breast cancer?

BWH
E. Orleans, MA

A: This is a very good question because there are many controversies surrounding the consumption of grapefruit and its adverse effects on estrogen metabolism.

In 2007, a study by Monroe et al. (2007) found that it is biologically possible for grapefruit consumption to increase the risk of breast cancer.

In the study of 46,090 post-menopausal women (1,657 diagnosed with breast cancer), it was found that the relative risk for the intake of a quarter of a grapefruit or more per day was significantly associated with a 30 percent increase in breast cancer occurrence.

Two more recent studies of this topic have found very different results.

Kim et al. (2008) used the Nurses Health Study, which includes women between ages 30-55, to compare grapefruit intake to breast cancer risk. This study found no association between grapefruit consumption and increased breast cancer risk.

In fact, in some groups, there was a significant decreased risk of breast cancer with an increased consumption of grapefruit.

The group studied included women who had never used hormone therapy and women who had estrogen and progesterone receptor negative cancers.

The final and most recent study, Spencer et al. (2009), used the European Prospective Investigation into Cancer and Nutrition to examine the relationship of grapefruit intake and breast cancer.

Researchers followed 114,504 women for about 10 years. Of those, 3,747 had breast cancer during the time of the study. They found no relationship among grapefruit intake and breast cancer in either premenopausal or postmenopausal women.

The study concluded that grapefruit intake was not related to the risk of breast cancer.

Among these three contradictory studies, it is difficult to make one final conclusion on this controversial issue.

However, recommending that women include grapefruit in their diet in moderation is a prudent approach.

Grapefruits are high in vitamins C and A, fiber, and the antioxidant lycopene, which can help to keep the immune system strong and may protect against heart disease, certain cancers, and eye disease.

Eating grapefruits in moderation is a healthy choice, but you should discuss with your doctor if the fruit could have any harmful effects based on medications that you are taking, including statin drugs that lower cholesterol.

Sources:

KR Monroe, SP Murphy, LN Kolonel and MC Pike. Prospective study of grapefruit intake and risk of breast cancer in post-menopausal women: the Multiethnic Cohort Study. British Journal of Cancer. 10 July 2007; 1-6

EH Kim, SE Hankinson, AH Eliassen, and WC Willett. A prospective study of grapefruit and grapefruit juice intake and breast cancer risk. British Journal of Cancer. 15 January 2008; 98 (1) 240-241.

EA Spencer, TJ Key, PN Appleby, CH van Gils, A Olsen, A Tionneland, F Clavel-Chapelon, MC Boutron-Ruault, M Touillaud, MJ Snaches, S Bingham, KT Khaw, N Slimani, R Kaaks, and E Riboli. Prospective study of the association between grapefruit intake and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cancer Causes Control. 18 February 2009 ;20(6):803-9.

Q: What factors determine the amount of fiber an individual needs daily? Currently I eat four fruits and 2 1/2 cups of raw and cooked vegetables daily. Also included in my daily food plan are sprouted grain breads/tortillas and a half-cup of nuts plus 2 tablespoons of almond butter. I drink 48 ounces of water each day, plus 16 ounces of 100% herbal teas. My weight is 122 lbs and my height is 5’4″. I am a breast and skin cancer patient at BIDMC (surviving 11 years and nearly 3 years, 8 months, respectively). Thank you.

Susan S.
Cambridge, Mass.

A: Fiber is part of a healthy diet for many reasons. It can help slow digestion. It keeps you feeling full longer, helping you with weight management. It can also lower blood sugar and blood cholesterol, as well as help regulate the bowels.

Fiber is found in the cell walls of plants. Only plant-based foods, like fruits, vegetables, whole grains, nuts and seeds, contain fiber. Fiber cannot be absorbed by the body, so it does not contribute to a person’s total carbohydrate or calorie intake.

There are two different types of fiber: soluble and insoluble.

  • Soluble fiber can help lower blood cholesterol by binding to excess fats in your intestines. It also regulates how fast food moves from the stomach to the intestines, making you feel full for a longer time. It helps you maintain a regular blood sugar level. Soluble fiber is recommended for patients having either constipation or diarrhea.
  • Insoluble fiber helps move food through the intestines, helping battle constipation and maintaining bowel regularity. It can also help to “clean out” your large intestine by removing excess bacteria or waste buildup. Insoluble fiber is often recommended for patients experiencing constipation, but not for those having diarrhea.

The recommended daily intake for fiber for adults is 25-35 grams per day. That number may change depending on the person’s current tolerance for fiber.

For example, some patients with certain gastrointestinal illnesses or surgeries should eat less fiber because it may increase bloating and discomfort. Also, some cancer treatments, such as radiation or chemotherapy, can cause side effects like constipation and diarrhea, which may affect how much or the type of fiber you need.

From the information you provide in your question, you are probably eating between 25-30 grams of fiber per day. You are also drinking the right amount of fluids.

The amount of fluids you drink can impact how fiber affects you: if you are not drinking enough water and eating a lot of fiber, it may actually cause constipation.

Eating too much fiber or increasing your fiber intake too quickly may also cause some unpleasant side-effects. If you are eating above 50 grams of fiber a day, you may notice excess gas, diarrhea or constipation, bloating and general abdominal discomfort.

To maintain a healthy weight, stay regular, and keep your intestines healthy, eat around 25-35 grams of fiber per day. Just remember, as we’ve noted above, that many things can change this number. It’s best to consult your doctor or a dietitian to determine if this is the correct number for you at any given point in time.

Q: My mother has breast cancer and I have been trying to come up with a weekly diet plan for her. Could you send me an idea of what I should be feeding her daily?

RBB
Roseville, CA

A: Fruits, vegetables, whole grains and lean proteins are all highly recommended components of a diet for all cancer survivors. Please refer to this “Ask the Nutritionist” question and answer for more information on an optimal diet for someone with breast cancer.

Soy products can be a concern for many breast cancer patients. Foods that come from soybeans are a great source of protein, but soy also contains isoflavones, which exert a weak estrogen-like effect on the body.

Isoflavones are plant-based nutrients and can be referred to as a source of phytoestrogens. Isoflavones have been found to have a protective effect on the development of certain types of cancer, including prostate, breast, colon, and bladder cancer.

However, there are controversies surrounding consumption of soy foods after the diagnosis of Estrogen Receptor Positive breast cancer. It is still unknown whether or not excessive consumption of soy isoflavones may fuel the growth of estrogen-dependent breast cancer cells.

Current research suggests that it is prudent for women to avoid soy isoflavone supplements and highly concentrated foods, such as foods made with textured vegetable protein and soy protein isolate found in many protein powders and nutrition bars, because of the high concentration of isoflavones.

However, whole soy foods, like soymilk, edamame, and tofu, may still be consumed in moderation several times per week. Foods with soy in the name that do not have any phytoestrogen activity and are safe to eat include: soybean oil, soy sauce, and foods made with soy lecithin.

Preliminary research suggests that preventing vitamin D deficiency may also be important for cancer prevention and survivorship as well as for bone health.

Up to 800–1,000 IU of vitamin D supplementation per day is safe and may help prevent deficiency and provide an important nutrient for bone health.

Unfortunately, it is difficult for those who live in northern regions of the country to obtain an adequate amount of vitamin D through diet alone.

Vitamin D rich foods are healthy in their own right and offer many important nutrients. Some good food sources of vitamin D are: one cup of milk or fortified soy/rice beverages (100 IU), 3 oz. of canned light tuna (200 IU), 3 oz. of salmon (425 IU), 3 oz. of pink salmon (530 IU), and 3 oz. of canned sardines (250 IU).

Some other excellent sources of vitamin D include one tablespoon of cod liver oil (1,360 IU) and 3 oz. of herring (1,384 IU).

If your mother is not a fish person, have her try packets of Quaker Nutrition for Women Oats, which offers 140 IU of vitamin D.

The skin is often able to make enough vitamin D in the months between April and October in the northeast. For your mother, 15-20 minutes of sun exposure, without sunscreen on, between 9:00 a.m. and 3:00 p.m. (the best exposure is at mid-day) can cause the skin to synthesize enough vitamin D for the body.

Remember, however, that there are risks associated with too much sun exposure, so keep your mother’s time in the sunlight limited to 15-20 minutes.

If your mother is undergoing chemotherapy or is photosensitive for other reasons, she may need to wear sunscreen at all times and rely on supplements for Vitamin D instead.

Depending on the treatment that your mother is receiving, she may be able to handle some foods better than others. However, a well-balanced diet with protein, fruits and vegetables, and healthy fats is the recommended diet for someone diagnosed with breast cancer.

Please check out our recipe archive for great ideas for healthy meals and cancer-related health tips associated with each recipe.

It is also important that your mother maintain a healthy weight. Research shoes that in women who are overweight, a moderate weight loss (5-10% of her current weight) can reduce risk for breast cancer recurrence.

Serving your mother a well-balanced diet, with protein, fruits, vegetables, and healthy fats, in amounts to maintain a healthy weight, is the best thing you can do for her optimal health.

Q: What is a recommended diet after a bi-lateral mastectomy with reconstructive surgery using her own body tissue? I’ll be visiting/assisting a post-op friend approximately 2 weeks after her surgery and want to prepare meals that enhance recovery. Or send me to a Web site that will answer this for me. Thanks.

dd
Moosup, CT

A: By two weeks after your friend’s surgery, she should be able to return to her normal eating patterns again. A diet that will help her heal and keep her healthy should contain protein, fruits and vegetables, healthy fats, and carbohydrates.

It is important your friend is getting enough protein during her recovery period. Protein will help the growth and repair of all cells in the body, including muscles and hormones. Some good protein choices are poultry, fish, lean meat, cheese, eggs, low-fat dairy products, and beans. So far, there is no correlation between growth hormones in meat and dairy with harming the cancer recovery process. If you or your friend is worried about trace residual hormones, you can make the personal choice to buy organic meats and dairy.

Other foods that will help your friend heal are fruits and vegetables. Fruits and vegetables are full of vitamins, minerals and phytonutrients, which are all essential to aid healing in the body. The best way to include all of these vitamins, minerals, and phytonutrients is to eat a wide variety of fruits and vegetables. Just remember to wash produce thoroughly. If you choose to buy organic produce to avoid pesticide exposure, choose organic fruits and vegetable that have a thin skin, such as strawberries. Thick-skinned fruits like bananas are less likely to have high pesticides residue on them, and you don’t ingest the skin of these types of fruits, anyway. The Environmental Working Group Web site has a complete list of the types of fruits and vegetables that have higher and lower pesticide residue exposure.

Eating a variety of fruits and vegetables will also supply your friend with carbohydrates that will give her energy to combat fatigue that may occur after surgery and that will help her heal. It is important to serve her complex carbohydrates, including whole grain pastas, whole grain bread, brown rice, potatoes, and sweet potatoes.

Healthy fats should be included regularly in a well-balanced diet. These healthy fats will also help your friend heal. Monounsaturated and omega-3 fats are the best choices. They are found in fish, olive oil, nuts and nut butters, ground flax seed, wheat germ, and avocado. Monounsaturated and omega-3 fats have been shown to improve immune function, decrease inflammation in the body and prove beneficial to heart health. Fats that should be avoided are saturated fast and trans-fats. Trans-fats can raise bad LDL cholesterol levels and are not beneficial to helping your friend heal. These kinds of fats are found in butter and margarine, deep-fried foods, and the oils in processed foods. Anything in the ingredients list that says partially-hydrogenated or hydrogenated oils indicates there are trans-fats in that food.

Keeping up a well-balanced diet after surgery will help your friend heal the fastest and help her start feeling healthy again.

Q: What are the benefits of omega-3 fats and what foods are the healthiest sources of omega-3?

Anonymous

A: Omega-3 fats are increasingly recommended to be added to maintain a healthy diet, but many people do not know what they are or how to get the best sources of these beneficial fats.

Omega-3 fats can reduce the risk of heart disease and high blood pressure, prevent blood clots, and encourage healthy brain development in children. In cancer patients, preliminary research suggests that diets that include omega-3s may protect against the development of cancer, reduce inflammation, help prevent muscle loss associated with cancer treatment, and may increase the potency of certain chemotherapy drugs.

While there are various food sources of omega-3 fats, different sources provide different levels of the “active” substances that help reduce inflammation. There is Alpha-linolenic acid (ALA), and the more metabolically active eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA).

Fatty fish, such as sardines, mackerel, salmon, swordfish, herring and tuna steaks are good sources of omega-3 fats. These types of fish are rich sources of the more metabolically active EPA and DHA and don’t have to be converted from ALA. This is why fish is the preferred omega-3 source. Eggs and grass-fed beef are weaker sources of omega-3 fats.

Plant seed oils like flax (linseed), hemp, pumpkin, and walnut are all sources of ALA. Less than 10% of these oils are converted to EPA and DHA in the body, though. But for people who avoid fish, it is encouraged to include flaxseeds, hemp seeds, pumpkin seeds or walnuts on a daily basis to get omega-3 fats into their diet.

Fish oil capsules are also a useful way to get a consistent amount of omega-3 fats if dietary fish intake is inconsistent. Fish oil capsules should provide at least 500 mg combined of EPA/DHA per capsule. There are also “fish-free” omega-3 capsules that are sourced from sea algae for vegetarians. A doctor or dietitian can recommend a specific amount of omega-3 in pill form.

Q: What foods can I eat to gain weight pre-breast surgery and chemo if I also have ulcerative colitis and am not eating wheat or dairy? I am very thin and have been told I need to gain weight before the surgery and treatment for breast cancer.

AMG
Newton, Mass.

A: Crohn’s disease and ulcerative colitis are chronic digestive disorders commonly referred to as Inflammatory Bowel Disease (IBD). Ulcerative colitis primarily affects the large intestine. Although diet cannot prevent or cure IBD, maintaining an adequate caloric intake and a generally balanced diet between acute flare-ups is essential for replacing nutrient losses, promoting healing, and improving your tolerance for medications. An acute flare-up is a time when you are extra sensitive to the symptoms of your disorder. Food choices at this time should be based on individual preferences and tolerances. However, during an acute flare-up your diet may be modified to minimize symptoms and maximize comfort.

You are correct in avoiding wheat and dairy. Limiting fiber and milk or milk products may also help in minimizing symptoms. You may better tolerate small, frequent meals (5-6 times a day). Eat slowly and chew well so there is less work for your digestive system. Remember to drink plenty of fluids to replace any fluid lost through diarrhea and vomiting. Aim for at least 8 (8 oz.) cups per day.

Adequate calories can help to keep energy levels up and body processes running smoothly. Eating enough will also help to prevent weight loss during healing, spare protein for other uses, and promote faster recovery with fewer infections and/or complications.

The recommendations below are a starting point. We encourage you to meet with a Registered Dietitian one-on-one to develop an eating plan that suits your specific needs and nutritional goals.

Here are some recommendations for foods to boost calorie intake in healthful ways:

  • Peanut/Almond/Cashew butter: Spread on grains, baked goods, fruit, or veggies.
  • Avocado: Make guacamole or put slices of avocado on sandwiches or salads.
  • Beans: Add to salads or entrees, mix into soups, or combine with cheese and make nachos.
  • Bean dips/Hummus: Use as a veggie dip, add to nachos or baked potatoes, or dip into with pita bread or tortilla chips .
  • Eggs: Add chopped hard-boiled eggs to salads, dressings, casseroles, or other entrees; beat eggs into mashed potatoes, veggie purees, and sauces; add to custards, pudding, baked goods, or breakfast food; or fry or cook for a meal.
  • Oil: Stick to olive and canola oil. Use when stir frying or as a dip for bread; add to pasta or rice; cook all foods in oil; use as a salad dressing; add to cake or bread mixes; and try pesto sauce
  • Flaxseed Oil: Add to flavored yogurts and frappes; mix in with salad dressings.

In addition to following the above recommendation, you can also sip on higher calorie fluids such as juices (try cranberry, grape, and nectars), and commercial nutritional supplements (e.g., Boost, Ensure). In addition, try higher calorie soups like split pea, tomato bisque, chowders, cream soups, and chili.

Q: Since my breast cancer diagnosis and treatment, I have reduced my alcohol intake so that I drink only an occasional glass of red wine. I like to substitute it with de-alcoholized red wine, which is available from Trader Joe’s and a few other places. Is there any health benefit from these “wines”?

CSG
Newton, Mass.

A: It is recommended that breast cancer survivors consume alcoholic beverages in moderation.

The difference between a regular red wine and an alcohol-free one is only in the alcohol content. One of the touted benefits of wine drinking is related to the phytonutrients that are present in this type of alcoholic beverage.

Phytonutrients are present in both regular red wine and alcohol-free red wine, as well as in 100% red/purple grape juice.

Phytonutrients are natural compounds found in plant-based foods that give plants their rich pigment as well as their distinctive taste and smell. They are essentially the plant’s immune system and offer protection to humans as well.

There are thousands of phytonutrients that may help prevent cancer as well as provide other health benefits, including promotion of cancer survivorship.

Phytonutrients that are present in red wine come from red or concord grapes. Resveratrol is an example of a phytonutrient with some anticancer properties, found in the skin of red grapes.

Research shows that it can inhibit cancer formation in different ways. Resveratrol stops DNA damage, improves DNA repair, blocks oxidation of cells, slows down tumor growth, and slows cell transformation from a normal to a cancerous state.

Replacing your red wine with a de-alcohlized red grape juice was a healthy switch, but you can still enjoy an occasional glass of regular red wine.

Q: I have a question regarding soy products and breast cancer. I was diagnosed a year ago with DCIS, ER/PR+. I have read that people with this type of breast cancer should not consume products containing soy protein isolate. Is the same true for products with soy lecithin?

B.A.
Harford, Conn.

A: The relationship between soy intake and cancer is a topic that has been studied extensively. However, to date, the results have been inconclusive as to whether consumption of soy products, particularly excessive intake of isoflavones, can stimulate the growth of ER+ tumors.

Soy is naturally rich in isoflavoves, a phytoestrogen, that can bind to estrogen receptors (ER) and create weak estrogen-like effects. Chemical components of soy isoflavones have non-hormonal properties that have been associated in numerous prostate and breast cancer studies with decreased cancer cell growth. The majority of studies showing a benefit to soy intake have used “whole soy” products such as soy milk, tofu, soy nuts, tempeh, and edamame, which are all healthful, lean protein sources. Moderate consumption of foods high in phytoestrogens is unlikely to have any adverse effects, such as 2-3 servings per week. What should be avoided are soy products that are concentrated sources of phytoestrogen such as dietary supplements, pills, powders, and soy-based protein bars, as you mentioned in your question.

Soy lecithin, extracted from soy-bean oil, is often used in numerous foods, like chocolate to help keep ingredients emulsified. Many food labels will list a soy-based emulsifier like lecithin. The amounts are generally minute and don’t contribute a substantial level of phytoestrogens. Products with soy lecithin do not need to be avoided because they have such minor amounts.

Q: Should breast cancer survivors avoid soy milk? I’m an 11-year survivor and I love soy milk in my coffee.

Janet
Somerville, Massachusetts

A: It is not necessary for breast cancer survivors to avoid all types of soy foods. Research suggests that survivors with an estrogen receptor-positive breast cancer limit their consumption of soy foods, especially the more concentrated forms. Avoid foods made from soy protein powder, soy protein isolate, isolated soy protein (read the ingredient list to look for these). These forms of soy are often found in nutrition bars, soy protein powder, many high protein breads and cereals and vegetarian “meat-less” options, such as certain brands of veggie burgers or soy hot dogs.

Natural soy foods such as soy milk, edamame, tempeh, miso, and tofu can be safely consumed a few times a week (2-3 servings/week is the general recommendation). Foods such as soybean oil, soy sauce and soy lecithin do not contain any phytoestrogen and need not be limited or avoided.

Q: I am a fan of frozen grapes as a snack. I am also a breast cancer survivor. I understand that there is some research behind grapes and cancer prevention? What are the studies saying about grapes and cancer prevention? Myth or fact?

Nancy
Glenwood, Colorado

A: Grapes contain a polyphenolic compound known as resveratrol. Resveratrol first gained scientific attention in 1992 when it was discovered in red wine, leading researchers to question if this compound could explain the “French paradox” — the low incidence of heart disease among the French people, who eat a relatively high-fat diet. More recently, resveratrol has regained the attention of the scientific community as an anti-cancer compound.

Laboratory research has shown high-dose reseveratrol to inhibit the rapid cell division of a variety of human cancer cell lines, including those from breast, prostate, stomach, colon, pancreatic, and thyroid cancers. Although the laboratory data is promising, studies in humans suggest that even very high dietary intakes of resveratrol may not be sufficient to result in most of the protective effects demonstrated in cell culture studies. In other words, it would be difficult to consume enough food sources of reseveratrol to benefit from its anti-cancer properties.

It is important to note, however, that these studies are looking at one compound in isolation. Most foods contain hundreds if not thousands of bioactive compounds, which most likely work in harmony with one another to promote health. Therefore, as a general rule of thumb, it is important to eat a balanced diet, high in colorful fruits and vegetables including grapes, in order to obtain the maximum benefit from these health promoting compounds.

Q: What is the best way to lose weight, especially belly fat, brought on by very high doses of prednisone taken during chemotherapy?

V.G.
Worcester, Massachusetts

A: Weight gain during prednisone therapy is common. In general, the weight gain is due to a combination of factors including fluid retention, increased calorie consumption, and decreased physical activity.

When taking prednisone, the body will hold onto extra sodium (salt) and it will release extra potassium. Together, this causes the body to retain fluid, which can result in weight gain.

Decreasing the amount of sodium in your diet by limiting the use of table salt and decreasing the amount of processed foods in your diet, as well as increasing your consumption of potassium-rich foods (i.e. bananas, cantaloupe, kiwi, etc.), can help prevent fluid retention.

Increased calorie consumption is also common when taking prednisone, as the drug can result in an increase in appetite.

To avoid gaining weight because of increased hunger, you can: eat smaller meals more frequently (i.e. six small meals vs. three large meals), consume whole grains instead of refined carbohydrates, and include a serving of protein with all meals and snacks.

Keeping a food journal (including type of food, amount consumed, and method of preparation) can help you track the total calories you’ve consumed each day.

Also, meeting with a Registered Dietitian who can help you understand your individual weight goals and assist you in designing a healthful eating plan is highly recommended.

In addition to a healthful eating plan, physical activity such as walking can help prevent weight gain and promote weight loss. It is recommended you meet with your doctor to develop an activity plan that accommodates your lifestyle and medical condition.

Q: I have stage IIIC HER2-positive breast cancer. Because it is a protein-based cancer, should I restrict all proteins to make sure that I do not feed the cancer?

Mindy
Portland, N.Y.

A: Your question brings up an intriguing point.

HER2 is a gene that may influence cancer growth and aggressiveness in certain types of breast cancers. While genes are made up of protein-based building blocks, there is no research to suggest that restricting all forms of protein may help to fight cancer.

Protein is essential for the body to function properly and is necessary for the growth and repair of all cells. Protein is made up of amino acid building blocks, some of which cannot be made by your body, meaning they must come from diet.

Adequate dietary protein becomes more important for strength and healing during cancer treatment because your body is working hard to repair and rebuild. Most immune cells that help your body fight cancer are made up of proteins.

The data on consumption of soy protein after a diagnosis of breast cancer, however, is controversial.

This issue is specifically relevant to women with ER+ breast cancer. The research is inconclusive as to whether excessive consumption of soy isoflavones may help the growth of estrogen-dependent breast cancer cells.

It may be sensible for women with breast cancer to avoid isoflavone or soy supplements (pills and powders). However, soy foods (soy milk, tofu, soy nuts, tempeh, and edamame) may be consumed in moderation, or 1 serving about 3-4 times per week.

We recommend all cancer survivors choose plant-based proteins such as beans and nuts as well as lean sources of protein such as fish, chicken, eggs, and turkey.

Red meat should be eaten in moderation: once a week, according to the American Cancer Society guidelines.

Q: Is it safe to lose weight during treatment with breast cancer? If so, what is a safe amount?

Andrea
Bangor, Maine

A: Weight gain during breast cancer treatment is very common and certainly an unwanted side effect. Weight gain after diagnosis of early stage breast cancer is actually a risk factor for recurrence. Maintaining a healthy weight during treatment and beyond is recommended for all breast cancer survivors.

To answer your question, yes it is safe and advisable for many women to lose weight during breast cancer treatment. Most breast cancer patients hear that they should not lose weight during treatment. They also hear that if they are overweight, weight loss is very important for survivorship.

What should one do? Meet with a Registered Dietitian who can help you understand your individual weight goals and assist you in designing a healthful eating plan. It is possible to eat all the important nutrients for maintaining health, yet at the same time promote a very gradual, medically appropriate weight loss, even during treatment. There is not a uniform approach to this delicate situation, which speaks to the importance of meeting with a qualified professional who can help to guide you through your treatment.

It would certainly be detrimental to focus on treatment as a weight loss tool, although for many overweight cancer patients this has appeal. Rather, focus more on daily exercise and consuming ample amounts of healthful foods like fruits, vegetables, whole grains, lean proteins, and low-fat dairy products that will provide important nutrients and may contribute to gradual, appropriate weight loss if a person is overweight without compromising the immune system.

Q. I recently attended the New Hampshire Breast Cancer Retreat and enjoyed the lectures from Stacy and Stephanie. I missed several of the diet talks, so I have a question for them. I am a fan of frozen grapes as a snack. I am also a breast cancer survivor. I understand that there is some research behind grapes and cancer prevention. What are the studies saying about grapes and cancer prevention? What is myth and what is fact?

Anon

Grapes contain a polyphenolic compound known as resveratrol.

Resveratrol first gained scientific attention in 1992, when it was discovered in red wine. Researchers questioned if this compound could explain the “French paradox”, a phrase that describes the low incidence of heart disease among French people, who eat a relatively high-fat diet.

More recently, resveratrol has regained the attention of the scientific community as an anti-cancer compound.

Laboratory research has shown high doses of reseveratrol inhibit the rapid cell division of a variety of human cancer cell lines, including those from breast, prostate, stomach, colon, pancreatic, and thyroid cancers.

Although the laboratory data is promising, studies in humans suggest that even very high dietary intakes of resveratrol may not be sufficient to result in most of the protective effects demonstrated in cell culture studies.

In other words, it would be difficult to consume high enough levels of reseveratrol in food sources to benefit from the compound’s anti-cancer properties.

It is important to note, however, that these studies are looking at one compound in isolation. Most foods contain hundreds – if not thousands – of bioactive compounds, which most likely work in harmony with one another to promote health.

Therefore, as a general rule of thumb, it is important to eat a balanced diet, high in colorful fruits and vegetables (including grapes) in order to obtain the maximum benefit from a variety of health-promoting compounds.

Q: I was diagnosed with stage 1 >90% er+ pr+ breast cancer. I have been drinking a lot of green tea because I have heard of many health benefits and I enjoy it. I have now read that green tea may contradict tamoxifen. Is this true? Should I avoid green tea?

CBC
Wilmette, IL

A: The current research in mice indicates that green tea may actually improve the effects of tamoxifen for breast cancer treatment, not contradict it. The evidence shows that the combination of green tea and tamoxifen may be more potent than either drug alone in suppressing breast cancer growth, in animal models. Whether this benefit translates to humans is uncertain, as studies have not yet tested this hypothesis in humans. There are no significant drug interactions or contraindications with tamoxifen and green tea, when the tea is consumed in reasonable amounts (2-3 cups/day maximum), based on current evidence-based literature.

You should continue to drink green tea, but choose a decaffeinated one more often.

Q: Is drinking kombucha tea healthy for a breast cancer survivor taking Letrizole? Does it have any possible health benefits or is it hype?

Suzanne
Newburyport, MA

A: Scientific evidence does not yet support the proposed health benefits of kombucha tea.

It is often used with the intent of strengthening of the immune system and metabolism and to help hair grow back.

This tea is often expensive, up to $4 per bottle. Given the evidence supporting the health benefits of fruits and vegetables, your money may be better spent at the farmer’s market.

There are some adverse reactions that may be associated with drinking kombucha tea.

It should not be prepared in a lead-glazed ceramic container because that can result in lead poisoning.

Orally, use of kombucha tea can cause stomach problems, yeast infections, allergic reactions, jaundice, nausea, vomiting, and head and neck pain.

It is also worth mentioning that fermented tea contains alcohol. So, it may be contraindicated with prescribed medications. It is also important for breast cancer survivors to limit alcohol intake.

During the summer of 2010, some varieties of kombucha were pulled from grocery shelves due to too high alcohol content.

It is recommended that you contact your physician or oncologist before making or purchasing this kind of tea. It may pose some health risks associated with its interaction with Letrozole and other medications you may be taking.

 

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