Eating Well (1/2)

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Eating well is one of the 7 Healing Practices—an aspect of your well-being that you have control over. Eating well means nourishing yourself with food that is not only healthy but delicious.

Eating Well

Eating well is one of the 7 Healing Practices—an aspect of your well-being that you have control over. Eating well means nourishing yourself with food that is not only healthy but delicious.

Of all the healing practices, eating well tends to be the one most often tried as either a complementary or alternative therapy for cancer. (See our Diets and Metabolic Therapies: Overview page for more guidance about using diet as an alternative cancer treatment.)

We at BCCT believe that eating well is one of the therapies that may help enhance your cancer treatments as well as restore your health and reduce your risk of recurrence. However, we strongly emphasize that eating well alone will not likely prevent, cure or control cancer. Like every other therapy or approach included on this website, eating well is one component of an individualized integrative plan rather than a stand-alone therapy.

You may have heard the famous quote from Hippocrates: “Let food be thy medicine and medicine be thy food.” For some people, eating specific foods is a bit like taking medicine. Many drugs were even derived from plants, including some very powerful chemotherapy agents like vincristine or Taxol. However, putting faith in diet as a “magic bullet” cure for cancer is not supported by evidence, even if it is tempting.

On this page, you’ll find information about how to nudge your habits toward healthier eating, what foods are most beneficial and why, and the connection between eating well and cancer. Every step you can take toward healthier eating gives your body the fuel it needs to build your health and resilience.

Clinical Practice Guidelines for Diet and Cancer

Society for Integrative Oncology Guidelines

Clinical practice guidelines from the Society for Integrative Oncology (SIO) conclude that “many epidemiologic studies demonstrate an association between diet and cancer incidence. Other than smoking cessation and exercise, a healthy diet is perhaps the most important lifestyle change a person can make to help reduce the risk of cancer.”2

SIO goes on to cite the combined work of the American Institute of Cancer Research and the World Cancer Research Fund which presents evidence and recommendations on the role of food, nutrition and physical activity in reducing cancer risk as well as improving survival. This expert report included thousands of studies and hundreds of experts worldwide. Based on the vast body of evidence, these experts have published recommendations related to diet and physical activity for a number of cancers:3 Evidence and recommendations are posted on the AICR’s Continuous Update Project webpage.

Specific clinical practice guidelines from SIO:

  1. Lung cancer:4
    • A diet rich in non-starchy vegetables and fruits is suggested to reduce the risk of lung cancer in people at increased risk.
    • Limiting the consumption of a large amount of red meat and processed meat is suggested; lower meat consumption may reduce the risk of lung cancer in people at increased risk.
    • Adding high-calorie and protein supplements (1.5 kcal/mL) is suggested to achieve weight stabilization in patients undergoing treatment of lung cancer who have experienced weight loss,
    • Oral supplementation with omega-3 fatty acids is suggested in order to improve the nutritional status In patients with lung cancer who have sarcopenia (loss of muscle mass)
  2. Cancer in general:5
    • As individual dietary supplementation has not been shown to prevent cancer or cancer recurrence, SIO recommends that patients get necessary dietary components in whole foods.
    • Patients, especially older ones, at risk for nutritional inadequacies should see a trained professional for guidance on nutritional supplementation to “promote optimum nutritional status, manage tumor-and treatment-related symptoms, meet increased nutritional needs and correct any nutritional deficits during treatment.”

 

JCO Oncology Practice published a guideline summary in 2021: Nutrition in Cancer Care: A Brief, Practical Guide with a Focus on Clinical Practice

American Cancer Society Guidelines

From the American Cancer Society:6

Achieve and maintain a healthy weight throughout life.

 

  • Be as lean as possible throughout life without being underweight.
  • Avoid excess weight gain at all ages. For those who are overweight or obese, losing even a small amount of weight has health benefits and is a good place to start.
  • Get regular physical activity and limit intake of high-calorie foods and drinks as keys to help maintain a healthy weight.

 

Eat a healthy diet, with an emphasis on plant foods.

 

  • Choose foods and drinks in amounts that help you get to and maintain a healthy weight.
  • Limit how much processed meat and red meat you eat.
  • Eat at least 2½ cups of vegetables and fruits each day.
  • Choose whole grains instead of refined grain products.

 

If you drink alcohol, limit your intake.

  • Drink no more than one drink per day for women or two per day for men.

Guidelines for People in Treatment or with Advanced Disease

Integrative oncologist and BCCT advisor Keith Block, MD, recommends these approaches for those undergoing chemotherapy treatment, with advanced disease or experiencing wasting (cachexia):7

 

  • Increase the caloric and nutritional density of your diet:
    • Use calorically dense foods, including healthful concentrated carbohydrate sources.
    • Lower your dietary fiber.
    • Increase proteins, including fish, egg whites, l-glutamine, chlorella supplements, and whey protein.
  • Increase your intake of oils rich in omega-3s , medium-chain triglyceride oil, and, to a lesser extent, omega-6 rich oils.
  • Adjust your meal schedule to a grazing pattern of six to eight meals a day.
  • Shift your largest meal of the day to breakfast, when your appetite may be best.
  • Supplement with shakes or smoothies with whey protein, soy protein, and medium-chain triglycerides.
  • For wasting (cachexia), use anti-inflammatory supplements  such as curcuminfish oilboswellia or scutellaria.

 

Making Eating Well a Priority

How do you know when to focus on eating well as part of your integrative cancer care? We say “when” and not “if”, because at some point, if your “eating well” practice is weak, it will need tending, and it will always need maintenance long after your cancer treatment ends. If any of the following apply to you, then you might make eating well a priority practice:

  • You are drawn to this practice of health, for whatever reason; trust your intuition.

 

  • You have a cancer that is strongly linked to diet—diet contributes to cancer growth, or diet is linked to improved outcomes, or both; making eating well a priority strategy makes sense.
  • You have a metabolic imbalance or disease, such as insulin resistance, diabetes or obesity (all of which are associated with cancer). Good evidence shows that diet might improve these conditions and make the microenvironment less hospitable to cancer.
  • You love to cook and/or eat—or you have family or friends who love to cook and will cook for you—and the idea of preparing and eating delicious, health-supportive food is appetizing.

 

Parting Ways with the Standard American Diet

The diets advocated by integrative oncology clinicians are all departures from the standard American diet, also known as the SAD diet:

Typical SAD Foods

Insufficient or Missing from the SAD

  • High in unhealthy fats
  • Refined carbohydrates and sugar, including sugary drinks and fruit juices
  • High in unhealthy animal protein such as cured meat and red meat
  • High-fat non-organic dairy
  • Highly processed foods
  • Plant-derived foods:
  • Non-starchy, dark-colored vegetables
  • Whole grains
  • Beans (pulses), including lentils, chickpeas and dried beans
  • Nuts and seeds
  • Whole fruit

 

The unhealthy effects of SAD are heightened by eating in ways that do not promote digestion, healthy absorption of nutrients, and natural hormone rhythms:

  • Eating in a hurry
  • Skipping meals, then binging on unhealthy quick-energy foods
  • Eating while watching TV or “screening” on cell phones or computers
  • Eating late at night

Impacts of these foods and eating patterns:

  • Inflammation
  • Increased blood sugar and insulin
  • Insulin resistance
  • Increased weight
  • Increased “bad” cholesterol
  • Imbalance of the microbiome and the immune system
  • Upset healthy biorhythms
  • Other metabolic changes

If these conditions persist, your body’s terrain may become fertile ground for cancer to grow, evade programmed cell death, and spread.

When to Eat

When you eat can impact not only your digestion, absorption of nutrients and metabolism, but your sleep and your response to cancer treatments.

Integrative oncologist and BCCT advisor Keith Block, MD, and his colleagues offer guidance about what and when to eat to promote normal circadian (sleep-rest) function.8

 

General Dietary Guidelines

  • Eat a nutrient-dense, vegetable-rich diet.
  • Maintain a low dietary fat intake; emphasize omega-3 fatty acids.
  • Reduce your dietary glycemic load, especially in the morning.
  • Optimize your potassium–sodium intake and ratio (lower salt intake).
  • Eliminate chemicals that overstimulate neuron receptors (excitotoxins) including monosodium glutamate (MSG) and aspartame.
  • Avoid depressants and stimulants such as alcohol, caffeine and nicotine.
  • Do not overeat—consume the largest meal between noon and 6:00 pm when insulin is highest.
  • Supplement with basic vitamins and minerals for stress reduction.
  • Eat meals at the same time each day during normal waking hours

Daylight Dietary Guidelines

  • Reduce or eliminate caffeine (optional) or stop early in the day.
  • Emphasize protein earlier in the day (breakfast and lunch).
  • Avoid tyramine-containing foods after dinner, which increase norepinephrine release.
  • Take adaptogens—such as Siberian ginseng (eleuthero), rhodiolaginkgo or American ginseng—purported to aid in normalization of stress reactions and improve energy; take only in the morning if your sleep is disturbed.

Nighttime Dietary Guidelines

 

How Do I Start Eating Well?

Begin by setting some realistic expectations. Recognize that diet alone is not likely to cure cancer—be suspicious of any clinician or program that claims otherwise. However, most integrative cancer care clinicians and programs consider diet an important component of a treatment plan.

If eating well is a big change for you, begin by committing first to your healing and health. Realize for yourself why health and healing are important: make a list, read it to yourself often, say it out loud to yourself and to supportive people in your life. Then ask yourself what change(s) seem the most important to you now to help you toward your goals of health and healing. If eating well is high on the list, then you can begin to learn how to do that, keeping your ultimate goals of health and healing in the forefront.

Partnering with Your Medical Team

With your basic strategy for eating well in mind, ask yourself what else you need to know and what kind of help you need with figuring this out. If you primary oncology team does not think diet is important—saying something such as, “It doesn’t matter what you eat, just make sure you’re getting enough protein and calories.”—then you might let them know that it is important to you and you would like help with it.

Unfortunately, many physicians are not trained in the basics of health-supportive diets and nutrition and simply may not be equipped to give advice. Some oncology dietitians may focus their expertise on supplemental nutrition—tube feedings, nutritional supplement drinks and such—without much experience in counseling for eating well.

If necessary, ask your doctor to refer you to someone who is well-versed in whole-foods nutrition to assess your nutritional status and recommend a nutritional plan for you. If your doctor cannot refer you, investigate local resources, such as a naturopathic oncologist, an integrative medicine physician, a functional medicine physician or nutritionist, or an oncology nutritionist dietician in the community. Ask other cancer survivors, members of a support group, or others whose experience and advice you trust for recommendations (but carefully consider if the recommendations you receive resonate with your situation).

If you have no in-person, trained guide available, you can identify for yourself how you can eat well, starting with the information and resources on this page. BCCT especially recommends Rebecca Katz's article, Make food part of your plan to thrive when your taste or appetite has changed, as a starting place.

You may want to have your primary care medical team check whether you have any of these:

  • Nutritional deficiencies
  • Food sensitivities
  • Challenges to your ability to eat, digest and assimilate your food
  • Appetite changes
  • Weight problems

Factor this information into a plan for eating well.

If you are working with an integrative cancer care team and they recommend a certain diet, follow their recommendations. Ask if they will also provide information and support on following this diet, but if not, and you don’t know how to follow their recommendations, ask for instructions or for a referral to a clinician with experience in “culinary translation” of this particular diet—help with turning nutritional advice into real food.

Going from a Plan to Meals

After you have a prescription or plan for eating well, you can learn how to translate that prescription onto your plate as well as into a pattern of lifelong eating habits:

  • Menu-planning (even if you eat out or someone else prepares your food)
  • Selecting quality ingredients
  • Preparing food
  • Eating mindfully
  • Optimizing your digestion, absorption and use of nutrients

If this feels like a challenge for you, start with baby steps and, if possible, get some help from a culinary translator—a dietician, health-supportive chef or nutrition coach—who can teach you about healthy eating and food preparation as well as help you set short- and long-term goals for eating well for a lifetime. Examples of baby steps:

  • Eat one extra serving of dark leafy greens each day.
  • Learn to make one healthy recipe per week until you have enough for a whole menu for a meal. Then learn a new set of recipes until you have a week’s worth of menus.
  • Find a restaurant or supermarket that prepares foods that fit your budget and your plan for eating well.

If you have the energy and mindset to leap into the process full tilt, then do so, but don’t hesitate to call for help or give yourself permission to regroup if this becomes overwhelming. Remember, your ultimate commitment is to your health and well-being, and being overwhelmed is counterproductive to reaping the benefits of eating well. Remember also: you don’t have to go from zero to 60 in one day. Every step you can take toward healthier eating gives your body more of the fuel it needs to build your health and resilience.

Addressing Barriers to Change

Anticipate a few stumbling blocks. Discipline is important, but so is compassion. You will find times when eating well may be difficult; have a plan for those times and how you will steer yourself back on track. If family or friends are in the habit of bringing or serving you foods that you’re trying to avoid, let them know that you appreciate their good wishes, and you feel cared for, but that you’d really appreciate something else from them—and then specify what you’d like instead. Perhaps instead of doughnuts, some fresh blueberries would be a treat. Try baked seasoned sweet potato slices instead of French fries. You don’t have to deprive yourself of tasty food. Eating well can be delicious and satisfying as well as nourishing.

Celebrate both small and big successes—but if you typically reward yourself with unhealthy foods, look for other personal rewards. What else will make you feel pampered? A massage? A phone call with a favorite person? An outing to see a sunset? Some extra play time with a pet? A game? A favorite movie? Find rewards that promote your well-being and make you feel like you’re celebrating.

Another stumbling block is the temptation to demonize certain foods and consider other foods a panacea. We demonized fats in the 80s and wound up with more obesity, diabetes and heart disease by living off a diet of low-fat, high refined carbohydrate foods such as white pasta. Conversely, when we find out about any food that “makes you healthy”, we tend to overdo it . . . for instance, dark chocolate is being drizzled, infused, folded into and on all kinds of foods. A small square of dark chocolate a few times a week would do the trick . . . a whole bar eaten in one afternoon is not a good idea. Everything in moderation, including moderation!

Sometimes our emotions and ways of thinking can be barriers to eating well. For instance, perhaps you have a pattern of unhealthy eating as a comfort to feeling sad, anxious, stressed, and such. Perhaps you spiral into negative, self-defeating thinking. Or perhaps you eat highly processed convenience foods while watching television or “screening” on a computer or smartphone. Perhaps your meal times are rushed or unpleasant. Many cognitive-behavioral strategies can help in situations like these. You might look into therapists, group therapy or educational programs who focus on the psychology of eating.

Enlisting the Reserves: Ask for Help

If you don’t have the time and/or the energy for any or all the changes needed to eat well, this may be when you let your family, friends, church members, work colleagues or others know that you want to take them up on their offers to be helpful. Whether shopping for you, picking up a prepared meal, cooking for you, or eating with you, let your support team know what you need. Recognize that you are not alone, then go the extra step to get the help you need. Ideas:

  • A group can get together one day a week and prepare a number of different dishes that can be eaten over the next few days or frozen for later use—your helpers can fix food for themselves as well as for you, allowing everyone to eat well!
  • Ask one of your support team to plan with you to eat well, to be your purpose partner or sounding board, and to give you moral support when you’re having trouble keeping on track with your commitment to your health.

Notice Your Food and Your Response to It

For each change, for every step you take in eating well, remember to notice the tastes, the colors, the smells, the textures, how it feels in your mouth, throat and belly, how you feel after the meal, how you are feeling after a few days, a few weeks of eating well. Notice where you find pleasure in any part of the process of translating your goal of eating well to your plate, including who you’re eating with. Celebrate your success, be compassionate with yourself if you think you’ve gotten off track, and call on your inner and outer resources to help you put your next goal in sight.

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