[2020-11-15] Eating and cancer

As the head of communications for Health Canada and the Public Health Agency of Canada for the past four years, I've read a lot about nutrition, including the science behind Canada's Food Guide, as well as food safety. I model my eating habits and my handling of food on this guidance. So it was comforting to read the US National Cancer Institute's booklet Eating Hints: Before, during, and after Cancer Treatment, which provides familiar advice, along with directions specific to cancer patients—some of which was new to me.

Healthy Eating

Eating Hints notes that:

For most people, a healthy diet includes:
    • Lots of fruits, vegetables, and whole grain breads and cereals
    • Modest amounts of meat and milk products
    • Small amounts of fat, sugar, alcohol, and salt
However, it goes on to say:

When you have cancer, though, you need to eat to keep up your strength to deal with the side effects of treatment. When you are healthy, eating enough food is often not a problem. But when you are dealing with cancer and treatment, this can be a real challenge. When you have cancer, you may need extra protein and calories. At times, your diet may need to include extra milk, cheese, and eggs. If you have trouble chewing and swallowing, you may need to add sauces and gravies. Sometimes, you may need to eat low-fiber foods instead of those with high fiber. A dietitian can help you with any diet changes you may need to make.

This was new to me, though not surprising. I've managed to maintain my weight since diagnosis and even gained a pound or two. At 120 pounds, I'm about 5 to 8 pounds below my normal weight. That's actually not bad, but I didn't want to lose more weight. Fortunately, I've continued to have a healthy appetite, helped along by great home cooking.

The guide also cautioned against special diets and supplements:

Many people want to know how they can fight cancer by eating certain foods or taking vitamins or supplements. But, there are no studies that prove that any special diet, food, vitamin, mineral, dietary supplement, herb, or combination of these can slow cancer, cure it, or keep it from coming back. In fact, some of these products can cause other problems by changing how your cancer treatment works.

This was echoed by my oncologists. So I'll stick with Canada's Food Guide.

Eating Hints provides this helpful guidance for eating during treatment:

During treatment, you may have good days and bad days when it comes to food. Here are some ways to manage:
    • Eat plenty of protein and calories when you can. This helps you keep up your strength and helps rebuild tissues harmed by cancer treatment.
    • Eat when you have the biggest appetite. For many people, this is in the morning. You might want to eat a bigger meal early in the day and drink liquid meal replacements later on.
    • It’s okay if you feel like you can’t eat a lot of different foods. Eat the foods that sound good until you are able to eat more, even if it’s the same thing again and again. You might also drink liquid meal replacements for extra nutrition.
    • Do not worry if you cannot eat at all some days. Spend this time finding other ways to feel better and start eating when you can. Tell your doctor if you cannot eat for more than 2 days.
    • Drink plenty of liquids. It is even more important to get plenty to drink on days when you cannot eat. Drinking a lot helps your body get the liquid it needs. Most adults should drink 8 to 12 cups of liquid a day. You may find this easier to do if you keep a water bottle nearby. Also, try some...clear liquids.
My most challenging times for eating and drinking were right after surgery and after my first round of chemotherapy. I think I'm doing better because I'm making better use of my nausea meds and have found drinks that I can better tolerate.

Food Safety

The most fascinating part of the Eating Hints guide was advice on taking care with food to avoid infections.

Some cancer treatments can make you prone to infections. When this happens, you need to take special care in the way you handle and prepare food. Be careful to:
    • Keep hot foods hot and cold foods cold.
    • Put leftovers in the refrigerator as soon as you have finished eating.
    • Scrub all raw fruits and vegetables with a brush and water before you eat them.
    • Soak berries and other foods that are not easily scrubbed in water, then rinse.
    • Scrub fruits and vegetable that have rough surfaces and peels, such as melons, oranges, and avocados, with a brush and water before you cut or peel them.
    • Soak frozen fruits and vegetables in water and rinse if you are not going to cook them (for a smoothie, for instance). If cooking, you do not need to wash frozen fruits and vegetables.
    • Wash your hands, knives, and counter tops before and after you prepare food. This step is most important when preparing raw meat, chicken, turkey, and fish.
    • Wash your hands each time you touch raw meat, chicken, turkey, or fish.
    • Use one cutting board for meat and another one for fruits and vegetables.
    • Thaw meat, chicken, turkey, and fish in the refrigerator or defrost them in the microwave. Cook meat, chicken, turkey, and eggs thoroughly. Eggs should be hard, not runny. Meats should not have any pink inside. To be sure meat, chicken, turkey, and fish is safe, use a meat thermometer and cook to the safe temperature. Refer to a safe minimum cooking temperature chart....
    • Make sure your juices and milk products are pasteurized.
    • Eat nuts that are shelled and roasted.
Do not:
    • Eat raw fish or shellfish, such as sushi and uncooked oysters.
    • Eat raw nuts.
    • Use foods, condiments, or drinks that are past their freshness date.
    • Buy foods from bulk bins.
    • Eat at buffets, salad bars, or self-service restaurants.
    • Eat foods that show signs of mold, including moldy cheeses such as bleu cheese and Roquefort.
    • Eat any perishable foods that have been sitting at room temperature longer than 2 hours.
    • Eat leftovers that have been in the refrigerator longer than 3 days.
    • Leave meat, chicken, turkey, or fish sitting out to thaw.
Many of the tips about handling food are the same ones that we should all follow. However, I would not have thought that I needed to soak frozen fruits and vegetables in water and rinse them if not cooking with them, or to not eat raw nuts.

Whether you have cancer or another illness that makes it challenging to eat, or are caring for someone who is ill, or are just trying to keep your family safe, the guidance in Eating Hints is a good reminder to all of us about the do's and don'ts of eating well and handling food.