Prevention & Early Detection

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Nutrition Guidelines

People who live healthful lives have a better chance of avoiding cancer. Research shows that the majority of all cancers may be prevented with healthy lifestyle choices that should begin as early as childhood. These healthy lifestyle choices may reduce your risk of getting cancer during your lifetime

Fat

Everyone needs some fat as part of a healthy diet. Fat contains important nutrients, including vitamins A, D, E and K, and is an important part of each cell in your body.

More research is needed to determine the effect fat has on cancer, but it is probably a good idea to reduce the amount of fat of animal origin (butter, meat) that you eat, while increasing your intake of omega-3 fatty acids. Omega-3 fatty acids are known to reduce the risk of heart attack, but their role in preventing cancer, if any, needs further research.

Goals

  • Choose healthy fats, including monounsaturated fats and polyunsaturated fats. These can lower LDL (“bad”) cholesterol and increase HDL (“good”) cholesterol.
  • Limit your intake of saturated fats and avoid trans-fatty acids. These can increase LDL cholesterol.
  • Eat foods containing omega-3 fatty acids two to three times weekly. The omega-3 fatty acids in fish (EPA and DHA) appear to provide protection against cancer and heart disease. Ground flaxseeds contain a different form of omega-3-fatty acid (alpha-linoleic acid = “ALA”). There is some evidence that ground flaxseeds, but not flaxseed oil, may be protective against cancer. Ground flaxseeds are also rich in fiber.

Types of Fat

Poly-unsaturated Fat
(good)
Mono-unsaturated Fat
(good)
Omega-3 Fatty Acids
(good)
Saturated Fat
(limit)
Trans Fat
(avoid)
Olive oil
Olives
Canola oil
Peanut oil
Almonds
Cashews
Hazelnuts
Peanuts
Peanut butter
Pine nuts
Walnuts
Avocado
 
Corn oil
Soybean oil
Safflower oil
Cottonseed oil
Fish
Pine nuts
Walnuts
Flaxseed
 
Mackerel
Salmon
Trout
Tuna
Flaxseed oil
Flaxseed
Walnuts
Walnut oil
Wheat germ
Soybean oil
Canola oil
 
Whole milk
Butter
Cheese
Cream cheese
Cream
Half and Half
Ice cream
Red meat
Chocolate
Coconut
Coconut milk
Coconut oil
Palm oil
Palm kernel oil
 
Most margarines (especially stick margarine)
Vegetable shortening (Crisco)
Partially hydrogenated vegetable oil
Deep fried chips
Many fast foods
Most commercial baked foods (cookies, crackers, chips, cake mixes, some cereals and frozen entrees)
 

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Fruits and Vegetables

Some research studies have found that eating fruits and vegetables may reduce your risk of developing cancer. Other studies have found a significant association between eating vegetables and a lower risk of cancer. In particular, eat yellow or orange vegetables and those in the cruciferous family, which includes broccoli.

Fruits and vegetables provide the vitamins, minerals and fiber that your body needs. They're also packed with hundreds of disease-fighting phytochemicals—natural substances that work as a team to protect good health. Only fruits and vegetables, not pills or supplements, can provide all of these nutrients together.

The different colors of fruits and vegetables—green, yellow/orange, red, blue/purple and white—all contain unique varieties of disease-fighting phytochemicals that work together to protect your health. Here are some examples of the phytochemicals found in various fruits and vegetables. Try to eat a variety of “colors” each day.

Carotenoids

Carotenoids are found in red, yellow or orange fruits and vegetables, such as tomatoes, sweet potatoes and carrots.

Lycopene

Lycopene is found in tomato-based foods, such as tomato sauce and tomato paste, as well as in watermelon, pink grapefruit, papaya and apricots.

Lutein and zeaxanthin

Lutein and zeaxanthin are found in leafy greens, such as spinach and romaine lettuce.

Flavenoids

Flavenoids are found in brightly colored fruits and vegetables, such as blueberries, cherries and strawberries. Further research is needed to study the role of lycopenes in reducing cancer risk. The evidence that eating lycopenes will reduce your risk of developing cancer is weak. Studies have not been controlled for total vegetable intake, and the actual amount of lycopene intake has been difficult to quantify.

The best advice currently is to consume a variety of fruits and vegetables every day, as part of an overall wholesome diet.

Cruciferous vegetables appear to protect against cancer. These include broccoli, cauliflower, cabbage, Brussels sprouts, kale, chard, collards and mustard greens. They contain compounds that boost the production of certain enzymes that can protect cells against cancer-causing agents.

What’s a serving size?

Use these measurements to determine a serving size:

  • 1 cup salad greens
  • 1/2 cup cooked legumes or peas (lentils, pinto beans, kidney beans, black beans, etc.)
  • 1/4 cup dried fruit
  • One medium piece of fruit or 1/2 cup cut-up fruit
  • 3/4 cup or 6 ounces fruit juice.

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Fiber

Dietary fiber comes from the parts of plants your body can't digest. There are two types, soluble fiber and insoluble fiber.

Soluble fiber

When eaten regularly as part of a low-fat, low-cholesterol diet, soluble fiber can help lower blood cholesterol, mainly be lowering LDL-cholesterol or “bad” cholesterol. Oats have the highest proportion of soluble fiber of any grain. Foods high in soluble fiber include oat bran, oatmeal, beans (legumes), peas, rice bran, barley, apples, strawberries and blueberries.

Insoluble fiber

Insoluble fiber, also known as “roughage,” helps to promote normal bowel function. Foods high in insoluble fiber include whole-wheat breads, wheat cereals, wheat bran, corn bran, and many vegetables such as broccoli, carrots, tomatoes, cauliflower, as well as seeds (pumpkin seeds; flaxseeds), and nuts.

Read food labels to help you estimate and increase your daily fiber intake.

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Soy

There is some evidence that soy may help prevent cancer, and more evidence that it can help to reduce heart disease. However, we do not know how much soy you need to eat in order to help prevent cancer.

Soy contains phytonutrients called isoflavones. Researchers think that isoflavones may prevent more advanced stages of cancer from developing. Soy may cause some gastrointestinal upset (such as gas), so if you do not eat soy foods regularly now, it may be better to introduce them to your diet gradually over several weeks. In some cases, as in estrogen-positive breast cancer, soy is not a good thing to eat at all. So be sure to consult your doctor.

Sources of soy

(in order of most to least amount of isoflavones):

  • Soynuts, dry roasted, 1/2 cup
  • Edamame (green soybeans), 1/2 cup
  • Tempeh, uncooked, 4 ounces
  • Soy protein powder, 1 ounce
  • Soy flour, 1/4 cup
  • Tofu, 4 ounces
  • Soy milk (1 cup or 8 ounces)
  • Miso dry soup mix, 1 ounce
  • Soy cheese, 1 ounce.

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Bone Health

Cancer treatment may result in a loss of bone density. It is important to consume enough calcium and vitamin D to help keep your bones strong. Exercise is also important to prevent osteoporosis.

Calcium

The role of calcium in cancer is unclear. Too much may increase the risk of cancer, while too little calcium may increase the risk of colon cancer. Avoid consuming more than 2000 mg. of calcium daily from food and supplements.

Your calcium requirements will vary, depending on whether or not you are receiving hormone therapy and whether or not you have osteoporosis.

If you have had a normal DEXA scan  and you are not receiving androgen suppression therapy, you need between 1000 and 1200 mg. of calcium a day.

If you have osteoporosis or osteopenia or are receiving androgen suppression therapy, you need 1500 mg. of calcium per day.

An SCCA dietitian can give you more information about calcium from foods and calcium supplements. If you do not consume enough calcium in food, you should take a supplement. Divide your intake of calcium supplements throughout the day to maximize absorption, and try not to take more than 500 mg. at a single time from food and supplements. Calcium carbonate supplements should be taken with meals for best absorption. Calcium citrate can be taken between or with meals.

Vitamin D

Vitamin D is a hormone that, with adequate sun exposure, can be manufactured in the body. However, if you wear sunscreen you may not make enough vitamin D. In addition, as you grow older your ability to manufacture vitamin D declines. Vitamin D helps the body utilize calcium and phosphorus to build bones and teeth. Preliminary research suggests that vitamin D may reduce the risk of breast, prostate, and colon cancers. Many people, especially those over 60, are deficient in vitamin D. Therefore, it is best to get vitamin D from food, a multivitamin supplement or a calcium supplement that includes vitamin D.

Daily Vitamin D requirements:

  • Males under 70: 400-600 IU
  • Males, 70 years and older: 600 IU
  • Males with osteopenia, osteoporosis or who are receiving androgen suppression therapy: 800 IU.

Sources of vitamin D include:

  • Fortified milk, soy milk or yogurt
  • Fortified orange juice
  • Fortified cereal
  • Multiple vitamin supplements or a calcium supplement with vitamin D.

Check labels of fortified foods for vitamin D content (Hint: “25 percent DV” = 100 IU vitamin D).

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Exercise

Physical activity is important for weight management, muscle maintenance, keeping bones strong and reducing your risk of heart disease. Staying active will also help with balance, will improve your sleep and help reduce anxiety.

You can lose extra weight and keep it off by increasing your resting metabolic rate (RMR), the rate at which your body burns calories when you are resting. Your resting metabolic rate accounts for 60 to 75 percent of your daily calorie expenditure, so even a small increase in RMR will help burn off more calories.

Your RMR is closely linked to the amount of muscle you have. Muscle burns 35 to 50 times more calories than fat. So if you increase your muscle mass, you will raise your RMR. Raising your RMR can help you lose weight and can help prevent weight gain.

Strength training

Strength training, also known as resistive exercise, can help you increase your muscle mass and therefore increase your resting metabolic rate. Strength training is also important for healthy bones and for improving balance (and thus preventing falls).

Types of strength training include biking, carrying bags of groceries and working out with weights. Talk with your doctor about the level of strength training that is safe for you.

Aerobic training

Aerobic exercise (such as fast walking, dancing, hiking, swimming, running and cross-country skiing) causes your calorie expenditure to increase during the workout and for a few hours after the workout. By doing aerobic exercise, your body burns calories at your resting metabolic rate plus the additional number of calories burned by the aerobic exercise.

How much exercise?

Although physical activity does not need to be vigorous to provide health benefits, the health benefits you gain are directly related to the amount of regular physical activity you get. Physical activity might include bicycling, dancing, doing active household chores, climbing stairs, gardening and working at a job that has physical demands.

Examples of moderate activity include playing volleyball for 45 minutes, raking leaves for 30 minutes, swimming laps for 20 minutes, playing basketball for 15 to 20 minutes, or running 1.5 miles in 15 minutes. These examples illustrate the balance between duration and intensity. You must perform less strenuous activities for longer periods of time to achieve the same caloric expenditure.

The American Heart Association recommends gradually working up to exercising at least three to four times a week for 30 to 60 minutes at 50 to 80 percent of your maximum capacity. Whatever exercise you choose, you must continue it (or some variation) for the rest of your life in order to produce lasting benefits. Many people find that if they can stick with their activity program for six months, it becomes an important part of their daily lifestyle.

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Supplements

Food is the best sources of nutrients. If you choose to take supplements, be sure to choose supplements with appropriate amounts of vitamins, minerals or other chemicals. Remember, an appropriate dose of a supplement for one disease may not be the correct dose for another disease.

Multiple vitamin and mineral supplements

If you avoid specific groups of foods, such as meat, milk, cheese, eggs, or fruit, you may need to take a multiple vitamin/mineral supplement in order to get some of the nutrients these foods supply. A multiple vitamin/mineral supplement is also a good source of vitamin D. Look for a supplement with 100 percent of the daily value for most of the vitamins and minerals.

Selenium

The role of selenium supplements in reducing the risk of cancer is not clear. One study showed that only people with low blood selenium levels benefited from taking selenium supplements. Other studies have suggested a potential increased risk of some types of cancer for persons taking selenium supplements. Based on current knowledge, the best source of selenium is food. Foods rich in selenium include Brazil nuts, wheat germ, bran, brown rice, whole wheat bread, barley, onions, garlic, turnips, soybeans, mushrooms, fish, and eggs.

Vitamin E

Studies of the role of vitamin E in cancer prevention have reached various conclusions. Some showed that vitamin E had no effect; others showed a positive effect or a positive effect only for former smokers. The amounts of vitamin E given to participants in these studies were 50 mg. or less.

One study currently underway to evaluate the effectiveness of selenium and vitamin E supplements in cancer prevention may provide further information. Until more is known regarding the role of vitamin E supplementation in cancer, focus on consuming foods rich in vitamin E. These include nuts (such as almonds, hazelnuts and peanuts), vegetable oils (olive and canola), seeds, wheat germ and whole-grain products, and spinach and other dark, green leafy vegetables.

Lycopenes

The safety of lycopene supplements in cancer has not been tested. Lycopene supplements are also fairly expensive.

As a result, it is better to consume lycopene-rich foods as part of a diet high in fruits and vegetables. Tomatoes and tomato products (such as tomato sauce, tomato juice, tomato paste, salsa, tomato soup and spaghetti marinara sauce) are major sources of lycopenes. Watermelon, pink grapefruit, papaya and apricots also contain lycopenes.

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Benefits of a Good Diet

A better diet can help you prepare for surgery, help speed your recovery after cancer treatment, and may help keep your cancer from coming back. In addition, a nutritionist can recommend dietary changes to help you deal with side effects of cancer treatment, including:

  • Osteoporosis
  • Weight gain
  • Fatigue, which can be a side effect of hormone therapy, radiation therapy, or chemotherapy
  • Nausea, a common side effect of chemotherapy
  • Taste changes, sometimes related to chemotherapy
  • Constipation, or other gastrointestinal problems, which can result from radiation therapy and other treatments.

"A lot of people in cancer treatment don't realize that nutrition counseling can help them enjoy eating again," says Jean Stern, an SCCA dietitian and patient education coordinator who works with cancer patients. "If you have questions or symptoms, ask for help." 

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Red Meat and Grilling

Based on research from the American Institute of Cancer Research (AICR), we know that diets high in red and processed meats have been shown to increase risk of colorectal cancer. Currently, the recommendation to decrease risk for all cancers is to consume less than or equal to 18 ounces of red meat per week. Red meat includes beef, lamb, and pork. Processed meats include ham, bacon, sausages, hot dogs, and salami.

Grilling meat poses another health concern with the combination of the meat and the high heat. This includes not only red meat but fish and poultry as well. When the meat protein is cooked at high temperatures, it forms heterocyclic amines (HCAs), carcinogenic compounds that can damage our DNA. The best way to avoid formation of these compounds is by cooking meat at lower temperatures. Examples of healthier cooking techniques include roasting and stewing.

Polycyclic aromatic hydrocarbons (PAHs) are formed when fats and juices from the meat drip onto the heat source/charcoal causing flames and smoke to rise. The PAHs from this smoke also riseand coat the surface of the food. While evidence of their impact on humans is limited, HCAs and PAHs are considered potential cancer promoters.

The factors that can affect the formation of HCAs and PAHs include cooking time, cooking temperature, type of meat, and method of cooking. The high temperature itself, not the source of the heat, is the main factor in formation of the HCAs and PAHs. Foods cooked below the heat source were also shown to produce less of these compounds which may be explained by the juices and fats not dripping down and producing smoke.

Tips for healthier grilling:

  • Cook food in the center of the grill and move coals to the side to reduce fat and juices from dripping on the coals and smoke from rising up over the food.
  • Use tongs to flip food on the grill to prevent additional juices from dripping. Flip foods frequently.
  • Marinate meats before grilling: even 30 minutes has been shown to reduce the formation of PAHs and HCAs.
  • Trim fat from meat to reduce fat drip flare-ups.
  • Partially cook meats in the microwave or oven before grilling and pour off the juices.
  • Shorten grill time by using thinner and leaner cuts of meat, checking with a thermometer to prevent overcooking, and cooking over a low flame. Remove meat from the grill before it chars.
  • Make kabobs which have smaller amounts of meat and require less cooking time.
  • Line grill with foil that has holes in it. Fat will be allowed to drip down but this prevents smoke from rising up to coat meat and will prevent smoke flare-ups.
  • Cook food at low temperatures and on a high grill rack.
  • Cut off the charred portions from meat.
  • Grill more vegetables and fruit. These can include zucchini, bell peppers, onions, mushrooms pears, bananas, and peaches. Put a light amount of oil on them to prevent sticking to the grill.
  • Cook meat in a liquid to prevent it from getting too hot. 

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Meet a Nutritionist

Nutritionists are available to meet with you at the SCCA clinic. Ask your doctor or nurse to refer you for an appointment, or if you have questions, e-mail nutrition@seattlecca.org.

Read more about SCCA Nutrition Services for cancer patients or more about nutrition guidelines.

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