Eating well can have a huge impact on your cancer experience. Good nutrition can help to manage symptoms and side effects, assist with recovery after chemo, radiotherapy or surgery, improve energy levels and body composition and keep you feeling your best well into the future.
Everyone has unique preferences and needs when it comes to food. This can get really confusing when trying to sort fact from fiction and figuring out what’s relevant for you during or after treatment. Here we’ll be breaking things down to help you better understand and apply key info to optimise your nutrition for your body and mind.
WHY GOOD NUTRITION MATTERS
We all know the importance of healthy eating, but there are benefits of particular relevance to those with a cancer experience.
Eating well during treatment can:
- Reduce the likelihood and impact of side effects such as nausea, diarrhoea, mouth ulcers, changes in appetite and fatigue
- Improve cell healing and speed your recovery after treatment and surgery
- Reduce the risk of infections and improve wound healing
- Reduce muscle loss
- Improve energy levels and your ability to undertake daily activities
- Optimise your overall health, wellbeing and body composition, including preventing significant weight change
Eating well after treatment can:
- Improve sleep, energy levels, work and social capacity
- Improve long term cancer outcomes and reduce your risk of cancer recurrence
- Reduce your risk of chronic diseases such as heart disease and type 2 diabetes
- Optimise body composition and your overall health and wellbeing
SORTING FACT FROM FICTION
You’ve probably read or been on the receiving end of plenty of advice from others about diets to follow or things to avoid when going through a cancer experience. As well-meaning as such advice often is, it is important to separate fact from fiction, and ncoeven more important to be aware of any dietary, complementary or alternative therapies that may interfere with your treatment or be unsafe.
The table below summarises some commonly promoted ‘anti-cancer’ diets and eating styles and whether they are worth considering.
Based on the premise that cancer cells tend to prefer glucose (sugar) as fuel
The science:
Avoiding sugar means avoiding not only processed or added sugar, but all carbohydrates, which are present in all fruit and vegetables, legumes, dairy and grain-based products. Denying the body of carbohydrates (which our bodies break down into sugar) is likely to have more of an impact on healthy cells than it will on cancer. If there isn’t enough energy coming in from carbohydrates, our bodies will switch to breaking down fat and muscle for fuel. This can lead to weight loss, muscle wasting and malnutrition. And it doesn’t slow cancer growth.
The verdict:
Sugar feeds everything, and cancer feeds off everything. Carbohydrates are an important part of a balanced diet, and processed or added sugar is okay in moderation.
Claims that cancer thrives in an acidic environment; therefore, eat only alkaline foods (mainly vegetables and low-sugar fruit).
The science:
The pH of the foods we eat will influence the pH of our waste, not our blood. Cancer grows in alkaline environments too. There is no scientific evidence to support avoiding so-called ‘acidic’ foods.
The verdict:
No evidence to support it. Nutritionally restrictive.
Complete avoidance of animal products; based on the concept that animal products drive cancer development.
The science:
- Lack of convincing evidence to support claims that vegan diet independently reduces cancer risk
- Possible benefits: high consumption of dietary fibre, many vitamins and minerals and low in saturated fat
- Possible risks: weight loss, vitamin and mineral deficiencies
The verdict:
Include animal products in moderation, if you wish. Guidance from a dietitian recommended to ensure nutritional needs are met if you choose a vegan diet.
Based on the concept that cancer can be 'starved.'
The science:
Denying the body of nutrients is likely to have more of an impact on healthy cells than it will on cancer. If there is insufficient energy supply coming in from food, our bodies will switch to breaking down fat and muscle stores for fuel. This can lead to weight loss, muscle wasting and malnutrition.
There are no human clinical trials demonstrating a benefit of fasting in cancer patients. Short-term fasting before, during and after chemo may increase effectiveness and tolerance, but studies are still ongoing.
The verdict:
Insufficient evidence in humans at this stage, but studies are ongoing. Guidance from a dietitian required as compliance can be hard and it’s important to still meet nutritional needs.
Based on the concept that cancer can be starved of its main energy source (glucose), which is derived from carbohydrates.
The science:
There are no human clinical trials demonstrating a benefit of a ketogenic diet in cancer patients. Denying the body of carbohydrate foods is likely to have more of an impact on healthy cells than it will on cancer. If there isn’t enough energy coming in from carbohydrates, our bodies will switch to breaking down fat and muscle for fuel. This can lead to weight loss, muscle wasting and malnutrition.
The verdict:
Insufficient evidence in humans at this stage, but studies are ongoing. Guidance from a dietitian required as compliance can be hard and it’s important to still meet nutritional needs.
Based on the claim that cooked food leads to diseases such as cancer.
The science:
No scientific support for this claim. Possible benefits of raw foods include avoidance of preservatives such as salt or toxins created by cooking (e.g.
).Possible risks of relying solely on raw foods include gastrointestinal discomfort and increased risk of infections in people with weakened immune systems.
The verdict:
No evidence to support it. Nutritionally restrictive and lacks variety.
Based on claims that they can reduce cancer risk and/or benefit the body in ways equal to whole foods.
The science:
Insufficient evidence. The presence of fibre and other
in whole plant foods makes them superior to tablet, liquid or powdered forms.Caution should be taken during radiotherapy and chemotherapy as some supplements may interfere with treatment and should be avoided.
The verdict:
Insufficient evidence. Supplement only with specific nutrients when clinical inadequacies or deficiencies have been identified by your dietitian, GP or treating team.
Based on claims that it can prevent or cure cancer.
The science:
Insufficient evidence to support claims that apple cider vinegar reduces cancer risk or can cure cancer.
The verdict:
Insufficient evidence. May contribute to erosion of tooth enamel or burning the lining in your oesophagus (throat).
Based on claims that it can prevent or cure cancer.
The science:
No scientific evidence to support these claims. Juicing celery also removes most of the valuable fibre that can promote gut health.
It is important that people with kidney dysfunction or irritable bowel syndrome (IBS)
about their load of celery juice intake.The verdict:
No evidence to support claims; however, generally safe to include.
A FEW WARNING SIGNS...
If it...
- promises to prevent or cure cancer
- is loaded with ‘testimonials’ (did you know that registered health professionals in Australia aren’t allowed to include testimonials? This is because we base our advice on best-practice evidence rather than individual cases. What works for Sam won’t necessarily be right for Sally!)
- makes no mention of seeking individual advice
- costs a bomb
...it’s probably too good to be true.
The best advice? Check anything you’re interested in trying with a dietitian, your GP or treating team for advice tailored to you.
DO I NEED SUPPLEMENTS?
For most people, the answer is no. It is recommended that you get all the nutrients, vitamins and minerals you need from your food, as whole foods provide additional benefits that supplements do not (e.g. fibre, , protein).
Some supplements may also interfere with chemo, radiotherapy and/or medications, and others can build up and become toxic if you have too much. For these reasons it is important to always notify your GP or treating team if you plan on taking any supplements. A dietitian can also help you with building a balanced diet and supplementing only the nutrients you need or are lacking.
OKAY, SO WHAT DO I ACTUALLY EAT?
WHAT TO EAT MORE OF:
- Regular sources of protein such as poultry (chicken, turkey), lean meat, fish and seafood, eggs, legumes, dairy, tofu, nuts and seeds. Protein is important for strength and cell repair.
- Low Tools like this one can help you make lower GI choices more often. carbohydrates such as whole grain bread, barley, quinoa, rolled oats, basmati rice and starchy veggies (e.g. sweet potato, corn, peas). These provide your body with longer lasting energy and help reduce your risk of long term health problems.
- Go nuts with the fresh produce for an array of vitamins, minerals and antioxidants. A diet rich in vegetables, fruits, wholegrains, legumes (such as chickpeas, beans, lentils etc), nuts and seeds can prevent and repair cell damage.
- Include the skins and seeds of fruits, veggies and legumes to provide fuel for your gut bacteria to keep your digestive system working well. Improving gut health can also enhance immune function, disease risk and mood, so don’t ditch the skin!
- Oily fish (salmon, sardines, mackerel), plant-based oils, nuts and seeds to boost your healthy monounsaturated and omega-3 polyunsaturated fatty acids, which help to keep your brain firing and inflammation under control.
WHAT TO EAT LESS OF:
- High GI carbohydrates, and sugar. Go for dense, grainy bread over white and choose whole foods and dairy over processed cereals, crackers and refined grains.
- Reduce red meat intake (beef, lamb, pork) to reduce cancer risk, aiming for less than 500g per week.
- Minimise your intake of butter, fried and processed foods such as chips, biscuits and cakes to reduce saturated fats that impair brain function and increase your risk of heart disease.
- Avoid overly charred foods as these can produce . While charred meats or fish hold the greatest risk, it is best to limit char on all foods, including barbecued veggies, toast and other plant-based products.
- Avoid processed meats such as bacon, ham, salami and hot dogs as they are known and increase your risk of many chronic diseases.
OTHER TIPS:
- Avoid the “eat whatever you feel like” trap. During treatment, you may have been encouraged to eat whatever you wanted to prevent malnutrition. Try to avoid the trap of relying on energy-dense, nutrient-poor foods. A dietitian can help guide your nutritional choices for faster recovery, feeling strong and promoting long term health.
- Talk to an oncology dietitian before making any extreme changes to your diet. Many 'anti-cancer' diets exist that may cause more harm than good. It’s important to work together with your health professionals to find a plan that works best for you and your goals.
- Keep hydrated. You can calculate your fluid needs by multiplying your body weight (in kgs) by 35-45mls per day. Most people need 2-3L fluid per day. Opt for water in the first instance followed by sparkling water and herbal teas (other teas and coffee don’t hydrate very well due to their effect). Try to limit your intake of sugar-sweetened drinks.
- Ask to have your vitamin D levels checked if you’re . Vitamin D has all sorts of benefits for the body but it’s almost impossible to get enough through food alone.
TAILORING YOUR PLATE
The foods we eat can be a powerful tool in improving our health after cancer treatment. Building a nourishing meal can be as simple as using the guide below, selecting your preferred ingredients or what you have on hand and getting creative. Try out new foods every now and again too!
Breakfast
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Lunch
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Dinner
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Snacks
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- 150g raw weight:
- Chicken / turkey breast
- Lean chicken / turkey mince
- Fish, prawns, fresh calamari
- Lean beef, lamb or pork (max 500g or 2-3 serves per week)
- Kangaroo
- Tofu
- 2 eggs
- 1/2 - 3/4 cup cooked/tinned legumes (e.g. lentils, chickpeas, kidney beans, black beans, peas)
- 200g YoPro yoghurt
- 1/2 cup ricotta or cottage cheese
- 1/2 cup cooked quinoa, barley, freekeh, basmati rice, pasta
- 1/2 cup rolled oats
- 2 Mountain Bread rye wraps
- 1 slice wholegrain bread
- 4 Arnott’s Vita-Weat 9 grain crackers
- 1/2 cup ricotta or cottage cheese
- 1/2 cup cooked/tinned legumes (e.g. lentils, chickpeas, beans, peas)
- 1/2 cup starchy vegetables (e.g. pumpkin, sweet potato, corn, peas)
- 1 piece / small handful (30g) fruit
- 1/4 - 1/2 avocado
- 1 tbsp extra virgin olive oil, sesame oil, peanut oil, flaxseed oil
- Small handful (30g) nuts (opt for natural, dry roasted or unsalted)
- 1-2 tbsp seeds
- 1 tbsp natural nut butter (e.g. Mayvers, Pic’s)
- This includes except potato, pumpkin, sweet potato, peas and corn
- Eat as much as you want!
- Include a wide variety in your diet- generally the more colour, the better for micronutrient variety
Flavour your food with:
- Spices (paprika, turmeric, cumin, oregano, basil, rosemary, pepper)
- Chilli
- Miso paste
- Kimchi
Use salt, soy sauce, oyster sauce, hoisin sauce, or sauces with added salt and sugar sparingly.
WHAT A MEAL MIGHT ACTUALLY LOOK LIKE:
LOW GI CARBOHYDRATES
e.g. oats, quinoa, barley, pasta, basmati rice, starchy veggies like sweet potatoes, peas and corn
GOOD QUALITY PROTEIN
e.g. chicken, turkey, fish, red meat, tofu, legumes, eggs
FRUIT AND VEGETABLES
A wide variety of fruits and nonstarchy vegetables (lots of different colours!)
Tip: Save all the other foods with less nutritional value for after you’ve included all the stuff your body needs. Meet your quota first.
SHOULD I GO PLANT-BASED OR VEGAN?
SMART SWAPS AND TIPS FOR UPGRADING YOUR HEALTH
You wouldn’t go from the couch to a marathon, so let’s not try the same with your diet. You’re far more likely to develop healthier habits that last if you make small changes gradually. Below are some tips on where to start.
Try including breakfast 2-3 times per week to keep your body and metabolism guessing!
(e.g. Nutrigrain, Corn Flakes, Rice Bubbles)
Try an untoasted muesli, some oats with berries and yoghurt or try your hand at some overnight oats, bircher or chia puddings. Super easy and that much better for you!
Try a green or herbal tea or cold infusion to skip all that unnecessary sugar.
Try an unsweetened natural or Greek variety (YoPro or Chobani also provide a decent serve of protein).
Try shaved turkey breast or falafel in your sandwich or wrap, or some hearty baked beans with avocado, mushrooms and spinach for breakfast.
Get creative with chicken, turkey, oily fish, tofu or legumes to pimp your gut microbiome and reduce your risk of chronic health problems. Start with a meat-free Monday and maybe progress to meat-free lunches if you’re keen.
Opt for extra virgin olive oil for its anti-inflammatory properties and .
Try some quinoa, barley, freekeh or bulgur - you can cook them on the stovetop or in a rice cooker just as you would rice, but with adjusted water ratios.
Or try some convenient microwave options such as quinoa and brown rice blends.
Get some frozen veggies. They’re nutritionally great and super convenient. Look for a winter vegetable mix to get plenty of non-starchy veggies, antioxidants and fibre.
Get a drink bottle that you love and pimp your water with some bubbles (soda stream anyone?), a squeeze of lemon, some berries or a herbal infusion tea bag. Set yourself a daily target based on and make steps towards it.
Try a kombucha (so long as you’re not or , as the live cultures are bacteria your body doesn’t need) or sparkling herbal iced tea.
Delay your snack for 10 minutes. Allow yourself to have it, but make yourself wait. Give yourself some time and space to figure out if you really want it, rather than acting impulsively. Try a 5 minute mindful eating meditation or mindful eating guide for additional support.
Try one of these healthier savoury snacks with crunch:
- Whole-grain crackers (Vitaweat or Ryvita grainy varieties) topped with avocado, cottage cheese, goats cheese, ricotta, hummus, natural nut butter, shaved turkey breast, tomato or cucumber
- Veggies like carrot, cucumber, capsicum, cherry tomatoes, celery or mushrooms alone or dipped in hummus, tzatziki or tahini
- A handful of natural or dry roasted (unsalted) nuts
- Pre-packaged snacks like Sunbites or Cool Pak air-popped popcorn or The Happy Snack Company’s Roasted Chickpeas or Fava Beans
Upgrade to some healthier sweet snacks, such as:
- A piece of fruit +/- yoghurt
- Wholefood balls or ‘bliss balls’ (there are tons of recipes online; no cooking required- just blitz up a few healthy ingredients in a food processor, roll into balls and chill in the fridge)
- Pre-packaged whole food bars like those made by Get Farmed, Kez’s Kitchen, Emma and Toms, Googys, Keep it Cleaner, Slim Secrets, Lori’s Wholesome Pantry, Carmen’s or Food for Health.
Whip up a ‘nice cream’ in your blender with some frozen fruit (try blending 1.5 frozen bananas with ½ c frozen berries and a handful of walnuts).
Prepare some meals in bulk so you’ve got options in the freezer for when you simply can’t be bothered, or opt for healthier pre-prepared options such as:
- You Foodz (most supermarkets or online)
- Super Nature Super Foods (most supermarkets)
- We Feed You (online)
Aim for four alcohol-free nights per week. Or set yourself a target from where you are currently at, write it down or tell someone (to make it real) and try to stick to it.
Cut your sugar load massively by switching to a vodka lime and soda, wine, champagne or low carb beer
Set yourself a time to stop (it might be 8pm, or 2 hours before you plan to hit the hay...everyone's a little different) and stick to it. A cup of herbal tea before bed is a delicious way to wind down.
Include some in your pre-workout meal (1-2hrs before you exercise). Get a friend or family member to join you to make exercise fun and keep you accountable!
Consume a within 2 hrs (ideally within 30 mins) of your strength-based workout to maximise those gains. Speak to a dietitian about the right protein powder for you if you’re interested in a little extra.
NEED SOME RECIPE INSPO?
Here are some websites with easy, healthy recipes to help get you started:
- Australian Healthy Food Guide
- Cancer Council’s quick meal and snack ideas for when you’re not feeling great, and easy snack and lunch recipes for when you’re up to cooking
- OnCore Nutrition – recipe ideas from oncology dietitians
GETTING SUPPORT
The World Cancer Research Fund recommends everyone who has experienced cancer get specialised nutrition support from a trained professional. To find a dietitian:
- for a referral (see box below)
- Ask your treating team for a referral to the oncology dietitian at your hospital
- Use the Dietitians Association of Australia ‘find a dietitian’ function, where you can search for dietitians by location, language, area of practice (including cancer) and more
DID YOU KNOW?
When searching for a nutrition professional, look for the titles ‘Accredited Practising Dietitian’ (APD) or ‘Accredited Nutritionist’ (AN). Keep in mind that the chronic disease management plan available through your GP (see box above) and most private health insurers will only cover sessions with an APD.
TIPS FOR MAKING THE MOST OF YOUR DIETITIAN APPOINTMENT
- Find one with experience and knowledge in cancer care. Ask your GP or treating team for recommendations, or use the Dietitians Association of Australia ‘find a dietitian’ search function (be sure to choose the Cancer (Oncology) option under ‘Area of Practice’)
- Write down your goals and any areas of concern or interest e.g. nutrition for managing symptoms, optimising your exercise or training, strengthening your hair and nails.
- Be prepared with any questions you wish to clarify.
- Bring a copy of any recent blood tests or medical results.
- It can be helpful to for 1-3 days and bring this with you as well.
DIETITIANS VS NUTRITIONISTS: WHAT’S THE DIFFERENCE?
In Australia, all dietitians are nutritionists, but nutritionists are not necessarily dietitians.
Dietitians have undertaken significant university training (minimum 4 years) and their practice is highly regulated, whereas almost anyone can call themselves a nutritionist regardless of formal education or training, and there is no authority that assesses their qualifications.
Dietitians are also the only professionals formally trained to provide individually tailored nutrition advice.
USEFUL LINKS AND RESOURCES
There is an overwhelming amount of information (and misinformation) out there about diet and nutrition in general and as it relates to cancer, so it’s particularly important to make sure that your sources are trustworthy and knowledgeable (i.e. websites or organisations with recognised expertise in diet and nutrition, cancer or both). Below are some resources to get you started.
Always keep in mind that diet and nutrition is highly individualised- we are all unique in how we respond to and process foods and nutrients based on our genetics, physiology, metabolism and more, so there is no one size fits all approach. See a dietitian for advice tailored to you.
- Healthy eating after cancer (Cancer Council NSW) – info on everything from serving sizes, food labels and supplements to advice on sugar and alcohol as it relates to life after treatment
- World Cancer Research Fund – evidence-based information about diet, nutrition and physical activity as it relates to cancer risk and prevention, categorised by food/dietary exposures and cancer type
- OnCore Nutrition – podcasts, guides, factsheets, recipes, newsletters and mindful eating recordings by oncology dietitians
- Memorial Sloan Kettering Cancer Centre ‘About Herbs’ database – evidence-based information on complementary or alternative therapies, herbs, vitamins and minerals
- ‘Find a Dietitian’ (DAA) – search for Accredited Practising Dietitians by location, language, area of practice (including cancer) and more