Eating when you have cancer
Sore mouth and swallowing difficulties
Frequently asked questions on food and cancer
Developing cancer is one of our most common health worries. If we don’t suffer from cancer ourselves, it’s likely that we know someone who has it now or has had it in the past. In fact it’s estimated that one in two of us will develop a form of cancer at some point in our lives.
Inheriting certain genes increases our likelihood of developing some cancers, which is why genetic research is so important and will increasingly provide valuable insights into how and when to screen at-risk people. The incidence of different cancers varies hugely but, worryingly, the numbers of people affected are on the rise. Bowel cancer is now the third most common cause of cancer death in women in the UK, according to the charity Bowel Cancer UK. Like many cancers, bowel cancer is thought to be a disease of the older generation but 2,500 men and women under the age of 50 are diagnosed every year – an increase of 45 per cent since 2004. Breast cancer is the most common cancer in women in the UK, with around 53,000 new cases each year. Latest figures from the Office for National Statistics show an eight per cent rise in the number of people with pancreatic cancer, which has one of the highest incidence to mortality ratios of any disease. The four most common cancers – breast, lung, bowel and prostate – make up over half of all cancer cases.
It's important to look at what we can do to reduce our cancer risk in the first place – and what we put into our body has a profound impact on that. A massive two-thirds of bowel cancer cases could be prevented by eating, drinking and living well. Weight gain is strongly linked to an increased risk of stomach and oesophageal cancer, according to a new study from the National Cancer Institute in the US. The Mediterranean Diet has recently been found by the World Cancer Research Fund to reduce risk of contracting one of the most dangerous forms of breast cancer by 40 per cent. The same study also found a strong relationship between weight gain around the waist and incidences of womb cancer – even a small increase in waist size can lead to a 21 per cent increase in risk of the disease.
Eating when you have cancer
We never really talk about the fact that it is often malnutrition which causes someone to die, not the disease itself – cancer doctors in Ireland recently warned that fad diets and lack of access to a qualified dietician early on in their treatment were harming patients, with worrying numbers suffering from malnutrition that worsened the side effects of chemotherapy. It’s incredibly important that we look at ways in which we can help nourish the body, especially as cancer treatment can make eating difficult. By looking at common symptoms and providing simple, delicious solutions for them, we can help to support the body and use food as an empowering force when living with cancer.
- Your nausea may come in waves, so capitalise on those times of day when you don’t feel so sick. You may find that you need to have your evening meal earlier or that you have five smaller meals instead of your usual three.
- Keep a food and symptom diary to log what you eat over a 24-hour period to help work out any nutritional gaps and also provide useful insights to your cancer care team to see if drug tweaks can also help alleviate side effects etc.
- Cooking food can make you feel queasy before you’ve eaten a mouthful, so try to get someone else to help with food preparation. When you’re not feeling sick, cook more than you need to stock up the freezer with meals for when you feel below par. Freezing doesn't reduce the nutritional power of the food, but if you'd like to boost the vitamin c levels of for instance a soup you've defrosted, simply squeeze a little fresh lemon or lime into it, on serving.
- Toast especially thinly sliced sourdough bread, simple rice and pasta may sit well on your stomach but if you can manage some fruits and vegetables and a few sources of protein as well, this is a real plus.
- You could find that cooked vegetables suit you more than raw ones for a time and you will still glean useful vitamins.
- If you don’t feel like chomping your way through a steak or piece of chicken, think about incorporating protein in something more appealing, such as a small portion of shepherd’s pie, which contains all sorts of vegetables as well. Experiment with the topping, which could include cauliflower, parsnips or carrots as well as the traditional potato.
- If you’re feeling lousy and don’t fancy a plate or bowl of anything, then a mug of clear, consome or brodo as the Italians call it- style soup could be both comforting and nourishing.
- You could also incorporate egg or nut milks like almond milk into pancakes or little Scotch pancakes, as they both provide a little protein without you noticing. You could also add a sliver of lean ham or smoked fish, or some pure fruit spread or sliced banana and a little butter on top.
‘When I was having chemotherapy for breast cancer, the smell of cooking during the day would make me feel queasy. Instead, my lovely husband would leave platters of fresh fruit and delicious nut smoothies in the fridge for me, until I was ready to face a meal at night.’
Sore mouth and swallowing difficulties
- Drink plenty to keep your mouth moist and less sore, which may increase your appetite. Maybe try a little organic aloe Vera juice, a traditional anti inflammatory which can soothe a sore mouth. Note as with all supplements and herbs/remedies its best to check your medical team is happy for you to take whilst undergoing treatment.
- If the soreness is intense, try easy-to-swallow dishes like risotto loosened with plenty of stock; small-shaped pastas or lasagna, made with plenty of rich tomato and meat sauce; soup/noodle dishes with a good base stock some soft chicken or small prawns and peas or mushrooms.
- Cut the crusts off soft, fresh bread and have plenty of moist fillings inside, such as egg mayonnaise, cream cheese and very thinly sliced cucumber, or salt beef with thinly sliced tomatoes and a little mild mustard.
- Crumpets can be soft and delicious when warm, buttered or topped with something soft like a little smoked mackerel pate, or a pure fruit spread.
- Make soups as nourishing as possible by adding ingredients such as Greek yoghurt, crème fraiche or cream at the end.
- Casseroles and tagines tend to produce soft textures and can be a good option if you add some little dumplings or serve them with gnocchi. Cooking meat for a long time, for example a slow-roasted shoulder of lamb, can render the meat ready to melt in the mouth.
- With fish, go for larger, fleshier varieties, where the bones are easier to remove. Bake or poach them in stock for soft flesh or make a fish pie with creamy sauce and fluffy mashed potato. See our delicious light smoked trout mousse.
- Sorbets, jelly, ice creams and frozen yoghurts need not be seen as treats but more of a necessity! Little pots of cold yoghurt or chocolate mousse are also worth keeping in your fridge.
- Add butter, cream, Greek style thick yoghurt, olive or avocado oil, and or finely grated Parmesan cheese to puréed and mashed vegetables.
- Serve a thick creamy custard with stewed fruit, and add a soft melt-in-your-mouth buttery biscuit on the side.
- Make porridge with all milk and add some cream when serving, plus some brown sugar, or honey.
- With toast, putting a good layer of butter or nut butter on it could make it easier and more enjoyable to eat, as well as higher in calories.
- Keep a food diary for a few weeks to help you assess how much you are really eating.
- Cut back on very sugary foods, eating naturally sweet fruit such as dates and grapes in place of chocolate, cakes and sweets. Unsalted nuts and crispbreads can replace savoury crisps.
- Help to balance blood sugar levels – and sweet cravings – by eating wholegrains that release energy slowly.
- Try to avoid energy-rich saturated fats found in butter, cream, cheese and fatty meats.
- Put the emphasis on vegetables and salads, with moderate amounts of protein, such as chicken and fish.
Frequently asked questions on food and cancer
A While several studies have suggested that a high consumption of red or processed meat – bacon, ham – is linked with an increase in the risk of bowel cancer, the evidence is a lot stronger for a link between a diet heavy in processed meats than if we ate some really good-quality lean steak a couple of times a week. Overall, studies suggest that eating about 50g of processed meat a day (around two slices of ham or a slice of bacon) may increase the risk of bowel cancer by around 20 per cent. The studies don’t distinguish between a piece of cheap salami and a slice of well-reared pancetta, although for me this makes a stronger case for choosing our meat well and eating a smaller amount of good quality.
Scientists advise us to limit our consumption of processed meat, and keep our consumption of red meat to 500g a week or less, which gives us real scope for enjoying some delicious meat-based meals. Bear in mind that a bolognaise sauce made with 500g of lean, good-quality beef mince would serve a good six hungry adults. And to put the role some meats can play into perspective, studies suggest that by smoking 20 cigarettes a day our lung cancer risk is 100-200 times greater than the effect of eating more than the recommended amount of processed meat!
A When it comes to salt’s relationship with cancer, studies are in their infancy, but the stomach can be more likely to fall prey to cancer if you have a high-salt diet. Smoked foods can be heavy in salt – this includes, unfortunately, such delicacies as smoked mackerel and salmon and rashers of bacon and ham. There isn’t any need to avoid them completely, just try not to have too much and give your body a dose of fresh vegetables and wholegrain goodness alongside to help compensate. So a few slices of smoked salmon on warm wholegrain bread, served with a big watercress and raw spinach and tomato salad, is far better for you all round than if you have the same smoked salmon with white bread, with a poor quality margarine on it, and a bag of crisps.
A A relationship exists between carrying too much weight and cancer, particularly cancer of the oesophagus (the tube leading from your mouth to your stomach), bowel, pancreas, endometrium (the lining of the womb), kidney, gallbladder and breast (in post-menopausal women). To put a context on the risk, men are a staggering 50 per cent more likely to develop bowel cancer if their weight rises and puts them into the obese zone, while the figure for women is 25 per cent.
Exercise can help us to lose weight but also get into the positive eating zone that so often goes hand in hand with being motivated to get active. Keeping fit has also been shown to make the likelihood of bowel, endometrial and post-menopausal breast cancer go down. As to how much exercise we need to do, while the recommendation is for at least half an hour five times a week, something is always better than nothing, even if it’s cycling to work, or getting off the bus or tube a few stops early and walking.
A Seldom a week passes without a headline discussing the antioxidant properties of beer or red wine. We now know that it’s really only in the laboratory setting that red wine’s antioxidants offer us any real benefits, and I suspect that the other types of alcoholic antioxidants won’t fare any better.
In fact, studies find a convincing relationship between drinking too much alcohol and the development of mouth, throat, oesophagus, liver and bowel cancers. Alcohol is also a key factor in increasing the risk of breast cancer in women. If we’re really serious, we shouldn’t be going above two units per day for men and one for women.
A Studies have not yet given clear results. Recent research shows that a higher intake of calcium (found in dairy products) can protect against bowel cancer, but some early research also suggests that there could be a link between dairy intake and the risk of developing prostate and ovarian cancers. For breast cancer the evidence is conflicting. A link between breast cancer and dairy products has been suggested, possibly because of the saturated fats they contain, or contaminants that could be present, but there is no clear evidence to support this. Another theory is that dairy products might help protect against breast cancer. But again, this needs to be backed up by firm evidence.
A large European study called EPIC (European Prospective Investigation of Cancer) is currently looking at the relationship between diet, lifestyle and cancer. It will produce reports on diet and lifestyle and a variety of cancers over the next 10 to 20 years, starting with bowel cancer and breast cancer. For the time being I believe that we should continue to include some dairy foods in our diet, as they’re such a good supplier of calcium.
A Whether soya is good or bad is one of the hottest contested topics surrounding cancer. Soya contains phytoestrogens, chemicals naturally found in plants. Phytoestrogens have a similar structure to the female sex hormone oestrogen and have been found to influence the effects of the menopause. There are different types of phytoestrogens – as well as those found in soya bean products (isoflavones), others are found in the fibre of wholegrains, fruit, vegetables and flax seed (lignans).
Soya isoflavone types of foods are attracting the most research. A joint study by Cancer Research UK, the National Cancer Institute of the USA and the National University of Singapore found that women with a soya-rich diet had breast tissue that was less dense than that of women with a low-soya diet. Higher density of breast tissue has been linked to a higher risk of breast cancer. This is the first study to directly link eating soya with an effect on breast tissue. Asian women, who eat the highest amount of soya foods, have a lower risk of breast cancer. However, it's not clear whether genetic make-up (which influences the way that the body metabolises food) and environmental factors interact with the soya and therefore produce different effects in the body. What we can say is that in other parts of the world, and it's certainly the case in Britain, most women do not eat enough soya to reduce their risk of breast cancer.
A Although studies still don't give us any clear guidance on eating soya-rich foods if you have been diagnosed with an oestrogen-dependent type of breast cancer, I would suggest staying away from soya. A little isn’t going to cause anything disastrous, I just mean that you shouldn’t choose the soya-rich options on menus, or think about becoming vegan at this stage in your life. The possible downsides of creating an environment that could potentially encourage the growth of these tumour cells far outweighs any potential benefits you may glean from soya. If you're vegetarian this presents a practical hurdle, as so many vegetarian foods are soya-based, so focus on lentils, beans, nuts, seeds and grains like spelt and quinoa as good sources of protein.
A There is some evidence that consuming large amounts of sugar is associated with an increased risk of certain cancers, including oesophageal cancer. Too much sweet stuff can also lead to weight gain and increase the risk of obesity and diabetes, which may increase the risk of cancer. The problem with sugar is that it’s pretty addictive yet satisfying for only a few moments. If you’re struggling with cravings, try to avoid all sweet foods apart from fresh fruits for a short time. Go for a walk, chant a mantra, sniff a vanilla pod (it works for some people), do whatever it takes to distract you from raiding the biscuit tin. After 48 to 72 hours you’ll be past the danger zone and won’t need half as much willpower to resist.
A Sugar doesn't make cancer grow faster. All cells, including cancer cells, depend on blood sugar (glucose) for energy, but giving more sugar to cancer cells doesn't speed their growth. Likewise, depriving cancer cells of sugar doesn't slow their growth.
This misconception may be based in part on a misunderstanding of positron emission tomography (PET) scans, which produce three-dimensional images of inside the body and are used to find out if a cancer has spread or how well it is responding to treatment. Before a PET scan you will be injected with a small amount of radioactive trace, typically a form of glucose. All tissues in your body absorb some of this tracer, but tissues that are using more energy — including cancer cells — absorb greater amounts, which allows them to be identified by the scan. For this reason, some people have concluded that cancer cells grow faster when we eat more sugar. But this simply isn't true and cutting out all sweet foods can leave you exhausted, may cause you to lose weight when it's advisable not to, and can deprive you of a valuable source of calories.
Satisfy sweet cravings with foods that contain additional nutrients, such as delicious fresh or dried fruits, including medjool dates, figs and apricots, or a simple fruit crumble made with stewed fruits and topped with a crunchy wholemeal crumble topping containing ground nuts and a little muscovado sugar. Agave, date syrup, honey and coconut sugar are delicious to cook with but still affect blood sugar in a similar way to unrefined sugar, so you need to ensure that you don't overdo them.