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LIVING WITH CANCER Eating well during cancer treatment Kia pai te kai i te w maimoatanga matepukupuku A guide for people with a dry treatment A guide for eating well during mouth Copyright (c) 2012 Cancer Society of New Zealand Inc PO Box 12700 Wellington. Fifth Edition 2007 ISBN 0-908933-70-3 Sixth Edition 2012 ISBN 0-908933-92-4 Publications Statement The Cancer Society s aim is to provide easy-to-understand and accurate information on cancer its treatments and the support available. Our Living with Cancer information booklets are reviewed every four years by cancer doctors specialist nurses and other relevant health professionals to ensure the information is reliable evidence-based and up-to-date. The booklets are also reviewed by consumers to ensure they meet the needs of people with cancer. Other titles from the Cancer Society of New Zealand Te Khui Matepukupuku o Aotearoa Booklets Advanced Cancer Matepukupuku Maukaha Bowel Cancer Matepukupuku Puku Hamuti Bowel Cancer and Bowel Function Practical advice Breast Cancer Te Matepukupuku o nga- Breast Cancer in Men From one man to another Cancer Clinical Trials Cancer in the Family Talking to your children Chemotherapy Hahau Complementary and Alternative Medicine Eating Well During Cancer Treatment Emotions and Cancer Got Water He Wai Lung Cancer Matepukupuku Pkahukahu Melanoma Tonapuku Prostate Cancer Matepukupuku Repeure Radiation Treatment Haumanu Iraruke Secondary Breast Cancer Matepukupuku Tuarua - Sexuality and Cancer Hkakatanga me te Matepukupuku Understanding Grief Te Mate Pmamae Brochures Being Active When You Have Cancer Being Breast Aware Bowel Cancer Awareness Gynaecological Cancers Questions You May Wish to Ask Talking to a Friend with Cancer Thermography This edition of Eating Well During Cancer Treatment Kia Pai te Kai i te W Maimoatanga Matepukupuku includes a new feature in response to suggestions from those who review our booklets and to meet the needs of our readers. Our key messages and important sections have been translated into te Reo Mori. Our translations have been provided by Hohepa MacDougall of Wharetuna Mori Consultancy Services and have been peer reviewed by his colleagues. Eating well during cancer treatment This booklet has been prepared to help you with questions you may have about your diet while undergoing cancer treatment. It will help you to deal with any eating problems caused by your cancer or by your treatment. You might like to pass this booklet on to your family whnau and friends. Kia pai te kai i te w maimoatanga matepukupuku I whakaritea te pukapuka nei hei whina i a koe ki te whakautu i ng ptai tr pea ka ara ake e p ana ki t nohopuku i te w e whakamahia ana ng maimoatanga matepukupuku. Ka whina hoki i a koe e whaihanga ana i ng raruraru ka ara ake n t mate n t maimoatanga rnei. Tr pea ka prangi koe ki te hoatu i te pukapuka nei ki t whnau ki hoa rnei. 1 Contents Eating well feeling better What is a healthy diet Food safety Staying the same weight Foods high in calories (energy) and protein Adding to what you can eat (nutritional supplement drinks) Eating problems Loss of appetite (not feeling hungry) Nausea (feeling sick) Taste and smell changes Mouth or swallowing problems Dry mouth Making food easier to eat Soft foods Pureed foods (food with no lumps) Bowel problems Constipation (hard bowel motions) Diarrhoea (loose bowel motions) What is a low fibre diet Eating a low residue diet Intolerance to some foods (food that makes you feel unwell) Fatigue Easy ways to make meals Recipes Suggested reading and websites Notes Feedback 2 3 5 17 19 20 24 26 27 28 30 32 34 36 36 38 42 42 44 45 47 48 48 49 50 65 67 71 Eating well feeling better Eating good food is important when you are well and it is also very important when you are receiving treatment for cancer. It is important that you eat well so that you will feel better and have more energy get the most benefit from your treatment with fewer side effects improve your body s ability to heal and to fight infection maintain a healthy weight. If you are thinking about making a dramatic change to your diet look at your choices closely and discuss them with your cancer doctor or dietitian. Once a cancer has developed it cannot be cured through diet alone. Many unproven dietary treatments particularly those that cut out whole food groups such as meat or dairy may not provide enough energy (calories or kilojoules) protein or essential nutrients. This can cause unwanted weight loss tiredness and decrease your immune function. Your recovery and quality of life can improve if you eat a healthy diet. There is no evidence to support claims that special diets or single nutrients such as a particular vitamin can cure cancer. Some diets or nutrients do no harm but there are some that are harmful and can interfere with the success of your treatment. 3 Kia pai te kai kia ora ake ai He mea nui te kai i ng kai pai i a koe e noho ora ana he pr an hoki i te w e whai maimoatanga ana koe m te matepukupuku. He mea nui rawa atu kei te kai pai koe kia piki te ora ki a koe kia whai kaha hoki kia puta ng painga o t maimoatanga me te iti ake o ng pnga kino kia pai ake t tinana ki ng mahi whakaora me te patu i te mate urut kia noho hauora ai te taumaha o t tinana. Mehemea kei te whakaaro koe ki te tino whakarerek i t nohopuku ta tirohia kwhiringa ka korero ki t rata ki t mtanga nohopuku rnei. Ka p ana te matepukupuku ehara i te mea ka ora te tangata m te kai pai anake. He nui ng maimoatanga nohopuku korehua kre e pai m te whakarato pngao (pngoi he kilojoules rnei) pmua me ng whakammona tino matua tae noa ki ng nohopuku whakakore i te katoa o ttahi momo kai pr ki te whakakore i te kai mti i ng kai ahu mai i te miraka. M tnei tr pea ka heke rawa te taumaha o te tangata ka tere muiuitia rnei me te heke iho o te mahi whakat rai mate. Ka pai ake t whakamui me t oranga mehemea ka whai koe i ttahi nohopuku hauora. Kore he krero pono hei tautoko i taua whakaaro ka ora ake te tangata i te matepukupuku m te kai motuhake m ttahi momo whakammona rnei pr i ttahi hauora hngai. 4 Ehara i te mea he kino tahi o ng kai nohopuku motuhake ng whakammona rnei heoi ar etahi momo kore i te pai tr pea ka whakararu i t maimoatanga. What is a healthy diet Choosing a wide variety of healthy foods is something very positive that you can do to help you feel stronger and maintain a healthy weight. You can check how you are doing by following these guidelines which will provide all the nutrients you need. If what you usually eat includes foods that are not listed talk to your treatment team. He aha hoki te kai ttika Ko te kai i te maha o ng momo kai huaora ttahi mea pai hei whina i a koe kia pakari ake kia pai hoki te haere o t taumahatanga. Every day you need Ia r ia r me whai koe i nei Calories (energy) Ng pngoi (pngao) Calories provide fuel for your body to do daily activities and maintain body weight. 5 Calories (energy) are provided by Protein Pmua Protein maintains and renews your body tissues and helps your body defend itself against infection. The American Institute of Cancer Research also has recommendations on healthy eating. To view these recommendation visit the Institute s website http www.aicr.org new-american-plate Sources of protein are Ahu mai ai te pmua i Milk and milk products Te wai me ng hua wai Have at least two servings of milk or milk products a day. One serving is a glass of milk or two slices of cheese or a pottle of yoghurt or dairy food. You can also choose cottage cheese soft cheeses ice cream or milk puddings. Milk and milk products are a valuable source of calcium for bone health. See page 50 for our fruit smoothie recipe. 6 7 Meats poultry fish eggs (animal protein) Mti heihei ika hki (pmua kararehe) Have at least one serving a day. Choose meat chicken fish (a serving size is equal to the size of your palm or two cooked eggs or two drumsticks). Meat chicken and fish also provide iron and zinc. Use low fat cooking methods such as stewing baking microwaving grilling slow cooking or poaching. See page 52 for our quick and easy wraps recipe. 8 Nuts and pulses (plant protein) Nati me ng kai kkano nei te hua (pmua tipu) Have at least one serving a day. Choose nuts and pulses (dried beans peas and lentils) for example baked beans tofu lentil burgers bean salad and lentil soup. A serving size is equal to cup of cooked legumes. 9 Carbohydrates Warowaih Carbohydrates provide fibre vitamins (for example vitamin C) and minerals such as selenium. They are an important source of energy. Breads and cereals Paroa me ng pata kai Try to have six servings of breads and cereals each day. These foods should form the basis of most meals and snacks. Serving size examples are 1 2 cup of cooked cereal or muesli or one cup of cornflakes one cup of cooked rice couscous polenta or pasta one roll muffin or slice of bread. Also try semolina sago pikelets scones crackers roti chapatti naan plain biscuits and other products made from grains. Ideally they should be wholemeal or wholegrain if tolerated for additional fibre. 10 11 Vegetables and fruits Ng huawhenua me ng huarkau Have at least five servings of vegetables and fruits each day. Vegetables and fruits provide a wide range of vitamins and minerals as well as carbohydrates and fibre. Include a variety of colours and choose fresh frozen stewed or canned. Serving size examples are one medium potato kumara carrot or equivalent piece of pumpkin taro or yams 1 2 cup of cooked vegetables for example broccoli peas silverbeet spinach corn peppers carrot courgette cauliflower cabbage Brussels sprouts bean sprouts lettuce puha or watercress one tomato or a cup of salad one apple pear banana or orange two apricots plums kiwifruit or mandarins 1 2 cup of fresh canned or stewed fruits three prunes dates or dried apricots. See pages 54 to 57 for our roast vegetable medley and Waldorf salad with a difference recipes. 12 Fats Eat less of these foods or use sparingly unless you are having difficulty maintaining your weight. You can choose from butter margarine oils sour cream peanut butter coconut cream. Fats provide energy and vitamins A D E and K. If you are trying to lose weight eat less of these foods or choose lower fat versions for example lite coconut milk. 13 Mmona Me iti ake te kai i nei momo kai me whakaomoomo rnei atu i te tangata e noho tpuhi ana. Pai noa iho te kwhiri i te pata te margarine ng hinu te kirmi kawa te pnati pata te kirmi kknati. M te mmona ka whai kaha ka whai hoki i ng huaora A D E me te K. Mehemea kei te whakaheke koe i t taumaha kia iti ake te kai i nei kai kia iti ake rnei te mmona i roto i ng kai pr ki te miraka kknati lite. 14 Fluids (drinks) Aim to drink eight glasses of water (1500ml) or other drinks each day (more if your cancer doctor recommends it). Limit alcohol coffee tea and caffeinated drinks. Ng momo wai Me kaha to inu ia r ia r kia 8 ng karhe wai (1500ml) aha atu inu rnei (nui ake mn ka tohua e t rata). Kia iti ake te inu kawhe inu t me ng inu caffeine. 15 Vitamins and minerals These help your body use the food you eat. The best source of vitamins and minerals is food. If you follow the guidelines outlined here it is unlikely that you will need vitamin and mineral pills unless you are found to be lacking in something. Ng huaora me ng manawa whenua Ka whina nei i t tinana ki te whakamahi i ng kai ka kainga e koe. Ko te matamata pai m ng huaora me ng manawa whenua ko te kai. Ki te whai koe i ng aratohu kua takoto i konei e kore pea koe e hiahia i ng pire huaora manawa whenua hoki in r mei kore koe e mate i te hiahia m ttahi mea. Some people believe that if a little bit of a nutrient is good for you then a lot must be better. There is no scientific evidence to support this idea. High doses of some nutrients can have harmful effects and some vitamins herbal supplements and minerals should not be taken during treatment. Discuss with your cancer doctor or dietitian any vitamin and mineral supplements you are taking or think you should be taking. 16 Food safety Food safety is of special importance to cancer patients especially during treatment that may suppress immune function. To make food as safe as possible it is recommended that patients follow the guidelines below Wash hands thoroughly before eating. Keep all aspects of food preparation clean including washing hands before preparing food and washing fruit and vegetables. Handle raw meat fish poultry and eggs with care and clean thoroughly any utensils and surfaces that have been in contact with these foods. Keep raw meats separate from cooked food. Cook meat poultry and fish thoroughly and use pasteurised milk and juices. Cover and refrigerate food promptly to minimise bacterial growth. When eating out avoid foods that may have bacterial contamination such as salad sushi and raw or undercooked meats fish poultry and eggs. If there is any concern about the purity of your water for example if you have well or tank water have it checked for bacterial content and boil before use. To purify water boil for at least a minute if you have any concerns. 17 Kai haumaru He mea tino nui m ng troro matepukupuku te kai haumaru ko te w tino nui rawa atu ko te w o te maimoatanga n tna kaha phi i te mahi whakaturi mate. Kia noho haumaru ai ng kai me whai ng troro i nei aratohu e whai ake nei ta horoia ringaringa i mua i te kaitanga. Kia m tonu ng mea katoa e p ana ki te whakataka kai tae noa ki te mahi horoi ringaringa i mua i ng mahi whakataka kai me te horoi huarkau huawhenua hoki. Me tpato i te w mahi ai i te taha o ng mti ng heihei me ng hki me ta horoi hoki ng whi i p ng kai nei. Me noho wehe ng mti mata i ng kai moa. Me tino moa te tunu i ng mti ng ika me te whakamahi i te wai pasteurised. Kia tere te uwhi i ng kai ka rau ki roto i te whata mtao kia iti ake te tipu o te kitakita. I ng w puta ki ng wharekai kai ai me tpato ki ng kai ka p te kitakita pr ki ng whi kai huamata ki ng kai sushi me ng kai mata pr ki te mti mata te ika mata me te hki mata. Mehemea he paku raru e p ana ki te pai o te wai pr ki ng wai i roto i te puna i roto i te taika pupuri wai rnei whakaritea kia tirohia te nui o te kitakita kei roto ka pera i te wai i mua i te whakamahia. Hei whakapai i te wai me pera m te nui ake i te kotahi meneti kia kore ai koe e mharahara. 18 Staying the same weight Ideally you should stay at the same weight you were before you had cancer but you may find it difficult to maintain your weight during treatment. If you were a little overweight before you had cancer you might think that it will not hurt to lose a few kilos. However losing weight during treatment can be harmful. The effects of your cancer and of reduced activity may be that this weight is lost from muscles rather than from fat stores. If you maintain your weight it can help you recover better from the effects of cancer and its treatment. If you are losing weight include frequent meals and snacks in your diet. Also include some of the high energy foods listed in the following pages. You should talk to your nurse cancer doctor or radiation therapist if you are concerned about your weight they can arrange an appointment with a dietitian. 19 Foods high in calories (energy) and protein Use these foods when you are not eating well or you are losing weight. Butter margarine oil mayonnaise dressings avocado coconut cream Use with bread rice pasta vegetables when frying in salads dips and in curries or casseroles if you can tolerate these foods. Milk skim milk powder cream ice cream evaporated or condensed milk cheese sour cream cream cheese Use in puddings fruit cereals sauces soups in casseroles on vegetables in salads on biscuits and in drinks. Double strength milk Sprinkle three tablespoons of skim milk powder into 600ml (one pint) of milk and whisk until the powder is dissolved. One or more of the following can be blended into a glass of milk yoghurt ice cream skim milk powder mashed pureed fruit powder liquid flavourings essences cordial. Nuts and dried fruit Snack on these between meals or add to cereals puddings and salads. 20 21 See page 58 for our ready to go snack recipe. Tofu Add to soups vegetables and dried bean dishes. Peanut butter honey jam marmalade golden syrup Spread on bread crackers and baked products. Add to porridge or puddings. Sugar Add to drinks desserts and cereals. Use ordinary cordials and fizzy drinks rather than diet or low calorie versions. Eat cakes biscuits baked products chocolate and sweets between or after meals. Pickles chutneys pate hummus and other dips Add to crackers bread and in cooking. Fluids Choose fluids that provide energy for example milky drinks cordials non-diet drinks soups and juices. 22 23 Adding to what you can eat (nutritional supplement drinks) These are not a meal replacement. They should be used in addition to meals and snacks when you need to gain weight or if you are not eating normally. These provide all the major nutrients found in food and vitamins and minerals. Some brand name supplements are listed below. They are available from supermarkets and pharmacies. Those marked with an can be obtained on prescription but you will need to have a special authority number which your cancer doctor can arrange. If you think you would benefit from these products talk to your cancer doctor or nurse. Powders that are mixed with milk or water Complan Vitaplan Sustagen classic. These can be purchased from a supermarket. They do not meet all your nutritional needs. Ensure powder Sustagen hospital formula. 24 Ready-made drinks (funded only for those having tube feeding) Ensure Plus Fortisip Fortisip Multi Fibre. These are lactose free and provide all your nutritional needs if consumed in the right quantity. Fortified fruit juice These juices do not meet all your nutritional needs but do supply additional calories protein and carbohydrates. These juices are not available on prescription. Enlive Fortijuce. 25 Eating problems If you are having or recovering from surgery or treatment it is important to eat well. You may have some eating problems like a loss of appetite nausea taste and smell changes and mouth or swallowing difficulties. Between your treatments symptoms should improve so take advantage of this and eat a variety of foods that you enjoy. Tell your nurse cancer doctor or radiation therapist if you have not eaten well over the last few days. Ng raruraru e p ana ki te kai Mehemea e whai oranga ana koe i te w o ttahi pokanga ttahi maimoatanga rnei he mea nui kia pai t kai. Tr pea ka whai atu ko ttahi mate e p ana ki t kaha ki te kai pr ki te kore hiahia ki te kai te hia ruaki te rerek o te rongo i te kai ki te horomi kai rnei. I ng w kore koe i te whai i te maimoatanga ko te tikanga ka pai ake koe n reira me kaha tonu t kai i ng momo kai pai katoa ki a koe. Mehemea ka hipa ng r me te kore pai o t kai me krero ki t tapuhi t rata t kaituku iraruke. Listed on the following pages are some tips you may find helpful. 26 Loss of appetite (not feeling hungry) Eat small frequent meals and snacks rather than three big meals. Use a smaller plate and present meals attractively. Eat more at times you feel hungry. Serve your favourite foods often. If possible eat with family or friends rather than by yourself or try eating while watching TV or reading a magazine or newspaper to take your mind off the food. Choose fluids that provide calories rather than water coffee tea or broth. Drink fluid after or in between meals but not just before. Relaxing before meals can reduce anxiety. Try foods that are easy to eat for example eggs milk puddings crackers soups spaghetti macaroni cheese chicken fish mashed vegetables and fruit. Garnishing food with chopped herbs watercress onion rings orange slices nuts or tomato wedges can make food more appealing. Chop food up into bite-sized portions to make eating less of an effort. Prepare enough for several servings when cooking so you can eat when you are hungry. Accept offers of meals from friends and family if you live on your own. Make use of ready-made foods. A short walk before a meal might make you feel hungry. 27 Nausea (feeling sick) Not eating for an extended period of time can prolong nausea therefore try to eat small amounts regularly. Talk to your cancer doctor about anti-sickness drugs and take them as directed. Keep up your fluid intake--sip drinks slowly or use a straw. Try ginger ale or lemonade fruit juice weak tea yeast spreads made into broths clear broths fruit or vegetable juices nectars ice blocks and ice chips. Eat your main meal at the time of day when you feel the best. Choose foods that do not have a strong smell. Try a short walk in the fresh air before eating or try some slow deep breathing. Avoid fried fatty foods because they may make you feel worse. Dry foods such as toast or crackers might help (with drinks between meals). Rest after eating. Keep away from the kitchen if cooking smells put you off eating or ask someone else to prepare your food. Generally foods at room temperature have a mild smell compared with hot foods. Eat and drink slowly. Sit upright for meals and avoid tight clothing. 28 Te hia ruaki E kore koe e hia ruaki ki te kore koe e kai m te w roa n reira me auau te kai ahakoa paku noa iho. Krero ki t rata m ng whakapauau patu mate me te whai i ng tohutohu m te kai. Kia kaha te inu--engari me ta inu me whakamahi ngongo rnei. Whakamtauria te inu paitu kanekane ng inu waireka t ngoikore nei ng momo hupa ng wai o te huarkau me te huawhenua ng poraka aihikirmi me ng kotakota hukapapa. Kainga t kai matua i te w o te r e tino pai ana t hua. Kwhiria ng kai kore i kaha te haunga. Me paku hkoi ki waho i mua i t noho ki te kai me whakah pturi me te hhonu ake rnei. Me karo ng kai parai me ng kai mmona i te mea ka kino ake t hua. Tr pea he pai te kai i ng kai maroke pr ki te thi ki te pihikete pakapaka i waenganui i ng kai nui (me te inu hoki). Me whakat i muri te kai. Kaua e noho ki te khini mn he anuanu te kakara o ng kai e tunu ana me tono rnei i ttahi atu hei tunu i kai. Ko te tikanga he iti ake te kakara o ng kai mehemea kei te rite te pmahana ki te rma in ka whakaritea ki te kai wera. Me pturi ake te kai i kai. Me ttika te noho ki te kai kaua e mau kkahu kik rawa. 29 Taste and smell changes Your treatment may cause your sense of taste or smell to change temporarily. You may not like foods which you once enjoyed or find that you enjoy food which you previously disliked. Here are some ideas that may help Experiment with flavourings such as lemon juice herbs chutneys and pickles spices pepper celery salt chocolate fruit or cheese. Add a little salt to foods that taste too sweet and sugar to foods that are acidic (sour) or too salty. If you have lost your taste for meat try marinating meats using soy sauce honey ginger fruit juice or wine before cooking. Or try canned or fresh fish eggs beans nuts lentils or cheese instead. If your taste for salt is increased eat small quantities of meats such as corned beef sausages luncheon meat bacon ham salty savouries olives anchovies tinned or smoked fish smoked chicken tasty or feta cheese. Use fruit or fruit puree in ice cream or desserts junket milkshakes or puddings to add extra flavour. 30 Ka rerek t rongo me t hongi kai Tr pea ka rerek t rongo i te kakara o te kai i te w o t maimoatanga. Tr pea kore koe e prangi ki tahi kai e pai ana ki a koe i ng r ki mua kua hiahia hoki koe ki ng kai kore koe i prangi i ng r ki mua. Anei he whakaaro tr pea ka whina i a koe Whakamtauria ng pkara pr ki te wai rmana ng rauamiami ng chutneys me ng pkara ng namunamu te pepa te tote hrere tiakarete huarkau me te thi. Poua he tote ki te ng kai mn he reka rawa me te huka ki ng kai kawa rawa totetote rawa rnei. Mehemea kua ngaro t hiahia kai mti whakamtauria te pkarakara mti m te whakamahi i te wairanu soy te mere te paitu kanekane te wai huarkau te waina i mua i te tunutanga rnei. Whakamtauria rnei te ika kua puototia te ika mata te hki ng pni ng nati ng lentils te thi rnei. Mena kua piki t hiahia m te tote kainga he paku mti pr ki te mti kau mina-tote te ttiti mti luncheon pkana poaka tauraki mkarakara totetote he oriwa he korowhwh ika mina-auahi te ika puoto rnei heihei mina-auahi thi reka thi feta rnei. Raua he huarkau ki roto i te aihikirmi te purini rnei te junket ng milkshakes hei whakapkarakara. 31 Mouth or swallowing problems There may be times when eating is physically difficult. You may have difficulty chewing or moving food around your mouth difficulties swallowing or pain in your mouth or throat. Here are some tips to help Avoid foods that may sting your mouth such as acidic or highly spiced foods for example pineapple kiwifruit citrus fruits tomatoes spicy and salty foods very hot or icy cold foods and drinks. Avoid rough and crunchy foods such as nuts chips and hard toast. Add dressings and sauces to make food moist. Try drinking liquids through a straw. Cook meat until very tender so you do not have to chew so much. It is important to keep your mouth clean to prevent infection and dental decay. It will help to clean your teeth with a soft toothbrush and use a mouthwash after each meal. Check dentures are well-fitting. Ensure dentures are sterilised regularly to avoid infection. 32 33 33 Mouthwash recipe 1 teaspoon salt 1 teaspoon baking soda 4 cups water Add lemon juice for flavour if desired (although this may sting if your mouth is tender and sore). If your mouth is too sore to eat adequately pain relievers may help. Ask your cancer doctor or nurse for their advice. Dry mouth Serve drinks with meals. Sip when eating. Suck on ice blocks to provide moisture. Ice blocks will also help you to make saliva. Tart foods and drinks may also encourage the flow of saliva. Try pineapple juice or lemon juice in ice blocks for a refreshing mouthwash. Avoid dry foods. Add gravy sauce custard cream milk melted butter oil or dressing to make food moist. Lemon juice is highly acidic and long-term use can lead to tooth decay. 34 I have found that the dry mouth that followed radiation treatment on my tongue had two quite separate effects. The most obvious one is that I have less saliva. This is very easily addressed by sipping drinks while eating. The second though is less well understood. My saliva is now less able to disperse the fibres that are being chewed. This means that some food tends to wad in my mouth and is difficult to swallow. Sipping a drink helps a bit but the real gains come from including a natural saliva substitute such as white sauce or mashed potato. The foods that are most prone to wadding are salad greens boiled rice instant pasta chicken breast steak (unless very tender) and firm-fleshed fish. I love all of these but have difficulty eating them by themselves. I find it easiest to do so if they are served with potato or a white (flour-based) sauce. Other tips When the rice is prepared as risotto or a creamed rice dessert its consistency is changed and there is no problem. Instant pasta such as spaghetti or lasagne is fine if they are part of a dish that has a sauce. Cook a chicken breast in a way that retains its moisture and serve with potatoes or a white sauce. Brian 35 Making food easier to eat Changing the texture of foods can make it easier to chew and swallow. Soft foods These are foods that are soft enough so that they can be cut with the side of a fork. Vegetables may need to be cooked for longer and meat or chicken cooked longer on a lower heat with liquid to make them soft and tender. Here are some soft food suggestions. Soups Smooth with no hard lumps. Eggs Scrambled poached boiled or made into an omelette. Quiche or souffl . Cooked sliced egg in a cheese sauce or mild curry sauce with rice. Milk and milk products Dairy food yoghurt ice cream milk puddings soft cheeses and cheese sauce. Avoid hard cheeses or those with dried fruit or nuts in them. Avoid grilled cheese that has gone hard. 36 Fish Fish in white sauce cheese sauce parsley sauce. Convenience foods--boil in the bag fish fingers fish nuggets canned tuna smoked fish salmon. Chicken Boiled steamed microwaved roasted or rotisserie and diced with gravy white sauce mushroom sauce cheese sauce other sauces or mashed potato. Meat Boiled stewed roasted grilled and diced or sliced served with gravy mint sauce redcurrant jelly mustard sauce other sauces or mashed potato. Cold meats--ham pork and apple sauce ham and chicken. Mince with spaghetti meat balls potato top pie and hamburger patties. See page 60 for our mince pasta dish recipe. Breads and cereals Soft breads without crusts with soft fillings for example ham egg and grated cheese and pineapple minced chicken and mayonnaise canned fish and smooth peanut butter or asparagus. 37 Fruit and vegetables Fresh stewed or canned fruit and vegetables. Soften by chopping mashing or grating. Snacks Baking--biscuits or cakes for example shortbread sponge or Madeira cake fruit loaf muffins pikelets scones and crackers. Pureed foods (food with no lumps) Use a blender stick blender or food processor to puree foods so that they have a smooth texture with no lumps. Method Food processor--if you do not have a blender stick blender or food processor a mouille and strainer can produce similar results but it will take more time. Add liquid (ideally use a nutritious liquid for example gravy full fat milk white sauce soup cream sauce or fruit juice rather than water). Continue adding more liquid until the desired consistency is reached. Blend until the mixture is smooth with no lumps. 38 39 Tips Some fibrous fruit and vegetables (for example peas corn celery onions and pip fruits) may not puree very easily. Try straining after pureeing and they may be soft enough. Individual flavours and colours of a meal can be preserved better when vegetables and meat are pureed separately. Pureed meat often loses its colour and flavour--try adding tomato soya or Worcestershire sauce herbs mushrooms or tomatoes. Serve meats with gravies sauces or jellies for example mint sauce or redcurrant jelly with lamb. Pureed meals can be frozen. Thaw in the fridge and heat thoroughly add a little more liquid if necessary. If stored in the refrigerator pureed meals will keep for only 12 hours. Green vegetables can look unappealing when pureed. Try mixing with a little mashed potato or instant potato flakes. Tasty pureed vegetable combinations include swede and carrot carrot and parsnip and beans and parsnip. 40 41 Bowel problems Treatment can alter your normal bowel habit causing constipation or diarrhoea. Consult your cancer doctor if symptoms persist. (These recommendations need to be adjusted for people with some types of cancer for example bowel cancer.) Constipation (hard bowel motions) If you are constipated increasing the fibre content of your diet can help Eat regular meals. Do some exercise each day. Increase the amount you drink. Aim for 8 to 10 glasses each day. Hot drinks may help. Ensure you are having 5 servings of fruit and vegetables each day. Eat raw or cooked. If too much wind is a problem try avoiding vegetables that may cause wind or discomfort such as cabbage onions cucumber peas and baked beans and limit fizzy drinks. Choose wholemeal or wholegrain breads and cereals for example porridge Weetbix All Bran muesli wholemeal bread wheat germ bran biscuits or muffins. Use wholemeal flour for baking or in sauces. See page 63 for our fruit kebabs with yoghurt and honey dipping sauce recipe. 42 Commercial products such as Kiwicrush Benefiber Metamucil or Stimulance may be useful. Kiwifruit prunes and their juices are helpful in preventing constipation. Add extra fibre to your food for example one or two teaspoons of wheat bran flakes or oat bran daily. This can be gradually increased to an amount that will give you a regular bowel habit. The bran can be added to cereals or used in cooking. When you use bran to increase your fibre it is important to increase your fluids as well. Prune mix Try some of this prune mix daily. Ingredients 1 cup pureed apple 1 cup bran flakes cup softened prunes 1 cup prune juice Directions Puree together using a blender stick blender or food processor and serve two to three tablespoons with breakfast daily. 43 Diarrhoea (loose bowel motions) Some chemotherapy drugs cause severe diarrhoea. If you have diarrhoea contact your cancer doctor or nurse immediately. Following an acute bout gradually start eating bananas rice apples and toast. Drink more to replace lost fluids. Choose from diluted fruit juice flat soft drink vegetable juice vegetable broth weak tea and nutritional supplements. Aim to drink at least eight glasses (1500ml) of fluid daily. Eat small frequent meals. Krere (mate tikotiko) Ka puta te mate krere kino rawa atu n tahi o ng whakapauau hahau. Ki te pngia koe ki te mate krere me kakama tonu te whakap atu ki t rata matepukupuku t tapuhi matepukupuku rnei. Whai muri i te mate tikotiko me tmata ki te kai panana raihi poro me te thi. Kia kaha te inu hei whakahoki i te wai kua ngaro. Me kwhiri mai i te wai huarkau kua waimehatia te inu waireka kore mirumiru inu huawhenua wairenga huawhenua t ngoikore me ng tpiringa kai ttika. Me whai kia 8 ng karhe inu (1500ml) i ia r ia r. Kia iti te kai engari kia maha tonu ng w kai. 44 What is a low fibre diet Your dietitian or cancer doctor may advise you to eat a low fibre diet. A low fibre diet is when you have less of or none of these foods Breads and cereals Breads that contain whole grains nuts seeds and kibbled wheat cereals such as muesli which contain nuts seeds or dried fruit and brown rice or pasta. Fruit Fruits with seeds pips pith or hard skins for example kiwifruit berries apples citrus fruits and dried fruit. Vegetables Vegetables with hard skins seeds or stalks for example corn celery vegetables from the cabbage family onions cucumbers garlic peas and broad beans. Nuts and seeds Crunchy peanut butter nuts and seeds--whole or chopped. Meat fish poultry eggs and pulses Tough gristly meat fried meat fish or poultry fatty or highly seasoned meats such as sausages curry prepared dried meals fried eggs baked beans and pulses. 45 Other foods or drink that may make diarrhoea worse Drinks Alcoholic drinks strong tea or coffee. Fat Rich sauces highly seasoned dressings rich pastry batter and fried foods. Any new foods should be introduced one at a time so that you can check their effect. You can gradually return to a normal diet. If you have severe diarrhoea see your cancer doctor. A low residue diet may be recommended. Mmona Ko ng wairanu mmona ng wairanu huamata ng ph mmona te kaihau me ng kai parai. Me ta kai i ng kai hu kia paku noa iho i ia w kia pai ai t whakamtau i tna pnga. A tna w ka hoki ki tu ake kaha ki te kai. Ki te kaha pngia koe ki te mate tikotiko haere ki te kite i t rata. Tr pea ka taunakitia ttahi nohopuku iti ake te paranui. 46 Eating a low residue diet This is the same as a low fibre diet plus the points below If you experience cramping pains bloating and diarrhoea (these can result if lactose (milk sugar) is not digested) you could try limiting the amount of cow s milk you drink to 300ml daily. Hard cheeses are usually well-tolerated. Cow s milk should be replaced with soy or rice milk or nutritional supplement drinks. You will be able to tolerate lactose again after the diarrhoea has settled. Cow s milk may then be re-introduced. Many people do tolerate milk products and they should only be avoided if not tolerated on a regular basis. It is wise to limit fruit and vegetables to three servings a day. All fruit and vegetables should be peeled and cooked without pips or seeds. You do not need to limit the fruit and vegetable juices you drink. Use white bread for toast and sandwiches. Use cream crackers and water crackers for snacks. Only use baked or cereal products made from white flour for example white rice noodles spaghetti cornflakes and rice bubbles. Avoid pepper curries foods containing spices alcohol and fatty foods. Re-introduce foods one at a time so that you can judge their effect. 47 Intolerance to some foods (food that makes you feel unwell) If you have had bowel surgery you may find for a time that your body can no longer tolerate some foods that were a part of your diet. It will take time for your body to adjust to the changes made by the surgery but usually it will slowly return to a normal or near normal state. After a time (it may take some weeks or months) slowly introduce a new food into your diet. Try one new food at a meal and start with a teaspoonful. Once you find that your body accepts the new food you can increase the quantity. You will then be able to do the same for another new food. Fatigue You may experience extreme tiredness (fatigue) during or after surgery treatment Eat small frequent meals. Have a variety of foods to keep meals interesting and appetising. Remove rules around eating. You may find nutritional supplements useful (see page 24 for more information). Use ready prepared foods have two to three pre-prepared meals in the freezer for treatment days or days that you have a lot of appointments. For more information on managing your fatigue read our Information Sheet Cancer-Related Fatigue on the Society s website (www.cancernz.org.nz). 48 Easy ways to make meals Prepare and freeze extra meals when you are feeling better to save time and effort when you are not feeling so well. Keep stocks of convenience foods-- ready to prepare noodle or rice dishes spaghetti baked beans canned fish packet or canned soups instant gravy or sauce sachets eggs cheese milk canned or packet dessert foods. Use the freezer to store bread pizza pies fish meat and chicken portions frozen vegetables and individual meals. Use the microwave oven to cook vegetables quickly and to reheat leftovers and frozen convenience foods. Keep stocks of nutritious fluids such as nutritional supplement drinks fruit juice and milk. 49 Recipes Fruit smoothie Have your favourite fruit and increase your bone health at the same time. Experiment with your favourite fruit to create your ultimate quick and easy snack. Ingredients 1 pottle low fat berry yoghurt 1 banana 1 cup trim milk Directions Place all of the ingredients in a blender. Blend until smooth. Serve in a tall glass with a straw and if desired garnish with a sprig of mint. Cook s tip Add your favourite fruit into the mixture to suit your taste buds. If you choose not to have cow s milk products calcium fortified soy or rice products should be included as substitutes. 1 drop of coconut essence 1 tsp flavoured milkshake mix 50 51 Quick and easy wraps Wraps are so versatile and easy perfect as a snack or a meal on the run. Ingredients 1 packet of wholemeal tortilla 2 cups cabbage shredded or naan bread (wraps) 1 3 cup red capsicum diced 1 Tbsp oil 1 3 cup green capsicum diced 1 onion sliced 1 2 cup Edam cheese grated 400g pork cut into bite-sized 2 Tbsp balsamic vinegar pieces 100g hummus 1 Tbsp soy sauce 2 Tbsp sweet chilli sauce 2 carrots grated (optional) Directions Place the vegetables and cheese in a large bowl. Mix well. Toss in the balsamic vinegar and set aside. Heat the oil in a fry pan on a medium heat. Brown the onion and then add in the pork. Add in the soy sauce and stir regularly. Cook the pork until the meat is browned. The inside of the meat should be white right through and the juices run clear. Place the wrap on a plate and heat in the microwave for 10 seconds. Spread a teaspoon of the hummus and chilli sauce onto the centre of the wrap. Place a small portion of the pork and vegetables in the middle of each wrap fold in the edges and roll up. 52 Cook s tip There is an endless list of fillings you can put into a wrap. Try adding stir-fries falafel refried beans other cuts of meat salads and rice. This way each wrap will be slightly different each time. 53 Roast vegetable medley Jazz up your roast vegetables by adding a variety of different vegetables adding colour flavour and a boost of anti-oxidants. Ingredients 4 small-medium sized potatoes (skin on and scrubbed with a scourer to remove dirt) 1 kumara (skin on and scrubbed) pumpkin 2 carrots Directions Preheat oven to 220 C. Chop the vegetables into manageable sized chunks. Try to keep all of the vegetables around the same size for even cooking with the exception of the carrots and celery which can be bigger. Arrange all of the vegetables except the celery in a large roasting dish. Do not put the vegetables in the same dish with any roast meats. Pour over oil and toss to cover all of the vegetables. Season with salt pepper and herbs to taste. 1 parsnip 1 celery stick 2 courgettes 1 bulb of garlic Favourite herbs (optional) Iodised salt and pepper to taste 2 Tbsp oil 54 Bake for 30 minutes before adding the celery and bake for a further 20 minutes or until golden and soft. Remove from the oven and allow to cool for 5 minutes. Serve with roast meats fresh steamed green vegetables and gravy. Cook s tip Cook the vegetables in their own dish. 55 Waldorf salad with a difference This is a healthier option to the classic waldorf salad which has a high energy creamy mayonnaise. This version is better for you and still full of flavour. Ingredients 2 apples chopped and left unpeeled 1 lemon juiced 5 celery sticks roughly chopped 1 carrot chopped 1 cup grapes 100g feta cheese cubed Directions Place the apples in a large mixing bowl and toss through the lemon juice. Then add the other ingredients. Place in the fridge or serve immediately as a side or a light main dish. Garnish with pumpkin and sunflower seeds. Cook s tip Don t forget to put the lemon juice on the apples or they will turn brown. Salt and pepper to taste cup vinaigrette or balsamic vinegar cup parsley leaves (optional) cup pumpkin and sunflower seeds (optional) cup walnuts roughly chopped 56 57 Ready to go snack Jam-packed with energy this snack is super easy to make and perfect for school lunches or a snack on the go. Ingredients 1 cup mixed dried nuts 2 cups mixed dried fruit cup pumpkin seeds Directions Mix all of the ingredients in a large resealable bag or airtight container. This can be portioned out into smaller containers or bags for midday snacks or served in a bowl for guests. Cook s tip Keep your portions to a minimum. Dried fruit can be deceiving. Remember that fresh fruit shrinks a lot as it dries so a small handful of dried fruit contains the same energy as the full-sized fresh fruit. Nuts and seeds also contain a lot of energy. cup sunflower seeds cup chocolate buttons roughly chopped cup shredded coconut 58 59 Mince pasta dish This one-pot-wonder is a great way of preparing a nutritious meal. It s also a great comfort food with leftovers to freeze for another night. Ingredients 1 Tbsp oil 2 onions chopped 3 garlic cloves minced 3 celery sticks chopped 1kg minced beef 100g tomato paste 3 cups beef stock 3 carrots sliced 2 cups broccoli florets cup corn kernels--fresh frozen or canned Directions Heat the oil in a large saucepan on a medium to high heat. Brown the onions and then the mince before adding in all of the other ingredients with the exception of the capsicums and mix well. Simmer the ingredients for 10 minutes before adding in the capsicums. Cook for a further 5 10 minutes or until the pasta is al dente (almost soft) and the vegetables are soft. 2 cups pasta shells 1 tsp basil cup red capsicum chopped cup green capsicum chopped Iodised salt and pepper to taste 2 tsp cornflour (optional) Parsley and grated Parmesan or Edam cheese garnish (optional) 60 Add more water if needed. You want enough fluid to just cover the ingredients allowing the pasta and vegetables to simmer and prevent the ingredients sticking to the bottom of the saucepan. If the mixture becomes too watery combine cornflour and a small amount of cold water and add into the mince mixture. Mix well. Serve with grated Edam or Parmesan cheese and fresh parsley. Cook s tip Use different vegetables depending on the season such as leeks in winter and courgettes in summer or add frozen mixed vegetables. 61 62 Fruit kebabs with yoghurt and honey dipping sauce Fruit kebabs are a simple but effective way to make fruit look appealing. Encourage your kids to help make them-- they re easy. Ingredients 1 cup plain yoghurt 2 Tbsp honey Use your favourite fresh fruit 1 red apple diced (core removed skin on) 1 banana chopped into 2cm thick chunks 10 grapes 2 mandarins broken into segments Summer suggestions 3 kiwifruit cut into chunks 1 Tbsp lemon juice 6 bamboo skewers cup favourite unsalted unroasted nuts (optional) Sprig of mint garnish strawberries melons apples kiwifruit peaches oranges cherries. apples bananas pears mandarins kiwifruit grapes persimmons. Winter suggestions Directions Place the honey in a heatproof cup and heat in the microwave for 30 seconds or until it has become runny. Allow to cool for a minute before mixing the honey into the yoghurt. 63 Cut the fruit into chunks. Place apple and banana in a plastic bag. Pour in the lemon juice. Mix the ingredients in the bag to coat the fruit with lemon juice to prevent it from browning. Thread the fruit and nuts onto the skewers alternating between the different types of fruit making a colourful pattern. Serve with the yoghurt dipping sauce or pour the yoghurt mix over the kebabs and add the mint to garnish. Cook s tip For the best effect these will need to be prepared right before serving. Make up a huge platter of fruits and vegetables and encourage everyone to make their own with their favourite fruits. 64 Suggested reading and websites Reading Beliveau Richard and Gingras Denis. (2007) Foods to Fight Cancer. Australia DK Publishing. Besser Jeanne et al. (2009) What to Eat During Cancer Treatment. Atlanta American Cancer Society. Buckman Weinstein Jodi. (2010) Tell Me What to Eat Before During and After Cancer Treatment. USA New Page Books. Clegg Holly and Miletello Gerald. (2006) Eating Well Through Cancer. USA Favorite Recipes Press. Gourley Glenda. (2010) The New Zealand Vegetable Book. New Zealand Hyndman Publishing. (There s also a good website (www.vegetables.co.nz).) Grant Barbara L. et al. (2010) American Cancer Society Complete Guide to Nutrition for Cancer Survivors (2nd ed.). Atlanta American Cancer Society. Katzin Carolyn. (2011) The Cancer Nutrition Center Handbook--An Essential Guide for Cancer Patients and Their Families. Los Angeles CFK. van Mil Jos . (2008) Healthy Eating During Chemotherapy. USA Kyle Books. For more suggestions visit your Cancer Society s library or local library. 65 Websites American Institute of Cancer Research www.aicr.org patients-survivors New Zealand Food Safety Authority Food Safety When you have low immunity http www.foodsmart.govt.nz elibrary lowimmunity.pdf The suggested websites (other than our own) are not maintained by the Cancer Society of New Zealand. We only suggest sites we believe offer credible and responsible information but we cannot guarantee that the information on such websites is correct up-to-date or evidence-based medical information. We suggest you discuss any information you find with your cancer care health professionals. 66 Notes You may wish to use this space to write down any questions for or advice given by your cancer doctors nurses or health providers at your next appointment. Whakamahia tnei whi wtea hei tuhi ptai e hiahia ana koe ki te ptai i t rata ng tapuhi ng kaiwhakarato hauora rnei m te w e hoki atu ai koe. 67 Notes 68 Cancer Society of New Zealand Inc. National Office PO Box 12700 Wellington 6144 Telephone (04) 494-7270 Auckland Division PO Box 1724 Auckland 1140 Telephone (09) 308-0160 Covering Northland Waikato Bay of Plenty Division PO Box 134 Hamilton 3240 Telephone (07) 838-2027 Covering Tauranga Rotorua Taupo Thames and Waikato Central Districts Division PO Box 5096 Palmerston North 4441 Telephone (06) 364-8989 Covering Taranaki Wanganui Manawatu Hawke s Bay and Gisborne East Coast Wellington Division 52 Riddiford Street Wellington 6021 Telephone (04) 389-8421 Covering Marlborough Nelson Wairarapa and Wellington 69 Canterbury West Coast Division PO Box 13450 Christchurch 8141 Telephone (03) 379-5835 Covering South Canterbury West Coast and Ashburton Otago Southland Division PO Box 6258 Dunedin 9059 Telephone (03) 477-7447 Covering Urban and rural Otago and Southland Cancer Information Service Telephone 0800 CANCER (226 237) www.cancernz.org.nz 70 Feedback Eating well during cancer treatment Kia pai te kai i te w maimoatanga matepukupuku We would like to read what you thought of this booklet whether you found it helpful or not. If you would like to give us your feedback please fill out this questionnaire cut it out and send it to the Information Manager at the address at the bottom of the following page. 1. Did you find this booklet helpful Yes No Please give reason(s) for your answer. 2. Did you find the booklet easy to understand Yes No Please give reason(s) for your answer. 3. Did you have any questions not answered in the booklet Yes No If yes what were they 71 4. What did you like the most about the booklet 5. What did you like the least about the booklet 6. Any other comments Personal information (optional) Are you a person with cancer or a friend relative whnau Gender Female Male Age Ethnicity (please specify) Thank you for helping us review this booklet. The Editorial Team will record your feedback when it arrives and consider it when this booklet is reviewed for its next edition. Please return to The Information Manager Cancer Society of New Zealand PO Box 12700 Wellington. 72 Information support and research The Cancer Society of New Zealand offers information and support services to people with cancer and their families whnau. Printed materials are available on specific cancers and treatments. Information for living with cancer is also available. The Cancer Society is a major funder of cancer research in New Zealand. The aim of research is to determine the causes prevention and effective methods of treating various types of cancer. The Society also undertakes health promotion through programmes such as those encouraging SunSmart behaviour eating well being physically active and discouraging smoking. We appreciate your support The Cancer Society receives no direct financial support from Government so funding comes only from donations legacies and bequests. You can make a donation by phoning 0900 31 111 through our website or by contacting your local Cancer Society. Acknowledgements The Cancer Society would like to thank for their reviews advice and contributions Kathy Hamilton Dietitian Oamaru Hospital Waitaki District Health Service and Otago HEHA Manager Southern DHB Helen Brown Dietitian Nurse Maude Christchurch Professor Lynette Ferguson Auckland Cancer Society Research Centre School of Medical Sciences Head of Department of Nutrition School of Medical Sciences The University of Auckland Dr Jan Pearson National Health Promotion Manager National Office Cancer Society of New Zealand Meg Biggs Julie Holt and Michelle Gundersen-Reid Cancer Society Information Nurses Associate Professor Chris Atkinson Medical Director of the Cancer Society of New Zealand and Oncologist at St George s Cancer Care Centre Sarah Stacy-Baynes National Information Manager We thank the people who have experienced cancer who reviewed this edition and offered many valuable suggestions. We also thank the Cancer Society volunteers who agreed to be photographed for our booklet. Photography This cover photo was taken by Moxie Communications. 73 www.cancernz.org.nz ANY CANCER ANY QuESTION 0800 CANCER (226 237) Cancer Information Helpline PI 106