When Nancy Shapiro was diagnosed with breast cancer three years ago, she didn’t realize the importance of nutrition in influencing her health and her future.
“I was so nervous about the cancer and I wasn’t sure how to prepare for chemo,” said Shapiro, a Davie resident who sells tools for a Miami company. “I never read a food label. I didn’t know what to eat, what was good, what was bad.”
Shapiro said she learned how to make crucial changes in her diet thanks to a nutrition class led by Amanda Amigo, a registered dietitian at Cleveland Clinic Weston. Amigo taught her how to improve her diet with menu ideas, recipes and suggested portion sizes.
“Prior to my diagnosis, I would eat anything,” Shapiro said. “I would have a lemon drop martini. I didn’t know that glucose fed cancer. I had tons of meat, doughnuts, white bread.”
After her treatment, her efforts to improve her diet and exercise continued.
“I was still heavy after chemo but I’ve lost 32 pounds on this journey,” said Shapiro. “I go to the gym four or five times a week. I’ve learned so much.”
Eating healthy foods and hydrating are critical when undergoing cancer treatment. Certain foods can bolster your immune system, contain anti-inflammatory properties and can fill your body with power antioxidants associated with a reduced rate of cancer. Hydration, too, is important so you don’t become dehydrated with all the medications.
“When patients get a cancer diagnosis, their nutrition is one thing they can control at a time when a lot of things are out of control,” said Amigo, who is also certified in oncology nutrition. “We tell them that food is their medicine during this time.”
Ideally, establishing a healthy diet and weight before treatment can help patients stay stronger, reduce the risk of infection and better handle side effects, said the experts.
“If patients are losing weight because they’re not eating or drinking, they’re more likely to feel the effects of chemotherapy because they’re malnourished or dehydrated,” said Amigo.
To compound the problem, treatment “can cause further weight loss,” said Claudia Ferri, a clinical nutritionist at the Miami Cancer Institute, part of Baptist Health South Florida.
A lack of calories and a deficiency in protein “makes people feel weak and tired,” said Lesley Klein, medical nutrition therapist and clinical dietitian/manager at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine. “Protein helps to build up and repair tissue that’s been torn down. Chemo is going to affect the tumor cells and hopefully break them down, but it affects normal cells as well.”
Dietitians said treating a patient’s dietary needs takes an individualized approach, often depending on side effects such as a change in taste or smell, mouth sores, nausea, difficulty swallowing and lactose intolerance.
For a nauseous patient, it’s a good idea to eat small meals every three or four hours, said Ferri.
“If someone is very nauseous and losing weight and they want a ham sandwich, you’re not going to say no to that,” she said.
Adding a nutritional component like whole grain or multigrain bread, some carrots or tomatoes would add a nutritional boost to the sandwich, said Ferri.
Patients may better handle drinking a smoothie, shake or soup “than looking at a plate of food,” said Amigo. “To some people, everything tastes like cardboard.”
Some patients have found success overcoming taste issues with a small red berry called Miracle Fruit, which can enhance the flavor of food, said Klein. There are tablets and powders but you can find the berry at the Miracle Fruit Farm in Redland in South Dade, she said, advising patients to chew the fruit but not the seeds.
“Lemons taste like lemonade. Goat cheese tastes like cheesecake. It changes sour flavors to sweet,” Klein said.
Whether a patient chews miracle fruit or blends ginger in a smoothie, knowing what to eat and how much to eat matters, said the experts.
“My outlook is so much different. I eat better. I look better. I feel better.”
Eating tips for cancer treatment
▪ Get plenty of protein: Sources include nuts, nut butters, eggs, hummus and high-protein yogurt as well as lean meats, said Cleveland Clinic’s Amigo.
▪ Drink lots of water: Patients are generally advised to drink about eight, 8-ounce glasses of water a day, though “some chemo requires more,” said Amigo.
▪ Trouble drinking all that fluid? “A cup of applesauce is equivalent to a cup of water,” said Sylvester’s Klein. “A cup of fruit nectar is equal to a half-cup of water.” Try mixing green tea and water, said Ferri. Also consider soup broth, Popsicles made from fruit juice or puréed fruit and crushed ice.
▪ Organic doesn’t hurt: Avoiding chemicals and pesticides is a good thing, but can be costly. Check out the Environmental Working Group’s lists of “Dirty Dozen” and “Clean 15” foods (not organic) with the highest and lowest levels of pesticides to better pick priorities. Strawberries currently top the Dirty Dozen, while avocados lead the Clean 15.
What to eat
“I love the rainbow,” said Sylvester’s Klein. “Foods in different colors have different nutrition.” Dietitians recommend adding these foods to your diet.
▪ Green foods: Artichokes, asparagus, broccoli, spinach, Brussels sprouts, green tea, edamame, cucumbers and lettuce are good sources. They’re anti-inflammatory, a vitamin powerhouse, and help with heart and liver health, brain cognition.
▪ Blue and purple foods: Eggplant, grapes, blueberries, purple onions and purple carrots are also anti-inflammatory and good for cognition.
▪ Red foods: Tomatoes, watermelon, red bell peppers, shrimp and kidney beans have lycopene, a powerful antioxidant associated with a reduced rate of cancer and they help vascular health.
▪ Orange foods: Butternut squash, oranges, sweet potatoes, mangoes, nectarines, carrots and turmeric (try grating it into soups, salads or teas) are good for the immune system, skin and eyes.
▪ Yellow: Yellow bell peppers, corn, pineapple and carambola are anti-inflammatory and good for the eyes and skin. Yellow or green kiwis are good sources of Vitamin C.
▪ White and tan foods: Nuts, pistachios, legumes, quinoa, cinnamon, garlic and ginger are good for the digestive system, hormone health, liver and heart health. Try ginger tea or a smoothie with ginger root. Whatever color, lentils are high in iron.
Patients quickly learn that food safety is crucial during cancer treatment, particularly for patients who have low blood counts.
“If someone’s white blood cell count is low, their immune system is compromised and more prone to infection,” said Klein. “Think of picnic safety: When in doubt, throw it out.”
Dietitians advise patients getting treatment to avoid anything raw in a restaurant and be sure to thoroughly clean fruits and vegetables purchased at a supermarket or outdoor stand.
“Wash greens even if it says they’re triple washed,” said the Cleveland Clinic’s Amigo. Klein recommends using a spray bottle filled with half vinegar/half water to clean produce and kill germs. Afterward, rinse fruits and vegetables with water to get rid of the vinegar taste and smell, she said.
Avoid any food that’s been touched by other people or exposed to germs, said Klein.
“If you live in a house with other people, did someone stick their hand in the cereal box to look for the toy?” said Klein. “It’s not necessarily the type of food but the process.”
What to avoid
▪ Sugar: Increases inflammation
▪ Restaurant salad bars: “People are pinching and squeezing produce in the store,” Klein said. “Now 10 people have had their hands on the food.”
▪ Raw foods that are hard to clean, raw nuts (eat them roasted).
▪ Precut fruit and vegetables
▪ Buffets because multiple people have access to food, people can walk by and cough, sneeze.
▪ Undercooked meats
▪ Limit red meat, which includes beef, pork, lamb and goat