A Community Guide to Cancer Nutrition: Practically applying cancer nutrition knowledge

A Community Guide to Cancer Nutrition:

Practically applying cancer nutrition knowledge care of Chef Amy Symington, MSc.

The Presenter:
Amy Symington, MSc: Amy is a nutrition professor, chef and researcher at George Brown College (GBC) in Toronto, ON. She is also the nutrition and culinary program coordinator at Gilda’s Club Greater Toronto (GCGT), a not-for-profit cancer organization that provides social, emotional and nutritional support to those touched by cancer. At GCGT Amy runs nutrition workshops, culinary demonstrations and supper club programming. In partnership with GBC, GCGT and SSHRC Amy recently published a cookbook entitled The Long Table Cookbook, which is a practical application of research conducted at GCGT and the community guide to cancer nutrition. All author proceeds go to GCGT’s social, emotional and nutrition programming.

Workshop Description:
It is apparent that there is a void in the cancer care realm for a concise, evidence-based cancer nutrition guide equipped with recipes to provide to those touched by cancer, their caretakers, oncologists, doctors and/or nurses to alleviate the stress and frustration of seeking out information related to cancer nutrition. Please join nutrition professor, researcher and chef, Amy Symington, MSc for a nutrition focused workshop and food demonstration showcasing the SSHRC funded research, community guide to cancer nutrition and the evidence-based cookbook she has compiled in collaboration with George Brown College and Gilda’s Club Greater Toronto. Chef Amy will discuss what to consume for cancer prevention and management and to help prevent recurrence as well as how to manage the side effects of treatment through whole foods. Following the discussion Chef Amy will showcase the practical application of this important nutrition information via quick, easy and affordable recipes!  All information provided during this workshop is available via our online Community Guide to Cancer Nutrition found here:  https://gildasclubtoronto.org/cancer_nutrition/

The Evidence:
There is now overwhelming data that shows exercise, good nutrition, and management of stress can improve the likelihood of cancer survival and aid in preventing recurrence. When discussing specifically nutrition during cancer treatment, the research and recommendations to date is quite strong, particularly when it comes to eating patterns. The evidence currently suggests focusing on whole, plant-based foods and to eliminate or minimize highly processed and animal-based foods.

Adherence to a high-quality, nutrient dense dietary pattern is inversely associated with overall mortality among cancer survivors, whereas a Western dietary pattern (a diet low in fibre, functional foods and phytonutrients and high in alcohol, overly processed, high sugar and high animal-based foods) is positively associated with overall mortality among cancer survivors. For example, vegetables are inversely associated with overall mortality amongst cancer survivors and alcohol consumption is positively associated (Jones et al., 2006, Rock et al., 2012, Schwedhelm et al., 2016).

Lifestyle and dietary measures for cancer prevention and management:

• Eat mostly foods of plant origin
• Aim to meet nutritional needs through diet, not supplements
• Focus on foods that support immune function and aid in reducing inflammation
• Have a sufficient, but not excessive energy intake
• Maintain a healthy body weight
• Be physically active a minimum of 30-60 minutes of moderate to vigorous exercise per day
• Eliminate exposure to cigarette smoke
• Reduce consumption of concentrated sugars and refined flour products that contribute to impaired glucose metabolism (which may also lead to Type 2 Diabetes)
• Eat a high fibre diet including ample fruits and vegetables (i.e. all plant-based foods contain fibre, all animal-based foods do not contain fibre)
• Eliminate or limit the consumption of red and processed meat
• Eliminate or limit alcohol consumption
o No more than 1 serving (i.e. 12 oz beer, 1.5 oz spirits, 5 oz wine) per day for women and 2 servings per day for men
• Keep sodium intake to less than 2400 mg (or 6 g of salt) per day.
• Ensure that there is not an imbalanced consumption of omega 3 and omega 6 fatty acids. Ie. a lower ratio of omega-6/omega-3 fatty acids is more desirable in reducing the risk of many of the chronic diseases
• Consume healthy fats and minimize the consumption of less healthy fats
o Focus on mono- and poly-unsaturated fats (i.e. nuts, seeds, avocado)
o Eliminate trans-fats from the diet
o Use cooking oils with a higher smoke point (i.e. grapeseed, sesame, coconut)
o Focus on healthier cooking methods with and without oil i.e. steaming, roasting, poaching, and sautéing
• Consistently consume functional and phytochemical rich foods, which includes foods containing:
o Antioxidants i.e. Polyphenols, carotenoids, flavonoids
o Dietary fibre
o Monounsaturated and polyunsaturated fatty acids
o Phytoestrogens
o Plant stanols and sterols
o Prebiotics and probiotics
o Soy proteins
o Sulphuric Compounds
• Consume allium and cruciferous vegetables as they are especially beneficial
• Consume protective elements such as selenium, folic acid, vitamin B12, vitamin D (Donaldson, 2004, WCRF & AICR, 2007 & 2018)

“When a diet is compiled according to the guidelines here it is likely that there would be at least a 60–70 percent decrease in breast, colorectal, and prostate cancers, and even a 40–50 percent decrease in lung cancer, along with similar reductions in cancers at other sites. Such a diet would be conducive to preventing cancer and would favor recovery from cancer as well (Donaldson, 2004).”

Specific foods to focus on for management of cancer:

• Citrus fruit – lemons, limes, oranges, grapefruit
• Dark coloured berries/fruit – blackberries, blueberries, raspberries, strawberries, cherries
• Cruciferous vegetables – cabbage, cauliflower, broccoli, kale
• Dark leafy greens – collard greens, spinach, swiss chard, kale
• Red vegetables – cabbage, beets, raddichio, red pepper
• Orange vegetables – carrots, pumpkin, sweet potato, squash
• Mushrooms
• Whole grains – whole rolled oats, spelt, kamut, millet, barley, wild or brown rice, teff, sorghum, whole wheat, quinoa
• Beans/legumes – black beans, pinto beans, chickpeas, lentils, aduki, kidney beans
• Healthy fats – avocado, nuts (almonds, walnuts, hazelnuts), seeds (hemp, chia, flax, pumpkin), minimally processed oils
• Herbs and spices – turmeric in particular
• Foods high in fibre -> whole plant based foods in general, avoiding overly processed foods and foods low in fibre
• Foods low to medium on the Glycemic Index

Tips and tricks for cancer nutrition:

  1. Eat breakfast and small meals throughout the day to avoid insulin spikes as insulin has been shown to be a growth factor in cancer.
  2. Eat for prevention. The World Cancer Research Fund and American Institute for Cancer Research (AICR) recommend cancer survivors follow guidelines set for those wishing to prevent cancer in order to reduce recurrence of cancer.
  3. Avoid or eat in moderation red meat, processed meats, trans fat, dairy, refined sugar, alcohol and processed foods.
  4. Aim for a healthy weight and be active – obesity has been directly linked to an increase risk of certain types of cancers so eating well and exercising are your best tools against cancer cell growth. Exercise helps with immunity, sleep patterns, reduces cancer induced fatigue, improves brain function and helps with the rebuilding of healthy cells.
  5. If you wouldn’t eat it, don’t put it on your body.
  6. Manage stress using relaxation tools like yoga, meditation, breathing exercises and tai chi.
  7. Eat slowly, avoid distractions while eating and chew your food well and carefully to aid with digestion.
  8. Create a positive, emotional and social support system for yourself including family, friends and community organizations.
  9. Get a professional opinion! In addition to following the standard guidelines for cancer prevention, seek nutritional (and exercise) advice that is personalized for you!

Common side effects and nutrition tips for management:

  1. Fatigue – eat small, nutrient dense plant-based snacks/meals throughout the day and eliminate blood glucose spiking foods (i.e. refined carbohydrates), get plenty of sleep and exercise
  2. Dry Mouth – sip water throughout the day, keep your foods moist to aid in swallowing, avoid alcohol, avoid salty, dry or hard foods, smoothies are a great nutrient dense aid
  3. Sore mouth – Choose easily chewable, soft food, take smaller bites, eat cold or room temperature foods, suck on ice chips and eat frozen foods like healthy popsicles, avoid foods that will irritate mouth ex. Citrus, spicy, salty
  4. Taste changes/food aversions
  5. Weight loss/gain
  6. Constipation – eat high fibre foods, drink plenty of fluids and exercise
  7. Nausea and vomiting – eat small nutrient dense, stomach settling snacks/meals throughout the day (i.e. plain almonds), drink plenty of fluids (little sips), avoid smelly situations, eat more blandly
  8. Appetite loss – eat a healthy version of your favourite foods to increase interest, exercise, eat small frequent snacks/meals
  9. Anemia – up iron intake via beans, legumes, nuts, seeds, and leafy greens paired with vitamin C rich foods, minimize alcohol and coffee/tea consumption as they may interfere with iron absorption

Important research resources:

  1. Donaldson, M.S., 2004. Nutrition and cancer: A review of the evidence for an anti-cancer diet.
  2. Nutrition Journal, 3:19. https://doi.org/10.1186/1475-2891-3-19.
  3. Jones LW, Demark-Wahnefried W., 2006.  Diet, exercise, and complementary therapies after primary treatment for cancer. The Lancet Oncology, 7:1017–1026.
  4. Rock CL, Doyle C, Demark-Wahnefried W, et al., 2012. Nutrition and physical activity guidelines for cancer survivors. Cancer Journal for Clinicians, 62:243–274.
  5. Schwedhelm C, Boeing H., Hoffmann G., Aleksandrova K., Schwingshackl L., 2016. Effect of diet on mortality and cancer recurrence among cancer survivors: a systematic review and meta-analysis of cohort studies. Nutrition Review, 74(12):737-748.
  6. World Cancer Research Fund (WCRF) / American Institute for Cancer Research (AICR), 2007. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007.
  7. World Cancer Research Fund (WCRF) / American Institute for Cancer Research (AICR), 2018. Diet, Nutrition, Physical Activity, and the Prevention of Cancer.  Available at: https://www.wcrf.org/sites/default/files/Cancer-Prevention-Recommendations-2018.pd
  8. World Cancer Research Fund (WCRF) / American Institute for Cancer Research (AICR), Continuous Update Project Expert Report 2018. Wholegrains, vegetables and fruit and the risk of cancer. Available at: dietandcancerreport.org

Practical Resources:

Cancer Support Community

Canadian Cancer Society

American Cancer Society

American Institute for Cancer Research

The Long Table Cookbook
Available on Amazon, Indigo or at your favourite local bookstore

A program generously supported by: