Adapted from the diagram at <www.dh.gov.uk/health/2012/06/about-the-eatwell-plate/>
When you have cancer, you may need more protein and more calories.
When working out what amounts of energy and nutrients you need during your day, it can be helpful to think of food nutrients as a currency. While the normal currency used is calories or kilojoules, consider each of the key food nutrients as being worth a certain amount of money. If you are losing weight and having a difficult time, you need to try to eat more to increase the savings you have in the bank. These savings will be then available for you to spend on each of the body’s key functions, including:
•brain function
•immune system function
•mobility
•extra healing
•cellular repair
•energy to go out.
If you find you are putting on extra, unwanted pounds, keep to a stricter budget that focuses on just including the foods that provide the most nutrient value, such as fruits, vegetables, lean proteins and wholegrains, without too many high-fat, sugar or alcohol purchases. Now you can plan the shopping either to build up the bank or to try and keep a tighter control on the total daily spend to balance the energy books.
| Energy intake = | energy for essential body function + energy for stress and repair + energy for activity or exercise |
The main food nutrients which provide energy for body function, repair and activity are called macronutrients. Ensuring you are taking enough of these should be the first step in any dietary plan.
The energy allowances of the macronutrients are as follows:
•carbohydrates: 4 kcal/g
•protein: 4 kcal/g
•fat: 9 kcal/g
•alcohol: 7 kcal/g
•fibre: a small amount of energy.
Carbohydrates form the body’s major provider of energy. This is a group that I would like to champion as many people, when considering their dietary needs, forget that carbohydrates give the body the fuel it needs for physical activity and proper organ function. They are a valuable source of many nutrients for health, including vitamins, minerals, wholegrains and fibre.
The best sources of carbohydrates include fruits, vegetables and wholegrains – these also supply the body’s cells with many of the essential vitamins and minerals, fibre and phytonutrients (‘fight-onutrients’: important chemicals found in plants; more about them later in this chapter and in Chapter 10).
Wholegrains or foods made from them contain all the essential parts and naturally occurring nutrients of the entire grain seed. Wholegrains are found in cereals, breads, flours and crackers. Some wholegrains, such as quinoa, brown rice or barley, can be used as side dishes or part of an entrée. When choosing a wholegrain product, look for terms such as ‘wholegrain’, ‘stone ground’, ‘whole ground’, ‘wholewheat flour’, ‘whole-oat flour’ or ‘whole-rye flour’.
The Glycaemic Index (GI) or Glycaemic Load (GL) concept can be used to select carbohydrates to improve satiety and blood sugar control. The types of carbohydrates which are best in helping with unwanted weight gain, blood sugar control, hunger pangs or low energy are the lower GI or slower-release type carbohydrates. Basically, as these foods are mostly wholegrain or unprocessed grain or cereal type foods, the body takes longer to break them down. In addition to helping you feel full for longer, the energy they provide tends to last for around two to three hours.
The higher GI or fast-release carbohydrates are the ones which are either cooked more or processed more, or are in more broken-down form. These give a quicker hit of energy and tend not to fill you up as much. They may be better if you are experiencing early satiety or are losing weight. Table 5.1 lists some slow- and fast-release carbohydrates.
Table 5.1 Fast- and slow-release carbohydrates
| Fast-release carbohydrates or higher GI (lower satiety) | Slow-release carbohydrates or lower GI (higher satiety) |
| Well-cooked or fresh pasta | Durum wheat pasta cooked al dente |
| Cornflakes, Rice Krispies, Frosties, Coco Pops, etc. | All-Bran, natural muesli made with whole oats, whole oat porridge |
| Large well-cooked or mashed potato | Baby or new potatoes cooked whole in the jacket |
| Quick-cook oats | Whole oats or pinhead type oats, oat groats |
| White or wholemeal bread | Wholegrain or soya and linseed bread |
| Soft drinks, cordials, fruit juice | Milk, yoghurt |
| Jasmine or short-grain rice | Basmati or brown rice |
| Rice or corn cakes | Ryvita crispbreads |
While the GI (slow or fast) is a well-researched concept, there are a number of confounding factors and the choices can be hard to apply to real meals.
The best advice I can give is to use the GI concept either to eat more of the foods that fill you up, or to eat more of the foods that are easy to eat and don’t cause as much of a problem with early satiety. It is best only to apply the GI concept to grain- or cereal-based carbohydrate foods including pasta, bread, potatoes, beverages and breakfast cereal choices. It is important not to worry about the GI with fruit and vegetables as, owing to the lower carbohydrate content of these foods, the difference is negligible and it is always better to try to get in as many different fruit and vegetable colours as you can.
It is very easy to adjust your old recipes from high GI to low GI. To slow down the rate of carbohydrate release in any type of baked goods you can adjust and switch the ingredients to incorporate more of the following: apple, fructose sugar, oats, All-Bran, linseeds, etc.
For savoury casserole-type meals, try adding a small tin of lentils to your mince; use sweet potatoes instead of normal potatoes in a stew, curry or roast dinner and even for mashed potato. There are many recipe books available now that have low GI recipes.
This recipe is a good example of eating for sustained slow-release energy, giving you an excellent blood sugar control and energy for three hours after eating.
NOTE: This batter has to stand overnight.
2 eggs
60 ml (4 tablesp) rapeseed oil
375 ml (1½ cups) flour, sifted before measuring
1 large grated apple
5 ml (1 teasp) ground cinnamon
5 ml (1 teasp) vanilla essence
150 g (1 cup) soft brown sugar (could use fructose sugar)
250 ml (1 cup) oat bran, pressed down into the cup
500 ml (2 cups) digestive bran
15 ml (1 tablesp) bicarbonate of soda
2 ml (½ teasp) salt
250 ml (1 cup) sultanas
500 ml (2 cups) low-fat milk
Beat together the eggs, sugar and oil. Add all the dry ingredients, the grated apple and the sultanas. Mix thoroughly, lifting the mixture a few times with the spoon to incorporate air. Mix the milk and vanilla and add to the flour mixture. Stir until well blended, but do not over-mix. Leave overnight in the refrigerator. When ready to bake, stir and drop into muffin pans and bake at 180° C/170° C fan/350° F/Gas Mark 4 for 15 minutes. Makes 24 large muffins.
This mixture can be kept in the refrigerator for up to 30 days. Do not freeze the batter, but baked muffins freeze very well.
Using more of the refined types of flours and sugar with ripe or more tropical fruits generally means the GI is higher and the food processed by the body at a quicker rate.
2½ cups self-raising flour
1 tablespoon caster sugar
¾ cup milk
1 egg, lightly beaten
½ cup vegetable oil
¾ cup brown sugar
1 teaspoon vanilla extract
½ cup frozen blueberries
2 ripe bananas, mashed
Preheat oven to 190° C/170° C fan/375° F/Gas Mark 5. Line a 12-hole muffin pan with paper cases. Combine the flour, caster sugar and brown sugar in a bowl. Make a well in the centre and add the milk, egg, oil and vanilla. Mix until just combined. Fold in the blueberries and bananas. Spoon mixture evenly between paper cases. Bake for 20 to 22 minutes or until golden and just firm to touch. Stand in pan for 5 minutes. Transfer to a wire rack to cool.
Muffins are best served on the day of cooking. Avoid over-mixing the muffin batter or it results in a tough texture.
Protein needs to be a focus nutrient for people with cancer. Cancer does take it out of you, along with the treatments, and surgery can place quite a bit of stress on the body. Enough protein, and a better quality of protein, can increase the rate of tissue repair and boost the immune system, making recovery time quicker and easier.
In addition to eating regular bite-sized portions of protein-rich foods throughout the day, include more of the higher quality protein sources, which provide more of the specific tissue building blocks or amino acids that the body uses for growth and repair.
It is also important to know that if your energy budgets are not being met or if you are losing weight, the protein you eat will need to be put into the fuel tank and used as a basic energy source. This means the rate of growth and repair is generally sluggish.
During treatment, eat more high biological value proteins, where the amino acid profile is a closer match to what the body needs more of at this time.
•High biological value proteins include fish, poultry, lean red meat, eggs, dairy products and whey-based protein (supplements).
•Other good protein sources, although not as high in their biological value scores, are nuts and nut butters, dried beans, peas and lentils, and soy foods. These are good supplement protein foods.
Lean red meat is a very high quality type of protein. It contains a potent source of iron and is often a food the body needs more of during treatment. This is an example of a food that should generally not be restricted during the treatment phase, although I do encourage choices which are lean, come from a good source and are from a better quality cut. The guidelines on red meat are intended for those trying to prevent their first cancer or who have finished treatment and are eating well to prevent a future recurrence. They are not intended for individuals, particularly those who might be struggling with their diet, during the active treatment stage.
Many people give up dairy foods when they find out they have cancer, especially women with breast cancer. I certainly do not recommend this and would advise anyone who has taken this step to revisit the evidence behind this hot issue. (For more information, see Chapter 9, page 124.)
Generally, individuals who are well and not experiencing any additional problems should aim for around 0.8–1.0 g of protein per kilogram of body weight. This would be around 60–75 g/day of protein for a 75 kg (12 stone) person.
However, if you are in treatment, more active and trying to build muscle, then you may need to increase your protein intake towards 1.2–2 g per kilogram of body weight. At the upper end this would be around 135–150 g of protein for the same 75 kg (12 stone) person.
These broad-brush guidelines have been taken from published data on protein needs for healthy individuals, athletes and people who are experiencing illness or stress. They are only suitable if you have no problems with your liver or kidney function.
A person who is cachexic and losing weight has a very challenging protein requirement of 1.8–2.0 g per kilogram of body weight, a target that can be more difficult to reach as often appetite is poor. This is when it might be easier to use supplements such as protein powders. The cheapest protein powder is skimmed milk powder and it is easy to add to most meals.
Table 5.2 lists foods providing approximately 10 g of protein from both higher and lower quality types of protein.
| Animal (high-value protein) | Plant |
| 2 small eggs | 4 slices wholemeal bread |
| 30 g (1½) slices low-fat cheese | 3 cups wholegrain cereal |
| 250 ml (1 cup) low-fat milk | 2 cups cooked pasta |
| 70 g cottage cheese | 3 cups cooked rice |
| 30 g lean chicken or beef or pork | ¾ cup lentils or kidney beans |
| 50 g grilled fish | 200 g baked beans |
| 50 g tuna or salmon | ½ cup tofu |
| 200 g low-fat yoghurt | 60 g nuts or seeds |
| ¼ cup parmesan cheese, grated | 300 ml soy milk |
| 2 cups ice cream | 100 g soy meat or Quorn |
| 180 g Greek yoghurt | 2 tablespoons peanut butter |
| ¼ cup skimmed milk powder | ⅓ cup edamame (soy beans) |
| 30 g canned tuna | |
| 1–2 scoops protein powder (There are many options for protein powders and you can discuss with your doctor or dietitian the most suitable one and the sorts of amounts you should be aiming for. The amount of protein per serving is detailed in the nutrition panel on the packet.) | |
Rather than a big slab of chicken, fish or meat at the end of the day, it is better to spread protein intake in more bite-size chunks over the day.
This is a good recipe for the day of treatment.
1 egg
5 egg whites
120 g oats
Honey or maple syrup
Blueberries
Oil spray for frying (or use a non-stick pan)
Whisk together egg whites and oats. Pour mixture into hot pan. Turn when it starts to bubble. Serve with honey or maple syrup and blueberries.
What a yummy way to boost the morning, with 38 g of protein, of which 25 g is high-value protein.
Despite its bad press, fat has an important role in treatment nutrition, especially if you are trying to boost or maintain your weight and muscle levels. Omega 3 fatty acids can also help reduce inflammation and boost memory and mood.
Fats and oils are made of fatty acids and serve as a rich source of energy for the body. The body breaks down fats and uses them to store energy and to insulate body tissues, transporting some types of fat-soluble vitamins through the blood. Low mood is also associated with very low-fat diets and inadequate intakes of omega 3 fatty acids, an important fat for the body, which is found in oily fish, rapeseed, linseeds and, to a lesser degree, olive oil.
You may have heard that some fats are better for you than others. While heart health shouldn’t be the main focus when you are in treatment for cancer, it is good to keep it on the radar, especially if you are otherwise well. I would suggest using a delicious olive oil on salads or bread, and cooking with rapeseed oils, nut oils, hemp oils and other vegetable-based margarines or oils. It can be a good idea to mix your oils around, although when you are not well it is hard to beat the taste of real butter. I generally tell people to worry about cholesterol and the like once they have finished treatment, unless it is a major health priority to them. Quite often I find myself gently persuading gorgeous – but little – older ladies that really the cholesterol concern is not that important to them at this time. It certainly has been a public health message that many people get stuck on, but it is not normally one of the main nutritional priorities during the treatment phase unless you are otherwise advised by your doctor or you have a cancer like prostate and some colon cancers, which are often related to heart health and excessive amounts of weight.
•Mono-unsaturated fats are found mainly in vegetable oils like olive, rapeseed and peanut oils.
•Polyunsaturated fats are found mainly in vegetable oils like safflower, sunflower, corn and flaxseed. They are also the main fats found in seafood.
•Saturated fats are mainly in animal sources like meat and poultry, cream or whole-fat milk, cheese and butter. Some vegetable oils, like coconut, palm kernel and palm oil, are saturated. After treatment it is important to know that saturated fats can raise cholesterol and increase your risk of heart disease. Less than 10 per cent of your calories should come from saturated fat. People on hormonal treatment can have a higher risk of heart disease further down the track.
•Trans-fatty acids are formed when vegetable oils are processed into margarine or shortening. Sources of trans-fats include snack foods and baked goods made with partially hydrogenated vegetable oil or vegetable shortening. They can raise bad cholesterol and lower good cholesterol; try to eliminate them from your diet, although this is not necessarily the biggest priority during the treatment phase.
High doses of the fish oil EPA (2 g/day) can act as an anti-inflammatory, and there is a moderate amount of evidence to suggest that a daily dose may reduce the loss of appetite often experienced with more advanced cancers. It should be noted that fish oils should not be taken if you are receiving any platin-based chemotherapy agents. If you are unsure, check with your doctor or nurse specialist.
Fibre is the part of plant foods that the body cannot digest. There are two types:
•Insoluble fibre provides the bulk, and this is important to move food waste out of the body quickly, acting like a big broom. Insoluble fibre sources include wholegrain cereal foods such as bread, wholegrain crispbreads, higher-fibre breakfast cereals (look at the fibre levels on the side of the packet), brown rice, wholemeal pasta, popcorn, fruit skins and pips.
•Soluble fibre binds with water in the stool to help keep stools soft, and this type of fibre is more fermentable. Soluble fibre sources include fruit, legumes, vegetables and oats.
For bowel function a good balance between both types of fibre throughout the day is important.
If you are experiencing difficulties with sluggish bowels, it may be worth discussing with your doctor or clinic whether the gradual build-up of your insoluble and soluble fibre intakes is safe and appropriate for you. Also see the Food Fix ideas in Chapter 7 on diet tips for constipation. However, please note that in some situations constipation is not related to diet and a high-fibre diet can further aggravate the situation. This needs to be discussed with your doctor.
If you are experiencing wind and bloating, start by checking you are not overdoing the fruit and vegetable intake. Quite often this is an issue for individuals who move from ground zero to eating fruits and vegetables until they are coming out of their ears!
Although we encourage lots of variety and colours in your diet, during treatment it can be harder for the body to manage large volumes of these foods, especially when this has not been the normal dietary practice. In such situations, it’s best to start with four to five servings of fruit and vegetables a day and slowly build up.
Other foods which can affect bloating are referred to as the more fermentable types or higher FODMAP foods. FODMAP is an acronym standing for a group of carbohydrates which are poorly digested plant residues particularly fermentable in the large bowel. The diet can be used to assess whether reducing these types of foods can help in the management of what are referred to as functional gastrointestinal symptoms, which may include bloating, excessive wind, pain and continuing changes in bowel habit such as diarrhoea or constipation. The diet should be worked out in consultation with a gastroenterologist and a specialist dietitian; however, you can experiment with cutting out foods such as onions, garlic, high fructose fruits such as apples and pears, pulses, sorbitol or xylitol-containing mints or gums.
It is always important to consume enough water so that you strike the balance between dehydration and over-hydration. Too much water can cause hyponatremia, a life-threatening drop in your sodium levels. Smaller, less active women are at a higher risk of taking in too much water.
We all know that water and liquids or fluids are vital to health and that our cells need water to function. During treatment, taking in enough fluid is also important to help flush out the drugs from the system once they have finished working. Being slightly dehydrated – by as little as 1 to 2 per cent – can affect how you feel and function. Studies indicate that if you are dehydrated by 2 per cent or more, you will not perform as well as if you were hydrated. This is key if you are losing fluids through vomiting or diarrhoea.
In general, around six to eight glasses of fluid are recommended a day. This should include water, although other fluids such as tea, coffee, juices and cordials all contribute. If you are having chemotherapy, you are advised to try to take in two litres a day, although this can be difficult and may contribute to waking during the night, which is not helpful if fatigue is a problem. It is certainly better to try to take more of this fluid earlier in the day. One way to gauge whether you are drinking enough is to observe the colour of your urine. Some drugs and vitamins may affect the colour, but you should be aiming for pale yellow to straw. Dark-coloured urine can be an indication of dehydration. Some sport nutritionists have put together a clever iPhone app called Ipee Daily. This app provides a Dulux-type colour chart to track the colour of your urine!
Finally, if you are unable to keep fluids down or are experiencing extreme diarrhoea, contact your clinic immediately.
Although vitamins and minerals are essential for good health, the body only needs small amounts. Quite often there is a disproportionate focus on the need for enough or extra vitamins and minerals, which probably has something to do with aggressive supplement company promotions.
Vitamins and minerals are found naturally in food, and in general a person who eats a balanced and varied diet with enough calories and protein gets plenty. There are, of course, times when this is difficult in the treatment phase, and in such instances it would be appropriate to discuss the use of a low-dose multi-vitamin and mineral supplement with your medical advisers.
What I do want to caution you against is the practice of megadosing. Often, people with cancer are advised to take – or believe they need – large amounts of vitamins, minerals and other dietary supplements to try to boost everything from their energy levels to their immune system. They may even believe that these supplements can destroy cancer cells. This is not the case; in fact, taking larger doses of supplements can be harmful and there are many studies which associate this practice with a higher incidence of cancer. Large doses of some vitamins and minerals are also known to be likely to impact on the effectiveness of chemotherapy and radiation therapy.
The most prudent advice is to aim to eat enough of a variety of foods to provide for your requirements. If you are concerned, and if your oncologist agrees, talk to your pharmacist about selecting a supplement with no more than 100 per cent of the daily value (DV) of vitamins and minerals and one with a lower level of iron (unless your doctor has found your iron to be low and would generally advise an appropriate level of iron supplementation).
These are plant compounds like carotenoids, lycopene, resveratrol and phytosterols that are thought to have health-protecting qualities. They are found in plant products such as fruits, vegetables and teas. Pill or supplement forms of phytochemicals have not been shown to be as helpful as eating the foods that contain them. I have included more detail on this in Chapter 10 (see page 135).
Among the focus phytonutrients in the cancer arena are antioxidants, as there is widespread interest in their potential to attack and block free radicals, considered to be harmful molecules that cause damage to normal healthy cells.
The main antioxidants of interest have included vitamins A, C and E, selenium and zinc, and some enzymes. However, as with many areas in nutrition, once something is found to be positive people somehow become convinced that bucket-loads must be much better than ordinary moderate amounts. This enthusiasm is fuelled by companies who package them as supplements, and they start to appear in weird and wonderful forms, to be loaded into the body throughout the day, whether in the form of a pill or powder or by having that juicer going 24/7. The number of times I have inwardly cringed when I hear of people trying to down litres of broccoli juice and other horrible-looking green powder mixes that claim the wonders of being ‘super-green’! I remember meeting one lady who was drinking around two litres of broccoli, cabbage and beetroot juice a day. I could not imagine having to clean a juicer every day after that mix.
It is understandable that people want to do all they can to fight cancer. However, what needs to be recognized is that we just do not fully understand the complex nature of cellular function. While we have labelled the free radical action as a bad thing, it may in fact be a good thing for our cells. Perhaps the free radicals help cull cells which are not functioning as well as they should, and perhaps our amazing body does have a better idea of cell regulation than many of the quasi-nutritionists who advocate the need for copious amounts of super-greens and the like, without any strong evidence to show that the effort involved in downing all these extras is in fact helping. Or, even more importantly, that they are not doing more harm than good.
If you want to take in more antioxidants, what we strongly recommend is that you try to eat a variety of fruits and vegetables, which are also good sources of other valuable nutrients, as well as fibre. In most clinics I know, people are not advised to take extra and certainly not large doses of antioxidant supplements or vitamin-enhanced foods or liquids. This is because of their potential to interact and compete with the tasks assigned to the chemo- or radiotherapy. Talk with your doctor or dietitian about finding a safe way to enjoy an adequate intake of antioxidants in your diet. (See also Chapter 10.) There is nothing wrong with having some food boosters to help you out during the treatment stage, just as long as the food priorities are in the right order.
Figure 5.1, the Eatwell Plate, shows recommendations for healthy, balanced eating. It can be a good starting point if you are well and not experiencing too many difficulties with your diet. However, your plate may need to look quite different, with more emphasis on protein and dairy foods if you are struggling with your appetite and normal food intake, as in Figures 5.2 and 5.3 (see pages 57–8).
Adapted from the diagram at <www.dh.gov.uk/health/2012/06/about-the-eatwell-plate/>
Milk is an important food as it provides high amounts of protein, energy and calcium. The type of milk you choose depends on whether you are trying to ‘build up’ or ‘hold on’ to where you are. The choice is full fat or low fat, the difference being that:
•whole or full-fat milk contains about 3.5 per cent fat;
•semi-skimmed contains about 1.7 per cent fat;
•skimmed milk contains 0.1 to 0.3 per cent fat.
A lower fat content doesn’t mean a lower calcium content – but low-fat milk contains less energy and lower amounts of fat-soluble vitamins unless they are fortified.
A lactose-free milk (available in the fresh dairy section of most supermarkets) or soya or other alternatives can also be used if these suit your bowel or are your personal preference. Milk can be used for cereals, home-made milkshakes, tea and coffee. It is also useful to make milk jellies, custard or other milk puddings, easy to eat if you are wanting something bland without overt food smells.
One of the easiest and most inexpensive ways to boost the protein content of your foods is to add 2–4 tablespoons of dried skimmed milk powder to a pint (450 ml) of milk. A heaped tablespoon of skimmed milk powder provides around 3 g of protein.
200 ml semi-skimmed milk
10 ml (2 tablesp) dried skimmed milk powder
Scoop of ice cream
10 ml (2 tablesp) frozen or fresh red berries
Put all ingredients into a jug. Blend with a hand-held blender (worth having one of these in the house). Pour into a glass and sip with a straw.
Delicious as a snack or as a breakfast quick fix.
1 cup plain generic muesli
1 cup coconut
1 cup rolled oats
10 ml (2 tablesp) linseeds (best to add only if the bowels are sluggish)
½ cup raw or white sugar
¼ cup dried skimmed milk powder
180 g butter or margarine
1 tablesp honey
1 egg, lightly beaten
Combine muesli, coconut, oats, sifted flour, sugar, linseeds and powdered milk in a bowl. Melt butter and honey together. Add to mixture, then stir in egg. Drop teaspoonfuls of mixture on to lightly greased tray. Bake at 180° C/170° C fan/350° F/Gas Mark 4 for 10–15 minutes or until light golden. Cool on trays.
Eggs are one of the most nutritious and versatile foods that a person in treatment can use. A very compact source of nutrition, they provide a potent type of protein, every vitamin except C, and a host of essential minerals including iron. Their neutral flavour can be enjoyed in a simple way or they can be dressed up with sauces and seasonings or added for an extra boost in a range of sweet and savoury dishes. They are easy to digest and the texture is soft and easy to swallow. A quick omelette or frittata or even just a poached or boiled egg is something easy and always on hand to cook. If your appetite is poor or you are struggling, try adding extra chopped egg into rice dishes (like fried rice) or mixing it into a pasta with some cheese or ham. A dish like a quiche often suits if cold food is preferred, and foods like egg custard, cake or muffins are nutritious extras when a boost is needed. Try the omega 3 boosted eggs or even quail eggs as an in-between nibble. Eggs are an ideal start to the day; a healthy filling option could be some poached eggs with grilled tomato, mushrooms and perhaps some wilted spinach, with a tasty grain or sourdough bread.
2 eggs
5 ml (1 tablesp) single cream or milk (whatever milk you prefer)
Salt and freshly ground pepper
15 g butter or margarine
In a bowl, whisk together the eggs, milk or cream and seasoning with a fork. Melt the butter gently in a heavy-based saucepan on a low heat, until it starts to bubble slightly. Tip in the egg mixture and, using a wooden spoon, slowly and smoothly move the egg around the base of the pan until it is thick and creamy. It should look just cooked. Remove from heat and serve immediately with a piece of bread or toast.
Can be used as a lovely high protein spread or dessert. The slightly tart but smooth taste often suits mouths whose taste buds are in need of a bit of a kick.
2 large lemons (adjust quantity depending on what your taste buds are doing)
85 g butter or margarine
225 g granulated sugar
3 eggs, lightly beaten
Grate lemons on the finest grater gauge, taking care not to add any of the pith. Set zest aside. Squeeze the juice from the lemons. Put lemon juice, butter, sugar and eggs into a heavy-based saucepan or double boiler and heat gently, stirring all the time, until the mixture is thick and a few large bubbles rise to the surface of the mixture. Sieve to remove any egg bits and then stir in the lemon zest. Spoon into a warmed jam jar. Will keep in the refrigerator for a week.
Lemon curd can be spread on toast, scones and pancakes, or you can add it to muffins or cakes. It goes well on ice cream, or mixed with a little custard or cream or rice puddings. It is also a great topping for cheesecake (you can buy plain cheesecake and spread it over the top).
I would suggest that during treatment you use either butter or margarine, depending on your preference or other health needs. After treatment, you might want to switch back to margarines. I prefer those based on olive oil. Other alternatives could be spreading some avocado or hummus, or dipping your bread in a delicious olive oil with a dash of balsamic, just like the Italians. If you really prefer the taste of butter during treatment, then I would stick with a good quality butter. Extra butter can be a help if you are losing weight, but if you are gaining it is better to use it quite sparingly.
It is best to keep a few different oils in the cupboard for cooking and salad dressings and to add some extra omega 3 health benefits. I recommend rapeseed oil for cooking as its flavour is lighter and its omega 3:6 ratio is more favourable than either olive or vegetable oils. A good quality extra-virgin olive oil is best for dressing salads, although extra-virgin olive oil is not intended for frying or cooking. Other healthy oils to experiment with are walnut, macadamia, hemp and flaxseed oils. These have a slightly nutty flavour and are a good source of omega 3 fatty acids. Sesame oil is also good for added flavour in stir-fries.
Flaxseeds or linseeds are small, shiny, dark brown seeds about the size of a sesame seed. They are the richest plant source of omega 3 fatty acids, as they provided a fatty acid called alpha-linolenic acid (ALA), a building block of omega 3 oils found in fish. Flaxseeds are also rich in ligans, a type of plant oestrogen that lowers female oestrogen levels, helps the unpleasant side effects of the menopause such as flushing and has anti-tumour properties. Flaxseeds are also helpful in the management of constipation. They are very important for vegetarians or people who do not eat fish or eggs. One or two tablespoons a day is all it takes. Flaxseeds should not be taken if you have had recent bowel surgery or are having problems with diarrhoea.
½ cup linseeds or flaxseeds
1 cup oat or rice bran
½ cup linseed meal or flaxseed meal
½ cup almond meal or almond flakes
½ cup sesame seeds, toasted
½ cup psyllium husks
Mix all ingredients together. Use 1–2 tablespoons on either cereal, fruit or yoghurt daily. While this mix provides a mighty boost of fibre, protein and ALA, it may not be suitable if you need to eat less fibre or to rest your bowel.
Low in saturated fat, rich in zinc and a great source of anti-inflammatory omega 3 fatty acids – there are just so many reasons to include three or four oily fish meals across the week. Fish is also an important source of protein, potassium and prostate-protecting zinc. Fish is a very versatile food as it can be eaten canned, smoked or cooked in many ways. Easy fish meals can include fish cakes or fish pie, and there can be nothing better than a quality piece of salmon pan-fried or barbecued (always put the skin of the fish on the hot grill for protection). Tinned or smoked salmon or other fish mixed with a quality tomato sauce or some Philadelphia cheese with some capers is a very easy meal.
450 g fresh salmon fillets
350 g mashed potato (not too wet)
2 eggs, beaten
1 tablespoon fresh parsley (chopped)
Small can corn (optional)
Dried white breadcrumbs
1 red pepper, chopped
Seasoned flour
Oil for frying
Poach the salmon in a little water and let it cool. Remove the skin and break the fish into flakes. Mix salmon and potato together. Season well with salt and pepper. Add the butter, parsley and corn (if used). Add a small amount of egg if needed to bind the mixture, but don’t make it too sloppy. Shape the mixture into six to eight cakes.
Put seasoned flour in one bowl, beaten egg in another bowl and breadcrumbs in a third bowl. Dip each fish cake in flour, then egg and then breadcrumbs. Heat oil in a frying pan and fry until the fish cakes are golden brown on both sides.
Serve with some sweet chilli sauce.
Despite some concerns regarding the role of red meat as a possible risk factor in cancer development, it is important to know that in most of the studies on this there has been little distinction between the quality and type of red meat consumed. Lean lamb or beef, trimmed of all visible fat, makes an important contribution to a treatment diet. It offers high quality protein with all the essential amino acids required by the body; it is a key source of iron needed to help boost blood counts, as well as zinc, potassium and a range of B vitamins including thiamin, niacin and vitamins B6 and B12.
Like all red meats, lean high quality lamb or beef is most valued for its iron, which occurs as haem iron, the type most easily absorbed by the body. Iron is important for healthy blood, brain and immune function. It is somewhat perverse that people who usually eat red meat decide to cut this important food just as they are about to start their treatment, in which treatments like chemotherapy and radiotherapy affect blood – and if surgery is involved, there is often some blood loss and need for tissue repair and healing.
Also, lamb is particularly environmental as it is a grass feeder and accumulates fewer chemicals or toxins as it is killed when young. If you are having trouble with your taste buds, try some mint or fruity marinades.
One of my favourite food groups encompasses the healthy versions of bread, pittas and potatoes. Wholegrains are a nutrition power plant, while these foods also contain slow-releasing or lower GI type carbohydrates which help keep energy levels constant throughout the day. When portions are contained they are also a low-energy dense food which can be helpful if you are trying to control your weight.
Other examples of foods made with wholegrain or whole-meal ingredients include wholemeal and mixed-grain breads, rolls, wraps, flatbreads and English muffins, wholegrain breakfast cereals, wheat or oat flake breakfast biscuits, wholegrain crispbreads, rolled oats, wholemeal pasta, brown rice, popcorn, bulgar (cracked wheat) and rice cakes.
Wholegrains are low in fat and are important sources of protein, dietary fibre (lignans, beta-glucan and soluble pentosans), vitamins (especially B-group vitamins and antioxidant vitamin E), minerals (iron, zinc, magnesium and selenium) and many bioactive phytochemicals, including:
•phytosterols – which have cholesterol-lowering properties;
•sphingolipids – which are associated with tumour control and maintenance of normal epithelia;
•polyphenols and phenolics – such as hydroxycinnamic, ferulic, vanillic and p-coumaric acids, which have antioxidant properties;
•carotenoids – such as alpha- and beta-carotene, lutein and zeaxanthin, which have antioxidant functions;
•phytates – which may have a role in lowering glycaemic responses and reducing oxidation of cholesterol.
The antioxidant content of wholegrains is worthy of note, with research showing that the in vitro antioxidant activity of whole-grain foods is on a par with, or higher than, that of vegetables and fruits. A 2007 study by the Agricultural Research Service of the United States Department of Agriculture ranked foods for their antioxidant capacity. Cereal-based foods including ready-to-eat cereals, oats, wholegrain breads and legumes were found to be among the highest antioxidant-containing foods by ORAC (oxygen radical absorbance capacity) score, as shown in Table 5.3.
Table 5.3 ORAC antioxidant capacity of selected fruits, vegetables, grains and legumes
| Grains | Fruit and vegetables | Legumes |
| Rice bran 24,287 | Blueberries 6,552 | Pinto beans 904 |
| Cornflakes 2,359 | Blackberries 5,347 | Carrots 666 |
| Granola 2,294 | Strawberries 3,577 | Chickpeas 847 |
| Oat bran 2,183 | Apples 2,828 | Green peas 600 |
| Rolled oats 2,169 | Avocados 1,933 | Lima beans 243 |
| Pumpernickel 1,963 | Oranges 1,819 | |
| Popcorn 1,743 | Spinach 1,515 | |
| Mixed grain bread 1,421 | Broccoli 1,362 | |
| Shredded Wheat cereal 1,303 | Green tea, brewed 1,253 | |
| Mangoes 1,002 |
As you can see, based on quantities consumed, in some cases grain foods provide higher amounts of antioxidants than most fruits and vegetables. The antioxidant vitamins in grains, such as vitamin E and its isomers (tocopherols and tocotrienols), and minerals such as selenium contribute to the antioxidant activity as phytochemicals like phytates, phenolics and lignans or alkylresorcinols.
There are also some grain-specific antioxidants, such as oryzonol in rice, avenanthramides in oats and ferulic acid in corn and wheat. Certain other phenolics, phenolic lipids, flavonoids, tocopherols and dietary fibres (e.g. beta-glucan) found in grains are anti-mutagenic and anti-inflammatory. This means they can help prevent cancer.
Choline, betaine and alkylresorcinols (particularly abundant in rye) are other important compounds found in wholegrains which play a role in the prevention of cell mutations (cell mistakes) and tumour formation.
Research has shown (and continues to bring to light) the many nutritional and functional components of wholegrain cereals that work alone and/or in synergy to promote good health and help reduce risks of certain types of cancer. I have also included some additional information on boosting antioxidant intakes across your diet in the fruits and vegetables recipes below.
Popcorn is a great source of fibre and provides a big antioxidant boost. It is a great snack food that should not just be reserved for the movies. If you need to boost your weight the taste is enhanced with some melted butter and a little salt. Those on a stricter energy budget can enjoy it plain with just a sprinkle of salt for extra flavour.
Put ¼ cup raw corn kernels (I prefer the raw kernels to the prepackaged microwave variety) into a large microwave dish. Put the lid on and then cook on high in the microwave for 2–3 minutes. Add butter or salt as desired.
Try these tantalizingly tasty jacket potatoes.
4 large (1.2 kg) sebago potatoes (baby or new potatoes can be used if you would prefer to eat a lower GI potato)
425 g can tuna in spring water, drained and flaked
2 x 125 g cans corn kernels, drained and rinsed
¼ cup whole-egg mayonnaise
1 spring onion, thinly sliced diagonally
Position oven rack just above centre of oven. Preheat oven to 200° C/180° C fan/400° F/Gas Mark 6. Scrub and rinse potatoes. Pat dry. Pierce each potato six times with a fork and wrap in foil. Place on oven rack. Bake for 1 hour 30 minutes or until tender when a skewer is inserted into centre. Transfer to a plate. Stand for 10 minutes.
Combine tuna, corn and mayonnaise in a bowl. Season with salt and pepper. Remove foil from potatoes and cut a deep cross in the top of each. Using a tea towel to protect your hands, take each one and squeeze the base gently to open the top. Place potatoes on plates and top with tuna mixture and a sprinkling of onion. Serves four.
Fruits and vegetables are an essential part of a treatment diet plan, as they provide the body with many essential nutrients including vitamins, minerals and the phytochemicals. The most benefit comes from eating as many different varieties as you can, and generally the darker and richer the colour, the higher the level of these phytochemicals. This means throwing extra dark green leafy vegetables into pasta dishes, stews, omelettes and so on – my kids never notice when I put grated courgette (zucchini) in their brownies! Red fruits such as frozen berries work well in crumbles and smoothies and mixed with meringues.
Here are some other ways to boost your intake of fruit and vegetables:
•Add some fresh fruit or dried fruit to your cereal in the morning, e.g. sultanas and banana go well on porridge, as does a handful of blueberries.
•Include a piece of fresh fruit as a morning or afternoon snack. A banana is easy to grab as you are walking out of the door, and remember to put a couple of pieces of fruit in your bag before you leave home. It’s also an idea to keep some dried fruit in the car or in your bag. I suggest the organic apricots which are dark in colour.
•Always add lots of salad to your sandwich or have a salad at lunch. This is easy with ready-prepared bags of leafy green salad. A handful of rocket gives a fresh, peppery taste to any salad or sandwich.
•Enjoy a hot cup of vegetable soup for lunch or as a snack. If you are unable to prepare these yourself, try out some of the supermarket options. There are some lovely varieties of soups in the chill section and the old canned soups can work just as well.
•Fill your plate with at least two or three colours of vegetables in the evening. If you are not eating as well as you normally do, then you can fork-mash these or blend them. (Puréed carrot and swede with butter is particularly nice, maybe with a teaspoon of sugar and a squeeze of lemon juice.)
•Keep some frozen or canned fruit in the cupboard to add to recipes or puddings (e.g. tinned peaches or apricots in lime jelly).
•Visit the local markets to pick up some seasonal fruit and vegetables, or organize a regular delivery of a seasonal box.
•Adapt your recipes to include more vegetables or fruit. For example, bolognese sauce is good with grated carrot, courgettes, aubergines and a small can of kidney beans. Add extra vegetables such as peas, carrots and swede to stews. Try something different, like a vegetarian curry, and add chickpeas.
•Grill some Mediterranean vegetables like red and green peppers, aubergines, asparagus and artichokes, and drizzle with a little olive oil (a good way to boost the energy content of your food).
•Dry-roast a selection of starchy vegetables such as sweet potato, parsnip, butternut squash, swede, celeriac, etc.
•Include lots of the brassica family of vegetables, such as broccoli, cauliflower, cabbage or brussels sprouts. However, if your treatment is causing bowel problems it may be best to limit these foods.
Although herbs and spices have long been a part of our history, most of us do not use them anywhere near enough. Not only do herbs and spices impart a wide range of flavours, aromas and textures to foods – which is very useful if the taste buds need a bit of a kick – but they are in fact the most concentrated sources of antioxidants and other phytochemicals.
One which has been in the spotlight is curcumin, the active component of turmeric. It is a powerful antioxidant with a similar potency to vitamins C and E. It also has wide-ranging effects on the body’s immune system, acting on lymphocytes and other immune cells as well as enhancing wound-healing. Additionally some studies have found that curcumin can help prevent tumour growth, kill cancerous cells, arrest the spread of cancer and disrupt the tumour’s blood supply. Turmeric is a very versatile flavour which works well in a mild chicken curry, sprinkled on roasted vegetables or added to soups. When it is mixed with a little oil and black pepper, the potent nutrients are absorbed over a thousand times better than if taken in a capsule form.
Try this simple but delicious turmeric-containing chicken curry recipe. Minced chicken can also be used if a softer texture is needed.
2 tablespoons vegetable oil
2 large chicken breast fillets, skinned and cut into chunks
1 clove garlic, finely chopped
1 large onion, sliced and chopped
½ teaspoon ground ginger
½ teaspoon chilli powder (optional and best left out if the mouth is a little raw)
½ teaspoon ground cinnamon
½ teaspoon ground turmeric
½ teaspoon ground white pepper
250 g tinned chopped tomatoes
4 tablespoons chicken stock
2 tablespoon ground almonds
4 tablespoons double cream
4 tablespoons plain yoghurt
Heat oil in a frying pan and fry chicken, garlic and onion until chicken is cooked through (cut open a small piece to test that it is no longer pink). Season with ginger, chilli powder, cinnamon, turmeric and white pepper and set the heat to medium. Mix in the tomatoes and chicken stock. Return to a simmer, and then stir in the almonds. Stir in cream and yoghurt, and then cook gently for 2 to 4 minutes, before serving on a bed of rice. Serves four.
Ginger is another helpful spice as it also may offer a range of anti-cancer and therapeutic properties. There are at least 50 antioxidants from the rhizome of ginger. One of these, the active component gingerol, has suppressed tumour growth and tumour blood supply and killed cancerous cells in several human lab experiments. Ginger is also known for its anti-nausea properties.
The key to harnessing the benefits from herbs and spices is to use them in their whole form, added to food, rather than taking a supplement form. Herbs and spices are also great to give a health boost for individuals who are not managing to eat quite the variety of foods that they might normally have. They can be added to all textures of food, and spices like ginger, cinnamon and nutmeg can be added to smoothies and milk drinks.
Some of the other herbs and spices that you can try to incorpor ate in food and cooking are shown in Table 5.4.
| Herbs and spices | Activity | Flavour | Uses |
| Anise | Reportedly can help boost appetite and inhibit cancer-stimulating enzymes | Warm minty/liquorice taste | |
| Basil | A beneficial antioxidant, and reported to have digestive properties | Spicy, minty flavour | Great with tomatoes, lemons, fish, chicken, pasta, pizza, salads, dressings and teas Best added at the end of cooking |
| Black pepper | Enhances antioxidant enzymes | Spicy flavour that enhances natural flavours of food | Can be added to all savoury dishes |
| Cloves | Highest concentration of polyphenol antioxidants | Spicy, fruity flavour | Great added to fruit dishes such as apple crumbles and pies, and goes well with nutmeg-type dishes |
| Fennel | Reported as a digestive aid | Sweet, liquorice flavour | Lovely over salads, fish such as salmon, soup and cooked vegetables Can also be added to mashed potato |
| Garlic | High in many minerals including magnesium, zinc, sodium and potassium Source of Vitamins A, B and C Contains some potent antioxidants | A strong flavour, use sparingly | A must with tomato-and onion-based dishes, roasted meats and pesto, and great in stews and soups Try adding roasted varieties with salad dressing and roasted vegetables, or making some garlic bread, squeezing out the flesh for a more gentle, creamy flavour |
| Rosemary | Antioxidant and antibacterial properties | Can vary from eucalyptus to pine-like | Awesome with lamb, roasted vegetables, fish and soups, and in bread |
| Mint | Reported as a digestive aid and has antioxidant properties | Mint flavour | Makes a refreshing cup of tea Great with yoghurt or vegetables and can be scattered over berries, served with cheese, other fruits and with lamb |
This is just a starter list and I would recommend Jekka McVicar’s book (see Further reading, p. 155) for further ideas on the tastes and use of the vast array of herbs and spices in cooking.
Many of the nutrients found in fruit and vegetables are highly unstable and easily destroyed by exposure to the environment (light, oxygen, soaking in water, heat). It is therefore better to prepare fruit and vegetables in a way that retains most of their nutritional value.
•Try eating vegetables raw whenever possible, e.g. cut up crudités or grated cabbage in salads or coleslaw. This is a good snack for both you and the kids before dinner.
•Try to use fruit and vegetables when fresh. Keep in the fridge until needed.
•Cut into large chunks rather than little bits.
•Steam or microwave vegetables in small amounts of water rather than boiling with lots of water. If possible, re-use the water in your cooking as an addition to a sauce or gravy.
•Avoid unnecessary peeling or slicing and try to keep the skins on vegetables like potato, sweet potato and tomatoes to increase the fibre content.
