Childen's Cancer Nutrition Handbook

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CHILDEN’S CANCER NUTRITION HANDBOOK

Appreciation for the sponsorship of

MODERN CLASSICAL WEDDING PHOTOGRAPHY.

Children’s Cancer Foundation

Table of Contents

CONTENTS ...... 1

Preface ...... 3

Basic Nutrition Concepts ...... 4

Diet Before or in the Early Period of Treatment ...... 6

Diet During the Treatment ...... 7

Diet during the Rehabilitation ...... 11

Frequently Asked Questions about Diet ...... 13

CONTENTS Original page 2-4

Preface……5 Basic Nutrition Concepts……6 Diet before or in the early period of treatment……10 Diet during the treatment……12 Diet during the rehabilitation……20 Frequently Asked Questions……23

Recipes during the treatment Recipes dealing with Xerostomia (dry mouth) Soup of papaya, snow fungus, conch and lean meat……28 Soup of red seabream (pagrus major) and white radish……29 porridge of peanut and pig bone……30 Almond juice with white fungus……31 Milk with papaya……32 Soup of sugarcane, perotis indica, carrot and water chestnut……33 Fish Chowder……34

Recipes dealing with Mouth ulcers Stir-fry spinach and ginger……35 Conpoy soup……36 Japanese egg custard with vegetables and meat……37 Porridge of fish meatball and vegetables……38

Recipes dealing with dysphagia (difficulty in swallowing) Meat sauce pasta……39 Maize porridge with minced chicken……40 Soup of minced fish and tofu……41 Banana milkshake……42 Soup of sliced fish and mushroom……43 Rice with conpoy, mushroom and shredded taro……44

Recipes dealing with altered taste Seafood with vegetables……45 Yellow croaker with sweet and sour sauce……46 Stir fry ostrich meat with garlic and Welsh onion……47 Baked tuna with tomato……48

Recipes dealing with vomiting Fresh lotus root juice with ginger……49 Water chestnut juice with ginger……50

Recipes dealing with diarrhea Rice porridge……51 Grape juice with ginger and honey……52

Recipes dealing with constipation Sesame paste……53 Stewed prune……54 Spinach porridge……55 Brown rice porridge with maize and mushroom……56 Porridge with dried apricots and grape……57 Soup of winter melon, coix chinensis, dried oyster, douchi and lean meat……58 Recipes during the rehabilitation Mini pizza with chicken and egg……60 Baozi with spring vegetables……61 Pie with beef and potato……62 Stir fry Shanghai Nian-gao……63 Egg dumpling with minced fish……64 Maize porridge with sweet potato……65 Lady Finger with cheese……66 Chinese chips……67 Stir fry shredded meat with asparagus and mushroom……68 Potato salad with fruits……69

Appendix I Diagram of the percentage of the height, weight and age of boys and girls……70

Appendix II Vitamin content of anti-cancer food……76

Acknowledgements……80

Preface Original page 5

This handbook is specially for parents with children suffering from cancer or during their rehabilitation, hoping to help parents provide adequate diets for children under treatment or during recovery. The book tries to be simple and practical. Therefore besides necessary descriptions and explanation, there are plenty of recipes and appealing pictures, aiming to help parents learn needed knowledge under a relaxed mood and quickly put it into practice. While adequate food promotes children to recover, it is only the parents’ great love and attentive care that will cure children’s sick body and mentality. Thus, we deeply believe that a healthy and delicious diet cooked carefully by parents will definitely accelerate children’s complete recovery.

For all parents giving all what they can to their children!

Basic Nutrition Concepts Original page 6-9

Food helps human live, and nutritious food can contribute to the acceleration of recovery, or even the disease prevention and becoming more healthy. Then what indeed is nutrition? How does it influence our body’s function? This chapter tries to use the introduction of NUTRIENTS and PYRAMID OF FOOD to answer the above questions and therefore help parents to have a basic understanding of the nutrition of food.

NUTRIENTS According to surveys, when we eat food, our body will absorb various nutrients to keep physical functions, which involve: (1) Carbohydrates Functions: (1) to serve as the primary energy for brain’s function (2) to promote the formation of membrane and organs (3) to help the absorption of other kinds of nutrients Sources: sugar, kinds of cereal, vegetables and fruits The needed amount: ranking at the top among all kinds of nutrients needed, as the most important origin of body’s energy (2) Fat Functions: (1) to provide energy for the body (2) to keep the body warm (3) to protect organs against damages resulted from collision (4) to make hormones Sources: from animals: meat, dairy products, seafood from plants: nuts, beans, vegetables The needed amount: should not be much, for it can harm the functions of veins and heart (3) Protein Functions: (1) to serve as the primary element of the formation of human body (2) to repair cells and wounds Sources: from many kinds of food, particularly in meat (including pork, beef and poultry), milk, seafood and bean food The needed amount: 250 to 400g per person per day (4) Vitamin Functions: depending on the certain kind; eg. Vitamin C for the prevention of wound infection, Vitamin A beneficial for the sight and to strengthen the immunity Sources: most food are of different kinds of vitamin The needed amount: not much but necessary; kinds of vitamin (eg. Vitamin A, D, E) can result in poisoning when intaken excessively. (5) Minerals Functions: (1) to form cells

(2) to balance the body’ PH Sources: particularly from green leafy vegetables The needed amount: very tiny (6) Cellulose Functions: (1) to promote gastrointestinal motility and therefore to eliminate body’s toxins (2) to decrease the cholesterol levels Sources: plenty in vegetables, fruits and kinds of cereal The needed amount: 20 to 40g per person per day (7) Water Functions: (1) to serve as the most important element of human body (about 70%) (2) to transport oxygen and eliminate waste Sources: from most kinds of food and drank The needed amount: at least 8 cups of fresh water per person per day

PYRAMID OF FOOD The nutrients in different kinds of food vary, and so does the human body’s needed amount of them. Both the lack and excessive intake of certain nutrient can cause harm to human body. The PYRAMID OF FOOD below will tell us which kinds of food we should eat more (near the bottom) and which kinds we should eat less (near the top) to guarantee a nutritional balance. From top to bottom (to see the picture) To eat as little as possible: oil, salt, sugar Dairy products: low-fat or skimmed milk, or soy milk 1 to 2 cups per day Protein products: lean meat 200 to 350g per day Fruits: 2 to 3 per day Vegetables: no less than 300 to 400g per day; cooking with less oil Cereal: 3 to 6 bowls per day

Generally, cereals should form the largest part of our daily diet (including rice and bread), which consists of also plenty of vegetables and fruits and an adequate amount of meat and dairy products. And we should eat fat, oil and other kinds of food with much sugar as little as possible. But for children suffering from cancer, their needed amount of nutrients changes according to the development of treatment and the treatment-related side effects. We will talk more details in the following chapters.

Diet Before or in the Early Period of Treatment Original page 10-11

Tips for parents: Physical situation: children’s suffering continues to be more serious with the development of their medical states and the treatment, but they can still keep some appetite. Mental situation: children suffer from anxiety when facing physical pains and changes of the disease. Diet: protein-rich and high-calorie food should be the main part of children’s diet suffering from cancer. Parent-child interaction: parents should take their initiative to communicate with children and try to tell children their certain medical states to dispel their anxiety and fear.

Children should try to eat protein-rich and high-calorie food to store enough energy dealing with the coming/the early period of the series of treatment (including chemotherapy, electrotherapy and surgeries). For those children with weight loss, this point is particularly important. Therefore, parents should encourage children to eat more bean products, dairy products and meat, such as: Bean products: tofu, dried tofu, tofu skin, soybean, cowpea and broad bean. Milk products: fresh milk and cheese Meat: kinds of lean meat, poultry, fish and egg

For children needing surgeries, parents should encourage them to eat food rich of protein (including pork, beef, fresh milk, fish and soybean, etc.) and Vitamin C (eg. kiwi fruit, grapefruit, orange, tomato, broccoli, green grape and cucumber, etc.) in order to accelerate wound healing and lessen the possibility of wound infection. Besides, parents can try to add some supplements into children’s diet to increase the amount of protein and calorie, such as glucose and protein powder. It should be noted that in the following treatment, children may suffer from loss of appetite as a result of medical side effects, or even eating disorders (eg. mouth ulcers and difficulty in swallowing), and therefore indigestion. Thus, parents should try to using this period (before the treatment) to help their children store energy as much as possible and maintain a comparatively ideal weight.

Diet during the Treatment Original page 12-19

Many children under the treatment may suffer from difficulty in eating or loss of appetite, which worries also parents. In this chapter, we will discuss primarily how to deal with these difficulties as a result of treatment (mainly chemotherapy and electrotherapy).

Tips for parents: Physical situation: Children will be apparently troubled by the medial side effects and suffer much, generally from difficulty in eating and loss of aapetite. Mental situation: Children’s mood will fluctuate mainly with the changes of medical side effects. And the long and monotonous time in hospital will also aggravate their loneliness, helplessness, or even depression. Diet: Children should have more meals with less food at each. Parents should choose different kinds of food and change the cooking way to deal with certain kinds of side effects. Parent- child interaction: Parents should show their care and support through patient talk or play with children and thus lighten children’s discomfort.

Xerostomia (dry mouth) To do more: Drink more fresh water; Choose more juicy food or those with more water, such as Pasta alla Bologness or milkshake; Eat chewing gum or have light sour dranks in order to stimulate salivation, such as fruit juice, vegetable juice with honey, chrysanthemum tea, pomelo tea or plum juice; Hold ice in the mouth to keep it moist; Use lip balm to keep lips moist; Use man-made saliva when necessary. To avoid: Eat dry food, such as toast, chips or cookies which will aggravate xerostomia and cause discomfort when attaching to the mouth. Suggested recipes: Soup of papaya, snow fungus, conch and lean meat……28 Soup of red seabream (pagrus major) and white radish……29 Porridge of peanut and pig bone……30 Almond juice with white fungus……31 Milk with papaya……32 Soup of sugarcane, perotis indica, carrot and water chestnut……33 Fish Chowder……34

Mouth ulcers To do more: Choose food of light taste;

Keep food in the room temporature; Use drinking straw instead of spoon; Eat moist, tender or even liquid food, such as porridge or noodles; Hold ice in the mouth to lessen pain or discomfort; Must use saline or soda to clean the mouth in order to prevent infection. To avoid: Eat spicy or irritating food, such as those of sour, salty or hot taste, which would cause pain in ulcers; Eat rough or hard food, such as nuts, deep-fried meat, which would break ulcers; Use common mouthwash directly which may cause pain; it should be diluted before use. Suggested recipes: Stir-fry spinach and ginger……35 Conpoy soup……36 Japanese egg custard with vegetables and meat……37 Porridge of fish meatball and vegetables……38

Dysphagia (difficulty in swallowing) To do more : Have more meals and eat less at each; Cook food with methods such as stewing and steaming in order to make food tender enough for swallowing; Choose materials such as tofu, egg and minced meat which are easy to be cooked tender; Make food into semi-liquid form using mixer (adding water) when necessary; Use juice and nutritional supplements, such protein powder, glucose or minced fruit. To avoid: Eat rice with soup together, the rice in which may be chewed not enough and therefore cause discomfort in the stomach; Force chidren to eat, which may cause high pressure and dislike to eat. Suggested recipes: Meat sauce pasta……39 Maize porridge with minced chicken……40 Soup of minced fish and tofu……41 Banana milkshake……42 Soup of sliced fish and mushroom……43 Rice with conpoy, mushroom and shredded taro……44

Altered taste To do more: Choose food that children like; Increase the sweetness of food (for at this time ill children’s taste of sweetness is rather obtuse) Add sugar, ketchup or fruit juice into food;

Eat marinated food; Gargle more times and drink juice to lessen mouth odor To avoid: Eat bitter food, such as bitter melon or Chinese mustard (for patients are especially sensitive to bitterness at this time). Suggested recipes: Seafood with vegetables……45 Yellow croaker with sweet and sour sauce……46 Stir fry ostrich meat with garlic and Welsh onion……47 Baked tuna with tomato……48

Vomiting To do more: Choose food of light taste; Eat more dry food, such as toast or cookies without filling; Eat food of light taste or cookies right after waking up, in order to prevent vomiting; Drink more carbonated dranks, such as carbonated soft drank or soda to soothe vomiting; Choose soft and looser clothes; Use pillows to make the child’s upper body lean with 45 degree to prevent gastric reflux. To avoid: Eat hot and cold food at the same time, which may cause esophageal spasm and vomiting; Eat heavily-flavoured, too sweet, or deeply fried food; Eat food two hours before electrotherapy; Lie down directly after eating food; Stoop Suggested recipes: Fresh lotus root juice with ginger……49 Water chestnut juice with ginger……50

Diarrhea To do more: Eat liquid food, such as porridge or gruel, rice soup and milk; Choose food with less cellulose, such as white bread or apple jam; Eat more meals with less at each; Drink more soft dranks to replenish water and electrolyte; Maintain food in the room temporature; Eat slowly; Request the doctor for antidiarrhoeal drugs when necessary. To avoid: Eat heavily-flavoured or fatty food; Eat food easily to create gas, such as beans and broccoli; Drink irritating dranks, such as coffee or liquor

Suggested recipes: Rice porridge……51 Grape juice with ginger and honey……52

Constipation To do more: Choose food with more cellulose, such as kinds of fresh vegetables and fruit, red rice and whole wheat bread; Drink more water or fruit juice; Try to have beverage with laxative effects, such as plum juice and fig juice; Do exercises adequately to stimulate intestinal peristalsis and defecation; Request the doctor for laxatives when necessary. To avoid: Eat deeply fried, dry, baked or spicy food. Suggested recipes: Sesame paste……53 Stewed prune……54 Spinach porridge……55 Brown rice porridge with maize and mushroom……56 Porridge with dried apricots and grape……57 Soup of winter melon, coix chinensis, dried oyster, douchi and lean meat……58

Diet during the Rehabilitation Original page 20-22

Tips for parents: Physical situation: the discomfort caused by the disease and medical side effects will generally disappear with the accomplishment of the treatment; children’s physical functions and appetite recover, too. Mental situation: children are optimistic and outgoing for they can be back to the normal life. Diet: parents should try to make their children have more meals and eat less at each, and to guarantee the diet balanced with various nutrients. Parent-child interaction: parents should use a relaxed attitude to help children find back their confidence and face their daily life optimistically.

After months living in the hospital, each child and his/her parents are happy for the coming recovery. For parents, it is important to help children to come back to the common daily life in the mental and social aspects, apart from accelerating children’s physical recovery arranging an adequate diet.

To balance nutrients A balanced absorption of various nutrients is the most important point for children in recovery. Parents can refer to PYRAMID OF FOOD (in page 9) to arrange the daily diet for children. And given that children’s ability to absorb has not yet completely recovered, we suggest parents to make children have more meals and eat less at each, which can help them absorb nutrition effectively and fairly simply. For parents with children just back to school, it is a good way to prepare snacks such as sanwich or milk with supplements for children during the relax between lessons. This way is helpful to soothe problems such as sleepiness and difficulty in focusing which are common for children just back to school.

To give mental treatment Apart from an adequate accelerating children’s physical recovery, parents can use it as a good chance to better their relationship with children and enhance children’s confidence when they cook meals together. During choosing, cleaning materials and cooking with ease, parents can discover many interesting topics to talk with children and shorten the distance with children. And through sharing food and speaking highly of children’s cooking, parents can do much to enhance children’s confidence, which will play a great role in children’s recovery and coming back to common life.

To rebuild children’s social life It is a necessary stage for children to rebuild their social life, for which “eating and drinking” is a very popular way nowadays. For children and teenages, to eat pizza or go picnic and have barbecue together are rather common. But parents will be worried about

11 that pizza and barbecue are unhealthy and this worry may cause quarrels between parents and children. Admitted, fast food and barbecue will do no good for children when considering nutritionally. Nonetheless, it will not be seriously harmful when eaten occasionally. Unless children have apparent discomfort for these kinds of food, parents have not worry too much. Thus, parents should leave some ‘free space’ for children’s diet according to children’s certain situation to avoid preventing their normal social life.

To request for help If children keep suffering from following problems after leaving the hospital, parents should take their initiative to request the doctor or professional dietitian for help: excessive loss of weight (to refer to Appendix I, page 70-75) difficulty in eating (such as mouth ulcers and vomiting) paleness loss of appetite sleepiness and tiredness

Suggested recipes: Mini pizza with chicken and egg……60 Baozi with spring vegetables……61 Pie with beef and potato……62 Stir fry Shanghai Nian-gao……63 Egg dumpling with minced fish……64 Maize porridge with sweet potato……65 Lady Finger with cheese……66 Chinese chips……67 Stir fry shredded meat with asparagus and mushroom……68 Potato salad with fruits……69

Frequently Asked Questions about Diet Original page 23-24

Question 1: Can eating chicken or drinking chicken soup stimulate cancer cell regeneration and therefore increase the possibility of cancer recurrence?

Chicken is of much nutrition medically and dietetically. Up to now, there is no evidence showing that eating chicken or drinking chicken soup will raise the possibility of cancer recurrence. Instead, chicken is of much protein, Vitamin B and iron element, which are rather helpful for patients in recovery. Besides, the public’s worry about chicken is to a certain degree related to the so-called ‘injected chicken’. In fact, however, the Hong Kong government has prohibited any injection of hormone for chicken since 1986. Thus, there is no ‘injected chicken’ in Hong Kong any more.

Question 2: Can eating egg or beef after surgury prevent wound healing, or even raise the possibility of inflammation and purulence?

This idea is also unscientific. Both beef and egg are full of protein and iron element. Unless patients are allergic to the above elements or have suffered discomfort after eating these materials before, eating more beef and egg is good for patients’ physical recovery. In fact, wound inflammation and purulence are caused by bacterial infections, which are commonly related to certain environment, hygienic situation and nursing ways. Other kinds of food full of Vitamin C are also helpful for wound healing, such as kiwi fruit, grapefruit, orange, green grape, tomato, lemon, broccoli, green bean sprout, and cucumber.

Question 3: Is fish soup helpful for children in the recovery?

Fish soup is full of protein and easy for absorption, and therefore worthy of recommendation to children under treatment or in the recovery. To add nutrition into fish soup, I suggest that parents put in the soup bean products (including cowpea, black bean, red bean, tofu and tofu skin, etc.), minced meat, which can add more protein and raise the sweetness of the soup. When dealing with fish, parents can choose some wine, vinegar, ginger and Chinese onion to eliminate apparently fishy taste.

Question 4: Which kinds of food are helpful to lessen the possibility of cancer recurrence?

To prevent disease recurrence, it is most important to keep a great balanced diet, good habits and continuous exercises. Besides, to eat following kinds of food is useful for lessening the possibility of cancer recurrence: kinds of fungus, kinds of seaweed, cruciferous vegetables (including broccoli, cauliflower, watercress, Chinese kale, Napa cabbage, and Chinese cabbage, etc.) and those full of Vitamin A, C, and E. Food with much Vitamin A: red radish, tomato, pumpkin, melon, watermelon, dried apricot, green bell pepper, red bell pepper, papaya and Chinese wolfberry, etc.

Food with much Vitamin C: kiwi fruit, grapefruit, orange, tangerine, lemon, tomato, broccoli, green bean sprout, fresh grape and cucumber, etc.. Food with much Vitamin E: sesame, sesame oil, walnut, pumpkin nut, green bean, kinds of nut, hazelnut, and cashew nut, etc.. (For more details, please refer to Appendix II: page 73—76)