FOOD AND CANCER – WHAT’S THE DEAL? An expert nutrition guide brought to you by Trekstock, Dr Hazel Wallace & Friends Navigating all the information around diet and cancer can be overwhelming. There’s a lot of confusing stuff out there and we know you probably don’t have the time or energy to digest it all. So we’ve created this guide to everything you might be asking about how what you put into your body affects it during CONTENTS treatment and beyond. FOREWORD 4 We’ve included the latest research CONTRIBUTORS 6 and unpacked controversial topics HOW FOOD SUPPORTS in a balanced way offering you all RECOVERY 8 the information you need to make LET’S TALK ABOUT... 16 decisions that work for you. FOOD PREP MADE EASY 26 RECIPES 31 SIGNPOSTING 39

KEY Important Note Reminder

2 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 3 FOREWORD by Dr Hazel Wallace

You never expect to get diagnosed with cancer, let alone I promise this is not another prescription and we invite when you’re in your 20s or 30s. When it does happen, it you to dip in and out of it whenever you feel the need understandably shakes every aspect of your world. You to. Remember, dealing with cancer is enough pressure don’t need me to tell you how much of a shock a cancer for anyone, so try to be as kind as possible to yourself diagnosis can be, how hard treatments are, how difficult when you’re thinking about what to eat. Food should be recovery can be, or how much it can change the way you a pleasure as well as something to fuel your body with, so feel about yourself and your body. Finding some sense of enjoy what you’re eating when you can, and don’t beat normality is key at such a turbulent time. yourself up if you’re not eating what you think you ‘should’.

If there’s one thing that remains totally constant I hope you find this resource, and some of the further notes throughout your treatment and recovery, it’s the need to we’ve included in the back, empowering and helpful. give your body the support necessary to deal with all of the treatments and stresses that are being thrown at you. Happy eating, Food can play an important role here. But the internet, and of course social media, is the modern-day equivalent of the Wild, Wild West – full of misinformation, dubious claims, and conflicting advice. When we asked, 45% of you said that social media makes you confused about what to eat. Dr Hazel Wallace @TheFoodMedic So, how do you know what to trust and what to listen to? It’s a minefield, but hopefully, we can help with that.

When I came on board as a Trekstock Ambassador, I realised there was a need for a nutrition resource that was available specifically for people going through cancer treatment and recovery. So Trekstock and I brought together a group of doctors, dietitians, patients, and members of the Trekstock community to create a no nonsense, evidence-based, and easy-to-follow nutrition booklet to help support you.

4 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 5 CONTRIBUTORS ENJOY DIPPING IN

Dani Binnington Camilla Ferraro Dr Ailsa Sita Lumsden Think of this as a handbook you Founder of Registered Dietitian Consultant Medical can dip in and out of when you need it. HealthyWholeMe, (RD): Oncology + Oncologist, Guys and We recognise in the early days of a cancer diagnosed with breast Surgical Nutrition St Thomas’ Hospital cancer in her 30s and (NHS), Women’s Health – Having worked in diagnosis you’re bombarded with information passionate about + Eating Disorders. Oncology for 10 years from everywhere (and everyone!) on what to eat, how food helped Ailsa is committed to what not to eat, when to eat and how to eat. her recovery. improving knowledge and access to support for young people We’re not here to add to that pressure. We want to with cancer. make your life easier, so we aim to provide you with Alice May Purkiss the knowledge and tools to make informed decisions Copywriter around diet and cancer, based on the latest research. Sarah Dixon extraordinaire and You know your body better than anyone else, so a lot of Trekstock Young Adult author of Life, Lemons Ambassador, diagnosed and Melons diagnosed this will be about guiding you to support your intuition. with Breast in her 30s, with breast cancer in Dr Hazel Wallace passionate about food her 20s. Medical Doctor No matter where you are with your diagnosis – and how it helped (BSc, MBBCh, MSc) whether it was last week and you’re trying to figure her recovery. and founder of the food medic. out which way is up, or it was three years ago and you’re keen to find your new normal – we know how important it is to learn to trust your body again. Monika Siemicka Senior Specialist We hope you find this booklet empowers you Haematology and TYA and gives you the helping hand you need to Dietitian at Guys and St Thomas’s Hospital. make simple changes that suit you and your lifestyle.

Food is a great tool for Jemima Reynolds doing just that. Health Programmes Lead for Trekstock For more information about anything you’ve read in the booklet, or to find out how Trekstock can support you, please get in touch at [email protected]. 6 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 7 Section 1 Just been diagnosed? So if you’re considering going vegan because you read it’ll reduce your We know this isn’t a club you ever risk of cancer returning, or if you’re HOW FOOD SUPPORTS wanted to be part of. But we’re here desperate to know how to combine to help you make sense of some of a new lifestyle with a balanced diet, RECOVERY the trickier parts of this section of we’ve got you. your life. Why is food so important? Those early days of cancer are A few years down the A healthy, balanced diet provides all the nutrients we need a whirlwind where it’s hard to line but keen to know to support our body’s functions. Bodies do amazing things remember who you are, let alone more about looking what on earth you’re doing with every day but we need to give them the right tools to help yourself. Food can be a great after yourself? them do that, especially if they’re being put through their place to reconnect with your body Cancer changes things. And it keeps paces elsewhere. and look after yourself at what’s changing things long after treatment otherwise a pretty turbulent time is over. No matter how long it is since Good nutrition during and beyond Important: (understatement of the year). your diagnosis, we know there’s a chance you still have questions. So cancer treatment can help us to Despite what you might have maintain a healthy weight, retain Whether you’re looking for guidance with research changing all the time, read in the darkest depths of on what to eat to aid your recovery we’ve pulled together information to muscle mass and strength and the internet, no one ‘food’ or ‘dietary decrease overall side effects. from surgery or what you might be help you continue on with your happy pattern’ directly causes (or cures!) able to tolerate during chemo, we and healthy lifestyle on your terms. cancer so there’s no need to be overly want to help. But cancer itself and cancer restrictive with your diet. treatments can make it harder to ‘First things first. eat a healthy diet due to changes Food is about so much more than Recently finished treatment in your taste, smell or ability to just nutrition – it provides enjoyment and trying to find that Dealing with the absorb nutrients. while sharing food with others is elusive ‘new normal’? side effects of crucial for our social health too. So During treatment it’s super try not to get so bogged down in the Finishing treatment can be an ordeal treatment is hard important that you’re giving nutritional nitty gritty at the expense in itself. It can be a time that’s rife with yourself the right amount of enjoying the food you eat. uncertainty and anxiety, among all the enough, let alone of protein and calories to prevent other challenges that you’re facing. malnutrition, and to allow your body coping with changes to recover and heal. Should I change my diet? During times of stress, eating well to your body image You certainly don’t have to but we can be something that suffers. But would always encourage you to retain working out the best ways to look too – remember to be or adopt as many healthy eating after yourself is absolutely crucial. habits as you can, during treatment or And science says that the emotional kind to yourself.’ beyond. If you are considering making and mental benefits of cooking are Alice May Purkiss any changes, then we’re here to help multiple. It’s a way to channel energy guide you through the ‘facts’ and into something positive, a useful dispel the ‘faff’ when it comes to diet distraction and a way to express and cancer. emotions through a different medium.

8 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 9 I’m not hungry and I’m Sometimes nourishing drinks are an SO WHAT SHOULD I EAT? easier way to get what you need. Try: losing weight – what There is no ‘one diet’ for cancer. It’s about eating • Smoothies made with whole milk, should I eat? what works for you, but try to aim for… plant milk or yoghurt We get that treatment can make • Cups of soup, made with extra oil you feel awful and that eating lots or added cream of healthy foods or large meals, often feels like too much to stomach. • Hot chai or chocolate (especially Sometimes it’s important to make the good with whole milk or a dash LANCE PLA most of your meals and snacks when of cream!) BA TE you are feeling well enough, opting for calorie or energy dense options A word on protein MEAT/FISH/ to ensure you keep your weight and powders… DAI energy levels up. ES RY/P Whilst we generally BL LA recommend getting all your nutrients TA NT Opting for smaller meals and snacks GE P from whole food and not pills or VE RO over three large meals a day can also supplements, plain and neutral Y T be much more manageable. Little and H EI protein powders (whether whey or RC N often can be your friend. plant based) can be an easy way to A T add some extra protein and calories S Try these nutritious, energy filled to drinks or meals like soups and D snack options: N porridge. A cheaper option is also A F A • Slices of apple or banana skimmed milk powder which is S T N S with nut butter available in most supermarkets. I A • Hard boiled eggs R Remember protein powders

G • Avocado on toast should never be used as a S

W • Oat cakes with spread (avocado/ replacement for food but as

E

E cream cheese/nut butter) an addition to your diet. T

S Full fat greek yoghurt with granola * • and berries • Cheese toastie (don’t forget to butter the bread!) L • Bowl of soup (ie. creamy pumpkin) OT + buttered toast. S OF C T OL UI OU FR R. NO ES + N-STARCHY VEGETABL

*While sweets are not an essential part of the diet, a little bit now and then can certainly be part of a healthy, balanced diet.

10 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 11 My tastes have changed, I’m nauseous, what can One minute I have diarrhoea Five tips to combat diarrhoea: what can I do? I eat? and the next minute I’m 1 Drink up! When you have diarrhoea you lose a LOT of fluids so it’s Taste changes affect up to 50% of Nausea is one of the biggest side constipated, what can I do? important to replace them. Aim people going through treatment. effects we hear about during cancer If your bowels have gone to sh%^!, for fluids like water and avoid Treatment can make things taste treatment. If the thought of food don’t fret – it’s a really common side sugary drinks, juices and sports unusual and some chemo can cause is turning your stomach and you’re effect of treatment. Whilst prescribed drinks as these can make the things to taste metallic. finding it hard to bring yourself to eat products can be useful, there are also diarrhoea worse. anything, there are a couple of things a few other strategies that can help Five Clever tips to cope you could try. 2 It can be useful to opt for plain, get things back on track. starchy foods when you’ve 1 If you are finding the taste of red Five tips to combat nausea: got really bad diarrhoea and meat too much because food Five tips to combat constipation: temporarily avoid eating too much tastes metallic try to opt for fish or 1 Avoid having an empty stomach 1 Keep your fluids up. Aim to drink fibre (eg. raw fruits and vegetables, white meat. as it can make feelings of nausea enough water so your urine is pale beans, nuts and seeds). 2 Avoid using metal cutlery. worse – even grazing on plain toast, straw coloured. oat cakes or a banana is better 3 Avoid rich and greasy meals (such 3 Suck on sugar-free mints or lemon than nothing. 2 Try to eat regular meals and keep as takeaways) and spicy dishes until drops to help get your saliva your routine fairly consistent diarrhoea resolves. 2 Try taking your anti-nausea going and distract from lingering day-to-day. 4 It can be useful to temporarily avoid bad tastes. medications at least 30 mins before meals and try to not lie down for at 3 Gentle movement such as walking, alcohol and coffee. 4 Go OTT with the flavouring in least 30–60 mins after eating. especially in the morning, can help 5 If your diarrhoea is related to your meals. Add extra spices and to get things moving. 3 It can be useful to avoid strong antibiotic use then it may be useful sauces and opt for strong, sour or 4 Aim to increase soluble fibre. to include servings of probiotic opposing flavours. Try using pickles cooking smells or avoid the kitchen if you need to. This means adding things like foods like live yoghurt into and relishes or adding vinegar or 1–2 tbsp soaked flaxseed to your your diet. lemon to your meal. 4 Cold or room temperature foods oat porridge, eating 2–4 prunes, may be more palatable than hot or 5 Speak to your team about aiming for wholegrain cereals and Important: mouthwashes that can help to strongly flavoured meals. breads and trying to include extra keep your mouth fresh from bad 5 Sipping on ginger tea or sucking on servings of fresh or cooked fruits If you are experiencing severe tastes that won’t go away BUT ginger lollies /crystallised ginger and vegetables. diarrhoea (eg. up to 6 times a day) then it’s important to touch avoid any that contain alcohol as may also help. Some people find 5 Some people also say warm they can dry your mouth out. Brush that peppermint tea can also help base with your medical team or go to beverages can help to get things A&E as this may be an acute effect of your teeth or rinse your mouth out settle the stomach. moving along nicely. So to speak. before meals. treatment or may be caused by a bug. It’s crucial to get checked out and have your fluids replaced. The good news is, taste changes are generally temporary and your tastebuds should return to normal after finishing treatment.

12 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 13 I’ve put on weight, There are many reasons why Neutropenia – what the Your team will give weight may increase during what might help? treatment but it’s important heck should I eat?! you more specific Weight gain is a really common side to know that this is ‘okay’ and there’s If you’ve been told by effect of cancer treatment that can be no need to be so hard on yourself. your doctors that you’re advice if you’re upsetting. Often this is due to steroid neutropenic (meaning your severely neutropenic treatment increasing your appetite. We know it’s easy for us to say but risk of infection is higher) you should try not to get overly anxious about be more careful than usual with too – ask to speak to a Cancer can also lead to fatigue and restricting your diet to ‘lose weight’. practicing good food hygiene. When decreased physical activity levels and Instead when you’re feeling well, you’re neutropenic your immune registered dietitian at the emotional toll of a diagnosis may focus on working towards getting system is less able to resist any your trust. lead to eating for comfort too. plenty of fruit and vegetables, potential foodborne bugs, so reduce wholegrains and lean sources of the risk of putting it through its paces. Our number one tip? Cut yourself protein (such as eggs, fish, poultry, some slack when it comes to weight tofu, nuts, seeds and red meat), Five tips to manage neutropenia gain. We know some medications and try to move your body as much 1 Wash your hands thoroughly before can increase appetite and cause as you can. eating and preparing food. biochemical changes that may contribute to changes in weight, Check out page 10 for our tips 2 Store leftovers in the fridge and and also, often food choices have to on what makes up a healthy, reheat dishes until piping hot! be adapted to deal with all the side balanced diet. 3 Temporarily avoid food items effects we’ve already discussed. This that contain live bacteria (eg. all can lead to a temporary reliance on unpasteurised dairy products, convenience foods or decreased soft serve icecream, mould- intake of fruit and veg. ripened cheeses, live yoghurts and fermented foods). 4 Steer clear of uncooked foods that may harbour nasty bacteria such as raw fish and seafood, cold salads, cold meats, raw or runny egg and sushi. 5 Wash all fruit and vegetables well before cooking or eating.

14 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 15 Section 2 If you can, it’s worth choosing good So how did dairy even quality and sustainably farmed sources and focusing on including become linked to cancer? LET’S TALK ABOUT… lots of plant based foods on your The hysteria around ‘dairy and cancer’ plate too. Having some meat-free started when geologist Professor meals every week is a great step in Jane Plant claimed that cutting dairy the right direction. from her diet slowed the progression Pretty much everyone and their wife has an opinion about of her breast cancer. Do you need to go vegan though? what you should and shouldn’t be eating both during Absolutely not, unless you want to. The cornerstone of her work was and beyond cancer treatment. The internet is awash with That’s a personal choice. based on the fact that women in ‘research’ and ‘studies’ decrying meat, dairy, soya, booze China had lower levels of breast cancer and consume low levels of and sugar while recommending fasting, juicing, going 2 Dairy dairy. But there are many differences organic and going vegan. First things first, currently there between Chinese and Western is NO evidence of any clear link women that may account for this. It’s a lot to process, especially when chemo brain is between dairy and cancer. There has been lots of conversation around milk We can’t just draw a straight line to VERY REAL, so we’ve pulled together the facts on the hot and dairy intake increasing levels of dairy intake. Chinese women also topics so you don’t have to. certain growth factors in our blood tend to have lower rates of alcohol that can be linked to tumour growth. consumption, early pregnancy age, If you’ve ever googled ‘dairy and along with lower rates of obesity. All 1 Meat How much is too much? cancer’ you’ll have seen this. of these are proven to lower the risk Evidence indicates that eating red The World Cancer Research of breast cancer. meat (beef, pork, lamb and goat) Fund advise reducing red meat Many research studies have explored is a probable cause of colorectal or consumption to 500g (cooked) per this and found no ‘cause and effect’ bowel cancer, but that processed week, but avoiding processed meat between eating dairy and increasing red meat is a convincing cause of entirely if possible. risk of cancer. In fact, some studies colorectal cancer. actually show increased rates of The UK government have less cancer in those with a lower intake Yep, the evidence is that consuming stringent guidelines and advise simply of dairy foods. meats which have been smoked, reducing both red and processed cured or had salt or chemical meat consumption to 70g per day. preservatives added rather than having just been cooked or reformed, Does that mean no more can increase your cancer risk. bacon? Salami? Chorizo? What’s the link? We don’t want you to worry that you can never eat bacon at brunch again. Scientists think the link between The occasional bit won’t be harmful, consumption of processed meats but try to focus on quality over and an increased risk of bowel cancer quantity when it comes to red meat. relates to the preservatives added to these meats.

16 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 17 Calcium Examples of the quantity of non Here’s what you should To get a similar amount of calcium dairy food you need to eat to get as that in a glass of milk you need your daily calcium intake know about your to consume: calcium intake: • 150g yoghurt or a matchbox size Milk and dairy products are a piece of cheese. concentrated source of protein • 200 mls non dairy milk (fortified and calcium (which is vital for bone with calcium) health and to counter the effects of SARDINES steroids during cancer treatment). It’s • 60g of soya bean tofu (check important to make a conscious effort the back of the pack for calcium to find these nutrients elsewhere if chloride/carbonate in the dairy doesn’t feature in your diet. ingredients though!) TOFU • ½ tin of sardines (60g) with SALMON Dairy isn’t the only way to get your edible bones calcium hit. Here are some non dairy • ½ large tin of canned salmon (110g) sources of calcium and how much with edible bones you would need to consume to match your recommended daily allowance • 3 medium oranges of calcium. • 4 x heads of raw broccoli! YOGHURT • 5 x servings (75g) spring greens ORANGES How much calcium • 3 tablespoons of tahini CHEESE do we need daily? • A handful of whole, raw almonds. MILK Around 2–3 servings of dairy foods or equivalent is the recommended amount. However, if you are taking TAHINI high doses of steroids, are pregnant or breastfeeding or have pre-existing osteopenia/osteoporosis then you should aim for around 4–5 servings per day. ALMONDS BROCCOLI Important! SPRING GREENS If you drink plant-based milks then make sure to buy one that is fortified with calcium – NOT all ‘mylks’ are created equal.

18 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 19 3 Sugar 4 Booze 5 Soya Sugar has been made the villain of Alcohol consumption has been Scared of soya? You’re not our diet. But how did the sugar and linked with many cancers including alone. Somehow this perfectly cancer idea come about? breast, bowel, liver, throat/mouth and acceptable source of plant based oesophageal cancers protein has got itself a pretty bad rep. Tumour cells grow very quickly, multiplying at a fast rate and thus Consuming alcohol has also been The supposed link between soya need a lot of glucose. SO, using this linked to changes in hormone foods and cancer stems from logic, if cancer cells need lots of metabolism, increasing levels of the the fact that soya beans contain glucose, then cutting all sugar out main form of oestrogen in women and compounds called phytoestrogens. of our diet must help stop cancer the risk of breast cancer. So, should The fear of eating soya, especially growing in the first place, right? It’s you cut it out completely? for people with hormone positive not that simple. breast cancers, stems from the idea Why? – Alcohol is broken down by that these compounds are said to Stating that sugar is responsible the bacteria that live in our guts have ‘oestrogen-like’ properties for kick-starting or fuelling a which can damage healthy tissue, so must drive the growth of breast cancer’s growth is a massive over- such as the cells that line our large tumours. Right? simplification of some pretty bowel – increasing the risk of bowel complicated biology. Cutting Out Carbs? cancer, for example. The reason Wrong. These plant based oestrogens This can be particularly concerning for this is that consuming alcohol are chemically different to human Healthy cells need glucose too when you have cancer because some has also been linked to changes in oestrogen. In fact, research on and there’s no way of telling our of the treatments can put the body hormone metabolism, increasing consumption of soy foods and cancer bodies to let healthy cells have the under a lot of stress and result in levels of the main form of oestrogen (although limited), suggests that glucose they need, whilst not giving weight loss and loss of muscle mass. in women and the risk of breast eating whole soybean products like it to cancer cells. Our bodies have a Compromising your nutrition by cancer. Like smoking, there is tofu, tempeh, edamame, soy milk or fail-safe system that never lets our restricting your diets can heighten unfortunately NO safe level when it similar may actually have a positive blood glucose level get too low. So this effect and interfere with tolerance comes to drinking alcohol and cancer impact on overall mortality and eating less sugar will just make the of treatment and hinder recovery. risk, so your best bet is to follow prevention of breast cancer. Women body use its other resources (like government guidelines. in countries with high consumption fat and muscle stores) to produce of soya foods (eg. Japan and China) the glucose it needs. Following low Eating less sugar isn’t a bad Current guidelines suggest a appear to have lower rates of breast carbohydrate or restricted diets thing though? maximum of 14 units per week and cancer and consuming soy-based may also compromise our health in No. Not over-consuming refined not all in one sitting. This is the foods even appears to decrease risk the long term by eliminating foods sources of sugar is still key to a equivalent of 14 single spirits and of lung cancer in non smokers. that are good sources of fibre and healthy diet. While we don’t endorse six pints of lager or small glasses of vitamins or minerals. cutting sugar out altogether, we could average-strength wine. Aim for as So the bottom line is: there’s no all do with eating less of the sugar and many alcohol free days in the week reason to avoid soya foods. When refined carbohydrates we get from as you can. included as part of a broad diet, they fizzy drinks, sweets, cakes, pastries provide a valuable source of plant- and white breads. based protein.

20 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 21 6 Fasting A glimmer of hope? 7 Juicing 8 The Alkaline Diet Fasting and cancer is one of the ‘hot Although the scientific evidence A glass of fresh made juice can be a Are ‘acidic’ foods actually topics’ in nutrition at the moment. around fasting during treatment and great addition to your diet, especially causing cancer? Findings from several animal studies potential beneficial effects is very to get a few extra servings of fruit No. The alkaline diet is based on the have shown that fasting appears to LIMITED, it has resulted in a plethora and vegetables. If you’re struggling theory that the food that we eat has both reduce the toxicity and increase of unproven claims appearing on to get all of your 5-a day in and don’t the potential to change the acid-base effectiveness of chemotherapy. the interwebs. Claims that fasting feel up to eating a lot, juicing can be a balance of our body. You may have Although the results from these treats cancer, prevents recurrence, or simple solution. read that eliminating acidic foods and animal trials show promise, can they ‘renews the entire immune system’ only eating alkaline foods can cure be translated to patients? have been made but are completely But juices should never replace cancer? This is based on bad science. unfounded. There are also many whole meals and we would never, In a case report of 10 patients, being ‘fasting products’ including liquids ever recommend juice-only fasts, Does eating acidic foods affect treated for a variety of cancers, and supplements being marketed as you would be unable to get the the pH of our body? those who fasted by consuming online that claim to ensure ‘effective’ protein, fibre and calories that water alone, or with vitamins in fasting during cancer treatment. your body needs to support you The short answer is NO. some cases, before and after to thrive and maintain your weight chemotherapy reported greater Sounds like little more than a money during treatment. Our bodies are tightly regulated and tolerance to treatment. Compared making scheme to us. this is all taken care of behind the with previous non-fasting treatments, When juicing only fruits we can scenes by your lungs and kidneys. The they also reported less side effects Important! potentially consume large amounts only time blood and body pH tips out such as fatigue, weakness, and of sugar too, and we are also missing of balance is when something very Any sort of fasting carries untoward is going on inside the body. gastrointestinal symptoms. risk and can be incredibly out on all that valuable fibre from the dangerous if you’re diabetic – so fruit and veg. If you’re keen to have There were some side effects the odd juice, try including veg too- The foods that we eat do not change inform your medical team if you are the pH of our blood. reported from the fasting though, ever thinking about trying any form spinach, kale, cucumber, carrot and including dizziness, hunger, of fasting. beetroot work well. headaches and weight loss. ‘But I know that my urine pH changes depending on the foods Fasting is not appropriate for all that I eat?’ Sounds ideal, right? Should patients receiving cancer treatment, It’s true that the foods we eat can all chemo patients, fast? especially those with a history of eating disorders, diabetes, a low body influence urine pH. Your urine is a fluid Well, no. The findings we have from mass index (less than BMI 20) or full of waste products. Excess acidity animal studies and a small pool of those who have lost more than 10% of is eliminated in the kidneys. Eating human studies suggest that fasting their weight in the preceding year. more ‘acidic’ foods can make your during cancer treatment is not overly urine more acidic – but just your urine, harmful and may be beneficial. not your blood, or cells, or brain, or Fasting is also seemingly easy to do, your big toe. so it’s understandable that patients may want to experiment with fasting There is absolutely no link between during treatment BUT there are a lot eating foods that have an acidic pH of unanswered questions. and cancer.

22 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 23 9 Supplements 3 If your appetite is very low, or you’re 10 Organic food Our advice? suffering with vomiting or diarrhoea Should I take supplements? No. and you don’t feel like you’re able The truth is, research into the It’s a personal choice, if you If you have a healthy balanced diet nutritional benefits of eating organic to get all the nutrients from your can afford to buy organic you should be able to get all of the diet, supplements can be helpful to fruit and vegetables has been essential nutrients that your body support your nutritional needs. mixed and largely overhyped and in produce (and we know that needs through food alone. You can do the media. not everyone can) then by this by eating a diet rich in: There is not enough evidence to all means do as it may have • fruit and vegetables suggest that taking high dose What’s the evidence? some benefit and won’t do • wholegrains and legumes (beans, dietary supplements can help treat Findings from a recent study peas and lentils) cancer or stop it from coming back. suggested that the risk of developing any harm. Some supplements may interact cancer was reduced by 25% in those • dairy or fortified alternatives with your cancer treatment so who ate organic foods. What wasn’t At the end of the day • good quality meat and fish or plant make sure to be honest with your made clear was that this was the foods rich in protein such as tofu, doctor or pharmacist before starting relative risk between those that ate though eating adequate in addition to healthy fats from oils, anything new. a little bit of organic food vs those servings of any plant foods nuts and seeds. that ate a lot BUT the absolute risk will likely have a bigger A cancer pharmacist will be able to reduction in getting cancer from impact over time at helping However, there are a check that there are no interactions eating organic food was only 0.6%! few exceptions: that could affect the effectiveness of to decrease your cancer risk, your cancer treatment or increase the What’s the fuss organic or not. 1 Vitamin D is made in our skin side effects. There is not yet enough following exposure to sunlight. evidence to blanket recommend about organic? In the UK, advice from Public vitamin/mineral supplements to all The theoretical risk relating to non- Health England (PHE) is that all patients with cancer. organic food is pesticides. There are adults should be taking a 10 mg at least three that are classified as supplement of vitamin D each day In general food is the best source of probable carcinogens according to throughout the autumn and winter vitamins and minerals, so up your the International Agency for Research months. Be sure to check your daily fruit and veg to at least 5 a day. on Cancer. Vitamin D level with your GP and they’ll advise you of the best way to Organic products are less likely supplement if necessary. to contain pesticide residues than conventional foods. Previous studies 2 If you exclude certain foods from have found that pesticide residue is your diet, for example if you more prevalent on conventionally don’t eat meat or other animal grown produce than on its products, you might be at risk of organic counterparts. deficiencies in certain nutrients, in D particular vitamin B12. This cannot Consuming fewer pesticide-related be obtained from plants. In this chemicals certainly seems like a good case we’d recommend including idea – but whether it’s associated with a supplement. an actual health benefit is unclear. B12

24 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 25 Section 3 Grocery delivery: Once you’ve Ask for help: planned your meals for the week ahead, it can be really useful to do Don’t be afraid to FOOD PREP MADE EASY a grocery shop online and get it ask for help from delivered to your house. As well as friends and family on the allowing you to conserve your energy for other things, this also tends to be weeks when you might Tips and Tricks for Making Slow cooker: Slow cookers are more cost effective than shopping not be feeling up to much. Cooking Easy without doubt a gift to those looking daily. And don’t be afraid to ask the Often, these people are only to make cooking as easy as possible. delivery team for help unpacking if We’ve heard from several of our Throwing a load of ingredients into a you’re taking a delivery on your own. too happy to help, they just community that basic tasks like pot and letting it cook for most of the Include a few items that you can need to be told HOW they shopping, cooking and tidying up day with little need to attend to it is a easily pull out to rustle up a meal if can. Cooking, shopping and after dinner can be so overwhelming GREAT way to produce lots of meals you’re caught short. when you’re undergoing cancer with minimal effort. cleaning up are all things treatment that it becomes easier to Pre-cooked or pre-chopped: your loved ones can help skip meals than to cook. Skipping Microwavable options: When your There’s absolutely no guilt in buying with to make your life a bit meals or eating inadequately can energy is low, it’s better to eat things that are pre-cooked or pre- result in: something than not eating anything chopped to make your life easier. easier. Some people get • muscle loss at all. Microwaveable meals are Most supermarkets now offer pre- their friends involved in a • increased fatigue extremely low effort. Bags of veg, prepared fruit and veg, pre-made food rota which can be a baked potatoes and popcorn can all salads or rotisserie options which are • delayed healing work as easy options to chuck in the good to eat straight away or to cook great way for your people to • treatment delays microwave. with ease. rally round and help out. • lowered tolerance to treatments, increasing the risk for more Meal planning: The better prepared One pot wonders: Dishes that you can side effects. you are, the easier things are going cook in one pot are usually incredibly to be, so planning your meals when easy to create and don’t usually leave you’re feeling well can help you on the much washing up. Minimal stress. So how can you make the whole days things are a bit more tricky. Minimal chores after eating. Ideal. process easier? Check the internet for inspiration – Batch cooking: If there are some days Whether you’re able to plan a week there are loads of tasty when you have more energy than ahead, a month ahead (if you’ve options out there. others, get into the habit of cooking got a freezer!), or even just a few big pots of food. Cook enough to days ahead, to paraphrase a popular last you a few days or, if you have the supermarket chain, every little helps. freezer space, make enough to freeze Call us old fashioned but a shopping and go back to later in the week. list is a good way to make sure you Things like curries, chillis, tagines, remember everything you went to pasta sauces and stews are all easy the shop for too. Chemo brain is to rustle up as a big batch (and don’t real, right?! usually make too much washing up either!)

26 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 27 Take short cuts: We are often told to If you have one, befriend avoid processed foods and only go your freezer: for fresh foods in their whole form • Maximise freezer space by storing – but let’s be honest, that is pretty stuff in ziplock bags rather than difficult to do in this day and age and boxes, and stack them on top of almost all foods we consume have one another like a pile of pillows. undergone some form of processing, Grab some tape and label them so it’s unrealistic to cut them out with a black marker so you don’t completely. While we advocate mix up your veggie chilli with your getting as much fruit and veg into bolognese sauce. your diet as you can, we also want to remind you that it doesn’t always • Include the date of freezing so you have to be fresh (frozen, tinned, juiced know what’s good when. counts too!). • Portion up meat and meals before freezing. Freezing in bulk means Some of our favourite defrosting in bulk, which often shortcuts include: means you have to cook more • Microwaveable packets of grains than you need and you end up and pulses (e.g. lentils) wasting leftovers. • Tins of beans and chickpeas • Divide batch-meals into individual portions before freezing them. • Ready-cooked chicken, salmon fillets and tinned fish. Freeze the unusual. Here are some • Ready made stocks and soups foods that you might not have • Carrot batons and other considered freezing, but doing so pre-chopped vegetables will change your life; • Shop bought hummus and • Slice a loaf of bread before freezing nut butters. it. In the morning you can simply separate a couple of slices and pop them in the toaster on the defrost and toast settings. • Freeze fresh herbs and simply crumble them into dishes whenever you need to. • Frozen bananas make the creamiest smoothies, and blended on their own make a one-ingredient ice cream. • Add a teaspoon of peanut butter to the middle of a pitted date and freeze for an instant afternoon treat. Also works well with melted dark chocolate.

28 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 29 Section 4 RECIPES

30 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 31 SARAH’S CHICKPEA DANI’S BLACK CURRY BEAN BROWNIES

Ingredients I had this so much during chemo Ingredients I loved making these black bean • 1 onion chopped because it’s so tasty and nutritious. • 1 can of black beans, chocolate brownies when I was in • 4 cloves of garlic Sometimes the chemo left a really odd washed and drained treatment. They’re sweet and delicious crushed taste in my mouth so the flavours from • 2 eggs but still contain a huge portion of • 2 tsp cumin • 3 tbsp coconut oil, • 3 tsp tikka spice this curry overpowered that taste, melted plant-based protein, so it’s a really • 2 tsp turmeric I found that making this in batches • 45g raw cacao nutritious dessert. • 2 tsp chilli flakes was also great as I could freeze it or powder Method • Ginger 1cm/thumb refrigerate and get out on the days I • 120g of maple syrup 1 Preheat your oven to 180 degree fan. grated was too tired to cook or even think. • Vanilla extract • 1 tin tomatoes (optional) 2 tsp 2 Mix all the ingredients in 1 bowl and blend • Handful coriander Method • A pinch of salt until smooth. chopped Raspberries (to serve) 1 Blitz the cashews and then leave to one side. • 3 Either pour into a lined square baking dish so you • 1 tin chickpeas can cut chunks off later on or pour into greased Fry off the onion and garlic in coconut oil or Drained 2 Note: If you want your muffin tins. olive oil on a low heat for 3–4 minutes, add in 200g mushrooms brownies to become • the ginger, cumin, tikka spice, turmeric and chilli 4 Tip the raspberries on top, pressing in slightly. Sliced a little more fluffy, flakes. Add a couple tsp’s of water to keep the mix cake-like, then add 1 5 Bake in the preheated oven on 180 degree for 400g vegetable • cooking slowly for another 5 minutes. tsp of baking powder. about 25 minutes. Stock 3 Add in the chickpeas and mushrooms and cover If you’d like them more 6 If your mixture is in muffin tins, it should only take • 1 cup cashews in the paste, then add the tomatoes and stock add fudge-like, don’t use about 15 minutes. Keep checking so that your blended (I used my half of the chopped coriander. Cover and cook for the baking powder. brownies don’t get too dry. The edges will come nutri-blender) 10–15 minutes. At this point you can put your rice off slightly from the tin when ready. • 200g of washed onto cook. 7 Serve on chilled yogurt and top with berries and spinach 4 Add in the blended cashews and stir through, this mint. Delicious! will add thickness and so much extra taste. Add Team it with your the spinach to the top and then put the lid back favourite rice mix – on for 3–4 mins. Take off the heat and stir through mine is brown rice the spinach and the other half of coriander. and quinoa, cooked in vegetable stock. 5 Serve with rice of your choice.

32 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 33 ALICE’S PORK AND AILSA’S CHICKEN BACON BOLOGNESE NOODLE SOUP

Ingredients I know that there are some question Ingredients We are a busy working family so I often (for 2+ leftovers marks around eating processed meat Chicken bone cook multiple meals in one go to save for lunch) broth/stock during cancer treatment but when I time. Food is a chance to be together • 1 tbsp olive oil • 1 chicken carcass was on chemotherapy there was very as a family and we often have a roast • 1 red onion, finely • 2 celery sticks chopped little I could stomach and this became roughly chopped chicken on a Sunday. I often make a • 2 cloves of garlic, a fast favourite. It’s a made up recipe • 1 large carrot roughly bone broth stock from the leftovers finely chopped but is packed with flavour and has a chopped that serves as a base for this delicious • 500g pork mince good helping of veggies in it too. Serve • 1 onion quartered and nutritious soup. The bone broth • 4 rashers of smoked, • 1 tbsp black rindless back bacon – with linguine and a wee sprinkling of peppercorns is full of flavour and any leftover can cut into chunks cheese on the top. • 1tbsp apple cider be frozen in ice cube trays or portion • 5 large fresh vinegar sizes to become the basis of stews Method tomatoes, quartered • As much water as is and soups. • 1 tin chopped 1 Fry your onion and garlic in a large saucepan with needed to cover the tomatoes 1 tbsp of olive oil until soft ingredients Method: bone broth/stock Drizzle of • 2 Add the pork mince and bacon, then fry for about Place all the ingredients in a large saucepan and Worcestershire Sauce 10 minutes or until browned Chicken Noodle Soup bring to the boil then lower the heat and leave • 2tbsp smoked 3 Throw in your tinned tomatoes along with your • 1 litre chicken stock to simmer for anywhere between 5 and 10 hours. paprika fresh tomatoes, making sure the fresh tomatoes Scrape off any scum that appears on the surface • 2 carrots • 2tbsp cayenne are submerged and top up the water as needed. Drain and then pepper • 1 courgette 4 Add your paprika, cayenne, tomato sauce, tomato store the broth. 2 tbsp white miso • Squirt of tomato puree, oxo cube, herbs, worcestershire sauce and • paste sauce season with salt and pepper to taste. Leave to Method: noodle soup • Squirt of tomato simmer for 10 minutes, then add your pepper. • 1 red chilli Bring the stock to a simmer. Using a potato puree Handful of frozen 5 The longer you leave this, the better it tastes, but • peeler, peel ribbons off the carrots and courgette. edamame beans • 1 beef oxo cube as long as you leave it for a minimum of 15–20 Add to the simmering stock with the rest of the • 1 –2 tbsps mixed minutes, it’s good to go. • Handful of shredded vegetables and the shredded chicken. In a cup, herbs cooked chicken (I use mix the miso paste with a ladleful of hot stock then 6 Serve with pasta of your choice and a side of the leftovers from the add to the pan. Add the rice noodles and cook in • Salt and pepper spinach leaves (either fried with leeks for more roast the day before) the simmering stock for the time indicated on the to taste veggies or just on their own) Coriander and packet. Serve the soup with a garnish of coriander • 1 red, green or yellow • soya sauce to serve leaves and a drizzle of soya sauce or Tamari if pepper, sliced to taste gluten free. Linguine and spinach to serve

34 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 35 CAMILLA’S CLASSIC DR HAZEL’S QUICK BANANA BREAD CASHEW PESTO PASTA

Ingredients It’s common to be nervous about Ingredients The perfect quick and tasty recipe for Makes 1 loaf sweet treats when you’re going For pesto lunch or dinner. I often double up and • 2 cups spelt or plain through cancer treatment, but it’s • 2 handfuls of portion out the rest into lunchboxes flour (white and/or fresh basil important to treat yourself to a little of for work the next day. This recipe wholegrain) • 2 cloves of garlic, • 1/2 cup raw sugar or what you fancy. This delicious banana chopped serves 2 (or one hungry person). golden caster sugar bread is quick and easy – minimal • 2 tbsp of cashew nuts Method • 2 tsp baking powder effort for maximum reward. • 60ml olive oil • 2 tsp cinnamon, • Juice of a lemon 1 To make pesto – whizz all the ingredients in a blender until desired texture achieved. Taste test ground Method 2 tbsp water • and season. • 3 medium ripe 1 Preheat oven to 200 C and grease and line loaf tin • 2 tbsp of grated bananas (save one for with baking paper. parmesan (or 2 Simply cook the pasta as per packet instructions slicing on the top) (usually 8–10 mins) and add the frozen peas in for 2 In a large bowl, mix together dry ingredients (flour, nutritional yeast to 250 ml milk (of your the last 4 minutes. Drain. Stir the pesto through • baking powder, cinnamon, sugar). In a separate make vegan) choice) the pasta. Serve. bowl (or jug) whisk together milk, eggs and oil. • Salt and pepper • 2 large eggs to season 3 Incorporate wet ingredients into dry, being careful 1/4 cup olive oil • now to over-mix the cake batter. • A handful of • Butter (for greasing) frozen peas 4 Remove the skins from the bananas and roughly 200g of penne pasta • Handful granola and/ mash TWO of the three bananas with a fork (save • (or pasta of choice) or chopped dark one for the top). Then incorporate this mashed chocolate (optional banana into the cake batter. topping) 5 Carefully pour cake batter into prepared tin. Notes Cake will keep Top with long slices of remaining banana and fresh for 2–3 days at a handful of chopped dark chocolate and/or room temperature granola if you wish. (although sometimes 6 Bake in preheated oven for 40–45 mins and/or if the weather is very until cake is golden brown and skewer inserted warm we will pop it into centre of cake removes clean. Do keep an eye into the fridge as the on the cake as it cooks – if you find it browning banana can cause too quickly then simply place a sheet of baking the loaf to spoil paper on top to cover. too quickly!). 7 Allow cake to cool in tin for at least 10–20 mins before removing and allowing to completely cool on a wire rack. 8 Best served warm/toasted with lashings of fresh ricotta and a drizzle of pure honey!

36 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 37 MONIKA’S Section 5 OVERNIGHT OATS SIGNPOSTING

Ingredients Life can get super busy especially We know there’s a tonne of information out there that Makes 1 portion but when working as a dietitian in the NHS. can sometimes be overwhelming, so if you need more can be doubled up to save time: That’s where these overnight oats information, we recommend these resources for honest, • 40g oats come in. They’re a nutritious and tasty helpful advice and guidance. 1 grated apple start to the day and so quick and easy • Check out our YouTube videos with Life Kitchen: Free cooking classes • 100ml milk to make after a long day. Why not pop Dr Rupy Aujla from The Doctor’s for patients on chemo • 10g flaked almonds them in a container and take them Kitchen and Kelly Anderson www.lifekitchen.co.uk • 10g mixed seeds to work with you. Easy goodness on from Maggie’s and Food to Glow unpacking more of your questions Maggie’s Centres run a number • 1tbsp pomegranate to the go. serve (optional) www.youtube.com/trekstock of nutritional classes www.maggiescentres.org Method Dr Hazel Wallace, Medical Doctor, Put all ingredients in a Tupperware, stir and leave Personal Trainer and resource Nourish Flourish Me: Trekstock overnight in the fridge. Take out in the morning and contributor. Hazel is currently community member, former patient enjoy with a sprinkling of pomegranate seeds. pursuing a masters degree in Clinical and resource contributor Sarah Dixon Nutrition and Public Health nutrition www.nourishflourishme.com at University College London – The Food Medic (available from AlimentalSage: Nutritionist, all good bookshops) NHS dietician and resource www.thefoodmedic.co.uk contributor Camilla Ferraro www.thealimentalsage.com World Cancer Research Fund – for evidence based research and findings on diet, nutrition, physical activity and cancer www.wcrf.org/dietandcancer

Supplement interaction checking tool www.nccih.nih.gov/health/providers/ digest/herb-drug

Healthy Whole Me: Trekstock community member, former patient and resource contributor, Dani Binnington www.healthywholeme.com

38 TREKSTOCK FOOD AND CANCER – WHAT’S THE DEAL? 39 A NOTE FROM TREKSTOCK We hope you found this useful, we’d love to hear how it’s helped you

Share your nutrition journey @trekstock #trekstock

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