The important role of nutrition for cancer survivors
With improvements in diagnosing and treating cancer, the number of cancer survivors now exceeds 25 million people in the United States. Healthy eating habits play an important role for cancer survivors in preventing cancer recurrence as well as other chronic diseases including heart disease and diabetes.1 However, cancer survivors often eat less healthy than the general population, consuming foods high in sugar and saturated fat while not eating the recommended amounts of vegetables and whole grains.1 <15% of the 9105 cancer survivors in the American Cancer Society's Studies of Cancer Survivors II met the recommended minimum intake of 5 daily servings of fruits and vegetables.2
Research published in 2015 analyzed the diets of approximately 1,500 adult cancer survivors and 3,000 people with no cancer history who were all part of the National Health and Nutrition Examination Survey from 1999 to 2010. 24-hour diet recalls were compared to the 2010 Dietary Guidelines for Americans recommendations. Cancer survivors consumed less fiber, Vitamin D, Vitamin E, potassium and calcium; and more sodium and empty calories from sugar, less healthy fats, and alcohol than recommended.1
The American Cancer Society recommends two major strategies for cancer survivors:
- Achieve and maintain a healthy weight. If overweight or obese, limit high-calorie foods and beverages and increase physical activity to promote weight loss.
- Achieve a dietary pattern that is high in vegetables, fruits, and whole grains. Follow the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention.1
Overweight and obesity are clearly associated with increased risk of developing most types of cancer, and also increase the risk of recurring cancer, impacting health and survival. Losing 5-10% of body weight is associated with improved health and reduced risk of cancer recurrence. On the other end of the weight spectrum, cancer treatment may result in weight loss and nutrient deficiencies, and gaining weight to a healthy weight is important as part of cancer recovery and survival.1
The Dietary Guidelines emphasize a plant-based eating style based on vegetables, fruit, whole grains, low-fat or non-fat dairy products and lean sources of protein. While consuming more plant foods that are good sources of fiber is important, there is no direct evidence that a vegetarian diet has any additional benefit over a diet that includes animal sources of protein, as long as red meat and processed meat including bacon, sausage, lunch meats and hot dogs are avoided.1
Vegetables, fruit, whole grains and legumes contain carbohydrate as well as antioxidants, phytonutrients, vitamins, minerals, and unsaturated fatty acids that are believed to reduce the risk and progression of cancer as well as heart disease and type 2 diabetes. In addition, these foods are typically high in fiber and water content, which promote satiety and are important for weight loss and healthy weight maintenance. Foods and beverages high in added sugar such as honey, raw sugar, brown sugar, high fructose corn syrup and molasses contain few beneficial nutrients and are typically high in calories and should be limited or avoided.1
What about supplements?
Supplements, including vitamins, minerals, fiber, and herbs may sound like a healthy way to promote health, but the American Cancer Society cautions against routinely using supplements and recommends these three guidelines:1
- Before supplements are prescribed or taken, all attempts should be made to obtain needed nutrients through dietary sources.
- Supplements should be considered only if a nutrient deficiency is either biochemically (eg, low plasma vitamin D levels, B12 deficiency) or clinically (eg, low bone density) demonstrated and based on the recommendation of your physician.
- Supplements should be considered if nutrient intakes consistently fall below two-thirds of the recommended intake levels. Such a determination should be made by a registered dietitian, who is most qualified to assess the nutrient adequacy of the diet, especially in view of emerging data suggesting that higher nutrient intakes, especially through sources other than foods, may be harmful rather than helpful.
Follow these 7 tips for healthy food choices
to improve the health of cancer survivors:
- To lose weight or maintain at a lower weight, choose more vegetables and fruits that are high in fiber, water content, vitamins and minerals; and low in calories. Aim for at least 2 ½ cups of vegetables and fruit per day.
- Reduce or eliminate foods with added sugar including candy, cookies, pastries, cakes, and ice cream and instead choose fresh fruit.
- Choose smaller portions of higher calorie foods and eat these foods less often.
- Avoid red meat and processed meat and instead choose skinless poultry and fish as protein sources.
- Replace refined grains with whole grains that are higher in fiber. For example, choose 100% whole wheat bread instead of white bread, and brown rice instead of white rice.
- Avoid deep-fried foods such as French fries, onion rings, and fast-food fried meals.
- Drink unsweetened beverages including water and herbal teas instead of sweetened beverages such as soda, sweet tea, sweetened coffee, and fruit drinks.
American Cancer Society Guidelines for Nutrition and Physical Activity3
- Achieve and maintain a healthy weight throughout life. For most adults, experts consider a BMI within the range of 18.5 to 24.9 to be healthy, a BMI between 25 and 29.9 to be overweight, and a BMI of 30 and over to be obese.
- Be physically active. Adults should get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week.
- Eat a healthy diet, with an emphasis on plant foods.
- If you drink alcohol, limit your intake. People who drink alcohol should limit their intake to no more than 2 drinks per day for men and 1 drink per day for women.
- Zhang, F. F., Liu, S., John, E. M., Must, A. and Demark-Wahnefried, W. (2015), Diet quality of cancer survivors and noncancer individuals: Results from a national survey. Cancer, 121: 4212–4221. doi:10.1002/cncr.29488
- Blanchard CM, Courneya KS, Stein K. Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society's SCS-II. J Clin Oncol. 2008; 26:2198-2204.
- American Cancer Society. ACS Guidelines for Nutrition and Physical Activity. https://www.cancer.org/healthy/eat-healthy-get-active/acs-guidelines-nutrition-physical-activity-cancer-prevention/guidelines.html last revised 4-13-17. Accessed 5-25-17.