If you’re preparing to go through cancer treatment this coming year, you’re probably wondering how to prepare your body and make sure it gets the nutrition it needs to get through in the best possible way.
Here comes our conversation and expert advice from Adele Hug, Oncology Dietician* over at World Cancer Research Fund and Dr. David Heber, MD, PhD and Founding Director of UCLA Centre for Human Nutrition, who walk us through a few things to think about regarding nutrition before cancer treatment (aka “prehab”), during, and rehab after cancer treatment.
What is prehab and rehab?
Prehab is a new term and similar principle to rehab but it’s happening much earlier in someone’s pathway. There’s three pillars for prehab: nutrition, psychological support, and physical activity. These three areas work together, and it’s important to pay attention to all three aspects in order to comprehensively approach your cancer treatment. This article will focus on nutrition, though gaining control and feeding your body well goes hand in hand with improved mental health too. Check out this article on how to cope with a cancer diagnosis to care for your mental health, and this exercise class if you’re looking for something to move with during and after cancer treatment.
Rehab as a term has been around for quite a while and it’s short for “rehabilitation” and normally means recovery – recovering from something that you’d like to get back to some form of normal.
Before the approach of prehab and rehab in combination existed, a lot of cancer recovery was focused on after treatment. This meant waiting to give information to people experiencing cancer until after they’ve finished treatment, which for many was not the right time. Instead, accessing information and being informed early on can help you gain control and make better informed decisions throughout you or your loved one’s experience with cancer.
Before doing anything, always consult with your doctor and health care professionals to know what is best for you.
Nutrition before, during, and after cancer treatment
It’s important to remember that nutrition comes from the word “nourishing” which, Dr. Heber explains is “to give your body everything it needs every day,” whereas diet comes from a regiment, and is usually associated with the desire to lose weight. Adele Hug describes herself as “a non-diet dietician so I would never tell anyone to restrict their eating because that normally causes more metabolic damage in the long run, and it’s more about being able to nourish your body.”
Keep this in mind as you prepare yourself for going through cancer treatment – no food is off-limits, it’s about getting the energy you need to best serve you during cancer treatment. Let’s break down a few different scenarios that can help guide you depending on where you find yourself.
Pre-surgery or cancer treatment
This is where there is the most evidence on a prehab nutritional status – the earlier you’re able to keep a stable weight, increase muscle mass, increase fitness, your cardiovascular fitness, and how your heart and lungs are working, the more helpful it is to understand your surgical outcomes. Getting the nutrients you need from proteins, vitamins and minerals, and other micronutrients like the fiber nutrients in fruits and vegetables can better prepare you for what your body will go through during cancer treatment.
Protein is one of the key nutrients for most people preparing for surgery. Some might need more intensive nutrition support, which we’ll come to later, but for most people, this is a simple intervention. Protein is found in foods like eggs, fish, beans, pulses, lentils, soya, dairy, nuts, seeds, and meat. As people age, some may not be eating enough protein to meet the increased requirements for something like a surgical intervention, so it might be something that you want to start incorporating into your food as early as possible.
While there is more evidence that suggests the health benefits of protein intake pre-surgery, it’s also known that this sort of advice is relevant regardless of what treatment you’re preparing for. So if you’re going to be having chemotherapy, radiotherapy, immunotherapy – all of those things will often have an increased need for protein.
Why though? Protein helps your muscle cells, mobility, and while it doesn’t boost your immune system, it supports your immune system. These are critical functions in order to help you as you recover from cancer treatment, such as chemotherapy. In an ideal world, early interventions can really help get through those things and support your weight and your muscle mass to help you cope and recover faster. So obviously that’s an ideal world.
When it comes to the rest of food, Dr. Heber breaks down what to eat through 7 color groups (check out this podcast episode where he covers nutrition during and after cancer treatment, or his book here). The red group consists of tomatoes and watermelons, which contain lycopene. The orange group is carrots, squash, and pumpkins which have alpha and beta-carotene. The green group is broccoli, brussel sprouts, bok choi, horseradish, all of which are called cruciferous vegetables and have glucosinolates, which evidence points to are cancer preventative. The white-green group which includes onions, chives, and garlic, which have allyl sulfides. The red-purple group comprises all of the berries and pomegranate, which have very powerful antioxidants.
During cancer treatment
Being able to control your intake, physical exercise, and mental health throughout cancer sounds great in theory, but in reality, side effects from cancer treatment or symptoms from your cancer can affect your ability to get the nutritional intake you need.
Taste changes: Your taste buds can change during cancer treatment and it’s actually quite common. These changes can be short term or more permanent. The first thing to do is to check if the cause is treatable.
For example, oral thrush can affect your taste, which can be caused by cancer treatment, a lower immune system, or high blood sugars, all of which can happen during treatment, especially if you’re taking different steroids, for example. This can cause a coating on your tongue which changes your taste, but is also very treatable. Dehydration can actually affect your taste as well so making sure you’re well hydrated might be something that can help.
So, make sure you know the cause and if you can treat it.
Be a bit curious and experiment in the kitchen – what is it that you’re enjoying or not? Make changes and don’t be afraid if you’re liking things you used not to, or vice versa. Want some tips on how to approach food and make it taste a bit better when going through cancer? Check out these tips and see if they help.
Nausea, vomiting, or constipation: Again, though it may be frustrating, it’s important to figure out if this side effect is treatable. Seek professional advice from your healthcare team and see if there’s a medication that can help you with this, because normally, there’s not a nutritional change that you can make here that will cure you. Don’t be afraid to take medication in the short term if it will help you feel better during an otherwise very challenging time for your body. If you’re experiencing nausea and vomiting, it may soothe you to eat softer and blander foods, and there is some evidence that ginger may also help ease things. When it comes to constipation, there are some nutritional things that can help you, such as getting more fiber, fruits and vegetables in your system, but eating those things may not be something you can cope with. Laxatives are a good short-term solution to get you through, and hydration really helps with bowel health.
Intensive nutritional support: If you’re struggling to get the nutritional intake you need, you may need some additional help through nutritional supplements, food fortification, increasing your calories and proteins from the food you’re able to eat. Whether that comes in the shape of supplements or tube feeds, before or during or after cancer treatment, there are plenty of ways to get you the energy you need to help you best cope through cancer treatment. Check with your doctor or dietician what works best for you.
Weight gain: Going through cancer treatment is a diverse and individual experience, and in line with that, every body has its own response to it. Instead of needing to increase intake, others find themselves gaining weight, whether that be from medication or hormone treatments that can interfere with our body composition. Or, you’re more stressed during cancer treatment (also normal) and your body stores more.
The answer to weight gain during cancer treatment is not to restrict food intake. Restricting food intake will do more metabolic and psychological damage in the long run and is not the way in which your body is getting the nutrients it needs to tackle cancer. Instead, look at the quality of the food you’re eating. Is it giving you the nutrients and energy your body needs? Also, it’s normal to feel stressed when going through cancer treatment, and that can affect the quality or length of your sleep. Another reason could be is that you’re not getting enough physical activity, which has the knock-on effect of improving your mental health and helps you get better sleep. Keep in mind, physical activity is about finding movement you enjoy, not burning calories. Don’t focus on a number on a scale. Try and find out what it is that’s affecting you – medication, quality of food, or the quality of your sleep, and see if you can find a way to manage it and find a balance that makes you feel better. Again, make sure to consult with your doctor.
Rehabilitation – after cancer treatment
When it comes to rehabilitation, the same mindset can be applied as prehab. Feed yourself nutrient-rich foods that keep your energy up. In the end it’s about finding a balance between feeding yourself healthy foods, moving your body, and taking care of your mental health.
An important aspect of this means giving yourself permission to eat what you want to and enjoy the foods that you like. Don’t restrict yourself to specific foods – eat healthily and enjoy chocolate. Food is also an important means of enjoyment, so if you find ways to enjoy your food, you’ll also help your mental health while experience cancer. If you’re looking for a hard number to hold yourself to, Dr. David Heber recommends allowing yourself to eat whatever you want 13% of the time, and nutrient-rich foods the other 87%.
You might have had some sort of permanent changes to your anatomy and physiology with surgery and your treatments or radiotherapies, so you might be re-plumbed a bit differently, and there might be some things you just can’t tolerate after or during your treatment. That’s okay too. It’s about learning the new normal about what you can eat and drink to get the best out of the food that you can have.
Another aspect to keep in mind is patience with yourself – oftentimes, we think we should be able to function, be, perform, whatever it is, the same after going through an illness or treatment. This is not the case. Your body needs your patience to best recover. Listen to it, what it needs, and act on it.
What if you’re coping okay?
Also, if you’re coping pretty okay with your cancer treatment, that’s normal too! If your nutritional intake is quite normal but you want to be a bit healthier, try eating more fiber rich foods – fruits, vegetables, plant-based foods. There’s no need to go vegetarian or vegan, but incorporating plant-based foods is good overall. They also have loads of fiber, which helps nourish our gut bacteria, helps us feel satisfied or full, and seems to be linked with a little bit of risk reduction for cancer recurrence in some cancers. Obviously, this isn’t a cure, but it can be nutrition that supports your body and is positive to incorporate if you can, before, during, and in the rehab phase of cancer treatment.
*Dieticians have a code of conduct to follow and are registered professionals with HCPC which means they have a code of conduct that must be followed in order to practice. The name is protected so specific training and continued professional development is a requirement. For your own health and safety, make sure your information is coming from legitimate sources and from registered healthcare professionals.
The information shared does not constitute a medical consultation and is not intended to replace professional medical advice, diagnosis, or treatment. Consult with your doctor or other qualified health providers for questions regarding a medical condition, especially during the active period of Corona / Covid19. Please do not disregard professional health provider advice or delay in seeking it because of something you have read here. In the event of a medical emergency, call a doctor, 112 or 911 immediately.