Good Nutrition for Everyone
Nutrition During and after Cancer Treatment
Food Safety 
Cancer Drug Therapy and Nutrition
Your Appetite
Weight Gain
Dental Health
Drink Enough Water
The Neutropenic Diet
Dietitians and Nutritionists
Evaluating Nutrition Information
Contact Us
Helpful Links

Good Nutrition for Everyone

Eating well is important for everyone. The types and amounts of foods that we eat affect our energy levels, our moods and how we feel about ourselves.

A healthy lifestyle plays a key overall role in keeping the body strong, supporting the immune system and reducing risk for some diseases, such as certain kinds of heart disease and some types of cancer.

Many nutrition professionals agree that a good diet for everyone, including cancer survivors, is a varied diet of nutrient-rich foods, such as a balance of:

• Fruits and vegetables
• Whole grains and
• Low-fat protein foods, such as fish, lean meats and poultry

Many people who are motivated to eat well for good health want to know about "phytonutrients," also called "phytochemicals" (terms for certain natural compounds that are found in fruits, vegetables, whole grains and other plant-based foods).

Phytonutrients give plants their rich color, distinctive taste and smell. There are thousands of phytonutrients that may provide a number of health benefits. These compounds work together as a team and provide more protection when eaten as whole foods, rather than supplements.

You can increase your intake of phytonutrients by eating a variety of plant-based foods including fruits, vegetables, and whole grains. Phytonutrients are also in spices and tea.

Tips for eating fruits and vegetables:

• Aim for five to 10 servings of fruits and vegetables each day (a serving is 1/2 cup for most fruits and veggies, one cup for leafy greens, melon and berries). 
• Include one or more servings of "cruciferous" vegetables in your diet almost every day. Cruciferous vegetables include: broccoli, cauliflower, cabbage, Brussels sprouts, kale, watercress and radish. A serving is one cup for leafy greens such as kale and a 1/2 cup for the other vegetables such as cauliflower. 
• These foods are also safe to consume during and after cancer treatment. However, some patients may be advised to have only cooked fruits or vegetables for a period of time, as described in The Neutropenic Diet.

One reliable source of information about healthy food and nutrition for everyone is the American Dietetic Association.

Good nutrition should be part of a healthy lifestyle that also includes

• Maintaining a healthy weight
• Drinking water or other non-caffeinated beverages 
• Daily activity, such as walking 
• Relaxing (managing stress)
• Getting enough sleep
• Not using tobacco or abusing drugs and alcohol

back to top

Nutrition During and after Cancer Treatment

Eating well helps people living with cancer to feel better and stay stronger during and after cancer treatment. Patients who eat well and maintain their weight often tolerate treatment side effects better. Good nutrition also helps the body to replace blood cells and tissues that are broken down as a result of treatment.

There is no diet, food or supplement that is known to prevent, cause, treat or cure leukemia, lymphoma, myeloma or myelodysplastic syndromes. However, there are several food and nutrition-related actions that can make a difference in your health and how you feel.

back to top

Food Safety

Handling food safely is important for everyone. People who are being treated for cancer have weakened immune systems. This puts them at increased risk for food-borne illness.

These are some ways to help keep food safe for everyone:

• Keep your hands, counters, dishes, cutting boards and utensils clean.
• Change sponges and dishtowels often.
• Wash fruits and vegetables thoroughly.
• Use separate dishes, cutting boards and utensils for preparing raw meat, fish or poultry.
• Thaw frozen items in the microwave or refrigerator, not on the kitchen counter.
• Use a food thermometer to make sure that meat is fully cooked. 
• Read the expiration dates on food products and look for signs of food spoilage. If in doubt, throw it out.

For more information and fun ideas for children see food safety from the Partnership for Food Safety Education.

Food Safety Update - February 2008

The U.S. Food and Drug Administration (FDA) has confirmed that peanut butter and peanut paste produced by the Peanut Corporation of America (PCA) are sources of the illnesses caused by a type of bacterium known as Salmonella enterica, strain Typhimurium. All peanut products produced by PCA on or after January 1, 2007 have been recalled. People with impaired immune systems, including some cancer patients, are more likely than the general adult population to become severely ill from a Salmonella infection. The National Cancer Institute (NCI) has developed the fact sheet Peanut Product Recall and Cancer Patients to addresses the concerns of cancer patients and healthcare providers.

back to top

Cancer Drug Therapy and Nutrition

Some drugs that are used to treat cancer can have specific food interactions that members of your treatment team will tell you about.

When you begin a new treatment or start using a new drug it is a good idea to tell your doctor about any food allergies you may have and to ask:

• Will I have any special nutritional needs while taking this medication? 
• Do I need to take this medication with food? Without food? 
• Are there any known food-drug interactions of this treatment? 
• Are there any known vitamin or supplement-drug interactions of this treatment? 
• Are there any foods or beverages I cannot have while in treatment? 
• Do I need to drink extra water or other fluids while in treatment or while taking this medication? 
• Can I drink alcoholic beverages, including beer and wine while in treatment or while taking this medication?  
• What if I vomit immediately after taking my medication?

For other questions to ask your doctor about treatment and side effects see LLS's Understanding Drug Therapy and Managing Side Effects.

back to top

Your Appetite

People living with cancer may have different nutrition goals and challenges, depending on

• Patient age 
• Type of disease or treatment 
• Stage of disease or treatment
• Other medical conditions such as high blood pressure, heart disease, diabetes or depression

Your disease and treatment may increase your body's need for calories and protein. Chemotherapy, certain other drug therapies and radiation therapy also create a need for more calories and protein each day. At the same time, the side effects of your treatment may make it a challenge for you to take in enough calories and protein.

Eating enough can be a challenge for patients both during and after treatment. For some people, certain side effects of the disease or treatment affect

• Appetite, taste and smell 
• Chewing or swallowing
• The ability to absorb the nutrients from food.

Side effects can often be managed with medications or other therapies. Managing side effects is important to help patients get the nutrients they need to:

• Tolerate and recover from treatment
• Prevent weight loss
• Maintain general health

Eating enough food, including protein foods, are important for: 

• Healing, including growing new blood cells
• Fighting infection
• Providing energy and preventing muscle loss

Whenever possible and in accordance with medical advice, eat a variety of foods including fruits, vegetables and whole grains on a daily basis.

Some good sources of protein-rich foods are:

• Lean meats
• Fish 
• Beans and tofu (bean curd)
• Dairy products (eggs, milk, yogurt, cheese)

Some nutrition tips to help you get enough calories and protein:

• Eat frequent, small meals or snacks, perhaps four to six times a day. 
• Keep prepared snacks or small meals on hand. 
• Have liquids such as juices, soups or shakes if eating solid foods is a problem.
• For extra calories, blend cooked foods or soups with high-calorie liquids such as gravy, milk, cream or broth instead of water.
• Sip water and other clear liquids such as broth, ginger ale, or lemonade frequently to prevent dehydration.
• Choose soft foods or foods that can be cooked until tender. 
• Cut foods into bite-sized pieces or grind or blend them so that less chewing is needed. 
• Bring snacks when away from home (especially doctors' appointments).
• Try new foods and recipes to accommodate changes in taste or smell.
• When possible, take a walk before meals to improve appetite. 
• Eat with friends or family members when possible. When eating alone, listen to the radio or watch TV.
• Accept help with food shopping and meal preparation.
• Many areas offer cooking classes for people with cancer. If this is of interest, your local LLS chapter may know of classes that you can attend.

back to top

Weight Gain

For some patients, weight gain may occur as a result of increased appetite or fluid retention associated with certain drug therapies. Weight-loss diets are not recommended without medical advice. Patients may be advised to switch to a lower fat diet (less butter, margarine, oil; lean meats only) or a low-sodium diet. The advice of a nutritionist or dietitian may be helpful. If needed, ask your oncologist for a referral.

back to top

Dental Health

Nutrition and dental health are interrelated - and dental care is an important part of overall cancer care. Problems with the teeth, gums or mouth can interfere with eating well. Likewise, poor nutrition can lead to dental problems. Visit the dentist before treatment begins if possible, and

• Maintain good dental and oral hygiene to help prevent gum disease and infection, including the use of prescribed mouthwash. 
• Inspect your mouth daily to detect any problems.
• Speak with the oncologist and dentist as soon as possible if you have any mouth, teeth or jaw pain-or any other symptom of possible dental problems.
• If needed, your oncologist may refer you to a dental oncologist (a dentist who is specially trained to treat people with cancer).
• Seek the advice of your healthcare team for oral hygiene tips and dietary suggestions to reduce or relieve discomfort.

Patients should update their medical history records with their dentists to include cancer diagnosis and treatments, and provide their dentist and oncologist with each other's name and telephone number for consultation. Patients may be advised to have any necessary major dental procedures completed prior to beginning therapy if possible.

back to top

Drink Enough Water

There are many reasons patients need to get enough water.

• Certain cancer therapies, including chemotherapy, other drug therapies and radiation therapy can cause patients to lose fluid and become dehydrated.
• Some side effects of treatment, such as diarrhea or vomiting, can also increase the need for more fluids.
• Getting enough liquids is important and may help specifically with fatigue or constipation.

Intravenous (IV) fluids are given during treatment for some chemotherapies. If you are taking oral medications, with your treatment team's guidance, drink plenty of water or other non-caffeinated beverages every day. It is best to drink water and other approved liquids throughout the day. Sipping even small amounts of water throughout the day will help if that is all a patient can manage.

It is possible to drink too much water. Guidelines for the amount of water to have each day vary, so check with your treatment team and follow medical guidance. Your treatment team may recommend liquids, such as broths or sports drinks, which can restore the body's electrolyte balance. The main electrolytes in the body are sodium, potassium, calcium, magnesium, chloride, phosphates, and bicarbonate. Electrolytes have many important functions in the body.

In general, patients should limit liquids such as caffeinated drinks and alcohol that may increase electrolyte depletion. If you drink alcohol or caffeinated beverages, your treatment team may advise you to have a non-caffeinated beverage for every caffeinated beverage or serving of alcohol you drink.

back to top

The Neutropenic Diet

Certain individuals with lower than normal neutrophil counts (neutropenia) may be advised to follow a special diet called a "neutropenic diet" as part of a plan to protect against infection. This diet may protect individuals from infection caused by bacteria and other harmful organisms found in some raw foods and drinks made from raw fruits or vegetables. The value of following a neutropenic diet for blood cancer patients is a topic of ongoing research. Patients are advised to discuss the potential benefits with their doctors.

Every cancer center has different rules regarding the neutropenic diet. Ask your treatment team for any special instructions. A patient who had a stem cell transplant may have to follow stricter diet rules for a period of time than a patient who was treated with chemotherapy and/or radiation therapy without a transplant.

The basic guidelines for a neutropenic diet are:

• Avoid all uncooked vegetables and most uncooked fruits. Cooked vegetables, canned fruits and juices are fine. You may eat fruit that you can peel a thick skin off of, such as a banana or an orange. 
• Avoid raw or rare-cooked meat, fish, and eggs. Meat should be cooked to the "well done" stage. All eggs should be thoroughly cooked (no runny yolks). 
• Avoid salad bars, fruit bars, and deli counters. Buy vacuum-packed lunch meats rather than freshly sliced meats. 
• Eat or drink only pasteurized milk, yogurt, cheese or other dairy products. 
• Avoid soft mold-ripened and blue-veined cheese, including Brie, Camembert, Roquefort, Stilton, Gorgonzola and Bleu. 
• At home, you may use tap water or bottled water. Avoid well water or boil it for one minute before using.

back to top

Tips for Eating Fruits and Vegetables

• Aim for five to 10 servings of fruits and vegetables each day (a serving is 1/2 cup for most fruits and veggies, one cup for leafy greens, melon and berries). 
• Include one or more servings of "cruciferous" vegetables in your diet almost every day. Cruciferous vegetables include: broccoli, cauliflower, cabbage, Brussels sprouts, kale, watercress and radish. A serving is one cup for leafy greens such as kale and a 1/2 cup for the other vegetables such as cauliflower.
• These foods are also safe to consume during and after cancer treatment. However, some patients may be advised to have only cooked fruits or vegetables for a period of time, as described in The Neutropenic Diet.

Dietitians and Nutritionists

You may want to ask your doctor to refer you to a dietitian or nutritionist for specific nutrition advice and guidance. The terms "nutritionist" and "dietitian" are often used in place of one another. Dietitians may refer to themselves as nutritionists, but not all nutritionists are dietitians. The registered dietitian (RD) credential signifies that a clinician has completed academic and accredited internship experience, has successfully passed the national credentialing exam, and maintains ongoing continuing education/professional development in accordance with the national Commission on Dietetic Registration.

A dietitian or nutritionist can

• Develop an eating plan for you that meets your needs
• Help you manage changes in appetite and weight
• Help you deal with side effects of treatment
• Advise you about foods, vitamins, herbs and supplements
• Develop a personalized cancer survivorship wellness plan

Patients who cannot eat and drink enough for extended periods of time may be referred by their oncologists to a dietitian for help with prescribed supplements that are high in calories and protein or tube feedings until they can resume normal eating. Patients who have had a stem cell (bone marrow) transplant generally do not receive nutrition through a tube feeding. These patients receive their nutrition through an IV. These forms of therapy may be used to keep the patient as healthy and strong as possible during treatment.  

back to top

Evaluating Nutrition Information

Nutrition and cancer research is still in its early stages. It may be hard to sort out dependable, science-based advice from misinformation and myth.

If you are interested in understanding more about nutrition news you have seen on the Internet, read about in a magazine or newspaper, or heard on the news or from a friend or relative, it is important to speak to a member of your oncology team. Trying a supplement or herb on your own could interfere with your cancer treatment. For example,

• Omega-3 fatty acids supplements may increase the blood-thinning effects of aspirin or warfarin. These supplements should only be taken together with blood thinners under the guidance and supervision of your doctor.
• St. John's Wort, an herbal product used to treat depression, reduces the effectiveness of imatinib (a drug used to treat chronic myelogenous leukemia and Ph-positive acute lymphocytic leukemia). Patients who are experiencing depression should talk to their doctors about safe treatment options and be sure to tell their doctors about any medications or supplements they are taking.

back to top

Contact Us

The Leukemia & Lymphoma Society
1311 Mamaroneck Ave.
White Plains, NY 10605

or call the Information Resource Center at (800) 955-4572.

back to top

Helpful Links

American Dietetic Association
216 West Jackson Blvd.
Chicago, IL 60606-6995
Nutrition Information Hotline: (800) 366-1655, 9 a.m. to 4 p.m. CT, Monday through Friday.

You can call ADA's Consumer Nutrition for individual nutrition counseling information. You will receive a referral to a registered dietitian (RD) in your area.

Cancer Nutrition Info
Provides up-to-date, comprehensive and science-based information about nutrition and cancer.

Food and Nutrition Information Center
National Agricultural Library
USDA, Room 304
10301 Baltimore Ave.
Beltsville, MD 20705-2351
(301) 504-5719

The Food and Nutrition Information Center (FNIC) is part of the U.S. Department of Agriculture. It provides access to information on topics like dietary supplements, food safety and the nutritional composition of foods. The web site has a "Consumer Corner" that answers questions frequently asked by the public.

MEDLINEplus
Provides links to current, trustworthy health care information. Links are compiled by the National Library of Medicine at the National Institutes of Health (NIH). Topics include health and nutrition, drug information, dictionaries of medical terms, directories of doctors and hospitals, and other resources.

Nutrition and Cooking Resources for People Living With Cancer
Provides a list of nutrition and cooking resources to turn to when side effects of cancer treatments interfere with a patient's ability to eat well.

NUTRITION.GOV
(800) 843-8114 or (202) 328-7744
Provides easy access to all online nutrition information from the U.S. government. You will find reliable advice on healthy eating, physical activity and food safety.

PubMed
A service of the U.S. National Library of Medicine that enables you to search for science-based information. PubMed includes over 17 million citations from MEDLINE and other life science journals for biomedical articles, includes links to full text articles.  

Quackwatch, Inc.
A nonprofit corporation whose purpose is to combat health-related frauds, myths, fads, fallacies, and misconduct. Activities include investigating questionable claims, debunking pseudoscientific claims, and improving the quality of health information on the Internet.