Transcript Click here to view - Isle of wight urology cancer support group

NUTRITION
- Eat a Rainbow
Sarah Todd
Senior Dietitian
St Mary’s Hospital
TOPICS
1. Super foods? –
 Pomegranates
 Tomatoes
2. Side effects of Hormone treatment –
Weight gain, Metabolic rate
3. Radiotherapy – Side effects
Pomegranates
The fruit is comprised of
peel (pericarp), seeds,
and aril (outer layer
surrounding the seeds).
Arils are mainly composed of
water and also contain
phenolics and flavonoids.
The peel makes up 50% of
the fruit and contains a
number of bioactive
compounds, including
phenolics, flavonoids, and
ellagitannins, and minerals
such as potassium,
magnesium, and sodium.
How Many Seeds??!!
• A pomegranate can contain 200 – 1400 seeds
depending on size (that’s a lot to pick up with a pin!!)
• The seed or Arils is what is consumed, the taste can
sometimes be sour from the acidic tannins found in the
arils.
• This is what the juice is made from, a glass of
pomegranate juice is made from more than one fruit.
• What about Mixed juice drinks – they contain added
water and less pomegranate juice but some do contain
other healthy berries.
Pomegranate Juices
POM
100% Pomegranate Juice
from concentrate
Tesco Pomegranate
juice drink
Pomegranate Juice
From Concentrate (32%)
Tropicana Trop 50 Pomegranate
& Blueberry Juice
Pomegranate Juice (2.5%)
Sainsbury Pomegranate
Pomegreat Pomegranate Juice
Drink
Pomegranate Juice From
Concentrate (25%
Fruit Juices from Concentrate
33% (Pomegranate 30%, Aronia
Berries)
PomeGreat 100%
Pomegranate
& Blueberry Juice Drink
Innocent Pomegranate smoothie
67 Pressed Red & White Grapes, 2 Mashed Bananas , 1 Squeezed
Oranges, 1 Pressed Pomegranates 14% , 96 Crushed Blueberries
3.5% ,56 Peeled Acai Berries 2% ,And a squeeze of Lemon
Are they as super as they claim?
• Antioxidant benefits – from phenolics, flavonoids, and
ellagitannins
– Antioxidants mop up excess Free Radicals, which are produced by
the body as it protects itself from outside invaders, like bacteria, If
free radicals get out of control, they can damage normal cells and
tissues.
• May help prevent the clogging up of the artery walls - due
to Polyphenols, such as tannins and flavonols – which are
actually found in many fruit and veg.
• Small studies have shown they may suppress tumour
growth and lower Prostate Specific Antigen (PSA) levels
BUT more larger clinical trials are need.
• In these studies the participants consumed 8oz
pomegranate juice a day
Any Harm??
• In studies the equivalent of a large glass a day was
consumed – so not excessive
• Pomegranate juice is higher in natural sugars and
energy (Kcal), a possible concern if you have diabetes or
are trying to control weight.
• Perhaps spilt into 2 smaller glasses and take with food.
• In 8oz (220ml) there are 150Kcals compared to 77Kcal
in Orange Juice and 30Kcal in Tomato juice
• May impact on how some medication is broken down
in the body (e.g. Statins, Warfarin) – best speak to
your doctor/pharmacist.
• Overall –it is just a fruit with no negative effects if taken
in moderation.
The potential benefits are from the antioxidants
• Other Antioxidant rich foods:
•
•
•
•
•
Blueberries
Goji Berries
Strawberries
Cranberries
Bilberries
–Super berries??
Also:
Tomatoes, green tea and all fruit and veg!
Lycopene
• Gives fruit and vegetables the ‘red’ colour
• Antioxidant properties
• Sources: Tomatoes, guava, watermelon, papaya, pink
grapefruit, apricots
• Lycopene best absorbed from cooked vegetables and
fruits, also aided by a small amount of fat (e.g. pasta
mixed with tomato sauce and drizzle olive oil)
• Evidence that Lycopene in fruit and veg probably protects
against Prostate cancer.
Inconclusive evidence that it helps slow progression –
but doesn’t harm.
Ways to include Lycopene in your diet
• Mix sun-dried tomatoes into bread dough or add them to
a sandwich or salad.
• Have Pasta with a tomato sauce
• For a refreshing start to your day, enjoy a pink grapefruit.
• Reach for tomato juice to quench your thirst.
• Make a quick bruschetta by toasting baguette slices and
lightly brushing with olive oil. Top with canned, diced
tomatoes and a sprinkling of basil.
• Have a few dried apricots as a snack or chop and
sprinkle on your cereal
• Have watermelon or papaya as a fruity pudding
– (….with cream or ice-cream)
Summary
• Pomegranate and Tomatoes (Lycopene
rich foods) may be beneficial
• Overall aim for a diet rich in antioxidants
– By eating more fruit and vegetables (5 a day
(at least))
– Snack on fresh/dried fruit or add to cereal,
have a glass of fruit juice a day, have a fruity
pudding and have veg / salad with your meals
– Eat a rainbow though…
• This message is the basis of healthy
Hormone treatment
• Hormone treatment for prostate cancer can cause weight
gain and tiredness. In turn these symptoms may make
you less active, which may make weight gain worse.
• May be a loss of muscle mass due to lower testosterone
levels and an increase in the amount of body fat, so you
may have a change to your body shape.
• Some studies show that the weight gain stabilises after
first year of treatment (?)
Controlling weight is never easy
• We have no other tools than trying to:
–Maintain a healthy diet
–Be active
•Exercise can help to maintain muscle strength, especially
resistance exercise such as swimming
•Aim for 30mins exercise 5 days a week (but during
treatment just do what you can)
•Don’t have to join a gym – take a walk, ride a bike, go
swimming, take the stairs in shops rather than escalator,
speak to a healthcare professional regarding chair based
exercises if needed
Metabolism
• Metabolic system?
• We all need a certain amount of energy to maintain life –
Basel metabolic rate
• If you have a high percentage of body fat you are more
likely to store fat more easily, giving a lower metabolic rate
• As people get older they naturally lose muscle mass which
reduces metabolic rate slightly
• Exercise is the way to combat this – especially strength
exercises to maintain muscle mass.
• If you lose weight too quickly via ‘fad diets’ you lose muscle
mass, which lowers your metabolic rate.
• It can be ‘tricked’ by if you become more active and burn
off more energy.
Healthy Eating
•
Foods Groups
–
Starchy carbohydrate – bread, rice, pasta, potato
etc
– Fruit and vegetables (fresh, dried, frozen, canned)
– Dairy – milk, cheese, yoghurt
– Meat, fish, pulses, eggs, nuts – Protein group
– Foods containing fats and sugars
 When looking at a plate of food – ½ should be
vegetables or salad, a ¼ starchy carbohydrate and
a ¼ protein containing foods.
•
Regular meals – don’t skip breakfast
Healthy eating
• Eat 5 a day fruit and veg (remember the rainbow)
• Chose high fibre carbohydrates (e.g. wholegrain bread,
eat skin on potatoes, wholegrain cereal)
• Remove all visible fat from meat and limit fat used in
cooking
• Replace some meat with beans/pulses (if able) to
increase dietary fibre.
 Lower fat cheeses (e.g. Edam), choose low fat soft
cheese even as an alternative to butter/marg on bread.
• Limit high energy snacks and puddings (e.g. biscuits,
cake, gateaux's, ‘stodgy’ puddings)
• Watch alcohol intake (A 250ml glass of wine contains
250Kcals)
Fat Facts
• Different types:
• Saturated animal fat – bad for your heart
• Unsaturated (Vegetable) fats
– Polyunsaturated – e.g. sunflower oil rich Omega 6
– Fish Oils – Omega 3 – Anti – Inflammatory
– Monounsaturated – e.g. olive oil healthier fat for you
heart
Bottom line – all contain same Kcals 1 tablespoon oil = 100Kcal
(Equivalent to 3 rich tea biscuits or a crumpet)
Watch those extra’s
• Naan bread ( a large Naan contains 400Kcal compared
to 550 in an average curry and rice. – meal total
950Kcal)
• Garlic bread (3 small slices contain ½ Kcals of a portion
of lasagne – meal total 750 Kcal)
• Crisps – can vary from 80Kcal – 200Kcal per packet
• A portion of sticky toffee pudding and custard has same
Kcal content as an average meal
• 4 chocolate coated biscuits has same Kcal content as a
ham sandwich
Radiotherapy
• Causes tiredness
• Can irritate your bowel leading to soreness and /
or diarrhoea (reported 80% of patients having
radiotherapy to pelvis region have stomach
upsets
• Stomach cramps
• Can cause inflammation of your bladder
• Can make blood vessel fragile leading to blood
on passing stools or urine
Dietary changes may help
• Drink plenty – aim 8 -10 cups of fluid a day
• If you have diarrhoea – speak to your doctor
regarding medication to help.
– A Low Fibre diet may help some individuals – no evidence
that routine reduction helps alleviate incidence or severity
– Lactose – Some people feel that milk/lactose makes the
diarrhoea worse but the enzyme that breaks down lactose
is Lactase, found in high in small bowel – Radiation is
highest further down.
Low Fibre Diet
• Breakfast cereals: Cornflakes, Rice Krispies, Coco Pops,
Special K
• Bread, flour, pasta & rice: White: bread, rolls, pitta,
chapatti, crumpets, white rice, white pasta, cornflour, sago,
tapioca, semolina, couscous
• Biscuits, cakes, crackers: Biscuits made with white flour:
Rich Tea, Nice, Ginger Nuts, Shortbread, Custard Creams,
Jaffa Cakes, Plain cake e.g. sponge cake, plain scones ,
White crackers or crispbreads e.g. Cream crackers,
• Fruit : Tinned, stewed or fresh fruit without skins or seeds:
peeled apples, pears or peaches, melon, ripe bananas
Fruit juice without ‘bits’
• Vegetables: Well-cooked vegetables e.g. carrots, Swede,
parsnip, beetroot, cauliflower and broccoli florets
Potatoes without skins
• All Meat, fish, eggs, dairy products are ok.
• Only follow this diet whilst the symptoms of
diarrhoea may still be present.
• Re-introduce fibre slowly back into your diet
• Other foods that can aggravate diarrhoea:
– Caffeine drinks: tea, coffee, cola (use decaf versions,
herbal teas)
– Alcohol
– Sugar-free products containing Sorbitol eg chewing gum
– Fruit juice (limit to one small glass (150ml) per day)
– Spicy foods
– Fried foods
Eating during radiotherapy
•Common side effects:
•Poor appetite, Nausea, tiredness, low mood
•Travelling to treatment centres can worsen above symptoms
•Result – reduced oral intake –
• Little and often approach, have energy dense snacks,
Puddings after meal or in between as snacks,
Add fats to foods (e.g. butter in mash potato, cheese
sauce on veg, parsley sauce with fish, roasted veg in oil),
Grate cheese onto meals, have milky drinks,
Full fat diary products
Summary
• Pomegranates may slow progression of tumour but further
studies needed
• Cooked/sun dried tomatoes good source of Lycopene - an
antioxidant
• Aim to eat 5 portions of different fruit and veg (a rainbow)
to have an antioxidants rich diet (include tomatoes +
Pomegranates as part of a healthy diet).
• A healthy lifestyle helps control weight gain – but it is
difficult
• Symptoms of diarrhoea can be helped with a low fibre diet
• If your appetite is poor due to treatment then a ‘little and
often’ approach to eating is needed with energy dense
foods.
• If you require specific individual dietary support speak to
your doctor regarding referral to a Dietitian