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Diet and breast cancer Factsheet

This factsheet is for people who are having treatment for, or recovering from, breast cancer. It looks at healthy eating and what you can do if your appetite or diet changes due to any side effects of treatment. It also outlines some different types of diet and other nutritional issues.

02 | Introduction

Eating and drinking are an important part of our lives and when you have breast cancer you may become even more aware of what you eat and drink. Or you may simply want to find out if diet can play a role in your recovery and future health.
There are many conflicting ideas, theories and media stories about diet and cancer. This can be confusing, particularly when you are trying to understand all sorts of other information about breast cancer and its treatment. We hope the information in this factsheet will enable you to discuss any issues or concerns with your doctor, breast care nurse or dietitian.

What is a healthy diet?


Eating a healthy diet can help some people cope with breast cancer and its treatments. Most experts agree that a healthy diet is balanced and varied and provides all the nutrients needed for your health. For a healthy diet it is important to:  enjoy a wide variety of different foods  try to eat breakfast  include low-fat protein foods, such as pulses, chicken, lean meat and fish particularly oily fish  eat the right amount to be a healthy weight  eat plenty of foods rich in fibre, such as fruits, vegetables and wholegrain starchy foods  eat at least five portions of fruit and vegetables a day  limit foods that contain a lot of fat, especially saturated fat, for example by choosing low-fat dairy foods  limit sugary foods and drinks  limit your salt intake  limit your alcohol intake  drink around six to eight glasses of fluids a day (such as water, tea, herbal tea, coffee or low-calorie drinks)  enjoy your food. Most foods can be included as part of a healthy diet as long as you get the right balance. A healthy diet is made up of a variety Visit www.breastcancercare.org.uk

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of foods including lean meat, fish, eggs and beans; low-fat dairy foods; starchy foods such as wholegrain cereals, breads, rice, pasta and potatoes; and plenty of fruits and vegetables. Foods containing fat and sugar can be eaten in moderation. Your hospital dietitian or practice nurse can provide you with more information about healthy eating, or you can get a free booklet from the Food Standards Agency (see Other organisations at the end of this factsheet).

Diet during treatment


Recovery from surgery
When you have breast surgery, you may miss one or two meals, which should not be a problem. Depending on the time of day surgery takes place, most people are able to start eating again either the same day or the day after and your appetite will improve over the following few days. Eating well will help your body recover and your wound/s to heal. At this time, you need to balance a healthy diet with foods you enjoy and that appeal to you. Nutritional supplement drinks are not usually needed and should only be taken with the advice of your specialist or dietitian.

Chemotherapy
Many people find they are able to eat normally while having chemotherapy. However, there may be times when your eating habits change as a result of how you are feeling or because of side effects you are experiencing. You can read more about side effects in our Chemotherapy for breast cancer booklet.

Appetite

Chemotherapy can affect your appetite so you may not feel like eating your normal diet. It is important to make sure you keep drinking and eating what you feel able to. If your appetite is small, it may help to eat little and often rather than having larger meals. Call our Helpline on 0808 800 6000

04 | Diet during treatment

Your appetite should improve within a few days of completing each cycle of treatment. Some people eat more because the drugs they are being given stimulate their appetite. If you are worried about gaining weight, try to choose low-fat foods and low-sugar drinks, and eat plenty of fresh fruit and vegetables.

Nausea

Nausea and vomiting can be a problem for some people during and after each chemotherapy treatment. However, there are several types of anti-sickness (anti-emetic) drugs that can be prescribed, which are very effective. Dont worry if you miss a meal or two, but try to drink as much as you are able to. You might find it easier to take frequent sips from a drink rather than trying to drink a lot at once. Some people find herbal teas such as mint or ginger can reduce nausea. Others find ice lollies, either bought or homemade, can help. If you are sensitive to cooking smells, it might be a good idea to eat cold or chilled foods. Salads and sandwiches can be easier to prepare. If its possible you may also want to ask someone else to cook. It can help to eat dry foods such as toast and crackers. Again, eating little and often may also help.

Sore mouth

Chemotherapy can make your mouth sore or dry, which can make eating uncomfortable. Keep your mouth clean and fresh by cleaning your teeth or dentures with a soft toothbrush after youve eaten and using a mouthwash. Your doctor or nurse will be able to prescribe mouthwashes and advise you about caring for your mouth. Soft, moist foods such as soups, stews and desserts can be easier to eat. Ice cubes and lollies can be soothing and fizzy drinks may make your mouth taste fresher. You may find drinking with a straw helps you avoid any sore areas in your mouth. It may be a good idea not to eat foods that can Visit www.breastcancercare.org.uk

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irritate or hurt your mouth, such as crunchy, salty, spicy, acidic or hot foods, until the problem settles.

Taste changes

During the time you are having chemotherapy, your taste can change; some foods may seem bland or different and you may find certain foods you like do not taste so good anymore. Certain chemotherapy drugs can cause you to experience a metallic taste in your mouth, although some people find that using plastic cutlery can help with this. Unless your mouth is sore, adding herbs or spices to your meals or trying stronger flavoured foods can sometimes help disguise any taste changes you are having. Sharp tasting foods may appeal, such as grapefruit or pineapple, but it is important to try a variety of foods. Remember this can change over a few weeks so it may be worth trying different things. Drinking plenty of water can also help.

Constipation

If you are not as active as normal, or if you drink less fluids or change your eating habits, you may become constipated. This can also be due to medication you may be taking such as pain relief and some anti-sickness drugs. Drinking plenty and eating high-fibre foods such as wholemeal bread, high-fibre breakfast cereal, fruits and vegetables can help. If your constipation persists, ask your GP (local doctor) or specialist for a suitable laxative. Gentle exercise such as walking can also help prevent and relieve constipation.

Diarrhoea

Certain chemotherapy drugs can cause diarrhoea. If this happens, drinking plenty of fluids is important. It can help to reduce the amount of high-fibre food you eat including wholemeal bread, high-fibre breakfast cereal, fruits and vegetables. Your GP or specialist may also prescribe medication to stop the diarrhoea.

Are there any foods I should avoid?

Some people may be advised to avoid certain foods while having chemotherapy treatment because they are more at risk Call our Helpline on 0808 800 6000

06 | Diet during treatment

of developing an infection. This can be due to either inadequate food hygiene, or eating foods that might contain harmful bacteria. These include:  soft cheeses  raw or lightly cooked eggs pt. However, your specialist team will be able to give you further advice on specific food hygiene or avoiding particular foods.

Radiotherapy
Having radiotherapy for breast cancer should not cause any problems to your appetite or normal diet. You should still try to eat a healthy, balanced diet with a wide variety of foods and drink plenty. Travelling daily for radiotherapy treatment may involve a long journey and sometimes there might be a wait at the hospital for your treatment, so it can be useful to take a drink and snack with you and also try to plan easily-prepared meals if you find you are tired when you get home.

Shopping and cooking


When you are having treatment or recovering from it, carrying out normal activities like shopping and cooking may seem exhausting. If you can, get someone to take over or help. Try to accept any offers of help, even if you are used to coping on your own. You might want to find out if any of your local shops will deliver shopping ordered over the phone. Or if you or someone you know has internet access, you may want to try ordering online from a supermarket. It is important to have some fresh food in your diet, but if you arent able to shop regularly, remember frozen and tinned vegetables and fruit are also full of nutrients and can be eaten daily. Planning a menu of simple meals ahead or preparing meals in advance when you feel well may make life easier when you dont feel up to cooking. Visit www.breastcancercare.org.uk

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Weight gain and weight loss


It is not healthy to be either underweight or overweight. Your specialist team, GP or practice nurse will be able to give you more information on achieving a healthy weight if needed. They can also give good dietary and lifestyle advice, and help monitor your progress, and can refer you to a dietitian for further advice if necessary. For more information on healthy living after breast cancer, see our DVDs Eating well, being active: healthy living after breast cancer and Getting fitter, feeling stronger: exercises to help recovery after breast cancer surgery.

Weight gain

Some people find they put on weight during and after treatment, which can be distressing. This may be due to:  being less active than normal  increased appetite generally and eating more when feeling anxious  the side effects of some drugs  the body retaining fluid as a side effect of certain drugs  the menopause (if treatment has caused your periods to stop) which makes you more likely to put on weight, particularly around the waist. It is not a good idea to follow strict diets and attempt to lose too much weight during treatment. However, it is beneficial to try to eat healthily and take regular exercise to try to maintain a healthy weight and not put weight on. If you want to start losing weight at this time or after treatment, it is fine to cut down, aiming for a realistic weight loss of about 0.51kg (12lbs) a week until you achieve a healthy weight. To achieve this you will need to eat regularly, but reduce the amount of food you eat, especially foods containing fat and sugar. It is also helpful to reduce portion size, replace snacks with healthy alternatives and increase the amount of exercise and activity in your daily routine.

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08 | Diet during treatment

Weight loss

Weight loss can be a problem for some people due to poor appetite, anxiety, or side effects of treatment such as nausea. If you are losing weight you can make simple changes to the balance of your diet. To maintain or put on weight you need more energy and protein, and adding certain types of foods into your daily diet can help. For example, add extra healthy fats such as a little extra oil, nuts, dried fruit, starchy snacks, whole yoghurts and cheese. Make drinks with milk rather than water and have full-fat products. It may also help to eat smaller amounts more often. There are also high-protein or high-energy nutritional supplement drinks and soups available. Powders are also available that you can add to your normal foods to increase the calorie content and boost your energy levels. The dietitian at your hospital will be able to give you advice on the use of these products and about maintaining or increasing your weight.

Bone health
Bone health is important throughout life, and becomes more important as we get older. This is because bone loss increases as part of the natural ageing process, and this can result in osteoporosis (a thinning of the bones that can lead to an increased risk of fracture). Some breast cancer treatments including those which can lead to an early menopause (such as chemotherapy) or hormone therapies (particularly aromatase inhibitors such as anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin)) can affect bone health. These treatments affect the level of oestrogen in your body. The female hormone oestrogen has a protective effect on bones by maintaining bone density and strength, so without it your bones may become weakened. A healthy, balanced diet will help you get the vitamins and minerals you need to maintain strong, healthy bones. It is particularly important to get enough calcium and vitamin D. Vitamin D is needed to help your body absorb calcium. The best source of vitamin D is sunlight. About 1520 minutes of sun a day Visit www.breastcancercare.org.uk

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during the summer will usually provide most people with enough for the year. The recommended daily intake of calcium in your diet is 700mg (1,200mg if you have osteoporosis). It is always better to try to get any essential nutrition from your diet rather than from supplements. Including low-fat dairy foods in your diet such as milk, cheese and yogurt which are rich in calcium will help achieve this. If you do not eat dairy food, you will need to ensure you include other good sources of calcium, such as: fish with edible bones such as sardines and tinned salmon green leafy vegetables (except spinach) soya bean products, such as tofu beans and pulses breads and other baked goods made with calcium-fortified flour muesli figs nuts and seeds calcium-fortified soya milk. Some people may still require calcium and vitamin D supplements. Your consultant or GP can prescribe these if necessary. For more information about bone health and osteoporosis, see our Breast cancer treatment and the risk of osteoporosis factsheet and the list of Other organisations at the end of this factsheet.

Dietary supplements
Most people get all the nutrients they need from a healthy, balanced diet. Unless you are having problems recovering from treatment, supplements such as iron or multivitamins are not usually needed. Evidence is conflicting about how safe it is to take some types of supplements.

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10 | Diet during treatment

While having the potential to do good, dietary supplements may also be harmful, have side effects or interfere with your other treatments. If you are taking, or considering taking, any herbal or dietary supplements, it is a good idea to discuss this with your specialist team.

Organic food
The term organic refers to food produced without the use of synthetic agents like fertilisers, additives and pesticides. Some people who have had breast cancer choose to eat organic food to avoid any potential residue of these in the food as they are concerned it may affect their risk of breast cancer recurring. Farmers who grow organic food use approved fertilisers and pesticides, but their use is limited to within strict guidelines. Both conventional and organic foods have to meet the same legal food safety requirements. Some people choose to eat organic fruit, vegetables and meat because they believe that they are more nutritious than other food. However, a recent review of the available evidence found there were no important differences in the nutrition content or additional health benefits to eating organic food when compared with conventionally-produced food.

Phytoestrogens
Phytoestrogens are plant oestrogens found in foods and soy products. These foods include alfalfa sprouts, pulses, cereals, green vegetables and soya milk, and supplements such as red clover. A balanced diet will naturally contain some phytoestrogens. However, some women take phytoestrogen supplements to try to relieve menopausal symptoms, such as hot flushes, that can occur as a result of breast cancer treatment. Others believe that they may play a part in reducing the risk of the cancer coming back. But their effectiveness in relieving menopausal symptoms is unclear and researchers are also not certain exactly what effect phytoestrogens have on breast cells and breast cancer Visit www.breastcancercare.org.uk

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risk. Because the evidence supporting their use is uncertain and inconsistent, it is important to talk to your specialist or dietitian before changing the balance of your diet in favour of phytoestrogen-rich foods or taking such supplements. The National Institute for Health and Clinical Excellence (NICE) is an independent organisation responsible for providing national guidance on promoting good health and treating ill health. NICE does not recommend soy (isoflavones) or red clover supplements for the treatment of menopausal symptoms in women with breast cancer because the evidence on their effectiveness and safety is limited and conflicting.

Alcohol
Studies have shown that women who regularly drink more than the recommended amount of alcohol are at an increased risk of developing breast cancer. However, fewer studies have looked at the effect alcohol has on the risk of breast cancer recurrence and these have produced mixed results. Some studies suggest that consuming more than the recommended amount of alcohol once you have had breast cancer may increase the risk of the breast cancer coming back, particularly in post-menopausal and overweight women. Longer follow-up studies are needed to confirm this link. Department of Health guidance recommends no more than two units a day for women, and three units a day for men (one unit usually equals about half a pint of beer, a 70100ml glass of wine or a 25ml measure of spirits). Alcohol is also high in calories, so it is worth bearing this in mind if you are concerned about putting on weight.

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12 | Diets for other medical conditions

Diets for other medical conditions


You may already be following a specific diet because you have an existing medical condition, such as diabetes, Crohns disease or irritable bowel syndrome (IBS). Having breast cancer does not mean your diet has to change, but if you are concerned about how breast cancer treatment may affect your diet or any existing condition, talk to your specialist team to ensure any existing condition remains under control during your treatment.

Alternative diets
Some women who have had breast cancer consider following an alternative diet. As described above, increasing evidence reinforces the benefits of being a healthy weight, exercising and following a healthy, balanced diet. There is no conclusive scientific evidence to show that any other type of diet will stop the cancer coming back. These alternative diets can often be very restricting, expensive and can lead to a deficiency of nutrients and complications such as anaemia (lack of red blood cells) or osteoporosis. If you are thinking about changing your diet or want to find out more about different diets, you may find it helpful to talk to your specialist team or a dietitian. You may also want to contact some of the organisations listed at the end of this factsheet for more information. Below there are brief details of some alternative diets.

The Bristol Approach to Healthy Eating


The Bristol Approach to Healthy Eating is part of the Penny Brohn Cancer Care programme of care and treatment. It offers a set of dietary recommendations for people living with and beyond cancer. The recommendations are mainly based on plant foods. These include fruit and vegetables, wholegrains, pulses, nuts, seeds, herbs and spices. Animal products are permitted in small amounts.

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Contact details for Penny Brohn Cancer Care are listed at the end of this factsheet.

Dairy-free diet
Many people with breast cancer are concerned about eating dairy foods, and believe that following a dairy-free diet will reduce the chances of a recurrence of their breast cancer. This belief is mainly based on the observation that the number of breast cancer cases is low in countries where dairy intake is low, such as China. However, most experts feel that these low rates are due to other lifestyle or environmental factors. In a dairy-free diet, dairy foods are avoided altogether and are replaced with soya products or other non-dairy alternatives. There is no evidence to suggest that following a dairy-free diet once diagnosed with breast cancer will reduce the risk of it returning. As dairy foods are one of the main rich sources of calcium it is still important to include non-dairy foods that contain the calcium the body needs. See the Bone health section on page 8 for examples of foods that are high in calcium.

Macrobiotics
Macrobiotics is based on the Chinese principle of yin and yang. Yin is said to represent a feminine force and yang a masculine force and it is thought when the forces of yin and yang are not balanced you become ill. Macrobiotics is considered to be an approach to life rather than just a diet, and looks at aspects such as how food is prepared, your lifestyle and environment. The diet is high in wholegrains and low in fat and protein. It is important to bear in mind that this diet does not provide a balanced intake and can be low in calories, calcium, iron and B vitamins and other nutrients, so may not be suitable. Speak to your dietitian or breast care nurse for advice.

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014 | Further support

Further support
Breast Cancer Care
From diagnosis, throughout treatment and beyond, our services are here every step of the way. Here is an overview of all the services we offer to people living with and beyond breast cancer. Our free, confidential Helpline is here for anyone who has questions about breast cancer or breast health. Your call will be answered by one of our nurses or trained staff members with experience of breast cancer. Our website gives instant access to information when you need it. Its also home to the largest online breast cancer community in the UK, so you can share your questions or concerns with other people in a similar situation. Through our professionally-hosted Discussion Forums you can exchange tips on coping with the side effects of treatment, ask questions, share experiences and talk through concerns online. If youre feeling anxious or just need to hear from someone else whos been there, this is a way to gain support and reassurance from others in a similar situation to you. Our One-to-One Support service can put you in touch with someone who knows what youre going through. Just tell us what youd like to talk about and we can find someone whos right for you. We host weekly Live Chat sessions on our website offering you a private space to discuss your concerns with others getting instant responses to messages and talking about issues that are important to you. If you find it difficult to talk about breast cancer, we can answer your questions by email instead our Ask the Nurse service is available on the website.

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We run Moving Forward Information and Support Sessions for people living with and beyond breast cancer. These sessions cover a range of topics including adjusting and adapting after a breast cancer diagnosis, exercise and keeping well, and menopause. In addition, we offer Lingerie Evenings where you can learn more about choosing a bra after surgery. We also offer a HeadStrong service where you can find alternatives to a wig and meet other people who understand the distress of losing your hair. Our Younger Womens Forums, Living with Secondary Breast Cancer courses and Seca Support Groups for people with secondary breast cancer are also here to offer specific, tailored support. Our free Information Resources for anyone affected by breast cancer include factsheets, booklets and DVDs. You can order our publications by using our order form, which can be requested from the Helpline. All our publications can also be downloaded or ordered from our website. To request a free leaflet containing further information about our services for people recently diagnosed with breast cancer or for people having treatment for breast cancer please contact your nearest centre (contact details at the back).

Other organisations British Association for Applied Nutrition and Nutritional Therapy (BANT)
27 Old Gloucester Street, London WC1N 3XX

Telephone: 0870 606 1284 Email: theadministrator@bant.org.uk Website: www.bant.org.uk Holds a register of practitioners who are fully qualified in both the science of nutrition as well as clinical practice.

Call our Helpline on 0808 800 6000

16 | Further support

British Dietetic Association (BDA)


5th Floor, Charles House, 148/149 Great Charles Street, Queensway, Birmingham B3 3HT

Telephone: 0121 200 8080 Email: info@bda.uk.com Website: www.bda.uk.com (main website); www.bdaweightwise.com (website for maintaining a healthy weight) Enables you to check that a dietitian is appropriately trained and qualified.

British Nutrition Foundation


High Holborn House, 5254 High Holborn, London WC1V 6RQ

Telephone: 020 7404 6504 Email: postbox@nutrition.org.uk Website: www.nutrition.org.uk Promotes nutritional wellbeing by providing scientifically based nutritional knowledge and advice.

The Dairy Council


93 Baker Street, London W1U 6QQ

Telephone: 020 7467 2629 Email: info@dairycouncil.org.uk Website: www.milk.co.uk Provides science-based information on the role of dairy foods as part of a healthy, balanced diet and lifestyle.

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Foods Standards Agency


Aviation House, 125 Kingsway, London WC2B 6NH

Publications order line: 0845 606 0667 General enquires: 020 7276 8000 Website: www.food.gov.uk Provides advice and information to the public and government on food safety and diet. Produces a healthy eating booklet called Your guide to the eatwell plate. The following section of their website has information about safer eating: www.food.gov.uk/safereating

The Genesis Appeal

The Nightingale Centre and Genesis Prevention Centre, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT Telephone: 0161 291 4400 Website: www.genesisuk.org A charity dedicated to preventing breast cancer. They provide information about diet and lifestyle.

National Osteoporosis Society


Camerton, Bath BA2 0PJ

Telephone: 0845 130 3076 Helpline: 0845 450 0230 Email: info@nos.org.uk Website: www.nos.org.uk Provides a range of booklets and a pocket-sized guide to vitamins. Helpline staffed by nurses offering information on all aspects of osteoporosis.

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018 | Further support

Penny Brohn Cancer Care


Chapel Pill Lane, Pill, Bristol BS20 0HH

Telephone: 01275 370 100 Helpline: 0845 123 2310 Email: helpline@pennybrohn.org (helpline); info@pennybrohn.org (other enquries) Website: www.pennybrohncancercare.org Offers two and five day holistic courses (led by doctors and therapists) for cancer patients which include counselling, relaxation, visualisation, meditation, art and music therapy, healing and dietary advice. Also provides seminars and courses for health professionals.

World Cancer Research Fund


Second floor, 22 Bedford Square, London WC1B 3HH

Telephone: 020 7343 4205 Email: wcrf@wcrf.org Website: www.wcrf-uk.org An organisation focusing on the relationship between diet and cancer. Their international and UK sections are based at the same address. Among other topics, their website also includes a set of nutrition questions that may be useful: www.wcrf-uk.org/cancer_ prevention/diet/ask_the_nutritionist.php

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This factsheet can be downloaded from our website, www.breastcancercare.org.uk It is also available in large print, Braille or on audio CD on request by phoning 0845 092 0808.
This leaflet has been produced by Breast Cancer Cares clinical specialists and reviewed by healthcare professionals and people affected by breast cancer. If you would like a list of the sources we used to research this publication, email publications@breastcancercare.org.uk or call 0845 092 0808. Centres London and the South East of England Telephone 0845 077 1895 Email src@breastcancercare.org.uk Wales, South West and Central England Telephone 0845 077 1894 Email cym@breastcancercare.org.uk East Midlands and the North of England Telephone 0845 077 1893 Email nrc@breastcancercare.org.uk Scotland and Northern Ireland Telephone 0845 077 1892 Email sco@breastcancercare.org.uk We are able to provide our publications free of charge thanks to the generosity of our supporters. We would be grateful if you would consider making a donation today to help us continue to offer our free services to anyone who needs them. Please send your cheque/PO/CAF voucher to Breast Cancer Care, FREEPOST RRKZ-ARZY-YCKG, 513 Great Suffolk Street, London SE1 0NS Or to make a donation online using a credit or debit card, please visit www.breastcancercare.org.uk/donate-to-us

Breast Cancer Care is here for anyone affected by breast cancer. We bring people together, provide information and support, and campaign for improved standards of care. We use our understanding of peoples experience of breast cancer and our clinical expertise in everything we do. Visit www.breastcancercare.org.uk or call our free Helpline on 0808 800 6000 (Text Relay 18001).
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