About this ebook

Many people want to make positive changes to their lives when they have been diagnosed with cancer. Taking steps to live a healthier lifestyle is often a major part of these changes.

This eBook is for people living with or after cancer who want to know more about a healthy diet. It explains why diet is important and has tips on how to eat well and keep to a healthy weight. It also looks at some commonly asked questions about diet and cancer.

This eBook is part of a series of booklets on diet and cancer. The other booklets in the series are Recipes for people affected by cancer, Eating problems and cancer, Managing weight gain after cancer treatment and The building-up diet. Check with your cancer doctor, nurse or dietitian that this is the right booklet for you, and whether you need more information.

How to use this eBook

This eBook is split into sections to help you find what you need. You can use the contents list to help you. You do not have to read this eBook from start to finish.

At the end of the eBook, there are details of other organisations that can help.

If you find this eBook helpful, you could pass it on to your family and friends. They may also want information to help them support you.

Quotes

In this eBook, we have included quotes from people who have wanted to know more about healthy eating, which you may find helpful. Some are from our Online Community. The others are from people who have chosen to share their story with us. To share your experience, visit macmillan.org.uk/shareyourstory

For more information

If you have more questions or would like to talk to someone, call the Macmillan Support Line free on 0808 808 00 00, 7 days a week, 8am to 8pm, or visit macmillan.org.uk

If you would prefer to speak to us in another language, interpreters are available. Please tell us, in English, the language you want to use.

If you are deaf or hard of hearing, call us using NGT (Text Relay) on 18001 0808 808 00 00, or use the NGT Lite app.

We have some information in different languages and formats, including audio, eBooks, easy read, Braille, large print and translations. To order these, visit macmillan.org.uk/otherformats or call 0808 808 00 00.

Diet and cancer

Healthier diets could help prevent up to one-third of cancers (30%) in the UK. A lot of research is being done into which types of food may affect your risk of developing cancer.

Research shows that being overweight increases the risk of developing some types of cancer. There are many reasons why people are overweight. But an unhealthy diet and lack of physical activity are often factors.

Some foods may increase our risk of cancer, but others may protect us. The link between diet and the risk of developing cancer is complicated. Scientists still do not completely understand it. Research suggests that eating more fibre may reduce the risk of certain cancers. Eating a lot or red and processed meat may increase the risk of bowel cancer.

What we do know is that a healthy, balanced diet and regular exercise helps us keep to a healthy weight. This can help reduce the risk of developing some cancers.

‘When I got the diagnosis, it made me take a look at myself and think about my kids. I realised that I needed to turn a corner, start exercising and change my diet.’ David

Why is a healthy diet important?

Food has nutrients that our bodies need. The main groups of nutrients are carbohydrates, proteins, vitamins and minerals, fats, fibre and fluids.

A healthy, balanced diet gives you all the nutrients you need to keep your body working well. For most people, this includes:

- lots of fruit and vegetables – at least 5 portions a day

- plenty of starchy foods (carbohydrates) – choose wholegrain types such as wholemeal bread, rice, pasta, noodles, couscous and potatoes

- some protein-rich foods, such as lean meat, poultry, fish, nuts, eggs and pulses (beans and lentils)

- some milk and dairy foods, such as cheese and yoghurt.

You should limit foods that are high in fat and sugar. This is because they often do not have any additional vitamins or minerals. High-fat or sugary foods give you a large amount of energy, but they can cause weight gain. Choose unsaturated fats, such as nuts, avocados and olive oil.

It is best to drink water or unsweetened squashes that contain no added sugar. You can also drink tea and coffee (without sugar). If you drink fizzy drinks or sugary squashes, try to reduce the amount you drink and have the diet, sugar-free types instead. Try to limit the amount of fruit juice you drink to 1 glass a day (150ml), as these also contain sugar. It is better to eat whole fruits.

Try to reduce the amount of processed and red meats you eat, such as takeaways. You should also avoid foods which have a lot of salt or sugar.

Having a healthy, balanced diet is one of the best choices you can make for your overall health. This includes thinking about what and how much you drink. Many people find making the decision to follow a healthy, balanced diet helps give them a sense of control. It can also help you feel that you are doing the best for your health.

Eating well and keeping to a healthy weight will help:

- you feel stronger

- increase your energy levels

- keep your immune system healthy

- improve your sense of well-being.

It can also help reduce the risk of new cancers and other diseases, such as heart disease, diabetes and strokes.

After cancer treatment, some people have a higher risk of other health problems. This can include diabetes, heart disease or osteoporosis (bone thinning). If you have been told that you are at increased risk, it is very important to follow a healthy diet to help prevent them.

What makes up a healthy, balanced diet?

A healthy, balanced diet contains a variety of foods, in the right amounts. This will give you enough energy, protein, vitamins and minerals to stay healthy.

Try to eat plenty of fruit and vegetables. They should make up over one-third of the food you eat each day. Starchy foods (carbohydrates) should also make up over a third of what you eat each day. The amount of protein you eat should be smaller. The amount of dairy you have should be even smaller. You should try to have only a small amount of oils and spreads.

Foods that are high in fat and sugar should be limited because they often do not have any extra vitamins or minerals.

You do not need to get the balance right with every meal, but try to get it right over a day or even a week.

This chart shows the amount of each food group you should try to eat for a healthy, balanced diet.

Food groups pie chart

Know your food types

Not many of us check the energy (calorie) content of everything we eat. But knowing about the different types of food can help you make healthier choices. It can also help you manage your weight.

Fruit and vegetables

Fruit and vegetables are a good source of vitamins, minerals and fibre. They are also usually low in fat. Most of us do not eat enough fruit and vegetables. You need to aim to eat at least 5 portions a day.

The following each count as 1 portion:

- 1 apple or banana

- 1 slice of melon

- 2 small fruits – such as kiwi fruits or plums

- a handful of berries – for example strawberries, blackberries or blueberries

- a small can of tinned pineapple, or a few slices of fresh pineapple

- 1 glass of orange or apple juice (this only counts once a day)

- 1 whole vegetable – such as a courgette or a small pepper

- 3 heaped tablespoons of vegetables – such as diced carrots, shredded cabbage or peas

- a cereal-sized bowl of mixed salad

- 7 cherry tomatoes

- 2 broccoli florets

- 3 heaped tablespoons of peas or lentils (this only counts once a day).

Different types and colours of fruit and vegetables contain different nutrients. Try to have a wide variety of fruit and vegetables of different colour groups – green, yellow, red, purple, orange and white.

Potatoes are not part of the fruit and vegetables group. They do not count towards your 5 a day.

Eating the recommended amount of fruit and vegetables may lower the risk of heart disease. It may also reduce the risk of developing some types of cancer, such as cancers of the mouth, throat and lung.

Fruit and vegetables should make up about one-third of the food you eat every day.

Tips for eating more fruit and vegetables

- Have a mixed salad, such as a starter or as a side dish with your main meal.

- Reduce portions of starchy foods (carbohydrates) and replace with larger servings of vegetables and salad.

- If you need a snack between meals, choose fresh fruit or vegetables.

- Frozen vegetables and tinned fruit in juice (not syrup) are just as healthy as fresh ones. They can also be cheaper.

- Use vegetables in dishes such as soups, stews and pasta.

- Try to avoid adding butter, rich sauces or dressings to your vegetables and salads. This will increase the calories you eat and drink. But you can include them if you are trying to gain weight.

Starchy foods (carbohydrates)

Starchy foods (carbohydrates) are an important part of a healthy diet. They are a good source of energy and contain nutrients including fibre, calcium, iron and B vitamins.

Starchy foods are broken down in the body to become glucose. Glucose is a type of sugar that gives us energy. Energy is measured in calories. We all need a certain number of calories each day for energy, even if we are not being very active. For example, you need energy to breathe even when you are sitting in a chair.

The amount of energy you need each day varies. It depends on how quickly your body uses the energy, and on your level of activity. An adult man needs about 2,500 calories a day. An adult woman needs about 2,000 calories a day. If you eat and drink too many calories, you can gain weight. If you do not have enough, you use up your body’s energy stores and lose weight.

Starchy food should make up about one-third of what you eat each day. Starchy foods include:

- bread

- breakfast cereals

- potatoes and yams

- rice

- pasta.

Tips for eating starchy foods

- Try to choose wholegrain or wholemeal bread, rice and pasta. These usually contain more fibre.

- Try to choose wholegrain or wholemeal starchy foods if you are trying to lose weight. They usually contain more fibre and make you feel fuller for longer.

- Leave potato skins on where possible. They contain fibre and vitamins.

- Try not to add butter, cheese or creamy sauces. They increase the number of calories you eat.

- Boiled or baked potatoes are healthier than deep-fried chips.

- If you want to eat chips, have low-fat, oven types or choose thick cut chips rather than skinny fries.

Fibre

The main role of fibre (roughage) is to keep the digestive system and bowels healthy, and prevent constipation. Fibre is the part of cereals, fruits and vegetables that is not digested and passes down into the gut.

Many studies show that foods high in fibre may reduce the risk of bowel cancer. Most people do not eat enough foods that are high in fibre. Starchy food can be a good source of fibre. Increasing the amount of fibre in your diet can help you feel full more quickly and for longer. This means you are less likely to eat too much.

Tips for eating fibre

Try to eat:

- wholemeal, seeded or granary breads, and wholemeal chapatis and pittas

- wholegrain (high-fibre) cereals and pasta

- brown rice

- yams and potatoes with their skins on

- peas, beans, lentils, grains, oats and seeds

- fruit and vegetables with the skins on (if you are able to eat them).

- The fibre in foods such as oats, beans and lentils may help reduce the amount of cholesterol in the blood.

Sugar

Sugar gives us energy. It is found naturally in some food and drinks, such as fruit and milk. The body also gets sugar by breaking down carbohydrates.

There are different types of sugar. It is better to get energy from natural sugar. Natural sugar is in foods such as whole fruits (not just juice) and starchy foods, such as wholemeal breads. When these sugars are broken down, they are released more slowly. This helps to keep your energy levels more even.

Processed sugars are sugars that are added to many types of food and drink. These are sometimes called free sugars. Some free sugars are also found naturally in honey, syrups and some fruit juices. Processed sugars are not usually recommended if you want to maintain a healthy weight.

Fizzy drinks and alcohol often contain a lot of sugar. Try to avoid food and drinks with added sugar.

If you find it hard to reduce your sugar intake, a sweetener might help in the short term. But this will not reduce your craving for sugar, so it is not a long-term solution.

Tips for eating less sugar

- When you are shopping, check food labels for the sugar content. Choose foods that are low in sugar.

- Choose tinned fruit in juice rather than syrup.

- Try a low-fat spread, sliced banana or low-fat cream cheese on toast instead of jam or marmalade.

- Try using less sugar in your recipes, or use a sweetener.

- Drink water, milk or reduced-sugar drinks instead of sugary, fizzy drinks.

- Dilute fruit juice with sparkling water to make a fizzy drink.

- If you add sugar to food or drinks, reduce the amount you add every day. This helps you get used to the change until you can stop having it altogether.

- Choose wholemeal breakfast cereal rather than those that are sugar-coated or high in sugar.

Fats

Having some fat in our diet helps us to absorb vitamins A, D, E and K. Foods that are high in fat are also high in energy (calories). Eating a lot of fat, or the wrong type of fat, can make you more likely to gain weight and develop other health problems.

There are two types of fat: saturated and unsaturated. It is important to try to eat less fat, and to choose foods that contain unsaturated instead of saturated fats. Unsaturated fats are still high-energy (high-calorie) foods.

Even foods labelled as ‘low-fat’ can still be high in calories. But if you are trying to gain weight, you may need to have more fat in your diet. You may find our booklet The building-up diet helpful.

Saturated fats

Saturated fat can raise cholesterol levels in the blood and increase the risk of heart disease. Foods high in saturated fat include:

- cheese, especially hard cheese such as Cheddar

- butter, ghee and lard

- palm oil and coconut oil

- meat products, such as burgers and sausages

- biscuits, pastries and cakes

- some savoury snacks, like cheese crackers and crisps

- chocolate.

Most people eat too much saturated fat. The current advice is that:

- men should eat no more than 30g of saturated fat a day

- women should eat no more than 20g of saturated fat a day.

You can use the nutrition labels on foods as a guide. High-fat foods contain more than 20g of fat per 100g. Low-fat foods contain less than 3g of fat per 100g.

Unsaturated fats

Unsaturated fats are a healthier option. Choosing unsaturated fat instead of saturated fat may help to reduce the risk of high cholesterol levels in the blood. There are two types of unsaturated fats: monounsaturated fats and polyunsaturated fats.

Monounsaturated fats are found in:

- olive oil and spreads

- rapeseed oil and spreads

- avocados

- some nuts, such as almonds, brazil nuts and peanuts.

Polyunsaturated fats include omega-3 and omega-6s. Omega-3 fats are found in oily fish such as:

- kippers

- mackerel

- salmon

- trout

- sardines.

A healthy balanced diet should include 2 portions of fish a week, including 1 oily fish. Eating 1 to 2 servings of fish a week helps reduce the risk of developing heart disease. But too much oily fish may not be good for you. This is because it can contain low levels of pollutants that can build up in the body.

You can get more information about how much white or oily fish you should eat on the NHS Eat Well website.

Omega-6 fats are found in vegetable oils, such as rapeseed, corn and sunflower oils, and in some nuts. Most of us get enough omega-6 in our diet.

Tips for eating less fat

- When you are shopping, check the labels for unsaturated and saturated fat. Choose lower-fat options.

- Eat less red meat, or choose lean cuts of meat and trim off the fat.

- Eat skinless fish and chicken, rather than red meat.

- Eat less fried food. Bake, grill, steam or poach food instead.

- Choose lower-fat dairy products when you can.

- Add vegetables and beans to stews and curries, and use less meat.

- Try more vegetarian recipes.

- Avoid fatty takeaway foods, or reduce the number you eat. This includes burgers, curries and kebabs.

- Avoid snacks that are high in fat, such as pastries, crisps and biscuits.

Salt

Too much salt in your diet can lead to high blood pressure. This can cause heart disease and strokes. A diet that is high in salt can also increase the risk of developing stomach cancer.

Try to have no more than 6g of salt (1 teaspoon) a day. It is not just the salt you add to your food that counts. Some foods already contain high levels of salt. These include:

- many cured or processed foods – such as sausages, cured ham or bacon, and cheese

- tinned foods

- ready meals.

It is important to check the label for the salt content when choosing food.

You can find out how much salt is in processed foods by checking the labels. If there is more than 1.5g of salt per 100g, the food is high in salt. Low-salt foods contain 0.3g or less of salt per 100g.

Low-salt alternatives are not recommended as these can be high in potassium. Try to gradually reduce your salt intake instead.

Tips for eating less salt

When you are buying bread, cereal and ready meals, compare the amount of salt in different types and choose the ones with the lower amounts. Frozen ready meals usually have less salt than chilled ones.

When you are buying tinned vegetables and tuna, choose the types in spring water rather than salted water or brine.

Try not to add salt to your food.

- Add herbs, spices or black pepper to pasta dishes, vegetables and meat instead of salt.

- Marinate meat and fish before cooking to give them more flavour.

- Swap high-salt snacks, like crisps, for a healthier option, such as fruit or a yoghurt.

Protein

Your body needs protein to do things like building and repairing muscles and other body tissues. When we are ill, injured or stressed, we need extra protein (as well as extra energy) to repair any damage.

Protein-rich foods can also be a good source of vitamins and minerals. There is protein in:

- red meat

- poultry, such as chicken and turkey

- fish

- dairy products, such as milk and eggs

- pulses, such as peas, beans and lentils

- some plant-based meat alternatives, such as soya, tofu and mycoprotein (Quorn).
‘Smoothies made with fruit and vegetables can be frozen in ice lolly moulds. Nearly every type of fruit and vegetables can be blended together and you can add protein powder to bulk them up.’ Ian

Meat

Several studies suggest that eating lots of red or processed meat can increase the risk of developing bowel cancer. Red meat is beef, pork, lamb, and veal.

Processed meats include sausages, bacon, salami, tinned meats and packet meats (for example, sandwich ham).

People who eat 2 or more portions of red or processed meat a day have the greatest risk. People who eat less than 2 portions a week seem to have the lowest risk. No link has been found between eating poultry, such as chicken and turkey, and the risk of developing cancer.

Eating meat that is cooked at high temperatures, such as fried or barbecued meat, may also increase the risk of developing some cancers.

Tips for eating less red or processed meat

- Cut down on meat, especially sausages, burgers, pies and sausage rolls which are high in saturated fat.

- Try to reduce your meat portions and have more plant-based sources of protein instead.

- One portion of meat should be about the size of a packet of playing cards.

- Choose leaner cuts of meat that have less fat, such as those labelled ‘lean’ or ‘extra lean’. You can also look at the labels to see which cuts have the least fat. Or ask a butcher or grocer if you are not sure.

- Try to eat more fish, chicken, turkey, beans and lentils instead.

- Skinned turkey or chicken is a lower-fat alternative to red meat such as lamb, beef or pork.

- Grill or roast your meat instead of frying it to reduce the number of calories.

Fish

Fish is a good source of protein, vitamins and minerals. It is often low in saturated fat. Aim to have at least 2 portions of fish a week. Try to have:

- 1 portion of white fish, such as haddock, cod or plaice

- 1 portion of oily fish, such as sardines, salmon or mackerel.

Shellfish, such as prawns and mussels, are also good. They are low in fat and a source of minerals, such as selenium and zinc.

Tips for eating fish

- Try to grill, steam, poach or bake fish. This is healthier than frying it.

- Tinned fish such as tuna, sardines and pilchards are also low in saturated fat. Avoid tinned fish in oil or brine.

- Frozen fish can be cheaper than fresh fish

- Avoid high-fat, processed meals with fish in them, or fish in batter.

Milk and other dairy products

Milk and dairy products are good sources of protein, vitamins and calcium. But some dairy products, such as cheese, can also be high in fat.

It can be good to include whole-milk and dairy products in a building-up diet for weight loss. But to maintain a healthy weight or lose weight, try semi-skimmed, 1% fat or skimmed milk, and low-fat yoghurt. Have only small amounts of cheese. 1 portion of cheese is about the size of a matchbox.

Pulses and nuts

Pulses such as beans, lentils and nuts, are a good source of protein. Pulses can be used in lots of meals, such as stews or soups.

Nuts can be used in both sweet and savoury dishes and are high in energy. They contain good amounts of protein and some healthier, unsaturated fats. Nuts are a good source of protein if you do not eat meat or animal products. If you are trying to lose weight, you should limit your portion sizes of nuts. This is because they are high in fat and contain a lot of calories.

Other sources of protein

Some vegetarians include eggs and dairy products, like cheese, for protein in their diet. Eggs are a good source of protein. But hard cheese can be high in unhealthy saturated fats and should be eaten in small amounts. Vegan cheese made from soya can be a healthier alternative to dairy cheese. Other soya alternatives include soya mince, soya burgers and sausages, soya milk and tofu.

Mycoprotein (Quorn) can also replace mince, burgers and sausages as a source of protein.

There have been some concerns about soya and its effect on breast cancer. There is currently no evidence to suggest that a moderate amount of soya is harmful. Recommendations say it is safe to have 1 to 2 servings a day of whole soya foods.

Whole soya foods are unprocessed soya foods, such as miso, tempeh, tofu, soya beans (edamame), soya nuts and soya milk.

One serving of soya is equal to:

- 1 large glass of soya milk

- 50g of tofu

- 100g of soya mince

- 28g of soya nuts or edamame beans.

If you have questions about soya, talk to your doctor, dietitian or specialist nurse.

Vitamins and minerals

The body needs minerals for various functions, such as maintaining healthy nerves, bones and teeth. Vitamins are essential to help our bodies work normally, but we only need tiny amounts of them. If you are eating a healthy balanced diet with plenty of fruit and vegetables, you are probably getting enough vitamins. But if you are not able to eat well for a long period of time, you may need multivitamins and mineral supplements. Your doctor, dietitian or pharmacist can give you more advice about these.

High-dose vitamin and mineral supplements are not recommended during cancer treatment. It is not known if they will affect how your treatment works.

Fluids

Your body needs fluid to work properly. You should aim to drink at least 2 litres (31/2 pints) of fluids each day. You will need to drink more if:

- you are more active than normal

- it is warm

- you are losing fluid through sweat.

Water is the best fluid to drink to keep your body hydrated. It contains no calories and no sugars. If you do not like the taste of plain water, you could add a slice of lemon or lime. Some flavoured water drinks contain a lot of sugar and calories, so check the label before you buy.

Milk is a good source of calcium. This is good for bone health. It also contains other vitamins and minerals. It is healthier to drink semi-skimmed or skimmed milk.

Fruit and vegetable juices and smoothies contain a variety of nutrients. But they also contain sugar and calories. Aim to have no more than 1 small glass a day.

Juice drinks, squashes and fizzy drinks can be high in sugar and calories. They contain very few nutrients, so you should avoid drinking them where possible.

You can include tea and coffee when you are adding up how much you drink each day. But try to have other fluids that do not contain caffeine as well.

Sometimes when you think you are hungry, you are actually thirsty. Try having a drink and waiting for 10 minutes before having a snack. This can help you eat less.

Food labels

Most packaged foods have labels giving information to help you make healthier choices when buying food. The labels give information about what the food contains, including:

- fats

- salt

- sugars

- calories.

The label also sometimes gives information about sodium and fibre.

Many food manufacturers and supermarkets use a food traffic light system on their labels. This tells you the amount of fats, saturated fats, sugars and salt in 100g (3½ ounces) of the product.

The colours show if the level is high, medium or low:

- Red – the level is high.

- Amber – the level is medium.

- Green – the level is low.

You should eat more foods with amber and green labels and fewer with red.

If a product does not have traffic light labelling, you can use this diagram to check by comparing it with the list of ingredients. We have also included this diagram on a card on the inside front cover of this eBook, so you can take it with you when you go shopping.

Food labelling diagram

Alcohol

Alcohol is high in calories and can cause weight gain. It is also linked with an increased risk of some cancers. Following the recommended drinking guidelines is good for your health and weight.

NHS guidelines suggest that both men and women should:

- not regularly drink more than 14 units of alcohol in a week

- spread the alcohol units they drink in a week over 3 or more days

- try to have several alcohol-free days every week.

1 unit of alcohol is:

- half a pint of ordinary strength beer, lager or cider

- 1 small glass (125ml) of wine

- 1 single measure (25ml) of spirits.

There is a table opposite to show this.

Drinkaware has more information about alcohol and drinking guidelines.

Number of calories and units of alcohol in a drink

Drink

Calories

Units of alcohol

Pint of lager

170 to 250

2

Standard glass of white wine (175ml)

130 to 160

2

Single vodka (25ml with a mixer)

115

1

Tips for having less calories when drinking alcohol

- Have a shandy instead of a beer – this is beer mixed with low-calorie (diet) lemonade.

- Add low-calorie or calorie-free mixers to spirits or white wine.

- Have a low-calorie, non-alcoholic drink between each alcoholic drink.

- Have a glass of water with each alcoholic drink.

- Try alcohol-free beer, wine or cider. These can often be low in calories too.

Keeping to a healthy weight

It is not healthy to be overweight or underweight. Eating too much can make you overweight. This can lead to health problems such as:

- heart disease

- high blood pressure

- diabetes.

Eating less food than your body needs can make you underweight. This can also affect your health.

Many people in the UK are heavier than the recommended weight for their height. And some types of cancer treatment, such as hormonal therapy or steroids, can lead to weight gain.

Losing weight can be difficult. But trying to keep to a healthy weight is one of the best ways to reduce your risk of developing cancer. Being overweight increases the risk of many types of cancer including bowel, kidney, womb and gullet (oesophagus) cancer. Women who are overweight and have been through the menopause have an increased risk of breast cancer. Being a healthy weight may also help reduce the risk of some cancers coming back.

Being overweight may increase the chances of complications if you need surgery.

Try to keep your weight within the normal range for your height. Your GP can advise you on your ideal weight. If you are concerned about your weight, ask your GP or a dietitian for advice and support. Dietitians can give you advice about healthier food choices that still make you feel full. Fruit and vegetables are better than unhealthier snacks, such as biscuits and cake.

Be patient with yourself. Losing weight is a gradual process. It is important to eat a healthy, balanced diet to make sure you get all the nutrients you need to keep your body healthy. It is reasonable to aim to lose about 0.5 to 1kg (1 to 2 pounds) a week.

Tips for keeping to a healthy weight

- Only eat as much food as you need. This depends on how active you are. You may need to talk to a dietitian about this.

- Eat a healthy diet with lots of fruit and vegetables and less fat and sugar.

- Try to be physically active.

Using a food and activity planner

Writing down your meals and physical activity for the week ahead can help you plan what you are going to eat and do. This can help you keep track of your goals each week. Remember to go easy on yourself. If you are not sticking to the plan, think about why that might be. Maybe you can set yourself other goals.

Tips for using the planner

- Photocopy or print the planner before you fill it in. This means you can use a new one each week.

- Try to write down everything you plan to eat for a week. Make a note of when you do not stick to the plan. At the end of the week, you can see what you have done and use it to plan for the next week. You will also have a record to show your doctor or dietitian.

- Mark down each portion of fruit and vegetables you plan to eat and record if you did.

- Use the activity section to plan and record physical activity.

- If you eat a lot in one sitting, make a note of where you were, who you were with and how you were feeling. This may help you find any eating habits that are causing weight gain.
‘I think slow and steady wins the race. Exercise and eating well, with meals cooked from scratch. Chemo wrecked my gut so I eat a very high fibre diet with lots of fruit and veg and things that are good for my gut bugs. I also did Macmillan’s Move More, and aim to walk at least half an hour every day.’ Linda

Healthy eating tips

These tips will help you make healthy decisions when choosing or cooking your food. This will help you keep to a healthy weight.

Change your habits

- Try to plan what you are going to eat for the week. This means you will be less likely to buy unhealthy food at the last minute. You can use the planner to help you record this.

- Start the day with a healthy breakfast. This may help you to stop eating unhealthy snacks in the morning.

- Try to eat meals at regular times. This will help your body get used to a routine of when you eat. This may mean you are less likely to snack between meals.

- Make sure you drink plenty of fluids. Sometimes we mistake being thirsty for being hungry. Try to have a glass of water before meals.

- Turn off the TV and put down mobile phones or other devices during meals. You are less likely to eat more than you need if you concentrate on your meal.

Change how much you eat

The amount you eat is just as important as what you eat. If you eat big portions, you are more likely to gain weight. If you want to lose weight, there are things you can do to help you eat smaller portions:

- Use a smaller dinner plate. Bigger plates need more food to fill them.

- Choose a healthy starter, such as low-fat soup, melon or salad.

- Eat slowly and avoid having second helpings. It takes about 20 minutes for your stomach to tell your brain that you are full. Try to wait a while before deciding whether you want more.

- Avoid snacking straight from a bag or packet. Put the amount of food you want to eat on a plate.
‘I‘ve taken exercise, meditation and a healthy diet seriously and tried to incorporate all of this into my daily routine. Food is my passion, so I really took it upon myself to make sure I nourish my body.’ Saima

Fast foods and eating out

Fast food is usually high in calories and fat. If you eat a lot of fast food, you could try to cut down.

Try to plan your healthy meals and snacks in advance. If you do not plan, you may end up buying take-away food when you are hungry.

Even when you have changed to a healthier way of eating, there may be times when you want to be more relaxed about it. You can still enjoy treats or meals out with family or friends.

If you have a take-away or eat out, try to follow these tips:

- Look for the healthier options on the menu. These may be labelled as a ‘light’ option.

- Have a boiled or jacket potato instead of chips. Or ask for boiled rice instead of fried rice.

- Choose baked options rather than fried.

- Try to avoid bread or nibbles before the starter or main course.

- Ask for a standard or smaller portion size, or order a starter as a main course.

- You could share a main course with someone.

- Choose tomato-based sauces with vegetables rather than creamy sauces.

- Order vegetables or a side salad to add to your meal.

- After you finish your main course, wait a while before you decide whether to order a dessert.

- If you order dessert, choose one that is fruit-based. Ask for low-fat, low-sugar yoghurt instead of ice cream or cream.

Eating and socialising

Food gives us what we need to keep our bodies healthy and energised. But it is also an important part of our social lives. This may be spending time with family and friends at barbecues, or celebrating an event with treats like cakes.

Even when you have successfully changed to a healthier balanced diet, you may not always feel like following it strictly. This is normal. Everyone enjoys having an occasional treat or meal out. Try having a smaller portion than you would normally.

Food hygiene

Cancer and some cancer treatments can weaken your immune system, which protects us from infection and disease. If your immune system is weak, you are more at risk of getting food poisoning. This is because you are less able to fight infection. You may also be less able to cope with the symptoms of food poisoning.

To reduce this risk, you should:

- use fresh ingredients

- check the use-by dates on food

- store food and drink at the correct temperature – look at the packaging for instructions

- rinse all fruit and vegetables in cold running water before eating or cooking

- cook food thoroughly

- throw away mouldy food.

In the kitchen, you should:

- wash your hands before you touch food

- clean cooking utensils and chopping boards thoroughly

- wipe worktops with hot, soapy water or an anti-bacterial spray – this is very important if you have prepared raw meat or eggs

- wash or replace dishcloths and tea towels regularly

- keep pets out of the kitchen.

Leftovers

If you decide to store food to eat later, let it cool down completely and then store it in the fridge or freezer.

Freezing extra portions can save you time later. It is a useful thing to do before starting cancer treatment. You must defrost food fully before reheating it. This is very important if you have low immunity because of treatment.

Only reheat food once, and make sure it is hot all the way through before you eat it. Do not reheat cooked rice. Eat rice as soon as it is cooked. Take care not to burn your mouth or tongue if you are reheating food.

Eating out

It is best to avoid eating out and takeaway food if your immunity is low. If you eat out, try to choose somewhere where you know the food will be freshly prepared and properly cooked. Avoid eating food from salad bars, buffets and street vendors because it is difficult to know how fresh the food is. Also avoid having ice-cream from an ice-cream van.

Common questions about diet and cancer

These questions could help you understand more about diet and cancer and may help you make decisions.

Can diet reduce the risk of cancer coming back?

After cancer treatment, some people change how they eat because they hope it will reduce the risk of cancer coming back. There is some evidence from breast and bowel cancer studies that diet may make a difference to the chances of cancer coming back. But there is not enough clear information to give advice about what someone with a particular type of cancer should eat.

Cancer experts recommend that people who have had cancer continue to follow the same healthy, balanced diet that is recommended for cancer prevention. It is thought the same factors that can increase the risk of developing might also increase the risk of it coming back after treatment.

For most people, the factors that are most likely to improve their health after cancer treatment are:

- eating a healthy diet

- keeping to a healthy weight

- doing regular physical activity. We have more information in our booklet Physical activity and cancer.

The biggest benefits will probably be from a combination of these, rather than from one change. Your GP, dietitian, doctors and nurses can advise you if there are any lifestyle changes you can make.

What foods should I avoid when I have low immunity?

Your medical team may tell you that your immunity might be low during treatment. You can ask them whether there is any special dietary advice you should follow.

We have some tips for good food hygiene.

For most people, low immunity will not last long, so there is no need to follow a special diet. If you are having high-dose chemotherapy, or a stem cell or bone marrow transplant, there will be foods you cannot have. Your cancer doctor or nurse will explain more about foods to avoid.

Foods to avoid

- Meat and fish pate.

- Runny or raw eggs, and any product containing raw egg – such as homemade mayonnaise.

- Raw or undercooked meats, poultry, fish, or shellfish.

- Cold meats that have been smoked but not cooked, such as salami.

- Yoghurt or other products that contain probiotics.

- Cheese or other foods or drinks made from unpasteurised milk.

- Mould-ripened and blue-veined cheeses.

Should I take dietary supplements?

For most people, a healthy, balanced diet that contains a range of fruit and vegetables will provide all the nutrients they need. Large doses of vitamins, minerals and other dietary supplements are not usually recommended.

If you find it difficult to eat a balanced diet, it might help to take multivitamins or a mineral supplement. Supplements can contain up to 100% of the recommended daily allowance.

Talk to your doctor, nurse or dietitian before taking supplements or multivitamins.

Supplements may help in some situations, such as for people who cannot absorb all the nutrients they need after surgery for stomach cancer. People at increased risk of bone thinning (osteoporosis) may also benefit from taking calcium and vitamin D supplements. These can help to strengthen their bones.

Studies looking at whether taking supplements can reduce the risk of developing certain cancers have been disappointing. The evidence shows that taking supplements does not reduce the risk of cancer. There is even evidence that taking high doses of some supplements can be harmful. It can increase the risk of cancer developing in some people or may have a harmful effect on people who have had cancer.

It is possible that some supplements may interfere with how cancer treatments work. This may make these treatments less effective.

If you are having cancer treatment, it is important to get advice from your cancer doctor before taking any supplements. They can advise you about:

- any supplements you should take

- the doses of any supplements that may be suitable for you

- how often you should take the supplements.

They can also tell you about any possible side effects of supplements and how they might interact other medicines.

What about ‘superfoods’?

‘Superfoods’ are foods that are thought to have special health-related powers. They are thought to be able to prevent or even cure many diseases, including cancer. Popular ‘superfoods’ include blueberries, broccoli, kale, raspberries, green tea and turmeric.

But the term ‘superfood’ is just a marketing term used to try to sell these foods. There is no scientific evidence for any type of food being a ‘superfood’. It is much better to eat a balanced diet that includes a wide range of foods.

You should aim to eat a diet that includes lots of different types of fruit, vegetables and wholegrain foods. This will help you make sure you are getting the widest possible range of nutrients. It may make your diet more enjoyable and interesting. It will probably cost less too.

Should I follow a dairy-free diet?

Dairy products, such as milk, cheese and yoghurt, are an important source of protein, calcium and some vitamins. Calcium is needed for strong bones and teeth.

Many research studies have looked for a link between diets that have a lot of dairy products and cancer. But these studies have not found a clear link. There is some evidence that dairy products may help reduce the risk of bowel cancer. But no links have been found for any other types of cancer.

Cancer experts do not recommend following a dairy-free diet to reduce the risk of cancer. If you prefer to follow a dairy-free diet, you need to make sure you get enough calcium from other foods, such as:

- tinned sardines and tinned salmon (with bones)

- dark green, leafy vegetables, such as spinach

- kidney beans

- dried figs

- foods fortified with calcium, such as some types of soya, rice, almond or oat milk.

Does sugar feed cancer?

All cells in our bodies need glucose (sugar). Glucose gives cells energy to survive. Cancer cells, like all other cells, also need glucose.

The idea that sugar feeds cancer developed because cancer cells grow and multiply quickly, and need a lot of glucose. It was thought that cutting sugar from our diet would starve the cancer or even stop it developing. But this is a very simple idea of the biology involved. There is no evidence that sugar directly increases the risk of cancer or encourages it to grow.

Too much sugar in our diet can increase the risk of cancer. This is because too much sugar can cause weight gain. Being overweight or obese can increase the risk of some cancers.

It is important for the healthy cells in our body to get enough energy from our diet. This is especially true during cancer treatment. As well as from sugar, our bodies get glucose and energy from starchy foods (carbohydrates), such as bread, breakfast cereals, rice and pasta. There are also sugars in some fruit, vegetables and dairy products. Sugar itself contains no useful nutrients, apart from energy. It is possible to get all the energy you need from healthier foods.

It is best to limit the amount of sugar in your diet, unless you have received specialist advice from a dietitian. Foods high in sugar include:

- biscuits and cakes

- chocolate and sweets

- syrups

- fruit juice

- fizzy drinks.

What about artificial sweeteners?

Artificial sweeteners are used in many foods and drinks. Large studies in humans have provided strong evidence that artificial sweeteners do not increase the risk of cancer.

Should I only eat organic food?

Many people wonder whether they should follow an organic diet to prevent cancer or reduce the risk of it coming back. So far, no research has proven that eating organic food will reduce the risk of cancer. Some studies claim that organic fruit and vegetables have better flavour and stay fresh for longer. But others find them expensive compared to non-organic products.

Some people worry that pesticides used in non-organic farming may cause cancer. In the UK, a pesticide can only be used once its safety has been tested. Laws ensure that all agricultural pesticides are used within a safe level.

It is your choice whether you buy organic or non-organic food. Current advice is to thoroughly wash all fruit and vegetables before you eat them, whether they are non-organic or organic. This removes pesticides and harmful bacteria.

What about GM foods?

Genetically modified (GM) foods have not been around for very long. They are not common in the UK. So far there is no research to show that they cause cancer. Because GM foods have not been available for long, their long-term effects are unknown, and more research is needed. Because of this, some people choose not to eat them.

Do anti-cancer diets work?

There have been a lot of stories about alternative diets for treating cancer over the past few years. Many dramatic claims about cures have been made. It is understandable that people want to know about diets that seem to offer the hope of a cure. But there is no evidence that these diets can shrink or cure cancer, or increase someone’s chance of survival.

Some people get satisfaction from following these types of diet. But others find them expensive, unpleasant to eat and time-consuming to follow. Some diets may lack important nutrients or be unbalanced in other ways and may even be harmful. Because some of these diets can be hard to follow, you might feel unhappy if you find it hard to do.

It can be confusing to have different advice about what to eat. Dietitians, doctors and specialist nurses recommend a well-balanced and enjoyable diet as the best way to keep healthy. If you choose to follow a specific diet, speak to a dietitian to check if you are missing any important nutrients.

Further information

We provide expert, up-to-date information about cancer. And all our information is free for everyone.

Order what you need

You may want to order more booklets or leaflets, or download more eBooks like this one. Visit be.macmillan.org.uk or call us on 0808 808 00 00.

We have booklets on different cancer types, treatments and side effects. We also have information about work, financial issues, diet, life after cancer and information for carers, family and friends.

Online information

All of our information is also available online at macmillan.org.uk/information-and-support There you’ll also find videos featuring real-life stories from people affected by cancer, and information from health and social care professionals.

Other formats

We also provide information in different languages and formats, including:

- audiobooks

- Braille

- British Sign Language

- Easy Read booklets

- large print

- translations.

Find out more at macmillan.org.uk/otherformats If you’d like us to produce information in a different format for you, email us at cancerinformationteam@macmillan.org.uk or call us on 0808 808 00 00.

Other ways we can help you

At Macmillan, we know how a cancer diagnosis can affect everything, and we are here to support you.

Talk to us

If you or someone you know is affected by cancer, talking about how you feel and sharing your concerns can really help.

Macmillan Support Line

Our free, confidential phone line is open 7 days a week, 8am–8pm. Our cancer support specialists can:

- help with any medical questions you have about your cancer or treatment

- help you access benefits and give you financial advice

- be there to listen if you need someone to talk to

- tell you about services that can help you in your area.

Call us on 0808 808 00 00 or email us via our website, macmillan.org.uk/talktous

Information centres

Our information and support centres are based in hospitals, libraries and mobile centres. There, you can speak with someone face to face.

Visit one to get the information you need, or if you’d like a private chat, most centres have a room where you can speak with someone alone and in confidence.

Find your nearest centre at macmillan.org.uk/informationcentres or call us on 0808 808 00 00.

Talk to others

No one knows more about the impact cancer can have on your life than those who have been through it themselves. That’s why we help to bring people together in their communities and online.

Support groups

Whether you are someone living with cancer or a carer, we can help you find support in your local area, so you can speak face to face with people who understand. Find out about support groups in your area by calling us or by visiting macmillan.org.uk/selfhelpandsupport

Online community

Thousands of people use our online community to make friends, blog about their experiences and join groups to meet other people going through the same things. You can access it any time of day or night. Share your experiences, ask questions, or just read through people’s posts at community.macmillan.org.uk

Help with money worries

Call us on 0808 808 00 00 to speak to a financial guide or benefits adviser, or to find out more about Macmillan Grants.

We can also tell you about benefits advisers in your area. Visit macmillan.org.uk/financialsupport to find out more about how we can help you with your finances.

Help with work and cancer

Whether you’re an employee, a carer, an employer or are self-employed, we can provide support and information to help you manage cancer at work. Visit macmillan.org.uk/work

Work support

Our dedicated team of work support advisers can help you understand your rights at work. Call us on 0808 808 00 00 to speak to a work support adviser (Monday to Friday, 8am to 6pm).

Other useful organisations

There are lots of other organisations that can give you information or support.

Nutrition and diet information and support

British Dietetic Association (BDA)

Tel 0121 200 8080

Email info@bda.uk.com

www.bda.uk.com

Provides training and facilities for registered dietitians. The website includes food facts, and has information on the role of dietitians and how to find one.

British Nutrition Foundation

Tel 020 7557 7930

Email postbox@nutrition.org.uk

www.nutrition.org.uk

The website has information about healthy eating and lifestyle choices.

Diabetes UK

Tel 0345 123 2399 (Mon to Fri, 9am to 6pm)

Email helpline@diabetes.org.uk

Tel (Scotland) 0141 212 8710 (Mon to Fri, 9am to 6pm)

Email (Scotland) helpline.scotland@diabetes.org.uk

www.diabetes.org.uk

Gives information and support on any aspects of managing diabetes, including medication, diet and exercise.

General cancer support organisations

Cancer Black Care

Tel 020 8961 4151

www.cancerblackcare.org.uk

Offers UK-wide information and support for people from Black and ethnic minority communities who have cancer. Also supports their friends, carers and families.

Cancer Focus Northern Ireland

Helpline 0800 783 3339 (Mon to Fri, 9am to 1pm)

Email nurseline@cancerfocusni.org

www.cancerfocusni.org

Offers a variety of services to people affected by cancer in Northern Ireland.

Cancer Support Scotland

Tel 0800 652 4531 (Mon to Fri, 9am to 5pm)

Email info@cancersupportscotland.org

www.cancersupportscotland.org

Runs cancer support groups throughout Scotland. Also offers free complementary therapies and counselling to anyone affected by cancer.

Macmillan Cancer Voices

www.macmillan.org.uk/cancervoices

A UK-wide network that enables people who have or have had cancer, and those close to them such as family and carers, to speak out about their experience of cancer.

Counselling

British Association for Counselling and Psychotherapy (BACP)

Tel 0145 588 3300 (Mon to Thu, 10am to 4pm)

Email bacp@bacp.co.uk

www.bacp.co.uk

Promotes awareness of counselling and signposts people to appropriate services across the UK. You can search for a qualified counsellor.

UK Council for Psychotherapy (UKCP)

Tel 020 7014 9955

Email info@ukcp.org.uk

www.psychotherapy.org.uk

Holds the national register of psychotherapists and psychotherapeutic counsellors, listing practitioners who meet exacting standards and training requirements.

Emotional and mental health support

Mind

Helpline 0300 123 3393 (Mon to Fri, 9am to 6pm)

Text 86463

Email info@mind.org.uk

www.mind.org.uk

Provides information, advice and support to anyone with a mental health problem through its helpline and website.

Samaritans

Helpline 116 123

Email jo@samaritans.org

www.samaritans.org

Provides confidential and non-judgemental emotional support, 24 hours a day, 365 days a year, for people experiencing feelings of distress or despair.

LGBT-specific support

LGBT Foundation

Tel 0345 330 3030 (Mon to Fri, 10am to 6pm)

Email info@lgbt.foundation

www.lgbt.foundation

Provides a range of services to the LGBT community, including a helpline, email advice and counselling. The website has information on various topics including sexual health, relationships, mental health, community groups and events.

Support for carers

Carers UK

Helpline (England, Scotland, Wales) 0808 808 7777 (Mon to Fri, 9am to 6pm)

Helpline (Northern Ireland) 028 9043 9843 (Mon to Fri, 9am to 5pm)

Email advice@carersuk.org

www.carersuk.org

Offers information and support to carers across the UK. Has an online forum and can put people in contact with local support groups for carers.

Disclaimer, thanks and sources

Disclaimer

We make every effort to ensure that the information we provide is accurate and up to date, but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Some photos are of models.

Thanks

This eBook has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been approved by Prof Tim Iveson, Consultant Medical Oncologist and Macmillan Chief Medical Editor.

With thanks to: Lindsey Allan, Macmillan Oncology Dietitian; Dr Shreerang Bhide, Consultant Clinical Oncologist; Claire Donnelly, Dietitian; Carolyn Faulkner, Head & Neck Oncology Clinical Nurse Specialist; Catherine Green, Oncology Dietitian; Rosie Hill, Macmillan Specialist Dietitian; Jo Pain, Oncology Dietitian; and Rachel White, Oncology Dietitian.

Thanks also to the people affected by cancer who reviewed this edition, and those who shared their stories.

We welcome feedback on our information. If you have any, please contact cancerinformationteam@macmillan.org.uk

Sources

Below is a sample of the sources used in our healthy eating information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Fang X et al. Quantitative association between body mass index and the risk of cancer: A global Meta-analysis of prospective cohort studies. Int J Cancer. 2018 Oct 1;143(7):1595-1603.

British Nutrition Foundation website www.nutrition.org.uk (accessed December 2019)

Bhaskaran K et al. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. The Lancet, August 2014.

The Eatwell Guide: Helping you eat a healthy, balanced diet, Food Standard Scotland, October 2019.

Can you do something to help?

We hope this eBook has been useful to you. It’s just one of our many publications that are available free to anyone affected by cancer. They’re produced by our cancer information specialists who, along with our nurses, benefits advisers, campaigners and volunteers, are part of the Macmillan team. When people are facing the toughest fight of their lives, we’re there to support them every step of the way.

We want to make sure no one has to go through cancer alone, so we need more people to help us. When the time is right for you, here are some ways in which you can become a part of our team.

5 ways you can help someone with cancer

Share your cancer experience

Support people living with cancer by telling your story, online, in the media or face to face.

Campaign for change

We need your help to make sure everyone gets the right support. Take an action, big or small, for better cancer care.

Help someone in your community

A lift to an appointment. Help with the shopping. Or just a cup of tea and a chat. Could you lend a hand?

Raise money

Whatever you like doing you can raise money to help. Take part in one of our events or create your own.

Give money

Big or small, every penny helps.

Call us to find out more 0300 1000 200

macmillan.org.uk/getinvolved