Nutrition is critical to any healthy lifestyle, particular to gastric cancer survivors. To that end, we have continued our Nutrition Q&A section in the newsletter. Erika Connor is a RD and CSO who works in the Cancer Supportive Care Program at Stanford Cancer Center. If you would like to ask Erika a question for a future Q&A features, please submit it at email@example.com.
Q: Do you recommend any particular meal replacements: Ensure, Protein bars, Shakes, Etc?
A: It completely depends on the situation and need of the individual. There is a time and place for most everything. Homemade shakes are nice because you have control over what goes in them. Commercial shakes are convenient and helpful for when you are on the go and don’t have the ability to make your own. Shakes and bars can certainly be helpful in increasing calorie and protein intake for someone who is struggling. There are a lot of options for people who cannot tolerate certain commercial products whether they don’t like the sweetness, are trying to control blood sugars, trying to avoid dumping after surgery or simply cannot make food for themselves on a regular basis.
Q: Any tips for successfully eating out?
A: Overall recommendations are to limit fats, salt, and added sugars. Most restaurants have healthy options flagged on their menus. Look for items that are broiled or baked; have light sauces instead of heavy cream sauces. Take to opportunity to try fish dishes, or vegetarian options. Stick to small portions, or only eat half and take the rest home. Gastrectomy patients should feel comfortable asking questions about menu items. It is important to know if an item is heavily seasoned or contains something you may have a hard time tolerating like milk, cream or cheese.
Q: What do you think about alcohol and caffeine?
A: The recommendation is to limit both, if not eliminate. Our bodies do not need either one. Based on studies, there are links between high alcohol and caffeine intake and breast, head & neck, and gastrointestinal cancers. It is best to limit caffeine to 2 cups per day. Women should limit alcohol to 1 drink per day, men to 2 drinks per day, and if it doesn’t have a significantly adverse effect on your daily life, avoid it.
Q: Have you heard about concerns regarding cooking with Teflon?
A: There is confusing and conflicting information out there regarding cooking with Teflon. Here are some recommendations about cooking with Teflon that may help limit/avoid exposure to carcinogens, until we know more:
Avoid scratched pans. Avoid high heat >350º (deep fat frying, broiling, grilling).
Avoid heating foods in sandwich wrappers, French fry bags, pizza boxes, or other food packages that usually contain Teflon and require heating. One culprit used to make Teflon is PFOAs = perfluorooctanic acid and is suspected to be a carcinogen based on animal studies.
Q: Should people be concerned about sodium nitrates and the connection to stomach cancer?
A: This subject has been debated for well over 30 years. Nitrite and nitrates are chemicals used in fertilizers and commonly used as food preservatives. They are also naturally occurring compounds that are the byproduct of the digestion of waste by bacteria, as with animal feces or nitrogen-based fertilizers. Nitrate is reduced to nitrite by acid and bacteria in the stomach or private water wells.
Dietary sources of nitrosamines come from food containing preservatives, such as cured/processed meats, hot dogs and dried salted fish common in Asia. Nitrosamines are helpful as a preservative because they protect against the growth of botulism-producing organisms, acts to retard rancidity and stabilize the flavor of cured meats.
Prior to 1923 potassium nitrate was used for meat curing. As stated above, nitrate converts to nitrite during the curing process and as you would expect, the levels were extremely high. In 1923, sodium nitrite entered the industry and became the most popular preservative. A maximum nitrite concentration was also established and as a result the amount of nitrite in cured meats has significantly decreased. There has also been a significant decline in gastric cancer rates.
Many studies have shown a positive association between nitrite/nitrosamines and gastric cancer. However, there are no firm conclusions at this time, which is probably why the debate continues. But the studies have been consistent in showing this association, which is something we need to monitor closely. According to the World Cancer Research Fund/American Institute for Cancer Research Second Expert Report it is recommended to avoid processed meats all together, which would significantly reduce if not eliminate our exposure to dietary nitrosamine sources.
Q: In general, what are your recommendations on good cancer fighting foods?
A: There are so many great properties to the wide variety of fruits, vegetables and whole grains we have available to us. Studies continue to show that these great foods reduce our overall risk of cancer, as well as risk of recurrence. Whole grains not only provide fiber but most are fortified with folate and iron. The more whole grain, the higher the protein content as well.
Broccoli gets a lot of positive press because it is in the cruciferous vegetable family, along with brussels sprouts and cauliflower. These vegetables provide many different antioxidants that have even shown to have positive effects on tumors.
There are many different fruits that are wonderful as well; the media targets the pomegranate as well as blueberries. There are also many great benefits from apples, oranges (fiber & vitamin C), grapes (resveratrol), and tomatoes (vitamin C, lycopene).
The wide variety of leafy greens are powerhouses of nutrients and provide important carotenoids, look for dark green lettuce varieties, kale, chard, bok choy to add to your menu.
And there are so many more foods that have great health benefits. An easy way to make sure you are getting a variety of all these great properties is to look at all the colors you consume in the day. Strive for as many colors as you can.