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What are dietitians?

Dietitians are qualified and regulated health professionals that use the most up-to-date public health and scientific research on food, health and disease. They translate this research into practical guidance to enable people to make appropriate lifestyle and food choices.

Dietitians are the only nutrition professionals to be regulated by law, and are governed by an ethical code to ensure that they always work to the highest standard. (Taken from the British Dietetic Association)

What we do

We have a team of dietitians that see patients during their hospital stay. They help those who are unwell or have just had surgery to eat well and meet their nutritional needs during illness. This may involve helping people by advising nourishing foods and drinks, oral nutritional supplements and in some cases this may involve tube feeding or intravenous nutrition. 

Nutrition in Cancer clinic

The dietitian in this clinic can give you tailored and practical advice to help you manage any dietary concerns relating to your cancer, cancer treatment or longer term treatment side effects.  This might include:

  • Concerns about your weight
  • Gastrointestinal symptoms e.g. diarrhoea, constipation, wind, bloating and pancreatic enzyme replacement therapy
  • Eating when you have a stoma
  • Eating well when you are living with cancer and beyond

We can offer one to one appointments face to face, on video call or over the telephone.

How can I be referred to the dietitian?

Ask your health care professional to refer you (e.g. nurse, cancer support worker, doctor or GP)

Refer yourself! Download our self referral form.

Self referral forms are also available at the Cancer information and support centre on level 4 BHOC and at the Trust's health and wellbeing events (see below) 

If you are an inpatient, your nurse or doctor can refer you.

How can eating well help?

In addition to the many physical health benefits, taking steps towards eating well during cancer treatment can give you a sense of control, by focusing on something positive that you can do for yourself.

It may help to:

  • Boost your immunity
  • Improve your overall health and sense of wellbeing
  • Improve energy levels and reduce fatigue
  • Speed up your recovery after treatment
  • Improve your sleep
  • Manage some of the side-effects of treatment
  • Reduce the risk of your cancer coming back.

It is important not to lose weight during treatment, even if you are overweight and would like to. 

The effects of unintentional weight loss may mean:

  • You are more likely to lose muscle than fat. This can affect your strength, mobility and energy levels.
  • You are more at risk of infections and treatment side effects
  • Your body shape could change. This could affect the accuracy of your radiotherapy treatment because the X-rays are targeted at tumour cells.  If your body shape changes the radiographers may need to re-plan your radiotherapy to ensure they can treat accurately.
  • Your chemotherapy doses may need to be adjusted as chemotherapy treatments are often prescribed based on your weight.

 If you are losing weight without trying, you can find dietary information to help prevent further weight loss here.

What does eating well mean?

Food

Click on image to enlarge

The Eatwell Guide is a visual representation of how different foods contribute towards a healthy balanced diet. Trying to get all food groups in across the day or week will help you achieve a healthy balanced diet and get all the nourishment your body needs from food. The Eatwell guide is applicable for the general population and for people with cancer.

Fruit and vegetables:

  • Aim for 5 portions or more fruit and vegetables per day. A portion is 80g of fresh fruit or vegetables.
  • Fresh, frozen, or canned fruit and vegetables all count.  One portion of dried fruit (30g) and 1 portion of juice (150ml) also count as one of your 5 a day.
  • Fruits and vegetables provide the body with vital vitamins and minerals, phytonutrients and fibre.   

Potatoes, bread, rice, pasta and other starchy carbohydrates:

  • This group should make up a third of our daily intake.
  • Examples include bread, rice, potatoes, pasta, cereals, cous- cous, crackers and plain biscuits and other grains.
  • Try to choose wholegrain/higher fibre varieties unless you have been told otherwise by a healthcare professional. Foods rich in fibre and wholegrains provide us with vitamins and minerals and can help regulate bowel movements to prevent constipation.

Beans, pulses, fish, eggs, meat and other proteins: 

  • Meat, fish, beans, pulses, nuts, Quorn, soya and eggs.
  • Aim for 2 portions of fish each week, ideally one of which should be an oily fish e.g. salmon, mackerel, pilchards, sardines, or trout.
  • These foods are a good source of protein which is essential for growth, strength and repair especially after surgery and during cancer treatments.

Dairy and alternatives:

  • Cow's milk, yoghurt, cheese, dairy alternatives
  • These foods are a good source of protein and vitamins and minerals e.g. Vitamin B12, calcium and iodine
  • When choosing alternative milks be mindful that many have far less protein than cow's milk and are not nutritionally equivalent so you will need to ensure you get protein from other food sources. Try to ensure that dairy alternatives are fortified with Calcium.

Oils and Spreads:

  • These foods are the most energy dense foods. We need very small portions to obtain the nutritional benefits from them.
  • Try to choose unsaturated (vegetable) oils and spreads where possible e.g. olive or rapeseed oil, avocado nuts and seeds. 

Foods high in fat and sugar:

  • E.g. cakes, biscuits, ice cream, fried foods, takeaways, sugary drinks and sweets
  • Eat in moderation. These foods are generally high in calories (energy) and if eaten in excess can lead to weight gain.

Fluids:

  • Fluid is really important for hydration. Good hydration levels can also help with energy levels and concentration.
  • Aim to have at least 6-8 cups of fluid per day. This includes water, tea, coffee, low fat milk, or sugar free drinks but alcohol does not count! Fruit juice and smoothies can be counted but limit to a total of 150ml per day. 
  • You may need to drink more if you are having chemotherapy or if you are having treatment side effects such as constipation, diarrhoea and vomiting.

Dietary recommendations for cancer prevention and after cancer treatment

The World Cancer Research Fund (WCRF) recommends the following for cancer prevention and for health and wellbeing after cancer treatment.

  1. Be a healthy weight - After choosing not to smoke, being a healthy weight is one of the most important ways you can reduce your risk of cancer and other health conditions such as diabetes and heart disease. The WCRF Be a Healthy Weight guide can be found here.
  2. Move more
  3. Enjoy more wholegrains, vegetables, fruits and beans
  4. Limit processed foods high in added sugar, or low in fibre or high in fat
  5. Limit red meat (such as beef, pork and lamb) to 350-500g (cooked weight) per week and avoid processed meat (e.g. bacon, salami, chorizo, ham, corned beef)
  6. Limit sugar sweetened drinks
  7. For cancer prevention, don't drink alcohol (if you do, limit to 14 units per week with at least 2 alcohol free days)
  8. Don't rely on supplements to protect against cancer

Chemotherapy can interfere with the body's natural defence against infections and may:

  • Reduce numbers of white blood cells (neutrophils) which normally protect us against food poisoning bacteria. 
  • Damage the gut lining which provides a barrier between bacteria and our blood stream.

If you get a food-related infection during cancer treatment, it may be more serious and take you longer to recover. This may delay or interfere with your treatment, so it's best to be careful and try to avoid infections.

Important points to remember: 

Wash your hands thoroughly.   Wash your hands in hot soapy water before and after handling food, and dry them using a clean towel or paper towel.

Keep the kitchen clean. Wash all surfaces, cutting boards and utensils with hot soapy water. Make sure tea towels, cleaning cloths, sponges and brushes are changed regularly.

Prepare and store raw and cooked food separately. Keep a separate chopping board for raw meats and fish. Always clean the board thoroughly after each use. Cover and store uncooked meat and fish at the bottom of the fridge.

Keep canned food clean. Wash the can and the can opener before using.

Check all 'use by' and 'best before' dates carefully. Avoid buying foods on their use by date, and do not eat them after this date.

Avoid damaged or mouldy foods and those in damaged containers.

When shopping, take chilled and frozen food home quickly to refrigerate or freeze.

Take extra care when buying take-aways and eating out. Try to buy food which is freshly cooked and from a clean space. Look for the food hygiene rating sticker in the window.

Store eggs in a cool, dry place, ideally in the fridge. Make sure the egg shells are clean before cracking. Cook eggs well and do not eat food containing uncooked eggs.

Check fridge and freezer temperatures regularly. Fridge temperatures should be 5°C or lower, and freezer temperatures below -18ºC.

Wash and scrub fruit and vegetables very well before preparation.

Cook food well, especially meat, poultry and fish products. Always follow the manufacturers' cooking instructions carefully. Check food is very hot throughout the dish, especially if using a microwave. A food thermometer can be useful.

Keep cold food cold and hot food hot. Eat hot food within two hours of cooking, and all cold foods within four hours of preparation, unless refrigerated.

Do not eat leftover food from another meal. Eat rice as soon as it is cooked and never reheat.

If freezing home cooked foods cool the food at room temperature within an hour of cooking and then freeze it. Avoid putting hot food in the fridge or freezer.

Reheat frozen food safely. Defrost frozen portions in the fridge overnight (consume within 24 hours of defrosting) or defrost in the microwave. Reheat thoroughly in the oven until piping hot throughout. Never refreeze products once thawed.

Keep pets away from the kitchen and your food.

You will need to make further changes to your diet if you are having a bone marrow transplant, high dose chemotherapy and/or an autograph stem cell transplant. A healthcare professional will let you know if this is the case.

 

Are there any foods I should avoid?

Most foods if stored, prepared and cooked correctly are safe to eat. However, if you are having chemotherapy we suggest you avoid some foods which are likely to contain harmful bacteria during the time when your white blood cells are lowest and you are most vulnerable to infection.

These foods include raw or undercooked meat, poultry and eggs, unpasteurised dairy products including mould ripened and blue veined cheese (e.g. brie, camembert or stilton), pȃté, sushi and sashimi.

For more information please see our leaflet on food safety during cancer treatment.

 

What if eating becomes difficult?

Where possible, try to eat as healthily as you can, however there may be times when supporting your health and coping with cancer or treatment-related side-effects means that you need to adjust the way that you eat.  Dealing with some of the side effects of treatment requires patience and a willingness to experiment with different meal patterns, flavours and foods.

For information specific to some of the common symptoms and side effects of cancer and cancer treatments, please view a series of videos produced by The Royal Surrey dietitians.

Coping with a small appetite

Loss of appetite during cancer treatment is very common and can be related to the physical and emotional effects of cancers, or the side-effects of your surgery or treatment. Often a loss of appetite can make it difficult to eat as much as normal and can result in weight loss.

When your appetite is low or you have lost weight without trying you may need to make different food choices to what you are used to. When you are eating less, it is important to make sure what you do eat is as high in nutrients, calories (energy), and protein as possible. This can help to avoid weight loss and help you feel as well as you can.

For ideas of how to make your diet more nourishing click on the following links:

Coping with a small appetite

Coping with a small appetite on a plant based diet

Coping with a small appetite when you have diabetes

Sore mouth and throat

If eating and drinking is painful speak with your healthcare team as they may be able to advise and prescribe mouthwashes or medications to help ease the discomfort. Some of these may be best taken 20-30 minutes before eating but always follow the advice of your healthcare professional.

For dietary tips on coping with a sore mouth and throat read our leaflet.

Dry mouth

Often people find that regularly sipping drinks and choosing moist foods help them cope with a dry mouth, however, some find that special lozenges and chewing gums can also be helpful and are available to buy from a pharmacy. Artificial saliva is also available on prescription. Talk to your doctor or nurse about these.

For further dietary tips on coping with a dry mouth.

Taste changes

Sometimes as a result of cancer or cancer treatments and medications, the taste of your food changes. Some people may find foods taste too salty, too sweet or they may not taste of anything at all. Some people report a metallic taste, and others will report that everything tastes like 'cardboard'. For others some things just might taste 'off'.

Dealing with taste changes requires patience and willingness to experiment with different flavours and combinations of food and drinks. Here are some tips to help with your eating when you have taste changes.  

Nausea 

If nausea and vomiting is caused by your treatment, your doctor may need to prescribe anti-sickness medication. These medicines work in different ways so it may take time to find the right one for you. If they are not working for you, speak with your healthcare team.

There are some dietary recommendations to help manage your nausea.

Diarrhoea

Diarrhoea is a common side effect of cancer treatments and medications as well as after bowel surgery. Chemotherapy and pelvic radiotherapy can affect the lining of the bowel, causing looser bowel movements. This is usually temporary.

Infections and certain medications such as antibiotics can also give you diarrhoea. It's important to discover the cause of your diarrhoea to ensure that it's correctly treated or managed. If you are having diarrhoea please talk to your healthcare team about it.

  • Drink plenty to replace the liquid you have lost and avoid dehydration. If the diarrhoea is very frequent consider adding salt to foods or eating salty foods and drinks e.g. savoury drinks and crisps.
  • Limit or avoid caffeinated and alcoholic drinks as they can act as stimulants to the bowel and may make diarrhoea worse.
  • Limit fatty, greasy and oily foods as these can also make diarrhoea worse for some people.
  • For some, reducing the amount of fibre (roughage) in the diet in the short term can be helpful. Fibre can be found in the skins, pips and seeds of fruits vegetables and grains so peeling fruit and vegetables and choosing white or low fibre cereals and bread e.g. white bread, corn or rice based cereals will help reduce the fibre in your diet. You can reintroduce these higher fibre foods once the diarrhoea has settled as this is an important part of a healthy diet.
  • People who have had bowel surgery may have an altered bowel habit after surgery which differs to before surgery. The advice above may still be helpful but you can talk to your healthcare team about what is to be expected after surgery.

Constipation

Constipation can be caused by medications for example some chemotherapies, painkillers and antisickness medications. Changes in diet and reduced activity during cancer treatment can also affect your bowel habits. Sometimes laxatives are needed; you can speak to your healthcare team about this.

Some of the following tips can also help:

  • Caffeine, for example in tea, coffee and some fizzy drinks can sometimes have a mild laxative effect. However, be aware that caffeine is a stimulant and can affect your sleep pattern.
  • Increasing the amount of fibre that you eat can also help with constipation. Foods which are naturally high in fibre are fruits, vegetables, whole grains and beans and pulses. For packaged foods a good source of fibre would contain more than 3g of fibre per 100g. You can find this out by looking at the nutritional information on food packaging.
  • Be mindful that increasing fibre intake can cause abdominal symptoms of bloating and gas but this should settle
  • Be sure to drink plenty of fluids when increasing your fibre intake and increase fibre gradually to minimise symptoms

Inform your healthcare team if you remain constipated after trying these measures.

If you are having treatment that involves the bowel, you should always seek specialist advice from your healthcare team before increasing your fibre intake. 

Fatigue and tiredness

Fatigue can make food shopping, meal preparation and eating more difficult. Eating a nutritious and balanced diet can be an important step towards improving your energy levels.

Practical tips:

  • Make the most of times when you have more energy to plan meals, or batch cook. Freeze individual portions for the days you have less energy or time.
  • Take friends or family up on any offers to help with food shopping or preparation.
  • Using items which can be kept in the kitchen store cupboard or freezer can help simplify meal and snack preparation. Some foods are available pre-portioned for ease of preparation.
  • Eat when you feel like it, even if this differs from your normal eating pattern.
  • Soft, moist foods require less chewing and therefore can be easier to eat.
  • Most supermarkets offer an online home delivery service.
  • Ready-prepared/frozen meals can be delivered by a meal delivery companies or supermarkets. Or some companies offer recipe boxes with all the ingredients needed to prepare a meal.
  • Some people find it helpful to set alarms or write daily checklists to prompt them to eat, this can be useful when you have lost interest in food
  • Local voluntary organisations may also be available in your area (ask your Cancer Support Worker or the Cancer Information and Support Centre at Level 4 Bristol Haematology and Oncology Centre or First floor Weston General Hospital).

 

 

What should I do if I am losing weight without trying?

Your nutritional requirements can increase during times of illness, after surgery and when you have cancer, this can cause weight loss. Choosing high energy and protein foods can help increase your nutritional intake. You will find ideas of ways to do this in the 'Coping with a small appetite' leaflet. If you continue to lose weight speak with your healthcare professional for advice.

What should I do if I am gaining weight?

Having cancer and cancer treatment can affect our lives in many ways. Sometimes people find they are less active than normal, or symptoms like fatigue and lots of appointments can make it difficult to cook meals. Certain medications such as steroids can also increase your appetite and may lead to eating more in the short term.

If you are gaining weight and eating more try to follow a healthy balanced diet. It can also help to be mindful of your portion sizes and choose healthy snacks.

British Nutrition Foundation - Portions 

World Cancer Research Fund - Be A Healthy Weight

Does sugar feed cancer?

There is no strong evidence to suggest sugar directly increases cancer risk or cancer progression. If the body is starved of foods containing natural sugars such as dairy, fruits and vegetables, starchy carbohydrate such as grains, and added sugars such as cakes and biscuits, then the body breaks down its muscle protein and fat stores to give the body a source of sugar. Therefore, a diet low in natural or added sugar will not stop cancer cells getting energy. Additionally, cutting out food groups can cause malnutrition, and loss of weight and strength.

It is useful to remember that foods high in sugar, and sugary foods like cake, confectionary and fizzy drinks are often high in calories and in quick-release energy, which can result in increased weight gain and body fat, which are known risk factors for many cancers. These foods are also low in other nutrients. Therefore as part of a healthy diet, it is a good idea to limit sugar and sugary foods.

Instead of refined carbohydrates, like white bread/rice/pasta choose foods which are rich in fibre and slower release carbohydrates such as whole grain bread, pasta and cereals and brown rice, and all potatoes with their skin on. These provide fibre and other nutrients, as well as energy for the body.

Is red meat bad for you?

Red meat is a good source of protein and minerals such as iron and can form part of a healthy, balanced diet, but we don't need it every day. The evidence suggests that regularly eating more than 350-500g red meat (cooked weight) or 700-750g raw red meat per week can increase the risk of bowel cancers. Other sources of protein are recommended such as fish (1-2 portions per week, 1 of which oily), lean poultry, eggs, beans and pulses or vegan/vegetarian alternatives such as Quorn or tofu.

There is strong evidence that processed meats increase the risk of  bowel and stomach cancers. Processed meats are those that have been smoked, cured, or had salt or chemical preservatives added to it rather than having just been cooked or reformed (like some sausages and burgers). Processed meats include bacon, salami, chorizo, corned beef, pepperoni, pastrami, hot dogs and all types of ham. (These are all generally higher in fat and salt). The World Cancer Research Fund continuous update report recommends avoiding processed meat.

Should I take dietary supplements to protect against cancer recurrence?

There is currently no evidence that dietary supplements can reduce the risk of recurrence or improve the likelihood of survival. There is strong evidence that taking high doses of some supplements may be harmful and may interact with some cancer treatments. It is better to obtain essential nutrients from foods as opposed to supplements. Some dietary supplements may be indicated where there is an identified clinical need (such as calcium and Vitamin D for individuals with osteoporosis, or when someone is unable to manage a normal, balanced diet), and in such cases, a doctor, dietitian or specialist nurse can offer advice. If you are taking nutritional supplements please discuss this with your doctor or pharmacist. 

World Cancer Research Fund - supplements

Is juicing vegetables and fruit a good way to increase vitamin and mineral intake?

It is much better to eat whole vegetables and fruits than to juice them because they contain fibre as well as less concentrated amounts of sugar. Some of the natural goodness may be lost in juicing, as some vitamins deteriorate rapidly after cutting or chopping. Eating whole fruits or vegetables are also more filling.

Juicing, can however, add variety to the diet and can be a good way to eat fruit and vegetables for people who have difficulty swallowing or chewing.

Should soya be avoided if you have a hormone responsive cancer?

Soya foods can provide a useful source of protein, particularly for those who follow a vegetarian or vegan diet. Some people think that they need to avoid soya based products following a diagnosis with a hormone responsive cancer. Present guidance from the World Cancer Research Fund is that soya can be included as part of a healthy diet if liked, as research so far has not shown soya to either increase or decrease risk of these cancers. Soya supplements, however, should be avoided due to their concentrated nature and limited research into their safety.

Is red wine protective against cancer?

There is strong evidence that alcohol increases the risk of a number of cancers such as cancers of the mouth, pharynx, larynx, oesophagus, liver, bowel and breast cancer. Strong evidence refers to conclusions of "convincing" and "probable" associations. Alcohol is also high in calories so can lead to weight gain.

For cancer prevention, the recommendation is either to avoid alcohol, or limit intake to 14 units for both men and women, spread evenly over the week. 

Do 'superfoods' help to boost immunity?

While certain foods have been reported to have cancer-protective effects and other health benefits, there's no such thing as a 'superfood' despite thousands of websites claiming otherwise. It's a marketing term used to sell products and has no scientific basis. No one food in isolation can have a profound effect on our health, or provide all the nutrients we need. 

However some foods are clearly healthier than others. Choosing foods such as blueberries, beetroot, and broccoli is a great idea, and eating a range of different fruit and vegetables is helpful too, but the specific types doesn't really matter.

Watch our FAQ webinar

Information on the Cancer research Uk page.

Self referral:

Download our self referral form

 

Download our resources:

Coping with a small appetite  

Coping with a small appetite on a plant based diet

Coping with a small appetite and diabetes

Easy to eat for people with diabetes 

Eating with a sore mouth and throat 

Eating with a dry mouth

Taste changes 

Nausea and vomiting 

Easy to eat

Food safety during cancer treatment

Nutrition support when swallowing is difficult

 

Information videos:

The Royal Surrey Dietitians have created a number of helpful short videos covering the side effects and frequently asked questions.

 

Other recommended links:

WCRF

World Cancer Research Fund

 

Our cancer prevention recommendations | WCRF UK (wcrf-uk.org)

 

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Macmillan Cancer Support

Cancer information and support - Macmillan Cancer Support

 

 

 

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Cancer Research UK

 

3Nutritional supplements advice

 

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Eating well during cancer treatment

Eating well when eating becomes difficult 

These resources have been written by dietitians across the Bristol and Weston area, Macmillan and Penny Brohn.

 

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Trekstock

This website provides advice about food and cancer for young adults.

 

 

 

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NHS Choices

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British Dietetic Association 

Untitled Design (30)

British Nutrition Foundation

  


Healthy weight information

World Cancer Research Fund - Healthy weight

Macmillan - Tips for weight loss 

Recipes

World Cancer Research Fund recipes  https://www.wcrf-uk.org/uk/recipes/recipes-home

World cancer research fund Ryan Riley recipes - These recipes are designed for people who are experiencing taste changes 

Macmillan recipes

Examples of organisations/companies which provide a meal delivery service include:

Tumour specific sites:

Leukaemia care

Lymphoma association

Myeloma UK 

Breast cancer care 

Bowel cancer care 

Pancreatic Cancer UK 

Oesophageal patients association