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Life Beyond Cancer - Healthy Living

To the Patient and Family:

A healthy lifestyle has many benefits for people, especially for cancer survivors. When you are eating well and getting regular physical activity, it helps you to regain your strength, manage stress, sleep better and maintain emotional health. This site offers general guidelines for people who have been diagnosed with cancer. If you have any questions about the information, please ask your health care team.

Click on the links below to read more information on these five topics:

Nutrition

Nutrition plays a big part in a healthy lifestyle after cancer treatment. A healthy lifestyle can:

  • Help you lower your risk for heart disease
  • Give you more energy
  • Lessen feelings of sadness and improve your mood

Scroll through these topics or click on one to go directly to that content:

  • Understanding Nutrition Research
  • American Institute for Cancer Research
  • Eat Healthy Foods
  • How Much Should I Eat?

Understanding Nutrition Research

With ongoing research we are starting to see more specific guidelines for cancer survivors. Most experts agree that following the guidelines for cancer prevention should be a reasonable approach for cancer survivors. This may help prevent a cancer from coming back or a second type of cancer to occur. There are several reasons why this makes sense:

  • Cancer survivors who have finished treatment may still have tiny, undetected cancer cells in their bodies.
  • Cancer survivors have a higher risk of:
    • A second type of cancer
    • Osteoporosis
    • Obesity
    • Heart disease
    • Diabetes
    • Problems with being able to perform daily activities
  • Nutrition and lifestyle changes for cancer prevention are similar to the guidelines for general good health and well-being. They offer overall health benefits in preventing disease.

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American Institute for Cancer Research

The American Institute for Cancer Research ‘s recommendations for cancer prevention have been simplified to include 3 pillars, that explain how the choices about food, physical activity and weight management can reduce your chances of developing cancer.

  • Choose mostly plant foods; limit the amount of red meat consumption
    and processed meat.
  • Be physically active every day in any way for 30 minutes or more.
  • Aim to be a healthy weight throughout life
  • Always remember-do not smoke or chew tobacco 

Cancer Prevention - balance weight, diet, and physical activity

The AICR Cancer Prevention Guidelines are as follows:

  • Be as lean as possible without becoming underweight
  • Be physically active for at least 30 minutes every day
  • Avoid sugary foods
  • Eat more of a variety of fruits, vegetables, whole grains and legumes
  • Limit consumption of red meat and avoid processed meats
  • If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day
  • Limit consumptions of salty foods and foods processed with salt
  • Don’t use supplements to protect against cancer

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Eat Healthy Foods

Plant-based foods are healthy because they give the body nutrients, such as vitamins, minerals, antioxidants, phytochemicals and fiber. Each of these nutrients is essential to good health. Examples of plant-based foods include:

  • Fruits
  • Vegetables
  • Beans, peas, and soy beans
  • Whole-grain bread, cereal, rice, and pasta
  • Olives, nuts, and seeds
  • Canola oil, and olive oil

Animal-based foods, when eaten in moderation and cooked correctly, are fine, too. Animal protein contains saturated fat, so it is better to eat lean meats. Your body makes cholesterol from saturated fat, so eating some saturated fat is OK, but eating too much of it is unhealthy. Use low-fat cooking methods, such as stir frying, baking, broiling and boiling. Do not fry meats.

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How much should I eat?

Most people only need about 6 ounces of animal protein per day.  Choose lean cuts of chicken, turkey, fish, pork and beef.  Try to limit red meat, such as beef and pork to no more than 3 ounces per day.  Other animal based protein includes:

  • Milk, yogurt, and cheese
  • Eggs
  • Venison and wild game
  • Lard
  • Bacon and ham

If you choose to eat animal protein as part of your meal, limit the portion to 3 ounces cooked which is the size of a deck of cards, or 1/3 or less of your plate.  The other two parts of the plate should be plant-based foods.

Remember to:

  • Eat five to nine servings of vegetables and fruits every day. A serving is ½ cup cooked or 1 cup raw.
    • Eat fruits and vegetables at each meal
    • Snack on fruits and vegetables
    • Limit french fries, chips and other fried vegetable choices
  • Choose whole grains, rather than processed (refined) grains and sugars. White flour and white rice are both refined grains.
    • Healthy whole grains include brown rice, quinoa, whole oats and whole barley, whole wheat pasta and whole grain cereals and breads. Choose foods made with whole grain flour.
    • Eat at least 25-30 grams of fiber per day. Good sources of fiber include bran cereals, wheat germ, wheat bran, fruits, vegetables, 100 percent whole grains, beans, soy, nuts, and seeds.
  • Limit red meats, especially high-fat and processed meats. Processed meats are cured, smoked or preserved and include hot dogs, bacon, sausage, ham and lunch meat.
    • Choose fish, poultry and beans in place of beef, pork and lamb.
       - Prepare meat by baking, broiling or poaching rather than frying or
      charbroiling
    • Add soy foods into your diet in moderation (one to two servings per day).
    • Try a meatless meal one to two times a week. Eat beans or lentils instead of meat.
  • Limit “empty calories,” which are foods with calories but few vitamins, minerals or protein.
  • Avoid sweetened cereals, sweetened juices, soft drinks, pastries, candy and other sweets 
    • Avoid fried foods and foods prepared with a lot of oils and fats. 
    • Avoid trans fats. Trans fats are created by taking a healthy plant-based oil and putting it through a chemical process called hydrogenation. This converts the oil from a liquid form to a solid form. Your body makes cholesterol from trans fats, so try to avoid all trans fats. Trans fats are in some margarines and many processed and convenience foods.
  • Avoid “fad” or severely restrictive diets. Choose foods that help you maintain a healthy weight.
  • When you eat away from home, choose foods that are lower in calories, fat and sugar. Eat smaller portions; for example, share a meal with your dinner partner.
  • Substitute salads, vegetables or fruit for calorie and high-fat foods, such as french fries, cheeseburgers, pizza, ice cream, doughnuts and sweets.

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Physical Activity

Exercise has many benefits:

  • Improves overall health and prevents disease, including diabetes
  • Improves heart and lung health, and lowers risk of heart attack
  • Helps you lose weight and maintain your weight
  • Increases your energy, endurance, strength, and flexibility
  • Lessens the effects of stress, anxiety, and fatigue and gives you emotional well-being
  • Helps you maintain normal bowel function

Always ask your doctor before starting an exercise program. Be careful if you have:

  • Severe anemia
  • Compromised immune system
  • A stem cell transplant
  • Severe fatigue
  • Radiation burn
  • Indwelling catheters
  • Significant peripheral neuropathy

Scroll through these topics or click on one to go directly to that content.

What kind of physical activity do I need?

Moderate exercise like a brisk walk is best. Start with shorter sessions (10-15 minutes) at a relaxed pace to avoid injury. Then over time, increase the length and intensity of your activity. If your doctor advises you to exercise, start slowly.

Aerobic Exercise

Aerobic exercise makes the heart and lungs work harder. Aerobic exercise moves oxygen through the blood and helps you maintain a healthy weight by burning calories.  As your strength and stamina improve, do moderate to vigorous activity for at least 30 minutes on most days. This improves fitness, heart and lung health. Please see the chart below for information on certain activities.

Activity Calories Burner per Hour
 By a 150 pound person*
Walking 3 miles per hour 320
Swimming 25 yards per minute 275
Jogging 5.5 miles per hour 740
Cross country skiing 700
Bycycling 6 miles per hour 240
*A heavier person burns more calorie; a lighter person burns fewer.

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Weight Training

Lifting weights several times per week can increase the size and strength of muscles, and improves your metabolism. Muscle weighs more than fat, so having more muscle may make your weight go up slightly. With your doctor’s approval, talk to a personal trainer for a weight-training program.

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How do I start?

  • Use the stairs instead of the elevator
  • Park at the far edge of the parking lot
  • Walk a few laps around the store before you begin to shop
  • Purchase a new or used stationary bicycle, and peddle while watching television
  • Walk, jog, or jump rope in place while watching television
  • Increase your steps by taking a longer route

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Tips for Success

  • Schedule exercise on your calendar to reserve time for this important activity
  • Find an exercise partner to help you stay with your program and to keep you company
  • Warm up and cool down at a low intensity for five minutes. Remember to stretch after both your warm up and cool down
  • Always talk to your doctor before beginning an exercise program

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Healthy Weight

Maintain a healthy weight throughout life. There are several ways to find your healthy weight. Here are two examples:

  1. Quick method: These are healthy weights within 10 percent for an average person with average activity levels.
    Women:
    Add 100 pounds for the first 5 feet of height + 5 pounds for each additional inch.  For example, a 5-foot, 4-inch woman should weigh 100 lbs + 20 lbs = 120 lbs. (Ten percent of the range lower and higher would be 108-132 lbs.)
    Men:
    Add 106 pounds of the first 5 feet of height + 6 pounds for each additional inch.  For example, a 5-foot, 10-inch man should weigh 106 lbs + 60 lbs = 166 lbs.(Ten percent of the range lower and higher would be 150-183 lbs.)
  2. BMI between 18.5 and 25
    Body mass index (BMI) uses a formula that considers both a person’s height and weight. BMI equals a person’s weight in kilograms divided by height in meters squared. (BMI=kg/m2)
    Ask your doctor or dietitian if you would like to know your BMI and the healthy BMI range for you.

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Alcohol

Alcoholic drinks are high in calories with limited nutritional benefit. In other words, they are “empty calories.” Too much alcohol causes:

  • Cirrhosis of the liver
  • Obesity
  • Heart disease
  • Liver cancer and cancers of the gastrointestinal tract, such as cancer of the mouth and esophagus

Alcohol is also linked to breast cancer and colorectal cancer, but alcohol and the link to cancer risk needs more research. We do know that drinking alcohol and smoking cigarettes adds to cancer risk. We also know that the more alcohol you drink, the greater chance you have of getting cancer and other types of disease.

What is a serving of alcohol?
If you do not drink alcohol, don’t start.
A serving of alcohol is:

  • 5 ounces of wine
  • 12 ounces of beer
  • 1 ½ ounces of liquor

Men should have two servings or less per day. Women should have one serving or less per day. Instead, try fruit smoothies, green tea, herbal teas or alcohol-free cocktails.

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Understanding Health Claims

Reading packaged foods is hard to do because the facts are not always clear. Please see below for the claims that the U.S. Food and Drug Administration allows. You can scroll through this list of topics, or click on a topic to go directly to that content.

Calories

  • Calorie free: Less than 5 calories per serving
  • Low calorie: 40 calories or less per serving
  • Diet: At least 40 percent less calories than a similar food (20 percent less calories if it is a liquid)
  • Light or lite: Food has been changed to contain ¹/³ fewer calories or ½ of the fat. It can also mean that the sodium of a low-calorie, low-fat food has been cut by 50 percent. If the food is not low calorie or low fat, it must say “light in sodium.”

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Fat and Cholesterol

  • Low fat: 3 grams or less fat per serving
  • Fat free: Less than 0.5 grams of fat per serving
  • Low saturated fat: 1 gram or less saturated fat per serving
  • Saturated fat free: Less than 0.5 grams of saturated fat per serving
  • Trans fat free: Less than 0.5 grams of trans fat per serving.
  • Low cholesterol: 20 milligrams or less cholesterol and 2 grams or less of saturated fat
  • Cholesterol free: Less than 2 milligrams of cholesterol per serving and 2 grams or less of saturated fat
  • Percent (%) fat free: This food is already low fat or fat free. It shows how much fat is in 100 grams of food. For example, if 100 grams of food has 2 grams of fat, then the food is 98 percent fat free. If the food is 75 calories, then the 2 grams of fat adds 18 calories (9 calories per gram of fat) or 24 percent of calories from fat.
  • Lean and extra lean - Tells about the fat content of meat, chicken, seafood and game.
    • Extra lean:
      Less than 5 grams fat
      Less than 2 grams of saturated fat
      Less than 95 milligrams cholesterol
    • Lean:
      Less than 10 grams of fat
      Less than 4 grams of saturated fat
      Less than 95 milligrams of cholesterol per serving

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Fiber 

  • High fiber: 5 grams or more fiber per serving 
  • Good source of fiber: 3 grams or more fiber per serving

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Organic

All organic foods are approved by national organic standards. 

  • 100 percent organic: Only organic ingredients used
  • Organic: At least 95 percent of the ingredients are organically grown
  • Made with organic ingredients: At least 70 percent of the ingredients used are organically grown

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Overall Health

  • Enriched or fortified: Food contains at least 10 percent or more of the daily value of a nutrient than a similar food.
  • More: Food has 10 percent or more of the daily value for a nutrient. This is the same for foods that are “fortified,” “enriched” and “added.”
  • Good Source of: Food contains 10 to 19 percent of the daily value for a single nutrient.
  • High/Rich in/Excellent source of: Food contains 20 percent or more of the daily value for a single nutrient.
  • Healthy: Meets limits on fat, saturated fat and sodium. Contains 480 milligrams or less sodium per serving and has at least 10 percent daily value of one of these nutrients: vitamin A, vitamin C, calcium, iron, protein or fiber.
  • Fresh: Never frozen or heated and contains no preservatives. “Fresh frozen” refers to foods that are quickly frozen while still fresh.
  • Reduced: Food contains 25 percent less of a nutrient or calories than the regular food; this cannot be claimed if the regular food is already “low” in calories.

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Sodium

  • Low sodium: 140 milligrams or less per serving
  • Very low in sodium: 35 milligrams or less per serving
  • Salt free: Less than 5 milligrams of sodium per serving

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Sugar

  • Sugar free: Less than 0.5 grams of sugar per serving
  • No added sugar: No sugar has been added, but there may be natural sugar in the food
  • Zero net carbs: Sugar alcohols and fiber have been taken away from the total carbohydrate amount in the food

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Gain Protection from Antioxidants

Antioxidants protect cells from damage caused by free radicals. Free radicals are unstable molecules that damage healthy cells, including DNA. If the DNA of a healthy cell is damaged, it can develop into cancer.
Free radicals come from:

  • Pollution
  • Radiation
  • Sunlight
  • Cigarette smoke
  • Herbicides
  • Alcohol
  • Aging
  • Injury

Antioxidants are found naturally in foods from plant sources. Examples of antioxidants are:

  • Vitamin E blocks the formation of cancer and may reduce the size of some tumors. Vitamin E is in:
    • Corn, soybean and safflower oil
    • Wheat germ
    • Nuts (sunflower seeds, almonds, peanut butter)
  • Vitamin C protects cells from damage by free radicals. It also works with vitamin E. It may also have a role in immunity, bone and collagen formation and protecting the vascular system. Vitamin C is in:
    • Kiwi
    • Citrus fruits (oranges, grapefruit, lemons, limes)
    • Strawberries
    • Cantaloupe
    • Broccoli
  • Selenium is a mineral that helps protect cells from free radicals, regulates thyroid function and plays a role in the immune system. Selenium is in:
    • Brazil nuts
    • Beef
    • Seafood
    • Turkey
    • Chicken breast
  • Zinc enhances the activity of enzymes in the body. Zinc helps in wound healing and improves the senses of taste and smell. Zinc is in:
    • Oysters
    • Red meat
    • Chicken
    • Beans
    • Nuts
    • Whole grains
    • Fortified foods (like breakfast cereal)
  • Phytochemicals are found in plant sources of food and play a vital role in a healthy diet. Read more about phytochemicals in the next section.

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What are phytochemicals?
Phyto is Greek for plant. Phytochemicals are plant chemicals that act as antioxidants and are found in fruits, vegetables, legumes, nuts, seeds, whole grains, fungi, herbs and spices. They add to the smell, color and flavor of the plant.

Phytochemicals have a major role in preventing and fighting disease in our bodies. We are still learning more about how they fight cancer. Early research hints that they may offer frontline defense against cancer.

The best way to include phytochemicals in your diet is to eat plant-based foods. The table below lists examples of phytochemicals and the foods that have them.
The key is to eat a mix, or rainbow, of colored fruit and vegetables. Choose whole grains, and eat five to nine servings of fruits and vegetables every day.

Phytochemicals Food Sources
Adiallyl sulfides Onions, garlic, leeks, chives
Anthocyanin Purple grapes, blueberries, cherries, plums, eggplant skin, red cabbage
Beta carotene Oranges, carrots, apricots, cantaloupe, mangoes, pumpkins, sweet potatos, winter squash, spinach, broccoli, kale
Capsaicin Chili peppers
Catechins Apples, grapes, pomegranates, rasberries, red wine, tea, dark chocolate
Curcumin Ginger, turmeric
Indoles Broccoli, cabbage, kale, cauliflower, Brussels sprouts
Isoflavones Soy beans, tofu, soy milk
Isothiocynates Broccoli, cabbage, kale, cauliflower, Brussels sprouts
Labiatae Rosemary, sage, oregano, thyme
Lignans Flaxseed oil, flaxseed flour, flaxseed meal (Whole flaxseed cannot be digested, so it has no health benefits.)
Lutein Kale, spinach, collard greens, Swiss chard, romaine lettuce, broccoli, Brussels sprouts, kiwi
Lycopene Tomatoes, ketchup, tomato sauce, sun dried tomatoes, guava, watermelon, red grapefruit
Monoterpenes Citrus fruits, mint, sage, cherries, cranberries
Phthalides Celery seed
Quercetin Outer part of onion
Reservatrol Red and purple grape skin, red wine, grape juice

How can I be sure of the quality of a supplement?
Unlike food, the U.S. government does not review the safety of dietary supplements. This includes all vitamins, minerals and herbal products. Therefore, it is best to use dietary supplements that are reviewed by an independent third party organization like the United States Pharmocopeia or ConsumerLab.com.

  • United States Pharmocopeia (USP) www.uspverified.org To receive the USP Verified seal of approval on a product label, the supplement manufacturer must volunteer to participate in the program. The product is then tested for quality, purity and potency. Many brand and generic supplements are USP Verified.
  • ConsumerLab.com (CL) www.ConsumerLab.com ConsumerLab performs independent reviews of dietary supplements and publishes this information on their Web site. However, this information is only available to subscribers.  Brands that meet CL standards may carry the CL seal of approval on their label.

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How do I choose a multivitamin?
Choose a multivitamin with 100 percent daily value of the nutrients that are listed on the label. This information is on the right side of the nutrition label. Avoid multivitamins that have herbal products. Herbal ingredients may interact with other prescription or over-the-counter medicine. Take multivitamins once a day with food. A multivitamin should not take the place of nutrients found in a healthy, well-balanced diet.

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Should I take additional vitamins, minerals, antioxidants or herbal products?
It is usually not necessary to take additional vitamins, minerals or antioxidants. It is best to make healthy food choices and eat a plant-based diet. Some research has found that taking single vitamins, minerals or antioxidants in supplement form does not have the same health benefit as eating the whole food. In some cases, excess or high doses of some supplements can be harmful. Some supplements may also interfere with prescription or over-the-counter medicine.

Talk to your health care team about any dietary supplements you are taking or those you have questions about. If you are taking blood-thinning medicine this is especially important.

There is not enough research data to say if herbal supplements are safe or useful. Herbs vary from region to region and from each other, so it is hard to know if herbal supplements are all the same. Talk with your health care team before taking these.

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Soy and Breast Cancer
Currently, the research is unclear on whether or not breast cancer survivors should avoid or limit their intake of soy foods.

At the present time, most experts agree that it is probably safe and possibly beneficial for breast cancer survivors to eat up to three servings of soy foods per day.

Soy is a protein-rich food in the legume family. Soy-based foods can be used as low fat entrees or meat replacements, but they are also used in side dishes, soups, beverages, snack bars, and other foods. Soy is available in many forms such as fresh and dried soybeans, soybean sprouts, tofu, soy milk, and in processed foods such as snack bars, frozen foods/meals, and soy protein powder drinks. Some studies suggest that whole soy foods are a better source of the substances that influence cancer prevention.

Soy contains components that may help in cancer prevention; however, these same components may interfere with certain anti-cancer treatments.

  • Isoflavones found in soy are chemically similar to the hormone estrogen.
  • Isoflavones compete with estrogen for receptors. This lowers estrogen levels   in the body and may decrease the risk of breast cancer.
  • Isoflavones can also increase estrogen activity, which may enhance cancer development, especially in women with hormone sensitive cancer.

Genistein and daidzein are types of soy isoflavones associated with cancer prevention. They are often sold in dietary supplements. At this time there is no scientific evidence available to support use of isoflavone supplements by breast cancer survivors.

Tamoxifen and similar drugs are prescribed for some breast cancer survivors because they can block the effects of the body’s estrogen. At this time researchers are unsure whether soy can work with tamoxifen to block estrogen or if soy may interact with tamoxifen to increase the chance of cancer recurrence.
More research is needed, but at this time a moderate intake of soy (up to 3 servings a day) is considered safe.

If you are thinking about adding soy to your diet, it is important to discuss:

  • The stage of your cancer
  • Your usual dietary intake including history of eating soy foods
  • Your menopausal status
  • Whether you have a positive or negative weight history
  • What was the receptor status of your tumor (Estrogen/Progesterone +/-)

If you are currently eating soy foods, a moderate amount (no more than 3 servings per day) is considered safe and acceptable.

High doses of concentrated sources of soy such as that found in soy powders and isoflavone supplements are not recommended due to the potential estrogen-like effects and lack of safety data.

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Special Considerations
Do you have another chronic health problem, such as diabetes, heart disease, liver disease or kidney disease? You can still live a healthy, enjoyable life. In addition to these guidelines, monitor your carbohydrate, protein, salt and/or fat intake.

Seeking advice from a registered dietitian will benefit you and help you improve your health. Registered dietitians are licensed specialists. Their extensive education and training prepare them to create and implement unique care plans for patients during treatment and recovery.

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How Do You Feel?
After cancer treatment, you may feel different. Your normal routine changed when you started treatment, and now that it is finished, your routine will change again.
 
It is normal and OK to feel different about yourself and how you relate to the world around you. As a cancer survivor, you may have changes in your physical, social, emotional and/or spiritual self.

Having a good support group of friends or family will help you through this time in your life. For some patients, counseling and/or support groups provide extra benefits in helping to work through post-treatment experiences.

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Resources

National Cancer Institute:  www.cancer.gov

American Botanical Council:  www.herbalgram.com

American Cancer Society:  www.cancer.org

Academy of Nutrition and Dietetics:  www.eatright.org

National Center for Complementary and Alternative Medicine: www.nccam.nih.gov 

Natural Medicines Comprehensive Database:  www.naturaldatabase.com

American Institute for Cancer Research:  www.aicr.org

Adapted from MD Anderson Nutrition Guidelines

 

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Outcomes - Maine Medical Center Cancer Institute

Maine Medical Center Cancer Institute Team

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