Nutrition can be puzzling enough, but when you add a cancer diagnosis and a global pandemic, it’s even harder to make sense of it all. Julie Lanford, MPH, RD, CSO, LDN, "The Cancer Dietitian" for Cancer Services, will help put the pieces together so you’re equipped to navigate nutrition during cancer and COVID-19.

1. Navigating Nutrition During
Cancer and COVID-19
SHARE Cancer Support
Julie Lanford, MPH, RD, CSO, LDN
Wellness Director, Cancer Services, Inc.
Author, www.cancerdietitian.com
Aug 18, 2020

2. • Registered Dietitian Nutritionist
• Board Certified Specialist in Oncology
Nutrition
• MPH, UNC Chapel Hill
• BS in Biology, NC State University
Expertise:
About Julie

3. Topics
Nutrition for Treatment
Nutrition for Survivorship
Cancer Myths
Cancer Truths
Plant Based Diet Recommendations
Food Safety & COVID-19

4. Nutrition
During
Treatment

6. ● Lessen side effects
● Support your immune system
● Help maintain weight
● Keep you energized
What can nutrition do for me during cancer
treatment?

7. What can nutrition do for me during cancer
treatment?
Calorie and protein needs
aren’t met
Can’t get enough food
Body is not strong enough
to tolerate treatment
Missed Treatments
Fat & muscle losses in the
body
Weight loss
Feel weak and tired
Fatigue & Poor Immune
Function
Body uses fat and muscle
stores to meet nutrition
needs
Use energy stores
Treatment is less effective
Worse Outcomes
Calories and protein needs
are met
Meet nutrition needs
Tolerate treatments and
blood counts are stable
Treatments are Tolerable
Weight is stable
Immune system supported
and more energy
Immune System & Energy
Body is able to add to
stores and meet nutritional
needs
Build energy stores
Best chance at good
outcomes
Effective treatments

8. How do I know if I am not eating enough
calories and protein?
● Weight loss
● Muscle loss
● Muscle weakness
● Less energy
● Easily fatigued

9. Trouble Shooting
For ideas on how to manage side
effects during treatment and
maintain calorie and protein intake,
talk with your treatment center
dietitian!
Also visit
www.cancerdietitian.com/tips!

10. Questions?

11. Nutrition
For
Survivorship

13. Cancer
Myths

14. Myth #1
Myth: Sugar Feeds Cancer
Fact: All our cells, cancerous or not, use
glucose for energy. Our body doesn’t pick
and choose which cells get what fuel

15. Myth #2
Myth: Breast Cancer Survivors should avoid soy
Truth: Eating soy in moderate amounts (1 to 2
standard servings a day) does not increase a
woman’s risk for recurrence or death. The human
evidence, clinical and epidemiologic,
overwhelmingly shows isoflavone exposure is not
harmful for, and may even benefit breast cancer
patients.

16. Myth #3
Myth: Meat and Dairy cause cancer, you
should never eat it.
Fact: It does not appear that vegetarian or
vegan diets are any more protective than
plant-based diets that include moderate to
small amounts of animal foods.

17. Myth #4
Myth: Acidic Diets cause cancers.
Fact: There’s no good evidence to prove that
diet can manipulate whole body pH, or that it
has an impact on cancer.

18. Myth #5
Myth: Superfoods prevent cancer
Fact: There’s no such thing as a ‘superfood’.
It’s a marketing term used to sell products
and has no scientific basis. It’s gross
oversimplification to say that any one food,
on its own, could have a major influence over
your chance of developing cancer.

20. Cancer
Truths

21. Truth #1
Recommendation:
Make whole grains, vegetables, fruits, and legumes like beans and
lentils a major part of your normal diet. Do this by aiming to make
most of your plate plant based foods.
Why:
Research shows that benefits of eating a mostly plant-based diet
include cancer risk reduction and a healthier life. Plants are high in
fiber, vitamins, minerals, and phytochemicals that have unique
benefits in the body. Additionally, plants help to manage body
weight and provide energy to the body.

22. Truth #2
Recommendation:
Limit processed foods in order to control your calorie intake.
Switch out fast food restaurants with fast foods like fruits,
vegetables and whole grains and choose foods in the grocery
store that are minimally processed and contain fiber.
Why:
Processed and fast foods are calorie dense, but not rich in
nutrients. These foods can contribute to weight gain.

23. Truth #3
Recommendation:
Eat moderate or low amounts (12-18 oz) of red meat, such as
beef, pork, and lamb per week. Limit processed meat consumption
to as little as possible.
Why:
Red meat is not necessary to a healthy diet, but it is a good source
of protein, iron, zinc and vitamin B12. Eating more than 18 oz of
red meat/week can increase your cancer risk.

24. Truth #4
Recommendation:
Limit Consumption of Sugar-Sweetened Drinks
Why:
The myth that 'sugar feeds cancer' is not completely true. However,
regularly consuming sugary drinks contributes to weight gain. Water
is the best alternative. Unsweetened tea and coffee are also healthy
options.

25. Truth #5
Recommendation:
The less alcohol you drink, the lower your risk for cancer.
Why:
Alcohol is broken down into acetaldehyde in the body which
damages DNA and prevents the body from repairing the damage.
DNA damage affects cellular growth, which can encourage the
development of cancer cells.

26. Truth #6
Recommendation:
Move more and sit less. Be physically active for at least 30
minutes at least 5 times a week.
Why:
Our bodies function best when we are using them. Physical
activity has been proven to reduce cancer-related fatigue,
improves our mood and helps keep our metabolism at a healthy
level.

27. Truth #7
Recommendation:
Be a Healthy Weight.
Why:
Maintaining a healthy weight is one of the most important things you can do to reduce
your risk of cancer. AICR has found that any amount of excess body fat is linked to a
higher risk of cancers.

28. Truth #8
Recommendation:
Don't use supplements to protect against cancer.
Why:
To reduce your risk of cancer, choose a balanced diet
with a variety of foods rather than taking pills, powders,
juices or extracts for nutrients.

30. No studies have shown that people
who consume organic foods have
better health outcomes.
Bonus Truth

31. Plant Based
Eating

32. What is your food intake pattern?
What does plant based mean?
Eating food with a focus on plants such as fruits,
vegetables, whole grains, beans, and nuts.
Including limited amounts of animal foods such as low-fat
dairy, fish, and animal meats.
What are the benefits of plant based foods?
High in fiber, phytochemicals, vitamins, and minerals.
Low in added sugar, fat, and sodium.

33. Health Benefits of a Plant-Based Diet

35. Phytochemical Meter
Each day fill up your phytochemical meter as
much as possible!
Phytochemicals come from:
• Plant foods
• Less processed foods
• Variety of colors

36. Typical American or Healthy Survivor?
Frosted Flakes Oatmeal with fruit &
Cinnamon
Coffee Green tea
OJ Green smoothie
Nabs Yogurt & Fruit
Cheeseburger Sandwich with hummus &
veggies
Fries Minestrone Soup
Coke
Candy Bar Fruit
Trail Mix
Chicken
Green Beans Veggie Pizza
Potatoes Kale Salad
Salad
Ice Cream Chocolate Avocado
Pudding

38. Plant Based
Diet Daily
Goals
1 cup fruit with breakfast
1 cup veg with lunch
1 cup veg with dinner
Fruit or veg with snacks
Fruits & Veggies
4-5 cups EVERY DAY

39. Plant Based
Diet Daily
Goals
● Choose beans, nuts, or seeds as
protein at least one meal a day
● If eating meat, a small portion is
adequate (size of a deck of cards)
● 15-35 grams at meals
● Spread out throughout the day
Protein

40. Plant Based
Diet Daily
Goals
● 2-3 cups per day (4-6 servings)
● Choose 100% whole grain instead
of enriched “white” grains
100% Whole Grains

41. Plant Based
Diet Daily
Goals
● Drink 64 ounces a day from water,
unsweet tea or coffee
● Choose plain versions of foods and
flavor them yourself at home
● Drink water and unsweet tea or
coffee instead of sugar-sweetened
beverages of enriched “white”
grains
Fluids

42. Plant Based
Diet Daily
Goals
Flavor foods with plant based herbs and
spices instead of salt based flavorings
Flavor

43. Food Safety and
COVID-19

44. Where is the Risk?
• The greatest risk is for respiratory transmission. Coughing, sneezing,
breathing around someone who is infected. Some infected people do not have
symptoms!
• Less likely risk from contaminated surfaces (can technically live on
cardboard 24 hours and plastic/steel for 2-3 days). Touch a surface -> touch
your face.
• Unlikely spread from food. “The virus will not live long in food proper, and
while it's possible that food packaging from groceries or takeout could contain
small concentrations of virus particles, it is easy to mitigate this risk by
washing your hands after handling groceries or takeout” (NCSU professor of
food safety, Ben Chapman)

45. Current Evidence Regarding COVID-19
What do we know?
• There is currently no evidence to support
transmission of COVID-19 associated with
food.
• Risk is LOW for transmission from food or
food packaging
• Takeout is safe.
• Groceries are safe.
• Use good food safety practices.

46. Current Evidence
• Patients with cancer may be at greater risk of being immunocompromised
depending on the type of cancer they have, the type of treatment they receive, other
health conditions, and their age.
• The risk of being immunocompromised is typically highest during the time of active
cancer treatment, such as during treatment with chemotherapy.
• There is no specific test to determine if a person is immune compromised, although
findings such as low white blood cell counts or low levels of antibodies (also called
immunoglobulins) in the blood likely indicate an immunocompromised state.
What do we know?

47. Stay Well
During a
Pandemic

48. Use Common Sense!
1. Get Your Information From Evidence
Based Resources.
2. Get Your Information From People And
Places That Do Not Raise Your Blood
Pressure Or Stress Levels.
3. Be Honest With Yourself About What
Is Practical.
4. Be Confident In Your Choice For Today
And Be Open To Change!

49. My Hopes for You
● Better knowledge about the evidence
regarding food safety and cancer.
● jjjj
● Lower your stress, and enjoy your food!
● jjjj
● Don’t worry, be happy!

51. Other Resources
AICR Cancer Myths: https://www.aicr.org/news/seven-myths-about-cancer-
prevention/?gclid=Cj0KCQjwgJv4BRCrARIsAB17JI4bmSR1kE-8ylBrxpXOwUpRS_yuwwa85GFmrWwMfJTEKP-
6cR3kNhYaApFBEALw_wcB#1580308424329-10314fa0-04ef
AICR Cancer Fighting Foods:
https://www.aicr.org/cancer-prevention/food-
facts/?gclid=Cj0KCQjwgJv4BRCrARIsAB17JI44_oVAvRzE_50AQDGaWAkvo9meAi6hMehKYWx4-
epiH_P6Q6oV4PgaAqFHEALw_wcB
AICR Recommendations for Cancer Prevention:
https://www.aicr.org/cancer-prevention/
AICR on Supplements:
https://www.aicr.org/resources/blog/the-news-supplements-cancer-risk-and-health/
AICR on body weight:
https://www.aicr.org/cancer-prevention/recommendations/be-a-healthy-weight/

52. COVID-19 and Food Safety Resources
CDC, Who Is at Greatest Risk:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html
CDC, COVID-19 FAQ
https://www.cdc.gov/coronavirus/2019-ncov/faq.html

53. Protein Foods:
https://www.cancerdietitian.com/2017/03/amount-of-protein-in-various-foods-charts-and-lists.html
Tips for Combatting Nutrition Related Side Effects:
https://www.cancerdietitian.com/tips