Vegetarian Journal Excerpts July/August 1996 Volume XV, Number 4

Vegetarian Diets During Cancer Treatment

By Donna Paglia, M.S., R.D.

Donna Paglia is a clinical nutrition specialist at the Johns Hopkins Hospital Oncology Center in Baltimore.

A vegetarian diet can be both safe and beneficial for people undergoing cancer treatment, provided they know how to make appropriate food choices. In fact, vegetarian foods may even help people get through difficult times during cancer treatment when their diets may be suffering. However, the guidance of a registered dietitian is recommended for any vegetarian undergoing cancer treatment, even if this diet is not new to them. This article provides information for planning a vegetarian diet that will satisfy the special nutritional needs of the cancer patient, whether that person is yourself, a friend or family member, or a client.

Those who have been diagnosed with cancer and endured its treatment can attest to the nutritional deficiencies and weight loss which can be a difficult part of this experience. The foundation of this predicament is the increased calorie and protein requirements that often result from the presence of a tumor as well as from the need for repair of healthy tissues damaged by chemotherapy and radiation therapy. To complicate matters, these cancer treatments can challenge one's normal eating habits because of a variety of potential side effects. Chemotherapy, for example, works by attacking rapidly growing cells. This, unfortunately, targets not only the tumor, but some healthy tissues as well, including the lining of the gastrointestinal (GI) tract. While some of these drugs produce only mild side effects, others can severely impact quality of life. The effects of radiation therapy can be similar to those of chemotherapy, but are usually related to the part of the body that is being treated. Consequently, radiation to the head, neck, chest, and abdomen can induce significant GI distress and a decreased tolerance to many foods.

Following is a list of some of the more common problems experienced during cancer treatment which can influence the ability to eat regularly:

Diarrhea

During cancer treatment, you may be counseled on a diet that is high in both calories and protein in order to meet the body's increased demands, as well as to maximize the value of a reduced volume of food. Small, frequent, high calorie snacks may be helpful. The table below compares a variety of foods which are relatively high in protein. If you are unable to eat large amounts of foods, choose those which have more calories per serving.

Foods Supplying Approximately 7 grams of Protein Per Serving

Food	Serving Size	Calories
Meat, Poultry, or Fish	1 oz.	55-100
Lacto_Ovo:
Cottage Cheese	1 cup	50
Cheese	1 oz.	100
Milk, Yogurt	7 oz.	80-140
Egg Noodles	1 cup	160
Vegan:
Legumes	1 cup	80-100
Peanut Butter	2 Tbs	180-100
Nuts or Seeds	1-2 oz.	175-200
Tofu	1 cup	75
Rice	1 cup	300
Broccoli	1 cup, cooked	50
Tempeh	2.5 oz.	120

Vegetarian Foods for the Non-Vegetarian

Any of the treatment side effects mentioned can cause a change in food preferences. Your favorite foods may now be less appealing. You may develop an aversion to meat, poultry, fish, sweets, or coffee. Taste distortions often occur so that strongly flavored (or strong smelling), bitter, and sweet foods taste "off." From my experience counseling cancer patients, I have found that red meat is commonly among the first foods to be rejected, as well as coffee and highly acidic foods. This aversion to meat may be due to a heightened sense of bitterness or a metallic taste after the proteins are broken down in the mouth. Poultry may or may not have this effect. Dairy products and eggs are generally better tolerated. Smell sensitivity can also lead to a rejection of meat, fish, and poultry, as the odors produced while cooking can trigger nausea. In these situations, the adoption of vegetarian substitutes for these foods can help make up for potential calorie and protein deficiencies that could result from omission of these foods from your diet.

Lacto-Ovo Vegetarian Diet

For the lacto-ovo vegetarian, the choices of nourishing foods are many . Dairy products supply protein and are a good source of calories, as well as calcium, vitamin B12, riboflavin, and vitamin D. It is relatively easy to meet high calorie and protein needs with the use of foods such as milkshakes, cream soups, cheeses, and commercial nutritional supplements. Although these foods may be high in fat, the diet is often recommended only temporarily, and can also be adjusted according to individual fat tolerance. Eggs, egg substitutes, and legumes can be incorporated into the diet as additional protein and calorie sources.

Lactose intolerance is common in the general population, and even more prevalent in people receiving cancer treatment, even if only temporarily. This is especially true when diarrhea is a problem, as it can temporarily "wash" away the lactase enzyme, thus creating an inability to digest lactose. Fortunately, there are lactose-reduced and lactose-free dairy products available now, as well as lactase tablets and drops. These products may help some people digest milk products without developing abdominal discomfort, excess gas, or diarrhea. However, I have found that there are some people who just cannot tolerate any dairy products, no matter what, and for those with chronic diarrhea, dairy products may only worsen the condition. In these cases, vegan foods can be extremely helpful in filling in dietary gaps.

Vegan Diet

Although it probably would be easiest for most non-vegetarians to make the transition to a lacto-ovo vegetarian diet, a vegan diet can be appropriate for the well-informed patient. If a vegan diet is new to you , it should initially include as many familiar foods as possible, with "new" foods to fill in the gaps. The trick is to use products that are quick and simple to prepare, and can be easily exchanged for animal products in familiar dishes. (If you were a vegan before diagnosis of cancer, you should eat more of the most calorie- and protein-rich food s in your diet.)

My personal opinion is that macrobiotic diets are generally too restrictive for people with cancer, especially during treatment. The more limitations placed on the diet of a person who is experiencing eating difficulties or who may already be malnourished can set the stage for additional problems. If you wish to follow a macrobiotic diet during can cer treatment, you should consult a nutritionist who is familiar with both the diet as well as the specific cancer-related nutritional problems you may face.

The chart below lists several vegan substitutions for some common dairy products.

Vegan Food Substitutions

cow's milk	fortified soy milk
butter	vegtable oil margarine
ice cream	frozen yogurt, soy/rice frozen deserts, sorbet
sour cream	soy "sour cream"
cream cheese	soy "cream chees"
yogurt	soy yogurt
eggs	tofu, egg replacer

Meeting the Special Needs of the Cancer Patient with a Vegan Diet

Coping with taste changes:

• For those with an increased sense of strong or bitter tastes, the mild flavor of some soy products can be a welcome change.
• If taste blindness is a problem, using marinades and seasonings for tofu and tempeh can enhance the flavor.
  
  

Nutrient-Dense Snacks:

• Dry beans and peas, nuts, peanut butter, and seeds are examples of foods commonly eaten by non-vegetarians, but perhaps not very often or in small quantities. These can be maximized to supply a greater percentage of calorie and protein requirements.
  
• Shakes can be made with soy milk, tofu, and non-dairy frozen desserts and can be flavored with fruit, chocolate syrup, or extracts to make a tasty, calorie-rich treat.
  
• Many varieties of trail mixes are readily available and great for high-energy snacking.
  

Quick and Easy High Calorie Snacks:

Lacto-Ovo

Pizza, Bean Tacos/Burritos
Milk Shakes
Ice Cream
Yogurt, Puddings and Custards
Cheese and Crackers or Frui
Creamed Vegetable Soups;
Dried Fruit, Nuts and Seeds;
Bagels

Vegan

Bean Tacos/Burritos
Fruit Shakes
Non-Dairy Frozen Desserts
Puddings and CustardsSoy Yogurt and Puddings
Peanut Butter on Crackers or Fruit
Bean and Chunky Vegetable Soups;
Dried Fruit, Nuts and Seeds;
Bagels

What About Micronutrients?

Iron, calcium, and vitamin B12 are of particular concern with vegan diets. Following is a list of vegan sources:

Calcium: Lacto-ovo vegetarians should be able to meet their calcium requirements with approximately three servings of dairy products per day , or combine them with some of the following non-dairy sources: tofu processed with calcium sulfate, soybeans, figs, greens, blackstrap molasses, fortified soy milk or orange juice, almonds, tahini.

Iron: legumes, blackstrap molasses.

Vitamin B12: Fortified cereals and soy milk, vitamin supplement.

A multivitamin/mineral supplement is often recommended for patients undergoing cancer treatment, as you may not be able to eat a variety of foods in sufficient amounts to meet your needs, whether following a vegetarian diet or not.

References:

Dwyer, J.T., 1991. Nutritional Consequences of Vegetarianism. Ann Rev Nutr Vol. 11, pp. 61-91.

Dollinger, M., Rosenbaum, E.H., Cable, G. 1994.
Everyone's Guide to Cancer Therapy, 2nd ed. Kansas City: Andrews and McMeel.

Pennington, J.A.T. 1994. Food Values of Portions Commonly Used, 16th ed. Philadelphia: J.B. Lippincott.

Zeman, F.J. 1991. Clinical Nutrition and Dietetics, 2nd ed. New York: Macmillan.

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This article originally appeared in the July/August 1996 issue of the Vegetarian Journal. We encourage you to subscribe to the magazine.

Thanks to volunteer Jeanie Freeman for converting this article to HTML

• Lowering Cancer Risk/Plant Based Health Professionals
• Selecting Menus for Vegan Cancer Patients

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