Surviving cancer is quite a feat and should be commended. The chemotherapy, radiation, surgery, a stem cell transplant or whatever else it took to get in remission is a tough road to follow. When all of that is done and the doctor says “You’re cancer free,” those are probably some of the sweetest words you’ll ever hear.
According to the American Cancer Society, a cancer survivor is someone who has finished active treatment with the goal of prolonging survival and having the highest quality of life possible. Because of increasing awareness, earlier detection and improved treatments, the majority of cancer survivors (64 percent) were diagnosed 5 or more years ago and 15 percent were diagnosed 20 or more years ago.
“Of course, the most positive aspect of cancer remission is the fact that the cancer is gone,” said Dr. David Samadi, chairman of urology and chief of robotic surgery at Lenox Hill Hospital in New York City. “But a good oncologist will help their patients focus on ways to reach an optimal quality of life during any cancer recovery and remission period. Each patient has individual needs and there’s always a slight worry in the back of their mind that the cancer may return.”
But now what? Now that you’re in remission, how do you keep yourself cancer free and reduce the risk of it coming back again?
“We try to work with every patient to educate them throughout the entire process, but especially during remission,” Dr. Samadi said. “It’s critical that they understand every part of the recovery process and the likelihood of the cancer coming back. The fact is lifestyle habits such as healthy eating and regular exercise can have a tremendous impact in fighting the likelihood of cancer recurring. The key is working with the patient to understand that if they led an unhealthy lifestyle before their cancer diagnosis, they should focus on instilling healthier lifestyle habits going forward.”
This is where nutrition and physical activity can have a favorable impact on survival and quality of life. When a cancer survivor makes the effort to follow a healthy lifestyle, the benefits are supportive of lessening a cancer recurrence. Here’s how to keep the odds in your favor:
1. Use the power of plant-based foods. You don’t have to become a vegan but when filling your plate two-thirds should be composed of vegetables, fruit, whole grains, beans, legumes, nuts and seeds while one-third can be animal sources.
Plant foods contain various vitamins, minerals in addition to phytochemicals. Phytochemicals (phyto means plant) seem to have additional health benefits beyond that vitamins and minerals offer. Tens of thousands have been identified and most likely there are more yet to be discovered. Phytochemicals protect cells from harmful compounds in the environment as well as prevent cell damage and mutations. Cruciferous vegetables are particularly helpful – broccoli, kale, cauliflower, cabbage, Brussel sprouts – as they contain the phytochemicals isothiocyanates and glucosinolates which produce protective enzymes that may reduce cancer risk.
The American Institute for Cancer Research recommends at least five servings of a variety of plant foods each day.
All plant-based foods, minimally processed and without added sugar or fat, are acceptable. Use the chart below to help identify healthy whole grain food:
Instead of… Try…
White or “wheat” bread “Whole-wheat” or rye bread
White rice Brown rice or wild rice
Regular pasta Whole-wheat or whole-grain pasta
Macaroni Bulgur pasta
Corn flakes Bran flakes or other bran cereal
Crispy rice cereal Whole-grain cereals
Cream of wheat Old-fashioned or quick oatmeal
Flour tortillas Whole-grain or corn tortillas
Source: American Heart Association
In addition to the whole grains listed in the chart, try other whole grains that provide numerous health benefits as well: farro, spelt, kamut, quinoa, amaranth, chia, teff, and buckwheat.
2. Shake the sugar habit – Understand first that sugar does not cause or feed cancer. Cancer cells grow quickly and have a high demand for glucose, one of the components of sugar when it is broken down in the body. But, all cells, cancerous or not, use glucose for energy with glucose being distributed throughout the body.
However, consuming too much sugary foods or beverages can lead to weight gain, increasing cancer risk. In addition, sugary foods and beverages are empty calorie foods providing calories but few nutrients.
3. Reduce red meat and avoid processed meat – There is convincing evidence pointing to red meat (beef, pork and lamb) and processed meats (hot dogs, luncheon meat, sausage, bacon, salami), contributing to colorectal cancer. The high fat content in red meat and nitrates found in processed meats tend to raise the amount of carcinogens in the body.
Red meat should be consumed no more than 18 oz. per week and processed meats should be minimized as much as possible.
Dr. Samadi noted, “For prostate cancer specifically, we just evaluated two significant studies that showed a high-fat Western diet or a diet high in red meat may increase the risk of developing high-risk cancers as well as the risk of recurrence.”
4. Ease up on alcohol – The recommendation for this is to consult with your oncologist. The type of cancer a person had will determine the advice they will offer. Making recommendations about alcohol can be challenging, as moderate alcohol consumption can lower the risk of cardiovascular disease yet it can also increase the risk of developing cancers of the mouth, larynx, pharynx, esophagus, breast and colorectal cancer. If combined with smoking, it is particularly harmful.
For women, research has consistently shown that drinking alcoholic beverages increase their risk of hormone receptor-positive breast cancer. In addition, women who drink three alcoholic beverages a week have a 15 percent higher risk of breast cancer.
Heavy drinkers should reduce or stop drinking, moderate drinkers most likely can continue after consulting their physician, and nondrinkers should not start drinking to reduce cardiovascular disease but continue with other healthy lifestyle choices.
Moderation is considered no more than two drinks a day for a man and no more than one drink a day for a woman. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of hard liquor.
5. Slow down on salt intake – Research shows that higher intakes of salt, sodium, or salty foods is linked to an increase in stomach cancer, as it may cause damage to the lining of the stomach. The average American consumes about 3,400 mg per day – much higher than the 2010 Dietary Guidelines recommendation of less than 2,300 mg a day for people age 2 and up. People 51 and older, those of any age who are African American, or those who have high blood pressure, chronic kidney disease or diabetes, should reduce sodium to 1,500 mg per day.
High sodium foods include:
Bacon, hot dogs, sausage, packaged deli meats, ham
Frozen pizza and frozen dinners
6. Be as lean as possible within your normal body weight range – Carrying extra weight can pose a problem in keeping cancer away. If the excess pounds are stored in the abdominal area as belly fat, it can cause metabolic changes making it more likely for cancer to grow and develop.
Extra body fat can cause low-grade inflammation bringing about free radical production and cell damage. Insulin resistance can raise insulin levels in the blood, activating cell-signaling pathways and promoting the growth of cancer cells.
For women, there is a relationship between obesity and breast cancer after menopause. In obese women who have gone through menopause and the ovaries no longer produce hormones, fat tissue becomes a source of estrogen. Obese women have more fat tissue, thus their estrogen levels are higher, which could lead to growth of estrogen-responsive breast tumors. These high levels of estrogen produced by fat tissue may also be a reason why obese and overweight women have two to four times the risk of developing endometrial cancer (lining of the uterus) than women of a normal weight, whether they’ve gone through menopause or not.
7. Dietary supplements needed or not? It is understandable and not uncommon for a cancer survivor to want to turn to dietary supplements to improve their odds of survival and keeping cancer away. But there is no consistent evidence showing that dietary supplements reduce the risk of cancer recurrence, as they have shown little to no benefit in prognosis after cancer. In some cases, they can result in worse outcomes as observational studies have shown taking high levels of multivitamins may accelerate certain cancers.
Vitamin D may be the exception when it comes to supplementation. Cancer survivors with low circulating 25-hydroxy vitamin D, the recommended biomarker of vitamin D status, who were given vitamin D supplements did have improved survival outcomes in colorectal, prostate and possibly breast cancer survivors. Always consult with your physician for their advice.
If a cancer survivor has nutritional deficiencies, supplements can help improve the deficiency but does not lessen cancer recurrence. Our bodies want nutrients found in food, not supplements, as food offers a synergy of nutrients along with fiber and phytochemicals that work together as a team in keeping the body healthy that supplements can’t offer.
8. Does eating an alkaline diet help? Some cancer survivors have turned to an alkaline diet – also known as an acid alkaline diet – to reduce cancer recurrence. But there is no evidence or solid research to support it.
Supporters of this diet claim eating alkaline foods matches the chemistry of the blood and that eating a high-acid diet upsets the balance of the blood, increasing the risk of cancer.
Blood is slightly alkaline (7.35 to 7.45 pH range) but our body knows how to keep the blood within the range it needs to be in, preventing it from becoming too alkaline or too acidic. There is no special diet necessary to make this happen.
9. Exercise regularly – Exercise is important during and after cancer treatment and is usually safe and encouraged for cancer survivors. There are multiple benefits a cancer survivor will reap:
Reduces cancer-related fatigue
Reduces depression, anxiety, sleep disturbances and minimizes treatment-related side effects
Reduces body fat and increases lean muscle mass
Reduces elevated levels of insulin which is linked to cell proliferation, diabetes, metabolic syndrome and heart disease
Keeps the immune system strong
Is associated with increased survival and reduced recurrence, particularly in breast, prostate and colorectal cancers
Exercise goals and plans should be individualized for each cancer survivor. Making exercise a regular daily habit will assist the benefits it has to offer.
Last bit of advice
“The reality remains, what we consume highly effects the risk for many chronic diseases and if you’re recovering from cancer, this is not the time for small changes like we’ve spoken about for the average person looking to lose a few pounds,” advises Dr. Samadi. “Big lifestyle changes such as quitting smoking, limiting alcohol intake and kicking the sugar habit have never been more paramount. Most patients experience a huge amount of relief and beating cancer often pushes them to commit to major lifestyle changes. As their oncologist, the key is to be there to answer all their questions as well as help them along the way of making those changes.”
Everyone who’s ever beaten cancer into remission has been given a second chance. Don’t take it for granted. Do whatever it takes to promote your health in addition to making every bite of food count and making exercise as routine as getting dressed in the morning. Do this and you will enhance the odds in your favor of remaining cancer free.
Sources: American Institute for Cancer Research; Wolin, KY, Dart, H, Colditz, GA. Eight ways to stay healthy after cancer: an evidence-based message. Cancer Causes Control (2013) 24:827-837.; American Cancer Society. Cancer Treatment and Survivorship Facts and Figures, 2012-2013. Atlanta, GA: American Cancer Society; 2012; Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):243-274.; Frenkel M, Abrams DI, Ladas EJ, et al. Integrating dietary supplements into cancer care. Integr Cancer Ther. 2013; 12(5):369-384.