Eating well for breast cancer - A guide for patients and their families
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Eating well for breast cancer A guide for patients and their families We care, we discover, we teach
The Eatwell Plate
Use the eatwell plate to help you get the balance right. It
shows how much of what you eat should come from each
food group
Bread, rice,
Fruit and potatoes, pasta
vegetables and other starchy
food
Meat, fish,
eggs, beans Milk and
and other non- Foods and dairy food
dairy sources of drinks high
protein in fat and/or
sugar
Contents
Why it is important to eat well . . . . . . . . . . . . . . . . . . . . . 1
Guidelines for healthy eating . . . . . . . . . . . . . . . . . . . . . . 1
Gaining weight?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Hot flushes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Cancer-related fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Supplements and alternative medicines. . . . . . . . . . . . . . . 9
Eating difficulties when you are having treatment. . . . . . . 9
Ways to enrich food and drink . . . . . . . . . . . . . . . . . . . . 16
Ideas for snacks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Ideas for drinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
More information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Christie website . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Introduction
This booklet offers advice on healthy eating for
people with breast cancer with the long-term aim of
maintaining your weight and preventing weight gain.
There is also advice about eating difficulties as a result
of treatment.
We hope this booklet will help you during your
treatment and your recovery..
Why it is important to eat well
Eating well helps to ensure that you maintain a healthy
body for future health. Eating well will help to ensure that
your body has the energy and nutrients to rebuild damaged
tissues, fight infection and to cope with the side effects
of treatment. Not everyone has the same problems with
eating or finds the same things helpful. Try the ideas that
seem right for you. It is advisable to follow good hygiene
practices at all times when you are preparing and cooking
foods.
Guidelines for healthy eating
We need a wide variety of foods in our diet to maintain
good health.
To eat healthily, aim to include daily:
Fruit and vegetables
Fruit and vegetables are a good source of fibre, vitamins
and minerals and are generally low in calories. Aim for
a minimum of five portions of different colour fruit and
vegetables daily. These can be fresh, frozen, tinned or
dried.
1 A portion is
• 80g/3oz of fruit or vegetables
• three heaped tablespoons of cooked vegetables or
fruit salad
• two small fruits (kiwi/satsuma/plums)
• cupful of berry fruits
• one medium fruit (apple/orange/banana)
• one large slice of melon or pineapple
• one heaped tablespoon of dried fruit
• one small tin of baked beans
• one dessert bowl of salad
• one small bunch of grapes or a tumbler (150mls) of
fresh fruit or vegetable juice.
Note: Potatoes do not count. Fruit juice only counts as one
portion, no matter how much you drink.
Starchy Foods
Try to choose wholegrain starchy foods which are
low in fat and rich in fibre, B vitamins and minerals.
Wholegrain foods include:
• wholemeal and wholegrain bread, pitta, chapatti
• wholewheat pasta and brown rice
• wholegrain breakfast cereals.
Try to include at least one starchy wholegrain food with
each of your meals.
Protein foods
These are needed to help repair body tissues and
maintain your muscles.
Protein foods include meat, poultry, fish, cheese, eggs,
nuts, pulses, lentils, soya and quorn.
2 Aim for 2 portions daily. A portion is:
• 80-100g (3-4oz) lean meat or poultry (skin removed)
• 100-120g (4-5oz) fish
• 2 eggs
• 2 tablespoons nuts
• 40g (1½ oz) cheese
• 3 tablespoons baked beans, pulses, lentils or dahl.
Red meats, although generally high in saturated fats,
are a good source of iron which can help to prevent
anaemia. If you enjoy eating red meat, aim to include 2
to 4 servings of lean meat a week. Cut off any excess
fat and avoid frying.
Avoid processed meats, smoked meats and smoked fish.
Try to eat fish 2 to 4 times a week. Include two portions
of oily fish such as mackerel, sardines, pilchards, salmon,
herring or trout. These are rich in omega 3 oil which is
good for your heart.
Dairy foods
Dairy foods are an excellent source of calcium and
protein and help to maintain healthy bones.
Dairy foods include milk, yogurt and cheese.
How much calcium do I need?
An ideal calcium intake for adults is between 700mg to
1000mg a day. To assess your diet check the table below.
Each ‘point’ is worth 50mg of calcium so your in take should
be at least 14 points daily. 14 points daily. If you find it hard
to make up this amount from diet alone, you should take a
daily calcium supplement providing 400-600mg of calcium,
preferably one that also contains vitamin D. Take supplements
with food to help aid calcium uptake into your body.
3Calcium sources:
Each ‘point’ = 50mg calcium.
Aim for at least 14 points daily.
Points Calcium sources
5 • one pot (150g) plain or fruit yoghurt.
• one third pint milk (any type)
• 2oz (half tin) sardines in tomato sauce
• 50g (2oz) tofu
4 • 1oz (30g) Cheddar cheese
• 1oz (30g) Edam cheese
• large serving of spring greens/okra/kale/
spinach, boiled (130g or 5oz)
• one third pint calcium-enriched soya milk
3 • ½oz (1tablespoon) Parmesan cheese
• one medium cheese scone
• 2oz (half a small tin) pilchards in tomato sauce
• one scoop dairy ice-cream
• three dried figs
• 125ml (small pot) of calcium-enriched soya
yoghurt
• two slices white or wholemeal bread
• 500ml calcium-fortified mineral water
2 • one pot (100g) fromage frais
• half small tin canned salmon
• 4oz (small tub) cottage cheese
• 2oz (small bar) milk chocolate
• half large tin kidney beans
4Points Calcium sources
1 • one third pint soya milk
• three heaped teaspoons Horlicks powder
• one small tin baked beans
• nine Brazil nuts (30g)
• eight dried apricot halves
• 5oz (145g) boiled cabbage
Many breast care patients think they should give up dairy
foods.
There is no scientific evidence to suggest that dairy
products cause or affect breast cancer or that there is any
benefit from following a dairy-free diet.
If you decide to restrict or cut out dairy products in your
diet, you will need to ensure you have adequate calcium.
Soya foods
Soya foods can be part of a healthy low fat diet. If
you wish to take more than two portions a day and/
or take soya supplements, please discuss this with your
consultant as they may interfere with your treatment.
Fats
Fats are an important part of a healthy diet and are a
source of fat-soluble vitamins (A,D,E) and essential fatty
acids.
Limit your intake of fats and fatty foods, especially those
containing saturated fats such as butter, cream, fatty
meats, sausages, pies, pastries, chips, crisps, cheese,
cream cheese, mayonnaise, chocolate and ice-cream.
Try to use heart-friendly fats such as olive oil, rapeseed
oil and soya or vegetable oil.
5How do I know if a food is high in fat?
Look at the label to see how much fat a food contains.
Generally the label will say how many grams (g) of fat there
are in 100g of food.
Fat - this is how you can tell if a food is high or low in
fat:
High is more than 20g fat per 100g
Low is 3g fat or less per 100g
If the amount of fat per 100g is in between these
figures, then that is a medium level of fat.
Saturated fat - some labels also give a figure for
saturated fat, or ‘saturates’. This is how you can tell if a
food is high or low in saturates:
High is more than 5g saturates per 100g
Low is 1.5g saturates or less per 100g
If the amount of saturates per 100g is in between these
figures then that is a medium level of saturated fat.
Remember that the amount you eat of a particular food
affects how much fat you will get from it.
Sugars
Limit your intake of sugars and sugary foods, for
example, sweets, chocolate, puddings, biscuits, cakes,
sugary drinks, jam, syrup and honey.
Alcohol
Alcohol is high in calories. If you are trying to lose
weight then you should avoid alcohol.
The Department of Health recommends that men should
not drink more than 3 to 4 units of alcohol a day and
women not more than 2 to 3 units a day.
6 A unit of alcohol is equal to:
• half a pint of normal strength (3-5% ABV) lager, cider
or bitter
• a pub measure (25ml) of spirits
• 50ml pub measure of fortified wine (such as sherry or
port)
a pub measure of wine (175ml) is two units.
one bottle of alcopop is 1.5 units.
Aim for two alcohol-free days a week.
Fluids
Ensure you drink plenty of fluids – aim for approximately
two litres daily – Try water, juice, fruit tea, herbal tea,
low sugar squashes and fizzy drinks, in addition to cups
of tea and coffee.
Aim to maintain a healthy weight and try
not to gain weight.
Gaining weight?
Many people find that they gain weight after their
diagnosis. Being a healthy weight can help you keep
and feel better. The following guidelines can help you to
maintain or lose weight.
Follow the healthy eating guidelines from pages 1 to 8.
Take regular meals – this should include a breakfast, a
lunch and an evening meal.
If you are hungry between meals, snack on fruit or raw
vegetables, a low fat yoghurt, high fibre cereal with
semi-skimmed or skimmed milk, or plain malt loaf, oat
cakes or a scone.
7 Keep active: regular activity can help reduce your weight
or prevent weight gain. Weight-bearing exercises, such
as walking, dancing and aerobics, can help keep your
bones healthy and reduce the risk of osteoporosis. If
you are not used to exercising discuss this with your
medical team.
Be careful when choosing take-away meals. Try to
choose lower fat options such as tandoori chicken with
basmati rice (instead of nan bread or pilau rice), dry
curries (avoid coconut-milk based ones), chicken chop
suey, Szechwan prawns or stir fries, or shish kebabs
served with pitta bread and salad (instead of donner
kebab).
If you continue to struggle with your weight discuss this
with your medical team.
Hot flushes
Some people may experience hot flushes. The following
may help your symptoms:
• control your weight
• take regular exercise
• relaxation
• stop smoking.
You may find avoiding triggers such as hot temperatures,
alcohol, hot drinks, caffeine and spicy foods helpful.
Cancer-related fatigue
Cancer-related fatigue following treatment is very
common. Symptoms include tiredness, poor memory and
concentration, heavy limbs, feeling emotionally up-and-
down and affected sleep. When you are fatigued, you have
less energy to perform daily tasks.
8Fatigue may resolve within a few months but can
continue for up to one to two years if not well-managed.
Management of cancer-related fatigue involves:
Planning - plan what tasks or activities you wish to or
need to achieve each day.
Prioritising - prioritise which of those tasks or activities
are most important to you and concentrate on achieving
these. Leave the less important ones for another day.
Pacing - spread the tasks or activities throughout the
day, taking time to rest between each activity to allow
your energy levels to improve.
Exercise - even though you may be feeling tired it is
important to include exercise into your daily routine in
order to keep your muscles strong and in turn, to help
conserve your energy levels – try walking every day.
Regular meals - food provides our body with energy. In
order to maintain energy levels it is important not to
skip meals but to eat three regular meals a day – one at
breakfast, one at lunch and one in the evening.
If your fatigue is severe, you may think about including
snacks between your meals at mid-morning, mid-afternoon
and at suppertime. If you are concerned about gaining too
much weight, keep these snacks low in fat and in sugar
such as fresh fruit, raw vegetables, diet yoghurt, crackers,
dry toast, skimmed or semi-skimmed milk drink etc.
Following this advice is an effective way to help you
manage your symptoms of fatigue.
Supplements and alternative medicines
There are a number of alternative medicines and vitamin
supplements claiming to treat or cure cancer. There is no
scientific evidence that they can make cancers shrink or
cure the disease.
9Some may be harmful and may interfere with your
treatment. If you choose to take any supplements or
alternative medicines, please discuss this with your
consultant or specialist nurse.
Eating difficulties when you are having
treatment.
This section aims to help you if you are struggling to eat
because of treatment side effects. This is usually temporary.
You may need to eat foods higher in sugar and fat during
this time. But once your symptoms resolve, gradually return
to the healthy eating guidelines (pages 1 to 8).
If your mouth is dry... If your mouth is sore...
sip drinks frequently, especially with Avoid things that will hurt
meals or irritate:
suck ice cubes or lollies, try making them ✗ salty or spicy foods
with lemonade for a change ✗ acid fruits and juices such
fizzy drinks can make your mouth feel as oranges, grapefruit and
fresher tomato
suck strongly flavoured pastilles or mints ✗ coarse or dry foods such
to keep your mouth moist as crisps, toast & dry
sharp flavours such as lemonade may biscuits
help your mouth produce more saliva, ✗ alcohol
but don’t use them if your mouth is sore ✗ food that is very hot or
pineapple chunks are refreshing very cold.
artificial saliva or oral gels are available – Ask nursing staff for
ask your doctor or nurse about this. advice about mouth care.
Dry or sore mouth?
Radiotherapy or chemotherapy can make your mouth dry
or sore so that it is uncomfortable to eat.
Always take plenty of fluids - at least 6 drinks (mug or
large glass) a day. Drinking may be easier if you use a
10straw. Try to include nourishing drinks such as milk-
shakes.
Keep your mouth fresh and clean - ask the nursing staff
for advice about mouth care.
Eat soft, moist food such as stews and hearty or thick
soups. Add extra gravy or butter to make food more moist.
Use gravies, salad dressings and sauces with meals.
Food tastes different?
Your illness or its treatment can affect your sense of taste
so that food either loses its flavour or tastes different. This
can last a few months but it is important to keep eating.
Keep your mouth fresh and clean with good mouth care
and by drinking plenty of fluids. Ask nursing staff for
advice about this.
Make food as attractive as possible, so you can still
enjoy its appearance and smell. Concentrate on foods
you enjoy even if they are different from your usual
favourites. Don’t eat foods that taste unpleasant.
Sharp flavoured or fizzy drinks and fruits may stimulate
your taste buds. Herbs and spices add flavour, but be
careful if your mouth is sore, especially if you use spices.
Savoury foods may taste better than sweet ones. If red
meat tastes unpleasant, replace it with fish, chicken,
turkey, eggs or dairy produce such as milk, cheese and
yogurt. Pulses such as peas, beans and lentils may also
be useful. Soaking or marinading meat in fruit juice or
wine before cooking may improve the flavour. Cured
meats such as ham may taste better.
If you can sip drinks through a straw, you will avoid
some of the taste buds - this may cut down unpleasant
tastes.
11 If you have a metallic taste in your mouth try using
plastic utensils. Sugar-free mints or gum may help to
overcome metallic tastes.
Finding it difficult to swallow?
Some types of chemotherapy can make your throat sore,
so that it is hard to swallow. Concentrate on soft moist
foods such as -
Savoury - creamy soups and broth
- fish in sauce
- baked beans
- tender casseroles of meat or chicken
- minced meat eg spaghetti bolognese,
shepherd’s pie
- mashed tuna with mayonnaise,
fisherman’s pie.
Sweet - milky puddings
- mousses, crème caramel, yogurt,
fromage frais
- egg custard or fruit fool
- ice-cream
- jelly made with milk or fruit juice
- porridge or other soft cereals.
Make what you do eat as nourishing as possible (see
pages 17 and 18 for ideas).
Eat and drink little and often, for example, 5 to 6 small
meals/snacks a day instead of 3 large meals a day.
Try nourishing drinks between meals.
Add extra gravy, butter or margarine to make food more
moist.
* If you are only able to swallow liquids, please
contact a dietitian for more detailed advice.
12Feeling full?
It is quite common to feel full even after small amounts of
food and this can be very uncomfortable.
Eat small frequent snacks and drinks.
Liquids especially fizzy drinks, can fill you up, so try to
avoid taking drinks with food or just before meals.
Keep stocks of the foods you enjoy, so they are available
to eat whenever you fancy them.
Rich or fatty foods can be more difficult to digest and
leave you feeling full for longer.
Cold food and drinks, for example, yogurts, ice-cream,
fruit fool, and iced drinks can be easier to take.
Try to relax when you are eating, eat slowly and chew
foods well.
A little gentle exercise, such as a short walk after meals,
can be helpful.
Wind can make you feel very full and bloated. Avoid
foods such as fizzy drinks, cabbage, cucumber, onions
and pickles. Some people find cordial, tea or mints
helpful.
Feeling sick?
Some types of chemotherapy can make you feel sick. This
is usually only temporary but it can disrupt your eating.
New drugs to control nausea can be very effective, so speak
to your medical team.
If you are feeling sick
Try salty foods such as crisps, crackers or cheese cubes;
dry foods such as biscuits, toast, plain cake; or bland
foods such as chicken.
Some foods may make you feel worse such as greasy or
fried foods, spicy foods and foods with a strong smell.
13 Eat and drink slowly.
Avoid the smell of food or cooking. Cold foods usually
smell less. Drinks are better sipped through a straw.
Getting someone else to prepare food for you can also
help.
Try a little light exercise or fresh air before eating.
Sit up to eat and don’t lie down immediately afterwards.
Try ginger tea, ginger biscuits or flat ginger beer.
Try not to go without food for too long. Nibbling
frequently may keep the sickness under control. Keep
bowls of sweets and snacks around the house for easy
access.
If you are being sick
Keep taking fluids: cold, clear fluids such as squash or
fruit juice. They are sometimes better sipped through a
straw. Slightly fizzy drinks may be helpful. Aim for 6 to 8
drinks each day.
As the sickness starts to settle down, you can include
nourishing milky drinks.
Gradually move on to light meals and snacks.
Diarrhoea?
Some types of chemotherapy can cause diarrhoea. While
you have diarrhoea you may find it helpful to reduce the
amount of dietary fibre that you eat.
Replace wholewheat bread with white bread.
Replace wholewheat or oat based cereals with Rice
Krispies, Cornflakes or Special K.
Replace wholemeal biscuits with biscuits made from
white flour such as Rich Tea, Marie biscuits or custard
creams.
14 Avoid nuts and pulses (baked beans, kidney beans, peas
and lentils).
Take only small amounts of fruit and vegetables and
avoid eating the skins.
You will need to take a complete multi-vitamin and
mineral supplement daily (which provides no more than
100% for each vitamin and mineral of the recommended
daily amount) until you return to your full diet. These are
available from your local chemist or doctor.
Some people also find it helpful to cut down on fat by
avoiding fried foods, pastries, rich cakes and fatty meat.
If you have diarrhoea you must drink enough to replace fluid
that is being lost. Try to take at least 6 to 8 drinks a day.
When you have no more diarrhoea you should be able to
slowly start eating the foods you have been avoiding.
Constipated?
If you have been eating very little, you may become
constipated. This can be made worse by some treatments
and some painkillers. Changing what you eat may prevent
this becoming a problem.
Eat higher fibre foods such as:
• wholemeal, granary, wheatgerm, multigrain, seeded
or mixed grain bread, biscuits, rye bread and
wholewheat pitta bread
• wholewheat cereals such as Weetabix, Bran Flakes,
Shreddies or wholeoat cereals
• wholewheat crackers, wholegrain rice, oatcakes
• fresh, frozen or tinned vegetables, salad, nuts and
beans
• brown rice, wholewheat pasta, bulgar wheat
• fresh, tinned or dried fruit.
15 Fibre absorbs fluid, so you need to drink at least 6 to 8
cups of fluid each day in order to pass soft stools.
If you need to eat soft foods, include soft stewed fruits,
vegetables and fruit juice each day.
Ask your doctor or nurse about a suitable laxative if
changing your diet doesn’t make a difference.
Ways to enrich food and drink
Milk and dairy products can be used to add energy
and protein to food
• Try to use full fat dairy produce, especially milk and
yogurts, instead of low fat types.
• Add milk powder, Complan (natural or flavoured) to
soups, sauces, milky puddings and custards.
• Keep a box of grated cheese ready in the fridge, to
add to soups, sauces, sandwiches and potatoes.
• Serve evaporated milk, yogurt, cream or fromage
frais with cereals, puddings and pies or add to soups,
sauces and desserts. Also use when making jellies or
instant puddings.
• Make fortified milk by mixing 4 tablespoons of milk
powder with 1 pint of whole milk. Use whenever you
would use ordinary milk.
Fats and sugars can be used to add extra calories to
food
Example of fats and fatty foods:
• butter or margarine which are higher in calories than
low fat spreads
• mayonnaise and salad dressings
• cream, cream cheese, sour cream and crème fraîche
• nuts - including peanut butter
• chocolate - including chocolate spread.
16If you find you can eat these foods, use them wherever you
can. Spread them on bread, toast, cakes and scones. Add
them to hot vegetables, potatoes, fish, pasta and rice or stir
into puddings or soups.
Example of sugar and sweet foods:
• white or brown sugar
• jam, marmalade, and lemon curd
• honey, syrup or treacle.
These can be added to cereals, drinks or desserts.
Ideas for snacks
Here are some ideas for foods to keep handy, so you can
eat them whenever you feel hungry.
crisps, nuts and savoury toast, crumpets, pikelets,
biscuits currant tea-cakes or malt
small sandwiches or rolls loaf
cakes and biscuits baked potato
cheese and crackers, fruit: tinned or fresh, eg.
cheese cubes bananas and peaches
dried fruit mixtures small pieces of pizza or
quiche
chocolate biscuits, mini
chocolate bars sweets and mints
chewy oat bars ready-made desserts such
as yogurt, fromage frais,
ice-cream, sorbet or crème caramel, mousse,
frozen yogurt cheese cake, trifle
small sausage rolls or pies especially individual-size
portions.
cereal and milk
popcorn
17Ideas for drinks
These may be easier to prepare and swallow than solid
food.
hot milky drinks, for soya milk (calcium
example, Horlicks, enriched)
Ovaltine, cocoa, coffee special powdered drinks
cold milk shakes with such as: Complan, Build
added ice-cream and Up or Recovery (Boots).
flavoured syrups These can replace a
fruit juice or vegetable light meal. They are
juice best made with milk
and come in a range of
instant soups made with sweet and savoury (soup)
milk instead of water flavours. They can be
smoothies bought at most chemists
or supermarkets. Try a
variety to find the ones
you enjoy.
Some special meal replacement drinks are available on
prescription. Discuss this with your doctor or dietitian.
Ask staff for a copy of The Christie booklet ‘Nutritional
Drinks’.
18More information
The Christie produces a range of booklets which are free
to patients and carers attending The Christie. If you would
like a copy of any booklets, please ask the ward staff. If
you are an outpatient please ask your clinic nurse. They are
also available from the Cancer Information Centre.
Nutritional drinks. Describes all the special nutritional
products available to help people when eating is
difficult.
Advice about soft and liquidised foods. For people
who can only manage a soft or liquidised diet because
of swallowing difficulties. Offers practical suggestions,
recipes and nutritional information.
For the visually impaired: Large print versions of the
booklets are available. Please contact Patient Information
on 0161 446 3576 or you can download these from The
Christie website at www.christie.nhs.uk.
Websites/agencies you may find helpful:
World Cancer Research Fund – www.wcrf-uk.org
Cancer Research UK – www.cancerresearchuk.org
Breast Cancer Care – www.breastcancercare.bc.ca
British Colombia Cancer Agency – www.bccancer.bc.ca
Eating well can mean extra expense
If you have a low income and are finding it hard to manage
financially, you may be entitled to state benefits or help
from the Macmillan fund. For advice contact the benefits
and general advice service at The Christie on 0161 446
8539 or 8538.
19The Christie Website
www.christie.nhs.uk
Many of The Christie booklets and a list of UK help
groups are available on The Christie website. The
address is above. You can also access other patient
information sites in the UK such as Macmillan Cancer
Support and Cancerhelp UK via The Christie website.
© 2012 The Christie NHS Foundation Trust. This document may be copied for use within the NHS only
on the condition that The Christie NHS Foundation Trust is acknowledged as the creator.
2021
Visit the Cancer Information Centre on
the glass link corridor near Oak Road
Open: Monday to Friday
Tel: 0161 446 8100
Opening times can vary, please ring to
check before making a special journey
The Christie NHS Foundation Trust,
Wilmslow Road, Manchester,
M20 4BX, United Kingdom
T. 0161 446 3000
F. 0161 446 3977
Email: enquiries@christie.nhs.uk
Web: www.christie.nhs.uk
The Christie Patient Information Service
January 2012 - Review January 2015
CHR/NUT/089-05/02.04.03You can also read
