This transcript was extracted from the ‘Eating well‘ video.

Time’s moving on. So I’ll try and keep this short and sweet and I was hiding away at the break time I know I met a few people but if, afterwards if you want, I have some leaflets on the table there. If they’re of any interest to you and some of the things I’m talking about now. And I know I won’t have personally met any of you professionally, you may well have met my colleagues in Belfast Trust and everybody might be have a slightly different experience of how they were eating during their treatment.

I know Frances, you had talked about trying to eat healthily through yours as well. And I know everybody is individual, some people may have not been eating so well or perhaps lost weight, the weight could have stayed the same or sometimes after treatment, the weight can go up. So everybody might be coming from a different place.

So as I say, what I’m going to do over the next little while is focus more so on at this point in time, the role of diet in your health and wellbeing, for your future health and not focus as much on, some of the problems in this one. Now, ok. So as I say we would often get asked, you know about certain areas.

And I think certainly within the area of diet and cancer, you’ll often get maybe friends, family telling you you should you be eating that or not be eating that and it can be quite confusing. I think the information as a few people have said today and I know Frances you had said yourself, you know if you Google information, there’s a lot of convincing arguments out there for maybe avoiding certain foods or taking certain foods and sometimes that information isn’t always scientifically evidence based. And that’s what we try and provide our information on. Again, some of you may have had problems with either gaining weight or losing weight. I don’t know would many of you have had many difficulties during your treatment and anything in particular or? Right ok so you found that. Anybody else have any experiences?

Anybody not eating? So anybody maybe have any difficulties not eating so well? Hopefully not, well that’s good and I know everybody’s different and as I say I’ll not put anybody on the spot asking. So I’ll go through the rest of it. Again I know I’ve been chatting to a few people and sometimes chemo, Frances you said you got through yours well, which was good and that isn’t always the case for everybody. Sometimes the appetite can be affected and weight loss can happen and taste changes, and radiotherapy, certainly there can be altered bladder and bowel habit there. And I know I’ve spoken to a few people that that has affected as well. And as I said there the fatigue Judith has talked about and certainly diet has a role to play in that, as well.

And also on the internet, you may come across complementary and alternative diets or supplements recommended to try and cure cancer or prevent it coming back. Frances, I think you told me did or I heard you say did some of your friends try some of them as did you mention that during your talk? Right yeh so it is out there and I know I’ve come across patients telling me that, you know, I think even people in their town had sort of came to them and said, oh, don’t be taking your chemo take this other stuff instead of your treatment.

So it is, it’s there’s a lot of things out there that maybe aren’t so good for us and that’s just sort of highlighting, things to be careful with. Ok. So as I say, because of all that misinformation, it can be very confusing to know maybe what you should be eating and what’s right and what’s not right and look a little bit like this person scratching your head and perhaps wondering what, you should be eating.

Now I have to put this down now to turnover, I need an extra hand. Now so, as I say today I’m not going to focus on some of the nutritional difficulties and thankfully, hopefully most people are not experiencing those at the moment. So at the moment, the current guidelines, and as I say at the moment today, this will be general information.

If anybody is on a special diet and it has been advised by a health professional it’s important to keep following that. Certainly the current evidence would suggest that being a healthy weight and again, we’ve talked about that. Being physically active, choosing more wholegrain, vegetables, fruit and beans, avoiding sugary drinks. Limit the consumption of fast foods and other processed foods.

Limit the consumption of red meat again, that is something that they would recommend trying to not take large portions of red meat and the recommendation would be 500g of cooked meat per week and again, avoiding the processed meats. Alcohol again, keeping that low and not to rely on supplements. So the World Cancer Research Fund for people that are living with and beyond cancer would recommend that we would follow these, that you would follow these guidelines as appropriate.

And if, we can certainly if someone’s not eating so well or perhaps having altered bowel habits, some of these recommendations may not be appropriate. So it is individual, but this would be the guidance they would recommend.

And really I think it’s worth reminding ourselves just of the benefits of healthy eating and keeping active. I think sometimes it’s only when you’re not eating so well that you realise just how important it is. So it keeps the body working at its best, promotes health and wellbeing, improved energy levels, helps lower the symptoms of fatigue and really that’s what Judith was saying. Certainly if you’re not eating properly and not eating regularly, that can make the fatigue systems worse, symptoms worse. It helps the body fight infection and it helps prevent other health problems, such as heart disease, stroke and diabetes. So it’s as an important there. And also emerging evidence from studies is showing that it may help to reduce the risk of recurrence.

So as I say this information, if someone isn’t eating so well or is having any bowel symptoms, some of it may not be appropriate and it may be, that you need to seek individual advice if anybody is having any difficulties or experiencing any problems, certainly you can get your health professional or your GP to refer you to your local dietitian if you have any concerns or worries.

Ok, you may be familiar with the EatWell guide, and that really backs up the World Cancer Research Fund’s recommendations. And I have some of little leaflets and flyers over there if anybody’s interested in one and I’m just going to go through this very quickly as I know we’re pushed for time, but basically this shows us an evidence based, advice that which is of greatest benefit to our health and wellbeing and the foods to include and the proportions to include them in.

As you can see, there’s no one food that provides all the nourishment our body needs and it’s important to get a variety of foods. You can see the different food groups there. On the yellow section, you’ve got your carbohydrates and you’ve got your bread, your potatoes, your rice, your cereal and these would be your energy giving foods. So certainly from a fatigue point of view, it’s important to include those at at each meal just to keep the energy levels up and keep the energy going.

You may find sometimes if you grab something sweet, it might give you a quick lift and then the energy levels can drop again. Whereas these foods if you’re eating them, give you more sustained release of energy, and that keeps your energy levels up. If you can tolerate the higher fibre versions for bowel health if you haven’t got any difficulties from that side of things, that would be recommended. See.

As you can see, the oils and spreads and I know we talked a bit about heart health in the previous talks, poly or mono unsaturated fats would be the ones we would encourage. Things like olive, rapeseed, sunflower, trying to keep the saturated fat low. The dairy products. I’ll talk a wee bit more about those, with regards to calcium shortly.

Your proteins foods, I touched on the red meat, you’ve got fish. They would recommend two portions of fish a week. One of those oily again for heart health. Things like sardines, mackerel, herrings, trout. If, if you like those type of fish. You’ve got your, your beans and your pulses and then you’ve got your vegetarian alternatives there.

And as you can see, the fruit and veg. You’re probably very familiar with the five portions of fruit and veg recommendation. And again, that may depend on just your tolerance if you’re able to to take that, some people who are perhaps having bowel difficulties won’t be able to manage that recommendation. And it’s, it will be a bit of trial and error and your own personal, tolerance level there. Fluid’s important just up in the top right hand corner just to make sure you’re drinking enough fluid. I’m sure you’s have received that advice previously and they would say 6-8 glasses of fluid over the day. Caffeine, fizzy drinks can irritate bowel as well. So just be wary of that as well.

Spicy foods and certain foods that are maybe more gaseous, like onions, cabbage, brussels sprouts, those type of vegetables may aggravate symptoms as well. The top left hand corner. You may be familiar with the traffic light system. Just another way to help us make healthier choices. Highlighting the foods that are higher in the fat, sugar and salt, which wouldn’t be so good for us.

Trying to choose more that are green or amber. The bottom corner then, the higher calorie, higher fat, sugary foods that trying to keep those down to a minimum for our general health there. Ok. So as I say, that’s really what I’ve talked through so I’ll not, the only other thing there the fruit and veg as you can tolerate it, but it’s certainly a good source of vitamins, minerals and fibre and fresh, frozen and tinned are all beneficial.

And as I said about the starchy foods, if you can tolerate them and trying to make sure you’re always having those at each of your meals. And eating regularly is another important thing. Certainly to help keep the energy levels up as well that you’re not going too long without eating would be something we would recommend.

As I say, the protein and the dairy foods, we would say trying to aim for three portions a day if you can take dairy products. A portion would be equivalent to a third of a glass of, sorry, 200 mls of milk which is a third of a pint, a pot of yogurt or a matchbox size of cheese would be, roughly a portion size.

Again, you can choose the lower fat/sugar options if you’re eating well and if you are taking any alternative dairy products, maybe just to check they’re fortified with calcium because not all of them will be ok. Looking after your bones I know we had other speakers have talked about this. And certainly this is something as we get older and after the menopause, we lose strength in our bones and eating a balanced diet and making sure you have an adequate calcium intake is important. And your dairy products would be your best source of calcium. I have some information on calcium on the table there if anybody’s interested. Vitamin D, during the summer months our best source is the action of sunlight on our skin. There’s a few foods that have it in, but it is quite difficult to get your recommendation just from food.

It’s like oily fish, margarine, some fortified cereals, eggs. So during the, I don’t know if anybody’s on any calcium and vitamin D supplements I know sometimes, yeh. So again it’s important to keep going with those if you’ve been advised by your medical team. For the general population, the Public Health Agency actually now say that you may want to consider a ten microgram vitamin D supplement during the winter months when the sun isn’t there.

And that’s sort of October to the end of March they would recommend that. And exercise, and Maeve if I hurry up and stop talking Maeve will be talking about that shortly. Something that we, you can, has from emergence studies watching your weight is something that is beneficial and if you can try and aim for a healthy weight for your height. You may be familiar with the term body mass index.

Again it’s not appropriate for everybody. Sometimes if you’re a bit more muscular build, it’s not just as accurate. And the general for most adults would be the range would be 20-25. Now you can check online, there’s BMI ready-reckoners if anybody’s interested. And also carrying weight round your middle, your waist size again there’s more health risks associated for a man if it’s more than 37inches and a woman if it’s more than 31.5.

I know sometimes we would get asked, people are trying to lose weight and some guidance to try and help with that. I think choosing an appropriate time is important, I know I’ve spoken to ladies at these different events and sometimes they’ve had a difficult time during their treatment. And you know, that isn’t the time, they’re enjoying their food again, maybe they were off their food with chemo. So, you know, that maybe isn’t the time.

So it’s when the time is right and perhaps an initial goal is maybe if you’re trying to lose weight, just perhaps weight maintenance might be a goal until you’re ready to to give that you know, a go and try and start the weight loss.

I think it’s also important to remember that, diet can be quite a negative term. And it’s looking at it as a long term healthy eating plan rather than a diet as such and can be sound quite restrictive. And I think it’s also important that it has to be realistic. If you are trying to lose weight, it needs to be slow.

We’d only be recommending 1-2 pounds a week. And that way and remembering that any weight loss is still beneficial, and that helps take, you know, and it’s not just about the weight I think it’s how you’re feeling in general, I think’s important you know, you’ve more energy, hopefully less pressure in your joints, the pelvic floor.

So there’s other benefits, not just the weight, the number on the scales there. And, you know, people have different goals that could be health, could be getting into clothes in a wardrobe, holidays, trying to lose a bit of weight for holiday. So everybody’s reasons for motivation might be a wee bit different and it’s what works for you.

Some people find scales useful, others it’s maybe easier just trying not to be jumping on and off them and getting disheartened and just more go with your clothes and keeping active. As well I think sometimes that works for people. Choosing a regular meal pattern is important, as I say not only to help keep the energy levels up, but sometimes if you’re eating irregularly, it’s harder to keep the weight under control.

Watching the less nourishing foods, such as the high fat, high sugar foods and alcohol as well is something else that would be high in calories there, that can sneak in and add extra without you realising it. And keeping active, certainly if you have the combination of of watching what you’re eating and the activity that, certainly helps, it can be more difficult if you haven’t got the activity on on that side.

Just mentioning briefly there of alcohol, the World Cancer Research Fund would advise to avoid alcohol. And I know we’ve talked about it today. I suppose the number of units in a glass depends whether it’s a home or a pub measure maybe and the size of the glass and the type of alcohol but I’ve just put up there a few of the units, the government’s recommendations are 14 units per week for both men and women.

And there a small glass of wine would be about one and a half units, 25mls of spirit one unit, a pint of standard beer about 2.3. So, just as I say, sometimes that can can sneak in without you realising it, and they would recommend keeping a couple of alcohol free days. Just watching again if you’re trying to keep an eye on the weight, it can contribute to sugar and calories and it hasn’t got any nourishment in it.

So just to be wary of that and I think we’d already mentioned earlier about the alcohol can make the hot flashes worse. I think we probably have talked about this as I say, some of the information on the internet can be dangerous and misleading and I think even supplements that are sold now sometimes it’s they could put you at risk.

So it’s just to be very careful if there’s something you are thinking of taking, maybe just to run it by a health professional. Complimentary diets are those that go hand in hand with your conventional treatment, alternative diets are perhaps diets they would suggest instead of your conventional treatment. A lot of these can be expensive and nutritionally inadequate.

High dose vitamin supplements are often recommended and again some of these can actually be dangerous. So if you are going to I’ll talk a wee bit about vitamins shortly so I’ll leave that. And again there’s no scientific evidence that they’ll stop cancer coming back. So again, just some of the things we get asked, should I be avoiding certain foods?

The carbs we talked about, certainly they are an important part of your diet. Sometimes they get a bad press, but certainly the carbohydrates are an important food group. Or your starchy foods, two minutes so I better hurry up, and your dairy foods certainly we, there’s no reason why you need to be avoiding those, unless for some reason you’re unable to tolerate them.

Or a personal decision. Are there superfoods? Sometimes you’ll read in the paper/magazines about superfoods. As we’ve talked about it’s getting the variety of foods, there isn’t one particular food that’s better than every other food. It’s just trying to get a variety and a balance there is what we need. Does sugar feed cancer cells?

Again, sometimes this is something we get asked, and I’ve come across ladies that have actually cut out a lot of sugar and they’ve lost weight and actually got underweight. So it’s something just to be wary of. Sugar itself doesn’t feed the cancer cells. As a general health recommendation, keeping the amount of added sugar which would be, sugars added to foods, keeping them at a lower level as a general health message. And again, there’s some information on that on the table.

The supplements I’d mentioned about the vitamin D that may be useful. If someone is on a restricted diet, possibly a small general multi-vitamin, might be beneficial if not exceeding the reference nutrient intake. Large doses of any one vitamin wouldn’t be recommended. And the last one just sometimes we get asked about alkaline diet is something that I’ve been asked recently.

And again, there’s no scientific evidence that to about acid and alkaline foods, but there’s no evidence to suggest that. So the last lastly, just to summarise, it is important for all of us, to eat well and choose a healthy, balanced diet, include a variety of foods. I think the other important thing is to enjoy your food.

I don’t think there’s any point in taking foods that really you’re struggling with and not enjoying. And I think, you know, that is part of quality of life. Enjoying your food and that’s important. Trying to maintain a healthy weight for your height and keeping active. As I said, if anybody does have any individual concerns, please seek referral and hopefully a dietitian near will be able to help.

So thank you for listening. You did very well and if anybody has any questions or wants any leaflets, I’ll be about at the end. Ok. Thank you very much. There we are.