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Rachel Nandy Clinical Specialist Renal Dietitian Royal Free London NHS Foundation Trust Slide 2 Acknowledgments Thank you to James Whale Fund Slide 3 Overview Healthy eating Healthy weight Salt Food labelling Dietary supplements Use of sweeteners Alcohol Being Active Slide 4 The study of nutrition and cancer The scientific study of nutrition and cancer is highly complex and many important questions remain unanswered E.g. What is the exact role of nutrition in cancer? Few specific foods have been convincingly shown to increase or decrease the risk of cancer You may hear or read about new studies or diets Dont make drastic changes based on one study This talk reflects current research and recommendations for good overall health The WCRF/AICR (2007) reviewed the evidence linking diet and cancer and produced a report of dietary recommendations Slide 5 Is there a specific diet for people with kidney cancer? No - each person may have differing needs Diet will depend on factors such as: diabetes chronic kidney disease coronary heart disease stage of kidney cancer If in doubt discuss with your GP who can refer you to a Registered Dietitian Slide 6 Slide 7 What is a healthy diet? Provides sufficient energy and nutrients to prevent deficiency Helps to optimise health Reduces the risk of disease Is a balance of foods Slide 8 What is a healthy weight? Can use BMI (Body Mass Index) This is your weight for your height Calculated by dividing your weight in kilograms by your height in metres squared For example: 63kgs (10 stone) with a height of 1.72m (5ft 8in) 63/2.95 = BMI of 21kg/m 2 Slide 9 BMI chart Slide 10 Healthy Eating Enjoyable meals Regular meal pattern Starchy foods Increasing fibre Limit saturated fats Limit excess sugar Increasing fruit and vegetables Limit salt intake Alcohol within safe limits Slide 11 Regular Meal pattern Breakfast is important helps to break the fast A regular intake of meals ensures that energy is spread through the day Prevents peaks and troughs in blood sugar levels Prevents temptation to overeat and binge Many studies have shown that eating regular meals helps with weight loss Slide 12 Starchy foods Main source of energy Aim to include at each meal Sources: bread, pasta, rice, cereals, potatoes, chapatti, cassava, yam, plantain, noodles, ground rice Wholegrain varieties contribute fibre Source of B vitamins along with some calcium and iron Slide 13 Fibre Helps digestive system to process food and absorb nutrients Helps lower cholesterol Contributes to control of blood glucose levels which may help to control appetite Aim for 18g of fibre per day 2 types of fibre Insoluble sources brown rice, pasta, bread, lentils, oats beans and pulses Soluble sources all fruit and vegetables. High sources are oats, strawberries, pears and barley In addition to eating fibre you need to drink plenty of water to aid effectiveness Slide 14 Fats We all need some fat in the diet Concentrated source of energy and provides fat soluble vitamins such as A, D, E and K Required to protect organs, involved in metabolism and tissue repair 2 main types: saturated and unsaturated Slide 15 Fats Saturated (animal and trans fatty acids) Unsaturated (vegetable, oily fish and soft margarines) Raise cholesterol and may contribute to risk of certain cancers, stroke and heart disease Meat, butter, ghee, cream, eggs, cheese, full fat yoghurts, hydrogenated margarine or butter Contain essential fatty acids that cant be made by the body Omega 3 can help protect against heart disease Seeds, unsalted nuts, avocados, vegetable oils, oily fish such as mackerel, pilchards, sardines, trout and herring Slide 16 How to reduce fat Use lean cuts of meat and remove visible fat (includes fat on red meat, skin on chicken) Use less butter and opt for a vegetable based spread or oil Grill, steam or bake rather than frying Select lower fat dairy products such as semi-skimmed milk or lower fat yoghurts and cheeses Consider fruit, seeds or nuts as a snack rather than biscuits, cakes or crisps Slide 17 Fruit and Vegetables High in fibre, especially soluble, therefore may help to reduce incidence of some bowel cancers Help reduce cholesterol and control blood glucose levels Good source of antioxidants, vitamins and minerals which are essential for the body We should all be aiming for at least 5 portions per day from a variety of sources Low in calories Slide 18 What is a portion? 1 glass (150mls) of unsweetened fruit juice 1 medium fruit e.g. apple or orange 2 tablespoons of vegetables 1 small bowl of side salad 2 small fruits e.g. plum or satsuma 1 handful of berries / dried fruits Slide 19 Salt Most of us eat about 12 g of salt per day much of which is added during manufacturing NICE have a target for the population to reduce salt intake to 5g per day by 2015 Increased salt intake linked with high blood pressure Food manufacturers are looking to alternative flavourings to be used instead of salt e.g. potassium chloride Slide 20 How much salt? 3g in a shop bought ready made meal Can reduce intake to 1g if you prepare meal at home and avoid using stock cubes or salt to season Slide 21 How much salt? 1 Stock cube = 4g salt 1 teaspoon of salt = 5g Slide 22 How to reduce salt intake Reduce intake gradually Dont add any at the table try food before putting salt on Use herbs and spices for flavouring such as garlic, thyme, rosemary, lemon Be aware that stock cubes, seasoning and sauces often contain lots of salt Foods that are smoked or cured tend to be high in salt so try using unsmoked varieties Avoid salt substitutes such as Lo-salt as these contain lots of potassium Rock or sea salt are no healthier than table salt Slide 23 Sugar Some sugary treats can be included in the diet The key is everything in moderation Its often best to have a sugar-rich food after a meal as this prevents large fluctuations in blood glucose levels which is especially important for people with diabetes Sugar provides empty calories so when treats are eaten in excess may contribute to weight gain Huge contributor to tooth decay Slide 24 How to reduce sugar Use diet fizzy drinks or no added sugar drinks Can try sweetener instead of sugar in tea and coffee or cut back on the sugar until you no longer need to add this Ensure that fruit juices are unsweetened Slide 25 Sweeteners Used increasingly in order to reduce calorie content of meals Aspartame, saccharin, sorbitol Use of these in manufacturing is governed by the food standards agency Some concern that in animal studies high level of sweetener could be related to development of bladder cancer not proven Slide 26 Alcohol Recommended intake no more than 14 units per week for women 21 units per week for men 1 unit = 1 single pub measure (25ml) of spirit 125ml glass of wine pint of beer or lager Alcohol provides empty calories and so may contribute to weight gain Slide 27 Food labelling SugarsFatsSaturatesSalt HIGH (Per 100g) Over 15g Over 20g Over 5g Over 1.5g MEDIUM (Per 100g) Between 5g and 15g Between 3g and 20g Between 1.5g and 5g Between 0.3g and 1.5g LOW (Per 100g 5g and below 3g and below 1.5g and below 0.3g and below Slide 28 Need for supplements? You shouldnt need vitamin or mineral supplements providing you are eating a balanced and varied diet Taking excessive supplements can be harmful to health Good bone health is important as we get older Sunshine is the best source of vitamin D Slide 29 Functional foods Pro and prebiotics are commonly sold in supermarkets and health food shops They promote good bacteria in the gut therefore can help the digestive system May be added to some vitamin and mineral supplements Plant stanols and sterols Clinically proven to reduce absorption of cholesterol from the gut therefore lowering bad (LDL) cholesterol Need to be consumed as per manufacturers instructions to confer any benefits Slide 30 Being active Aim to undertake moderate activity for at least 30 minutes on 5 days of the week Moderate activity includes some of the actions involved in daily life such as walking or cycling. It makes you feel warmer or even sweaty if its a hot day. Makes you feel better as releases good hormones in the body Can help with weight management Slide 31 Summary There isnt specific dietary advice for individuals with kidney cancer The key is variety and moderation Reducing salt, sugar and fats can have positive health benefits Aim to be active whenever possible Slide 32 Thank you for listening Any questions?