Breast cancer is the most common cancer in women worldwide. With more women surviving breast cancer, diet and lifestyle changes are important to survival. While a healthy diet will not guarantee you a prevention of recurrence, it will help keep your body healthy and may reduce the risk of recurrence, or mortality. Also, Good nutrition reduces the incidence of breast cancer and the risk of breast cancer progression or recurrence. Diet is one of many factors associated with reducing the risk of developing cancer. Thus, women who have been diagnosed with breast cancer are highly motivated to pursue dietary regimens and often seek nutritional guidance. Small trials conducted in Russia, the Netherlands, and Poland reported on the effects of ‘healthy diet’ interventions for breast cancer survivors, either during or after treatment, and cancer recurrence. A reduced fat and energy diet decreased the recurrence of breast cancer in the Russian study. Unfortunately, weight gain often occurs in women after diagnosis of breast cancer; such weight gain is more prevalent among women who were premenopausal at diagnosis and who received adjuvant chemotherapy as part of their treatment.

No single food or food component can protect you against cancer by itself. But strong evidence does show that a diet filled with a variety of plant foods such as vegetables, fruits, whole grains and beans helps lower risk for many cancers. Talking with a health care provider or Dietician about foods to avoid or include in the diet can be helpful, in cancer survival. If you or someone you love has survived breast cancer, it is imperative to continue to support the body’s healing with proper nutrition. The American Institute for Cancer Research reports that there is evidence that a healthy, balanced diet may have cancer preventative effects. If you are a breast cancer survivor, a diet low in processed foods and high in protein, fiber, omega-3 essential fatty acids and other important nutrients can strengthen your immune system and help to improve the length and quality of your life. A healthy, balanced diet is important for breast cancer survivors to maintain optimal health and good nutrition. The Johns Hopkins Breast Center recommends a diet emphasizing fruits, vegetables and whole grains; these foods contain phytosterols, chemicals that have antioxidant, antiestrogen and chemopreventive characteristics that may reduce the risk of recurrence. Broccoli, cauliflower, kale and cabbage are very high in these chemicals. High amounts of dietary fiber, approximately 25 to 35 g daily, can also reduce the risk of breast cancer because the fiber helps change hormonal balances that are present in breast cancer.

Nutritional Guidelines for cancer survivors:

Nausea and vomiting are common after surgery. They are especially common after chemotherapy or radiation. Other symptoms after surgery include a loss of appetite or desire to eat, and “wasting syndrome” called cachexia. This is a wasting away of muscle, organ tissue, and other lean body mass. It’s often accompanied by weight loss and weakness. After breast cancer surgery, the body needs more than its usual supply of protein. It needs it to repair cells, fight infection, and heal incisions. Right after surgery, boost the protein intake. It will aid the healing and help to regain the strength. To ease symptoms of nausea after breast cancer treatment, eat several smaller meals throughout the day instead of three big meals. Try simple soups, such as chicken with vegetables and broth, if nausea persists. Try protein shakes, curd, and liquid protein drinks when solid foods cause you to feel sick. Here are some ways to increase the protein intake in the diet:
 Add protein powder or dry skim milk to dishes to boost their protein level.
 Add grated paneer to vegetables, potatoes, rice, and salads to increase protein and calories.
 Add high-protein snacks such as almonds, peanuts, and paneer in the diet.

The Nutritional Guidelines emphasize the importance of achieving or maintaining a healthy body weight; adopting a physically active lifestyle; consuming a healthy diet that emphasizes plant foods, particularly
within the context of weight management; and limiting consumption of alcoholic beverages. A healthy, balanced diet is important for breast cancer survivors to maintain optimal health and good nutrition. Diet is one of many factors associated with reducing the risk of developing cancer. Evidence suggests that following the same dietary recommendations for cancer prevention may also lower the risk of recurrence in cancer survivors.
 Plant-based diet
o Plenty of fruits and vegetables.
o High fiber – whole grains and beans/legumes.
 Low fat diet with emphasis on healthy fats.
 Limit processed and refined grains/flours/sugars.
 Drink plenty of fluids.
 Be physically active to help achieve and maintain a healthy weight

Plant based diet—
A lifelong commitment to a plant based diet may lower a woman’s risk of developing breast cancer and may also reduce the risk of recurrent breast cancer. A plant based diet consists primarily of fruits, vegetables, whole grains, beans/legumes, and other plant protein sources. Plant based diets also contain vitamins, minerals, fiber, and various cancer-fighting phytonutrients (for example: Carotenoids, lycopene, indoles, isoflavones, flavonols). A diet with nutrient- and phytochemical-rich vegetables, which provides an adequate intake of multiple constituents such as vitamins, fiber, and various potentially beneficial biologically active compounds, are beneficial. Considerable evidence from preclinical studies indicates that plant-derived foods contain anticarcinogens.
The American Institute for Cancer Research promotes eating a diet rich in plant-based foods for long-term breast cancer survival. They report that eating fruits, vegetables, beans and whole grains can provide the vitamins, minerals and phytochemicals needed to boost cancer preventative effects. While more research still needs to be done on the specific anti-cancer effects of plant-based foods, scientists do know that the low-calorie nature of plant-based diets can reduce excess weight gain sometimes associated with cancer while providing plentiful nutrients. This is not to say that a breast cancer survivor must maintain a vegetarian or vegan diet, but rather that it is important to acknowledge the nutritional value of plant-based foods and make efforts to include them in the diet as frequently as possible. Also, a comprehensive review of the literature found that a diet high in vegetables and fruit probably decreases breast cancer risk and that a diet high in total fat possibly increases risk. However, evidence of an association between a diet high in vegetables and fruit and low in total fat and prevention of cancer progression has been mixed in epidemiological studies.

Eat at Least 2.5 Cups of Vegetables and Fruits Each Day. Vegetables (including beans) and fruits are complex foods, each containing numerous potentially beneficial vitamins, minerals, fiber, carotenoids, and other bioactive substances, such as terpenes, sterols, indoles, and phenols that may help prevent cancer. Some studies suggest that individuals who eat more vegetables and fruits have less weight gain and a lower risk of developing obesity. Consuming vegetables and fruits also contribute to weight loss and maintenance because many vegetables and fruits are low in energy and high in fiber, and have a high water content, which may increase satiety and decrease overall energy intake. Choose vegetables, whole fruits, and other low calorie foods instead of calorie-dense foods such as French fries, potato and other chips, ice cream, doughnuts, and other sweets Include vegetables and fruits at every meal and for snacks. Eat a variety of vegetables and fruits each day. Emphasize whole vegetables and fruits;
choose100% juice if you drink vegetable or fruit juices. Consuming a varied diet that emphasizes plant foods may help to displace the calorie-dense foods. Eating plenty of fruits and vegetables is part of a healthy diet and can help lower mortality after breast cancer. According to a study published in the Journal of Clinical Oncology, a reduction in mortality was seen in those women who had a higher fruit and vegetable consumption, were physically active or had a body mass index that was neither extremely low weight nor obese. The women in whom the reduction in risk occurred ate five or more servings of fruits or vegetables daily, and this effect was seen even in women who were obese.
Phytochemicals: Fruits and vegetables contain phytochemicals, a class of chemicals found in plants that may help prevent certain cancers or improve the prognosis of cancer survivors. Some have either antioxidant or hormone-like actions both in plants and in cthe people who eat them.
Soy Foods: Soy and soy-based foods contain natural substances that act like estrogen in some organs while blocking estrogen in others. Soybeans contain weak estrogen-like compounds called phytoestrogens. Soybeans, tofu, soy milk, and miso soup all contain these phytoestrogens. Some researchers think they can help protect against the kind of breast cancer that depends on estrogen for its growth. Eating a moderate amount of soy foods — one to three servings a day — is advised. Soy protein contains many chemicals. For example, soy contains proteins known as protein kinase inhibitors, which can help regulate cell growth and also contain saponins and phytosterols that can help keep cholesterol levels low. Soy also contains important antioxidants that can help prevent DNA damage. Of particular relevance to the field of breast cancer are isoflavones, a type of chemical found in all soy products.
Antioxidants: Many vegetables, fruits, nuts, and other foods contain antioxidants. The body uses certain compounds in foods and chemicals made in the body, called antioxidants, Antioxidants protect the cells from damage from “free radicals.” These are atoms or groups of atoms thought to trigger cancer growth. Because such damage is linked with increased cancer risk, some antioxidants may help protect against cancer. Antioxidants include vitamin C, vitamin E, carotenoids (such as beta-carotene and vitamin A), and many other phytochemicals (chemicals from plants). Studies suggest that people who eat more vegetables and fruits, which are rich sources of antioxidants, may have a lower risk for some types of cancer. Examples of specific foods with antioxidants include broccoli, liver, and mangoes. It is advised to eat a balanced diet with a variety of fresh foods to provide antioxidants. That’s better than taking high “mega doses” of vitamin C, vitamin E, or other antioxidants.

Beta-carotene: Beta-carotene belongs to a group of antioxidants called carotenoids, B-carotene gives carrots, apricots, yams, and other orange-colored vegetables and fruits their color in the body. Beta-carotene is converted to vitamin A, which is thought to help prevent cancer. Some studies suggest that a diet high in beta-carotene-rich foods may reduce the risk of death from breast cancer.
Lycopene: Lycopene is what puts the red in tomatoes and the pink in pink grapefruit. It might also help prevent recurrence of breast cancer in some women. These are some tips for getting the most dietary punch from plant-based foods:
 Include fruits, vegetables, and grains in every meal.
 Snack on fresh, dried, or canned fruits and raw veggies.
 Drink 100% juice at breakfast or snack time.
 Try beans as an alternative to meat.
 Choose whole grains over refined ones

FIBER – A PLANT-BASED DIET IS NATURALLY HIGH IN FIBER
Dietary fiber includes a wide variety of plant carbohydrates that humans cannot digest. Good sources of fiber are dried beans, vegetables, whole grains, legumes, vegetables and fruits. Specific categories of fiber are “soluble” (such as oat bran, peas, beans, and psyllium fiber) or
“insoluble” (such as wheat bran, fruit peels and skins, nuts, seeds, and cellulose). Dietary fiber can improve bowel function and reduce the risk of heart disease. While the relationship between fiber and breast cancer recurrence is still unclear, a low-fiber diet may lead to higher estrogen levels, and estrogen may promote the growth of breast tumors. A diet rich in natural fiber obtained from fruits, vegetables, legumes (for example: lentils, split peas, black beans, beans), and whole-grains may reduce cancer risk and/or reduce risk of cancer progression. Fiber binds to toxic compounds and carcinogens, which are then later eliminated from the body. Various mechanisms have been proposed for the protective effects of dietary fiber against cancer. These include:
 Increased fecal bulk and decreased intestinal transit time, which allow less opportunity for fecal mutagens to interact with the intestinal epithelium, binding to bile acids, which are thought to promote cell proliferation, Fermentation in the gut, producing short-chain fatty acids (SCFA). SCFA improve the gut environment and may provide immune protection beyond the gut.
 Additionally, whole grains are also rich in antioxidants, including trace minerals and phenolic compounds, which have been linked to disease prevention. Furthermore, a high fiber diet works to reduce hormone levels that may be involved in the progression of breast cancer.
 A high fiber diet is also associated with less obesity. Total dietary fiber intake, particularly from cereals and fruit, was found to significantly reduce the risk of breast cancer in pre-menopausal, but not post-menopausal women.

Fat Intake
Like other women, those who have had breast cancer the diet should be low in fat to reduce the risk of other cancers and heart disease. As far as breast cancer itself goes, studies to date have failed to find a strong relationship between dietary fat and the initial development of breast cancer. However, in women who already have had the disease, a few studies have suggested that a low-fat diet may be linked to lower recurrence rates and better survival. Additionally, a low fat, high carbohydrate diet may result in a significant reduction in breast density, particularly in women going through menopause. Aim for close to 20% of your total calories from fat, with less than 7% of total calories from saturated fat. Research indicates that the type of fat may be of paramount importance. Dr. Christine Horner promotes the use of “healthy” fats in her diet plan for breast cancer survivors, as these fats are essential to the functioning of your body. Healthy fats include omega-3 and omega-6 fatty acids, conjugated linoleic acid, monounsaturated fats and polyunsaturated fats. Healthy fats are found in foods such as flaxseeds (Alsi), seafood, avocados and olive oil. Dr. Horner also makes clear that it is imperative for breast cancer survivors to avoid “unhealthy” fats such as saturated fats (Desi ghee, Malai and Butter), trans fats and hydrogenated fats as these fats may increase breast cancer risk by as much as 50 percent. Cornell University reported on the Nurses’ Health Study, which tracked the diet of 1,982 breast cancer survivors. The “women who ate the largest amounts of poultry, total protein and omega-3 fatty acids had a statistically lower risk of death than the women who ate the least amounts of these foods,” the report stated. Omega-3 fatty acids are found in flax seed and in cold-water fish, such as salmon, tuna, mackerel and trout. For health-supporting purposes, aim to consume two to three servings of these fish per week.

These are some tips for reducing fat in the diet:
 Less fat is better.
 Limit animal fats.
 Avoid hydrogenated fats. Trans fatty acids as in Margarine, fried foods, commercial peanut butter, salad dressings and various processed foods including breads, crackers, cereals, and bakery products like cake, pastries and cookies etc.
 Saturated fatty acids Meats, poultry skin, baked goods, and whole milk dairy products,
Including butter, cheese, and ice-cream.
 Reduce or eliminate meat and whole milk dairy products.
 Include these healthy fats daily. Common vegetable oils, such as corn oil, safflower oil, sunflower oil, and cottonseed oil, and processed foods made with these oils.
 Limit consumption of nuts to no more than ¼ cup with meal or snack to limit total fat and calories.
 Increase omega-3 fatty acids. Flaxseeds, chia seeds, walnuts, hempseeds, and pumpkin seeds.
 Replace fatty foods with fruits, vegetables, grains, and beans.
 Eat smaller portions of higher-fat foods.
 Bake or broil foods instead of frying them.
 Choose nonfat or low-fat milk and dairy products.
 Pick lean cuts of meat, and keep servings small.
 Try beans, fish, and poultry instead of beef, pork, and lamb.

The Johns Hopkins Breast Center also reports that the risk may be related to the type of fat consumed, and recommends limiting foods high in saturated fat like beef, cheeses, cream and ice cream. Foods containing trans-fats like bakery products, packaged foods etc should be limited, and more food with omega-3 fatty acids should be consumed, like chicken, fish and legumes. When you eat away from home, be especially mindful to choose food low in calories, fat, and added sugar, and avoid consuming large portion sizes. Prepare meat, poultry, and fish by baking, broiling, or poaching rather than by frying or charbroiling. Replace dietary fat with foods and/or beverages that are high in calories from added sugar with low fat’’ or ‘‘nonfat ‘foods and low calorie drinks like lemonade and buttermilk etc.which will also protect against overweight or obesity.

Reduce or Eliminate Processed Food

Food processing may also alter foods in ways that might affect cancer risk. An example is the refining of grains, which greatly lowers the amount of fiber and other compounds that may reduce cancer risk. The processing of meat, by adding preservatives such as salt or sodium nitrite to prevent the growth of germs, or smoking the meat to preserve or enhance color and flavor, may add compounds that might increase the potential of these foods to cause cancer. Some food processing methods, such as freezing and canning vegetables and fruits, can preserve vitamins and other components that may decrease cancer risk. Cooking or heat-treating (such as when canning) vegetables breaks down the plant cell walls and may allow the helpful compounds in these foods to be more easily digested. But some of these methods may also lower the content of some heat-sensitive vitamins, such as vitamin C and some B vitamins.
Many processed foods and beverages, including sugar-sweetened beverages, sweetened breakfast cereals, pastries, candies, and syrups, contain large amounts of added sugars. These added sugars come in many forms, such as high-fructose corn syrup, fruit juice concentrates, and honey. Consuming products high in these added sugars adds little nutrient value to the diet and contributes to excess caloric intake which leads to increase in body weight. It is important for breast cancer survivors to obtain a healthy weight. Cornell University reports that the consumption of a diet high in processed foods and baked goods, such as white bread, croissants, chips, muffins and doughnuts, has been linked to a decreased survival rate in breast cancer patients. These foods should be avoided or limited because the hydrogenated oils found in them can cause free radical-induced damage to your cells.
Limit consumption of processed meats and red meats, sausage, luncheon meats, and hot dogs. Choose fish, poultry, or beans as an alternative to red meat (beef, pork, and lamb). If you eat red meat, select lean cuts and eat smaller portions.Limit consumption of creamy sauces, dressings, and dips with vegetables and fruits.

ADEQUATE FLUIDS
Finally, be sure not to overlook water as a part of any healthy eating plan. Water is especially
important when you are going through chemotherapy, as it helps rehydrate skin cells and also flushes excess medicine and toxins from your system.
The functions of water in the body include the following:
 Carries nutrients and waste products.
 Participates in chemical reactions.
 Acts as a lubricant and cushion around joints.
 Acts as a shock absorber in the eyes and spinal cord.
 Aids in the body’s temperature regulation.
 Maintains blood volume.
 Increased fluid intake is needed for a high fiber diet.  Drink plenty of water daily to help meet fluid needs.  Limit consumption of sugar-sweetened beverages such as soft drinks, sports drinks, and fruit-flavored drinks.

Be physically active to help achieve and maintain a healthy weight— During and after breast cancer treatment, while it is important to get enough calories to nourish the body, it is also important to maintain a healthy weight. According to the American Cancer Society, obesity has been associated with a higher risk of developing cancer, higher risk of cancer recurrence and shorter survival times. It is also important for breast cancer survivors to obtain a healthy weight. If you are overweight, you should consult a doctor/dietician about a healthy weight loss diet. Current trends toward increasing portion size, the consumption of high-calorie convenience foods, sugar-sweetened beverages, and restaurant meals; and declining levels of physical activity are contributing to an obesity epidemic across all population segments. Longer workdays and more households with multiple wage earners reduce the amount of time available for the preparation of meals, the increased consumption of high-calorie foods outside the home, which are frequently less nutritious than foods prepared at home. Large portion sizes, calorie-dense foods, and sugar-sweetened beverages are extensively marketed by restaurants, supermarkets, and food and beverage companies. Reduced leisure time, increased amounts of time spent sitting, increased reliance on automobiles for transportation, and increased availability of electronic entertainment and communications media all contribute to reduced levels of physical activity. Poor access to sidewalks, parks, and recreation facilities is associated with greater obesity risk.
To maintain a healthy weight, most people need to limit caloric intake while increasing regular physical activity; it is difficult for most people to achieve and maintain weight solely through physical activity. Current trends indicate that the largest percentage of calories in the diet comes from foods high in fat, added sugar, and refined grain products.
The way to achieve a healthy body weight is to balance energy intake (food and beverage intake) with energy expenditure (physical activity). Excess body fat can be reduced by
decreasing caloric intake and increasing physical activity. For most adults, a reduction of 50 to 100 calories per day may prevent gradual weight gain, whereas a reduction of 500 calories or more per day is a common initial goal in weight loss programs. Similarly, 300 minutes or more of moderate to vigorous intensity physical activity per week may be needed to prevent weight gain or to sustain weight loss for previously overweight people. Caloric intake can be reduced by decreasing the size of food portions; limiting between-meal snacks; and limiting the intake of foods and beverages that are high in calories, fat, and/or added sugars, and that provide few nutrients (eg, many fried foods, cookies, cakes, candy, ice cream, and sugar-sweetened beverages). Such foods and beverages should be replaced with choices such as vegetables and fruits, beans, whole grains, and lower calorie beverages. Meals served in many fast food establishments and restaurants typically exceed the serving sizes needed to meet daily caloric needs and are often high in hidden fats and sugars. They also are often low in vegetables, fruits, beans, and whole grains. Keeping track of food intake and physical activity has been shown to be effective in weight management.
Achieve and Maintain a Healthy Weight throughout life. Be as lean as possible throughout life without being underweight. Avoid excess weight gain at all ages. For those who are currently overweight or obese, losing even a small amount of weight has health benefits and is a good place to start. Engage in regular physical activity as key strategies for maintaining a healthy weight.

Food Handling Tips

Patients who have undergone surgery and those receiving chemotherapy have compromised immune systems. Careful food handling in order to avoid food-borne illness is important. Make sure foods are refrigerated well and always wash hands prior to handling food. Fruits and vegetables should be rinsed well prior to eating. The American Cancer Society advises against buying produce that has been cut at the grocery store. Do not cross-contaminate food by using the same utensils to cut or stir foods and make sure all meat products are cooked thoroughly.