Nutrition: One Patient's View
To get a good understanding of the amount of calories and nutrients in various foods, it is helpful to obtain a copy of
Pennington, Jean A.T. Bowes and Church's Food Values of Portions Commonly Used. Lippincott. ISBN 0-397-55435-4.
In addition to "plain" foods, this book contains the same information about prepared foods such as frozen meals and commercially prepared fast foods.
You may also want to visit the web site written by Carolyn Katzin, a nutritionist in private practice in Los Angeles. I particularly like her approach because she realizes that an extremely specific, "all or nothing" approach only results in non-compliance for most people. But, in addition to this rather different spin, she has also spent considerable time and effort to determine what micronutrients are most affected by many of the different chemos commonly used in cancer treatments. The third aspect of her apparoach is that she takes the long view on nutrition, that is, sometimes it's important to be able to break the rules simply for our peace of mind.
Where I got help to figure this out
When I was diagnosed with breast cancer, I was also diagnosed with diabetes, hypertension, and hypercholesterolemia within 48 hours. (All of them are under control at this point.) Any time a patient is diagnosed with diabetes, they are instantly sent to a dietitian and, depending on their situation, to a diabetes teaching nurse. It is important with diabetes to get the patient's blood sugar under control and the first effort is to do that by reducing the amount of foods with concentrated complex sugars. These kinds of foods are things like sodas, ice cream, cake, pies, cookies, "regular" canned fruits, and, most importantly, chocolate. If you look at the labels on any of these products, nearly always the first or nearly first ingredient is sugar or high-fructose corn syrup. So, from 18 March, 1991, I have not had any non-diet sodas or other goodies as a regular part of my diet.
As things have turned out, comparing the diet recommended by the dietitian for diabetes comes very close to the diet she recommended for hypertension and hypercholesterolemia. And, if a standard "normal" diet for breast cancer can be found, it comes down to reducing the amount of fat and, particularly, saturated fats, and increasing the amount of fiber and proteins with unsaturated fats. Overall, she believed that, if I could organize my diet so that I was eating properly within the context of the diets recommended for all four conditions, I should not need to include supplements.
What makes a balanced diet
This whole program is based on the ideas I've described below.
It is important to get the food groups recommended by the government so that your food includes all the nutrients necessary to good health. With the apparent exception of calcium, I seem to be getting most of those nutrients. I do make certain that I get a calcium boost by drinking more milk, eating more cheese, and getting extra amounts of dark green vegetables.
Whenever I eat, I include protein, fat, and carbohydrates -- no exceptions. For example, when I take my meds at night, I need to have some food with most of them so I have an apple (or some similarly sized fruit) plus a piece of string cheese. The nurse suggested the string cheese because it's premeasured in 1 ounce pieces and the proportion of carbohydrate in the apple to the fat and protein in the string cheese is approximately in the proportions used properly by our bodies.
For lunch and dinner, I divide the plate into three pieces as follows:
In general, I have a little bit of butter or margarine on the complex
carbohydrate because we need some fat for things in our bodies to work
properly. I tend not to have sauces or dressings on things because
they usually are high in fat or in sugar. However, I love lemon-flavored
stuff, so I squirt about half of a lemon on on the veggies and/or fish.
For dessert, I usually have a cookie, a piece of fruit, or some sugar-free ice cream. Once in a while, I buy a no-sugar-added pie and have one piece a day for a week or so.
For lunch, having a sub sandwich with a BUNCH of veggies on top and a little vinegar and oil will get you close to the same thing (I personally like Subway's turkey and ham sub which has about 7 grams of fat). But, sometimes, I will also have things like tacos made with flour tortillas rather than corn tortillas or skinless chicken with veggies.
For breakfast, I have a bagel or a short stack of pancakes (with about a 1/2 of one of those butter tabs and sugar-free syrup on them) plus some kind of fruit and a glass of skim milk. Once in a long while, I'll have oatmeal and some fruit with milk and blue stuff (sweetener) on it. Sometimes I have an English muffin with a little butter and sugar-free jelly.
Keeping things on an even keel
Since I have a number of medications to take, I try to take the morning ones with breakfast and the evening ones twelve hours later so as to maximize the amount of medication floating around in me at any given time. A similar idea applies to keeping my blood sugar in equilibrium and around the same level most of the time. There are certainly ups and downs, but not wild swings and I think that's the key to feeling better. The apple/string cheese combination I mentioned earlier gives my system a boost that evens things out overnight when I wouldn't otherwise have some food going in for probably 10-12 hours.
One thing that may not be obvious is that juices give a blood sugar boost that is more intense than the equivalent fruit. I personally tend to minimize fruit juices in favor of fresh fruit because of my diabetes. By the same token, I also tend to avoid fruits that have relatively high juice content such as citrus in favor of apples, figs, pears which are higher in fiber.
Counting
Next, it's important to know that 1 gram of fat has 9 calories, 1 gram of anything else has 4 calories. With those numbers in mind, I aim to have an average of not more than 20 grams of fat per day in my diet over the long term. What that means is that I'm getting between 15 and 20 percent of my calories from fat. Having less tends to stop things up for me and I'd prefer not having to use laxatives to get things going.
Obsessing and the 80/20 rule
Finally, one of the things I've learned that's very important not to get obsessive about the whole issue of diet. The nutritionist mentioned at the beginning of this essay, Carolyn Katzin, suggests following the 80/20 rule which is sticking to your rules 80 percent of time and being allowed to break the rules up to 20 percent of the time. One important thing in my own 80/20 rule is a cheeseburger once a month (usually with French fries). Sometimes I'll go with my friends to a big Sunday morning brunch. But, when I do, I don't totally pig out. And, I do remember to eat things in the same proportions as I mentioned earlier so that my blood sugar doesn't get screwed up.
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