Nutrition Before During and After Cancer

Information on nutritional needs for cancer patients


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Vinegar and its story

Vinegar

Adding bacteria to diluted wine, ale, or fermented fruits or grains creates vinegar. Vinegar is made from nearly any food that contains natural sugars. The acetic acid is what gives vinegar its unique tangy flavor.

Generally unopened vinegars will keep for 1 to 2 years in a cool, dark place. Vinegar will keep for about 6 months once opened. Because of vinegar’s complex flavor and ability to accentuate a food’s other flavors, less salt or fat often is needed in recipes that contain vinegar.

Some varieties of vinegar

Apple cider vinegar

Apple cider vinegar: This vinegar is made from fermented apples. It is inexpensive and quite tangy. It is best in complex-tasting dishes, such as stews or marinades, but it is not as good for more delicately flavored foods.

Balsamic vinegar

Balsamic vinegar: This vinegar has a sweet and fruity flavor and mild acidity. It is used in a wide variety of dishes, ranging from grilled meat and cheese plates to fruit salads. Balsamic vinegar is available in many different qualities and price ranges. Traditional balsamic vinegar is made in Modena, Italy, and must meet the standards set forth by the Consortium of Producers of the Traditional Balsamic Vinegar of Modena. These vinegars will carry a seal advertising that they adhere to these guidelines.

Balsamic vinegar aged for 3 to 5 years is good for salad dressings, dipping sauces, sauces, and marinades. Balsamic vinegar aged for 6 to 11 years is great for a number of dishes, including for sauces, risotto, and pasta dishes, in marinades, and mixed with mayonnaise or sour cream on sandwiches. Balsamic vinegar aged from 12 to 150+ years is best when used to finish dishes that are already cooked and in mild foods, so that the flavor of the vinegar is prominent.

Homemade salad dressing

Champagne vinegar: This vinegar is so mild and sweet that it is most often used on salads or vegetables.

Distilled white vinegarDistilled white vinegar: Distilled white vinegar is most often used for pickling. It also is frequently used for cleaning and other household chores.

Fruit vinegar

Fruit vinegar: The most popular fruit vinegar is probably raspberry. These vinegars are good for making salad dressings and also add a nice flavor to meats, poultry, and fish.

Malt vinegar

Malt vinegar: This is made from malted barley. It is used  in the preparation of chutneys and is not a good choice for delicately flavored recipes.

Red wine vinegar

Red wine vinegar: This vinegar is frequently used in French cuisine, including in marinades, stews, and sauces. It is also good in fresh salsa.

Rice vinegar

Rice vinegar: Popular in Asian cuisine, rice vinegars are sweet and mild. They sometimes are referred to as “rice wine vinegars” in recipes. White rice vinegar is used in both Chinese and Japanese dishes. It is a key ingredient in sushi.

Vinegar has been receiving some attention lately for its possible role in lowering blood glucose levels after eating. While not much research has been done on this topic and the research that has been done is conflicting, a few studies have found that if people with diabetes or those at risk regularly drink a small amount of vinegar at the beginning of meals it may help lower blood glucose levels after eating.

The active ingredient in vinegar is acetic acid, and it is present in all types of vinegar. It is thought that acetic acid may influence blood glucose levels in several ways.

  • Delay how quickly the stomach empties after eating. Slowing digestion could cause the food to be digested more slowly and raise glucose less quickly.
  • Prevent the complete breakdown of starches, causing less to be digested and absorbed into your blood stream.
  • Help muscles use glucose more effectively.
  • Whether vinegar works the same on all types of carbohydrate-containing foods is unclear from the research.

How much do you need?

The research studies cited used between 2 teaspoons to 2 tablespoons of vinegar, mixed with at least 8 ounces of water.

Side Effects

  • Vinegar is high in acid, which can burn your mouth or esophagus, and damage tooth enamel if it is not properly diluted. Also, for some people with diabetes who have a complication called gastroparesis (slow stomach emptying), taking vinegar can worsen the condition and be dangerous.
  • Use caution if you take one or more glucose-lowering medications that can cause low blood glucose (hypoglycemia), especially insulin. If the vinegar lowers blood glucose, this can put you at risk for hypoglycemia.
  • Do not use vinegar as a substitute for your glucose-lowering medications. If you would like to use vinegar, discuss it first with your dietitian and healthcare provider to make sure you use it safely and minimize side effects.


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Food preservatives

Food Preservation

Food preservation was designed to prevent spoilage, the first food preservation practices were, salting of meat and fish, adding sugar in canned foods and pickling vegetables.

Food preservatives play a vital role in preventing deterioration of food, protecting against spoilage from mold, yeast, life-threatening botulism and other organisms that can cause food poisoning. Preservatives reduce food cost, improve convenience, lengthen shelf life and reduce food waste.

Functions, Names and Labeling

There are two modes of preservation: Physical and chemical.

Physical preservation refers to processes such as refrigeration or drying.

Chemical preservation is adding ingredients to a food for the purpose of preventing potential damage from oxidation, rancidity, microbial growth or other undesirable changes — and is considered a “direct additive.”

food-preservation

Per U.S. Food and Drug Administration, both natural preservatives, like lemon juice, salt and sugar and artificial preservatives are classified as “chemical preservatives.” While many common preservatives occur naturally, manufacturers often use synthetic versions of these chemicals.

All preservatives added to food products must be declared on the ingredient list on the food label using common names of ingredients. When no such name exists, synthetic forms can be listed. For example, synthetic vitamin B9 can be listed as “folic acid.” Preservative ingredients must either be identified as a preservative or the specific function must be given, such as “sorbic acid (to retain freshness).”

food label

Safety

According to the regulatory authorities, preservatives are generally recognized as safe, or GRAS, in the quantities in which they are allowed in individual food products. “Safe” for food additives is defined to mean “a reasonable certainty in the minds of competent scientists that the substance is not harmful under the intended conditions of use.” Still, there are some preservatives of concern.

Sodium nitrite/nitrate used in processed meats is an example of compounds that may increase the potential of these foods to cause cancer. Studies have linked eating large amounts of processed meats with an increased risk of colorectal cancer.

No Nitrites Label

Sodium benzoate and sulfites appear to be safe for most people, but may cause adverse reactions in others. A 2007 study published in The Lancet suggests sodium benzoate and artificial food colorings may exacerbate hyperactivity in young children.

Although butylated hydroxyanisole, or BHA, is listed by the National Toxicology Program as “reasonably anticipated to be a human carcinogen,” the FDA considers it a GRAS substance in minute quantities. Meanwhile, butylated hydroxytoulene, or BHT, has been banned in some countries but has not been shown conclusively to be carcinogenic.

A diet full of processed foods may contain excessive preservatives — both artificial and natural (salt and sugar) and should be limited. But preservatives within the context of an overall healthful diet help safeguard food and protect consumer health.

Removing preservatives compromises food safety, and there is no good scientific reason to avoid them. The risk of getting botulism from processed meats far outweighs the risk of the preservative especially when consumed in moderation.

Nonetheless, emerging technological innovations aimed at replacing traditional preservatives are in the works. Development of technologies, such as high pressure processing and ultrasonic preprocessing with pulsed light are promising and may yield additional benefits such as reduced water usage, energy efficiency and improved food quality.

High Pressure Processing

HPP-Process


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Food Labels

In the last blog we learned a little bit about food labels, let’s take it a little further and figure out a few more details. Remember some numbers are in grams and others in milligrams.

Food Labels

Servings information

Serving size:

This is an amount of the food that is considered a single serving. The rest of the nutrition facts then provide information based on that amount. If the serving size says 1/2 cup, then the calories, fat, cholesterol, sodium, protein, carbohydrates, fiber and other nutrients shown are for 1/2 cup of that food.

Servings per container:

This number tells you how many servings there are in the whole package. So if a package has 7 servings and you eat the whole package, you’ll be eating 7 times the calories and other nutrients. Yes! They add up.

Calories:

The calories are the number of calories in one serving. Don’t forget this important fact. So if you eat more than one serving, you have to multiply the calories by how many servings you eat. If a package says 1/2 cup is a serving and you eat 1 cup, that’s two times the servings (1/2 cup x 2 = 1 cup).

Fat, Cholesterol, & Sodium

Total Fat:

This is the number of grams of fat in a single serving. In a 2,000 calorie daily diet, most people should aim for between 45 and 78 grams of total fat per day, mostly from sources like plant oils, avocados, seeds and nuts.

Saturated fat:

This fat is often called a bad fat, but a little saturated fat in the diet may not be harmful. Most people should aim for 7-10% or less of their calories from this fat or about 20 grams or fewer per day based on a 2,000 calories diet.

Trans fat:

This is a bad fat. If the label shows trans-fats, find another food. Even if it says 0 grams, it’s important to look at the ingredient list to see if the word “hydrogenated” is on the list.

Cholesterol:

Most people are advised to consume less than 300 mg of cholesterol each day. Take a look at the number and pick foods with low cholesterol so it doesn’t add up to more than 300mg at the end of the day.

Sodium:

Most people should aim not to exceed 1,500 mg of sodium daily, while some are advised that 2,300 mg is safe. The label will say how many milligrams of sodium are in a single serving. It will also list a DV (Daily Value) showing what percentage of 2,300 mg  is in one serving.

Fiber, Vitamins and Minerals

Fiber:

This is listed in grams on the package. Women are advised to get 25 grams or more daily, men are advised to reach 35 grams.

Vitamins and Minerals:

Nutrition Facts panels are required to list Vitamins A, C, E and the mineral Iron. They will be listed by percent only. The goal is to achieve 100% over the course of the day.

Protein, Carbohydrates and Sugars

Protein

This will be listed in grams. Protein can help with feeling satisfied. Protein needs vary for people with kidney disease and other illness, on an average we need about 0.9 g x with your weight in kilograms. Not all foods will have protein.

Carbohydrates and Sugars:

Carbohydrates are listed in grams and there are many forms of carbohydrates from complex whole grains, fruits and veggies to simple sugars like honey, cane sugar (table sugar), and maple syrup among others. While recommendations for individuals will vary, carbohydrate recommendations can generally go up to 300 grams per day in a 2,000 calorie diet.


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What’s the problem with eating sugar?

sugar-spoon

The federal government’s decision to update food labels marked a change for consumers. For the first time, beginning in 2018, nutrition labels will be required to list a breakdown of both the total sugars and the added sugars in packaged foods.

added-sugar

Why are food labels being revised?

The shift came after years of urging by many nutrition experts, who say that excess sugar is a primary cause of obesity and heart disease. Many in the food industry opposed the emphasis on added sugars, arguing that the focus should be on calories rather than sugar. They say that highlighting added sugar on labels is unscientific, and that the sugar that occurs naturally in foods like fruits and vegetables is essentially no different than the sugar commonly added to packaged foods.

natural-sweeteners

What about “natural” sweeteners?

Food companies like to market agave nectar, beet sugar, evaporated cane juice and many other “natural” sweeteners as healthier alternatives to high-fructose corn syrup. But whatever their source, they are all very similar. To suggest one is healthier than another is a stretch. In fact, the F.D.A. urged food companies to stop using the term evaporated cane juice because it is “false or misleading” and “does not reveal that the ingredient’s basic nature and characterizing properties are those of a sugar.”

 What’s the issue with added sugars?

It mainly comes down to the way they’re packaged.

Naturally occurring sugar is almost always found in foods that contain fiber, which slows the rate at which the sugar is digested and absorbed. (One exception to that rule is honey, which has no fiber.) Fiber also limits the amount of sugar you can consume in one sitting.

sugar-in-nature

A medium apple contains about 19 grams of sugar and four grams of fiber, or roughly 20 percent of a day’s worth of fiber. Not many people would eat three apples at one time. But plenty of children and adults can drink a 16-ounce bottle of Pepsi, which has 55 grams of added sugar – roughly the amount in three medium apples – and no fiber. Fiber not only limits how much you can eat, but how quickly sugar leaves the intestine and reaches the liver.

Why is it a problem to have too much sugar?

Many nutrition experts say that sugar in moderation is fine for most people. But in excess it can lead to metabolic problems beyond its effects on weight gain. The reason, studies suggest, is fructose. Any fructose you eat is sent straight to your liver, which specializes in turning it into droplets of fat called triglycerides.

While many health organizations – including AICR – recommend avoiding sugary drinks, this highlights the powerful affect that cutting out one single part of the diet may have, independent of other healthy changes.

sweet_graphic

A study focused on non-alcoholic fatty liver disease (NAFLD), a condition that can eventually cause cirrhosis and even liver cancer, suggests that a daily sugary drink increases the risk for NAFLD, especially – but not only – among overweight individuals.

Obesity and overweight are key risk factors for NAFLD, when there is extra fat in liver cells not caused by alcohol. AICR’s latest report on liver cancer, found that obesity increases the risk of this cancer. And research currently links sugary beverages to weight gain and obesity.

How much sugar is too much?

One of the largest studies of added sugar consumption, which was led by the Centers for Disease Control and Prevention, found that adults who got more than 15 percent of their daily calories from added sugar had a higher risk of cardiovascular disease. The biggest sources for adults were soft drinks, fruit juices, desserts and candy.

While those might seem like obvious junk foods, about half of the sugar Americans consume is “hidden” in less obvious places like salad dressings, bread, low-fat yogurt and ketchup. In fact, of the 600,000 food items for sale in America, about 80 percent contain added sugar.

 Follow the World Health Organization’s guidelines, which recommend that adults and children consume no more than about six teaspoons daily of added sugar.

too-much-sugar


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Effect of Carbs

carbs

There are questions about possible negative health effects of some carbs, such as fructose, which is found in sugar and high-fructose corn syrup, and galactose, which is found in milk. But the question of how carbs affect health is mostly focused on how quickly and efficiently the body can break the molecule down and deliver glucose to the bloodstream.

But you don’t eat carbohydrates; you eat food, so it’s useful to categorize foods by the type of carbohydrates.

simple-carbs

Simple-carb foods are those that your body breaks down quickly and easily, such as sweeteners (sugar, honey, maple syrup) and refined grains (white flour, pasta, white rice). These are the carbs that tend to spike blood sugar.

Complex-carb foods, which include whole grains and legumes, have large, complex molecules that are more difficult to digest and don’t cause the same rapid increase in blood sugar.

complex-carbs

The simple/complex classification isn’t perfect. Many fruits and vegetables contain both types of carbohydrates: Some get broken down quickly, others more slowly. And it’s not always true that whole foods are digested slowly while refined foods are digested quickly. Potatoes, for example, have lots of carbohydrates in the form of starch, which is broken down quickly.

refined-grains

Carbohydrates in refined grains — bread, white rice, pasta — come packaged with some fiber, some protein and even a few other nutrients, their calories aren’t quite as empty, and the speed with which they’re digested varies. (Refined flour is also fortified with folate, essential to reducing the risk of fetal neural tube defects.)

white-bread

White bread, for example, lets loose a flood of glucose, so your blood sugar spikes, but pasta, particularly if it’s not overcooked, doesn’t have that effect. Although the ingredients of the two foods are almost identical, pasta has a difficult molecular structure that your body can’t break down as quickly.

glycemic-index

There is a measure for how much a particular food increases your blood sugar: the glycemic index, or GI. When carbohydrates in a food get converted quickly, that causes a spike in insulin, which your pancreas releases to prompt cells to absorb the glucose. The hormones that your body releases in response can make you feel hungry.

 


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Sugar in fruit

Fruits

Insulin does not spike if the fruit in question is whole fruit. Unlike honey, cane sugar, high-fructose corn syrup and other forms of sugar that are added to many processed foods, the sugar naturally found in fruit is consumed in the company of fiber, which helps your body absorb the sugar more slowly.

When you consume a food or beverage that contains carbohydrates, your digestive system breaks the carbs down into a type of sugar called glucose, which enters the bloodstream. When blood sugar levels rise, the pancreas produces the hormone insulin, a signal to your cells to absorb the glucose so it can be used immediately as energy or stored in the liver and muscles for later use. Repeatedly eating foods that cause surges in blood sugar makes the pancreas work harder. Over time, that can lead to insulin resistance and an increased risk of Type 2 diabetes.

Fruit juices

Refined grain products like white bread, crackers, and cookies, which tend to be low in fiber, deliver large amounts of carbohydrates per serving and are digested very quickly, raising blood sugar and insulin levels. Sugars enter into the bloodstream especially rapidly when you consume carbohydrates in liquid form, such as in sugary sodas, juices.

Starchy foods

But it’s not as simple as adding fiber to starchy foods or soda — the quality and physical form of carbohydrates are critical, which means favoring whole foods over processed foods and added sugars. That includes favoring whole fruit over fruit juice: Fruit juices can contain fiber, but some of that fiber is broken down in the juicing process, reducing the metabolic benefit compared with intact fruit.

Whole fruit

To minimize spikes in insulin, it’s best to eat fruit whole. That’s because with whole fruit the cell walls remain intact, this is how fiber can offer the greatest benefit, because the sugars are effectively sequestered within the fiber scaffolding of the cells, and it takes time for the digestive tract to break down those cells. Four apples may contain the same amount of sugar as 24 ounces of soda, but the slow rate of absorption minimizes the blood sugar surge.