Nutritional Management During and After Treatment

Dianne Zorn, RD
Clinical Dietitian
Inova Fairfax Hospital

Q: What kind of diet should I follow to reduce the risk for colorectal cancer?
Follow a high fiber diet that includes at least five servings of fruits and vegetables as well as whole grain breads, cereals, and pasta. Fiber speeds the passage of stool through the intestinal tract and therefore reduces the time the colon is exposed to possible carcinogens. Fruits and vegetables also contain vitamins, minerals, and phytochemicals that work together to reduce risk for colorectal cancer. Increase the amount of fiber in your diet gradually to allow your body time to adjust. Remember to drink at least eight classes of liquids daily.

Reduce fat in your diet by eating less red meat, removing the skin from poultry, and avoid fried foods. Use reduced fat margarine and salad dressings.

Q: Is there any type of vitamin, herb or other nutritional supplement that I can take to prevent colorectal cancer?
Unfortunately there is no proven nutritional supplementation that can prevent colorectal cancer. The Food and Drug Administration (FDA) does not regulate nutritional supplements. Supplements may contain unidentified substances or be labeled incorrectly. Interactions among nutrients, herbs, and drugs can be dangerous especially when taken in megadoses. Your best strategy to reduce risk for colorectal cancer is to follow the low fat, high fiber diet outlined above.

Q: What side effects can I expect from my treatments and what adjustments should I make to my diet?
Diarrhea is a common side effect of the treatment for colorectal cancer. Here are some suggestions to minimize the problem:

• Follow a low fiber diet. Avoid whole grain products and most raw fruits and vegetables. (You may eat bananas.)
• Drink clear liquids frequently throughout the day to prevent dehydration. Liquids are better tolerated at room temperature.
• Eat small portions of bland foods frequently throughout the day.
• Drink liquids 30 to 60 minutes before or after meals rather than at the same time as solid foods.
• Include foods and liquids that contain potassium and sodium to make up for these nutrients lost when diarrhea is severe.
• Limit milk or drink lactose free milk.
• Avoid fried, greasy foods.
• Avoid foods that are very sweet.
• Try eating foods that contain pectin such as scraped apples, applesauce, and bananas.
• Avoid high fiber foods such as broccoli, cabbage, cauliflower, Brussels sprouts, dried beans, and corn.
• Eat yogurt, rice, cream of wheat or rice, tapioca, cooked vegetables (except for those listed above), canned fruits, poultry without the skin, lean beef and fish.

Your oncologist or dietitian may suggest that you take glutamine, an amino acid supplement that in some cases can help minimize diarrhea. Do not take glutamine unless recommended and only take the recommended dosage.

Q: After my treatments are completed, how long will I continue to have diarrhea? Will I ever be able to return to a normal diet?
How long diarrhea continues to be a problem after treatment is completed depends on the individual. Some patients continue to have bouts of diarrhea for a prolonged period of time; for others diarrhea reoccurs in the future. Most patients are eventually able to resume a normal diet although they may not be able to tolerate specific foods. Reintroduce foods, in small amounts, slowly into your diet. If tolerated, increase amounts until you can eat a normal serving size. Try one food at a time, that way you can easily identify those that cause problems.

Q: How will having a colostomy affect my diet?
After surgery, your first foods will be clear liquids. You will gradually advance to solids. It may be easier to eat four to six small meals while adjusting to the colostomy. For the first six to eight weeks you will want to avoid nuts, raw vegetables, fruits with skins or seeds, high fiber cereals, and baked goods. Eventually you will be able to resume a normal diet while making allowances for foods that cause you problems. Try reintroducing problem foods later. Some patients have problems with gas-forming foods. After about six to eight weeks patients are advised to gradually increase insoluble fiber in their diet to promote regular bowel movements. It is important to get adequate fluids to prevent dehydration.

Resources
Eat Five a Day for Better Health
American Dietetic Association - Nutrition & Cancer Prevention
Diarrhea