Safe eating during cancer treatment Information | Mount Sinai

Cancer treatment – eating safely; Chemotherapy – eating safely; Immunosuppression – eating safely; Low white blood cell count – eating safely; Neutropenia – eating safely

Be Careful What You Eat

Some raw foods can contain germs that can hurt you when cancer or treatment weakens your immune system. Ask your health care provider about how to eat well and safely.

Eggs can have bacteria called Salmonella on their inside and outside. This is why eggs should be cooked completely before eating.

• Yolks and whites should be cooked solid. Do not eat runny eggs.
• Do not eat foods that may have raw eggs in them (such as certain Caesar salad dressings, cookie dough, cake batter, and hollandaise sauce).

Be careful when you have dairy products:

• All milk, yogurt, cheese, and other dairy should have the word pasteurized on their containers.
• Do not eat soft cheeses or cheeses with blue veins (such as Brie, Camembert, Roquefort, Stilton, Gorgonzola, and Bleu).
• Do not eat Mexican-style cheeses (such as Queso Blanco fresco and Cotija).

Fruits and vegetables:

• Wash all raw fruits, vegetables, and fresh herbs with cold running water.
• Do not eat raw vegetable sprouts (such as alfalfa and mung bean).
• Do not use fresh salsa or salad dressings that are kept in the refrigerated cases of the grocery store.
• Drink only juice that says pasteurized on the container.

Do not eat raw honey. Eat only heat-treated honey. Avoid sweets that have creamy fillings.

Cook Foods Safely

When you cook, make sure you cook your food long enough.

Do not eat uncooked tofu. Cook tofu for at least 5 minutes.

When eating chicken and other poultry, cook to a temperature of 165°F (74°C). Use a food thermometer to measure the thickest part of the meat.

If you cook beef, lamb, pork, or venison:

• Make sure meat is not red or pink before you eat it.
• Cook meat to 160°F (74°C).

When eating fish, oysters, and other shellfish:

• Do not eat raw fish (such as sushi or sashimi), raw oysters, or any other raw shellfish.
• Make sure all fish and shellfish you eat are cooked thoroughly.

Heat all casseroles to 165°F (73.9°C). Warm hot dogs and lunch meats to steaming before you eat them.

Be Careful When You Eat Out

When you dine out, stay away from:

• Raw fruits and vegetables
• Salad bars, buffets, sidewalk vendors, potlucks, and delis

Ask if all fruit juices are pasteurized.

Use only salad dressings, sauces, and salsas from single-serving packages. Eat out at times when restaurants are less crowded. Always ask for your food to be prepared fresh, even at fast food restaurants.

Freifeld AG, Kaul DR. Infection in the patient with cancer. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 34.

National Cancer Institute website. Nutrition in cancer care (PDQ) – health professional version. www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-hp-pdq. Updated March 23, 2022. Accessed July 1, 2022.

U.S. Department of Health and Human Services website. Safe Minimum Cooking Temperatures Charts. www.foodsafety.gov/food-safety-charts/safe-minimum-cooking-temperature. Updated June 23, 2022. Accessed July 1, 2022.

Last reviewed on: 1/25/2022

Reviewed by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Cancer Patients, Know Where Your Seafood Came From

Seafood isn’t for everyone. Some may be put off by its soft texture, briny flavor or an aroma that may smell, well, fishy.

For others, seafood is an important part of a healthy diet. Most fish is high in protein, low in fat and rich in omega-3 fatty acids, believed to be important for heart and brain health. Fish is also a versatile food to prepare: It can be poached, grilled, broiled, fried, served with any number of sauces and sides and even eaten raw (unless you’re a cancer patient—more on that later).

On the love-hate scale for fish, cancer patients may find themselves somewhere in the middle. Fish is generally an excellent source of low-fat protein. But patients struggling with loss of appetite, nausea and digestive issues brought on by cancer treatment may find the texture and aroma unappetizing. 

Still, it’s a good idea for patients try to incorporate some fish into their diets, if they can, says Carolyn Lammersfeld, Vice President of Integrative Care at Cancer Treatment Centers of America^® (CTCA). And you don’t have to eat a lot of it to garner its benefits.

“A 3- to 4-oz. portion a couple times a week is good,” Lammersfeld says. “That’s probably all you need to get the health benefits.”

In this article, we’ll explore:

• The nutritional value of fish
• Does fish cause cancer?
• Where did your fish come from?
• Eat this fish, not that one

If you’re interested in learning more about the nutritional support or other integrative care services we offer cancer patients at CTCA^®, or if you want to speak with someone about your cancer treatment options, call us or chat online with a member of our team.

Seafood’s nutritional value

Seafood is an umbrella term for dozens of species that come in a variety of shapes and sizes, from crustaceans like clams, crabs and crawfish to types as fish as small as smelts and as large as swordfish.

Considering their differences, most fish and shellfish have similar nutritional profiles. For instance, a 3-oz. serving of cod, a very healthy fish, has only 90 calories, 1 gram of fat and 20 grams of protein, while a dozen small clams have 110 calories and 1.5 grams of fat and 17 grams of protein.

Most seafood, in fact, is high in protein, with most common varieties ranging from 16 to 27 grams per serving. Seafood also is high in potassium, selenium, iron and B vitamins, and it’s rich in omega-3 fatty acids, a substance the body can’t produce on its own so it must get it from food. These essential fats are believed to support blood health, hormone production and cell signaling. Salmon, tuna, anchovies and mussels are among the best sources of omega-3 fatty acids.

For cancer patients struggling with digestive issues and weight loss, seafood may help them maintain a healthy weight while providing key nutrients.

“The omega-3 fatty acids are most concentrated in fish and may help prevent cachexia, or muscle wasting, for patients who are struggling with appetite and weight loss,” Lammersfeld says. “I encourage patients to eat a moderate amount of fish. Or, if they can’t, to take a good supplement.”

High-quality fish oil supplements are good substitutes for those who don’t like or can’t tolerate seafood, Lammersfeld says. To reduce potential aftertaste of fish oil products, she recommends storing them in the freezer and taking them out just before meals.

Some seafood is high in sodium and cholesterol. For instance, a serving of blue crab has 95 milligrams of cholesterol, nearly one-third of the daily recommended amount, and 330 milligrams of sodium, 14 percent of the daily recommended amount. Three ounces of shrimp has more than half the suggested intake of cholesterol.

Nutritional profile of some common seafood

Fish	Calories	Total fat (grams)	Cholesterol (milligrams)	Protein (grams)
Flounder	100	1.5	55	19
Haddock	100	1	70	21
Lobster	80	0.5	60	17
Oysters	100	4	80	10
Trout	140	6	55	20
Salmon	200	10	70	24
Shrimp	100	1. 5	170	21

Does fish cause cancer?

That question made headlines recently when a Brown University study suggested that fish intake was “positively associated with risk of both malignant melanoma and melanoma in situ.” But the researchers said more study was needed and stopped short of suggesting people reduce their fish consumption or stop eating it.

But, researchers said, if there’s an association between seafood consumption and melanoma, it’s because of the toxins in the fish, not the fish themselves.

“We speculate that our findings could possibly be attributed to contaminants in fish, such as polychlorinated biphenyls (PCBs), dioxins, arsenic and mercury,” study author Eunyoung Cho, ScD, an associate professor of dermatology and epidemiology at Brown University, said in a news release.

Where does your fish come from?

It does no good to increase the amount of fish in your healthy diet if that fish is not healthy to eat.

Fish are only as healthy as the waters in which they swim. And when those waters are polluted, the fish may absorb some of those toxins and pass them on to those who eat them. In fact, that’s in part how fish build up toxins to begin with. Small fish with toxins are eaten by bigger fish, which are eaten by bigger fish, and so on. With each link in the food chain, the larger fish build up more toxins.

In recent years, studies on the amount of dangerous substances in fish have produced disturbing findings. For instance:

A 2016 study by Scripps Institution of Oceanography at UC San Diego  found that fish around the world were contaminated with industrial and agricultural pollutants.

A 2019 report published in Nature said “fish are the predominant source of human exposure to methylmercury, a potent neurotoxic substance.”

In 2021, Canadian researchers published a report about the alarming amount of microplastics found in fish from the Great Lakes.

“It’s important to know where your fish came from,” says Pankaj Vashi, MD, AGAF, FASPEN, Gastroenterologist and Vice Chief of Staff at CTCA Chicago. “If you’re eating fish out of Lake Michigan, you won’t want to eat it more than once a week, at most. But if you’re getting your fish from a good source, from the open ocean waters, you can certainly eat it more frequently.”

Some larger fish, especially shark and swordfish, tend to be high in mercury and other contaminants. Eating large amounts of fish that may have high levels of mercury, PCBs and other pollutants may increase the risk of illness or disease. The U.S. Environmental Protection Agency (EPA) says children and women who are pregnant or breastfeeding should limit or avoid eating fish or shellfish from certain waters.

Lammersfeld recommends using any one of a variety of phone apps that help determine whether fish options in stores or restaurants came from responsible and sustainable sources that are likely to produce healthy products.

If you’re given fish that someone else caught, the EPA recommends asking where it came from and whether consumption advisories were issued for those waters.

Eat this fish, not that one

Most fish make good choices as part of a healthy diet—but some more than others.

The EPA categorizes fish as “best choices,” “good choices” and “choices to avoid.” Among them:  

Best choices: Salmon, cod, flounder, perch, clams, oysters, scallops, lobster, crab, sole, squid, tilapia

Good choices: Bluefish, grouper, halibut, mahi-mahi, Spanish mackerel

Choices to avoid: King mackerel, orange roughy, swordfish

Tuna, a very popular fish, is on all three lists, depending on the type. Canned light tuna is on the best list, albacore and yellowfin are on the good list, and big-eye tuna is on the list to avoid.

Cancer patients, especially those who have had a stem cell transplant, are undergoing chemotherapy or otherwise have a compromised immune system, shouldn’t eat raw fish, including clams, oysters or sushi, Lammersfeld says.

“They’re at a much higher risk of developing a foodborne illness,” she says. “A little bacterium that might make most people a little sick has the potential to make a cancer patient really sick. ”

If you’re interested in learning more about the nutritional support or other integrative care services we offer cancer patients at CTCA, or if you want to speak with someone about your cancer treatment options, call us or chat online with a member of our team.

Chemotherapy Nutrition | Nutrition recommendations during chemotherapy

Proper nutrition is an essential part of treatment. Food gives strength that is needed for recovery, so nutrition is also a healing process.

It is advisable to strictly adhere to a daily balanced diet, which should include the following food groups: protein group, milk group, fruit and vegetable group, grain and cereal group.

The therapeutic effect of anticancer drugs is accompanied by various side effects that patients need to be aware of in order to determine the time of their occurrence, be able to prevent or treat with special drugs, as well as diet and lifestyle.

Chemotherapy often has an adverse effect on the organs of the digestive tract and interferes with normal nutrition. At the same time, one of the indispensable conditions for the appointment and successful action of antitumor drugs is the general good condition of the patient, which largely depends on proper nutrition, which can alleviate and mitigate side effects. Patients using a balanced rational diet are more likely to resist side effects.

In the absence of diseases of the gastrointestinal tract, liver and pancreas, we recommend a diet that includes foods from the following four groups: protein, dairy, cereals and fruits and vegetables. The patient’s daily diet should contain products from all four groups both during chemotherapy and in between cycles.

Protein group includes beans and peas, nuts and soy products, eggs, fish, meat (veal, beef, pork, poultry), liver. The products of this group contain protein, as well as B vitamins and iron. During the day, it is advisable to include products of this group in the diet twice. It can be, for example, a cup of boiled beans or two eggs, or 60-90 grams of meat, fish, poultry, etc.

Dairy group includes all types of dairy products: kefir, fresh curdled milk, fermented baked milk, yogurt, cottage cheese, milk, cheese, butter, condensed milk, etc. The choice is determined by the preference of the patient. It is believed, however, that lactic acid products are healthier, especially those enriched with bifidobacteria (biokefirs, bifidok, etc.).

Foods in this group contain important vitamins as well as calcium and protein. Two intakes of dairy products per day are required. At each intake, the patient receives, for example, a glass of kefir or yogurt, 30 grams of cheese or 90 grams of cottage cheese, or a glass of milk, 1/3 cup of unsweetened condensed milk or 1/3 ice cream bar, etc.

Fruit and vegetable group includes all types of raw and boiled vegetables, salads and fruits, as well as juices and dried fruits. It is especially useful on the days of administration of anticancer drugs. Preferably 4-5 doses per day. Citrus fruits (grapefruits, tangerines or oranges), apples and any other fruits and berries containing vitamin C are recommended; vegetables – zucchini, eggplant, various types of cabbage (white, cauliflower, Brussels sprouts, etc.), sweet peppers, beets, carrots are required. Useful greens (lettuce, dill, parsley, green onions, celery, etc.). Each meal consists of fresh fruit or a glass of fruit or vegetable juice (you can mix half a glass of carrot and beet juice), as well as a salad of raw or boiled vegetables, etc.

Bread and cereal group includes bread, cereals and cereal products (oatmeal, corn and wheat flakes), various cereals, biscuits, straws, etc. Porridge according to the degree of usefulness can be arranged in the following order: buckwheat, oatmeal, “hercules”, oatmeal, semolina, barley, Poltava, rice. Products of this group provide the body with carbohydrates, vitamin B1. 4 doses per day are required. Each meal can contain a slice of bread or 2 cookies, half a cup of porridge, pasta, noodles. Butter or vegetable oil, sour cream or mayonnaise should be added to this diet to increase the calorie content of food. With any diet during chemotherapy, in between cycles and after it is completed, you must take a daily multivitamin. From domestic preparations, Dekamevit, Undevit, Complivit, 1-2 tablets per day, concentrates of the Golden Ball drink, etc., can be recommended, and from imported vitamins – various multivitamin complexes with microelements. It is advisable to combine the intake of multivitamins with ascorbic acid. During chemotherapy, it is desirable to increase the amount of fluid by drinking vegetable, fruit and berry juices. The expediency of this increases significantly in the treatment of platinum preparations. Especially useful are carrot, beetroot, tomato, raspberry and lingonberry juices. In the absence of edema or kidney disease with impaired excretory function, you should drink 1.5-2 liters of fluid per day: mineral water, tea, milk, lemon and other drinks. With edema, the presence of fluid in the abdominal or pleural cavity, the amount of fluid drunk should be reduced and should not exceed the amount of urine excreted by more than 300 ml. If you have no appetite, you can use the following recommendations:

10 Foods to Eat During Chemotherapy

Chemotherapy is the most serious test for the body, because healthy cells often die along with rapidly growing malignant cells. Chemotherapy provokes dry mouth, changes in taste, nausea. All this greatly interferes with normal nutrition.

At the same time, during the treatment of malignant diseases, nutrition plays an important role, since it helps to maintain a healthy state of the body. It is best to opt for mild-tasting foods that are easy to digest, yet rich in nutrients.

Healthline’s Top 10 Chemotherapy Foods:

1. Oatmeal

Oatmeal contains many nutrients that can help the body during chemotherapy. Oatmeal is rich in carbohydrates, proteins, and antioxidants. Oatmeal has more healthy healthy fats than other grains.
Oatmeal also helps regulate gut function with a specific type of soluble fiber that feeds on beneficial gut bacteria.

Mild taste, delicate structure will give this dish even more bonuses, especially if you are worried about dry mouth due to chemotherapy.

If you take cooked oatmeal with you, it is advisable to consume it within the next 2 hours, otherwise it will go bad. Or store it in the refrigerator until consumed.

Common additions to oatmeal include fruits, nuts, and maple syrup. You can also add avocado, eggs, or a pinch of salt if you’re worried about nausea or sores in your mouth.

2. Avocado

If you have no appetite, avocado can provide your body with the calories and nutrients it needs. This fruit is especially rich in monounsaturated fats, which will help lower bad LDL cholesterol while raising good HDL cholesterol.

Avocado is rich in fiber. 100 grams of this amazing fruit contains 27% of its recommended daily allowance. Fiber bulks up your stool and is food for beneficial gut bacteria.

Soft avocado is a great choice if you are concerned about dry or sore mouth, constipation, weight loss.

Before eating, be sure to wash the avocado, then peel and cut it. Listeria, a bacteria that can cause food poisoning, may be present on the peel of the fruit.

3. Eggs

Eggs help fight another common side effect of chemotherapy, fatigue. Eggs have this ability due to the high content of proteins and fats. About 6 g of proteins and 4 g of fats are contained in one egg.

Fats will fill the body with energy, and proteins will help maintain and build muscle mass, which is especially important in chemotherapy.

4. Meat broth

Taste sensations often change during chemotherapy. Even water can seem to taste completely different. To prevent dehydration, it is quite possible to use meat broth.

Broth is especially helpful if you are losing electrolytes due to vomiting, diarrhea or excessive sweating. Optionally, you can add chicken, tofu, vegetables to the broth.

To enrich the broth with nutrients, you can add a spoonful of protein powder to the mixture. Especially if you are concerned about dry mouth or decreased appetite. With nausea and vomiting, it is better not to add anything to the broth.

5. Nuts

Nuts have long been known to be rich in protein, healthy fats, vitamins and minerals. In particular, almonds are enriched with manganese and copper. 28 g of almonds contains 27% of the recommended daily intake of manganese and 32; daily intake of copper.

Manganese and copper form superoxide dismutase, one of the most powerful antioxidants in the body. Antioxidants are needed to fight free radicals and cell damage. With wounds and dry mouth, it is better to refuse nuts in order to avoid additional injury. They can be replaced with nut butter.

6. Pumpkin seeds

Pumpkin seeds are rich in fats, proteins, antioxidants in the form of vitamin E, which helps fight inflammation.

Pumpkin seeds contain about 3 g of iron per 33 g of seeds, which is about 15% of the recommended daily allowance.

The amount of iron-rich foods consumed should be closely monitored, as some medical procedures increase the risk of excessive iron intake.

7. Broccoli and other cruciferous vegetables

Broccoli, cauliflower, white cabbage have good nutrient content.

Broccoli is rich in vitamin C, which is essential for immunity. Broccoli also contains sulforaphane, a plant component that improves brain health. Studies have shown that sulforaphane has a positive effect on brain health by reducing inflammation and protecting cells from damage. This is especially important during chemotherapy courses.

8. Homemade Smoothies

Homemade smoothies are a great option if you find it difficult to chew solid foods and get enough nutrients through your diet.

For cooking, use fresh berries, be sure to rinse them under running water beforehand.

9. Bread and crackers

White bread or crackers are good choices for diarrhea.