Amanda Bontempo, MS RD CSO CDN is a registered dietitian and board certified in oncology nutrition, having received a bachelor's of science degree and master's of science degree from New York University. She has worked in oncology for over five years and consults with progressive health and technology companies in New York City. She's passionate about food and an equal lover of kale and chocolate. Follow Amanda on Twitter @AmandaBontempo and Instagram @amandabonbon.

Amanda Bontempo

People going through anti-cancer treatments may have a suppressed immune system, making them more vulnerable to everyday exposures. The majority of patients on treatment do not get sick from food contamination, but it remains important to stay vigilant.

The list that many patients get at the start of treatment of foods to avoid during chemo looks a bit like that during pregnancy. Avoid: 

 raw fruits and vegetables; raw or under-cooked meat and seafood; raw milk and milk products; and salad bars.

Surprisingly, eating food that has been on the shelf or in the fridge past the date on the package won't put you at high risk for foodborne illness. 

The federal government doesn't require foods, other than infant formula, to carry a date label and even then, the concern is nutrients, not safety. The USDA offers these general definitions:

: Manufacturers suggest retailers remove the product from shelves. The goal is to assure food quality for a time period after the consumer buys it.  That can be days or weeks depending on the food. For example, assuming appropriate refrigeration, milk should last five to seven days after the sell-by date before turning sour. 

: These terms are meant to tell a consumer when to eat (or freeze) a product by for best quality. For example, a jar of tomato sauce may start to taste bland or crackers may start to go stale. These dates are usually determined by manufacturer product testing, according to a report from the 

 and Harvard University. In many cases, these dates are conservative and you may notice no quality difference especially if the date is in the recent past. These dates are better used as general suggestions rather than hard-and-fast deadlines.

Ensuring that patients and caregivers maintain basic food safety practices are the key to reducing risk of food-related contamination.

		Food shouldn't sit out.  Keep cold food cold. Keep hot food hot. Defrost meat in the fridge and cook thoroughly. Refrigerate leftovers within two hours. 

		Avoid cross-contamination. Don't let raw meat or its juices touch other foods. Wash your hands, cutting boards and utensils in warm, soapy water. I even use two cutting boards: one for produce and one for meat.

		Consider avoiding high-risk foods. Deli meat is a too common source of listeria. Avoid eating 

 unless they reach 165 degrees (steaming!) first. They're certainly not healthy and should at the very least be limited. 

		Consider a meat thermometer. Meat should reach 

		Use your eyes and nose. Avoid food that is obviously spoiled.

		You can still eat out or get takeout foods. Just make sure that food from the outside is hot. Anything that requires vigilant washing, like cut fruit or salad should be made at home. 

		Patients, caregivers, friends and family should all wash hands with warm soapy water. 

Articles

How fresh is your food? Know what's behind those sell-by and best-by dates

Food Safety Smarts for Patients With Cancer

For people affected by cancer, the idea of starting fresh and with a clean slate is appealing. But especially when undergoing treatment, eating healthy can become difficult, scary, extreme, obsessive and even physical dangerous and psychologically limiting. The idea of “clean eating” is consistent with this mindset. 

Patients want to be healthy and avoid “bad” food. Of course, “bad” is a moving target and follows trends more than anything scientific. Too often, this contributes to not just confusion but people setting themselves up to fail. I've written about 

 before. On the other end of the spectrum, people want to include healthy “superfoods” which I've also written about 

I recently attended the summer Fancy Foods show, which is an expo of thousands of natural, organic and healthy food and beverage products for industry professionals. I realized that I really enjoy some of the current food trends. So, while I refrain from saying "out with the bad," I encourage "in with the good!"  Not that there's anything magical about them but that they fit into a healthy eating philosophy. Here are a few:

Matcha is a Japanese green tea made from the pulverized tea leaves. So instead of steeping a tea bag or whole leaves, you gently whisk the fine powder into water and voila. It's getting so trendy that it's increasingly becoming a staple in pretty much any coffee shop. And more and more brands and marketing the product exclusively or among their other products. And it's not just for drinks! It's being used as a “superfood” shot in juices, soups, smoothies, yogurt, pops, granola, muffins and even desserts. This antioxidant-rich green tea is so healthy that I wouldn't be surprised if it started showing up in beauty products!

Everyone is talking about the not-very-sexy underwater plant for its nutrient profile and 

. It is extremely rich in minerals with a delicious salty, briny, umami flavor that is even being used to replace added sodium in some processed foods. It gets it's dark green-brown color from chlorophyll and another carotenoid called fucoxanthin. It is essentially a marine macro-algae similar to spiraling and chlorella. Seaweed may even have some anti-cancer properties to help inhibit cell replication.

While there are many different types of seaweed, the most commonly used and widely available ones are kelp, nori and dulse. They're widely available usually in the Asian foods section of most groceries and supermarkets. I'm not obsessed with seaweed sheets for a salty snack and also the granulated kind called furikake that comes in a little shaker like salt that I add to my homemade popcorn. Delish.

Mainstream diets may not seem to have much relevance for most cancer patients, but when people are trying to eat better, they do sometimes rely on commercial plans or programs. I applaud those companies who are moving away from focusing on just the number on the scale to more of a health and wellness perspective. 

I counsel my patients daily to weigh their 

not their bodies for the sake of feeling good and fostering the kind of inner-strength necessary for optimal self-care and mental wellbeing. I remind readers to focus on whole foods and quality purchases and less on calorie counts. 

For people affected by cancer, the idea of starting fresh and with a clean slate is appealing. Here are a few of my favorite food trends.

"In With the Good" for Cancer Food Trends

Eating adequate dietary protein is essential, especially during anti-cancer treatments. It's important to improve protein intake to better meet the increased demands that the body requires while on chemo, radiation and/or immunotherapies. 

This is one of the recommendations that patients receive rather consistently from their medical teams. But recommendations on 

 to increase protein is imbued with myths and propaganda, which inevitably result in confusion. 

Some people (including our brilliant doctors!) wrongly claim that red meat is required to maintain red blood cell health. Red meat is not required to maintain or to boost immunity, red blood cells or hemoglobin. Protein, B-vitamins and iron can be gotten from other sources like lentils, whole grains or fortified cereals. Others claim that proteins should only be from vegetarian sources (including our brilliant doctors!). Some use powders and other use potions like bone broth. 

So what protein is best during treatment?

In general, and without contraindications, I advocate for a plant-based diet. This does not mean vegetarian, but it does reduce our reliance on meat and animal products. The reason is because large intakes of animal products and red meat may result in elevations in a hormone, called IGF-1 that leads to 

		Red meat: For those who enjoy red meat and want to eat it, there's a way to do it right. Red meat includes beef, pork, lamb, goat, veal and anything else that walks on four legs. Red meat should be limited for many reasons including increasing risk for heart disease, colon cancer; massive impacts on the environment; animal rights issues related to the crowded, hot, smelly, dangerous feedlots before they even get to slaughterhouses. Be mindful of portion size and limit the total amount eaten per week to no more than 

. To help limit the portions, try to think of meat as a “condiment” to add flavor to a dish rather than the main attraction. The best and healthiest cooking methods are low and slow like braising and slow cooking. Try to limit or avoid the charring methods like grilling, which inadvertently create low levels of carcinogens. Follow 

 to make grilling safer. When purchasing meat, try to find ethically-sourced, humanely-raised, 100 percent grass-fed or at least pasture-raised beef, when able, while minding portion size. Talk to your butchers. What animals eat affect the quality of their meat. What we eat effects the quality of our meat!

 should be avoided as much as possible since they have been announced to be carcinogenic per the World Health Organization. They were Processed meats include deli meat (ham, bologna, salami etc. and yes, turkey too!), hot dogs, prosciutto, and beloved bacon. Processed meats aren't just packed with artery-clogging fats but they can have up to 

400 percent more sodium and 50 percent more preservatives

		Dairy: The dairy section of groceries is always so neat and organized, but with so many choices we fall into the paradox of choice. Dairy is supposed to be good for you with healthy proteins, vitamins and minerals like riboflavin and calcium. But they are still high in saturated fats which contributes to heart disease. Saturated fat from dairy sources 

than meat but it does still contribute. Choose low fat, 2 percent milk and 

 yogurts and kefirs. There are also non-dairy milks, yogurt and cheeses made from soy and cashew sources that are increasingly easy to find.

 in chicken production. So, hormone-free labels are just a marketing tactic. Like the crowded and terrifying conditions of cattle, chickens suffer a similar fate. Try to find pasture-raised chickens, which are allowed to forage during the day for grass, seeds and worms and then cooped at night. Again, talk to your butchers and vote with your dollar. If your market doesn't carry it, speak to the store manager. If enough people ask for it, they'll get it.

		Eggs: The color of egg shells are determined by genetics, like our skin. Brown doesn't mean healthy. The sizes of eggs are determined by weight so the only thing that matters there is what you like and the price. Grades (AA, A, B) refer to 

 differences, not nutrition quality. Industrial production of laying hens protects them so well that they're confined to itty bitty cages stacked by the thousands. Again, in terrible conditions. If you don't give a hoot, buy whatever is cheapest, but if you care about hens are treated, how the egg tastes, and the nutrition quality of eggs, buy pasture-raised.

Fish: Fish is kind of the wild west of food production because there is little to no regulation. The nutritional benefits of fish are great with healthy lean protein, vitamins, minerals, healthy unsaturated fats with anti-inflammatory omega-3s which promote heart health and reduce risk of heart attack and stroke. In fact, the 

 recommends everyone eat fish at least twice a week. While healthy fatty fish like salmon, arctic char, herring, sardines and anchovies should be eaten, we should limit very large fish like tuna, swordfish, king mackerel and tilefish because of the mercury content. Many, not all, of farmed fish are raised in polluted waters causing polluted fish meat and they're often fed an unnatural diet of corn. Try to buy wild-caught whenever able. Use the Monterey Bay Aquarium 

		Powders and potions: Eating during treatment can be incredibly difficult. Patients suffer from taste changes, food aversions, nausea and odor sensitivities. If it's hard to eat natural sources of protein, patients may opt for protein powders. This is fine to help supplement the diet. I generally recommend protein powders that do not have a lot of added ingredients. You don't need tons of added vitamins, minerals and amino acids. You don't need anything marketed to body-builders either. Opt for vegan protein sources, like pea or hemp protein, or try whey protein, which is usually also lactose-free. I prefer unflavored powders because who wants to put vanilla flavor into their mashed potatoes? Bone broth is a “potion” that some claim to have super-healing properties like collagen. Bone broth can be hydrating and tasty, sure. But it is 

Saving best for last are vegetarian proteins, which are hands-down the 

Beans and lentils: Legumes are powerhouses of nutrition, indeed that we simply just do not eat enough of. They are so healthy, ecologically sound and inexpensive, that the

 named 2016, the “Year of the Pulse.” They are perfect protein sources with tons of iron and B vitamins. To release extra iron, serve with a vitamin C food source like lemon or strawberries. There's literally nothing these powerful little suckers can't do! They're healthy for our guts, reduce risk of chronic disease, promote healthy weight, maintain energy and heart health. For more information, recipes and to sign up for the half-cup habit, 

		Nuts and seeds: Nuts and seeds are not only healthy sources of good protein, but they're also loaded with essential minerals and healthy fats. When they’re not covered in chocolate, try to include them as snacks and incorporate into recipes every day. Nuts and seeds are so nutrient-dense that you only need a small portion! They help reduce heart disease risk and reduce inflammation. They're loaded with fiber, antioxidants and phytochemicals and so easy to add to everyday dishes! Flaxseeds and chia seeds get a lot of attention, but I'm partial to a good ol' pumpkin or squash seed and pistachios. Roast them at home with some cayenne pepper and turmeric for a spicy snack or with rosemary and salt for a mild herby flavor. 

Adequate protein is essential to meet the increased demands of the body, especially during anti-cancer treatment.

Protein Power for Cancer Survivors

Making healthy changes after a diagnosis is to be applauded and more importantly, supported. But in my practice, too often patients become hyper-focused on a single aspect of health that can undermine wellness itself. Even though I’m an oncology 

, it begs reminding that we could all focus on a renewed commitment to not just a healthy diet but a healthy life.

Here are some tips to help you find balance, stay focused and gain perspective.

 includes veggies, fruits, whole grains, beans, lentils, proteins and healthy fats to fuel and energize the body. The major *asterisk* here of course if unless your medical, radiation or surgical oncologist or oncology dietitian have given you specific restrictions based on your individual situation.

: This might mean walking to the mailbox and back or lifting soup-can-weights or hiking or hitting the gym. Whatever it means for you, exercise is important. When you exercise, you are present in the moment and less focused on worries. Studies show that exercise helps control stress and boost feel-good-endorphins. Talk to your doctor for an approved plan. Don’t know where to start? Talk to your doctor about a referral to physical therapy for a safe plan to start conditioning.

: Insufficient sleep makes coping with challenges a particular difficulty. Most adults need seven to eight hours of sleep per night for optimal function.

: Drink plenty of water throughout the day. Hydration helps regular body temperature, aid in the absorption of vitamins and nutrients. Promotes optimal organ function. Try to flavor water with fresh/frozen fruits, citrus and herbs if water has a funky taste when you’re on treatment. **Unless otherwise directed by your oncology doctor or dietitian.

: Accepting that some things are out of your control is damn difficult. Try to focus on living and being present 

instead of worrying about what will happen next week, next month or next year.

: People who approach life with a positive attitude are less stressed. It might sound like a silly exercise but try to make mental list of the things for which you are grateful every night before you sleep.

: Feeling out of control is fueled by being disorganized, which adds to general stress. Knowing where things are and reducing clutter let you focus on the more important things.

: I know, I know. Studies show that people who meditate regularly (even just three minutes! 

feel calmer and more in control. There are countless ways to meditate. Try yoga. Take a walk in nature. Sit quietly. Spent time with your pet. Take a bubble bath. Or try a three to four minute audio guide easily found online.

: Boundaries are important. Don’t feel bad when you feel like you need to say no. Avoid taking on more than you can reasonably commit to and do not feel guilty about it.

: Strong social connections means more than just Facebook. Truly staying connected with family and friends leads to less stress and better coping ability. Do not be afraid to ask for support during these times. It’s OK to take and your loved ones want to contribute. If you feel like this area is lacking, consider trying a support group or talk with your social worker.

If you're experiencing difficulties with any of these 10 points, I strongly recommend that you talk with your oncologist. The best cancer treatment is 

 and integrative and we don't just care for the 

Tips for a renewed commitment to a healthy life for balance, focus and perspective.

Amanda Bontempo

Food Safety Smarts for Patients With Cancer

"In With the Good" for Cancer Food Trends

Protein Power for Cancer Survivors

Mind Over Madness: Living Well With Cancer

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