Melissa Silverberg

Jean LaMantia was only 27 years old when she was diagnosed with Hodgkin lymphoma. Since then, the registered dietitian, cancer survivor and food blogger has completely overhauled her diet to focus on the plants, vegetables and nutrients best suited for cancer prevention.

One of her goals is to ingest a lot of antioxidants, such as beta-carotene, lycopene and the vitamins A, C and E. It is thought that these antioxidants — eaten in plant-based foods, rather than as supplements &mdash; may help to neutralize free radicals, cell-damaging chemicals that are made by our bodies and can contribute to the development of cancer.

Here’s a day in LaMantia’s dietary life:

LaMantia starts every day with a piece of sprouted flax bread, toasted, with almond butter, jam and cinnamon. Some very early research shows that flaxseed may help slow the growth of breast and colorectal cancers. LaMantia pairs that with a cup of organic green tea before dropping her kids off at school. Green tea contains antioxidants, which help prevent cell damage, and which some believe may help protect against cancer.

Next, she heads straight to the gym for a daily workout to help her immune system, relieve stress and control her weight — just some of the physical and mental health benefits of exercise.

Lunch is usually leftovers from dinner the night before, followed by an afternoon snack of a green apple or a small amount of nuts for some antioxidant-rich plant protein.

LaMantia considers herself a pescatarian, which means she eats fish, but not other meat. About twice a week, dinner at her house includes fish, usually salmon, which is filled with protein and omega-3 fats, thought to cut down on inflammation in the body and thus to potentially reduce cancer risk, although studies on this have shown mixed results. LaMantia also likes to include dark, leafy vegetables such as kale or brussel sprouts. These cruciferous vegetables are very high in antioxidants as well as in fiber, which some evidence suggests is protective against several kinds of cancer. On other nights, her dinner might include whole-grain pasta in tomato sauce with lentils, all of which contain antioxidants and fiber. An alternative meal would be organic tofu with brown rice, since soy has been shown to help protect against breast and colon cancers. And alongside every meal of the day is a large glass of water, which has been shown to help prevent bladder cancer.

After dinner, her family doesn’t eat again until morning. If she needs a taste of something sweet, LaMantia will treat herself to one or two squares of dark chocolate, which is packed with flavonoids that act as antioxidants. She makes sure to get enough sleep and gets up the next morning to start all over again.

She’s been cancer-free for 20 years, but says she is always looking for ways to eat healthier, and for research that may help her in that effort.

“I feel pretty confident in my diet, but I’m always thinking I can do better,” LaMantia says.

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Jean LaMantia was only 27 years old when she was diagnosed with Hodgkin lymphoma. Since then, she has completely overhauled her diet to focus on the nutrients best suited for cancer prevention.

A Cancer Survivor's Menu

After treatment for Hodgkin lymphoma, JEAN LaMANTIA became committed to following a healthy but sensible diet, and is encouraging others to do the same. PHOTO - BY DIANA NAZARETH

Almost every day there is a new dietary “discovery” being touted online as the magic bullet to prevent cancer. Friends and family are full of stories they heard about someone who tried the Paleo diet, the baby food diet or some other trend, and how it worked for them.

But the real question is: Does any of it actually work? The short answer, experts say, is probably not.

“Fad diets are generally over-restrictive, unhealthy to be followed long-term and are often followed by reverting back to the behaviors that people were trying to change in the first place,” says Hillary Wright, senior nutritionist with the Dana-Farber Cancer Institute. “These fad diets can serve as distractions from the bigger message, which is to watch your calorie intake, eat more plant foods and get at least 30 minutes of physical activity daily.”

That’s why any new study touting hard-to-believe claims should be taken with a grain of salt. 

f something sounds too good to be true, it probably is,” says Jean LaMantia, a 20-year cancer survivor, registered dietitian and food blogger.

When LaMantia was diagnosed with Hodgkin lymphoma at age 27, she went through chemotherapy and radiation, but then felt at a loss about what to do next. 

“I got through treatment and was left with a lot of fear. It was quite debilitating. I was so afraid the doctor would tell me the cancer had come back or that a new cancer was here,” she recalls.

Then she realized how she could take control of her own health: through food.

“It made me realize, ‘I’m not powerless here. There is a lot I can do,’” she says. “When you learn about food and how it works, you feel like you are taking your power back. What is one thing you have control over every day? It’s what you put in your mouth.”

Now, LaMantia runs her own blog dedicated to researching questions she has about food and those submitted by other cancer patients. She answers the questions with information from research-backed studies, not fads or anecdotes.

Three words LaMantia lives by that are supported by the evidence: “Eat your plants.”

“I like to focus on what you should eat rather than what you should avoid,” she says. “Otherwise, people are left wondering what they can actually have.”

That goes back to the old adage about moderation.

For example, while recent research has linked bacon, sausage, hot dogs and other processed meats to increased risk for colorectal cancer, causing the World Health Organization (WHO) in October to classify these foods as known carcinogens, one piece of ham won’t instantly lead to cancer.

“I don’t care what you do when you go to Fenway Park twice a year,” Wright says. “I tend to advocate the 80-20 approach. I’m interested in what people do 80 percent of the time, not 20 percent.”

Though eating a generally healthy diet is best for cancer prevention, the advice changes for patients going through treatment, which is why some may want to consult with a dietitian specializing in oncology care to get personalized suggestions.

For those who want to lower their cancer risk by shedding excess weight, these experts may share insights about which diets to choose, since there is debate about the relative value of various oft-used eating plans, such as those low in fat or in carbohydrates. The benefits and drawbacks of different weight-loss plans can be hard to parse, especially in light of a 2009 study published in the 

, which compared four diets emphasizing different levels of protein, fat and carbohydrates and found that participants lost similar amounts of weight on each, experiencing improved lipid-related risk factors and fasting insulin levels, as well as similar amounts of satisfaction with the eating plans. For those undergoing specific anticancer treatments, experts might suggest some tailored dietary restrictions or additions.

Patients can ask their doctors for referrals to dietitians, who often work in, or with, cancer centers or hospitals. Dietitians, who are required to complete more education than nutritionists in order to earn their titles, must have a bachelor’s degree from an accredited program and be licensed by the Academy of Nutrition and Dietetics.

Suzanne Dixon, epidemiologist, registered dietitian and past chair of the Oncology Nutrition Dietetic Practice Group, has spent years working in research, clinically and as a consultant. She notes that, during treatment, keeping weight on can be a bigger challenge than taking it off.

At such times, getting down any food can be difficult, so Dixon suggests bland fare that is easy to swallow, like soup or yogurt — and then returning to a more normal diet as soon as possible.

“There may be a few days of comfort eating, but then you want to get back on track,” she adds.

Wright calls those “life-preserver” moments, when you just need to hold on. “You may want to grab onto the bow and get back in the boat, but sometimes holding on is just better than drowning,” she says. “During treatment, people need to get in enough calories and protein to get them through whatever they are experiencing at that moment.”

That can be extremely difficult, depending on the type of cancer someone has. For example, patients with head and neck cancers have a particularly hard time getting the right nutrition, Dixon says. In worst-case scenarios in which they can’t get enough nutrition, they may need to rely on a feeding tube.

“If those folks waste away and lose a ton of weight, they can’t get their treatments and will do really badly,” Dixon cautions.

While some cancer patients are worried about getting enough nutrition, people with breast or prostate cancer actually tend to gain weight during treatment, Dixon points out.

“It’s a totally different problem than someone who is malnourished, but you still need to address it,” she says. Treatments for those cancers may slow the metabolism and cause patients to lose muscle mass and bone density. Gaining weight after diagnosis can be associated with bad outcomes and reduced quality of life, which is why Dixon says that any amount of exercise during treatment is important.

Cancer can often be a wake-up call for patients to change their way of life.

That was the case for Diana Dyer, who has survived two battles with breast cancer and now runs her own organic farm with her husband in Ann Arbor, Michigan. She also wrote a book called “A Dietitian’s Cancer Journey,” whose proceeds she donates to research.

“I could only see a future of this happening over and over again if something didn’t change,” Dyer says. “I didn’t have much to lose and I had a lot to gain.”

After her second diagnosis, she added more fruits and vegetables to her diet and cut down on meat. 

That doesn’t mean she deprives herself of what she wants, though.

“Life without Girl Scout cookies is a life not worth living,” Dyer jokes. “I can allow myself to enjoy a cookie with no guilt, but I have no need to eat the whole box.”

She doesn’t call this strategy moderation, but refers to it as a series of intentional choices. Like LaMantia, Dyer saw food as the way to get her power back after cancer.

“A long time ago, I realized and accepted that cancer may kill my body, but I’m not going to let it kill my spirit,” Dyer says. “I’m going to go down swinging.”

As far as specific foods to eat or not eat, Dixon says people should be limiting their intake of red meat because of its association with certain digestive tract cancers such as rectal, colon and stomach. In fact, the WHO recently classified red meat as “probably carcinogenic” to humans.

“Ten to 15 ounces of red meat a week, or below, is not a problem, but over that, you start to see colon cancer risk going up,” she says.

Not just the kind of meat you eat, but the way you cook it, matters, experts say.

“High temperatures can create carcinogenic or cancer-causing substances,” Dixon says. “Cook it slow and low. Then you will be less likely to generate those compounds.”

Looking at your plate, Dixon says, you should see it covered more than halfway with plant foods, and the rest with lean protein like chicken or fish.

“Most people say, ‘I’m going to have chicken: What should I have with it?’ Instead, make a big colorful stir fry with lots of vegetables, and ask, ‘What kind of meat can I put in it?” she says. “It’s a complete shift in how you see meal preparation."

Anne McTiernan, a doctor and Ph.D. researcher with the Fred Hutchinson Cancer Research Center in Seattle, wants to see more research dollars directed toward studying the links between food and cancer.

“I think it is really critical to look into treatments for cancer, but if we are not looking into what causes it and trying to prevent it, it’s a little bit like trying to fight a forest fire while somebody is at the other end of the forest lighting matches,” McTiernan says.

Lower-acid foods, such as fresh fruits, vegetables, nuts, legumes and root vegetables, contain prebiotic nutrients that nourish good bacteria in the gut, decreasing inflammation throughout your body that might otherwise contribute to cancer.

Also beneficial can be soy, eaten in moderation, which studies show is associated with a lower incidence of breast and colon cancers.

On the flip side of the coin, alcohol, while good for getting relaxed, is full of empty calories that contribute to weight gain, another cancer risk factor, says McTiernan, who suggests not having more than one drink a day.

The Mayo Clinic says that excessive sugar consumption can raise the risk of certain cancers, such as esophageal, although it won’t contribute to cancer’s growth once the disease has developed. And, according to the American Institute for Cancer Research, salt and foods processed with salt should be eaten in moderation, because they “probably increase the chance of developing stomach cancer.”

The jury is still out, meanwhile, on whether dairy or artificial sweeteners can raise cancer risk, and whether organic foods, green tea, the antioxidant lycopene (which is plentiful in tomatoes) or low-fat or macrobiotic diets can reduce risk or aid in recovery.

Some studies have indicated that coffee may have a protective effect against specific cancers or their progression or recurrence, among them prostate, endometrial, liver and oral cancers. It’s not entirely clear whether this is due to coffee’s caffeine content or to the antioxidants it includes, which are compounds that help cells stay healthy. Although there has been a lot of study about whether dietary antioxidants can help prevent cancer, randomized clinical trials have yet to provide much evidence that they help, according to the National Cancer Institute. Still, some experts, including Dixon, recommend eating foods that are high in antioxidants, including vegetables like broccoli, cauliflower, chard and kale.

Patients may want to ask their doctors if there are any foods that will interact negatively with medications they are taking. One possible example is grapefruit juice, which can interfere with the action of a number of targeted drugs, including Xalkori (crizotinib) for non-small cell lung cancer and Sutent (sunitinib), which treats kidney and some other cancers.

Also check in with health experts before taking natural supplements like vitamin D — in which most cancer patients are deficient &mdash; or vitamins B, C or E. While these are available on the market, they aren’t a cure-all.

Cancer patients should talk to their doctors before starting a course of supplements because, although some can be helpful, there is such a thing as too much of a good thing, Dixon says.

“Like most nutrients, too much can be just as bad as too little,” she says. “And a lot of vitamins act differently at different times in your life.”

There are always fads patients ask about, including juicing and the Rainbow and Gerson diets, which do push plant-based foods but have other drawbacks compared with an overall healthy and balanced diet, according to LaMantia.

The latest tactic Dixon has heard about is fasting.

While the idea is still new, the theory is that, when you fast, your healthy cells go into housekeeping mode and your metabolism slows way down, but cancer cells — as is their nature &mdash; continue their uncontrolled growth. The hope is that fasting on the days before, during and after a chemotherapy treatment will allow the medicine to target more cancer cells for destruction and do less damage to healthy cells, Dixon says.

Evidence supporting the technique is limited, although fasting did look promising in mouse studies and a phase 1 study in people receiving chemotherapy, conducted at the University of Southern California.

It’s not something you should try without talking to your dietitian, Dixon says.

“If you don’t know what you’re doing, you might make yourself weak or dehydrated,” she says.

Overall, it is important to make changes to your diet in a way that you will be able to stick to after cancer, and doing it cold turkey is not always the best practice.

“If someone is eating fast food three times a day, it is important for them to do anything they can to improve their diet. But telling them to cut out all those foods today is not realistic,” Dixon says. “Pick and choose different things to work on, build on that and, over time, it becomes the norm, so you are less likely to backslide after cancer.”

And don’t worry that one particular meal, or a certain eating pattern over time, is what led to your cancer. While there are broad associations between cancer and certain eating habits, that doesn’t mean those habits always cause cancer to arise, or that they are the only potential drivers of the disease.

“I’ve seen people drive themselves crazy asking if eating this or that caused their cancer,” Dixon says. “Just think, ‘Tomorrow is a new day, and I’m going to use it to move forward and make better choices.’” 

Despite the health benefits many fad diets claim to have, doctors recommend that patients and survivors of cancer should just maintain a diet high in fruits and vegetables while staying active.

Planting a Seed: Plant-Based Diets Prove Best for Patients and Survivors

Pam Pilch was sitting by her son Jonathan’s hospital bed while he was in treatment for leukemia when the phone rang. It was her older son. He wanted to take guitar lessons.

Where would Pilch find the time to scope out a guitar teacher for him, and take him to and from lessons, and make sure he was practicing his new instrument — all on top of getting her middle son to soccer practice and handling Jonathan’s health needs and the countless other stresses of everyday life?

“An overarching theme among caregivers is how to juggle the responsibility to take care of a loved one and themselves, and not just the medical care but all these other more mundane household things that, when piled up, can become incredibly stressful,” says licensed clinical psychologist Allison Applebaum, the director of the Caregiver Clinic at Memorial Sloan Kettering Cancer Center.

Pilch, of Richmond, Va., says that when her son was diagnosed at 2 ½ years old, the world came to a complete stop, except it didn’t.

“Treatment takes full priority. When you need to be at the hospital everything else has to yield, but in my case, I had two older children at home,” she says.

It won’t always be guitar lessons — it could be home maintenance, work responsibilities, personal finance or even just taking care of yourself &mdash; but no matter what the tasks are, time management while taking care of a loved one with cancer is a balancing act.

Pilch says the first step to successful time management is admitting that you can’t do it all and it may not all get done perfectly.

“You have to accept help,” she says. “Someone else may not put the dishes in my dishwasher the way I would have done it, but if the dishes got washed, who cares?”

Pilch says she called in grandparents and friends to help and, with the support of those around her, was able to get her son guitar lessons taught at the hospital. Years later, he still plays in a band.

“You’d be surprised how many people come out of the woodwork to help,” she says.

Staying flexible is also key. If you were someone before cancer who had to have your day run according to plan, Pilch says that will likely go out the window.

“You never know when you are going to wind up in the hospital for several days,” she says. “Don’t expect that you’re going to be able to control the things that come up.”

Rachel Cannady, a behavioral scientist with the American Cancer Society, suggests creating a master list of everything that needs to get done — “a brain dump of everything that happens throughout the day.” Then, decide what needs to be done by you, and what can get done by others.

Prioritizing is crucial, Applebaum says. “Making sure their loved one gets their medicine on time may be a top priority, but making sure the lawn gets mowed can wait,” she says.

Good tasks to delegate are the practical ones, such as grocery shopping or cooking, adds Carly O’Brien, an oncology social worker with the caregiver program at CancerCare, an organization that supports patients.

“The reality is that this is something that cannot be done by one person,” Applebaum stresses. “Delegating and expanding the support network is something that is critical.”

To help caregivers manage their time, Pilch suggests that they keep a good schedule. “Write everything down,” she says, “and write it down right away. When you make an appointment, put it in your phone right then and there so you don’t forget.”

Using a Google Calendar can help multiple caregivers coordinate what needs to get done when, and access changes to the schedule in real time. For those not as technologically inclined, oldfashioned paper calendars, lists and phone calls or emails might suffice.

“At the end of the day, it’s never going to be perfect,” O’Brien says. ”Helping people manage their expectations is important, because this is on-the-job training and there is going to be a little trial and error.”

One of Pilch’s friends, another cancer mom, didn’t go to the dentist for three and a half years while her child was in treatment. When she finally went, her mouth was full of cavities.

O’Brien says caregivers can’t ignore their own needs.

“That’s usually the first thing people forget about when they are taking on so many responsibilities,” she says. “Carve out intentional time to take care of yourself and do things to make you feel good and normal.”

Many caregivers feel guilty leaving their loved one so that they can do something for themselves like go to the gym or get a haircut, but O’Brien says it’s crucial. “You’re going to be a better caregiver for your loved one if you feel like yourself,” she says.

Cannady agrees. “Even though it’s counterintuitive to take time away for yourself as a caregiver, it’s almost necessary,” she says. “Don’t shy away from what your needs are.”

The emotional part of caregiving and its toll on your dayto- day life cannot be ignored.

“Realize that everything is going to take longer than you think it’s going to because you’re traumatized by the grief of cancer,” Pilch says. “It’s going to take longer for you to do the taxes if your husband did it every year, not just because you have to learn a new skill, but also because it’s really sad and scary that you have to do that. Grieving and trauma suck your emotional energy, and that’s just part of it.”

The shift in responsibilities can also strain the relationship between caregiver and patient, Applebaum says.

“Giving up control is very difficult for patients. The caregiver doesn’t want the patient to feel bad about what they can’t do, but the patient has to accept their new limitations,” she says. “There is a sense of sadness and loss on both sides. It’s a complicated juggling act.”

Caregivers shouldn’t be afraid to talk about those emotions, O’Brien suggests. “Talking to people in a similar situation can be really comforting and mitigate some of those feelings of guilt and stress,” she says.

Hospitals often have in-person support groups, but online forums and groups are another way to find support and hear what is or is not working for other caregivers in similar situations.

“There’s a common misconception among caregivers that they have to do it all themselves and, if they don’t, what does that say about them as a caregiver?” O’Brien says. “But they aren’t superhuman. They can only take on so much.”

Pilch’s story ended well. After treatment for more than three years, Jonathan has been in long-term remission and recently turned 10.

“There are days in my life now that I don’t remember we went through a cancer fight. I never thought we would reach a day when we wouldn’t think about cancer,” she says, though she realizes not everyone is so lucky.

For other caregivers, Pilch has some simple advice. “Don’t try to plan or control too far ahead,” she says. “Just take it one day at a time.”

Facing myriad responsibilities both new and old, caregivers can benefit from time management techniques.

Time Management Techniques for Caregivers

Managing your time and the health care needs of your loved one can feel like a monumental task, but advances in technology and mobile apps are working to make the job easier for patients and caregivers alike.

Experts say a major component of strong time management is staying organized. Web-based technology like Google Calendar, which is free, can be accessed by multiple people at the same time and shared to create a more accessible schedule of doctor’s appointments and daily tasks.

Another sophisticated option that may appeal to caregivers is Lotsa Helping Hands. The free app was specifically designed to help caregivers delegate tasks to the many friends and family who are willing to help in their time of need. You can post requests for support on a calendar, such as a need for groceries or a ride to an appointment. Other family members can log on and mark their availability and sign up to help.

There are plenty of time management applications available that don’t have to do with cancer. In Wunderlist, you can create to-do lists, share them with collaborators and set up reminders that work on your desktop, phone or Apple watch, making sure nothing gets forgotten no matter what other responsibilities come up. Using the free version of Wunderlist, users can assign up to 25 tasks on any shared list.

Keeping track of multiple medications can be made easy with apps such as CareZone, which allows you to scan prescription bottles with the camera on your phone; then, the app will create a complete list of medications and dosages that you can keep with you at all times, with reminders and a way to document symptoms and other health updates.

Patients can even take control of their own health using programs such as better, a paid subscription app that connects them with a personal health assistant who will help them to file insurance claims, schedule appointments and stick to an overall health plan, as well as coaching them in stress management; the app also allows users to ask health questions of nurses at the Mayo Clinic right from their phones. Better helps keep patients organized when there are multiple doctors involved in care, as is often the case with cancer. A subscription costs $19.99 a month for individuals and $49.99 a month for families.

“That would have been very helpful when I was going through this,” says Pam Pilch, a mother of three who went through a cancer battle with her youngest son a few years before apps were as advanced as they are today.

Local librarians may be able to help you search the app store, and more and more hospitals are employing specialists to help support caregivers, as Memorial Sloan Kettering Cancer Center is doing via its Caregiver Clinic.

Just as it’s important to not be afraid to ask for help with caregiving, experts emphasize that caregivers shouldn’t hesitate to get assistance with simply getting organized and staying that way.

A variety of social media apps can lighten the workload for caregivers by making it easier to recruit help from friends and family.

Melissa Silverberg

A Cancer Survivor's Menu

Planting a Seed: Plant-Based Diets Prove Best for Patients and Survivors

Time Management Techniques for Caregivers

Giving Caregivers a Hand

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