2 Healthy Eating Fruit and Vegetables Regular carbohydrates Low fat Low SugarLimited alcohol
3 AlcoholLinked with increase of developing certain cancers – as little as 1 unit per daySensible drinking guidelines: -Men drink less than 3 units alcohol per day or 21 per weekWomen drink less than 2 units per day, or 14 per weekAlcohol- 1 unitHalf pint standard strength (3-4%) beer, lager or ciderA single measure (25ml) of spiritsA standard 175ml glass wine – 2 unitsA large glass of wine – 3 unitsIncrease risk of mouth, oespho, breast and bowel.
4 Weight Maintain healthy weight Being overweight increases risk of many cancersTry to keep weight within normal range (normal BMI)If aiming for weight loss – 1kg (2lbs) per weekOnly eat as much as you needEat a balanced diet with lots of fruit and vegetablesEat less sugar and fatBe more physically activeOverweight – bowel, kidney womb and oesph and breast in post menopausal women.
5 BackgroundIn Sept 2005 The BDA produced a professional consensus statement for the use of clean dietsThis arose due to the inconsistencies of practice amongst trusts and a lack of published evidence.BDA Haematology Subgroup – currently update
6 NeutropeniaFollowing chemotherapy there is a risk of infection from bacteria or fungus in foods. This is due to:The white blood cells that would usually fight food poisoning bacteria are at a low level (neutropenia)The gut lining acts as a barrier between bacteria and the blood stream. Chemo and RT damage the gut lining making it easier
7 NeutropeniaNeutropenia is defined as a neutrophil count below 1.0x109/L in patients undergoing conditioning pre transplant and below 0.5x109/L but increasing post transplantLimited evidence based on RCT therefore recommendation vary between institutesLondon Haematology Dietitians reviewed literature in conjunction with recent consensus – published by Leukaemia Research(EBMT, 2008)Due to the high dose chemotherapy patients receive when undergoing stem cell transplants, they experience significant immune suppression and infection remains an important cause of morbidity and mortality especially if they have undergone an allogeneic transplant (1).An increased vulnerability to pathogenic bacteria from food and gut derived pathogens has been suggested in the presence of low neutropil count exacerbated by potential mucosal damage from the conditioning regime (chemo/ radiotherapy or combination of both).Recently the London Haematology Dietitians Group has reviewed the literature in conjunction with a recent consensus statement and has provided guidelines that have been published by Leukaemia Research7
8 Food SafetyShopping – avoid damaged/broken packaging, food from over packed fridges or freezersCheck best before datesStorage – fridge & freezer temps, shelf positionsFood preparationCookingEating out
9 Neutropenic Diet Foods to avoid: - Soft ripened cheese (Brie, Camembert, goats cheese)Blue veined cheeseRaw or lightly cooked shellfishRaw/undercooked meat, sushi, smoked itemsRaw eggs or undercooked eggProbiotic, live or bio productsPatéAll unpasteurised productsRaw unpeeled fruit or vegetables including saladUncooked herbs, spices and pepperNon-drinking water, bottle mineral or spring water