Ms. Greta Macaire is a registered dietician at the University of California, San Francisco.
She spoke with Prostatepedia about the types of recommendations she makes for men with prostate cancer during treatment.
What do you recommend for men about to start radiation, have surgery, or begin chemotherapy?
Ms. Greta Macaire: I always tell men undergoing radiation, surgery, or chemotherapy that there will be side effects from those treatments. They may need to modify their diet.
For example, patients who get radiation to the prostate bed in the pelvic area (or if lymph nodes are involved) can experience side effects such as gas, bloating, loose stools, and diarrhea. To decrease these side effects, they may have to modify their diet. These are almost always temporary recommendations, though, so it can be really confusing for men.
As a good diet for men with prostate cancer, everyone would recommend a lot of broccoli and vegetables. But men who go into radiation might get gas, bloating, and diarrhea, so they may need to avoid gas-producing vegetables and acidic foods like tomatoes to decrease these side effects. We would also recommend less fiber and more cooked vegetables in that case. But I always let them know these are temporary changes.
Once they recover from radiation, they’ll be able to introduce all these foods back into their diet gradually. It can be a little unnerving for them to think about backing off those foods that they feel are so important. The digestive tract usually heals pretty quickly from something like radiation, so it’s just temporary. Typically, we incorporate those foods back in within a couple of weeks after treatment.
Surgery can also result in gas and bloating because of the pain medications. Constipation and gas can be really uncomfortable because of the surgery. Again, that’s usually temporary.
Any dietary changes before chemotherapy?
Ms. Macaire: The most common side effect I hear about is taste changes: some foods are not appealing or taste like cardboard or metal. Nausea and decreased appetite are other common side effects.
You may have to plan out what you’re going to eat. Eat smaller meals, and eat more often. That way, you’re not getting too much so you’re not going to feel bloated and uncomfortable, but then you’re not going all day without eating, which will make nausea worse. If you experience a metallic taste, we can look at ways to tweak the flavor profile of foods to make them tastier.
Sometimes animal protein brings out the metals in food. There’s more iron and things like that even in chicken or fish. Choose alternative protein sources that don’t have as much of the metallic flavor. Lemon juice can brighten up flavor if everything tastes bland. These small modifications can help with the side effects.
I think it’s comforting for people to hear that these changes are temporary. You’re going to like food again. When you’re done with chemo, things will taste good again. Hold tight.
One of the big side effects of androgen deprivation therapy (ADT) is that men tend to gain weight quickly. What do you recommend for men on hormonal therapy?
Ms. Macaire: We strongly recommend physical activity. The research is pretty consistent on physical activity. Cardiovascular exercise is important, but resistance training is also important. Resistance training maintains lean body mass, which keeps the metabolism higher. The more muscle they can maintain and not lose due to hormone therapy, the more they can keep their body composition on track.
Men on hormone therapy need to be careful about what they eat, especially with foods that can cause weight gain: white foods—which can cause abdominal weight gain—like refined grains and sugary beverages (soda, fruit juice), desserts, and pastries. It’s really important to eat more green leafy vegetables, fill your plate with filling, high-fiber foods. Make at least half your plate non-starchy vegetables, fill a quarter of the plate with lean or plant protein and limit grains or starchy vegetables like potatoes, corn, or peas to no more than the other quarter of the plate.
I wouldn’t recommend a low-carb diet by any means, but eating lots of vegetables and including a lean protein with each meal will help to keep blood sugar levels stable, to prevent spikes and drops.