The importance of a varied and balanced diet

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To function properly, the body needs all kinds of nutrients. Some of these are used to meet the energy needs that all cells require in order to grow and replicate, others enable normal cellular chemical processes and others perform protective functions.

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A healthy diet should be as varied and balanced as possible. The diet should in fact contain: carbohydrates, fats, proteins, vitamins, minerals, fiber and water.The carbohydrates are the main source of energy. Fats, as well as providing energy in a concentrated manner, help absorb some vitamins. Our body needs a certain amount of fat, the important thing is to ensure it is not excessive. Proteins are essential substances to the body.Each body part is in fact made up of proteins and is therefore important to take protein every day to maintain healthy tissues, repair them and protect them from damage. Even protein is a source of energy. The vitamins and minerals play an important role in the proper functioning of the organism.

Eating a varied, balanced diet is the foundation of a healthy lifestyle in general.The type and amount of food we eat affects our energy and mood. A healthy lifestyle plays an important role in supporting the immune system (represented by cells specifically engaged in the production of antibodies) and in reducing the risk of certain pathological conditions, such as diabetes and cardiovascular diseases. Healthy and balanced nutrition is therefore all the more important for those who must face up to cancer and possible therapies.Eating a balanced and varied diet helps you feel better, manage therapies, optimize the treatment, handle the side effects, regain strength and prevent the risk of infections.

  • General principles of a healthy diet

    The following are some principles to help you eat a healthy diet. These principles are based on the indications contained in the INRAN Guidelines, the National Institute of Research on Food and Nutrition. They are general tips for those who want to eat a healthy diet and feel better but also offer helpful tips for people with cancer. But we must keep in mind that people with cancer may have, in some cases, special nutritional needs (for example, when you experience excessive weight loss or when there are specific problems related to chemotherapy).In these cases, you need to adapt your diet to your specific nutritional needs. you should always seek advice from an oncologist.

    Proteins are essential substances to the body. Each body part is in fact made up of proteins and is therefore important to take protein every day to maintain healthy tissues, repair them and protect them from damage. Even protein is a source of energy. The vitamins and minerals play an important role in the proper functioning of the organism. Fibers help to maintain proper bowel function. Water, the main component in our body, it is essential for the conduct of all the processes and reactions that occur in the body. Eating a varied, balanced diet is the foundation of a healthy lifestyle in general.The type and amount of food we eat affects our energy and mood.

    A healthy lifestyle plays an important role in supporting the immune system (represented by cells specifically engaged in the production of antibodies) and in reducing the risk of certain pathological conditions, such as diabetes and cardiovascular diseases.  Healthy and balanced nutrition is therefore all the more important for those who must face up to cancer and possible therapies. Eating a balanced and varied diet helps you feel better, manage therapies, optimize the treatment, handle the side effects, regain strength and prevent the risk of infections.

  • Check your weight and get more exercise

    We must first of all try to keep your weight within normal limits (you can ask your doctor to calculate the weight considered normal for your height). Our body weight is the tangible expression of the "energy balance" between what are intake and our caloric output.Energy is introduced with food and is used by the body both during rest (in order to maintain function in the organs such as the brain, lungs, heart, etc.), as well as during the physical activity (to operate the muscles). If your energy intake is higher than its output, the excess accumulates in the body as fat, resulting in weight gain beyond the norm.If you introduce less energy than your body consumes, the body uses the fat reserves to meet energy demands.

    Both the accumulation of fat and excessive thinness can be a health hazard.The first case increases the risk of developing certain diseases (e.g. diabetes, hypertension, etc.), while the latter case, even when fat stores are affected, has an effect on the muscles and internal organs, compromising many functions and weakening the body. A stable weight that falls within the norm thus contributes to a better quality of life. To achieve and maintain a healthy weight, it is important is to have a physically active life. Some tips: check your weight regularly; if overweight, reduce energy intake by eating less and favoring low-calorie foods that satiate more (vegetables and fruits), increase energy output by doing more physical activity; if underweight, maintain an appropriate level of physical activity and a varied and balanced diet, consuming all meals at regular times; avoid unbalanced diets or very drastic "do it yourself" approach, which can be harmful to health.If you are overweight or underweight, you should still seek advice from your physician.

  • Eat more grains, legumes, vegetables and fruit

    These foods are important because they provide carbohydrates, as well as vitamins and minerals; they are good sources of dietary fiber as is the case for most legumes, including proteins. Cereals and cereal products have always been the main source of carbohydrates in Italy. In a balanced diet about 60% of calories should come from carbohydrates. The importance of carbohydrates comes from the fact that they are easily absorbed and utilized by the body, ensuring the cells have an adequate supply of energy. Dietary fiber per se does not have a nutritional or energy value, but it is equally very important for the regulation of different functions in the organism, in particular at gastro-intestinal level.

    Main foods which are high in fiber ( Source: INRAN )

    • Legumes: beans, broad beans, chickpeas, lentils, peas
    • Cereals and cereal products: pasta, biscuits, bread and breakfast cereals (especially wholegrain), bakery products, pearl barley
    • Vegetables: artichokes, kale, chicory, carrots, eggplant, beets, mushrooms, cress, fennel
    • Fresh fruit: pears, apples, figs, bananas, kiwi, raspberries, prickly pears, currants
    • Dried fruits in shell: walnuts, hazelnuts, almonds
    • Dried fruits: dried apricots, dried figs, dried apples, raisins, prunes, dried chestnuts

    Fruit and vegetables are an excellent source of vitamins.

    Some examples:

    • oranges, tomato and kiwi for vitamin C and folate
    • carrot, apricot, green leafy vegetables for the pro-vitamin A
    • legumes and cereals for thiamin, niacin and folate.

    These products are also an important source of minerals (green leaf vegetables for calcium and iron, potato and tomato for potassium).
    Some vitamins together with other substances contained in the fruits, vegetables and legumes have also a protective action against so-called free radicals. Some tips:

    • Consume more daily servings of fresh fruit, vegetables and legumes; increase the consumption of both fresh and dry fruits, by limiting the additions of oils and fats, replacing them with herbs and spices.
    • Eat bread, pasta, rice and other grains (preferably wholegrains) regularly, do not add too many fatty products.
  • Limit fats, choose quality ones

    To feel good, you must consume be given a certain amount of fat, which, in addition to providing energy, promotes the absorption of some vitamins, but do not overdo it. Excessive intake of fat poses a risk for the onset of obesity and certain diseases, such as cardiovascular disease.In addition to the amount of fat ingested it is also important to distinguish between different fats.The different qualities of fat (determined by a different chemical composition) may in fact have important effect on health.

    Types of fats

    • Saturated fats: tend to increase the level of cholesterol in the blood. Among the foods that contain these types of fats are dairy products (cheese, whole milk, cream, butter), fatty meats and their derivatives and certain vegetable oils (palm oil and coconut oil in particular).
    • Unsaturated fats: these do not raise the level of cholesterol in the blood (some types also have a protective role on the body's health). They are found primarily in vegetable oils (seed and oil), nuts, hazelnuts, olives and fish.


    Some tips

    • Moderate the amount of fats and oils used for seasoning and cooking. If necessary, use non-stick pans, cooking in foil, microwave, steamer, etc.
    • Limit your consumption of fats of animal origin (butter, lard, cream, etc.), instead use fats of vegetable origin (especially extra virgin olive oil and seed oils).
    • Use the fat by seasoning preferably when it is in its raw, uncooked state and avoid reusing fats and oils which have already cooked.
    • Do not overindulge in fried foods.
    • Eating fish regularly, both fresh and frozen (2-3 times a week).
    • Opt for lean meats and remove any visible fat.
    • If you like eggs, you can consume up to four per week, spread over several days.
    • If you consume a lot of milk, opt for skimmed or semi-skimmed, which still maintains its calcium content.
    • Among the cheeses choose less fatty ones, or consume smaller portions.
  • Limit your sugar consumption

    The excess of simple sugars is partly responsible for the formation of dental caries and the onset of obesity. The most important sources of sugar come from foods and sweet drinks, the consumption of which should therefore be limited. Some tips:

    • Moderate consumption of sweet foods and drinks throughout the day.
    • For desserts, opt for traditional Italian baked products, which contain less fat and sugar and more starch (cookies, cakes, not stuffed, etc.).
    • Limit the amount of sweet spread on bread or toast (jam, honey, cream, etc.)
    • Limit consumption of products that contain a lot of sugar, and especially those that stick to the teeth, such as soft candy, nougat, etc.
  • Drink plenty of water every day

    Approximately 70% of the human body is composed of water and its presence, in adequate amounts, is essential for the maintenance of life. Water is essential for the performance of all processes and reactions that occur in our body. Therefore, maintaining a proper equilibrium of our "water balance" (i.e. the ratio between the 'input' and 'output' of water) is critical to maintain a good state of health. Some tips:

    • Drink when thirsty and, if you can, manage your water intake by drinking before you get thirsty. On average consume 1.5-2 liters of water a day.
    • Drink frequently and in small quantities. Drink slowly, especially if the water is cold.
    • Older people should drink frequently throughout the day, during and between of meals, and even when they do not feel thirsty (which decreases with age).
    • Maintain the water balance by drinking water. Drinks such as orange, cola-type soft drinks, fruit juices, coffee, tea, as well as providing water also contain sugar or psychoactive substances such as caffeine. These drinks should be consumed in moderation.
    • Drink during and after exercise, mainly water, in order to replenish losses due to perspiration.
    • Under certain pathological conditions (such as fever and diarrhea) that result in a greater loss of water, increase your intake of water.
  • Reducing your salt intake

    Excessive intake of salt can promote the onset of high blood pressure, especially in people who are predisposed, as well as other disorders of the heart and kidneys. Consequently, reducing salt intake can be an important measure, both preventive and curative for many people. Salt occurs naturally in foods (water, fruit, vegetables, meat, etc.), but is also added when cooking or at the table and is contained in various processed products (such as bread, crackers, cookies, etc.). In reality, the amount of salt contained naturally in foods is already sufficient to meet the body's needs. It is estimated that the daily salt consumption in Italy far exceeds the body's needs (by almost 10 times). Some tips:

    • Progressively reduce the use of salt both at the table in the kitchen (the palate can easily get used it)
    • Opt for salt enriched salt with iodine (iodized salt) instead of standard salt
    • Limit the use of salt-rich seasonings (bouillon cubes, ketchup, soy, mustard sauce, etc.).
    • Season foods with herbs (garlic, onion, basil, parsley, rosemary, sage, mint, oregano, marjoram, celery, leek, thyme, fennel seeds), spices (pepper, paprika, nutmeg, saffron, curry) or lemon juice and vinegar. You can thus enhance the flavors, using less salt.
  • Reduce or eliminate the consumption of alcoholic beverages

    Alcoholic beverages are made up of mainly water and to a lesser extent ethyl alcohol (or ethanol), and other substances in small quantities, naturally occurring or added (colorants, antioxidants, vitamins , etc.). The fundamental constituent and feature of alcoholic beverages is therefore the ethanol, a substance foreign to the body and not essential, and indeed for many toxic. The human body is generally able to withstand the ethanol without obvious damage, as long as it remains within the limits of a moderate consumption. Although it is not a nutrient, ethanol provides a significant amount of calories and promotes the accumulation of fat Moreover, it is important to emphasize the possibilities of interaction between alcohol and drugs. Those who undergo any drug therapy must indeed seek advice from their medical practitioner regarding alcohol consumption. The same attention should also be paid to common over-the-counter medications, many of which recommend abstaining from the consumption of alcohol. Some tips:

    • If you want to drink alcoholic beverages, do so in moderation during meals or immediately before or after eating.
    • Opt for drink which are low in alcohol (wine and beer).
    • Reduce your intake of alcohol if you are elderly.
    • Eliminate or reduce the consumption of alcohol if you are taking medicines (including medicines that do not require a prescription), ask for advice from your doctor on how to proceed.
  • How to adjust the diet when faced with some common problems

    Patients with cancer can present some special problems, such as  weight loss  or the  presence of a sense of fatigue and tiredness  (fatigue),  related to the oncological disease. In addition, chemotherapy can lead to a variety of disorders that often affect the gastrointestinal tract by altering the normal eating habits of the patients. A energy supply as balanced as possible can be a valuable aid for cancer patients. Some side effects of the treatment can be partially alleviated thanks to appropriate food strategies. Below are some tips on how to combat common problems in patients with cancer.

  • Tips to maintain a healthy weight

    Weight loss is a symptom that occurs frequently in people with cancer. It can be both a consequence of the disease or therapies. Some patients have no appetite or feel already satiated just by sitting at the table, others complain of nausea or food is no longer as appetizing as it once was. Those who do not eat enough, especially those who lose weight, need a diet which is higher in calories and protein.

  • Some practical advice to encourage recovery in appetite and weight
    • Eat smaller portions and often.
    • Making food as appealing as possible to tease the taste buds (e.g. put a small portion of food in the dish and garnish with slices of lemon or tomato or a sprig of parsley).
    • Always keep something on hand to snack on (e.g. Peanuts, dried fruit or parmesan cheese, a relatively light and tasty food).
    • Replace small meals with nutritious sweet or savory drinks.
    • Eat slowly, chew well and rest after each meal.
    • If you find the smell of cooking uncomfortable, ask someone else to prepare meals or eat cold, and serve in an inviting way.
    • The appetite also varies in relation to mood. Take advantage of the times when it is best to eat the foods you like best
    • Enriching the food with a source of protein and calories, such as adding cream to the soup, or butter or Parmesan cheese with vegetables (if recommended by the doctor, you can also use nutritional supplements or supplements).
  • Tips to fight tiredness

    Another symptom characteristic of cancer is the so-called fatigue, or a sense of fatigue and exhaustion that is felt regardless of the activity carried out and which is not alleviated by rest. Proper nutrition can help prevent and reduce fatigue. Some food tips to feel more energetic and combat fatigue

    • Try to take advantage of every time you feel hungry (small meals spread throughout the day)
    • Drink plenty of fluids
    • Tasting new foods or eat the ones you like most, especially if your sense of taste has changed. In addition to proper nutrition, it is important to remember that regular physical activity can help reduce fatigue. Clearly, physical activity must be related to the patient's general status (type of therapy, its values ​​of blood tests) and you should never forget to ask the specialist physician if you may or may not carry out regular physical activity and what sort of activity would be appropriate. Proper nutrition can help prevent and reduce fatigue.
  • Tips to relieve some common problems

    In addition to poor appetite and weight loss, some cancer patients may complain of other nutritional problems, some related to the disease or resulting from other treatments.

  • Inflammation of the mouth
    • Drink plenty of fluids nutrients.
    • Food and cold drinks can offer relief.
    • Avoid salty and spicy foods because they might give heartburn and coarse foods like toast or raw vegetables as they could scratch the mucosa (already inflamed).
    • Soften foods with non-spicy and non savory sauces.
    • Drinking through a straw.
    • In case of dental prostheses, leave to soak overnight in a special solution and try to use as little as possible during the day to avoid further irritation of the inflamed gums.
    • Report the problem to the doctor who may prescribe appropriate solutions.
  • Nausea
    • In the event that cooking causes a feeling of nausea you should ask someone else to take care of preparing meals or consume cold or frozen foods that should only be heated (make sure to thaw and cook them properly).
    • Avoid oily, fatty and fried foods.
    • Try eating dry foods, such as toast or crackers before you even get out of bed.
    • When you have nausea, initially only eat light and dry food, then add small portions of your favorite dishes, changing gradually to a more nutritious diet.
    • A popular remedy for nausea is sipping a soda. Try to drink slowly through a straw a glass of mineral water, tonic water, soda or lemonade.
    • Consult your doctor who may prescribe anti-nausea medication.
  • Constipation
    • Introduce a greater amount of fiber into your diet. Bran is particularly effective (for example, you can add it to cereals and soups). Other sources of fiber include: whole grains or granola to be eaten for breakfast, whole grain products (bread, flour, rice and pasta), fresh fruits and vegetables.
    • Opt for natural remedies such as syrup of figs, prunes or prune juice.
    • Drink plenty of fluids.
    • Even hot drinks can help.
    • Remember that moderate activity (e.g. walking) can help keep the intestines in order.
    • Consult your physician, especially if constipation persists.
  • Diarrhea

    Beware of food interactions and therapies

    Some seemingly harmless foods may actually interfere with some specific therapies.

    An example is the grapefruit and its juice that can reduce the effectiveness of some medications. It is very important to follow the doctor's instructions given in this regard. The same effect can also be induced by certain herbal remedies , before taking these products is good to consult your doctor. Some supplements (e.g. fish oil, vitamin E or flax seed) may in fact increase the risk of side effects if associated with certain therapies. Talk to your physician about taking any supplements. Finally, particular attention should be taken in relation to the consumption of alcohol, which should be reduced or eliminated in conjunction with the therapies, as recommended by your physician.

    Hygiene and food safety

    Patients with cancer and in particular with multiple myeloma (MM) have a higher risk than healthy individuals of infection. In particular, it should be remembered, the risk increases substantially when undergoing certain therapies. The chemotherapeutic drugs in combination with immunotherapeutics that still are routinely used to treat patients suffering from MM, can cause a state of immunosuppression and make the patient more susceptible to contracting infections.

    Food can be a source of infection.

    Caveats also help to ensure hygiene and safety in the kitchen, reducing the risk of microbial contamination and of contracting food-borne illness. In particular, it is important to remember to:

    • wash your hands before, during and after food preparation
    • keep the kitchen clean (worktops, sink, etc.), as well as utensils and crockery
    • prepare and store raw and cooked food separately
    • wash fruit and vegetables
    • cook food properly (especially eggs, meat and fish)
    • store food appropriately (in the pantry, in the refrigerator and in the freezer)
    • store leftover cooked food in the refrigerator as soon as possible

    Always check the expiration date and appearance of food (if they don't look right or have strange odor throw them in the trash without trying them).
    In specific cases, when using from certain types of chemotherapy particularly immunosuppressants, you may be advised to eliminate certain foods from the diet to prevent infections. It is always good to discuss you eating habits with your Medical Practitioner or if you need to add or remove certain types of foods from your diet. These may include:

    • raw or under-cooked eggs
    • seafood
    • all types of pâté
    • soft cheeses
    • takeaway food
    • pre-packaged sandwiches
    • cold cuts of meat
    • smoked fish.
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