Keeping a Food Diary During Chemotherapy

This week’s diarist is typically very active and eats healthy, but what adjustments will he have to make as he goes through cancer therapy?

Gender: Male.
Age: 34.
Height: Six-foot-one.
Weight: 185.
Location: Capitol Hill.
Profession: Entrepreneurial food educator; also works with a national organic/natural grocer.
Self-Described Activity Level: I am normally active at a high level. My activities include Muay Thai, Crossfit, Olympic lifting, flag football, and craft beer power drinking. I was diagnosed with testicular cancer in July and have been undergoing chemotherapy for the past ten weeks. It goes without saying that my activity level has dropped off, almost completely. I mean, I like to think about training, but then I go and look at a barbell, a kettlebell, a chin-up bar, and then turn away and find my couch. I just don’t have the strength. Since beginning chemo, I’ve lost about 15 pounds—my original weight was around 200 pounds.

My dietary lifestyle has always been quite sound, since I’m in the business of helping people understand their role with our food supply. When people ask if I’m vegan or vegetarian, which is common in my line of work, I say, “Absolutely not—if anything, I’m Paleo-ish.” I have a jug of water with me at all times. I’m not a nutritionist or a dietitian, but I have a PhD in traditional Chinese medicine, the roots of all dietary theory and food energetics. I teach people how to make personally sound dietary choices that are uniquely catered to them through uncovering their own natural intuition, so they may instinctively make positive choices that will allow them to thrive, as opposed to succumbing to Western-influenced disease: heart disease, diabetes, and obesity.

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DAY ONE

7:41 AM: I don’t normally use an alarm; I’m blessed with a pretty sweet work schedule, so I rise naturally. After some deep breaths while still horizontal, I sit up and plant my feet on the ground, and catch a few more breaths. I avoid hopping right out of bed; most heart attacks and strokes happen right as one wakes.
7:50 AM: The first thing I put down the gullet each morning is a tall glass of water with the juice of one lemon. If everyone started their day like this, the world would be a better place and folks wouldn’t be so pissed off all the time. It just gets everything moving and assists in the evacuation of built-up toxins residing in our lymph system. Highly acidic coffee is the last thing our stomachs wants to be accosted with first thing in the morning.
8:25 AM: Time for a smoothie now that my belly is ready for real food. Side note: I’m not feeling too hot today. Nausea kept me up throughout the night and is still hanging around, but I know I need to get some micronutrients and calories in me. Break out the Vitamix. In goes one head of baby bok choy, six ounces of frozen mango, six ounces of frozen goji berries (I like to use some frozen stuff so I don’t have to use ice and dilute the taste of the food), and equal parts hemp milk and coconut water. I use hemp milk because dairy is nasty and hemp is the only alternative that doesn’t have to be “fortified” or “enriched,” which is code for the addition of synthetic, isolated petrochemical sources of nutrients—you know, your standard USP-grade vitamins and minerals that are in theory unrecognizable by the human body. Blended, and down the hatch over the course of about 20 minutes.
4:25 PM: Yeah, big gap since breakfast. Chemo sucks. Pumped to make some killer dinner—even though I know I may not be able to eat it, I like the therapeutic effects of preparing real food. At this time, I eat a bar of raw chocolate.
7:30 PM: I make a braised grass-fed beef tongue, because corn-fed beef is destroying our world and has given red meat a bad rep. I have about eight ounces, along with a head of kale, steam-sautéed with apples and shallots.
8:40 PM: One bottle of Allagash Curieux and boxing on TV.

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DAY TWO

7:55 AM: Wake up and have a big glass of lemon water.
1:20 PM: Chemo is winning: Appetite is nonexistent, but I can smell the food trucks at the end of the block, so I risk wasting money on food that I think I may eventually throw up within 30 minutes. I devour three Korean tacos . . . slowly, of course. I chew my food very well.
2 to 6 PM: Cussing chemo.
6:40 PM: I Crock-Potted about ten oxtails in red wine and chipotle peppers early in the morning, in hopes that I would be able to eat dinner. I have about four, along with a large portion of roasted cauliflower and garlic.
9:25 PM: Bar of raw chocolate and a glass of coconut water.
11:30 PM: Ready for bed after an Epsom-salt bath and Dexter on Netflix.

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DAY THREE

6:00 AM: Wake up to texts from my girlfriend. She’s pissed that I didn’t call before I went to bed. What can I say? Don’t make me pull the cancer card! We say some sweet things to each other, and all is good. I get up and have a big glass of room-temp lemon water again.
6:20 AM: Big bowl of miso soup with sea veggies and cayenne pepper.
11:30 AM: I have a hankerin’ for some kale and I’m at Whole Foods, so I raid the food bars. I come away with a large container of garlicky raw kale and a container of steamed veggies. My appetite is all right, even though my body aches something awful. I also have a big cup of jasmine green tea.
2:20 PM: Can you guess, can you guess? Yep, another bar of raw chocolate.
6:00 to 8:00 PM: Slowly sip miso in my homemade bone broth. Chemo started kicking my ass around 4 PM, so I was a little scared to try eating anything solid.
11:20 PM: Long phone call with the lady friend, a handful of goji berries and cashews, and I’m off to a restless, nausea-filled sleep.

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See Also:

Counting Drink Calories at the Bar

Increasing Variety in a Gluten-Free Diet: Food Diaries

DAY FOUR

9:00 AM: After a night of being up and down and becoming even more familiar with the intricacies of my toilet, I arise, groggy but happy to be alive.
9:10 AM: Room-temp glass of lemon water. I spend about 30 minutes with it before I finally finish it.
10:00 AM: Big cup of miso soup made with my bone broth and some sea veggies and bonito flakes. I love bonito flakes, and the combo of that and sea veggies is a powerhouse of micronutrients and trace minerals we are so severely lacking in the US. I spend about an hour enjoying this on the couch while catching up on SportsCenter.
3:00 PM: I think I can eat. I raid the Whole Foods bars again. I make a kale and baby bok choy salad with shredded beets, shredded carrots, sunflower seeds, hemp oil, and lemon. Luckily, I keep it down. Score.
7:40 PM: I start a Crock Pot of pinto beans with a head of kale, a ham hock, jalapeños, and a few tablespoons of turmeric. Side note: I always use a broth of some type, usually one that I make myself so I can control the quality and sodium levels, when I prepare beans or legumes. It mineralizes the product on a much deeper level than water, and it tastes loads better. I enjoy a ton of it, baby! My appetite is in full effect. I feel so damn good that I have a beer with dinner.
9:20 PM: I enjoy more Dogfish Punkin Ale. What? Don’t judge.
11:50 PM: After a long and medicinal conversation with my girlfriend, I lie down for bed.

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DAY FIVE

8:45 AM: Feels good to sleep in some, but not too much, or else I’ll be worthless throughout the rest of the day.
8:55 AM: A big glass of hot lemon water today. Don’t ask me why, it just feels right. I enjoy this in the hot tub downstairs in my apartment complex for about half an hour. Bones are pretty achy.
10:00 AM: Time for a smoothie. I go for one bunch of red chard (about seven leaves and stalks), about six ounces of frozen pineapple (awesome enzymes in there), the flesh of one lemon, about six ounces of goji berries, a scoop of maca powder, a scoop of raw chocolate powder, and hemp milk. Insert into Vitamix and blend. Side note: I believe that smoothies in this country are way out of control on their sugar dominance. Fruit and yogurt smoothies do not create health. Veggies should always dominate your smoothies, unless you want to hang out with diabetes. I enjoy this while I’m just standing in the shower. I then decide to shave my head. I mean, I’m kinda bald as it is, but chemo has made the little bit of hair that I have left look like mange, so I just go ahead and Bic it. Smooooth.
12:30 PM: I love leftovers, especially Crock-Potted pintos with kale and ham hock. I have a large bowl with a big glass of coconut water. I’m feeling pretty decent today. I also get a call from my doc while eating. He wants to inform me that my tumor is dissolving at a higher rate than expected. Good news always makes food taste better.
2:00 PM: Goodness gracious sakes alive, I love raw chocolate. I have another bar and then a power nap.
6:20 PM: I meet a friend at Ripple in Cleveland Park. I love their simple, seasonal selections that seem to be on the more-Paleo side. I have a seasonal veggie salad, lobster quinoa risotto with a slow-cooked egg, and a grass-fed New York strip with maitake mushrooms. I also have a Fat Tire Hoptober to quench my thirst. After about two hours, I head back to Capitol Hill.
10:00 PM: Early night for me. I snack on some raw cashews and a few dried apricots while on the phone with my girlfriend, which lasts about an hour. I then have the urge to eat chips and salsa. Big mistake; the next morning, they visit me again.

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OUR EXPERT ADVICE

Marietta Amatangelo, a registered dietitian, holistic integrative nutritionist, and lifestyle coach at the George Washington Center for Integrative Medicine, says, “Ideally, in working with a patient going through chemotherapy or radiation, a diet diary would be considered along with diagnosis, current chemotherapy protocol, oncologist’s treatment, and other important factors. It would be important that the oncologist is included in the development of the nutrition program. If you or someone you know is seeking nutrition information for cancer, be sure that you work with someone who has expertise in this area.

“I was diagnosed with leukemia in 1995, given three years to live, and was on chemo for several years. I know the pain and anguish of cancer and chemotherapy. I empathize immensely. Support at a time like this is extremely important. Studies show that cancer patients who have adequate support, survive longer. Doing some group tai chi or chi kung would support activity and get him out in a community. It may be a good idea if he enlists some close friends to help him out by providing some weekly snacks or meals for him to pull from when he is fatigued or the nausea overtakes him. There are several great places in the area to draw support from other cancer survivors, such as Smith Center for Healing and the Arts in Washington, and Hope Connections for Cancer Support in Bethesda.

“Let’s forage into his food choices and eating pattern. He has quite a few positive moves in his dietary routine. He is following a Paleo diet, which, according to Dr. Loren Cordain, author of The Paleo Diet and several other books, can increase energy, improve sleep, even moods, increase mental clarity, and help with joint issues, stuffy sinuses, and chronic illnesses. It’s a way of life, based on our hunter-gatherer ancestors, who didn’t eat dairy; rarely or never ate cereal grains; ate only honey for sweetener, which was available only seasonally; and did not eat any processed foods. The diet is thought to be nutrient-dense, and, in theory, should need only Omega 3s and vitamin D as nutrient supplements.

“During cancer therapy, the body requires higher levels of nutrients and protein. In normal, healthy circumstances, an average person requires between one-third and one-half gram of protein per pound of body weight per day. These amounts need to increase to between two-thirds and a little more than three-quarters gram of protein per pound of body weight. This diarist needs up to 120 and 148 grams of protein a day during his chemotherapy. That is a whopping amount of protein to strive for in one day. He should consider including some type of Paleo protein every time he eats a small meal or snack, and including hemp in each smoothie would increase his intake. Quinoa, which is actually a seed, is another great source of protein. A helpful strategy might be to eat plenty of protein and calories whenever his appetite is the biggest, and avoid his favorite foods when he is [experiencing] nausea.

“Nausea can to be a constant companion with cancer therapy, and our diarist mentions it a number of times. As I learned going through my own journey, just boiling some fresh ginger for about 15 minutes, adding some fresh lemon juice, and drinking it down while watching a funny movie helps. Sometimes chewing ginger works, too. Fatty, spicy, greasy, and aromatic foods may cause problems, too, so he might want to be cautious of these foods. Some of his protein food choices—the oxtail, tongue, and New York strip steak—are not only high in fat, they can also be very inflammatory. Cancer arises from a state of inflammation in the body, and this would tend to compound that.

“When you are used to exercising a lot, it’s tough to slow down to a crawl. At this point, it’s really all about a
ny type of physical activity he can handle: walks on warm days, dancing, light treadmill, tennis. Basically, try for some movement every day.

“A therapeutic multivitamin and mineral would be insurance for nutrients he may miss in his diet. He may also want to consider taking an Omega 3 and a vitamin D supplement. Vitamin D is a very important nutrient to have checked, whether you have cancer or not. Many studies are connecting vitamin D deficiency with specific cancers and chance of longterm cancer survival. There are other herbs and nutrients that can be added to the arsenal, but these all have to be checked by your oncologist. Be sure to see an integrative dietitian if you are interested in what more you can do with supplements.

“And to our diarist, I wish him the best on his journey. Continue to take care of yourself in this process, and I send blessings on your way.”

Mindy Block Feirman, a registered dietitian in private practice at 2440 M Street, Northwest, says: “I am sorry you need to have chemo­therapy. It is good to see that your sense of humor, as reflected in your food records, remains intact. Your PhD in traditional Chinese medicine gives you a sound knowledge base for choosing your food intake. This is confirmed by your emphasis on fruits and vegetables, which you frequently eat via smoothies, soups, and stews. Keep that up! However, when one is nauseated and fatigued from chemo, the instinct to make positive choices may be compromised, so it is good that you have decided to participate in the food diaries to seek additional input. Some of my suggestions are specific to issues associated with chemo, while other suggestions have broader applicability.

“When undergoing chemo, weight loss is a common problem. Since you have lost 15 pounds, you should strive to maintain your current weight. This can be achieved through several strategies. Most important, you should try to spread out your food intake evenly throughout the day. Eating five to six mini-meals can give you a constant flow of energy without negative side effects. Also, having an empty stomach has been shown to increase nausea, so spreading out snacks and meals is likely to make you feel a lot better. In addition, people undergoing chemo tend to tolerate cold foods better than hot foods, and drinking liquids between meals instead of at meals may help combat nausea and vomiting. Many people undergoing chemo report that ginger tea helps with the nausea. Some people undergoing chemo complain of a metallic taste, so switching to plastic utensils and dishes may help. Finally, I am concerned about the amount of alcohol consumption, because alcohol reduces the effectiveness of some chemo drugs and interacts with medications often prescribed with chemo.

“Making some small changes can strengthen your immune system and improve your overall health. I hope you continue to receive good news from your doctors.”

Are you brave enough to keep a food diary? We dare you. E-mail wellbeing@washingtonian.com with your contact information and a paragraph or two about why you’d make a good diarist.

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