What is a healthy diet if you have had kidney cancer?

1. What is a healthy diet if you have had kidney cancer? Jan Flint Clinical Lead Renal Dietitian Royal Free Hampstead NHS trust

2. Acknowledgments • Thank you to Kidney Cancer UK

3. What will be covered • Healthy Diet • Healthy weight • Salt • Food labelling • Dietary supplements • Use of sweeteners • Alcohol • Exercise

4. Is there a specific diet for people with kidney cancer? • No! • Each person may have differing needs • Will depend on factors such as diabetes, chronic kidney disease or coronary heart disease • May also depend on stage of disease • If in doubt discuss with your GP who can refer you to a registered dietitian

6. What is a healthy diet? • Provides sufficient energy and nutrients to prevent deficiency • Helps to optimise health • Reduces the risk of disease • Is a balance of foods

7. What is a healthy weight? • Use BMI (body mass index) • This is your weight for your height • Calculated by dividing your weight in kilograms by your height in metres squared • For example: • 63kgs (10 stone) with a height of 1.72m (5ft 8in) • 63/2.95 = BMI of 21kg/m2 • Healthy BMI considered to be 20-25kg/m2

8. BMI chart

9. Healthy Eating • Enjoyable meals! • Regular meal pattern • Starchy foods • Increasing fibre • Limit saturated fats • Limit excess sugar • Increasing fruit and vegetables • Limit salt intake • Alcohol within safe limits

10. Regular Meal pattern • Breakfast is important – helps to break the fast • A regular intake of meals ensures that energy is spread through the day • Prevents peaks and troughs in blood sugar levels • Prevents temptation to over eat and binge • Many studies have shown that eating regular meals helps with weight loss

11. Starchy foods • Main source of energy • Aim to include at each meal • Sources: bread, pasta, rice, cereals, potatoes, chapatti, cassava, yam, plantain, noodles, ground rice • Wholegrain varieties contribute fibre • Source of B vitamins along with some calcium and iron

12. Fibre • Helps digestive system to process food and absorb nutrients • Helps lower cholesterol • Contributes to control of blood sugar levels which may help to control appetite • Should aim for 18g of fibre per day • 2 types of fibre • Insoluble sources – brown rice, pasta, bread, lentils, oats beans and pulses • Soluble sources – all fruit and vegetables. High sources are oats, strawberries, pears and barley • In addition to eating fibre you need to drink plenty of water to aid effectiveness

13. Fats • We all need some fat in the diet • Concentrated source of energy and provides fat soluble vitamins such as A, D, E and K • Required to protect organs, involved in metabolism and tissue repair • 2 main types: saturated and unsaturated

14. Fats Saturated (animal and trans fatty acids) Unsaturated (vegetable, oily fish and soft margarines) • Raise cholesterol and may contribute to risk of certain cancers, stroke and heart disease • Meat, butter, ghee, cream, eggs, cheese, full fat yoghurts, hydrogenated margarine or butter • Contain essential fatty acids that can’t be made by the body. Omega 3 can help protect against heart disease • Seeds, unsalted nuts, avocados, vegetable oils, oily fish such as mackerel, pilchards, sardines, trout and herring

15. How to reduce fat • Use lean cuts of meat and remove visible fat (includes fat on red meat, skin on chicken) • Use less butter and opt for a vegetable based spread or oil • Grill, steam or bake rather than frying • Select lower fat dairy products such as semi-skimmed milk or lower fat yoghurts and cheeses • Consider fruit, seeds or nuts as a snack rather than biscuits, cakes or crisps

16. Fruit and Vegetables • High in fibre especially soluble therefore may help to reduce incidence of some bowel cancers • Help reduce cholesterol and control blood sugar levels • Good source of antioxidants, vitamins and minerals which are essential for the body • We should all be aiming for 5 portions per day from a variety of sources • Low in calories

17. What is a portion? • 1 glass (150mls) of unsweetened fruit juice. • 1 medium fruit e.g, apple or orange. • 2 tablespoons of vegetables. • 1 small bowl of side salad. • 2 small fruits e.g, plum or Satsuma • 1 handful of berries / dried fruits

18. Salt • Most of us eat about 12 g of salt per day much of which is added during manufacturing • NICE have a target for the population to reduce salt intake to 5g per day by 2015 • Increased salt intake linked with high blood pressure • Food manufacturers are looking to alternative flavourings to be used in stead of salt e.g. potassium chloride

19. How much salt? • 3g in a shop bought ready made meal • Can reduce to 1g if you prepare at home and avoid using stock cubes, salt to season

20. How much salt? • 1 Stock cube = 4g salt • 1 teaspoon of salt = 5g

21. How to reduce salt intake • Don’t go cold turkey! • Don’t add any at the table – try food before putting salt on • Use herbs and spices for flavouring such as garlic, thyme, rosemary, lemon • Be aware that stock cubes, seasoning and sauces often contain lots of salt • Foods that are smoked, cured tend to be high in salt so try using unsmoked • Avoid salt substitutes such as Lo-salt as these contain lots of potassium • Rock or sea salt are no healthier than table salt

22. Sugary treats • Life is for living so allow yourself some sugary treats! • The key is everything in moderation • It’s often best to have a sugar treat post meal as prevents large fluctuations in blood sugar level which is especially important for diabetics • Sugar provides empty calories so when treats are eaten in excess may contribute to weight gain • Huge contributor to tooth decay

23. How to reduce sugar • Use diet fizzy drinks or no added sugar drinks • Sweetener instead of sugar in tea and coffee or cut back on the sugar until you no longer need or want this! • Ensure that fruit juices are unsweetened

24. Sweeteners • Used increasingly in order to reduce calorie content of meals • Aspartame, saccharin, sorbitol • Use of these in manufacturing is governed by the food standards agency • Some concern that in animal studies high level of sweetener could be related to development of bladder cancer – not proven

25. Recommended intake no more than 14 units per week for women 21 units per week for men 1 unit = 1 single pub measure of spirit 125ml glass of wine ½ pint of beer or lager Alcohol provides empty calories Alcohol

26. Food labelling

27. Need for supplements? • You shouldn’t need vitamin or mineral supplements providing you are eating a balanced and varied diet • Taking excessive supplements can be harmful to health • Good bone health is important as we get older and trying to expose ourselves to sunshine (when we get it!)

28. Functional foods • Pro and prebiotics are commonly sold in supermarkets, health food shops • They promote good bacteria in the gut therefore can help with digestive system • May be added to some vitamin and mineral supplements • Plant stanols and sterols • Clinically proven to reduce absorption of cholesterol from the gut therefore lowering bad (LDL) cholesterol • Need to be consumed as per manufacturers instructions to confer any benefits

29. Aim to undertake moderately active activity for at least 30 minutes, 5 days of the week Moderate activity includes some of the actions involved in daily life such as walking or cycling. It makes you feel warmer or even sweaty if it’s a hot day. Makes you feel better as releases good hormones in the body Can help with weight management Exercise

30. There isn’t specific dietary advice for individuals with kidney cancer The key is about having anything in moderation Reducing salt, sugar and fats can have positive health benefits Get exercising! Summary

31. Thank-you for listening • Any questions?