Ask the Experts

Joanna Injore BSc (Hons) RD MBDA – Specialist Oncology Dietitian

We are delighted that Joanna Injore has teamed up with Orchid as a Specialist Oncology Dietitian and will be running a series of Q&As on social media.

Joanna has over 17 years of experience supporting cancer patients. She has worked extensively in the NHS, the charity sector and in private practice.


1. Do I need to limit dairy in my diet?

Dairy products like milk, cheese and yoghurt are a good source of protein, vitamins and minerals such as calcium and iodine. Calcium is used for many different processes in the body including keeping your bones strong and muscles functioning well. 

The link between dairy and prostate cancer may have come from research papers which linked high calcium diets with increased risk of prostate cancer. However, the evidence is not clear as other studies has not showed a link. As a result, The World Cancer Research Fund (WCRF)* suggests there is limited evidence that a high calcium diet increases the risk of developing prostate cancer. So, there is no need to completely cut dairy from your diet, just make sure you don’t go over you daily needs.  

Men need 700mg of calcium daily to meet their needs which can be achieved with having 3 portions of calcium each day. If you do choose to limit dairy in your diet make sure you replace it with non-dairy alternatives (e.g. soya, oat, almond milk) which has calcium added and include other sources of calcium regularly e.g. nuts, green leafy vegetables, tinned fish with bones- salmon. 

If you are having hormone therapy treatment you may need extra calcium to protect your bones as this treatment can cause bone thinning or osteoporosis. If you don’t think you are eating enough calcium speak to you nurse or doctor. 

* World Cancer Research Fund (WCRF)* a world leading charity which produces recommendations on cancer prevention based by analysing all the research available on diet, lifestyle and cancer.   

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2. How can I maintain my muscle and strength during cancer treatment?

You may experience changes to your muscle and strength if you have receiving hormone treatment. Hormone treatment can lower your testosterone levels which can cause muscle loss called sarcopenia and loss of muscle strength- dynapenia and weight gain. 

To maintain your muscle and strength start by making sure you are eating enough and including all the food groups not just protein! Check you are having the following: 

  • Aiming for 3 meals a day- breakfast, lunch and dinner 
  • Include carbohydrates at each meal (e.g. bread, cereal, pasta, rice, potatoes, plantain, cassava, couscous) 
  • Eat protein foods at least 2-3 times a day (e.g. meat, chicken, fish, eggs or plant-based sources: beans, soya, pulses, tofu, nuts, Quorn) 
  • Aim for 5 portions of fruit and vegetables daily 
  • Have 3 portions of dairy products or dairy-alternative foods- (e.g. milk, cheese, yoghurt or plant-based sources just check they are not organic, as this will not be fortified with calcium and other important minerals)   
  • Have only small amount of fat (e.g. butter, margarine, rapeseed oil/olive oil, ghee and healthy fats from nuts, and oily fish 

Keeping active will also help to maintain your muscle and strength and it’s a good idea to do a combination of cardiovascular activities and strength training. Cardiovascular activities (e.g. walking, running, cycling and swimming) raise your heart rate and make you breathe harder which you should aim for 30 minutes five times a week. Strength training works your muscle against weight or resistance (e.g. using weights, machines or your own body weight) aim for these types of exercise twice a week. 

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3. Do I need to change to a vegetarian or plant-based diet?

Vegetarian and plant-based diets have grown in popularity over the years. Research studies has examined prostate-specific antigen (PSA) scores with men’s diet. Some studies have noticed that men eating more fruits and vegetables were less likely to have raised PSA scores compared to men who didn’t eat a plant-based diet. A recent study looking at the risk of prostate cancer also noticed that men who ate a plant-based diet had a lower risk of aggressive prostate cancer. So, plant-based diet appears to be positive for male cancers? Just remember this research is based on ‘observational studies’ so only suggest a possible link or association and does not mean plant-based diet prevent against cancer- other research is needed to back this up. 

So, you don’t need to switch to a vegetarian or plant-based diet but it may be useful to include some more plant-based meals into your diet over the week, as they are a good source of fibre and vitamins/minerals. 

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4. Does sugar feed cancer?

This is one of the most popular questions I receive as an Oncology Dietitian. Sugar is a type of carbohydrate and you will see it in many forms in such as glucose, fructose, lactose, maltose and galactose.  

The connection of sugar and cancer came from early research which looked at cancer cells in the lab. Cancer cells grow very fast so need lots of energy and when they were given glucose they appeared to grow fast. However, looking at cells in a lab/test tube is very different to how the human body processes food so this cannot be applied to cancer cells in the body. Our healthy cells need glucose and energy to thrive too and there is no way of limiting glucose to cancer cells without restricting good nutrition to your body overall.  

Having lots of sugar in your diet (from sugary drinks, sweets, biscuits and cakes) can lead to weight gain and we know obesity is a risk factor for cancer. So, can I eat sugar? Yes, you can as part of a healthy diet that also contains all the other food groups too (protein, carbohydrates, fruit & vegetables, dairy and fat). 

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5. What should I drink to keep hydrated?

It is really important to drink well throughout the day so you avoid becoming dehydrated and to reduce your risk of bladder infections after treatment. You should aim for 1.5-2.0 litres of fluid each day- if your urine is a pale-yellow colour then you know you are drinking enough! 

Some people find caffeine drinks (e.g. Tea/coffee) or alcohol and fizzy drinks irritate their bladder so you might want to limit these drinks. Try regular drinks of water, squash, decaffeinated drinks, herbal teas, flavoured water throughout the day. 

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6. How do I manage weight gain?

Hormone treatment can encourage weight gain which may be due to lower testosterone levels. During this time, it is important not to follow strict diet as you still need a good food intake to meet your body’s nutritional needs.  

Aim for a balanced diet: 

  • 3 meals a day- breakfast, lunch and dinner 
  • Include carbohydrates at each meal (e.g. bread, cereal, pasta, rice, potatoes, plantain, cassava, couscous) 
  • Protein foods at least 2-3 times a day (e.g. meat, chicken, fish, eggs or plant-based sources: beans, soya, pulses, tofu, nuts, Quorn) 
  • Aim for 5 portions of fruit and vegetables daily 
  • Have 3 portions of low-fat dairy products or dairy-alternative foods- (e.g. milk, cheese, yoghurt or plant-based sources just check they are not organic, as this will not be fortified with calcium and other important minerals)   
  • Include a small amount of fat in your diet (e.g. butter, margarine, rapeseed oil/olive oil, ghee and healthy fats from nuts, and oily fish) 
  • Look at your portion sizes- your plate should be half vegetables, ¼ protein and ¼ carbohydrates 
  • Limit sugary or high fat snacks (e.g. crisps, chocolate, sweets) 
  • Aim for regular activity – the target is 30 minutes moderate exercise 3-5 times a week 

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7. Is there anything I can do to manage the side-effects of hormone treatment (e.g. hot flushes)?

Hot flushes can be a side effect of hormone treatment such as goserelin (Zoladex) and occur due to changes in hormones like oestrogen which help regulate your body temperature.  

The following diet and lifestyle tips may help with hot flushes: 

  • Keep hydrated and aim for 1.5-2.0 litres of fluid each day 
  • Limit your alcohol intake as this can increase hot flushes  
  • Consider limiting your caffeine drinks like tea and coffee- aim for 3 cups a day and try de-caffeinated drinks instead 
  • Keep your weight stable and keep active (aiming for 30 minutes moderate activity 3-5 days a week) 
  • Limit spicy or food with chili if you find it increases your hot flushes 
  • Wear light clothes during the day 
  • Keep your room cool at night   

Discuss with your nurse or doctor if you need any support with your symptoms  

8. What can I eat to manage my fatigue?

Fatigue is a common treatment side-effect particularly experienced by men receiving hormone therapy. Fatigue can have a big impact on your eating as you may feel too tired to cook meals or skip meals due to tiredness. Here are my top tips to help manage this: 

  • Prepare and cook meals when your energy levels are better, then freeze for another day 
  • Avoid missing meals and aim to eat regularly throughout the day –4-6 small meals or snacks may provide a steady amount of energy during the day 
  • Make sure your meals contain all the food groups- protein, carbohydrates, fruits and vegetables and dairy products  
  • Use frozen, tinned or pre-chopped vegetables to make meal prep quicker 
  • Choose some healthy ready meals (look for ones which are low in salt and fat) and add an extra portion of vegetables 
  • Keep hydrated- aim for 7-8 glasses a day to prevent dehydration 
  • Keep moving even if it means you need to take regular breaks. Keeping active can actual help improve your energy levels and NICE (who provide evidence-based recommendations for health and care in England) recommends resistance and aerobic exercise programmes at least twice a week for 12 weeks can reduce fatigue. Contact your hospital to see if they have any programmes you can join.  
  • Improve your sleep routine by having set times to wake up and go to bed. 

For more help: 

9. What vitamin supplements should I be taking?

If you are regularly eating a range of foods from all the different groups (protein, carbohydrates, fats, dairy/non-diary, fruits and vegetables) you shouldn’t need a vitamin or mineral supplement.  

However, if you choose to take a supplement inform your doctor/nurse and check the label to ensure it doesn’t exceed 100% of the ‘Reference nutrient intakes ‘(RNIs) or ‘Recommended Dietary Allowance’ (RDA) as high doses can he harmful and interfere with your medication. 

There are some situations where you may need a supplement: 

  • If your blood tests show you have low blood levels (‘deficiency’) of a particular vitamin or mineral 
  • If you have been prescribed supplements from your doctor e.g. calcium supplements  
  • Vitamin D- in the UK during winter (October to March) a Vitamin D supplement is recommended (10µg/ 400 IU Vitamin daily). If you are from a black and ethnic minority group, cover your skin when you go outside or unable to go outside regularly you may need continue to take vitamin D all year round. 

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10. Do tomatoes reduce prostate cancer?

Tomatoes contains a natural substance called lycopene which gives the red colour. Lycopene has been investigated in animal and ‘test-tube’ studies and showed to reduce the risk prostate cancer however the results from human and population studies has been variable.  A large observational study in men and women in North America (Adventist Health Study-2 AHS-2) showed that men who ate a large amount (5-6 times a week) of cooked or canned tomatoes also had a lower risk of prostate cancer. However, these results should be interpreted carefully as it relied on patients self-reporting their own tomato intake which could been mis-reported affecting the results.  

To sum up there is not enough evidence to know if tomatoes or the lycopene it contains, protects against or treats prostate cancer so include cooked tomatoes in your diet if you enjoy them, as they are included in your recommended 5 a day vegetable intake! 

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11. Is there a safe alcohol level?

Drinking any type of alcoholic drink is linked to increased risk of cancer; particular mouth and throat, oesophageal, bowel, stomach, breast and liver cancer. If you can keep alcohol to a minimum and don’t exceed the UK recommendations of 14 units a week over at least 3 days. 

Remember your units: 

  • 1 pint of normal strength beer, lager or cider is 2 units 
  • 1 x 25ml measure of spirts (e.g. gin/whisky) is 1 unit 
  • 1x 125mls wine is 1.5 units  

If you are taking medication or on treatment discuss with your doctor or pharmacist in case of alcohol is not recommended.  

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12. Are there any tips to improve my appetite?

Having a reduced appetite is a common side-effect of treatment and cancer. You may not feel like eating due general lack of appetite, feeling sick (nausea), tired, having bowel problems (constipation/diarrhoea) or bloating. First make sure you speak to your doctor or nurse so they can advise you on how to manage the treatment side-effects. 

Tips to improve your appetite: 

  • Eat ‘little and often’- try smaller portions sizes of your meals with a small snack in between which may be easier to manage  
  • Try serving your meals on a smaller plate so meals feel more manageable  
  • Base your meals on all the food groups- protein at 2-3 meals, carbohydrates at every meal, fruits and vegetables 5 portions daily, dairy foods 2-3 times a day 
  • If you are losing weight you may need to add extra energy to your meals by adding extra milk, butter, cream or cheese to your meals (e.g. mash potatoes, soups, desserts) 
  • Go for nourishing drinks e.g. milkshakes, hot chocolate, malted drinks 
  • Go for foods you enjoy and like  
  • Ask for help from your doctor or nurse who may be able to refer you to a dietitian for more support 

For more help: 

Victoria Anderson – Clinical Exercise Specialist

We are delighted to introduce you to Victoria Anderson, Orchid’s Clinical Exercise Specialist. Victoria focuses on clinical exercise prescription and education for oncology patients.

She works with patients to deliver safe and effective exercise throughout their treatment and for those recovering after surgery or in remission. Victoria runs a series of Q&As on social media each month.

Exercise is now widely recognised as safe, effective and can reduce the risk of different types of cancers. It is important to remember that maintaining a healthy body weight is an important risk factor for cancer, and therefore, exercise and movement is the gold standard controllable factor to help reduce cancer risk and maintain health. Even small amounts of physical activity and exercise (even 10 minutes per day) can produce some health benefits.

1. What is physical activity and exercise?

Physical activity can be categorised as any movement that is carried out by the muscles in the body. Simple activities can count towards the amount of physical activity you are getting, for example: housework (hoovering, washing etc), walking and playing with young children.

Exercise differs to physical activity slightly; exercise is thought to be structured, with a main purpose or aim and often is repetitive. Exercise can include things such as going for a bike ride, a run, playing tennis, going swimming or weight training in the gym.

Benefits of exercise:

Physical activity and exercise can:

  • Improve cardiorespiratory fitness (the efficiency of the heart and lungs)
  • Increase muscle mass
  • Increase bone mineral density
  • Improve mood
  • Reduce stress, anxiety, and depression
  • Improve longevity and quality of life
  • Provide opportunity to socialise and meet new people

2. How much exercise or activity should I do if I have cancer?

Currently the exercise guidelines for individuals with a cancer diagnosis are the same as the general population.

Adults should aim to do at least 150 minutes of moderate aerobic activity each week, this can include fast walking, cycling/swimming, OR 75 minutes of vigorous exercise each week for example running or high intensity cycling. Alongside aerobic exercise, adults should perform muscle-strengthening exercises on at least two days per week.

For example: 30 minutes of brisk walking 5 X per week.

However, some cancer treatments can leave patients feeling tired, fatigued, and unwell. If this, is you, don’t panic about hitting the guidelines above, start at your own pace and gradually build up the amount of exercise you are able to do. Studies have proven that minimal amounts of activity or exercise can still produce health benefits, so no matter how little you start with, it gives you a good starting point to build from over time.

If you have had a surgery or other medical conditions that limit you from being active, then gradually reduce the amount of sedentary behaviour (the amount of time sitting) and increase this over time.

Regular physical activity after a cancer diagnosis can be used to prevent, reduce the loss or re-build muscle mass which can happen during and after cancer treatments. Regular activity may help avoid or reduce some of the side effects associated with cancer treatments such as: fatigue, weight gain, bone density loss, and lymphoedema.

It is recommended to speak to an exercise specialist to revise a personalised program to target your symptoms, and areas of weakness to help you improve your physical function and get back to the things you enjoy.

3. What type of exercise should I do?

There are different intensities of exercise and physical activity. We should all aim to reduce the time we spend sitting and replace this with periods of standing or walking. Regular breaks between sitting have been proven to induce health-related benefits.

Sedentary behaviour: long period of sitting or inactivity. For example: sitting at a desk.

Light activity: General housework, and yoga. Often something that you feel you could perform for a longer period.

Moderate activity: Walking, cycling, shopping, mowing the lawn, and hoovering. Moderate activity should feel like you are a little out of breath, your heart rate increases, body temperature increases but you can still talk and hold a conversation.

Vigorous activity: Running, brisk walking upstairs, carrying heavy shopping, playing football, or dancing. Vigorous activity should feel like you are out of breath, breathing harder and faster which makes it difficult to hold a conversation.

Muscle-strengthening activities: These activities can include carrying heavy shopping, lifting weights, and heavy gardening.

The national guidelines advise a combination of moderate; vigorous and muscle strengthening exercises each week for optimal health.