Eat Your Way to Better Health

This information describes how you can make healthy food and exercise choices.

The foods you eat and the lifestyle choices you make play a major role in your health. Healthy choices can:

• Lower your risk for developing chronic diseases, such as high blood pressure, diabetes, heart disease, and some cancers.
• Control symptoms of medical conditions, such as high blood pressure, high blood sugar, and high cholesterol.

In this resource, we outline 6 steps to improving your overall health, including how to manage your weight, control your food portions, understand food labels, increase your physical activity, and make healthy food choices. We also answer some frequently asked questions about living a healthy lifestyle. At the end of this resource, there are 3 sample menus that include healthy meals for you to try.

For more information about making food choices during treatment, ask your nurse for the resource Eating Well During Your Cancer Treatment.

Step 1: Achieve and Maintain a Healthy Weight

Your diet and exercise can make you gain or lose weight. If you take in more calories than your body needs, you’re likely to gain weight. If you take in fewer calories than your body needs, you’re like to lose weight.

If you’re overweight, you need to eat fewer calories than your body needs, increase your physical activity, or both to get to a healthy weight. There are many health benefits to maintaining a healthy weight, including lowering your risk for many chronic diseases. Obesity can increase your risk for:

• Colon, breast, prostate, and esophagus cancers
• Heart disease
• Diabetes
• High blood pressure
• Sleep apnea
• Other chronic diseases, such as asthma, arthritis, and gallbladder disease

If you’re underweight, talk with your healthcare provider about ways to gain weight safely.

Find out your body mass index (BMI)

BMI is a measurement of the amount of fat in your body based on your height and weight. It can help you learn if your weight is healthy or not. A healthy BMI for an adult is between 18.5 and 24.9.

You can calculate your BMI using the tool on this website: www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm. You can also find your BMI on the BMI table below. To use the table:

For example, if you’re 5 feet, 5 inches tall and you weigh 168 pounds, then your BMI is 28. This means you’re considered overweight. Your goal should be to achieve a BMI that puts you in the normal range.

If your BMI is above 25, look for the weights that correlate with a healthy BMI for your height. That should be your target weight.

Caloric needs

Your caloric need is the number of calories your body needs. It depends on:

• Your age
• Your muscle mass (how much muscle you have)
• The amount and type of exercise you do
• Your overall health

An adult female generally needs 1,600 to 2,200 calories per day. An adult male generally needs 2,200 to 2,800 calories per day. In general, if you’re older or less active, you need fewer calories. If you have a lot of muscle or are very active, you need more calories.

If you want to lose weight, try to eat fewer calories and be more active.

Step 2: Control Your Food Portions

Eating too many calories from any foods can result in weight gain. To avoid weight gain, it’s important to control your food portions (serving sizes).

The following tables list the amount of food that’s equal to 1 serving size.

Bread, cereal, rice, and pasta

Vegetables

Fruits

Milk, yogurt, and cheese

Lean meat, poultry, fish, beans, eggs, and nuts

You can also use the following examples of everyday items to help determine your portion sizes.

Step 3: Make Healthy Food Choices

Fats, oils, and cholesterol

“Good” cholesterol” versus “bad” cholesterol

Cholesterol is a fat-like substance. It’s found only in foods that come from an animal source, such as meat, eggs, and dairy. Cholesterol travels in your blood in packages called lipoproteins. There are 2 types of lipoproteins: “good” and “bad.”

• Low-density lipoprotein (LDL) is “bad” cholesterol. It can clog your arteries (blood vessels) and cause heart disease.
• High-density lipoprotein (HDL) is “good” cholesterol. It takes cholesterol out of your body.

Fats and oils

All types of fats have the same number of calories, but some fats are healthier than others. Cut back on the total amount of fat in your diet.

Saturated fats

Eating foods with too much saturated fat can raise your total cholesterol and LDL levels. Limiting the amount of saturated fat you eat can keep your heart healthy and make it easier to maintain your weight.

Saturated fats are found in:

• Beef, pork, veal and chicken skin
• Whole milk and milk products such as cheese and ice cream
• Butter
• Lard, bacon fat
• Coconut, palm, and palm kernel oils
• Baked goods such as cookies, pastries and croissant

Eating unsaturated fats (monounsaturated and polyunsaturated fats) instead of saturated fats may lower your risk of heart disease.

Monounsaturated fats

Choose mostly monounsaturated fats. These fats can lower your total cholesterol and LDL levels. They don’t affect your HDL level.

Monounsaturated fats come from plant-based sources. They’re mostly found in:

• Olives
• Olive oil
• Canola oil
• Peanuts, peanut oil
• Almonds, hazelnuts, pecans
• Avocados

Polyunsaturated fats

Polyunsaturated fats can lower your total cholesterol and don’t raise LDL levels.

Polyunsaturated fats also come from plant-based sources. They’re found in:

• Corn oil
• Safflower oil
• Sunflower oil
• Soybean oil
• Cottonseed oil

Trans fats

Trans fats (also called partially hydrogenated fats or oils) are made when hydrogen is added to oil. They’re artificially made, which means they’re man-made and usually don’t happen naturally.

Trans fats can raise your total cholesterol and LDL levels and lower your HDL level. There is no safe level of trans fats to eat. Try to avoid them completely.

Trans fats are found in:

• Many fried, prepackaged, baked, and processed foods
• Margarine, butter-like products, and shortening
• Powdered and liquid coffee creamers

Choose foods that say “zero (0) trans fat” on the label. Try not to eat processed foods that have partially hydrogenated oils, such as some crackers, cookies, peanut butter, and breaded frozen foods. Look at the ingredient list of a food to see if it has partially hydrogenated oils.

Omega-3 fatty acids

Omega-3 fatty acids are needed for good health, especially for heart health. They’re found mainly in oily fish. Try to eat at least 2 (4-ounce) servings of omega-3 rich fish per week. Fish that have omega-3 fatty acids include:

• Salmon
• Tuna
• Mackerel

Foods that have smaller amounts of omega-3 fatty acids include:

• Leafy green vegetables
• Walnuts
• Soybeans
• Flax seeds, chia seeds

Omega-6 fatty acids

Omega-6 fatty acids are also necessary for good health, since your body can’t make them. But, your body needs only small amounts. Omega-6 fatty acids are found in:

• Vegetable oils
• Margarine
• Baked goods
• Processed foods

How much fat should I eat?

20% to 35% of the calories in your diet can come from fats. Most of your fat intake should come from monounsaturated and polyunsaturated fats. 10% or less of the total calories in your diet can come from saturated fat.

There are 9 calories in each gram of fat. To find how many grams of fat you can eat each day:

• For total fat, multiply your daily caloric need by 20% and 35%
• For saturated fat, multiple your daily caloric need by 10%

Then, divide those numbers by 9 to get the number of fat grams you can eat each day. You can also use the table below.

Tips for trimming fat from your diet

• Limit spreads that are high in fat. These include:
  • Butter
  • Margarine
  • Cream cheese
  • Mayonnaise
  • Salad dressings
• Choose lean cuts of meat, such as skinless chicken or turkey and fish.
• Eat no more than 18 ounces of red meat per week.
• Remove the fat and skin from your meat before cooking it.
• Bake, broil, grill, steam, or poach your foods.
• Pan fry your foods with nonstick cooking spray instead of deep frying your foods.
• Add more flavor to your foods with herbs and spices instead of butter or oil.
• Use fruit or fruit juices in your marinades. Try kiwi, papaya, lemon, or lime juice.
• Use vegetable stock or low-sodium tomato juice instead of butter or oil to cook your vegetables, meats, and seafood.
• Refrigerate your soups and skim off the fat layer that forms on top.
• Make scrambled eggs or omelets by using 1 yolk with 2 egg whites. Or, use an egg substitute product.
• Choose canned tuna or sardines that are packed in water, not oil. Otherwise, drain oil-packed canned tuna or sardines to decrease the fat.
• Cook with canola or olive oil. These oils have the least amount of saturated fat.

Fruits and vegetables

Eating many different kinds of fruits and vegetables can help protect you against chronic diseases. Fruits and vegetables are:

• Rich in vitamins, minerals, antioxidants, and phytochemicals (good substances that are found only in plant foods).
• Rich in fiber.
• Low in calories, fat, and cholesterol.

Eat at least 2 ½ cups of vegetables and 2 cups of fruit per day. Include fruits and vegetables in most of your meals and snacks. Choose whole or cut-up fruits and vegetables, not juices. Juices contain little or no fiber. Fiber is important for healthy bowel function.

The Dietary Guidelines for Americans recommend eating more fruits and vegetables as part of a healthy eating plan. This includes eating different types of fruits and vegetables. You can do this by choosing different colors of fruits and vegetables, such as dark green, red, and orange. Legumes (such as beans, lentils) also contain many essential vitamins and nutrients and should be included in your diet.

The list below shows the best fruit and vegetable sources for vitamin A (carotenoids), vitamin C, folate, and potassium. These are important nutrients to have in your diet.

Source: Dietary Guidelines for Americans. United States Department of Agriculture, 2015.

Fiber and whole grains

Fiber is an important part of your diet because it:

• Helps regulate your bowel movements (pooping).
• Helps prevent constipation (having fewer bowel movements than usual).
• Helps you feel full.
• Helps with weight loss.
• Can help lower cholesterol.
• Can lower the risk for diabetes, heart disease, and obesity.

Plant foods are the best sources of fiber. Along with fruits and vegetables, eating a variety of whole grains, cereals, legumes, nuts, and seeds can provide the fiber you need.

Your fiber needs are based on your daily caloric need. Women usually need about 25 grams of fiber per day and men need about 35 grams of fiber per day.

To make sure you’re getting enough fiber, eat whole grains. They contain more vitamins, minerals, and fiber than refined or processed grains. Read ingredient labels carefully to find out if the foods you choose have whole grains. Food labels must have the word “whole” right before the name of the grain. For example, when choosing a wheat bread or pasta, the label must read “whole wheat,” not “enriched wheat flour.”

To get more fiber and whole grains in your diet:

• Eat foods such as whole-wheat bread, brown rice, barley, whole oats, oatmeal, bran cereals, and popcorn.
• Try pancakes, muffins, or bread mixes made with whole-wheat or buckwheat flour.
• Choose a whole grain like barley and add a small amount of dried fruit or toasted nuts.
• Add beans to rice, pasta, salad, and soups.
• Choose fresh fruits and vegetables instead of juices.

Increase your fiber intake gradually and drink at least 8 (8-ounce glasses) of liquids each day.

Use this table to choose foods that are good sources of fiber.

Sodium (salt) and potassium

Our bodies need some sodium, but too much sodium can increase your risk for:

• High blood pressure
• Congestive heart failure
• Stroke
• Kidney disease

The Dietary Guidelines for Americans recommend eating no more than 2,300 milligrams (mg) of sodium per day. If you’re in a high-risk group, such as if you’re over 40 years old, are African American, or have high blood pressure (also called hypertension) or diabetes, you should have no more than 1,500 mg.

Salt that’s found naturally in food makes up only about 10% of the salt we eat in a typical day. Adding table salt to your food adds another 5% to 10%. The remaining 75% of salt in our diet comes from salt that’s added when food is made. Fast foods and packaged and processed foods are especially high in sodium. A fast-food cheeseburger and medium serving of French fries has about 1,370 mg of sodium.

To lower the amount of salt in your diet:

• Don’t add salt to your food at the table.
• Avoid preparing and cooking food with salt. Use fresh herbs and spices for flavoring.
• Read labels on all packaged foods to find the amount of sodium per serving. Buy foods that are labeled “low sodium,” “very low sodium,” “salt free,” or “sodium free.” Low-sodium foods have less than 140 mg of sodium (5% of the daily value) per serving.
• Limit ketchup, soy sauce, and salad dressing. These are usually high in sodium.
• Limit pickled and cured foods (such as sauerkraut, pickles, hot dogs, bacon, and processed lunch meats).
• When you’re eating out, choose plain foods and avoid sauces and condiments. Ask the waiter to have no extra salt added to your food.

If your blood pressure is high, choose foods that are naturally low in sodium and rich in potassium. Potassium is a mineral found in many fruits and vegetables. It helps keep blood pressure within a normal range. The National Academy of Sciences, Engineering, and Medicine recommends that adult males should have at least 3,400 mg of potassium each day. Adult females should have at least 2,900 mg of potassium each day. Even if your blood pressure is normal, foods that are rich in potassium should still be part of your diet.

If you’re concerned about your blood pressure, talk with your healthcare provider.

Foods rich in potassium

Sugars

There are different kinds of sugars in food.

Natural sugars

Natural sugars are sugars found in whole, unprocessed foods, such as milk, fruit, vegetables, grains, and legumes. You should get most of your sugar from sources of natural sugars. You will get a variety of health benefits with much fewer calories to help you achieve and maintain a healthy weight.

Added sugars

Added sugars are sugars added to processed foods and drinks. Added sugars add calories to foods but don’t provide any nutrients. Manufactures use added sugars to:

• Give baked goods color and texture
• Help preserve food
• Use as a bulking agent (add volume to foods)

The Dietary Guidelines recommends that most Americans limit added sugars to less than 10% of total calories per day. A 2,000 calorie diet would be 200 calories (50 grams) of added sugar per day.

Added sugars are usually found in foods that have little nutritional value, such as cakes, cookies, regular soda, ice cream, sports drinks, and juices. They may also be found in pasta sauce, flavored yogurts and cereals, and condiments, such as ketchup.

The new food labels on packaged foods now include the amount of added sugars. You can also check the ingredients list for added sugars. The following ingredients are examples of added sugars:

• Agave
• Brown sugar
• Corn syrup
• Dextrose
• Evaporated cane juice
• Fruit juice concentrate
• High fructose corn syrup
• Honey
• Maple syrup
• Molasses
• Sucrose
• White sugar

Choosing foods and drinks with too much added sugars often results in having fewer healthier foods and drinks. This can lead to health issues, such as:

• Weight gain, which can contribute to increased risk of type 2 diabetes
• Hypertension (high blood pressure),
• Heart disease and other cardiovascular diseases
• Some cancers

Calcium and vitamin D

You need calcium in your diet every day to keep your bones and teeth strong and your muscles and nerves healthy. When you’re not getting enough calcium from your diet, your body takes calcium from your bones. This can make your bones weak and brittle and cause a disease called osteoporosis. Osteoporosis puts you at greater risk for bone fractures.

Here are tips for getting more calcium in your diet:

• Have at least 2 to 3 servings of skim or low-fat dairy every day. Include milk, yogurt, or cheese. If you have trouble tolerating lactose (a sugar found in milk products), try lactose-free products, such as Lactaid® milk or soy products.
• Almonds, leafy greens, soybeans, canned sardines, and salmon are also good sources of calcium.
• Foods such as cereals and orange juice usually have added calcium.
• Many people, including women during menopause, need calcium supplements. Speak with your healthcare provider or a dietitian to find out more about your calcium needs.

Your body needs vitamin D so it can absorb the calcium in your diet. Vitamin D is found in fortified dairy products and some fatty fishes. Your body can also make vitamin D from sunlight. Most people get all the vitamin D they need from sunlight. But, if you don’t spend much time outside or if you usually keep your skin covered (such as for religious reasons), you may need to take a vitamin D supplement.

Daily recommended intake

The table below lists the daily amount of calcium and vitamin D you need per day based on your age.

IU=International Units

Most of your bone mass is made during childhood and early adulthood. But, you’re never too old to improve your bone health. To do this, eat foods that are rich in calcium and vitamin D and take part in daily weight-bearing activities, such as walking, jogging, lifting weights, or jumping rope. All of these things can help make your bones stronger.

Alcohol

Alcoholic drinks provide calories but contain few nutrients. If you drink alcohol, do so in moderation. This means having no more than 1 drink a day if you’re female and no more than 2 drinks a day if you’re male. One drink equals:

• 12 ounces of beer
• 5 ounces of wine
• 1.5 ounces of 80-proof liquor

Drinking too much alcohol can lead to:

• Cirrhosis (liver scarring)
• Mouth cancer
• Head and neck cancer
• Esophageal cancer
• Breast cancer (evidence not as strong)
• Colon cancer (evidence not as strong)

Some studies have shown that moderate drinking can decrease the risk for heart disease by increasing HDL levels (good cholesterol). However, it’s still not a good idea to start drinking alcohol if you don’t already.

Step 4: Understand Food Labels

Reading and understanding food labels can help you make smart food choices.

Food labels have been updated to give more information and are easier to read. Food labels now include:

• Added sugars in a serving.
• The amount of vitamin D and potassium in a serving.
• Larger, bolder, calories and serving size so they’re easier to read.
• Serving size to reflect amounts that people actually eat.
• The percentage of daily value for nutrients such as sodium, fiber and vitamin D based on newer scientific evidence.

Here is an example of the new food label.

How to read food labels

This section explains how find certain information on a food label. The numbers next to the headings will help you find the matching information on the food label at the end of this section (see Figure 3).

Serving size (1)

Servings per container can sometimes be deceiving. Packages that look like a single serving can often be 2 or 3.

% Daily Value (2)

The % daily value is a guide to the amount of nutrients in 1 serving of food. For example, the labels above list 20% for calcium. This means 1 serving provides 20% of the calcium you need each day. The % Daily Values are based on a diet of 2,000 calories per day for healthy adults.

Fat (3)

The type of fat in your food is important. Choose products with 3 grams of fat or less per serving and choose products with the least amount of saturated or trans fats.

Fiber, vitamins, and minerals (4)

More fiber, vitamins, and minerals are better (up to 100% of the Daily Value). Select foods that contain at least 25% of 1 or more of these categories.

Sugar (5)

Less sugar is better. Save foods or beverages with more than 15 grams of sugar per serving for special occasions. Choose foods with less added sugar.

This food label shows that the food is high in added sugars. Due to the high sugar content, this food would not be considered a healthy choice.

Step 5: Get Active

Physical activity and exercise are a necessary part of a healthy lifestyle. By doing at least 30 minutes of moderate exercise most days of the week, you can stay fit. You can burn about 150 calories a day (about 1,000 calories a week) by doing moderate exercise.

• To stay at your current weight, do at least 60 minutes of moderate to vigorous activity on most days of the week.
• If you need to lose weight, do at least 60 to 90 minutes of moderate to vigorous activity each day.

Moderate exercise is when your breathing gets faster but you aren’t out of breath (for example, you can have a conversation but can’t sing) and you develop a sweat after 10 minutes. Vigorous activity is when your breathing is fast, you can’t say more than a few words without stopping for a break, and you develop a sweat in a few minutes.

A gym isn’t the only place to exercise. Here are some activities that provide moderate to vigorous exercise:

• Take the stairs instead of the elevator.
• Get off the bus or subway 1 stop early and walk the rest of the way.
• Walk to work, class, or the store or walk your pets.
• Take a 2-mile brisk walk in 30 minutes.
• Increase your time spent on household tasks, such as vacuuming, mopping, dusting, and washing dishes (45 to 60 minutes).
• Take “activity breaks” at work.
• Swim laps for 20 minutes.
• Take a 4-mile bike ride in 15 minutes.
• Play volleyball for 45 minutes.
• Play basketball for 15 to 20 minutes.
• Dance for 30 minutes.
• Rake leaves or do other yard work for 30 minutes.

Step 6: Put Your Plan into Action

These are the basic guidelines for a healthier diet and lifestyle. It’s best to make gradual changes, focusing on 1 change at a time. Set goals to achieve success. Once you have reached one goal, move on to the next.

If you would like information about nutrition, call 212-639-7312 to set up an appointment with a clinical dietitian nutritionist. They can help you plan a healthy diet and lifestyle.

Frequently Asked Questions

Should I take vitamin or mineral supplements?

A well-balanced diet with a variety of foods usually has the right amount of vitamins and minerals. However, people who have different nutritional needs or don’t have a healthy diet may benefit from taking a vitamin or mineral supplement. Examples are:

• People who are elderly
• People whose immune systems don’t work well
• Women who are pregnant or may become pregnant
• People on very low-calorie diets
• Premenopausal women
• Alcoholics
• Vegans

Ask your healthcare provider or clinical dietitian nutritionist if you need to take any vitamin or mineral supplements.

Should I buy only organic fruits and vegetables?

Organic foods are grown with little fertilizer and no pesticides. Some studies suggest organic foods may have higher amounts of phytochemicals (compounds found in plants that can promote health), but there isn’t currently enough research to know for sure.

Whether or not you buy organic, it’s best to wash all of your produce well to clean off any pesticides. There are certain fruits and vegetables that may have higher amounts of pesticides, including:

• Cherries
• Spinach
• Grapes
• Pears
• Strawberries
• Apples
• Nectarines
• Potatoes
• Celery
• Bell peppers
• Peaches
• Raspberries
• Kale

You may want to buy these products organic.

Should I buy hormone-free meat and dairy products?

Many people are concerned about hormones added to foods. The USDA doesn’t allow hormones to be given to pigs, chickens, turkeys, or other fowl. However, hormones can be given to cattle and sheep.

The amount of hormones you get if you eat beef, mutton, or lamb is very small compared with what your body makes each day. If you’re concerned, you can buy hormone-free meat and dairy products, or you can choose a mostly plant-based diet. This means eating mostly fruits, vegetables, whole grains, legumes, nuts, and seeds and reducing your meat intake.

Is a vegetarian diet healthier for me?

Not always. Many healthy diets include animal products.

However, a vegetarian diet can lower the risk of some diseases, such as heart disease, kidney stones, and gallstones. The benefits include a lower intake of saturated fat, cholesterol, and animal protein. Vegetarian diets also have more antioxidants, folate, magnesium, potassium, and fiber. Try a diet that’s mostly made up of plants. Talk with a clinical dietitian nutritionist to make sure that your vegetarian or mostly plant-based diet has all the nutrients you need.

Should I juice my fruits and vegetables?

Even though the fruit and vegetable juice provides water, vitamins, and minerals, it’s often missing the fiber that’s only in whole fruit. Also, if you throw out the skin of fruits and vegetables, you won’t be getting some vitamins, minerals, and needed fiber. We recommend that you eat whole fruits and vegetables instead, which will provide more fiber.

Should I be on a gluten-free diet?

Gluten is the name of the protein that’s found in wheat, rye, and barley.

If you have celiac disease, yes, you need to be on a gluten-free diet. Celiac disease is an autoimmune disease that causes damage to your small intestine when you eat gluten. You may also need to avoid gluten if you have gluten sensitivity. People with gluten sensitivity have gastrointestinal (GI) symptoms such as vomiting or diarrhea or have an allergic response after eating gluten.

If you don’t have celiac disease or discomfort after eating gluten, there’s little evidence to support that a gluten-free diet is healthier for you or can lead to weight loss. In fact, by eating only gluten-free “processed foods,” you may gain weight. This is because many of these products contain more fat and calories. The best approach is to include foods that are naturally gluten-free, such as fruits, vegetables, legumes, lean protein, and lowfat, unflavored dairy.

Sample Menus

Use these sample menus to help you incorporate healthy foods into your diet and to inspire ideas for recipes of your own.

Recipe for Black Bean and Corn Soup

• 28-ounce can of low-sodium crushed tomato and basil
• 8 ounces of low-sodium tomato juice
• 16-ounce can of rinsed black beans
• 16-ounce can of rinsed white beans
• 16-ounce can of rinsed kidney beans
• 16-ounce can of sweet corn
• 1 teaspoon of dry oregano
• ½ teaspoon of rosemary
• ½ teaspoon cracked red pepper flakes (optional)

Mix ingredients in a large pot and bring to a boil. Turn down heat and let simmer for 10 minutes. Serves 4.