Cancer and The Neutropenic Diet

July 15, 2017 at 12:01 pm  •  0 Comments

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Summertime is the time of escaping to the beach or pool on hot days, and enjoying cookouts on warm nights. It is a time made all the sweeter by the delicious bounty of juicy stone fruits and berries, achingly sweet tomatoes, fragrant herbs, and crisp salads. And let’s not forget the summer veggies: squashes, eggplants and sweet, sweet corn on the cob. I can feel the warmth of the sun on my skin and smell the perfume of freshly chopped basil as I write.

Some of us with cancer however, have to rethink this idyllic picture thanks to the restrictions of some of the clinical diets that our oncology teams may put us on, like a bland or low fiber diet for GI problems, or if our white blood cell counts are low, a neutropenic diet. Bland and low fiber diets recommend eating only cooked fruits and veggies as they are more easily digested, and the neutropenic diet means no raw or undercooked foods as they may carry bacteria. Luckily for today’s patients with the exception of some stem cell transplant patients, neither the Food and Drug Administration, the Centers for Disease Control and Prevention, nor the American Cancer Society support the neutropenic diet for fruits and vegetables, so if they are very well-washed, they are back on the menu. But the veggie restrictions on bland diet or low fiber diets still stand.

How Was I Going to Eat?

These types of restrictions can have you on the outside looking in. I know first hand. After my kidney surgery I was put on a bland diet, and although it wouldn’t happen today, during my chemo for breast cancer my oncologist put me on a neutropenic diet. Sadly for a foodie like me this happened in the summertime. I was given the list of ‘no’. As I read it I wanted to cry. No raw fruit: I wouldn’t be able to pick up that warm juicy peach and just bite into it. No raw salads or veggies: Adieu crisp crunchy sprouts and soft summer greens. And this was just the tip of the giant iceberg of ‘no’ that was about to roll over not just my summer eating pleasures, but over perennial favorites like soft-boiled eggs, soft and blue cheeses, real mayonnaise, sushi, miso, rare cooked fish, deli delights, even yoghurt. Instead, the list told me, I could eat canned fruit, hard -boiled eggs, well-done meats and cooked or canned vegetables, things I never ate normally. How was I going to be able to eat?

This is a question that is asked of me all the time both at classes and online. Although they are necessary, I hate these lists. They accentuate what patients can’t eat rather than what they can, and they and their caregivers, who are already worried about treatment outcomes, can become fearful of doing real harm at mealtimes from eating or feeding the wrong thing, the wrong way. When this is compounded with the tendency so many of us have to be worry about the quality of our food supply anyway, thanks to all the scary stuff we read online, the fear can become paralyzing. These dietary nightmares can be solved simply and deliciously. The secret? Keep it simple. Make it taste good.

Cook For Your LIFE

My cookbook, Cook for Your LIFE, is devoted to helping cancer patients and caregivers eat as normally, as healthily and as deliciously as possible. Having cancer does not mean that food cannot be enjoyed. It can. Being on a special diet does not automatically mean that patients can’t eat normal meals with their families. They can. My own experience of the disease and its treatment has given me an insight into the needs of cancer patients that many authors in this field simply don’t have. They have theory, yes, but they are on the outside looking in. I’ve been through the slash, poison and burn of cancer treatment. I know how it feels. The cookbook brings together my knowledge of cooking and food with my experience as a cancer patient. Because I understand that patients feel like eating certain foods rather than say ‘dinner’, the recipes in the book are arranged to suit those feelings rather than by meal. The chapters have titles such as ‘Simple’ ‘Soothing’ ‘Sweet’ ‘Spicy’ and Safe’. ‘Safe’ means just that. Safe food for people on neutropenic or anti-microbial diets, and it brings us right back to where I started, on chemo in the summertime, and on a neutropenic diet. This is where I solve the problem of the food list, and why the book can be so helpful to others.

Simply Get Cooking

That summer of chemo, after moping and feeling sorry for myself about the hardships of the list of restrictions I’d been given, it occurred to me that if I looked at them in terms of what I could eat instead of what I couldn’t, the list was basically only about two things: eating food that had been cooked long enough to kill any bacteria that could be lurking on it or in it, and to be careful with hygiene in the kitchen. Yay! Now I knew what to do to be a happy eater again, simply get cooking! I did a little research into the subject of cooking times for vegetables, and found that steaming or blanching veggies in boiling water for 3-4 minutes was enough to kill bacteria, yet still crisp enough for them to be perfect for cooked vegetable salads. This bit of information has been a joy to pass on to the stem-cell transplant patients I’ve met since, many of whom had been anxiously boiling their poor veggies for 30 minutes or more.

The ‘Safe’ recipes in the cookbook are among my favorites, maybe because of the pleasure I took in transforming that dreaded list into truly good tasting food. It showed me how experimenting with cooking methods can really alter the taste experience. Those summer fruits I’d hankered after got poached, baked, grilled, or made into quick compotes; sweet summer veggies were steamed, sautéed, roasted and broiled or made into rich summer soups. Home-cooked roasted chicken and fish were OK too. I love to add fresh chopped herbs to summer dishes to finish them, so instead of stirring them in after serving, I just added them to the dish and let them cook for a few minutes. And I cannot tell you how much quick tomato sauce I made! Those hard-boiled eggs I’d complained about having to eat became a favorite high protein snack, or part of a cooked veggie salad ‘Nicoise’. At the end of the day, it all ended up being a new normal that’s still part of my cooking repertoire.

As I say in the book, the moral of this story is that despite the restrictions of a clinical diet, life can be just a bowl of cherries, only made into compote! Enjoy the summer!

Pasta with Kale and Black Olives

Prep time: 15-20 minutes
Cook Time: 25 minutes

This recipe is super fast, super easy and super tasty neutropenic option. You can have it on the table by the time the pasta cooks. I happen to prefer to use whole canned tomatoes but if you’d rather not have the extra work diced will do the job. Same thing goes for the kale. Don’t hesitate to use pre-cut, or for even less work, frozen. Frozen kale can simply be added at the end of step 3.
Serves 4: Vegetarian

Ingredients

  • 3 quarts water in a large pot
  • 1 tablespoon salt
  • 8 ounces whole-wheat pasta, penne, rigatoni
  • 3 cloves garlic, smashed and sliced
  • 1 whole dried cayenne pepper (optional)
  • 1 medium shallot peeled and thinly sliced
  • ½ teaspoon sweet smoked paprika
  • 1 (2-inch) strip lemon peel, julienned
  • 1 x10 ounce pack of frozen kale or 1 bunch Lacinato or Dinosaur kale, steamed (see Ann’s Tips)
  • 1 (14 ounce) can diced tomatoes, chopped (See Ann’s Tips)
  • 10-12 oil-cured black olives
  • 1 cup pasta water
  • 2 tablespoons freshly grated Parmesan cheese
  • ½ cup Italian parsley, chopped
  • 1 small sprig rosemary, leaves stripped and chopped
  • Sea salt and freshly ground black pepper to taste.

Directions

  1. In a large pot add 1 tablespoon of salt to the water and bring to a boil for the pasta.
  2. Add the pasta to the boiling water. Cook one minute less than the packet time, approximately 10 minutes for penne or rigatoni. When the pasta is ready, drain reserving a cup of the cooking water. Set aside.
  3. Meanwhile, heat the oil in a sauté pan over a medium-high heat. Add the garlic and whole dried red pepper and cook until the garlic starts to turn light golden about 2 minutes. Add shallots, sprinkle with salt, and cook until they soften and start to color about 5 minutes. Add smoked paprika and lemon peel, stir to coat, then add the steamed or frozen kale and cook, stirring until well mixed.
  4. Add the chopped tomatoes and the olives. Cook over a medium heat until the tomatoes look orangey and saucy, about 5-7 minutes. Add ¼ cup water from the pasta pot and stir to mix. Add the grated Parmesan cheese. Cook stirring until it melts into the sauce and the extra water has almost evaporated, about 2 minutes. Do not add salt without tasting — the olives will have added quite a bit.
  5. Stir in the parsley and rosemary. Add the cooked pasta and another ¼ cup of the reserved water. Cook, stirring, until the pasta is just al dente. Serve immediately with freshly grated Parmesan cheese.

Ann’s Tips

If you can’t find Lacinato or Dinosaur kale, use regular curly kale prepped as in the Steaming and Freezing Greens recipe.

In the summertime, when tomatoes are good use 2 cups chopped ripe beefsteak or Roma tomatoes.

 

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