About this booklet

If you feel unsure about how to manage your diet during or after breast cancer treatment, this booklet is for you. It’ll give you tips on how to eat a healthy, balanced diet and how to manage the effects of treatment on your diet.

Even though we’ve included a lot of information about following a healthy diet, it’s important not to feel guilty if you don’t stick to it all the time – especially while you’re coping with the

other physical and emotional effects of breast cancer and its treatment. It’s just about getting the balance right.

Lots of people look for conclusive lists of what they can and cannot eat during and after breast cancer treatment. But we can’t always say whether you should eat or avoid certain foods because there hasn’t been enough research yet.

You may have read about specific foods being good or bad for people with breast cancer, but these claims often aren’t backed up by scientific evidence. It can be beneficial to eat a varied and nutritious diet, which you’ll find out more about in this booklet.

You can discuss any concerns with your GP or breast care nurse. Or you can ask to be referred to a dietitian (a healthcare professional who assesses and treats dietary and nutritional problems).

What is a healthy diet?

Eating healthily is important for everyone, but if you’ve been diagnosed with breast cancer, you may become even more aware of what you eat and drink. A balanced diet can have a range of health benefits.

The Eatwell Guide

To eat healthily, try to eat a variety of foods from each of the 4 main food groups every day.

The Eatwell Guide shows the different types of foods you should eat and in what proportions. It recommends you:

Eat at least 5 portions of a variety of fruit and vegetables a day

Eat plenty of starchy foods like potatoes, bread, rice, yams and pasta. They’re a great source of energy and the main source of various important nutrients – choose higher fibre or wholegrain options like brown rice

Have some dairy or dairy alternatives – choose lower-fat and lower-sugar options, and check the label to make sure they have added calcium

Eat some beans, pulses, fish, eggs, meat and other protein – aim for at least 2 portions of fish every week, 1 of which should be oily, such as salmon

or mackerel. Choose lean cuts of meat and mince, and eat less red and processed meat like bacon, ham and sausages

You should also try to:

• Choose unsaturated oils and spreads, such as olive or

sunflower oil, and use them in small amounts

• Eat smaller amounts of foods high in fat, salt and sugar, and have them less often
• Limit alcohol as much as possible (see page 20)
• Drink plenty of fluids – aim for 6 to 8 glasses a day. Carrying a

water bottle with you during the day can help you stay hydrated

Eating healthily doesn’t mean you can’t have any of the foods or drinks you enjoy that might not be considered healthy, such as those high in fat, salt and sugar. If you follow the Eatwell Guide you can still enjoy these from time to time.

The Mediterranean diet is an example of a diet that contains a balanced mix of different food groups. It’s high in vegetables and fruits, and contains healthy fats such as olive oil.

There are alternative versions of the Eatwell Guide available online for people following vegetarian, vegan, African and Caribbean, and South Asian diets. Find more information on page 23.

Hidden sugars

Some foods that seem healthy may contain a lot of sugar. For example, dried fruit contains much more sugar than fresh fruit. Alcoholic drinks and some diet foods may also have a high amount of sugar. It’s best to check the labels when considering your sugar intake.

If you’d like to learn more about sugar and diet, see the NHS website nhs.uk

Diet during treatment

Breast cancer treatments can sometimes affect what you want to eat and drink. Your usual routine may be disrupted, which can affect your eating pattern. Feeling worried or stressed can also affect your appetite, causing you to eat more or less than usual.

Eating aŁer surgery

Most people feel ready to eat the same day as their surgery or in the days following. You will likely be asked to eat something at the hospital before you go home. Eating well will help your body recover and heal.

Effects of chemotherapy

It’s hard to tell how your body will react to chemotherapy. You may be able to eat normally throughout your treatment or the side effects may change your eating habits.For more general information about chemotherapy and its side effects, see our Chemotherapy for breast cancer booklet.

Risk of infection

Chemotherapy can cause a drop in white blood cells, which can increase your risk of geGing an infection. You’ll have regular blood tests throughout your treatment to check your blood count.

If you’re at an increased risk of infection, you may be given some specific dietary advice to follow. Your chemotherapy team will explain more about this if necessary.

Although there aren’t any particular foods that will boost your white blood cell count, it’s important to follow a healthy diet.

Follow good food hygiene when storing, preparing and cooking food. This is particularly important if you’re at increased risk of infection.

You can find useful information on food safety when your immunity is low by searching for it on the Macmillan Cancer Support website macmillan.org.uk

Changes to your appetite

Your appetite might change during treatment.

If your appetite is small, or taste changes are affecting your diet, eating little and often can be better than having large meals.

It may help to:

• Eat 5 or 6 small meals or snacks each day instead of 3

bigger meals

• Drink milkshakes, smoothies, juice or soup if you don’t feel like eating solid food
• Do something active, if you feel able to, as exercise can increase your appetite – you might have more of an appetite if you take a short walk before eating
• Avoid drinking lots of liquid before or during meals

For more information about managing weight loss, see page 14.

Some drugs given alongside chemotherapy, such as steroids, can increase your appetite. If you’re worried about gaining weight:

• Choose low-fat foods and drinks
• Eat plenty of fresh fruit and vegetables
• Watch out for the sugar content of food including some “diet” foods
• Avoid sugary drinks

For more information about managing weight gain, see page 12.

Feeling sick (nausea) and being sick (vomiting)

You may feel sick or be sick during and after your chemotherapy. Anti-sickness drugs may help – your chemotherapy team can help find one that works for you.

Drink plenty of fluids, such as water or herbal teas. Taking frequent sips is better than trying to drink large amounts in one go. Herbal teas such as mint or ginger can help if you’re feeling sick.

Eating little and often can also help if you’re feeling sick.

Some people find eating cold food makes them feel less sick

because hot food can smell stronger and trigger their nausea.

Sore mouth

Chemotherapy can make your mouth sore or dry, making it uncomfortable to eat.

You might find it helpful to:

• Clean your teeth or dentures with a soft brush after eating

and floss gently

• Use an alcohol-free mouthwash (your chemotherapy team may recommend one)
• Choose soft or liquid foods such as soups, stews, smoothies and desserts
• Soothe your mouth and gums with ice cubes and ice lollies
• Drink sugar-free fizzy drinks or fizzy water to freshen your mouth
• Use a straw to drink
• Avoid crunchy, salty, very spicy, acidic or hot foods
• Avoid citrus drinks like lemon, lime, orange and grapefruit juice

If you have dentures, clean them regularly and try not to wear them all the time.

Smoking and drinking alcohol can make a sore mouth worse.

Taste changes

Your taste may change during chemotherapy, making foods taste bland or different. You may prefer to eat strongly flavoured foods or use herbs and spices when cooking.

Try a variety of foods to find the ones you like best. As well as going

off your usual foods, you may like foods you previously didn’t like.

Some types of chemotherapy can give you a metallic taste in your mouth. Using reusable plastic or wooden cutlery, instead of metal, can help reduce the metal taste. Using glass pots and pans when cooking can also help.

Constipation

Eating and drinking less than usual, being less active and taking certain medications can all lead to constipation.

Eating high-fibre foods can help. These include:

• High-fibre breakfast cereals, such as bran flakes or shredded wheat
• Beans and lentils
• Vegetables (fresh or frozen)
• Fruit (fresh, frozen, canned and dried)
• Brown rice
• Wholemeal bread
• Wholewheat pasta

Drink plenty of fluids (6 to 8 glasses of water a day) and do

some regular exercise such as walking if you’re able to.

If you’re still having problems with constipation, ask your treatment team or GP for advice. They can prescribe medication to help if necessary.

Occasionally, some chemotherapy drugs can cause diarrhoea. Your GP or treatment team can prescribe medication for diarrhoea if necessary. Drink plenty of fluids to avoid dehydration.

Contact your chemotherapy team if you have 4 or more episodes of diarrhoea in 24 hours.

Short-term fasting around the time of chemotherapy

Some studies suggest short-term fasting around the time of chemotherapy may help reduce side effects. However, more research is needed before any recommendations can be made.

If you’re thinking about fasting, always talk to your treatment

team or GP first.

Effects of radiotherapy

Having radiotherapy normally doesn’t cause any dietary problems but it’s still good to eat a balanced diet and drink plenty of fluids.

If you’re having radiotherapy around your collarbone or breastbone, you may have a sore throat, dry mouth, difficulty swallowing or indigestion. If this happens, speak to your treatment team. Taking liquid pain relief, such as liquid paracetamol, before eating may help.

If you have to travel for your treatment, take a drink and snack with you and plan meals that are easy to prepare for when you get home. See “Shopping and cooking during treatment” on page 11.

Effects of hormone therapy

Weight gain

If you’re having hormone therapy, you might find your weight increases. This may be because you’re less active due to fatigue or joint pain, or because of appetite changes. Weight gain is also a common menopausal symptom.

You can find tips for losing weight on page 12.

High cholesterol

Hormone therapy drugs such as anastrozole and letrozole can

increase the level of bad cholesterol (LDL) in your blood.

If you have too much bad cholesterol it can build up in your artery walls, leading to artery disease or other health conditions.

Following a healthy diet and maintaining a healthy body weight can help reduce your levels of bad cholesterol.

Your GP can tell you more about how cholesterol levels are measured and what dietary changes you may need to make.

Shopping and cooking during treatment

As you go through treatment and recovery, simple tasks like shopping and cooking can feel exhausting.

Try to accept any offers of help, even if you’re used to coping on your own. You can also take advantage of online shopping or ask local shops if they have a telephone ordering and delivery service.

It’s important to have fresh food in your diet, but if you can’t shop regularly, frozen and tinned fruit and vegetables are full of nutrients and can be great alternatives. Choose tinned fruit in juice rather than syrup and tinned vegetables that have less salt.

See our website for more information on coping with fatigue during and after treatment. Macmillan Cancer Support also has an information booklet called Coping with fatigue which you can order on its website macmillan.org.uk

Diets for other medical conditions

If you’re already following a specific diet because you have

a medical condition – such as diabetes, Crohn’s disease or irritable bowel syndrome (IBS) – having breast cancer doesn’t mean your diet has to change.

If you’re concerned about how your breast cancer treatment may affect your diet or any existing condition, talk to your breast care nurse or treatment team. They can talk to a dietitian or other medical staff to ensure any existing condition remains under control during your treatment.

Healthy eating aŁer treatment

After treatment for breast cancer, you may have gained or lost weight, or you may want to know if diet can play a role in your recovery and future health.

It can be helpful to speak with your breast care nurse, GP or practice nurse. They can assess if your current weight is healthy and determine your body mass index (BMI). They’ll also discuss your current diet and lifestyle and can help you put a plan together if changes are required.

If you’ve put on weight

You tend to put on weight when the amount of calories you eat is more than the amount of calories you burn through everyday activities and exercise.

You may put on weight during and after treatment due to:

• The side effects of some drugs, which can increase appetite
• The body retaining fluid
• Being less active than usual
• Eating more than usual when you’re anxious or because your usual routine has changed
• The menopause (as a result of your treatment)

How to lose weight safely

If you want to lose weight after treatment, aim for a realistic weight loss of about 0.5 to 1kg (1 to 2 pounds) a week. You can do this by making small changes to your usual eating and exercise habits.

Try to:

• Follow the Eatwell Guide and eat a varied, balanced diet (see page 3)
• Avoid keeping too many unhealthy snacks like sweets in the house – try popcorn, rice cakes or fruit instead
• Reduce your portion sizes – using a smaller plate can help

• Be active for 150 minutes a week – you can break this up, for example into 25-minute sessions
• Limit the amount of alcohol you drink
• Swap sugary drinks for water – you could add some sugar-

free squash for extra flavour

• Choose healthier options when eating out and remember that takeaways can be high in fat and calories
• Avoid skipping meals or extreme dieting
• Ask a friend or family member to help support and motivate you – they could join you for healthy meals or workouts

You may find the support from a local weight loss scheme or club helpful. Some pharmacies offer a free weight management service to assess your weight and give you advice and support. Your GP can also recommend and refer you to local support services. They may also refer you to a dietitian.

The NHS has a free 12-week weight loss plan. Your GP can tell you about it or you can download the plan and find out more about weight loss on the NHS website nhs.uk

There are also NHS digital weight management programmes, such as Oviva and Second Nature, available for people living with obesity and diabetes, high blood pressure or both. You can speak to your GP about joining. If you’re not eligible to be referred to these programmes through the NHS, you may have

to pay a monthly fee. But your GP should be able to recommend some free alternatives.

Obesity UK also has UK-based support groups for people living

with obesity. You can find out more at obesityuk.org.uk

You can find more information about physical activity and

breast cancer on our website.

If you’ve lost weight

If you’ve lost weight during your treatment, some simple changes to your diet can help.

To put on weight in a healthy way, you need to eat more calories and more protein. Adding an extra 300 to 500 calories a day is a good aim.

You can also try to:

• Eat 3 meals and some snacks throughout the day, based on the Eatwell Guide (page 3) – you could also try eating smaller meals more frequently
• Have more protein-rich foods like lean cuts of meat, fish, eggs, nuts, seeds and pulses (such as lentils and beans)
• Eat healthy fats such as avocados, olive or rapeseed oil, and unsalted peanut butter
• Drink high-calorie drinks like milkshakes. Adding milk powder or protein powder to drinks or food may also help
• Have snacks that don’t need preparation at home, like yoghurt pots
• Avoid drinking lots of fluid before a meal

because this might make you feel full

• Build up your muscles with exercise like strength training or yoga

Your GP can prescribe high-protein or high-energy drinks and soups if you need extra help to gain weight, or they may refer you to a dietitian.

Bone health

Treatments such as chemotherapy or hormone therapy can sometimes affect bone health. This can increase your risk of osteopenia or osteoporosis, conditions that affect the bones.

It’s important to get enough calcium from your diet as calcium is vital for healthy bones.

Good sources of calcium include:

• Milk and dairy products (including low-fat varieties) such as yoghurt, fromage frais and cheese
• Calcium-fortified breakfast cereals
• Dried fruit such as apricots and figs
• Fish with edible bones including anchovies, sardines, pilchards and whitebait, or canned fish that contains soft bones such as tinned salmon
• Green leafy vegetables like broccoli, watercress and curly kale
• Pulses, beans and seeds such as kidney beans, green beans, baked beans and tofu (a vegetable protein made from soya beans)
• Nuts and seeds such as almonds, brazil nuts, hazelnuts and sesame seeds
• Okra

Vitamin D is needed to help your body absorb calcium. The main source of vitamin D is sunlight. You can also get vitamin D from some foods including:

• Margarine
• Low-fat spreads
• Egg yolks
• Oily fish such as herrings and sardines
• Vitamin D-fortified breakfast cereals

Your GP may recommend a calcium or vitamin D supplement.

Supplements

If you’re struggling to get essential nutrients or vitamins from your diet during or after treatment, your GP may prescribe a dietary supplement. For example, if your bone health has been affected, they may prescribe a calcium or vitamin D supplement.

However, unless you’re having problems recovering from treatment, you do not need to take supplements.

Some people wonder whether certain supplements, such as vitamins, herbal remedies or probiotics, might help ease their symptoms or treatment side effects. But there’s conflicting evidence about the safety and effectiveness of many products.

Supplements do not have to comply with the same regulations or go through the same rigorous testing as conventional medicines. They may also affect how certain cancer treatments work, such as chemotherapy and radiotherapy.

Talk to your breast care nurse, treatment team or GP before taking any supplements or other treatments bought over the counter or online.

You can also find information about supplements on the Sloane

Kettering website mskcc.org

Can diet affect the risk of cancer coming back?

You may have heard that diet can affect the risk of breast cancer coming back (recurrence).

The World Cancer Research Fund (WCRF) recommends that people who have had breast cancer follow advice to reduce their risk of cancer coming back. This includes:

• Eating a healthy diet that is high in fibre and low in saturated fats
• Being physically active
• Maintaining a healthy weight
• Limiting alcohol

You can find out more about exercise and keeping active on

our website.

High-fibre foods

There is some evidence that fibre may reduce the risk of breast cancer recurrence, but further research is needed to find out more.

High-fibre foods tend to be lower in calories and can help you feel full for longer. Experts think fibre has many health benefits including improving digestive health and helping prevent heart disease and some cancers.

High-fibre foods include:

• Wholegrain foods such as brown rice, oats, wholewheat couscous and quinoa
• Pulses such as lentils and beans
• Starchy foods such as potatoes and sweet potatoes, ideally with their skins on
• Vegetables and fruits

Saturated fats

There is some evidence that saturated fat may increase the risk of

recurrence, but again further research is needed to find out more.

It’s a good idea to limit the amount of fat you eat, particularly saturated fat because it increases the risk of conditions such as heart disease.

Foods high in saturated fat include:

• Butter
• Fatty cuts of meat
• Processed meats such as sausages
• Full-fat dairy products, including whole milk, cream and hard cheese
• Chocolate, biscuits and cakes

Try to replace these with healthier fats such as:

• Olive oil, rapeseed oil and their spreads
• Oily fish such as salmon and mackerel
• Avocado
• Nuts and seeds

Soya

Soya foods such as soya milk and tofu contain natural compounds called phytoestrogens. Foods like chickpeas and linseeds also contain phytoestrogens.

Phytoestrogens have a chemical structure that is similar to the hormone oestrogen, but their effects are much weaker. As oestrogen can encourage some breast cancers to grow, some people worry whether foods or supplements containing phytoestrogens might have the same effect and increase the

risk of recurrence. But phytoestrogens are not the same thing as female hormones and don’t affect your body in the same way.

Current evidence suggests a diet containing naturally occurring phytoestrogens is safe if you’ve had breast cancer and may be beneficial.

Phytoestrogens are also found in herbal remedies like black cohosh, red clover and sage, which are sometimes taken to relieve hot flushes and other menopausal symptoms. However, these are not recommended because the evidence on their effectiveness and safety is limited and conflicting.

Soya supplements are also not recommended for people with breast cancer as we need more research to determine their safety.

Dairy

There is no evidence that dairy products increase the risk of breast cancer coming back.

You can eat or drink dairy products like milk, cheese and yoghurt as part of a healthy diet. They’re an important source of protein, calcium and certain vitamins.

Some dairy products are high in fat. Because maintaining a healthy weight can reduce the risk of breast cancer coming back, try to eat higher fat dairy foods like cheddar cheese and double cream in small amounts. You can also opt for lower-fat options like semi-skimmed or skimmed milk or low-fat cheese. Check the labels as some low-fat foods contain a lot of sugar, which can also cause weight gain.

If you prefer to follow a dairy-free diet, try to make sure you’re still eating calcium (see page 15).

Sugar

There’s no evidence that following a sugar-free diet will reduce your risk of breast cancer recurrence.

You can still eat sugar, but try to have sugary foods and drinks like biscuits, sweets and fizzy drinks in moderation as eating lots of sugar can lead to weight gain. Opt for healthier sweet foods like fruit if you can.

Organic foods

Some people eat organic foods as a way of reducing pesticides in their diet. However, no association has been found between eating an organic diet (before or after diagnosis) and the risk of breast cancer recurrence.

“Superfoods”

“Superfood” is a marketing term used to describe foods that are apparently beneficial for preventing or treating a range of health conditions. It is not based on scientific evidence. Foods promoted as superfoods include blueberries, raspberries, green tea and broccoli.

There is no evidence that any single food can reduce the risk of breast cancer developing or coming back.

Alcohol

Studies have shown drinking alcohol increases the risk of getting breast cancer. It’s less clear if drinking alcohol affects the outlook (prognosis) of breast cancer.

NICE (National Institute for Health and Care Excellence) recommends that people who’ve had breast cancer limit their alcohol intake to below 5 units a week.

You can find out how many units are in your drinks by using an

online unit calculator. As a general guide:

• Half a pint of average-strength (4%) beer = 1 unit
• A 175ml glass of wine (12.5%) = 2 units
• A single 25ml measure of spirits (40%) = 1 unit

It’s worth bearing in mind that alcohol is also high in calories.

You can learn more about calculating alcohol units on the NHS website nhs.uk

Special “cancer diets”

Some people who have had breast cancer consider following a special diet. They include:

• The Bristol Whole Life Approach to healthy eating
• Dairy-free diets
• Macrobiotic diets

These diets often encourage eating or avoiding certain types of food.

There’s no conclusive evidence that special cancer diets like these reduce the risk of breast cancer recurrence.

Special diets are often very restricting, expensive and can sometimes lead to a lack of nutrients. This may result in other conditions such as anaemia (too few red blood cells in the body), or bone conditions such as osteopenia or osteoporosis (see page 15).

If you’re thinking about changing your diet or want to find out more about different diets, you may find it helpful to talk to your treatment team or a dietitian. You might also want to contact some of the organisations listed at the end of this booklet for more information.

Diet and secondary breast cancer

Eating healthily is important for everyone, but if you’re living with secondary breast cancer you may be feeling anxious about what to eat and drink.

If you’re having treatment, you might be experiencing appetite and taste changes, or you might have lost or put on weight.

Research evidence about diet and cancer can be confusing. There’s no scientific evidence that people with secondary breast cancer should follow a special diet, or that a particular diet can make a difference to your outlook (prognosis).

However, a healthy, balanced diet can help give you energy and improve your mood. What this looks like for you will depend on your individual needs.

There are also changes you can make to help you manage symptoms like taste changes, feeling sick and poor appetite. If you need help, you can talk to your treatment team, or ask to speak to a dietitian for specialist advice.You can find more information on our website and in our Secondary breast cancer information pack. You can also talk to our specialist nurses on our free helpline on 0808 800 6000 or at breastcancernow.org

Useful resources

Vegetarian Eatwell Guide The Vegetarian Society vegsoc.org

Vegan Eatwell Guide The Vegan Society vegansociety.com

African and Caribbean Eatwell Guide The Diverse Nutrition Association diversenutritionassociation.com

South Asian Eatwell Guide MyNutriWeb mynutriweb.com

The Royal Marsden Cancer Cookbook

shop.royalmarsden.org

The Royal Marsden Cancer Cookbook contains over 150 healthy and tasty recipes for people with a cancer diagnosis. It contains recipes to cook both during and

aŁer treatment. You can order it from the Royal Marsden’s website and it costs £20

The Life Kitchen cookbook

lifekitchen.co.uk

The Life Kitchen aims to help people affected by cancer enjoy food again by focusing on taste and flavour. You can order their cookbook through the Life Kitchen’s website and it costs £20.

Useful organisations

British Dietetic Association (BDA)

bda.uk.com

Helps you find a dietitian who is appropriately trained and qualified.

British Nutrition Foundation

nutrition.org.uk Telephone: 020 7557 7930

Provides impartial, evidence-based information on food

and nutrition.

NHS Livewell

nhs.uk/live-well

Offers tips on eating healthily, losing weight and

physical activity.

Penny Brohn UK pennybrohn.org.uk Helpline: 0303 3000 118

Offers health and wellbeing information and courses for people affected by cancer. They provide practical tips on healthy eating and exercise, and managing uncertainty and anxiety

Royal Osteoporosis Society

theros.org.uk

Helpline: 0808 800 0035

Provides a range of booklets and online information about osteoporosis. They also have a helpline staffed by nurses with specialist knowledge of osteoporosis.

World Cancer Research Fund

wcrf-uk.org/uk

Nutrition and Living with Cancer Helpline: 0333 034 1988 / helpline@wcrf.org

Includes information for people living with and beyond

cancer on reducing the risk of their cancer coming back.

Further support

If you have any questions about diet and breast cancer, we’re here for you. You can speak to our specialist nurses on our free helpline 0808 800 6000 or through our website.

Find out more about the support services we offer at

breastcancernow.org

We’re Breast Cancer Now, the research and support charity. However you’re experiencing breast cancer, we’re here.

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We fight for the best possible treatment, services and care for everyone affected by breast cancer, alongside thousands of dedicated campaigners.

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ABouT ThIS BooklET

Diet and breast cancer was wriGen by Breast Cancer Now’s clinical specialists, and reviewed by healthcare professionals and people affected by breast cancer.

For a full list of the sources we used to research it:

Email  health-info@breastcancernow.org

You can order or download more copies from

breastcancernow.org/publications

We welcome your feedback on this publication:

health-info@breastcancernow.org

For a large print, Braille or audio CD version:

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Medical disclaimer

We make every effort to ensure that our health information is accurate and up to date, but it doesn’t replace the

information and support from professionals in your healthcare team. So far as is permiGed by law, Breast Cancer Now doesn’t accept liability in relation to the use of any information contained in this publication, or third-party information included or referred to in it.

© Breast Cancer Now, August 2024. All rights reserved

BCC98 Edition 8, next planned review August 2026

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