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Survivorship Guide for Bone Marrow/Stem Cell Transplant
Coping with Late Effects

Caring for Your Body

As cancer survival rates improve and more of us live into old age, it is increasingly important to protect ourselves against developing new cancers and other chronic conditions. Although we can’t change our health or treatment history, there is a lot we can do to improve our overall health and reduce our future risk of disease and chronic conditions. Research has shown, for example, that what we eat can actually influence how certain genes are expressed and thus affect our cancer risk. Our level of activity can affect our weight and hormone levels, which impacts the risk of developing certain conditions. Even small changes in our day-to-day activities can lead to improvements in our overall health and well-being.

One of the main recommendations for reducing our risk for cancer is to maintain a healthy weight. Body fat, particularly fat around the waist, is associated with the development of various cancers, including post-menopausal breast cancer, colorectal cancer, endometrial, kidney, and pancreatic cancers.[17] The most effective way to maintain a healthy weight is through an integrated approach that combines healthy eating with regular exercise. In addition to reducing our future cancer risk, a healthy diet and regular physical activity can reduce the risk of chronic conditions, such as heart disease, stroke, diabetes, and osteoporosis (weakening of the bones). A healthy diet and regular exercise are also associated with improved overall vigor and mood, reduced stress levels, and a more resilient body.

The key recommendations of the American Institute for Cancer Research (AICR) are to:

  • Choose mostly plant foods (fruits, vegetables, and beans) and limit red meat.
  • Eat whole grains rather than refined grains, and limit processed foods.
  • Be physically active in some way every day for 30 minutes or more.
  • Aim to maintain a healthy weight throughout life.

Healthy Eating

Depending on how well you know yourself and your relationship to food, you might want to make a big change in your eating habits all at once, or introduce change slowly, picking one or two items from the list below. Getting all the nutrients you need requires choosing a variety of foods. If you suffer from GVHD or have other conditions that make it difficult for you to digest properly, maintain a healthy mineral balance, or consume a well-balanced diet, it is recommended that you consult with a dietitian. Think creatively about your food choices, introduce more healthy foods into your diet, and enjoy new tastes and flavors.

Eat Plant-Based Foods
Shift your choices so that your diet includes more vegetables, fruits, whole grains, and beans. Include five or more servings of a variety of vegetables and fruits every day. By choosing fruits and vegetables that have different colors, you will get a fuller spectrum of nutrients. Fruits and vegetables are rich in vitamins, minerals, and other compounds that play a role in cell function, body regulation, and cell repair. Their high fiber content also contributes to a feeling of satiety and helps food and waste move through the digestive system. Some forms of fiber also play a role in lowering cholesterol. Fruits and vegetables have the added benefit of being relatively low in fat and calories.

Choose Whole Grains Over Refined Grains
Whole grains and the flour made from whole grains provide far more nutrients and fiber than refined grains, where the nutrient-rich outer covering of the grain has been removed. Whole grain products include breads, cereals, and pastas, where the flour that is used is made from 100% whole grains. You can get the benefits of whole grains by eating foods such as popcorn, oatmeal, brown rice, and wild rice, and dishes that include quinoa, barley, kamut, and rye, among others.

Reduce Your Consumption of Red Meat and Processed Meats
Although meats are a good source of high quality protein, they contribute to high levels of saturated fat and cholesterol in the diet.[18] Red meat in particular tends to be high in saturated fats and can contribute to higher cholesterol and blood pressure. Consumption of red meat is also associated with a higher cancer risk.[17] Examples of red meat include beef, pork, lamb, and goat. Processed meats are not recommended because they often have chemical preservatives and other additives that are known to be harmful. Processed meats include ham, bacon, salami, hot dogs, sausages, and meats that are preserved through salting, curing, or smoking.[17] The AICR recommends that we consume 18 oz. of red meat or less per week and strictly limit or avoid processed meats.[17] If you do choose to eat red meat, it is recommended that you eat meat from animals that have been grass fed, trim the fat off the meat before cooking,[19] and avoid cooking it at very high temperatures. Cooking meat at very high temperatures can produce chemicals known as heterocyclic amines which may increase cancer risk.[20] It is, therefore, advised to bake, stew, braise, or poach meats rather than to grill, broil, or fry them at very high temperatures.[18] When eating meat, choose poultry or fish more often.[18]

Replace Unhealthy Fats with Healthier Fats
Fats are found in many of the foods we eat. Some fats contribute to our health while other fats are associated with heart disease and other conditions. If you have lost weight or are underweight, a higher fat diet may be necessary to achieve a healthy weight. Choosing fats wisely allows us to continue to enjoy the flavors that they contribute to food without the negative effects. The key is to replace unhealthy fats with healthier fats.

Healthier Fats – Monounsaturated and Polyunsaturated Fats
The unsaturated fats – monounsaturated and polyunsaturated – can have a beneficial effect on health when consumed in moderation and when used to replace unhealthy fats. Monounsaturated fats are found in olive oil, canola oil, avocados, almonds, hazelnuts, and peanuts. It is also possible to find nonhydrogenated soft margarines that are made with unsaturated fats.

Polyunsaturated fats include omega-3 fatty acids. Consumption of foods rich in omega-3 fatty acids is associated with lower rates of heart disease.[21] Good sources of omega-3 fatty acids include cold water fish (salmon, sardines, halibut, and others), algae, chia seeds, flax seeds, walnuts, and canola oil.

Unhealthy Fats – Saturated and Trans Fat
Saturated fat is associated with increased risk for heart disease, obesity, diabetes, and certain types of cancer. Saturated fat is found in animal products such as meat and dairy. Common sources of saturated fat in the diet include meat, baked goods, mayonnaise, milk (other than skim milk), and other dairy products such as cheese and butter. Unfortunately, many popular foods, such as pizza, hamburgers, lasagna, tacos, and ice cream have high levels of saturated fats. To reduce your intake of saturated fats, you can choose low-fat dairy products or non-fat dairy products that contain no saturated fats.

One type of fat that is particularly bad for our health is trans fat. Trans fat both raises overall cholesterol and lowers our level of the good cholesterol (HDL) that protects against heart disease. Trans fat can also trigger inflammation,[22] an overactivity of the immune system that has been implicated in heart disease, stroke, diabetes, and other chronic conditions. Some trans fat occurs naturally in meat and dairy. But most is created in the manufacturing process when liquid oils are processed and turned into solid fats like shortening and margarine. Many types of fast foods, processed foods, cookies, donuts, and muffins contain trans fat. Read labels to avoid products with trans fat and high levels of saturated fats.

Drink Plenty of Water and Reduce Sugary Drinks
Water helps flush out toxins and keeps your kidneys and other organs in good shape. It is best to get most of your fluids from drinks that are either not sweetened or only slightly sweetened. Many of the drinks with added sugar have lots of calories but little nutritional value. Getting most of your fluids from sugary drinks increases the likelihood of weight gain. It is generally recommended to stay well-hydrated. Your needs may vary depending on your body size, the weather, your level of activity, and your diet.

Limit Alcohol
Alcohol is associated with increased risk of several types of cancer, including breast, colon, esophagus, mouth, and liver cancers. Heavy drinking is also associated with a variety of conditions, such as liver damage and heart disease.

Although modest amounts of alcohol may have a protective effect on heart health, cancer risk increases with the amount of alcohol consumed.[23] If you do choose to drink alcohol, women should limit their consumption to one drink or less a day, and men to two drinks or less a day.[17] [18] [19]

Cut Down on Salty Foods
Consuming too much salt can be harmful to our health, increasing our risk of high blood pressure and stomach cancer. Many processed foods, including some canned goods, as well as cookies and foods that are sweet, may have high levels of salt as well. Read the labels and limit your consumption of salt (sodium) to less than 2,400 mg a day.[17]

Get Your Nourishment from Food Rather than from Supplements
Aim to get your required nutrients by eating a healthy, well-balanced diet. However, there are situations when you may need to supplement your diet with vitamins or compounds. If you are post-menopausal, for example, you may need to supplement with calcium and vitamin D to prevent bone loss. Long-term survivors who do not get enough exposure to the sun may need to supplement with vitamin D. There is a growing body of evidence that vitamin D deficiency is associated with increased risk of cancer progression or recurrence.18, 24 Given the complexity of the posttransplant picture, it is advisable to consult with a dietitian to make sure that you are meeting your nutritional needs. Supplements vary greatly in their quality. It is therefore important to make sure that the active ingredients listed are actually present in the supplement. Consumerlab.com is an independent organization that verifies the content and quality of the manufacturer.

Exercise

Think creatively about ways to increase your activity level. This could involve signing up for a gym or an exercise class but could also simply entail a commitment to walk or bicycle more often, use the stairs instead of the elevator, or regularly park a few blocks from your intended destination. In addition to helping us maintain a healthy body weight, exercise can help to improve our mood and reduce depression and anxiety.[25]

Regular exercise can help increase strength, maintain muscle mass, and promote flexibility. Research also shows that people who exercise regularly have a lower risk of developing breast and colon cancer, as well as diabetes.[26] Activities that include weight-bearing exercises can also help to improve bone density and reduce the risk of osteoporosis, which is a thinning of the bones. Bones are living tissues, and like muscles, gain strength and density when they are put to work.

The key to exercising is to plan it into your schedule and find as many ways as possible to incorporate it into your everyday life. If you would like more company, weave exercise into your social activities. Keep in touch with a good friend by scheduling a weekly time to walk and talk. Instead of driving to a restaurant, invite friends to walk there with you. If you crave time to read, take your newspaper or book and read it on the exercise bike instead of on the couch. If you are a homebody, consider purchasing a few exercise videos to do at home. If you belong to a gym, arrange to have one of the trainers work with you to design a workout that will help you build strength, stamina, and flexibility.

The Centers for Disease Control recommends at least 30 minutes of exercise five times a week. If you find it difficult to exercise for a 30-minute time block, you can still derive benefit by doing 10 minutes of exercise three times a day. Studies show that quality of life and fitness levels can improve with even a small increase in activity.

Ideally, an exercise program should include activities that improve flexibility, cardiovascular health, strength, and bone density. Many activities provide overlapping benefits. Weight-bearing exercises that strengthen bones, such as weight lifting, jogging, brisk walking, racquet sports, and stair climbing, are also good for cardiovascular fitness and stamina. Even activities, such as yoga and T’ai Chi, which are often associated with improving flexibility, have poses that put weight on the bones and can improve bone density, strength, and stamina, if done regularly.

Weight Bearing/
Strength

  • Weight lifting
  • Jogging
  • Brisk walking/hiking
  • Racquet sports
  • Stair climbing
  • Dance
  • Using elastic exercise bands

Cardiovascular/
Stamina

  • Weight lifting
  • Jogging
  • Brisk walking/hiking
  • Racquet sports
  • Stair climbing
  • Dance
  • Bicycling
  • Swimming
  • Water aerobics

Flexibility/
Posture

  • Yoga
  • Pilates
  • T’ai Chi
  • Stretching
  • Dance

Exercising Tips

Start slowly and increase your level of activity over time. Overdoing it can be taxing and harmful to your body. Remember to consult your physician before beginning a new exercise program.

If you have osteoporosis or other underlying medical conditions, consult with your doctor or a physical therapist about any limitations. If your condition stops you from meeting the guidelines of 30 minutes, five days a week, come up with a physical activity plan that meets your abilities. In general, getting some exercise is better for you than getting no exercise.

Exercise can energize and can be helpful in combating fatigue. Even on days when you feel reluctant to exercise, pushing yourself to engage in some moderate activity can often feel refreshing and invigorating.

I lost so much flexibility after the transplant. Sometimes it can be depressing to compare my flexibility today to what it was. Instead, I focus on maintaining and increasing my flexibility by doing yoga a couple times a week. I remind myself that even though I am not as flexible as I used to be, I am so much more flexible than I would be if I did not stretch regularly.

For people who were never gym rats, it is the time to become one. Exercise has been so helpful to me to help me return to my strength levels and stay there.

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