Smilow Cancer Hospital Culinary Guide for Patients with Gastrointestinal Cancers by Smilow Cancer Hospital and Yale Cancer Center

Smilow Cancer Hospital

Culinary Guide for Patients with Gastrointestinal Cancers

INTRODUCTION

Nourishing foods can have a powerful impact on your overall health, and maintaining good nutrition and a healthy weight is especially important when you are dealing with gastrointestinal (GI) cancer Cancers of the GI tract involve parts of your body that control your nutritional health Depending upon your medical or surgical treatment, changes may occur in your body that disrupt how food is digested, and nutrients absorbed.

What you put on the end of your fork can enhance your overall wellness and improve symptoms you may be experiencing. There is no 'one size fits all' prescribed way of eating You are an individual and the way your body reacts to food and eating habits will be specific to you.

Created by GI oncologists and dietitians at Smilow Cancer Hospital, this guide to cooking and eating is tailored to meet the special needs of patients with conditions like yours. We will advise you on foods to limit and avoid, and foods that will improve your health. However, just because you may need to limit or avoid certain foods, that does not mean that your meals need to be boring and flavorless. We are hopeful that these tips and recipes will empower you with the tools to keep mealtimes FLAVORFUL and FUN

Pamela L. Kunz, MD

Director, Center for Gastrointestinal Cancers at Smilow Cancer Hospital and Yale Cancer Center

Kiran Turaga, MD, MPH Chief of Surgical Oncology at Smilow Cancer Hospital and Yale Cancer Center

Jeremy Kortmansky, MD

Associate Chief Medical Officer, Smilow Cancer Hospital and Yale Cancer Center

Developed in collaboration with:

Lora Silver, MS, RD, CDN, CNSC, CSO, Smilow Cancer Hospital

Molly Stryker, RD, CDN, CSO, Smilow Cancer Hospital

NUTRITION TIPS FOR PATIENTS

WITH GI CANCERS

Certainfoodsoreatinghabitsaremorelikelytoresultindigestive symptomssuchasdiarrhea,gas,bloating,andabdominalpain You onlyneedtoavoidparticularfoodsiftheycauseyoutohave symptoms.Herearesomehelpfultips:

Eat4to6smallermeals,insteadofthetypical3largermeals.Try nottowaituntilyou’rehungry.Eatevery2to2.5hoursfor constantenergy.Paceyourselfandeatslowlytofeelsatisfied.

Cookedvegetablesmaybebettertoleratedthaneatingraw vegetables Trysmoothpureedvegetablesinasoupifyouarenot toleratingcookedwholevegetables.Choosefrozenandcanned vegetableswithnosaltaddedtoeathealthyandsavemoney.

Stayhydratedbydrinkingwaterandothersources,suchas vegetablesandsoups Sipfluidsthroughouttheday

Eatavarietyoffoodsandyou’llgetmostofyourvitaminsand mineralsfromfood Tryforarainbowoffruitsandvegetables everyday Asyoucookmore,youwillhaveleftoverfoods,suchas cookedgrains,dressingsandsoups Youcanstoresomeinthe refrigeratorandfreezesomeforlater.You’llsoonhaveasupplyof preparedfoods.Stickwithplants!Wheneverplantsareatthe centeroftheplate--andthatincludesherbsandspices--you CANNOTlose.

Chooseadiethigherinprotein

Reduceyourfatintake.Youmaybeadvisedtoincreasehealthy plant-basedfatslikenuts,seeds,avocadoes,olivesandvegetable oilstohelpincreasecaloriesifyouarelosingweight

Limitoravoidhighlyprocessedfoods.You'llautomaticallyreduce manyaddedsugars,unhealthyfats,additivesandcoloring. Youmayneedtotakeasupplementalmultivitamin/mineral becauseoftheeffectsofsurgeriesorothertreatments.Workwith yourteamtomeetyouruniquenutritionalneeds.

Breakupcookingintoitsparts:planning,shopping,prepping, cooking,andcleaning.Washandcutvegetableswhenyouget home You'llbemorelikelytousethem,ifthey'reprepped beforehandandreadytogo

Askfamilyorfriendstohelpwithshopping,prepping,orcooking. Cookingwithfriendsandfamilymakesiteasierandmorefun.

NUTRITIONAL CONSIDERATIONS FOR DIFFERENT TYPES OF GI CANCER

Esophageal or Stomach Surgery

Followingesophagealorstomachsurgery,youwilltypicallystartonaliquiddiet,progress toasoftdiet,thenreintroduceregularfoodsastoleratedafter6-8weeks.Changesinthe sizeorpositionofyourpostoperativestomachcanleadtosymptomssuchasearlysatiety, reflux,ordumpingsyndrome whenincompletelydigestedfoodemptiestooquicklyinto yoursmallintestineresultinginnausea,vomiting,abdominalcramping,bloating,and diarrhea.Youmaybeatriskforweightlossduetoreducedstomachvolume.

Nutritiontipsfollowingesophagealorstomachsurgery:

Trytoconsume6-8small,frequentmealsperday

Eatslowlyandchewyourfoodsthoroughly

Situprightfollowingmeals.Avoidlyingdownfor2-3hoursaftermeals.

Consumeliquids30minutesbeforeoraftermeals,notduringmealstopreventfullness

Tomanagedumpingsyndrome,trylimitingconcentratedsweets,lactose,and fried/greasyfoods.Witheachmeal,eatasourceofprotein,fatand/orsolublefiber.

Discusstheneedforvitaminsupplementationwithyourteam

Smilow Dietitian-Approved Recipes to

try:

High Protein Tuna Salad (page 19)

Creamy Mashed Potatoes (page 20)

High Protein Eggs (page 21)

NUTRITIONAL CONSIDERATIONS FOR DIFFERENT TYPES OF GI CANCER

Pancreas Surgery

Followingpancreassurgery,youwilltypicallystartonaliquiddiet,progresstoasoftdiet, thenreintroduceregularfoodsastoleratedafter6-8weeks Changesinthesizeorposition ofyourpostoperativestomachcanleadtosymptomssuchasearlysatiety,reflux,or dumpingsyndrome–whenincompletelydigestedfoodemptiestooquicklyintoyoursmall intestineresultinginnausea,vomiting,abdominalcramping,bloating,anddiarrhea After surgery,theremainingpartofyourpancreasmaynotbeabletoproduceenoughenzymes toaiddigestion,andfatmalabsorptionmaybecomeanissue Thismayresultindiarrhea, bloating,gasandabdominalpain Youmayalsohavemoredifficultycontrollingyourblood sugaraftersurgeryduetoreducedinsulinproduction

Nutritiontipsfollowingpancreaticsurgery:

Trytoconsume6-8small,frequentmealsperday

Eatslowlyandchewyourfoodsthoroughly

Consumeliquids30minutesbeforeoraftermeals,notduringmealstopreventfullness.

Tomanagedumpingsyndrome,trylimingconcentratedsweets,lactose,and fried/greasyfoods.Witheachmeal,eatasourceofprotein,fatand/orsolublefiber.

Tomanagebloodsugar,limitrefinedcarbohydrates(whitebreads,cereals,rice,pastas), consumemealsatregularintervals,andincludesourceofprotein,fat,and/orfiberwith meals Youmayneedmedicationstohelpmanageyourbloodglucose

Monitorforlactoseintolerance Trylactose-freeorplant-baseddairyalternatives Cultureddairyproductssuchasyogurtorbuttermilkmaybetolerated.

Yourteammayprescribepancreaticenzymesforyoutotakewithallmeals/snacks

Discusstheneedforvitaminsupplementationwithyourteam.

Smilow Dietitian-Approved Recipes to try:

Congee Rice Porridge (page 22)

Peanut Butter Spread with Crackers or Banana (page 23)

Marinated Chicken (page 24)

NUTRITIONAL CONSIDERATIONS FOR DIFFERENT TYPES OF GI CANCER

Gallbladder Surgery

Aftergallbladderremoval,biledrainsdirectlyandmorecontinuouslyintoyoursmall bowel,whichcanresultindiarrhea Youmayalsorequirestentplacementtoopena blockedareaofthebileductorsmallintestines Asoftdietthatislowinfiberandeasy tochewandswallowwillpromotehealingandprotectthestent

Nutritiontipsfollowinggallbladdersurgery:

Smallfrequentmealswillbemorecomfortableandwillhelpreducegasandbloating

Limitfried/greasyfoods,full-fatdairy,creamsauces,andotherhighfatfoods

Eatslowlyandchewyourfoodsthoroughly

Discusstheneedforbileacidbinders(suchascholestyramine),anti-diarrheal medicationsandvitaminsupplementationwithyourteam

Smilow Dietitian-Approved Recipes to try:

Sweet Potato Power (page 25)

Cinnamon Yogurt Peach Smoothie (page 26)

Soothing Lemon Soup (page 27)

NUTRITIONAL CONSIDERATIONS FOR DIFFERENT TYPES OF GI CANCER

Bowel Surgeries

Surgerymayinvolveremovingorbypassingportionsofthesmallbowel(or,small intestines).Remainingportionsadapttoabsorbnutrients,butittakestime.Youwillstart withalow-fiberdiettoavoidblockagesandpromotehealing Thesmallbowelisthe primarysiteofmany,butnotall,neuroendocrinetumors.

Aftercolonandrectalsurgeriesinparticular,diarrhea,andirregularbowelmovements canbecommon.Rightaftersurgery,alow-fiberdietwillpromotehealingandmakebowel movementsmorecomfortable.Frequentandloosebowelmovementsmaycontinuefor severalweeksaftercytoreductivesurgery(withorwithoutheatedintraperitoneal chemotherapy).Experiencingnewgas,bloating,ordiarrheaafterconsumingmilkorother dairyproducts?Thisiscommonaftersurgery:trylactose-freedairyproductsinstead Experiencingnewdiarrheaafterconsumingconcentratedsugarsindessertsorsugary drinks?Thisisalsocommonaftersurgery:limitoravoidthesefoodsuntilyouhave recoveredandcanworkwithadietitiantotestthesefoodsagain.

NutritionTipsfollowingbowelsurgery:

Smallfrequentmealswillbemorecomfortableandwillhelpreducegasandbloating

Trytoeatbulkingfoodswitheachmeal/snack,includingapplesauce,bananas,boiled whiterice,cheese,creamypeanutbutter,peeledpotatoes,white bread/crackers/pretzels,andyogurt

Avoidcaffeine,sweets,sugarydrinks,prunes,fried/greasyfoodsastheycan aggravatediarrhea

Staywellhydratedtoreduceyourriskofdehydration.Aimforatleast8cupsoffluids perday.

Ifyouhavehadrectalsurgery,discusswithyourteamwhetherafibersupplementis rightforyou

Discusstheneedforanti-diarrhealmedicationsandvitaminsupplementationwith yourteam.

Smilow Dietitian-Approved Recipes to try:

Congee Rice Porridge (page 22) Watermelon Granita (page 30)

NUTRITIONAL CONSIDERATIONS FOR DIFFERENT TYPES OF GI CANCER

Neuroendocrine Tumors with Carcinoid Syndrome

NeuroendocrineTumors(NETs)arerarecancersthatbegininspecialized neuroendocrinecells Neuroendocrinecellshavetraitssimilartobothnervecellsand hormone-producingcells.SomeNeuroendocrinetumorssecretehormonesthatare associatedwithsymptomsofhormoneexcess;theclassicexampleiscarcinoid syndrome(CS)whichisassociatedwithserotoninproduction(oftenmeasuredasurine5HIAA) Serotoninisachemicalthattransmitssignalsbetweennervesinthebrainand throughoutthebody,alsocalledaneurotransmitter.InCS,itfunctionsasahormone,and whenelevatedcancausesymptomssuchasdiarrheaandflushing Thesesymptomscan oftenimprovebymodifyingfoodchoicesandeatingpatterns.

Certainfoodsoreatinghabitscanworsenflushing,diarrhea,gas,bloating,andabdominal painrelatedtocarcinoidsyndrome.ManypatientswithCSfindspecificfoodsthat containserotoninoraminescantriggertheirsymptoms Bylimitingoravoidinghighly processedfoods,youautomaticallyreducemanyamines,addedsugars,andfats.

NutritiontipsforpatientswithCS:

Keepafooddiarytohelpmonitorwhatmightbetriggeringsymptomsforyou You maynothavetogiveupafavoritefoodentirely.Smallportionsmaynottrigger symptoms.

Mostfrequentlyreportedtriggerhabitsinclude:

Eatinglargermeals

Drinkinglargeamountofanybeveragewithmeals

Eatinghighfatgreasy,friedfoods

Eatingspicyfoods

Workwithyourteamtotestyourlimits,andstartwithsmallportionsofmoderateand highaminefoodslikecoffeeorchocolate.

LowvitaminB3,niacin,ismorecommoninpatientswithCS Chicken,turkey,fish, beef,pork,brownrice,fortifiedbreakfastcereals,andpeanutsaregoodsourcesof niacintoincluderegularlyinyourdiet

NEUROENDOCRINE TUMORS WITH CARCINOID SYNDROME

Questions about the 5-HIAA test?

This is a blood or urine test that measures how much serotonin is in the body. It does this by measuring the substance (Hydroxyindoleacetic acid, also called 5-HIAA) left behind when the body breaks down serotonin. Did you know the foods you eat can change your blood and urine test results? Avoid these foods for 48 hours prior to and during testing: avocado, banana, cantaloupe, eggplant, pineapple, plum, tomato, hickory nut/pecan, plantain, kiwi, date, grapefruit, honeydew, and walnut.

Low Amine Diet for NET Symptom Management

[5, 6]

Foods that are naturally low in amines may help to reduce your symptoms. Even if this diet helps you to feel better, you may tolerate small portions of moderate or high amine foods However, none of these foods are proven to worsen your cancer or negatively impact your treatment This diet is for symptom management only

NEUROENDOCRINE TUMORS WITH CARCINOID SYNDROME

VeryHighinAmines

Avoid-likelytotrigger symptoms

ModerateinAmines

Smallportionslikelytobe toleratedinmoderation

Leftover foods older than 48 hours

Aged and fermented cheeses –swiss, gouda, cheddar, parmesan, blue cheese, camembert, brick, roquefort, provolone, emmentaler

Smoked, salted, or pickled fish or meats – herring, bacon, salami, sausage, corned beef, bologna, pepperoni

Broad beans, miso, soy sauce, tempeh

Alcohol – all types

Overripe bananas, pineapple, watermelon, dried fruit, canned fruit in heavy syrup

Tofu, fava beans, peanuts, coconut, some vegetarian meat substitutes, other beans and legumes

Caffeinated coffees and sodas, chocolate, cocoa powder, fruit juices

Raspberries, avocado, green and yellow bananas

Tomatoes, tomato products, pickled or fermented vegetables, raw onions

Cruciferousvegetables–broccoli,cauliflower,cabbage, brusselssprouts

Corn

Corn tortillas, whole grain bread products

LowinAmines

Eatfreely,likelywell-tolerated

Freshly cooked foods

Un-aged cheeses – American, cottage cheese, ricotta, mozzarella, yogurt, cream cheese, milk

Low-fat dairy and lactose-free varieties may be better tolerated.

Freshfish,seafood,leanchicken andturkey

Eggsandeggsubstitutes

Soymilk,edamame,almonds, pistachios,cashews

Water,flavoredwaters,diluted fruitjuices,dilutedsportsdrinks

Peeled fruits: apple, pear, peach, nectarine, mango, papaya, cantaloupe, honeydew

Blueberries, strawberries, blackberries, grapes

Peeled cooked vegetables: carrots, all squashes, potatoes, parsnips, turnips, asparagus, string beans, peas, shallots, onions, green onions, bell peppers

Raw vegetables: leafy greens, celery (with ribbing peeled), cucumber (peeled and seedless)

Oatmeal,whiterice,whitebread, quinoa

Fermented foods and condiments: sauerkraut, shrimp paste, fish sauce

Yeast extracts and “hydrolyzed” proteins: marmite, vegemite, brewer’s yeast, nutritional yeast

Butter, shortening, coconut oil

Olive,canola,safflower, sunfloweroils

NEUROENDOCRINE TUMORS WITH

CARCINOID SYNDROME

CS-Friendly Curry Powder

Store-boughtcurrypowderoftenhas cayennepepperandmustardseed,but youcaneasilyblendyourowntousein recipesthatcallforit.

Double,triple,orquadruplethisrecipe asneeded!

1 teaspoon tumeric

1/2 teaspoon cumin

1/4 teaspoon coriander

1/4 teaspoon ginger

1/8 teaspoon cinnamon

1/8 teaspoon ground black pepper

Spices, herbs, and aromatics are essential ingredients and the key to big flavor and nutrient density. Each is loaded with antioxidants and phytochemicals When it comes to cooking, spices or dried herbs are added at the BEGINNING, and fresh herbs go in at the END.

NEUROENDOCRINE TUMORS WITH CARCINOID SYNDROME

Missing Your Favorite Foods? Food Substitution Ideas

If you find yourself missing some of these CS trigger foods, here are a few substitution ideas.

Tomatoes

A simple romesco sauce can be made with roasted red peppers, toasted almonds, olive oil and garlic. Or look for No-Mato sauce in stores or online: www.nomato.com.

Avocado

Boiled eggs, hummus, or cashew cream, if tolerated, can add some of that creaminess avocados contribute.

Coffee

Green tea or an herbal coffee such as Dandy Blend or Teecino.

Nuts

Almonds, pistachios, and cashews are low in amines and are great if you aren't having any CS symptoms. However if you're not eating any nuts, then toasted sunflower or pumpkin seeds are an excellent substitution.

Vinegars or fermented foods

Zest from a lemon or lime offers a bright burst of flavor and the juice adds the sour flavor or acidity. Zest with a microplane.

Aged cheeses

Goat cheese or sheep feta add that umami and saltiness you're craving

Sweets

Baking or stewing fruit brings out the natural sweetness and concentrates the flavor. Try roasting fruit, a fruit crisp made with a nut or seed you can tolerate, or a little piece of chocolate, if tolerated.

NEUROENDOCRINE TUMORS WITH CARCINOID SYNDROME

Other Nutrition Resources:

General

https://www.aicr.org https://www.cookforyourlife.org https://www.oncologynutrition.org https://www.cancer.org/cancer/risk-prevention/diet-physicalactivity/eat-healthy/find-healthy-recipes.html

Carcinoid syndrome: https://www.carcinoid.org/ https://netrf.org/for-patients/ https://www.foodyoulovebook.com https://www.oncolink.org/cancers/carcinoid-neuroendocrine-tumors

DAILY NUTRITION FOR A PATIENT WITH GI CANCERS

Enjoy balanced meals by following the New American Plate, developed by the American Institute for Cancer Research The same healthy eating guidelines to prevent cancer are supportive and protective for you during treatment and beyond. Discuss your specific calorie and protein needs with your dietitian.

Fill up to 1/3 of your plate with protein-rich foods including poultry, fish, meat, eggs, and dairy foods.

Fill the other 2/3 with a variety of plant-based foods: vegetables, fruits, beans, and whole grains. Make room for these foods to benefit from their cancer-fighting nutrients!

DAILY NUTRITION FOR A PATIENT WITH GI CANCERS

Whatisoneservingofyourfavoritefoods?

2cupsofrawsaladgreens

1cupchoppedvegetables(aboutthesizeofyourfist)

1mediumpieceoffruit

½cupofdriedfruit

1sliceofbreador1smalltortilla

1cupreadytoeatcereal

½cupcookedbrownrice,oatmeal,ornoodles(aboutthesizeof yourcuppedhand)

1cupmilkoryogurt

2ouncesofcheese

3ouncesofcookedmeat,poultryorseafood(aboutthesizeofthe palmofyourhand)

1eggor2eggwhites

¼cupcookedbeans,peas,orlentils

1tablespoonnutbutter(aboutthesizeofyourthumb)

2tablespoonsofnutsorseeds

1tablespoonofoil,dressing,margarine,orbutter

DAILY NUTRITION FOR A PATIENT WITH GI CANCERS

Translating Science to the Plate

8-inch plate

10-inch plate

4 ounces of salmon

8-ounce glass

16-ounce glass

6 ounces of water

HIGH PROTEIN TUNA SALAD

2 SERVINGS READY IN 15 MINUTES

INGREDIENTS

1/2 cup 2% plain Greek yogurt

1 teaspoon Dijon mustard

Juice of 1/2 lemon

1 tablespoon extra-virgin olive oil

1/8 teaspoon Kosher salt

1/8 teaspoon freshly ground black pepper

6 ounces solid white tuna in water (two 3-ounce pouches, for example)

Optional: 1/2 ripe avocado, diced

DIRECTIONS

Mix everything together in a medium bowl until well combined Enjoy, or refrigerate in airtight container for up to 5 days.

210 calories, 25 grams protein, and 0 grams fiber per serving

CREAMY MASHED POTATOES

3 SERVINGS READY IN 30 MINUTES

INGREDIENTS

1 pound peeled red potatoes, cubed

2 tablespoon olive oil

2 tablespoons unsalted butter

2 tablespoons prepared broth/bouillon

6 tablespoons protein powder (bone broth for savory, plain whey protein isolate (?) for lactose-free, or pea protein for dairy-free)

1/2 teaspoon salt

1/2 teaspoon ground pepper

DIRECTIONS

1 Drain and mash the potatoes.

Cover cubed potatoes in a pot of water and boil 15-20 minutes until tender

2. Add remaining ingredients and stir until thoroughly combined. 3.

350 calories, 23 grams protein, and 2.5 grams fiber per serving

HIGH PROTEIN EGGS

2 SERVINGS READY IN 10 MINUTES

DIRECTIONS INGREDIENTS

4 large eggs

1/2 cup low-fat cottage cheese

1/2 teaspoon salt

1/2 teaspoon ground pepper

Non-stick cooking spray

notes

You will need a non-stick skillet

Spray non-stick skillet and start medium heat

Whisk all ingredients in medium bowl with a fork, then pour eggs into the warm skillet.

Gently and slowly fold eggs using a rubber spatula for about 2 minutes until set.

Enjoy right away, or refrigerate leftovers in airtight container up to 5 days

174 calories, 17 grams protein, and 0 grams fiber per serving

CONGEE RICE PORRIDGE

4 SERVINGS READY IN 1 HOUR 15 MINUTES

INGREDIENTS

3/4 cup long grain rice

9 cups bone broth (or, use water or prepared broth/bouillon)

1 teaspoon salt

Optional: Top with 1 teaspoon olive oil or sesame oil for flavor

Add shredded chicken or boiled egg for protein

Add ground herbs and spices as tolerated

DIRECTIONS

In large pot, bring rice and water to a boil 1

Once boiling, turn down to medium-low heat

3. Cook for about 1 hour until the rice breaks down and becomes thick and creamy.

Place the lid on the pot, tilting it to allow steam to escape.

Add seasonings to taste and optional items 5

Enjoy, or refrigerate in airtight container for up to 5 days 6

274 calories, 18 grams protein, and 1 gram fiber per serving

PEANUT BUTTER SPREAD

6 SERVINGS

READY IN 15 MINUTES

INGREDIENTS

5 tablespoons smooth peanut butter (try powdered peanut butter prepared with water for less fat if you are experiencing diarrhea)

1 tablespoon non-fat dry milk powder

1 teaspoon water

1 tablespoon honey

DIRECTIONS

Combine dry milk and water

2 Enjoy with crackers or banana. 3.

Add honey and peanut butter, stirring slowly until liquid blends with peanut butter.

Can also roll into balls and eat chilled. 4.

104 calories, 5 grams protein, 1 gram fiber per serving

MARINATED CHICKEN

4 SERVINGS READY IN 3 HOURS 15 MINUTES

INGREDIENTS

4 three-ounce boneless, skinless chicken breasts

1 cup plain low-fat yogurt

1 medium shallot, minced

3 tablespoons olive oil

1 tablespoon lemon juice

1/2 teaspoon lemon zest

1/2 teaspoon garam masala (or curry powder)

3 tablespoons chopped cilantro

DIRECTIONS

Place chicken breasts in resealable plastic bag

1 In blender, combine all remaining ingredients until smooth and add to the bag.

Marinate for at least 3 hours or up to overnight.

Cook on preheated grill on each side for at least 5 minutes until cooked through

Enjoy or refrigerate in airtight container for up to 5 days

228 calories, 24 grams protein, 0 grams fiber per serving

notes

You will need a large resealable plastic bag, a blender, and a grill or grill pan

SWEET POTATO POWER

3 SERVINGS READY IN 30 MINUTES

DIRECTIONS INGREDIENTS

1 medium-sized sweet potato

1 1/2 cup apricot nectar*

4 oz silken tofu (1/3 to 1/2 of package)

2 tablespoons maple syrup or honey

1 Steam potato for 10-15 minutes until soft 2 Transfer to mixing bowl.

Peel and cut sweet potato into ½-inch pieces

3. Add remaining ingredients and blend until smooth (use immersion blender, hand mixer, or a blender).

237 calories, 9 grams protein, and 2 grams fiber per serving

notes

You will need an immersion blender, hand mixer, or a blender

CINNAMON, YOGURT, PEACH SMOOTHIE

1 SERVING READY IN 15 MINUTES

INGREDIENTS

1 cup diced peaches (fresh, frozen, or canned)

1/2 cup low-fat plain yogurt

1/2 cup milk, soy milk, rice milk, Boost, Ensure, or a generic version of these products.

1 tablespoon honey

Cinnamon to taste (1/8 teaspoon is a good place to start)

notes

You will need a blender

DIRECTIONS

1 Place these ingredients in the blender

Clean, peel, and prepare the fruit and other solid ingredients

2 Add liquid ingredients to the blender.

3. Blend all of the ingredients together to your desired consistency.

4. Depending on the strength of your blender, you may need more or less liquid to make the mixture blend

244 calories, 15 grams protein, 2 grams fiber per serving

SOOTHING LEMON SOUP

6 SERVINGS READY IN 20 MINUTES

INGREDIENTS

6 cups bone broth or chicken broth/stock

1 cup orzo pasta

3 eggs, slightly beaten

1 large lemon, juiced

DIRECTIONS

Bring broth to boil in a large pot

Stir in orzo and cook for about 7 minutes until just tender

Turn off heat.

In a small bowl, whisk lemon juice into the beaten eggs. 4.

Whisk hot broth into the egg mixture now, adding 1 spoonful at a time and stirring continuously

Do this for 3 spoonfuls until egg mixture is hot

Add egg mixture to a large pot and stir everything together until well combined.

Enjoy right away or refrigerate in an airtight container for up to 5 days.

149 calories, 15 grams protein, 1 gram fiber per serving

OUTSTANDING OATMEAL

1 SERVING READY IN 10 MINUTES

INGREDIENTS

1/2 cup rolled oats (or cream of wheat for less fiber)

1 cup lactose-free milk

1/2 cup fruit (sliced banana, canned peaches, or peeled diced baked apples)

Optional toppings: 2 teaspoons butter adds 90 calories; 2 tablespoons peanut butter adds 190 calories and 9 grams protein

DIRECTIONS

Slice fruit of choice 1

Add rolled oats or cream of wheat into a bowl 2 Add milk. 3.

Top with preferred toppings. 4.

149 calories, 15 grams protein, 1 gram fiber per serving

CLOVE TEA

1

SERVING READY

IN 15 MINUTES

INGREDIENTS

5-7 whole cloves

8 ounces water

1 green tea bag

DIRECTIONS

Simmer the whole cloves in 8 ounces of water until the volume is reduced by half

Pour the hot liquid into a mug and remove the whole cloves. 2.

Add 2 ounces cool water to mug. 3.

Add green tea bag to mug and let steep for 2-3 minutes

Recipe from caring4cancer com

0 calories, 0 grams protein, 0 grams fiber per serving

WATERMELON GRANITA

INGREDIENTS

2 cups seedless watermelon, peeled and diced

1/4 cup fresh lime juice

4 large basil leaves

1 to 2 tablespoons of sugar, to taste

DIRECTIONS

Puree the watermelon, lime juice and basil until smooth 1

Stir in sugar and taste for desired sweetness

Pour the watermelon juice into a 9x9x2 inch glass baking pan and put into the freezer.

notes

You will need a 9x9x2 inch glass baking pan

4. Continue to scrape the surface every 30 minutes until you have a fluffy snowy consistency

After 30 minutes, with a fork scrape to form flaky texture.

Serve or keep in an airtight container in freezer, scraping every so often to keep a light texture.

50 calories, 1 gram protein, 0 grams fiber per serving

CURRIED SWEET POTATO SOUP WITH

COCONUT MILK

6 SERVINGS READY IN 2 HOURS

DIRECTIONS INGREDIENTS

3 medium sweet potatoes, peeled

4 tablespoons olive oil

1 onion, chopped

2 garlic cloves, finely chopped

2 stalks of celery, chopped

2 teaspoons cumin

2 teaspoons curry powder

1 teaspoon sea salt

5 cups of bone broth

1 cup of coconut milk

1/2 cup of water

Optional: crusty bread for dipping

Pre-heat the oven to 350F (180C). 1.

Slice the sweet potatoes into 2-inch rounds. 2. Place potatoes in a baking tray and drizzle with 2 tablespoons of olive oil 3

Season with a little salt. 4.

Bake for 1 hour or until tender. 5. Remove from oven and set aside to cool 6

Meanwhile, in a large saucepan, heat the remaining olive oil over a medium heat 7

Add the onion and celery and fry, stirring often, for 5 minutes. 8.

Add garlic and fry for 30 seconds. 9.

Add garam masala and curry powder 10

Fry, stirring constantly with a wooden spoon, for 30 seconds 11

Remove the saucepan from the heat. 12.

Scoop flesh out of sweet potatoes and discard the skins. 13.

Place potatoes into the saucepan and stir well to coat in spices 14

Add stock and bring to the boil 15

Turn the heat down to medium-low and cover 16

Simmer soup for 15 minutes. 17. Remove soup from heat and cool. 18.

(cont ’d next page)

CURRIED SWEET POTATO SOUP WITH COCONUT MILK

DIRECTIONS

19 Ladle soup into a blender or food processor and blend in batches until smooth and creamy.

20. Place soup back into saucepan on a medium heat.

21 Add coconut milk and water, and stir well to combine

22 Simmer soup over a medium heat for 5 minutes

23. Divide soup into bowls, and serve with a slice of crusty bread for dipping.

Adapted from www tastebuddies com

268 calories, 10 grams protein, 3 grams fiber per serving

notes

You will need a blender or food processor.

COCONUT MACAROONS

12 SERVINGS READY IN 45 MINUTES

INGREDIENTS

4 large egg whites

Pinch of salt

1/2 cup sugar

1 8-ounce package sweetened, shredded coconut, lightly toasted

DIRECTIONS

Preheat oven to 350 degrees F

In a mixer fitted with a whip attachment whip egg whites and salt until they become white and begin to stiffen

Add sugar in 3 parts.

Continue to whip until the egg whites are very stiff.

Using a rubber spatula fold in toasted coconut

On parchment lined cookie sheets, drop a teaspoon of the mixture leaving 1 to 2 inches around each cookie.

Place into the oven and bake for 15 to 20 minutes.

Bake until the outside becomes golden brown The insides should still be moist

164 calories, 3 grams protein, 3 grams fiber per serving

notes

You will need a stand mixer with a whip attachment or a hand mixer, parchment paper, and a cookie sheet

EGG MUFFINS

12 SERVINGS READY IN 45 MINUTES

DIRECTIONS INGREDIENTS

Non-stickcookingspray 1bagfrozenshreddedhash browns,atleast12ounces(try togetunsalted/unseasoned)

1cuplightlypackedbaby spinach,chopped 6eggs

4eggwhites

4sliceslow-fatAmerican cheese,cut

1/4teaspoonsalt

1/4teaspoondriedbasil

1/4teaspoondriedoregano

Optional:cookedgroundturkeyor cookedcrumbledtempeh;finely choppedredpepper

notes

You will need a 12-cup muffin tin

1. Preheat 350F oven 2

Prepare 12-cup muffin tin with non-stick spray.

Fill each muffin cup with about 1 ounce hash browns 3 Bake about 15 minutes until brown. 4. Remove from oven, and while warm, use back of spoon to press potatoes against sides and bottoms to create a crust

5. Whisk together remaining ingredients in medium bowl until combined

7. Bake about 20 minutes until eggs are fully set

Place even amounts of sliced cheese to each muffin cup, then layer egg mixture on top until almost filled.

8 Let cool for 5 minutes, then remove from pan to enjoy, or let cool on wire rack

10.

Refrigerate in airtight container up to 3 days.

136 calories, 6 grams protein, 1 gram fiber per serving

PUMPKIN SOUP

8 SERVINGS READY IN 40 MINUTES

DIRECTIONS INGREDIENTS

2 tablespoons olive oil

4 carrots, peeled and sliced

1 onion, chopped

28 ounces canned 100% pumpkin puree

4 cups bone broth

2 cups any cooked white bean 1/4 cup fresh basil, chopped

1. Add pumpkin, broth, and beans, bringing to a boil then reducing heat to medium 2 Cook on simmer about 20 minutes. 3. Remove from heat and puree with immersion blender (or transfer carefully to a blender in batches) until smooth 4.

Saute carrots and onions in olive oil over medium heat until they begin to brown.

Garnish with basil and enjoy 5

129 calories, 8 grams protein, 5 grams fiber per serving

notes

You will need an immersion blender or regular blender

BLACK BARLEY CILANTRO TABBOULEH

6 SERVINGS READY IN 40 MINUTES

INGREDIENTS

1/2 lb black barley, uncooked

1 cup edamame, shelled

3/4 cup red bell peppers, diced

3/4 cup green bell peppers, diced

1/2 cup green scallions, diced

1/4 cup cilantro, chopped

1/4 tsp salt

1/8 tsp ground black pepper

1/2 cup lemon juice

3 tablespoons extra virgin olive oil

DIRECTIONS

Cook barley in simmering water for 30-40 min or until tender 1 Drain and chill 2

Place barley in a bowl and toss with remaining ingredients. 3. Refrigerate tabbouleh in a sealed container for at least 3 hours to combine flavors 4. Serve cold 5

238 calories, 7 grams protein, 8 grams fiber per serving

CITRUS WATER

8 SERVINGS READY IN 30 MINUTES

INGREDIENTS

1/2 cup of cucumber slices

1/2 lemon, sliced

1/2 lime, sliced

1/2 orange, sliced

2 quarts of water

Optional: Add True Lemon or Crystal

Light Pure packets to taste

DIRECTIONS

Wash all produce before slicing

Place sliced produce in 2-quart pitcher and push down with the back of a spoon to start releasing flavor.

notes

You will need a 2-quart pitcher

Cover with water and refrigerate for up to 12 hours, then discard solids and enjoy

0 calories, 0 grams protein, 0 grams fiber per serving

NOTES

[1] Clement DS, Tesselaar ME, van Leerdam ME, Srirajaskanthan R, Ramage JK. Nutritional and vitamin status in patients with neuroendocrine neoplasms. World J Gastroenterol. 2019 Mar 14;25(10):1171-1184. doi: 10.3748/wjg.v25.i10.1171.

[2] Warner ME. Nutritional concerns for the carcinoid patient: Developing nutrition guidelines for persons with carcinoid disease. Carcinoid Cancer Foundation, Inc., New York. 2000. Updated 2008. Accessed April 1, 2022. https://www.carcinoid.org/for-patients/generalinformation/nutrition/nutritional-concerns-for-the-carcinoid-patient-developing-nutrition-guidelines-for-persons-with-carcinoid-disease

[3] Niacin Fact Sheet for Health Professionals. National Institutes of Health Office of Dietary Supplements. Updated March 26, 2021. Accessed April 1, 2022. https://ods.od.nih.gov/factsheets/Niacin-HealthProfessional/#h2.

[4] National Comprehensive Cancer Network® (NCCN). NCCN Guidelines Neuroendocrine and Adrenal Tumors. (Version 1.2022) https://www.nccn.org/professionals/physician_gls/PDF/neuroendocrine.pdf. Accessed October 6, 2022.

[5] Eating Right with Neuroendocrine Tumors. Neuroendocrine Tumor Research Foundation. Accessed April 1, 2022. https://netrf.org/forpatients/living-with-nets/nutrition/

[6] Find Food You Love. Lexicon Pharmaceuticals. 2017. Accessed April 1, 2022. https://www.foodyoulovebook.com

[7] New American Plate. American Institute for Cancer Research. Accessed April 1, 2022.