Food can be a tricky subject under the best circumstances. Add in the complications of cancer, the holidays, and family – now that’s a minefield that would make anyone want to crawl under the table and hide! It can be frustrating when meals are at the heart of all we do, but meals make us miserable. Emotions and stress can also affect how we process and digest our food, leading to flare ups and uncomfortable bathroom tips if we’re not careful.

Even in survivorship, colorectal cancer can often remain on our minds because our digestive systems are not the same as they once were. How then, can we enjoy our holiday meal after facing colorectal cancer? Good news: It’s possible!

Here are 7 tips for holiday eating after a colorectal cancer diagnosis.

1. Bring What You Can Eat

If you are asked to bring a dish or a snack, bring a dish that fits your meal plan. Set yourself up for success. Bring what you can eat.

Consider tracking what you’re eating throughout the day. This will encourage mindful eating and help eliminate grazing. It’s easy to get caught up in the holiday atmosphere and eat too much because it’s there.

Look for recipes that include healthy choices for you ahead of time.

2. Hydrate

Some health issues like constipation, weight gain, and fatigue can be lessened by drinking fluids throughout the day. Plan to hydrate well: have 8oz.–12oz. of fluids every three to four hours. Water, juices, decaffeinated tea, coffee, broths, soups, ices, popsicles, gelatins, and low-calorie beverages can help you feel more like yourself.

Dehydration is a common side effect of cancer treatment, so be sure to remain hydrated. Liquids assist in moving food through the digestive track and curb cravings for high calorie snacks. If lactose sensitive, choose lactose-free options.

3. Tell People How You Feel

Let them know in advance if you don’t feel up to hosting your usual holiday party. If unable to contribute your signature holiday dish for dinner, offer to bring condiments, plates, utensils, napkins, or cups. These items are essential to a great party.

4. Let Others Help

Family and friends want to help. Cancer is also really difficult for caregivers because so frequently there isn’t anything they can do. So, they’re happy to know that making some accommodations can help you.

Let others help you with eating good for the holidays. Guide them to a website with recipes for people with cancer. Allow them assist you with your nutrition and side effects. They can choose recipes that address your nausea, diarrhea, fatigue, and trouble swallowing.

The people who love you want to be sure you’re eating healthy for the holidays.

Communicating your needs won’t only help you, but it allows those around you to know what you need. Otherwise, they will be guessing, and that’s a recipe for problems.

5. Be Prepared

Your host wants you to be comfortable, so don’t be shy about asking for anything you need. However, it’s good to be prepared in case you don’t need something the host doesn’t have. Consider packing a holiday survival kit with the following:

Food Snacks you can eat and have had success with.

Clothes A complete backup outfit (including socks and shoes) in case you have an accident.

Supplies Creams and soft or doubly-ply toilet paper. Extra ostomy provisions.

6. Connect

Clearly communicating your needs allows you to connect. Cancer can be so isolating. You’re trapped in your own terrible experience while those around you go on with normal life.

How do you bridge the gap and reconnect? Connect and communicate.

When you share honestly, you will let others in and allow them to help.

Imagine a friend of yours is struggling, but you don’t really know why or how to help. What if they shared how they’re feeling and specifically let you know what you could do to help? What a relief! Communication opens up connections.

7. Embrace the Season

The real reason for the season is not food and drink but more about family, friends, and celebrating another year. Give thanks for those around you. Enjoy gratitude in the day.

Enjoy eating good during the holidays with foods that you haven’t had the energy to make lately. Embrace the season.

With the rise of pop culture’s interest in gut health, the microbiome has taken center stage. Simply put, the microbiome refers to all bacterial cells living inside the gastrointestinal tract. When the gut microbiome is out of whack, there is an imbalance of good bacteria versus bad bacteria. This imbalance can be caused by a variety of factors like diet, medicines, stress, and disease, among others. Many scientists around the world are avidly studying the microbiome to uncover health insights.

We connected with Drs. Michael G. White and Nadim Ajami from The University of Texas MD Anderson Cancer Center to help us understand the role of the gut microbiome, and more specifically, its role in colorectal cancer.

Q: The Gut Microbiome – What Is It?

A: The gut microbiome is a complex environment of bacteria, viruses and fungi comprising the vast majority of genetic diversity within each person – well beyond an individual’s own DNA. Increasingly well-defined, the gut microbiome has been linked with a myriad of health conditions. These interactions are now understood to occur both locally (in the gut) and systemically (with impact throughout the body) through changes in the immune system among other mechanisms. The gut microbiome’s local proximity to the colon led many early investigators to study its impact on colorectal cancers (CRC), placing CRC at the forefront of studies in the microbiome’s influence on cancer development, progression, and response to therapy.

Q: How Does the Gut Microbiome Connect to Colorectal Cancer?

While CRC incidence and mortality have decreased over recent years, its increase in young adults has prompted a deeper examination of factors affecting the gut microbiome, such as environmental exposures and diet. A variety of studies have demonstrated an imbalance in the microbiome of CRC patients, including a disproportionate amount of bacteria linked to pro-tumor microenvironments, DNA damage, and modulation of short chain fatty acids within the gut that may act as protective agents for cancers. CRC cancers themselves also demonstrate an increased diversity of viruses in their microbiome. Whether this is connected to the imbalance of gut bacteria in cancer patients or they are related to cancer development is an area of active investigation.

Q: What Does This Mean for the Future of Colorectal Cancer Care?

Recent findings have the potential to benefit CRC patients and the general population in the near future. Specific microbial species, metabolites, and alterations are being investigated and validated as strategies for cancer interception, treatment and prevention.

Carefully controlled trials to modulate the microbiome via fecal transplanatation are underway to measure the impact of shifting the composition and structure of the gut microbiome. Early data from melanoma patients demonstrates that fecal transplantation can induce a response to immunotherapy in patients who initially were resistant to immunotherapy.

Microbial markers of disease progression (genetic material of bacteria and viruses, other proteins, or metabolites) may also improve surveillance and treatment strategies. A future microbial signature could potentially act as a marker for risk of development of metastatic CRC measured using a simple blood draw15,16. This could help doctors decide when to prescribe adjuvant chemotherapy and influence the development of future therapeutics.

Lastly, microbial markers of CRC hold promise for fine-tuning cancer screening guidelines for the general public. Given the rising rates of CRC in young adults, the percent of the population for whom screening is recommended continues to increase. However, due to a limited number of endoscopists in the U.S., there is a need for improvement of risk assessment tools. Gut microbial insights could generate more effective screening methods, while also making sure those at the highest risk receive the screening they need.

Q. What are some key takeaways for patients concerned about their microbiome health?

Microbiome profiling is not akin to glucose or blood pressure measurements, where a single number defining “healthy” can be applied to the general population. Moreover, its complex interactions affect a variety of health conditions in different ways – therefore, an “ideal” gut microbiome for any given condition is not fully defined.

Your microbiome should only be studied under the direction and guidance of your medical team.

Direct-to-consumer profiling services (kits you can buy from online and box stores) do not offer appropriate medical follow-up and guidance.

To ensure your microbiome is functioning in the healthiest capacity, the best advice to date is the simplest:

• follow a diverse, high-fiber diet (as medically able)
• avoid probiotic supplements (unless recommended by your physician)
• only make changes after directed discussion with your physician

Microbiome Research

Lee Jones, a stage IV survivor and research advocate, was one of 10 research advocates from five countries selected to participate in the OPTIMISTICC study, a project investigating the relationship between the human microbiome and CRC. It is funded by a five-year grant from Cancer Research UK as part of their Cancer Grand Challenges program (now in partnership with the U.S. National Cancer Institute).

“This research tends to be mostly lab-related and it requires a much heavier knowledge of science than I have, but research advocates have played an important role. We have helped relate the lab findings to the real world so patients find more potential value. Also, dietary information and tumor, blood, and stool samples are collected at several points during participants’ chemotherapy or immunotherapy treatments. We have provided valuable input regarding this as well.

Findings of the study have so far demonstrated strong associations between several microbes and CRC. One of the studies, headed by Dr. Kimmie Ng at Dana-Farber, is looking specifically at the role the microbiome may play in young onset colorectal cancer. One of the more interesting findings is of a predatory bacterium that only attacks one of the cancer-associated microbes. We don’t know how this might play out in the human body, but it’s amazing to watch the attack under a microscope!” – Lee Jones, stage IV survivor and research advocate

Lots of people have a love/hate relationship with fiber. Too little fiber, and we have poop that’s too hard. Too much fiber, and we have poop that’s too soft, or maybe too watery, and that’s not good either. We are seeking the perfect poop: Not too hard. Not too soft. Just right. It sounds like a fairytale.

We spoke with Connie Rizzo, MEd, RD, LD, Medical Nutrition Therapist at Mercy Hospital, Cancer Resource Center, C.H. “Chub” O’Reilly Cancer Center of Springfield, Mo., to find out all about fiber.

Q: What kinds of fiber exist?

A: Fiber-containing foods are a mixture of soluble and insoluble fiber. Both types of fiber can aid in digestion and elimination. However, soluble fibers are soluble (dissolve) in water and can bring water into the digestive tract. The soluble fibers allow for slower movement through the digestive tract while reducing constipation and adding some bulk to the stool. On the other hand, insoluble fibers are insoluble in water, not digested, and travel more quickly through the digestive tract. These actions of fiber-containing foods occur before, during, and after colorectal treatment and surgery.

Q. How much fiber does a patient need?

A: This often depends on the side effects from the cancer treatment. Immediately after surgery, an individual may need to reduce the total amount of fiber and then slowly add fiber-containing foods to regulate any diarrhea, constipation, or consistency of the stool.

The goal after surgery or treatment is to work up to a healthy, well-tolerated amount of fiber, which can be similar to a person’s need for fiber before surgery.

There is value to fiber-containing foods, including vitamins, minerals, and numerous phytochemicals. Phytochemicals are a wide variety of compounds produced by plants; phytochemicals provide the flavor, aroma, and color to various fruits, vegetables, whole grains, and other plant foods. For example, the red pigment in a tomato or watermelon is the phytochemical called lycopene; allium plants like garlic, onion, and shallots produce compounds (phytochemicals) that contribute to their aroma and taste. Consuming a variety of plant foods containing these phytochemicals may assist in reducing risk and recurrence of cancer, as well as reducing risk of heart disease, diabetes, and high blood pressure.

Q: Where can I find the different kinds of fiber?

A: The fiber found in vegetables, fruits, and grains are a combination of both types of fibers. For example, oats, barley, and dried beans (like black and pinto beans) contain soluble fiber; wheat bran, fruit and vegetable skins, and whole-grain breads contain insoluble fiber.

I encourage people to try a variety of whole, plant-containing foods to get fiber in their diet. Fruits, vegetables, beans and legumes, whole grains and cereals all contain fiber and offer beneficial phytochemicals. The specific foods need to be adjusted for the individual.

Q: What is the value of fiber, especially to a patient with colorectal cancer?

A: The value is two-fold. First, the digestive tract contains a layer of muscle and fiber-containing foods keep the digestive tract fit and the individual healthier. Second, altering the types and amounts of fiber after colorectal surgery or treatment can allow an individual to adjust for challenges with either constipation or diarrhea. If the individual requires an ostomy, the individual will need to adjust the type and amount of fiber to assist with thickening the stool.

Q: Does colorectal cancer surgery impact how much fiber you need?

A: A low-fiber diet for the first six to eight weeks after ileostomy creation or a low anterior resection surgery may be recommended; however, it is important to transition to a well-balanced diet when you are able. A colostomy patient needs to consume adequate fiber and fluid to avoid constipation after surgery and to reduce diarrhea and/or thicken the stool.

Everyone is different, and each individual will have varying experiences. Sometimes a person will find that although a food that worked one day, the same food can be a challenge another day. It is important to remember that anxiety can stimulate the muscular layer of the digestive tract to move faster and create problems. Patience is necessary to explore how these fiber foods will affect each individual’s digestive tract.

Q: Is there such thing as too much fiber?

A: If too much insoluble fiber is consumed, the individual may have diarrhea because the food is moving too fast for the colon to absorb adequate water. Even though soluble fiber can slow the digestive tract and is often fermented in the colon, fiber-containing food is a combination of both soluble and insoluble fibers so too much of any fiber foods could cause diarrhea.

Also, absorption of nutrients can decrease if food is moving too rapidly through the digestive tract, and an individual can experience bloating, gas, cramping, and a decrease in appetite with too much fiber consumption.

It is best to increase fiber foods gradually so the body can adjust to it.

Q: What if someone doesn’t get enough fiber?

A: If an individual does not consume enough fiber during treatment or surgery, the individual may have constipation and will lack the health benefits of fiber in the diet.

Q: What about fiber supplements?

A: Whole foods with fiber are preferred because they contain a variety of vitamins, minerals, and phytochemicals (plant chemicals) that help your body remain healthy. Adding and regulating fiber in the diet is always the first choice. Some people may require a fiber supplement like Metamucil when it is difficult to manage the consistency of the stool with diet alone. Many fiber supplements are only soluble or insoluble fiber.

Benefiber is wheat dextrin, and FiberCon is calcium polycarbophil, and both are mainly soluble fiber. Citrucel is methylcellulose, which is mainly insoluble fibers that is nonfermentable. Metamucil contains psyllium, which is mainly soluble fiber, but also some insoluble fiber. The type of fibers (whether they are soluble or insoluble) in these supplements affect the digestive tract in much the same way as the soluble and insoluble fiber in foods.

If a fiber supplement is necessary, the individual should begin with a low dose and gradually increase the amount of fiber. It is important to ask your physician or dietitian how much fiber to add because too much fiber may decrease absorption of valuable nutrients. Fiber supplements can decrease the absorption of some other medications so I recommend the individual take other medications one hour before or two hours after consuming the fiber supplement to minimize the interaction.