Nutrition Know-How. 7. Choose nonfat dairy such as skim milk, nonfat yogurt, and nonfat cheese.

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1 Make Healthier Choices Swapping whole-grain or nonfat foods for processed or full-fat foods is often all it takes to give your diet a health boost. Here are a few tips for making healthful food choices: 1. Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety. 2. Eat nonstarchy vegetables such as spinach, carrots, broccoli, or green beans with meals. Nutrition Know-How 3. Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce. 4. Include dried beans (like kidney or pinto beans) and lentils in your meals. 5. Include fish in your meals 2 to 3 times a week. 6. Choose lean meats like cuts of beef and pork that end in loin such as pork loin and sirloin. Remove the skin from chicken and turkey. 7. Choose nonfat dairy such as skim milk, nonfat yogurt, and nonfat cheese. 8. Choose water and calorie-free diet drinks instead of regular soda, fruit punch, sweet tea, and other sugar-sweetened drinks. 9. Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats. Remember that fats are high in calories. 10. Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and full-fat ice cream. Remember that eating too much of even healthful foods can lead to weight gain, so it is important to watch your portion sizes. Discuss any diet questions with your health care team sanofi-aventis U.S. LLC, A SANOFI COMPANY All rights reserved Printed in the USA US.XON This health information is being provided for general educational purposes only. Your health care provider is the single best source of information regarding your health. Please consult your health care provider if you have any questions about your health or treatment.

2 Nutrition Know-How If you have cancer, you know you have to take care of a lot of things every day: medication, symptoms and side effects, fatigue, and sticking to the treatment plan from your health care team. Are you also paying attention to how and what you eat? Good nutrition is very important in managing your disease, and slowing its complications from getting worse. A healthy diet is one that is high in nutrients with a moderate number of calories per serving. Many patients eat diets that lack the proper nutrients. A few simple facts can start to increase your Nutrition Know-How and help create a meal plan that will make a healthier you! What is a Smart Meal Plan for Cancer Patients? A meal plan tells you how much and what kinds of food and drinks you can choose and how much to have at meals and snacks. More than half of all cancer deaths could be prevented by making healthy choices like not smoking, staying at a healthy weight, eating right, keeping active, and getting recommended screening tests. Follow a balanced eating plan filled with fresh fruits, vegetables, whole grains, and a controlled amount of lean meats and poultry. Also, cut back on beverages and foods with added sugars. And pay attention to how much you eat even with healthful foods, you can have too much of a good thing! Carbohydrates are 1 of 3 sources of calories or energy that we need in our diets (the other 2 are protein and fat). Carbohydrates provide most of the energy needed in our daily lives. Carbohydrates are found in fruits, vegetables, beans, dairy foods, and breads as well as mayonnaise, ketchup, and mustard. Balanced diet Fish (twice a week) Lean meats and poultry Whole grains Fresh fruits Vegetables Read the label! Low-fat or nonfat does not mean your food is low in calories. 2

3 4 Are you eating more, less, or the same? Nutrition Facts 8 servings per container Serving size 2/3 cup (55g) Amount per serving Calories 230 % Daily Value* Total Fat 8g 10% Saturated Fat 1g 5% Trans Fat 0g Cholesterol 0mg 0% Sodium 160mg 7% Total Carbohydrate 37g 13% Dietary Fiber 4g 14% Total Sugars 12g Includes 10g Added Sugars 20% Protein 3g Vitamin D 2mcg Calcium 260mg Iron 8mg Potassium 235mg 10% 20% 45% 6% * The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice. Compare your serving size to figure out the number of carbs you are eating. Total carbs per serving (in grams) are listed on the label. Protein comes from meat, chicken, fish, dairy products (such as cheese, milk, and yogurt), beans, and some vegetables. Try to eat more chicken and fish. Also choose nonfat or reduced-fat dairy products. Fat is contained in butter, margarine, oils, and many meat and dairy products. Your meals will be more nutritious if you eat less fat, especially saturated fat and trans fats. Saturated fat is found in meat, chicken skin, butter, 2% or whole milk, ice cream, and cheese. Trans fat is produced when liquid oils are turned into solids. Rather than use butter or stick margarine, choose soft margarine in a tub that lists a liquid oil, such as soybean or canola oil, as an ingredient. Creating a Healthy Plate Include sources of dairy products in your diet. It is an easy way to get calcium and high-quality protein. Many dairy products, like no-sugar-added, fat-free yogurt, can be eaten as a dessert. Fat-free or low-fat (1%) milk Plain nonfat yogurt Nonfat light yogurt without added sugar If you are trying to switch to lower fat dairy products, take the time to get used to the taste and texture difference. Check with your doctor about the best diet for you

4 Protein Meat and meat substitutes, such as soy products and cheese, are great sources of protein. A balanced meal plan usually has about 2 to 5 ounces of meat. All the plant-based protein foods and any breaded meats contain carbohydrates. The best choices are the cuts of meats and meat alternatives that are lower in saturated fat and calories. Try to include dried beans into several meals per week. They are a great source of protein and are loaded with fiber. Eat a variety of fish and shellfish (catfish, flounder, haddock, herring, orange roughy, salmon, tilapia, trout, tuna, crab, lobster, scallops, and shrimp). Eat poultry without the skin. Select and Choice grades of beef trimmed of fat including: chuck, rib, rump roast, round, sirloin, cubed, flank, porterhouse, T-bone steak, tenderloin. Meat, poultry, and seafood need to be cooked fully. Nonstarchy Vegetables There are 2 types of vegetables starchy and nonstarchy. Starchy vegetables like potatoes, corn, and peas are considered grains, since they contain more carbohydrates. There are numerous nonstarchy vegetables (below are a few common ones). Artichoke Asparagus Beans (green, wax, Italian) Beets Broccoli Brussels sprouts Cabbage (green, bok choy) Carrots Cauliflower Cucumber Eggplant Greens (collard, kale, mustard, turnip) Mushrooms Onions Peppers Radishes Salad greens (chicory, endive, escarole, lettuce, romaine, spinach, arugula, radicchio, watercress) Squash (cushaw, summer, crookneck, spaghetti, zucchini) Sugar snap peas Tomato Turnips Fresh, frozen, and canned vegetables and vegetable juices without added sodium, fat, or sugar (if using canned or frozen vegetables, look for ones that say low sodium or no salt added on the label). Frozen or canned vegetables in sauces are higher in both fat and sodium. If using canned vegetables with sodium, drain the vegetables and rinse with water then warm in fresh water. This will cut back on how much sodium is left on the vegetables. 6

5 Fruits There are many fruits to choose. Listed below are a few common ones: Apple Apricot Banana Blueberries Cherries Grapes Kiwi Mango Orange Peach Pear Plum Raspberries Strawberries Watermelon Choose fresh, frozen, or canned fruit without added sugars in juice or light syrup. Dried fruit and fruit juice are also nutritious choices, but the portion sizes are small, so they may not be as filling as other choices. Eat the Rainbow Enjoy lots of vegetables and fruits and the variety of nutrients they offer by choosing from the rainbow of colors available. Cancer Fighting Foods Studies have shown that eating more vegetables and fruits reduces cancer risk. However, many studies have found that supplements containing certain nutrients (like vitamins) do not reduce cancer risk and may even cause harm. Food and nutrients may interact in complex ways that are not well understood. The best advice at this time is to eat whole foods as part of an overall healthy diet, with a goal of maintaining a healthy weight. Antioxidants and cancer Antioxidants include vitamins C and E, carotenoids (such as beta-carotene and vitamin A) and many other chemicals from plants. The body uses certain antioxidants to help protect against normalwear-and-tear (oxidation) of body tissue. Because oxidation is linked with increased cancer risk, some antioxidants may help protect against cancer. Studies suggest that people who eat more vegetables and fruits, which are rich in antioxidants, may have a lower risk for some types of cancer. But this does not necessarily mean that only the antioxidants are responsible for this, as these foods also contain many other compounds. Some fruits and vegetables can interact with anti-cancer drugs. 8

6 What about organic foods? Vegetables, fruits, and whole grains should form the central part of a patient s diet, regardless of whether they are grown conventionally or organically. Whether organic foods carry a lower risk of cancer because they are less likely to be contaminated by compounds that might cause cancer is largely unknown. Does eating fish protect against cancer? Fish is a rich source of omega-3 fatty acids. Studies in animals have found that these fatty acids may stop cancer from forming or slow its growth, but it is not clear if omega-3s can affect cancer risk in humans. Does drinking coffee cause cancer? No. Possible links between coffee and cancer have not been confirmed in recent studies. What about foods treated with pesticides and herbicides? Both can be toxic when used improperly in farming or other settings. Although vegetables and fruits sometimes contain low levels of these chemicals, overwhelming scientific evidence supports eating fruits and vegetables. At this time there is no evidence that residues of pesticides and herbicides at the low doses found in foods increase the risk of cancer. Still, food should be washed thoroughly before eating, not only to lower exposure to these compounds, but also to limit the risk of infection from germs Can drinking tea reduce cancer risk? Some researchers have proposed that tea might protect against cancer because of its antioxidant, polyphenol, and flavonoid content. In animal studies, some teas (including green) have been shown to reduce cancer risk, but findings from studies in humans are mixed. Nutrition Know-How What to Eat During Cancer Treatment Eating habits that are good for cancer patients can be very different from the usual healthy eating guidelines. Healthy eating habits and good nutrition can help patients deal with the effects of cancer and its treatment. Eating too little protein and calories is a very common problem for cancer patients. Having enough protein and calories is important for healing, fighting infection, and maintaining energy. In fact, some cancer treatments work better when patients eat better. Cancer can change the way the body uses food Some tumors make chemicals that change the way the body uses certain nutrients. The body s use of protein, carbohydrates, and fat may be affected, especially by tumors of the stomach or intestines. A patient may seem to be eating enough, but the body may not be able to absorb all the nutrients from the food. Other challenges for patients trying to eat healthy come from the side effects of cancer treatment. Taste, smell, appetite, and the ability to eat enough food can all be affected Anorexia and cachexia can affect nutrition as well Anorexia (the loss of appetite or desire to eat) is the most common cause of malnutrition in cancer patients. Almost all patients who have advanced cancer will have anorexia. Cachexia (kuh-kek-see-uh) is a condition marked by a loss of appetite, weight loss, muscle loss, and general weakness. It is common in patients with tumors of the lung, pancreas, and upper digestive tract. It is important to watch for and treat cachexia early on, because it is hard to correct. It is important to treat weight loss caused by cancer Both nutrition therapy and medicine can help patients stay at a healthy weight. Medicine may be used for many of the side effects, in hopes of increasing appetite, helping food digest easily, and decreasing pain or discomfort. 10

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