Nutrition: Recipe Ready

The following information is available in more depth from pages 61-99 of your About Carcinoid Nutrition Guide provided by TerSera.

You may have noticed that we’ve been sending you a “Recipe of the Week”. If you don’t know, these recipes are all available in your About Carcinoid Nutrition Guide. We’ve been highlighting some recipes we thought you might enjoy but if you want more, there are tons available for you to explore!

These recipes were created using low amine and soluble fiber sources for ingredients, which, as you have learned, are very important. Each recipe is also labeled with tags to help you identify which might suit your needs. Pay attention to the recipes identified as low fat, low sugar, dairy-free, and high in protein to determine which ones are best for your diet.

If you are unsure or have any questions about which recipes are right for you, make sure to check in with your CNE or healthcare provider.

For a detailed list of recipes visit your About Carcinoid Nutrition Guide provided by TerSera.

Nutrition: Staples to Support Your Needs

The following information is available in more depth from pages 56-60 of your About Carcinoid Nutrition Guide provided by TerSera.

You’ve been learning a lot about nutrition and how to make informed choices. We wanted to take it a step further by giving you some staples that will help you better plan your meals at home or on the go.

It’s also important to remember that while these staples follow the general guidelines you have been learning, your triggers may vary.

Grains and Cereals

In general, you should try grains and cereals that are made with white or refined flour. For cereals, look for products that are made with refined grains and are low in fiber.

Here are some examples:

• White pasta

• White bread

• Bagels

• Corn cereal

• Quinoa

Proteins

When choosing your proteins, lean meats and poultry are good options.

To find “lean” proteins, look for the following on the Nutrition Facts label: less than 10 g of fat, less than 95 mg of cholesterol per 100 g per serving size.

Here are some examples:

• Ground beef

• Pork Tenderloin

• Boneless, skinless chicken breast 

• Tuna

• Kidney beans

Vegetables

You want to look for fresh vegetables that are a good source of soluble fiber. To improve digestibility, it’s a good idea to cook your vegetables.

Here are some examples:

• White potatoes (peeled)

• Asparagus

• Lettuce 

• Green beans

• Red bell pepper

Fruits

Similar to vegetables, you want to look for fruits that are high in soluble fiber. Remember to peel your fruits before eating them.

Here are some examples:

• Apple (peeled)

• Grapes

• Mango

• Blueberries

• Cantaloupe

Dairy

Fresh and low-fat dairy options are the best for your digestive system. Remember that aged cheeses can be high in amines.

Here are some examples:

• Non-fat sour cream

• Non-fat cream cheese

• Goat cheese

• Mozzarella cheese

• Ricotta cheese

Oils

Oils should always be used in moderation and should be high in unsaturated fats and low in amines.

Here are some examples:

• Canola oil

• Safflower oil

• Sunflower oil

Herbs and Spices

Herbs and spices can add pleasant flavor to your meals, but you’ll want to avoid any that can add too much heat.

Here are some examples:

• Cinnamon

• Curry

• Basil

• Chives

• Parsley

Want to know more?

Your CNE is available to help you with any questions or concerns you might have surrounding your diet. For more information and ideas for staples in ‘Staples to Support Your Needs’ go to your About Carcinoid Nutrition Guide provided by TerSera.

Get The Facts: Reading The Nutrition Facts Label

The following information is available in more depth from pages 39-41 of your About Carcinoid Nutrition Guide provided by TerSera.

You’ve been learning about the different foods and nutrients that support a healthy GI NET diet. To put that into action, it’s important that you learn about how to read the Nutrition Facts label in order to identify these essentials when you are making food choices.

Serving Size vs. Portion Size

A serving is a measured amount of food. When reading the Nutrition Facts label it is important to note the serving size as all of the values will be based on one serving.

A portion is the actual amount of food you decide to eat. For those with GI NETs, it may be beneficial to have smaller, more frequent portions and avoid large portions in one sitting.

Percent Daily Value

The percent daily value tells you how many nutrients are in one serving. For example, if the label lists 25% of Vitamin D, then one serving contains 25% of your daily value of Vitamin D.

Important: The Percent Daily Value is based on a 2000-calorie diet, this may not be right for everyone and you should talk to a registered dietician to find out how many calories you should be eating and drinking each day.

Types of Fat

Fats are a good source of energy and may help your body absorb essential nutrients.

Unsaturated fats are more heart-healthy than saturated fats. The Nutrition Facts Label does not always list unsaturated fats, some good examples to look out for are nuts, vegetable oils, and fish.

Saturated fats should always be included on the Nutrition Facts label and should be monitored carefully. It is a good idea to avoid foods like butter, vegetable shortening, and coconut oil, that are high in saturated fat.

What else should you look out for?

Sugars: Try to avoid foods that are high in sugar. Reach for foods with less than 12g of sugar per serving.

Proteins: Proteins support a healthy NET diet. Keep in mind that some aged foods may be high in amines.

Vitamins: Vitamin D is important for a healthy NET diet because it promotes the absorption of calcium in the small intestine, improves muscle strength, supports immune function, and reduces inflammation.

Want to know more?

Your CNE is available to help you with any questions or concerns you might have surrounding your diet. For more information on ‘Get The Facts: Reading The Nutrition Facts Label’ go to your About Carcinoid Nutrition Guide provided by TerSera.

Food To Focus On

The following information is available in more depth from pages 34-38 of your About Carcinoid Nutrition Guide provided by TerSera.

Remember to talk to your healthcare provider or a registered dietician before altering your diet to incorporate the following dietary recommendations which may be helpful in supporting the nutritional needs of those affected by some GI NETs and Carcinoid Syndrome.

Soluble vs. Insoluble Fiber

It is important to pay attention to the types of fiber you are including in your diet. Soluble fiber is a more desirable choice for people with GI NETs and Carcinoid Syndrome because it can dissolve into a gel-like substance, which allows the colon to absorb more water and results in more solid stools.

Soluble fiber can move through the GI tract slowly, allowing the body to absorb more nutrients when compared to insoluble fiber. Your body can have difficulty breaking down insoluble fiber, it moves too quickly through the GI tract for the body to absorb nutrients and remains intact. Insoluble fiber is not recommended for those who are experiencing diarrhea.

Examples of Soluble Fibers (to be enjoyed in moderation):

• Oatmeal

• Peeled fruit

• Nut butters (in moderation)

• Cooked vegetables (peeled with the seeds and stems removed)

• White rice

Examples of Insoluble Fibers:

• Wheat bran

• Whole grains

• Skin on fruits and vegetables (like the ribbing on a piece of celery or the skin of on an apple)

Eat High-protein Meals and Snacks

Protein is important for tissue repair, immune function, and energy. Conditions like cancer can cause a lot of physical stress on the body and a higher demand for protein.

Tryptophan is an essential amino acid that can be found in foods like eggs and poultry. Those living with GI NETs and Carcinoid Syndrome can have lower levels of Tryptophan and lean proteins can be a valuable dietary source.

Eat Small, Frequent Meals

Large meals may aggravate diarrhea symptoms. Try eating 4-6 high-protein meals or snacks a day.

Separate Food and Drink

If you’ve had a small bowel resection, it may help to avoid drinking a lot with meals. Small sips are okay.

Avoid Concentrated Sugars

Foods like fruit juices that are high in sugar can pull water into the GI tract. This can lead to excess fluid and nutrient loss. Try foods with less than 12g of sugar per serving.

Want to know more?

Your CNE is available to help you with any questions or concerns you might have surrounding your diet. For more information on ‘Foods To Focus On’ go to your About Carcinoid Nutrition Guide provided by TerSera.

What are Triggers

The following information is available in more depth from pages 21-28 of your About Carcinoid Nutrition Guide provided by TerSera.

In the previous section, we talked about the different types and causes of diarrhea. To learn more about how to identify the foods and drinks that trigger your diarrhea, you may want to take a close look at your diet. Before you make any changes to your diet, it is important to discuss those changes with your healthcare provider.

Here are some foods to pay attention to:

High-fat Foods

For those with steatorrhea, avoiding high-fat foods my help manage your symptoms.

Some common examples are fried foods, pastries, chips, bacon, and lunch meats.

Spicy Foods

Spicy food can increase the speed at which food moves through the GI tract.

Some common examples are cayenne pepper, black pepper, and mustard.

Amine-rich Foods

Amines are naturally occurring chemicals found in many foods. There are specific amines, called vasoactive amines, like tyramine and histamine, that can potentially trigger symptoms.

Common examples are foods that are aged, fermented, spoiled, or haven’t been properly refrigerated as these foods tend to have high amounts of vasoactive amines. Tomatoes can also be a common trigger as they contain histamines that can cause flushing and affect water absorption in the intestine, resulting in diarrhea.

Note: If you experience a strong reaction to these foods, it might be a good idea to avoid them all together. Some foods that are moderately high may be easier to tolerate if you stick to small portions. Some examples of moderately high-amine foods are drinks containing caffeine, chocolate, and peanuts.

Carbonated Drinks

Carbonated drinks can cause gas. If this is an issue for you, cutting down on soda and soda water may help.

Alcohol

Alcohol is fermented, which makes it high in amines. Alcohol can also increase flushing and cause dehydration.

Track Your Triggers

Tracking your triggers can help you identify and avoid foods that might be making your symptoms worse. You can do this by keeping a food journal, monitoring portion sizes or foods that might be triggers for you, and simplifying your meals to make it easier to determine which ingredients may be triggers.

Want to know more?

Get to know your triggers by tracking your food consistently in your Food Diary and recording any symptoms you experience after eating. Your CNE is available to help you with any questions or concerns you might have surrounding your symptoms. For more information about ‘What are Triggers?’ go to your About Carcinoid Nutrition Guide provided by TerSera.

Get To Know Your Symptoms

The following information is available in more depth from pages 14-19 of your About Carcinoid Nutrition Guide provided by TerSera.

In this article you will learn more about the different types and causes of diarrhea that can accompany some types of GI NETs. Having a better understanding of the type(s) you’re experiencing can help you have more informed conversations with your healthcare provider about making healthy changes.

Diarrhea Type/Cause: Steatorrhea

This type of diarrhea can happen when your pancreas is not producing the enzymes needed to properly digest food and break down fats. It can be caused by several factors, including some surgeries and side effects from somatostatin analog therapy (SAA). You are more likely to experience steatorrhea after receiving an SSA injection.

If you think it might be steatorrhea, you should keep an eye out for:

• foul smell

• floating stools

• gas and abdominal pain

• leaves a ring around the toilet, and may have a pale colour.

To address this type of diarrhea:

• you can stick to low-fat foods

• avoid foods like fried chicken and bacon that are high in fat

• ask your healthcare provider about pancreatic enzymes

Diarrhea Type/Cause: Secretory

Those with Carcinoid Syndrome may experience secretory diarrhea. When GI NETs spread, they can release several peptides and hormones, including serotonin. Overproduction of serotonin in the gut contributes to the symptoms associated with Carcinoid Syndrome. Somatostatin analog therapies may help reduce the amount of serotonin that the GI NETs produce and may help with symptoms. But over time, the SSAs can lose their effectiveness.

If you think it might be secretory diarrhea, you should keep an eye out for:

• watery stools

• waking up in the middle of the night for a bowel movement, even if you didn’t eat anything before you went to sleep

To address this type of diarrhea:

• you can eat small, frequent meals

• eat plenty of protein

• eat foods that are low in amines

• stay hydrated

Diarrhea Type/Cause: Rapid Transit Time

Rapid transit time diarrhea may be experienced by those who have had a small bowel resection. “Rapid transit time” refers to when food moves through your body at a faster-than-average speed.

If you think it might be rapid transit time diarrhea, you should keep an eye out for:

• having a bowel movement almost immediately after eating (in as little as 30 minutes)

• experiencing weakness, hunger, or a faster heart rate 2 to 3 hours after eating

To address this type of diarrhea:

• eat small, frequent meals (up to 5 to 6 per day)

• separate solids and liquids at meals (eat solid foods first)

• choose soluble fibre over insoluble fibre

• chew foods well

• limit fluids with meals

• avoid concentrated sweets

Diarrhea Type/Cause: Bile Acid

When a large amount of bile acid gets into the colon, it can result in bile acid diarrhea. This often happens in those who have had surgeries of the upper intestinal tract, including gallbladder removals.

If you think it might be bile acid diarrhea, you should keep an eye out for:

• burning diarrhea

• urgent and frequent trips to the bathroom

• yellow in color

To address this type of diarrhea:

• avoid greasy, high-fat foods

• ask your healthcare provider about taking multivitamins, probiotics, and oral bile acid sequestrants

Want to know more?

To get to know the kind of diarrhea you may be experiencing most often, remember to track your bowel movements in your Stool Tracker. Your CNE is also available to help you with any questions or concerns you might have about your symptoms. For more information on ‘Get To Know Your Symptoms’, go to your About Carcinoid Nutrition Guide provided by TerSera.