Non-Hodgkin lymphoma and diet

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Non-Hodgkin lymphoma (NHL) is a group of blood cancers that develop in the lymphatic system — a complex network of glands and vessels that carry lymphatic fluid throughout the body. White blood cells compose this fluid, and they help protect the body from infection and disease.

Non-Hodgkin lymphoma affects a type of white blood cells called lymphocytes. In NHL, abnormal lymphocytes divide rapidly and accumulate in the lymph nodes and lymphatic tissues. The lymphocytes divide before they can fully mature, making them ineffective at fighting infection and disease.

Scientists have not established the cause of NHL. However, possible risk factors for the disease include:

• infections
• immune disorders
• genetics and race
• a family history of NHL
• certain occupational and lifestyle factors

Symptoms of NHL may include:

• enlarged lymph nodes, typically in the neck, armpits, or groin
• night sweats
• fever
• persistent fatigue
• unexplained weight loss
• chest or abdominal pain
• feeling full or bloated
• a loss of appetite

Treatment for NHL may include:

• chemotherapy
• radiation therapy
• stem cell transplantation

According to the Physicians Committee for Responsible Medicine (PCRM), some research suggests there may be a link between diet and the risk of developing lymphoma. The PCRM reports the following findings:

• People consuming the highest amount of red meat may have a 10% greater risk of NHL compared to people who consume the least amount.
• A high intake of poultry may increase the risk for “B-cell lymphoma” by 22% compared to a lower intake of poultry.
• In one study, the risk of NHL doubled for females, who ate beef, pork, or lamb daily as compared to those who ate those meats less than once a week.
• A meta-analysis studying the association between milk consumption and NHL risk determined that people who drank the most milk had around a 25% increased risk of NHL compared with those who drank the least. A similar meta-analysis showed this increased risk to be as high as 41%.
• A high intake of total, saturated, and monosaturated fat may increase the risk of NHL by around 50%.

Certain dietary factors may prevent NHL. The PCRM reports the following findings:

• One meta-analysis suggests that a higher intake of vegetables and fruits may reduce the risk of NHL by 20% compared to a lower intake of these foods. Vegetables seem to contribute more to this result than did fruits.
• Other research found that women who ate 6 or more servings of fruits and vegetables a day had a 40% reduced risk of NHL compared to those who ate only 3 servings a day.
• A high intake of vitamin A and vitamin C may reduce the risk of NHL and large B-cell lymphoma, respectively.
• People with celiac disease have a greater risk of NHL. However, eating a gluten-free diet may reduce the risk.
• Obesity may increase the risk of NHL, particularly between the ages of 18–21.

The Leukemia and Lymphoma Society (LLS) suggests the following dietary and nutritional tips for people undergoing blood cancer treatment:

• Aim to eat 5–10 servings of fruits and vegetables every day, including cruciferous vegetables, such as:
  • broccoli
  • cauliflower
  • kale
• Drink plenty of water throughout the day to prevent dehydration and reduce treatment side effects.
• Drink broths or sports drinks to replace electrolytes, such as sodium and potassium.

Lymphoma Action recommends eating a balanced diet that includes the following:

• plenty of fruits and vegetables
• carbohydrates, including wholegrain carbs, should make up around a third of a person’s daily food intake for energy
• proteins, such as some meat, fish, eggs, and pulses, a type of legume
• some milk, other dairy products, or dairy alternatives
• small amounts of foods that are high in sugar and fat

Treatments, such as chemotherapy and radiation therapy may affect a person’s appetite, digestion, and weight. Below are some potential treatment side effects, along with some tips for preventing and alleviating these side effects.

Weight loss

People receiving chemotherapy or radiation therapy may lose weight due to appetite loss or nausea. The following tips can help a person boost their calorie intake and maintain a healthy weight:

• adding commercial, grade A honey or jams to foods
• choosing high fat options where possible, such as drinking whole milk rather than skim milk
• adding cheese or sauces to dishes, such as pasta
• adding butter or oil to bread, potatoes, or vegetables
• snacking frequently throughout the day

Weight gain

As part of the treatment protocol for NHL, doctors may prescribe steroids, which can cause the following side effects:

• increased hunger
• fluid retention
• weight gain

A person’s weight typically returns to normal once they stop steroid treatments. In the meantime, a person should continue to eat a nutritious diet.

Anyone concerned about weight gain while taking steroids can talk with their healthcare team for further advice.

Nausea

Chemotherapy and radiation therapy can cause nausea. To alleviate nausea, people can try the following:

• Eating plain foods: Plain foods, such as toast, crackers, and rice, are often easier to digest.
• Eating ginger: Ginger can aid digestion and reduce feelings of nausea. Some ways to incorporate ginger include:
  • adding ginger root or powdered ginger to food
  • eating ginger biscuits or small pieces of crystallized ginger
  • drinking ginger tea
• Minimizing food smells: Strong food smells may trigger feelings of nausea. People can minimize food smells by:
  • eating cold foods, such as sandwiches and salads
  • waiting for heated foods to cool before eating
  • cooking food in a microwave rather than on the stove, to help contain the smells

Changes to taste

Medications for NHL may alter a person’s taste perception of foods and beverages. To counter this, people can try the following:

• adding flavoring to food, in the form of herbs, spices, sauces, or chutneys
• trying herbal teas if tea and coffee lose their flavor
• maintaining good oral hygiene to help prevent oral thrush and other oral infections that can change a person’s taste perception
• switching to plastic cutlery to reduce metallic tastes

Diarrhea

Some people may experience diarrhea as a side effect of cancer treatment. People who experience this side effect should drink plenty of fluids to prevent dehydration. Some options include:

• plain water
• foods, such as soup, Jell-O, and popsicles
• fluids to replace lost electrolytes, such as broths, coconut water, and sports drinks

If diarrhea is an ongoing issue, people can speak with their healthcare team to discuss dietary changes or medications that may help.

Constipation

Some people may experience constipation, and they should talk with their healthcare team about taking laxatives. Laxatives help stimulate bowel movements or loosen the consistency of stools, so they are easier to pass.

People may also find relief in the following ways:

• Increasing their fiber intake: Fiber draws water into the stool, making it bulkier and easier to pass. People can increase their fiber intake by eating more fruits and vegetables.
• Increasing their water intake: Water helps soften stool, as well.
• Exercising: Gentle exercise helps stimulate the bowels and promote regular bowel movements.

Some research suggests a link between a high intake of meat and fats and an increased risk of NHL. Due to this association, a person with an NHL diagnosis should follow a balanced diet to minimize their food safety risks.

People who have a low amount of white blood cells may want to avoid certain foods or drinks that contain live bacteria. Doing so will help reduce their risk of bacterial infection. Examples of foods to avoid include:

• probiotic yogurts, foods, or drinks, such as kefir, kimchi, or sauerkraut
• unpasteurized foods and drinks
• blue or mold-ripened cheeses
• raw honey

People who want to determine which foods may be best for NHL may want to discuss a nutrition plan with a dietician.

Below are some FAQs about NHL and diet. However, people with specific questions or concerns about NHL and their diet should speak with their healthcare team for tailored advice.

Is it ok to eat a vegetarian or vegan diet with NHL?

People can eat a vegetarian or vegan diet with NHL and still get all of the nutrients they need. People following such diets can eat a range of foods, such as:

• fruits and vegetables
• a variety of carbohydrates
• vegetarian protein options, such as eggs and cheeses, or vegan protein options, such as:
  • tofu
  • soya products
  • nuts and seeds
• iron-rich foods, including pulses and dark, leafy greens

People following a vegan diet may need to take a vitamin B12 supplement.

Should a person with NHL eat organic foods?

People with NHL may choose to eat organic foods. These are foods from farms that restrict the use of certain synthetic pesticides and fertilizers.

Although organic foods may contain higher levels of antioxidants, there is not enough evidence to suggest that eating organic food can prevent or cure cancer.

Some research shows that organic foods may potentially lower the risk of NHL, but further research is necessary to establish a solid link.

Are supplements safe or beneficial?

If people eat a balanced and healthy diet, it is unlikely they will need to take supplements. However, if a person is finding it difficult to consume a nutritionally balanced diet, their doctor may suggest taking a vitamin and mineral supplement.

People will need to consult a doctor about any supplements they plan to take, as some may interfere with their cancer treatments.

Non-Hodgkin lymphoma (NHL) is a group of blood cancers that affect white blood cells called lymphocytes. People with NHL should aim to eat a healthy, balanced diet to ensure they meet all of their nutritional needs. However, treatments for NHL may cause side effects that affect a person’s nutrition and weight.

Chemotherapy and radiation therapy may cause side effects that lead to weight loss. To help prevent weight loss, people can try snacking frequently throughout the day, eating easily digestible foods, and adding extra flavoring to foods to increase their palatability.

Contrastingly, steroids may cause side effects that lead to weight gain. These side effects typically resolve once a person completes their steroid treatment.

Anyone concerned about their diet or weight while undergoing treatment for NHL can consult their healthcare team for further advice.