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Healthy Eating after Colorectal Cancer. A dietary guide for optimising health after treatment for colorectal cancer
- Todd Nelson
- 2 years ago
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1 Healthy Eating after Colorectal Cancer A dietary guide for optimising health after treatment for colorectal cancer
2 Contents Page Content 3 Introduction 4 What you should do 5 Working out your energy requirements 6 Food Group Calculator 7 Coloured and Starchy Vegetables 8 Fruit 9 Fish, Seafood, Lean Poultry and legumes 10 Red and Processed Meats 11 Low Fat Dairy Products 12 Breads, Grains and Cereals 13 Oils, Spreads, Nuts and Seeds 14 Alcohol and Drinks 15 Snacks and Eating Out 16 Exercise 17 Foods to Avoid 18 A Sample Day of Eating 19 A Healthy way to a Healthy Weight 20 Stoma Advice 22 Food Safety Tips Your Recovery Diet- A Summary Beat Bowel Cancer Aotearoa 2
3 Introduction Eat your way to a lower risk of cancer recurrence! Following treatment for colorectal cancer, a healthy diet is needed to optimise recovery and health. Recent research suggests diet and lifestyle factors after diagnosis can also affect your risk of colorectal cancer returning 1. So take charge of your health today, starting with your diet! Diet and lifestyle factors thought to influence your risk of colorectal cancer recurrence are listed below: DECREASES RISK OF RECURRENCE Fruits Coloured Vegetables Whole Grain Breads and Cereals Low Fat Milk Products Legumes (peas and beans) Tea (Herbal and Black) Physical Activity Fish Poultry Alcohol Red Meat Processed Meat Butter and Cream Deep Fried Foods, Pies and Pastries Whole Fat Milk Products Desserts, Chocolate, Sweets Potato Chips and fries High Fat Take-Away Options Obesity INCREASES RISK OF RECURRENCE Due to the nature of colorectal cancer, evidence for the effect of diet on cancer recurrence is limited. However, by following healthy eating guidelines you can not only optimise your recovery from colorectal cancer but also help prevent other health conditions such as obesity, heart disease and diabetes 2. All while being a healthy role model for your family! 3
4 So What Should You Do? What s really important when it comes to colorectal cancer recurrence and diet is your overall dietary pattern 1 (what you re eating every day, not just on the odd special occasion), This means Moving away from this Fat Alcohol Sugar And towards this! 4 Wholegrain breads and cereals, starchy vegetables Fruits and coloured vegetables Lean poultry and fish, eggs and nuts Low fat dairy products Limited high fat and sugar foods
5 Working Out Your Energy Needs The key to a healthy weight and diet is energy balance. This means the energy you put into your body from food, should match the energy you re putting out through exercise and day to day activities. Following healthy eating guidelines and eating appropriate serving sizes is the key to ensuring you put the right kind of energy into your body. The trick is to tailor guidelines to your specific needs. To work out your individual energy needs use the quiz below to find out whether your current daily energy/kilojoule (kj) requirements are low, medium or high. See page 19 to work out which BMI category you are in. Circle the option which best applies to you: 1. Age a) I am 65 years or older b) I am years c) I am 44 years or younger 4. Fitness a) I am physically unfit b) I am moderately fit c) I am very physically active 5 2. Body Weight a) I tend to gain weight easily b) I am in the healthy or overweight BMI category c) I am lean and in the healthy or underweight BMI category 5. Lifestyle a) I have a sedentary job/lifestyle b) I have a moderately sedentary job/ lifestyle c) I have an active lifestyle 3. Height a) I am up to 1.58m tall b) I am between m tall c) I am taller than 1.75m Now tally up how many A, B and C s you circled Mostly A s: You have a Low energy requirement of between kJ ( cal) per day Mostly B s: You have a Moderate energy requirement of between kJ ( cal) per day Mostly C s: You have High energy requirements of 10500kJ (2500cal) or higher per day
6 Food Group Calculator Now that you know your daily energy needs you can use the table below to find out how many servings from each of the healthy food groups you need each day to lower your risk of colorectal cancer recurrence. Use the My Plan column to note down what you should be having. Number of Servings per Day Based on Energy Requirements 2 Food Group Low kj Medium kj High kj My Plan Coloured vegetables Starchy vegetables Fruit Fish and seafood, lean poultry and legumes 1 ½ 2 2 ½-3 Red meat (beef, lamb, pork) 1 per week 1-2 per week 2 per week Processed meat (sausages, ham, salami) Low fat dairy products (milk, yoghurt, cheese) Breads, cereals and grains Oils, margarine, spreads, nuts, seeds avocado Adapted from the Guide to Heart Healthy Eating 2009, with permission from the National Heart Foundation For more detailed information about what an ideal serving of each food group is and healthy food choices, Read On!... 6 Studies suggest eating an unhealthy diet high in red and processed meat, potato chips/ fries, deserts, high fat dairy products and soft drinks could increase your risk of colorectal cancer recurrence! 1
7 Coloured Vegetables Coloured Vegetables are a nutrition powerhouse and diets high in these have been associated with a lower risk of colorectal cancer recurrence! Eat them throughout the day 1 serving of Coloured Vegetables: Tips: Aim to have 2 servings of coloured vegetables at both lunch and dinner Use a mixture of fresh, cooked, uncooked, frozen, canned or dried vegetables, they all count! Try to leave the skin on when preparing vegetables, it s loaded with nutrients. Wash vegetables carefully before eating to remove any bugs or sprays. ½ a cup of cooked green vegetables such as broccoli, spinach, watercress and green beans ½ cup of cooked mixed vegetables such as popular frozen varieties or stir fry (cauliflower, cabbage, peas, carrots, beans) 1 medium carrot or tomato (80g) 1 cup of green salad vegetables (cucumber, lettuce, mesculin leaves, sprouts, coleslaw) 1 wedge of pumpkin (130g) Aim to fill half your plate with coloured vegetables at lunch and dinner! Starchy Vegetables Starchy vegetables including potatoes, kumara, taro, corn, parsnip, yams, cassava and breadfruit are higher in energy and sugar than coloured vegetables. Studies have found diets high in potatoes and potato fries may actually increase the risk of colorectal cancer recurrence. Along with carbohydrates, starchy vegetables should only fill ¼ of your plate. 1 serving of Starchy Vegetables: 1 small Potato (135g) 3 Yams ½ cob of Corn ½ medium Kumara (1/2 cup) 7
8 Fruits Diets high in fruit are linked to a lower risk of colorectal cancer recurrence! Fruits are loaded with vitamins and minerals and natures sweetest treat! Have fruit with meals and as snacks in between meals. 1 serving of Fruit: 1 medium apple, nectarine, pear or orange (135g) 2 small apricots, kiwifruit or plums (100g) ½ cup canned fruit (135g) ½ cup stewed fruit Tips: 1 cup of fruit juice (250ml) 1 heaped tablespoon of dried fruit (raisins, sultanas, cranberries) grapes or cherries 1 small banana (10 cm long) 1 cup of berries, melon or pineapple Fresh, frozen, canned and dried all fruits count towards your 5+ a day. Wash fruit carefully before eating Choose canned fruit in natural fruit juice Look for fruit juices, made with real fruit rather than fruit drinks and limit to one glass per day Add fruit to your breakfast meal for a great start to the day Finding it difficult to eat fruit? Try mixing it in with a smoothie made with low fat milk and low fat ice-cream Studies have shown fruits and vegetables high in flavonols such as apples, beans, onions and broccoli may help prevent colorectal cancer recurrence! 3 8
9 Fish, Seafood, Lean Poultry and Legumes Fish, seafood, poultry and legumes provide iron, protein and zinc. They are also a great alternative to red meat when aiming to lower your risk of colorectal cancer recurrence. Try to incorporate them into two meals per day Tips: Include a serving of vitamin C (from fruit, tomatoes, broccoli or peppers) in meals to boost your body s absorption of Iron from meat and legumes Fish and seafood are a great source of omega-3 s for heart health, aim to have at least two servings per week Choose lean, skinless poultry such as skinless chicken breast 1 serving of Fish/ Seafood: 150g cooked white fish (e.g. hoki, orange roughy, blue cod) 100g cooked oily fish (salmon, dory, tuna, snapper) 1 cup mussels, prawns, scallops or other seafood 1 serving ½ cup of Poultry: canned fish (in lite oil or spring water) 2 small skinless chicken drumsticks 1 skinless chicken leg 1 small skinless chicken breast (120g) 1 serving of Legumes: 1 cup of cooked dried beans ½ cup cooked soy beans ½ cup Tofu ½ cup lite baked beans ¾ cup kidney beans or chicken peas Legumes: what are they? Legumes are a rich source of protein and include soybeans, kidney beans, chick peas, lentils, baked beans. They can be used dried or canned and make a cheap substitute for meat to bulk up meals. 9
10 Red and Processed Meat Red meat (beef, lamb and pork) has a bad name for its influence on colorectal cancer 4. However it does provide many important nutrients such as protein, vitamin B12 and Iron. Therefore if you choose to include red meat in your diet a strict limit of only 300g per week of lean, red meat is recommended. This is enough to ensure you receive enough of these nutrients whilst optimising your health outcomes following colorectal cancer. 1 serving of Red Meat: ½-¾ cup of premium or lean mince 2 slices of cooked lean meat (e.g. roast beef, 120g) 1 small lean steak (120g) A Meaty Issue Tips: To make sure you don t have more than 300g of red meat per week, plan to have it with only two dinner meals Use leftover chicken in sandwiches rather than processed meats (see page 22 for food safety tips!) Choose lean meats such as beef, venison, lamb or trim pork and trim off visible fat before cooking Avoid using too much oil when cooking meat by using healthy techniques such as grilling, boiling, dry roasting or casseroling Processed meats (sausages, deli ham, salami, luncheon and bacon) are often high in fat and salt and strongly associated with colorectal cancer 1, 4. It is therefore recommended that you avoid these meats. One serving of red meat should be the size of your palm Avoid eating burnt or charred meat, especially when barbequing as it can contain cancer-causing chemicals! 3 10
11 Low Fat Dairy Products Low fat dairy products are a rich source of calcium and protein. High calcium diets could lower your risk of colorectal cancer recurrence! Get off to a good start by including at least one serving of dairy products in your breakfast. 1 serving of Dairy Products: 1 glass of trim milk (250ml) 1 glass of trim, calcium fortified soy milk (250ml) 1 pottle of low fat yoghurt (150g) 2 slices edam cheese (40g) 1 tablespoon lite sour cream ½ cup of low fat custard Full fat dairy products can be high in saturated fat which can raise your cholesterol levels. High fat dairy products have also been associated with increased risk of colorectal cancer recurrence 1. So make the Pitucresmart high choice fat to trim and go for low-fat or trim dairy products. For a low fat, high calcium treat choose a milk based ice-block with less than 450kj and 4g fat per ice-block Some studies suggest a high calcium diet may help prevent colorectal cancer recurrence 5. Though dairy products contain the most calcium, other foods which contain calcium include peanuts, broccoli, canned salmon (in spring water) or sardines, spinach, baked beans and tofu. To supplement, or not? So far, there is no strong evidence that using dietary supplements such as omega-3 fatty acids or antioxidants will affect your risk of colorectal cancer recurrence. If you are worried that your diet is not providing you with enough nutrients, discuss this with your doctor before starting on a supplement. This is important as dietary supplements may interfere with your medication. 11
12 Breads, Cereals and Grains Breads, cereals and grains are loaded with carbohydrates, fibre and B vitamins, all important factors in maintaining healthy bowel function. Include at least 1-2 servings of these at every meal. Tips: Choose wholegrain breads and cereals which are high in fibre (over 5g per 100g) to keep you fuller for longer and prevent constipation Avoid high fat breads and cereals options such as croissants, garlic bread, danish pastries and toasted muesli. Instead choose healthy options such as Weetbix, rolled oats and high fibre breads Whole grain breads and cereals include foods with whole grains, grain, oats, oat bran, bran, kibbled wheat, rye or barley listed in their ingredient list 1 serving of Breads, Cereals and Grains: 1 small bread roll (30g) 1 slice of wholegrain bread (26g) 1 cup wholegrain breakfast cereal (50g) ½ cup muesli (55g) ½ cup cooked porridge (100g) 1 small wholegrain muffin (80g) ½ cup cooked wholegrain pasta (75g) ½ cup of cooked basmati rice (75g) 1 medium slice of rewena bread (30g) ½ cup cooked noodles (75g) Finding Fibre Hard To Handle? Foods such as fruit (prunes, apricots, apples) and wholegrain breads are high in fibre. Increasing your intake of these foods too quickly can lead to nasty side effects such as diarrhoea and bloating. Increase your intake of these foods slowly by introducing one food at a time. Avoid foods which cause unpleasant side effects. Also, make sure you drink plenty of water to help ensure easy bowel movements and avoid constipation. 12
13 Oils, Spreads, Nuts and Seeds Healthy plant fats are an important part of a healthy diet. Unhealthy dietary patterns, high in unhealthy animal fats are associated with an increased risk of colorectal cancer recurrence! Healthy fats also important for a healthy heart Tips: In New Zealand margarine is legally required to contain the same amount of fat as butter (around 81% fat!). However many of the spreads we think of as margarine are actually low-fat table spreads which look and taste like margarine. Look for table spreads with less than 60g total fat per 100g, and less than (<) 1g trans fat per 100g. 1 serving of oils/ margarine/ spreads: All oils have the same amount of fat in them, though not the same kind of fat. Choose vegetable oils such as flaxseed, grape seed, sesame, sunflower, canola, olive or rice bran oil. Avoid coconut oil, palm oil, ghee, lard, shortening or dripping. 1 teaspoon of oil 1 teaspoon or low fat table spread 2 teaspoons of lite mayonnaise 1 serving of Nuts/ Seeds: 1 dessertspoon of pumpkin or sunflower seeds 10 almonds, cashew nuts, hazelnuts, peanuts 8 unshelled walnuts 3 brazil nuts 1 tablespoon of avocado Selenium is an essential nutrient for good health which many New Zealanders don t get enough of in their diet 6. Boost your intake of selenium by eating 3 Brazil nuts per day. 13
14 Alcohol Drinking too much alcohol is associated with an increased risk of multiple health conditions including colorectal cancer. For that reason it is recommended that you avoid alcohol. If you choose to drink, do so in moderation. Follow the safe drinking guidelines outlined below 7, and make sure to have at least two alcohol free days each week: For Men: For Women: No more than 21 standard drinks per week. No more than 14 standard drinks per week. 1 Standard Drink: 30mL spirits 330ml can of 4% alcohol beer 100ml of wine One regular wine glass can hold up to 3 standard drinks! Choose smaller glasses and watch how much you re really drinking Drinks Hydration is essential for healthy bowels. Keep hydrated by drinking fluids throughout the day. Tea, coffee, trim milk and water all count towards your fluid intake. Try to avoid fruit juice, cordial, powder drinks and soft drinks as they are high in sugar and can contribute to weight gain. Did you know fruit juice contains the same amount of sugar as many soft drinks? For extra variety add a slice of fruit to your water or choose artificially sweetened or Diet juices and soft drinks 14
15 Snacks Preparing yourself with healthy snack options will help stop you buying unhealthy food options while you re out. Snacking is also a great way to help you gain weight if you are currently under weight. If you have a low appetite, snack throughout the day to keep your energy levels up and prevent weight loss. Healthy Snack Ideas Fruit (e.g. apple, orange, banana, grapes, frozen berries) 10 nuts or 1 tablespoon of seeds 1 cup of fruit salad 2 wholegrain crackers with cottage cheese 1 pottle of lite yoghurt 1 slice of toast with hummus and sprouts Vegetable sticks with hummus 1 slice of toast with avocado and tomato Tips: Eating Out Avoid high fat take out options such as burgers and fries, pizza, fried rice and deep fried/ battered foods Try not to be tempted by cheap up-sizing deals, stick to the small or regular size Save money by keeping dining out and takeaways for special occasions or limit yourself to once per fortnight. When ordering out try to avoid meals with creamy based sauces, go for tomato based sauces instead Sandwiches Sushi Salads with French Dressing Grilled or seared chicken Healthier Take-Out Options: Soups Kebabs without cheese Wraps Meals made with steamed or boiled chicken/shrimp and vegetables 15
16 Exercise The benefits of regular physical activity include improved bowel health, weight management, improved mobility, heart health, lower risk of colorectal cancer recurrence and the list keeps going! If you re just starting to increase your activity, or looking to get back into an active lifestyle, find a form of activity you enjoy. It s important to receive the all clear from your doctor before starting activity after your treatment. They can also provide advice on what form of activity is best for you. Tips: Get active by doing something you enjoy for 30 minutes every day. This can include all sorts of activity such as walking, swimming, cycling, jogging or getting to work on the gardening and house work. Break up the activity into three lots of 10 minutes to make it more manageable Set yourself weekly goals such as this week I will swim One more length of the pool than last week to keep you on track and motivated. Increase the amount of everyday activity you do, for example taking the stairs rather than the lift, banning the television remote or getting off a bus stop earlier to fit a short walk in. Finding it hard to get started with an active lifestyle or stay motivated? Talk to your doctor or nurse today about signing up to the green prescription. 16
17 High Fat Potato Chips (including corn and vegetable chips) Foods to Avoid Foods high in fat, sugar and salt are bad for your heart, weight and recovery. Avoid these foods or limit them to special occasions. High Sugar Cordial High Fat and Sugar Biscuits High Salt Potato Chips (including corn and vegetable chips) Cream Soft Drinks Cakes Salted Nuts Fried Foods Lollies Chocolate Vegemite High Fat Takeaways (burgers, fish and chips, fried chicken, pizza) Regular mayonnaise and aioli Puddings and Desserts Donuts Marmite Ice-blocks Muesli Bars Pickled Foods Processed Meats Fudge Regular Ice-Cream Processed Meats Pies, Pastries and Condensed Milk Single Chocolate Sausage Rolls and Syrups Ice-Creams Soy Sauce Fatty Meat (e.g. roast pork with crackling, chicken skin) Roll-ups Slices Soup Sachets Tips for reducing fat: Tips for reducing sugar: Tips for reducing salt: Trim visible fat from red meat and poultry Avoid creamy high fat sauces at restaurants by choosing tomato based dishes Use low fat cooking methods such as grilling, boiling, steaming, dry-roasting and stir frying Be careful when choosing low or reduced fat foods as often the fat is replaced by sugar. Look for foods with less than 15g sugar per 100g Limit the amount of sugar added to coffee and cereal to a maximum of 1 tsp Use herbs, spices and fruits to flavour meals in place of salt Add minimal salt when cooking and take the salt shakers off the table to avoid adding extra salt to your meals If using salt, use iodised table salt 17
18 Sample Day This example shows an ideal day of eating to promote optimal health after colorectal cancer. Breakfast: 1 bowl of wholegrain cereal, 1 handful of frozen berries, 1 pottle of lite yoghurt, 1 glass of fresh orange juice, 1 black tea Lunch: One chicken and salad sandwich on wholegrain bread, 1apple, 1 small low fat- high calcium ice-cream, 1 glass of water Dinner: Blue cod fillet with potatoes, carrots and peas, 1 glass of water, 1 bowl of fruit salad Snacks: 10 almonds, 2 wholegrain crackers with cottage cheese, 1 carrot, 2 cups of black tea Exercise Goal: 30 minutes of brisk walking, enough to break a sweat! 18
19 A Healthy way to a Healthy Weight Achieving a healthy weight, through healthy eating and regular physical activity is an essential factor in optimising your health outcomes after colorectal cancer. Many people find they either lose or gain excess weight during their treatment for colorectal cancer. Therefore reaching a healthy weight may involve gaining, losing or maintaining your current weight. Measure your height (m) and weight (kg) to work out where your current weight sits on the Body Mass Index (BMI) graph below: If your current BMI sits outside of the healthy section, use the graph to check what weight would put you into the healthy range based on your height. This is your ideal weight! 19
20 Living with a Stoma Do you currently have a stoma? If so diet is an important factor in having an Ileostomy or colostomy. Below are some basic diet tips for living with a stoma. These recommendations are different to the rest of this book because of the special requirements of living with a stoma. For more detailed advice contact a hospital dietitian or stomatherapist. Not everyone will react the same to foods, so experiment with different foods to work out what works best for you. Tips: Eat three regular meals each day with snacks in between. Irregular meals may cause watery bowel motions. Eat slowly and chew all food well. This well help prevent blockages. Avoid foods containing pips, seeds, nuts and skins for the first 6-8 weeks after receiving your stoma. Introduce new foods slowly 6-8 weeks after surgery. start trying new foods one at a time and in small amounts. If you experience any unpleasant side effects, avoid this food for another 2-3 weeks, then try again Keep up the Fluids! Particularly on hot days 20 Foods to include: Tender meat (e.g. skinless chicken or fish) and eggs Mashed or whole potatoes without skins Pasta, rice, white breads Pumpkin, kumara, carrots, Low fat sauces, breakfast spreads that don t contain nuts, seeds or skins Cooked fruit, fruit juice, bananas, ripe skinless fruit Living with an Ileostomy Because and ileostomy means your colon doesn t have a chance to absorb water, salt and potassium, it s important to increase these in your diet. This means: Aiming for 8-10 glasses of fluid each day, more when it s hot Using salt in cooking and sprinkling a dash onto meals Having potassium rich foods such as bananas, apricots, milk and fruit juice
21 Foods which can thicken output: Ripe bananas Boiled rice Porridge White bread Pasta Gelatine Coconut Dried fruit and pineapple Foods which can cause wind: High fibre fruits (e.g. pears, apples, grapes) Cucumber Sprouts Green beans and legumes Onions Curry power Beer and soft drinks Chewing gum Foods which can cause odour: 21 Asparagus, broccoli, cabbage, turnips and swedes Onions Green beans and legumes Cheese Alcohol (especially beer) Fish Foods which can loosen stools: Raw vegetables Curry powder and spices Prunes Nuts Life after a Stoma Foods which cause colour changes: Tomato sauce Red jelly Strawberries Asparagus and beetroot Food colouring Iron supplements Fresh fruit (e.g. kiwifruit) Coffee Alcohol After your stoma is removed, it s important to make dietary changes slowly. Even without the stoma, your bowel may not work the way it used to. Because of this it s important to try new foods gradually (particularly high fibre foods). Your bowel function should improve over time These guidelines can also help if you re experiencing unpleasant bowel motions
22 Tips on Food Safety Clean, safe food is an essential part of staying well during your recovery. To avoid any nasty illnesses make sure to follow good food safety practises, outlined below. Remember- When in Doubt, Throw it Out! Food Safety in the Home Before handling any food make sure to wash your hands with warm water and soap When reheating leftover foods make sure it s steaming hot right the way through. Only reheat food once Use clean kitchen utensils to prepare and serve food Set aside separate chopping boards, 1 for raw meats, 1 for cooked foods and 1 for vegetables/ other foods Buying Safe Food Check use-by dates before you buy If buying pre-cooked foods such as roast chicken, make sure it is still steaming hot, or that it has been refrigerated Safely Transporting Food Take refrigerated and frozen foods home quickly and unpack these items first to get them chilled quickly If your trip home is longer, use chilly bins or ice-packs to keep food cold When at a picnic or barbeque keep chilled foods cold by covering them up and storing them in a chilly bin Safely Transporting Food Keep your refrigerator chilled at between 2-4 degrees Cover all cooked food and keep it on the top shelves of the fridge, above raw foods. Keep cooked food for a maximum of 2 days Keep raw meat covered and on the lower shelves of the fridge where it can t contaminate fruits and vegetables or cooked foods Clean Keep your hands, utensils 22 and kitchen clean Cook Cook food thoroughly Cover Keep cooked and raw food covered Chill Always refrigerate food
23 Your Recovery Diet a Summary A healthy weight can reduce your risk of colorectal cancer recurrence so aim to achieve and maintain a healthy weight through healthy eating and regular physical activity. Have three regular meals each day Have 5+ servings of fruit and coloured vegetables per day. Try to have vegetables in every meal and choose fruit as a snack in between meals Choose wholegrain bread and cereal options where you can see the grains Choose low fat dairy products such as trim milk, lite yoghurt and cottage cheese. Aim to have 3 servings of dairy products each day Limit red meat intake to 300g per week and choose lean, low fat options. Trim visible fat off before cooking and avoid eating burnt or charred meat Avoid processed meats such as sausages, deli ham, salami and bacon. Choose white meat options such as chicken and fish instead Avoid having too much high fat foods such as pies, pastries and burgers by choosing healthy options when eating out such as sushi, sandwiches and stir-fry Avoid alcohol, or when drinking, do so in moderation and follow the safe drinking guidelines Drink plenty of fluids every day including water, trim milk and tea. Try to avoid high sugar soft drinks and limit fruit juice to one glass per day (250ml) Try to achieve some form of physical activity every day In making long-term lifestyle changes it s important not to take on too much at once. Set yourself small achievable goals every week such as: 23 This week I will eat two pieces of fruit everyday By making small permanent changes you re on your way to a healthy diet and lifestyle to optimise your recovery.
24 Beat Bowel Cancer Aotearoa a charity for patients and their families A vision shared by a group of bowel cancer patients, their families and medical advisors who first met in 2009, led to the launch of Beat Bowel Cancer Aotearoa in June Our charity is concerned that one decade into the Twenty-first Century, colorectal (bowel) cancer remains New Zealand s most common cancer and second leading cause of cancer death. We have among the worst mortality rates for bowel cancer in the OECD for men and women alike. Every three days, 10 New Zealanders die from bowel cancer. This is three times the national road toll, and is equivalent to a Boeing-737 crashing every six weeks. Despite New Zealand s appalling statistics, many New Zealanders are unaware of bowel cancer. Beat Bowel Cancer is working to change this. If bowel cancer is detected in time, it is one of our most treatable cancers. Unfortunately, New Zealand has fallen well behind other countries such as England, Scotland, Canada and Australia because we do not have a national screening programme for early detection of bowel cancer. A pilot screening programme is to run in one region of New Zealand from late 2011, but it is likely to be at least another five years before a decision will be made about introducing a national screening programme to save lives in New Zealand. 24
25 Our charity has the mission to reduce the impact of bowel cancer on our community through awareness, education and support. Since our launch, our charity has been distributing more than 10,000 pamphlets; we have a website and a facebook page, and work to ensure that the media remain aware of issues related to bowel cancer in New Zealand. Crucially, we need help with fundraising so awareness-raising and education can continue. Please visit our website for information, and to see how to make an electronic donation; look at our facebook page (link on website) to see media reports and fundraising events underway. Credit card Donations can be made via the Give a Little and Everyday Hero websites or by cheque posted to: PO Box 6405, Dunedin North, Dunedin 9059, New Zealand. Please or write to us if you would like to receive our Newsletters or become more directly involved in our activities: We look forward to your support to help save lives lost unnecessarily to bowel cancer in New Zealand. Sarah Derrett (Chairperson) November
26 Seek Advice If you re suffering from any diet related complications of colorectal cancer, diabetes, or any other condition requiring a special diet, ask your doctor for a referral to a registered hospital dietitian for individualised dietary advice. Recommended Reading Healthy Eating for Adult New Zealanders. Code Ministry of Health. (Ministry of Health resources are accessible from Eating Well for Healthy Older People. Code Ministry of Health A Guide to Heart Healthy Eating. National Heart Foundation. Dietary Advice for People with an Ileostomy or Colostomy- Southern DHB Nutrition and Food Services References. 1. Meyerhardt JA, Niedzwiecki D, Hollis D, et al. (2007). Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA, 298: Ministry of Health. (2004). Eating for Healthy Adult New Zealanders. Bobe G, Sansbury LB, Albert PS, et al. (2008). Dietary flavonoids and colorectal adenoma recurrence in the polyp prevention trial. Cancer Epidemiol Biomarkers Prev, 17: World Cancer Research Fund. (2007). Chapter 7.9: Colon and Rectum Cancer. In Food, nutrition, physical activity and the prevention of cancer: A global perspective. Washington, DC: American Institute for Cancer Research, Weingarten MAMA, Zalmanovici A, and Yaphe J. (2008). Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps (Review). Cochrane Database of Systematic Reviews, Thompson, c. (2007). Selenium and iodine intake in New Zealand and Australia. British Journal of Nutrition, 91: ALAC. (2010). Alcohol: Drinking levels. Retrieved from, Researched and developed for SDHB by Jessie Pullar, BSc, PG Dip Diet student under the supervision and guidance of Dr Christopher Jackson and Dr Alex Chisholm. The contribution of the many people involved in developing this resource is gratefully acknowledged. Jessie Pullar Images in this resource were purchased from istockphoto.com
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text:
Let us know when your receive great advice so we can thank our lawyers and point others with similar questions in the right direction.Got it!
I came to US with an L1A Visa for Company A on Sep 2010 and went back to India on Sep 2012.
I have re-entered US on L1A Visa on Feb 2013 where my L1A visa was expiring on Aug 2013
and got I-94 till Feb 2016.
Company B has initiated my GC processing(EB2) in Nov 2013 and is planning for H1B in Apr 2014.
My spouse is on L2 EAD and is planning to move to H1B with Company B or C in Apr 2014.
1.If my Labor gets approved in 2014 what are the pre-requisites for applying for I-140 for Company B.
Should I have H1B Visa approved in order for Company B to apply for I-140 ?
2.Can I still continue in L1A ( for Company A) if my H1B gets approved in 2014 ( for Company B).
If yes How ? What are the implications of doing so ?
3. If my H1B is rejected in 2014 will Labor be still valid ?
Please address these "queries" to the employer's immigration attorney. Part of their responsibility is to talk to you and advise you.
The information contained in this answer is provided for informational purposes only, and should not be construed as legal advice on any subject matter,not should it be viewed as establishing an attorney client relationship of any kind.Ask a similar question
1. None other than an approved PERM, the employer's proof of it being able to pay the proffered wage mandated by DOL and your proof of meeting the job's educational and/or on the job experience requirements. The ability to pay requirement on the employer "attaches" on the year your "priority date" is established and continues thereafter until the very date in which you are admitted to permanent residence.
2. Yes. No "implications". The PERM and I-140 are job offers for the future. There is no requirement that you currently work for the petitioning employer.
3. Yes, Labor is an animal of its own, with no relation and independent of the H-1B. (For ":Labor" to continue to be valid, however, employer is obligated to file an I-140 petition no later than within 6 months of the Labor certification's approval.)
Kindly be advised that the answer above is only general in nature cannot be construed as legal advice, given that not enough facts are known. It is your responsibility to retain a lawyer to analyze the facts specific to your particular situation in order to give you specific advice. Specific answers will require cognizance of all pertinent facts about your case. Any answers offered on Avvo are of a general nature only, and are not meant to create an attorney-client relationship.Ask a similar question
Direct all questions to Employer B's attorney, who is best placed to advise you as they have your documented immigration history. If completely non-responsive, notify the employer.
Co. B should be capable of paying the offered salary when filing I-140 and should intend to employ you for an indefinite term in the future (when you receive your green card).
You are not required to be employed by Co. B in the interim.
The GC process through employer sponsorship can continue even if you are not present in the U.S. or employed elsewhere, but you cannot remain legally in the U.S. solely on the basis of PERM/I-140.Ask a similar question
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Judicial Reform On The Horizon?
An apparent compromise has been developed to change the way we select our judges in New York State, according to a [must-read piece] today by Jason Boog at the invaluable JudicialReports.com
The new system, developed after years of lawsuits by the Brennan Center for Justice would apparently replace the entirely party-boss controlled judicial convention system with a hybrid of party primaries and the old conventions.
You can read a little more on the Brennan Center's lawsuit and the fight for judicial reform [here].
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Accommodations in ThorntonSee All
Find the best activities, restaurants and things to do in Thornton, United Kingdom. Explore Thornton travel guide before you plan your trip here. Thornton is located at a short trip away from Manchester a major city in United Kingdom. Manchester is bestowed with interesting set of attractions like Museum Of Science And Industry, The Lowry, The Village. Popular vacation packages of Thornton are of 1-2 days.
Yes,it is that simple really! Enjoy your trip! Keep travelling!
Explore the best journey planner for your visit to Thornton and create a flawless plan in few simple steps!


text:
Deny the Black Rhino Hunt Permit
US Fish & Wildlife Service is issuing an import permit for a hunted down endangered Black Rhino, a dangerous precedent.
US Fish & Wildlife Service is issuing an import permit for a hunted down endangered Black Rhino, a dangerous precedent.
"Breed & Greed: ATO Make Backyard Breeders Pay Their Tax!" Given the poor reputation many backyard breeders and puppy
I want to ensure no pet owner ever has to put down their pet when they could have recieved the care their owners are
Does an Animal Abuser Live in Your Neighborhood? Our communities have good reason to be concerned about the whereabouts
Orca Welfare & Safety Act would make it illegal to "hold in captivity, or use, orcas for performance or entertainment."
Taiji dolphin hunters have caught a real prize: A white albino dolphin calf who will die without his mother.
It's nearly 2014—and yet, millions of individual animals still face almost unimaginable cruelty and neglect.
The situation for bees and other pollinators is dire, and they need Mrs. Obama to set an example for the country.
Join the Global conversation -The United Nations and partners want to hear from YOU! Vote for Animals to be a priority!
America currently has NO national limits on carbon pollution from power plants--help us change that.
Carnival has the worst impact on our oceans of any other cruise line.
Help support key policy measures that lead to a price on carbon and a clean-energy future for us all.
The NRA's support of toxic lead in bullets is endangering millions of wild birds every year.
Cathay Pacific, Emirates, Qantas, all have banned freight of shark fins, Singapore Air should now be among the leaders
The U.S. is at risk of requiring archaic product testing methods in which animals are mutilated & killed for cosmetics.
Is killing animals entertainment? NBC is airing episodes of the NRA sponsored show promoting violence towards animals
Puppy Doe was rehomed through Craigslist, the people who took her sadistically tortured her.
"Re-homing" leads to sexual, physical, & emotional child abuse. This heinous practice must be investigated and stopped.
Please share story: Link: http://www.examiner.com/article/help-find-the-monsters-who-tortured-puppy-doe?cid=db_articles
Help us end the use of the last remaining antibiotic allowed in organic production
All animals deserve legal protection from exploitation, cruelty, neglect, and abuse.
BOSNIA! IMPLEMENT HUMANE STRAY-DOG AND CAT POPULATION CONTROL AND TREATMENT.. WHAT YOU NEED TO DO IS >>> Go to the
The Merced Police Dept. is killing injured kittens and dogs at their shooting range and it has to stop
Expansion of palm oil plantations in rainforests is pushing wild orangutans to the brink of extinction.
WILD SPIRIT WOLF SANCTUARY IS NOT ASKING FOR YOUR MONEY. Instead, I'm asking you for a different kind of
Photo of emaciated dog in Florida creates internet
Justice for Bruiser shot by Police- https://www.facebook.com/ForBruiser (https://www.facebook.com/ForBruiser) POLICE
ELLA was a tame Deer and a well loved member of the local community.Ella lived within the Elmwood Cemetery grounds a
DETROIT MICHIGAN USA - 2013. Once a vibrant and alive city. Now a city overwhelmed not only with poverty for its
Mr and Mrs Anderson, of Warrington, Cheshire, remained impassive as the abuse was read out and they were sentenced to 18
Bees are essential for one out of every three bites of food we eat. But they are being wiped out by the indiscriminant
You may have seen the disturbing stories
WELL ..just when we thought we had seen it all>> SANDY — A picture posted as a joke on Facebook has caused animal
Saving bees isn't just about saving the honey makers of the world so we can have it to drizzle on our toast in the
All the information about what is going on and why animal advocates are so concerned and demand change is in the link
This is why you should sign and share. Poor dog tied to truck and dragged to its death. Please read and then take
QUESTION - do you think that it's OK to use BLUNT FORCE trauma to kill an animal in the puppy mills? ANIMAL LOVERS
KILL A DOG WITH A HAMMER? WTH? this Politician needs to lose his job! His name is PETER WALSH. If you would like to
STOP our family dog's losing their lives to a " dog buy back scheme" Dog's are NOT disposable items. We say NO to
Cabela the Labrador was blown up by her owner. The Skamania County Authorities do not care. Let's work together to
My inspiration to become a conservationist came 20 years ago, when I was deep in the pristine forest of Virunga National
Please read and share - 25 years of RSPCA inaction on animal welfare in rural NSW. Cataloguing 20+ years of neglect
Rangers are giving their lives to conservation. It's our turn to give back.
PLEASE read and then sign our petition. Brownie lived his days on a short, heavy chain, and fell victim to a callous,
Ag gag laws criminalize the collection of evidence of animal abuse on factory farms and are a threat to people across
WARNING the images and videos posted by this man on facebook are GRAPHIC. HE LIVES IN - San Martín Texmelucan de
This is an amazing video - please watch and share. "I AM HERE" An Urban Intervention To Make The Invisible
If you haven't already watched this , then please do so. WARNING - it is upsetting. ANIMAL CRUELTY : once you know,
Our mission is to reform the meat industry and rebuild networks for sustainable farming across the country.
ANIMAL CRUELTY! Dog dies in LV Heat! The DA has promised to prosecute. PLEASE HELP US TO GET JUSTICE FOR THIS POOR
Elepahnt ( Elephant) being held hostage for ransom by Indonesian farmers. VIDEO - Published on 30th Jun 2013 The
Man 'killed German Shepherd puppy by putting it in dishwasher and dumping it in trash can'.. Marcus Curry is being held
Maryland teenager accused of stabbing family puppy to death! PLEASE READ and share widely. News
Published on 23 Jun 2013 This video is being published to expose a teenager's heinous acts against defenseless animals
BSL is out of control in so many countries worldwide. Have you got a Staffy? or any other breed that might resemble a
This is why should you sign and share this petition. Dog lured to its death by University of Limerick students in
E-Bay is profiting from the sale of Wolf fur! Please sign this petition to end the sale of Wolf fur on E-Bay!
PEPPA was an innocent 7 month old Pure bred Husky out on a drive with her family when she was shot and killed - we WANT
One decision could forever change the future of grey wolves in United States. The U.S. Fish and Wildlife Service (FWS)
A day in the life of a bird raised for foie gras includes several force-feedings in which a thick pipe is rammed down
Judge: Animal snuff films protected by 1st Amendment.. DEMAND THAT JUDGE SIM LAKE RETHINKS HIS DECISION ON ANIMAL CRUSH
FUR IS HORRIBLE! Boycott the Fur Trade! The Cruelty Of Fur Farms! HOW CAN YOU HELP TO GET THIS CRUELTY STOPPED
TELL THE PRESIDENT THAT ANIMAL CRUELTY NEEDS TO BE TAKEN SERIOUSLY....make the people who commit these acts of violence


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