Healthy Eating

Many factors determine whether you will have any of these side effects and how severe they will be. They include cancer type, body part being treated, type and length of treatment and the dose of treatment.

Nutrition Recommendations

• Nutrition recommendations usually stress eating lots of fruits, vegetables, and whole grain breads and cereals; including a moderate amount of meat and dairy products; and cutting back on fat, sugar, alcohol and salt.
• Nutrition recommendations for cancer patients may focus on helping you eat more higher calorie foods that emphasize protein. Eat or drink more milk, cream, cheese and cooked eggs. Other suggestions include increasing your use of sauces and gravies, or changing your cooking methods to include more butter, margarine or oil.
• Nutrition recommendations for cancer patients sometimes suggest you eat less of certain high-fiber foods because these foods can aggravate problems such as diarrhea or a sore mouth.
• Nutrition recommendations for cancer patients are different because they are designed to help build up your strength and help you withstand the effects of your cancer and its treatment. Eating enough food to get the nutrients you need becomes a challenge during cancer treatment, especially if you have side effects or simply don’t feel well.

Preparing Yourself for Treatment

Think Positively

• Many people have few or no eating-related side effects. Even if you do, they may be mild and most go away after cancer treatment ends. Also, there are new drugs now that can work well to control side effects.
• Having a positive attitude, talking about your feelings, becoming well-informed about your cancer and treatment and planning ways to cope can all help reduce worry and anxiety, make you feel more in control and help you keep your appetite.
• Give food a chance. Even if you do have eating problems, you’ll have days when eating is a pleasure.

Eat a Healthy Diet

• A healthy diet is vital for a person’s body to work its best. This is even more important for cancer patients.
• If you’ve been eating a healthy diet, you’ll go into treatment with reserves to help keep your strength up, prevent body tissue from breaking down, rebuild tissue and maintain your defenses against infection. You are also better able to cope with side effects.
• Don’t be afraid to try new foods.

Managing Eating Problems During Treatment

• When you eat, try to eat meals and snacks with sufficient protein and calories; they will help keep up your strength, prevent break down of body tissues and rebuild tissues that cancer treatment may harm
• Many people find their appetite is better in the morning. Consider having your main meal of the day early and have liquid meal replacements later on if you don’t feel so interested in eating.
• If you don’t feel well and can eat only one or two things, stick with them until you are able to eat other foods. Try a liquid meal replacement for extra calories and protein.
• On days you can’t eat at all, don’t worry about it. Do what you can to make yourself feel better. Come back to eating as soon as you can and let your doctor know if this problem doesn’t get better within a couple of days.
• Drink plenty of fluids, especially on days when you don’t feel like eating. Water is essential to your body’s proper functioning. For most adults, 6-8 cups of fluid a day are a good target.

Coping With Side Effects

Loss of Appetite: One of the most common side effects of cancer and its treatment.

These suggestions have helped other patients manage the same eating problems that you may have. Try all the ideas to find what works best for you and share your needs with those preparing your meals.

• Try liquid or powdered meal replacements such as "instant breakfast."
• Try frequent small meals throughout the day, rather than fewer big ones. It may be easier to eat more that way and you won’t get so full.
• Keep snacks within easy reach, such as cheese, crackers, muffins, ice cream, peanut butter, fruit and pudding.
• Even if you don’t feel like eating solid foods, try to drink beverages during the day. Juice, soup and other similar fluids can give you important calories and nutrients. Milk-based drinks also provide protein.
• If possible, try having something at bedtime.
• Changing the form of a food will make it more appetizing and help you eat better. Try mixing fruit into a milkshake.
• Try softer, cool or frozen foods, such as yogurt, milkshakes or popsicles.
• Take advantage of times when you feel well - have larger meals then.
• Make mealtimes as relaxed and pleasant as possible.
• Regular exercise may help your appetite. Ask your doctor about options open to you.

Recipes to Increase Calories & Protein

Banana Milkshake: 1 whole ripe banana, sliced Vanilla extract (few drops) 1 cup milk Place all ingredients into a blender. Blend at high speed until smooth.	Fortified Milk: 1 quart whole milk 1 cup nonfat instant dry milk Pour liquid milk into deep bow. Add dry milk and beat slowly with beater until dry milk is dissolved. Use when making macaroni and cheese, puddings and custards, cream sauces for vegetables, mashed potatoes, cocoa, French toast or pancakes and soup
High-Protein Milkshake: 1 cup fortified milk 2 tbsp butterscotch, chocolate or your favorite fruit syrup or sauce ½ cup ice cream ½ tsp vanilla extract Place all ingredients into a blender. Blend at low speed for 10 seconds	Peanut Butter Snack Spread: 1 tbsp nonfat instant dry milk 1 tbsp honey 1 tsp water 5 tbsp smooth peanut butter 1 tsp vanilla extract Combine dry milk, water and vanilla, stirring to moisten. Add honey and peanut butter, stirring slowly until liquid blends with peanut butter. Spread on crackers. Mixture also can be formed into balls, chilled and eaten as candy. Keeps well in refrigerator but is difficult to spread when cold.

Coping With Side Effects

Weight Gain

Some cancer patients experience weight gain as a result of certain medications or when on hormone therapy or chemotherapy. It’s important not to go on a diet right away if you notice weight gain. Instead, tell your doctor so you can find the cause. Certain anticancer drugs cause your body to hold on to excess fluid. Another cause may be the type of cancer. Weight gain may also be the result of increased appetite and eating extra foods and calories. If the latter is the case and you want to stop gaining weight, the following tips may be useful. Talk to your doctor or a registered dietician for more guidance.

• Emphasize fruits, vegetables and breads and cereals.
• Choose lean meats (lean beef or pork trimmed of fat, chicken without skin) and low-fat dairy products (skim or 1% milk, light yogurt).
• Cut back on added butter, mayonnaise, sweets and other extras.
• Choose low-fat and low-calorie cooking methods (broiling, steaming).
• Avoid eating high-calorie snacks between meals.
• If you feel up to it, and your doctor feels this to be an option, increase the amount of exercise you get.

Dry Mouth or Throat

Mouth sores, tender gums and a sore throat or esophagus often result from radiation therapy, chemotherapy or infection. See your doctor to be sure the soreness is a treatment side effect and not an unrelated dental problem. Certain foods will irritate an already tender mouth and make chewing and swallowing difficult. Carefully choosing the foods you eat can usually make eating easier. Here are some suggestions that may help.

• Try soft, easy-to-chew/swallow foods - milkshakes, bananas, applesauce, nectars, watermelon, cottage cheese, yogurt, mashed potatoes, noodles, macaroni and cheese, custards, puddings, gelatin, scrambled eggs, oatmeal or other cooked cereals, pureed or mashed vegetables (peas and carrots) or pureed meats.
• Avoid foods or liquids that irritate your mouth - citrus fruits and juices; tomato sauces/juice; spicy/salty foods; raw vegetables, granola, toast, crackers, rough, coarse or dry foods; mouthwashes containing alcohol.
• Cook foods until soft and tender, cut into small pieces or pureed.
• Mix food with butter, margarine, thin gravy or sauce.
• Use a straw to drink liquids and a smaller-than-usual spoon. If swallowing is hard, tilting or moving your head forward may help.
• Try foods cold or at room temperature.
• Drinking warm bouillon or salty broth can soothe throat pain.
• Try sucking on ice chips.
• Rinse your mouth often with water to remove food and bacteria and to promote healing.

Dental and Gum Problems

Cancer and cancer treatments can cause tooth decay and other problems for your teeth and gums. Changes in eating habits can also add to the problem. If you eat often or eat a lot of sweets, you may need to brush your teeth more often. Brushing after each meal or snack is a good idea. Your doctor and dentist should work closely together to fix any problems with your teeth before you start treatment. Here are some other ideas for preventing dental problems:

• Be sure to let your doctor know about any dental problems you are having.
• Be sure to see your dentist regularly.
• Use a soft toothbrush. Your doctor, nurse or dentist can suggest a special kind of toothbrush/toothpaste if your gums are very sensitive.
• Rinse your mouth with warm water when your gums and mouth are sore.
• If you are eating foods high in sugar, or foods that stick to your teeth, be sure to brush or rinse your mouth afterward so that the sugar won’t damage your teeth, or use sugar-free varieties.

Changed Sense of Taste or Smell

Your sense of taste or smell may change during your illness or treatment. Foods, especially meat or other high-protein foods, can begin to have a bitter or metallic taste. Many foods will have less taste. These changes can be brought on by chemotherapy, radiation therapy, or the cancer itself. For most people, changes in taste go way when their treatment is finished.

• Choose and prepare foods that look and smell good to you.
• Help the flavor of meat, chicken, or fish by marinating it in sweet fruit juices, sweet wine, Italian dressing, or sweet-and-sour sauce.
• Try using small amounts of flavorful seasonings, such as basil, oregano or rosemary.
• Try tart foods, such as oranges or lemonade, that may have more taste. However, be aware if you have a sore mouth or throat, tart or citrus foods may cause pain or discomfort.
• If smells bother you, try serving foods at room temperature, turning on the kitchen fan, covering foods when cooking and cooking outdoors in good weather.
• Try using bacon, ham or onion to add flavor to vegetables.
• Visit your dentist to rule out dental problems that may affect the taste or smell of food.
• Ask your dentist or doctor about special mouthwashes and good mouth care.

Nausea

With or without vomiting, is a common side effect of surgery, chemotherapy, radiation therapy and biological therapy. The disease itself, or other conditions unrelated to your cancer or treatment, may also cause nausea. Whatever the cause, nausea can keep you from getting enough food and needed nutrients. The following ideas may help:

• Ask your doctor about antiemetics that might help you control nausea and vomiting.
• Try foods that are easy on your stomach, such as: toast, crackers, pretzels, yogurt, sherbet, angel food cake, cream of wheat, rice, oatmeal, boiled potatoes, rice, noodles, skinned chicken (baked or broiled, not fried), canned peaches or other soft, bland fruits and vegetables, clear liquids, ice chips and carbonated drinks.
• Avoid foods that are fatty, greasy, fried, very sweet (candy, cookies, cake), spicy or hot and have strong odors.
• Eat small amounts, often and slowly. Eat before you get hungry, because hunger can make feelings of nausea stronger.
• If nausea makes certain foods unappealing, then eat more of the foods you find easier to handle.
• Avoid eating in a room that’s stuffy, too warm, or has disagreeable cooking odors.
• Drink fewer liquids with meals. Slowly drink or sip liquids throughout the day.
• Have foods and drinks at room temperature or cooler.
• Don’t force yourself to eat favorite foods when you fell nauseated. This may cause a permanent dislike for those foods.
• Rest after meals, because activity may slow digestion. It’s best to rest sitting up for about an hour after meals.
• If nausea is a problem in the morning, try eating dry toast or crackers before getting up.
• Wear loose-fitting clothes.
• If nausea occurs during radiation therapy or chemotherapy, avoid eating for 1 to 2 hours before treatment.
• Try to keep track of when your nausea occurs and what causes it (specific foods, events, surroundings). If possible and if it helps, change your diet or schedule. Share this information with your doctor or nurse.

Vomiting

May follow nausea and may be brought on by treatment, food odors, gas in the stomach or bowel, or motion. As with nausea, some people have vomiting right after treatment, while others don’t have it until a day or more after treatment. If vomiting is severe or lasts more than a day or two, contact your doctor. Very often, if you can control nausea, you can prevent vomiting. Try these suggestions to help further episodes of vomiting:

• Do not eat or drink anything until you have the vomiting under control.
• Once the vomiting is under control, try small amounts of clear liquids, such as water or bouillon. Begin with 1 teaspoonful every 10 minutes, gradually increasing the amount to 1 tablespoon every 20 minutes. Finally, try 2 tablespoons every 30 minutes.
• When you are able to keep down clear liquids, try a full-liquid diet or a soft diet. Continue taking small amounts as often as you can keep them down. If you feel okay, gradually work up to your regular diet. If you have a hard time digesting milk, you may want to try a soft diet instead of a full-liquid diet, because a full-liquid diet includes a lot of milk products. Ask a registered dietician for information about a soft diet.

Diarrhea

May have several causes, including chemotherapy, radiation therapy to the abdomen, infection, food sensitivities and emotional upset. Work with your doctor to find the cause so it can be successfully treated. Diarrhea may lead to dehydration. Long-term or severe diarrhea (lasting for more than a couple of days) may cause problems, so contact your doctor if this occurs. Here are some ideas for coping with diarrhea:

• Drink plenty of fluids to replenish what you lose with the diarrhea.
• Eat small amounts of food throughout the day instead of three large meals.
• Eat plenty of foods and liquids that contain sodium and potassium, two important minerals that help your body work properly. These minerals are often lost during diarrhea. Good high-sodium liquids include bouillon or fat-free broth. Foods high in potassium that don’t cause diarrhea include bananas, peach and apricot nectar, and boiled or mashed potatoes. Sports drinks contain both sodium and potassium and have easily absorbable forms of carbohydrates.
• Try: yogurt, cottage cheese, rice, noodles, potatoes, farina or cream of wheat, eggs (cooked until the whites are solid; not fried), smooth peanut butter, white bread, canned, peeled fruits and well-cooked vegetables, skinned chicken or turkey, lean beef, or fish (broiled or baked, not fried).
• Avoid: greasy, fatty or fried foods that make your diarrhea worse, raw vegetables and skins, seeds and stringy fibers of unpeeled fruits, high-fiber vegetables such as broccoli, corn, dried beans, cabbage, peas and cauliflower
• Avoid very hot or cold food or beverages. Drink liquids that are at room temperatures.
• Limit foods and drinks that contain caffeine, such as coffee, some sodas and chocolate.
• If you have a sudden, short-term attack of diarrhea, try having nothing but clear liquids for the next 12 to 14 hours. This lets your bowel rest and replaces the important fluids lost during the diarrhea. Make sure your doctor or nurse knows about this problem.
• Be careful when using milk and milk products. The lactose they contain can make diarrhea worse. Most people, though, can handle small amounts (about 1½ cups) of milk or milk products.

Lactose Intolerance

Means that your body can’t digest or absorb the milk sugar called lactose. Milk, other milk-based dairy products (cheese and ice cream), and foods to which milk has been added may contain lactose.

Lactose intolerance may occur after treatment with some antibiotics, radiation to the stomach or with any treatment that affects the digestive tract. For some people, the symptoms of lactose intolerance (gas, cramps, diarrhea) disappear a few weeks or months after treatments end or when the intestine heals. For others, a permanent change in eating habits may be needed.

Constipation

Some anticancer drugs and other drugs, such as pain medications, may cause constipation. Lack of fluids or fiber or being in bed for a long time may also cause constipation. The following suggestions are offered to prevent and treat constipation:

• Drink plenty of liquids - at least eight 8-ounce glasses every day. This will help to keep your stools soft.
• Have a hot drink about one-half hour before your usual time for a bowel movement.
• Check with your doctor to see if you can increase the fiber in your diet (there are certain types of cancer for which a high-fiber diet is not recommended). If you can, try foods such as whole-grain breads and cereals, dried fruits, wheat bran, wheat germ, fresh fruits and vegetables, dried beans and peas. Eat the skin on potatoes. Make sure you also drink plenty of fluids to help the fiber work
• Get some exercise everyday. Talk to your doctor about the amount/type of exercise that’s right for you.

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Blend all ingredients and store in refrigerator.
Take 1-2 tablespoons of this mixture before bedtime, then drink 8 oz. of water.

Note: Make sure you drink the water, or else it will not work to relieve constipation.

Fatigue and Depression

Fatigue during cancer treatment can be related to a number of causes: not eating, inactivity, low blood counts, depression, poor sleep and side effects of medicine. It’s important to discuss this with your health care team to determine the cause come up with a treatment plan.

Fatigue and depression aren’t eating problems, but they can affect your interest in food. Here are some suggestions that may help:

• Talk about your feelings and your fears. Being open about your emotions can make them seem more manageable. Consider talking to your nurse or social worker, who can help you find ways to lessen your worries and fears.
• Become familiar with your treatment, possible side effects and ways of coping. Being knowledgeable and acting on that knowledge will help you feel more in control. Don’t be afraid to talk with your doctor and ask questions.
• Make sure you get enough rest: take several naps or rest breaks during the day; plan your day to include rest breaks; make rest time special with a good book in a comfortable chair or a favorite video with a friend; and try easier or shorter versions of your usual activities, don’t push yourself to do more than you can manage.
• Save your favorite foods for times that aren’t associated with treatment sessions.
• Take short walks or get regular exercise, if possible. You might find this lessens your fatigue and raises your spirits.

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Keeping Track of Side Effects

Below you will find a list of some eating-related side effects that cancer patients may experience. Check the box next to any side effect listed below that you experience in a week. Next to each one you have checked, write a number from 1 to 3 indicating how severe you think each side effect was for you, where:

1 = mild; 2 = moderate; and 3 = severe.

Side Effect	M	T	W	TH	F	Sat	Sun
Appetite
Sore/Dry Mouth
Nausea
Vomiting
Constipation
Diarrhea
Fatigue
Other

 

Other Questions or Concerns (Use this space to write down questions or concerns you may want to talk about with your health care provider.)______________________

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Preventing Food-Borne Illness

Cancer patients undergoing treatment can develop a weakened immune system because most anticancer drugs decrease the body’s ability to make white blood cells, the cells that fight infection. That’s why cancer patients should be especially careful to avoid infections and food-borne illnesses. Here are some tips to help you prevent food-borne illness:

• Wash all raw fruits and vegetables well. If it can’t be well washed, avoid it. Scrub rough surfaces, like the skin of melons, prior to cutting.
• Carefully wash your hands and food preparation surfaces (knives, cutting boards) before and after preparing food, especially after handling raw meat.
• Thaw meat in the refrigerator, not on the kitchen counter.
• Be sure to cook meat and eggs thoroughly.
• Avoid raw shellfish and use only pasteurized or processed ciders and juices and pasteurized milk and cheese.

SPECIAL NOTES FOR CAREGIVERS

There is much that you can do to help your friend or loved one through the period of cancer treatment. Read over the tips and suggestions in "Managing Eating Problems During Cancer Treatment." Many may be useful to you as you prepare food or meals for the patient.

In addition, here are some other things to remember that will help you cope:

• Be prepared for the patient’s tastes to change from day to day. Some days he or she won’t want favorite foods because they don’t taste good. Other times, he or she will be able to eat a dish that couldn’t be tolerated just the day before.
• Have food within easy reach at home. For example
• a snack-pack of applesauce or pudding and a spoon on the bedside table if the patient isn’t feeling well that day
• a bag of cut-up carrots on the top shelf of the refrigerator
• Have meals and snacks ready so the patient can have something to eat when he or she is ready.
• Be prepared for times when the patient is able to eat only one or two foods for a few days in a row, until side effects diminish. Even if he or she can’t eat at all, still encourage plenty of fluids. The section on "Coping with Side Effects" has lots of ideas for getting enough fluids
• Talk to the patient about needs and concerns, and about ideas that might work best. A willingness to be flexible and supportive no matter what will help the patient feel in control of the situation.
• Try not to push the patient into eating and drinking. Encourage and support without being overwhelming.

After Cancer Treatment Ends

Most eating-related side effects associated with radiation, chemotherapy, or other treatments go away after cancer treatment ends. If you have had side effects, you should gradually begin to feel better, and your interest in food and mealtimes will come back. Sometimes, though, side effects persist, especially weight loss. If this happens to you, talk to your doctor and work out a plan together for how to address the problem.

After cancer treatment ends and you’re feeling better, you may want to think again about the traditional guidelines for healthy eating. Just as you wanted to go into treatment with all the reserves that such a diet could give you, you’ll want to do the best for yourself at this important time. There’s no current research that suggests that the foods you eat will prevent your cancer from recurring. But, we do know that eating right will help you regain your strength, rebuild tissue, and help you feel well. Here are the fundamentals:

• Focus on eating a variety of foods every day. No one food contains all the nutrients you need.
• Emphasize fruits and vegetables. Raw or cooked vegetables, fruits, and fruit juices provide the vitamins, minerals, and fiber you need.
• Emphasize breads and cereals, especially the whole grain varieties, such as whole wheat bread, oats, and brown rice. These foods are good sources of complex carbohydrates, vitamins and minerals, and fiber.
• Go easy on fat, salt, sugar, alcohol, and smoked or pickled foods. Choose low-fat milk products, and small portions (no more than 6-7 oz. a day) of lean meat and poultry without skin. Try lower-fat cooking methods, such as broiling, steaming, and poaching.

Ways to Get Back Into Eating

Even if your treatment is over and you’re feeling much better, you still may not feel completely back to your old self. Here are some ways to help you ease back to regular meals and mealtimes, without overdoing it:

• Make simple meals using familiar, easy-to-prepare recipes.
• Cook enough for two or three meals, then freeze the remainder for a later meal.
• Take advantage of the supermarket’s salad bard and prepared foods to make cooking easier.
• Think about ways you used to make mealtime special and try them again.
• Don’t be afraid to ask a friend or family member for help with cooking or shopping.

*** POSTED JANUARY 16, 2001 ***