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Nutrition and Coping with Cancer Symptoms

Side effects of treatment may affect your eating pattern, requiring you to explore new ways to get the calories, protein and nutrients that you need for optimal nutrition. Eating a well balanced diet at this time can help you maintain your strength, energy and your body's natural defenses.

In addition to reading this information, you can schedule an individual appointment with the dietitian at the Cancer Resource Center to address your specific concerns. For additional information on the nutrition program, call (415) 885-3693 or visit us on the first floor of 1600 Divisadero St.

Eat a Variety of Foods

Unless instructed otherwise, eat a low-fat diet with a focus on additive-free fruits, vegetables, grains and small quantities of good-quality protein. Examples of a good-quality protein include nonfat dairy foods, eggs, legumes, soy, lean chicken and fish. Do not eliminate one or more of these nutritional building blocks without consulting with a nutritionist to develop a personalized eating plan.

Limit Caffeine, Sugar, Sodium and Alcohol

In general you will want to limit your intake, but there may be exceptions. If you have lost a lot of weight, just getting enough calories to prevent weight loss may be a goal, and hence additional fat and some sugar can be good sources of calories.

Stay Hydrated

Drink as much as you can during the day. Dehydration can be a problem with certain drugs and when nausea or diarrhea occurs. Bring a water bottle with you when you leave the house. If you are losing weight or need to gain weight, choose higher-calorie liquids (in addition to water) such as fruit smoothies, nectars, juices, or your own fruit popsicles made in ice cube trays.

Nausea

Nausea is a common side effect of chemotherapy and radiation therapy. It may be due to the treatment or the cancer itself. If you experience it after surgery, be sure to discuss this with your doctor or medical team.

Here are some practical tips to help with nausea.

• Try dry Saltine-style crackers, toast, natural potato chips and pretzels.
• Keep crackers at your bedside if nausea is a problem in the morning or after a nap.
• Eat regular meals. Having some food in your stomach may help you feel better.
• Try foods that are easy on your stomach, such as:
  • Oatmeal , rice or Cream of Wheat
  • Boiled potatoes or noodles
  • Low-fat protein sources such as skinned chicken or tofu that is baked or broiled, not fried
  • Peaches or other soft, mild-tasting fruits and vegetables
  • Clear liquids such as apple and cranberry juice, low-salt broth and carbonated drinks without caffeine
  • Teas such as ginger and peppermint, served lukewarm or cold
• Eat small, frequent meals every few hours.
• Slowly drink or sip liquids throughout the day. A straw may help.
• Stay away from odors. Have someone else cook if possible. Eat in the dining room or in a room other than the kitchen.
• Try colder foods and main-dish salads. Avoid hot foods and hot liquids.
• Track your nausea by taking note of any particular food or events that trigger it. See if there is a pattern and if so, try to change that pattern.
• Inform your nurse or doctor about your nausea and ask about medications to control this side effect.
• Stay quiet after meals. Try to rest while sitting up for about an hour -- you can watch television, read a magazine, talk with a loved one or enjoy the company of your pet.
• Avoid fried, greasy, and rich foods.
• Don't force yourself to eat your favorite foods when you feel nauseated, as you may develop a dislike for these foods.

Vomiting

Vomiting may follow nausea and be brought on by treatment or food odors. If vomiting is severe or lasts for more than a day or two, contact your doctor. Visualization and relaxation exercises may help. Here are some other tips:

• Do not eat or drink anything until you have the vomiting under control.
• Try tiny amounts of clear liquids such as water or bouillon, apple or cranberry juice, fruit ices without fruit pieces, ginger ale or 7-Up, plain gelatin desserts, popsicles, sports drinks such as Gatorade, vegetable broth and teas.
• Begin with 1 teaspoon every 10 minutes, gradually increasing the amount to 1 tablespoon every 20 minutes, and then try 2 tablespoons every 30 minutes or as tolerated.
• Once these liquids are tolerated, try a softer diet with bland foods such as mashed potatoes, rice, pureed fruits, smoothies, fruit nectars, yogurts and cereals with milk or soy if you have problems with digesting milk.

• Drink and eat more potassium- and magnesium-rich foods when feeling better. Potassium-rich foods include bananas, potatoes, orange juice, tomato and apricots.

Constipation

Chemotherapy, certain medications, or lack of exercise may cause constipation. Adding more fiber to your diet may help. Here are some easy ways to add fiber to your diet and to help constipation.

• Try including kidney beans, chickpeas, lentils, fresh fruit and vegetables and dried fruit in your diet.
• Start your day eating bran cereals or shredded wheat, or foods made with whole grains such as bulgur or wheat berries.
• Aim for a cereal with at least 5 grams of fiber per serving.
• Try to have some fiber included in each of your meals.
• Add unprocessed wheat bran to hot cereals and yogurt.
• If you're not used to eating a lot of fiber, slowly increase your intake, as you may initially have increased flatulence/gas until your body gets used to more fiber in the diet.
• You can also reduce flatulence from eating beans by soaking beans first in water and discarding the water.
• Drink plenty of liquids. A high-fiber diet requires plenty of fluids to work effectively.
• Reduce your caffeine intake, as caffeine may promote constipation by causing you to lose fluids.
• Drink a hot, non-caffeinated beverage such as lemon water in the morning upon awakening.
• Add exercise to your daily routine. Check with your doctor first.

Diarrhea

Diarrhea may be due to many causes. You may get it because of chemotherapy, radiation therapy to the lower abdomen, malabsorption, or use of antibiotics. It can also develop because of intolerance to milk or difficulty in absorbing fats. If you experience weight loss from diarrhea, it may be due to dehydration, which means that your body does not have enough water. Speak with your health professional to try to determine the cause of the weight loss and obtain the proper treatment.

If you have diarrhea:

• Drink plenty of room-temperature liquids to help prevent dehydration. These might include water, teas, Gatorade, ginger ale, peach or apricot nectar or fruit juices. Limit caffeinated beverages.
• Allow carbonated beverages to lose their fizz or stir them before you drink them.
• Consume more potassium-rich foods such as orange juice, tomato juice, bananas and potatoes.
• Try the BRAT diet that consists of: bananas, rice, applesauce, tea and toast.
• Try frequent, small meals.
• Avoid greasy, spicy or high-fiber foods.
• Try breads made from oat flour or refined flour without seeds or nuts.
• Avoid raw vegetables and the skins, seeds, and stringy fibers of unpeeled fruits.
• Resume your consumption of higher fiber foods, fruits and vegetables once the diarrhea stops (check with your dietitian and doctor first).
• Have spicy or highly seasoned foods only as tolerated.
• If you are lactose intolerant, use dairy products sparingly. Instead of regular milk, try Lactaid, yogurt or soy milk.
• The use of probiotics, l-glutamine, and/or digestive enzymes may help to improve symptoms.

Please discuss the use of these supplements with a dietitian to determine if these products are appropriate and which brands you may wish to choose.

Loss of Appetite

Many problems such as pain, nausea, vomiting, diarrhea or a sore or dry mouth may make eating difficult and cause you to lose interest in eating. Depression, stress, and anxiety may also cause loss of appetite. If your appetite is no longer motivating you to eat, here are some suggestions to help ensure that you are getting the nutrition that you need.

• Eat by the clock rather than by your hunger mechanism. Eat because it is 9 a.m., noon, 3 p.m., 6 p.m. or whatever your daily pattern becomes.
• Snack between meals. Choose fruit smoothies, high-calorie puddings, shakes, high-calorie and protein drink supplements, sandwiches, avocados and nuts.
• Plan for special circumstances. If you have to miss or delay a meal for a test or therapy, bring a snack of nuts, dried fruit or cheese and crackers. Ask your dietitian if these foods fit into your medical diet.
• Choose high-calorie foods at this time, such as avocados, nuts, seeds, puddings, cooked cereals, dried fruits and vegetables dipped in hummus or prepared with olive oil. Use additional olive oil in salads.
• Plan your daily menu in advance. Make a shopping list of your favorite foods and beverages and have the food available. You may want to portion out snacks and keep them in the refrigerator in Ziploc bags so that they are readily available.
• Request help in preparing your meals. A friend or relative is often happy to help out by preparing food for you. Some grocery stores have shopping services that may be accessed through your computer. You are very important -- ask for help when you need it, and ideally before you anticipate that you will need it.
• Fix several portions of your favorite foods and freeze them. This can make it easier to decide what to eat when your appetite is poor or you do not feel like cooking.
• Make food visually appealing. Eye appeal is often the first step in eating. Attractive colors and garnishes such as parsley, lemon wedges, olives and cherry tomatoes help to enliven the appetite.
• Appeal to your sense of smell. Tap into the sense of well being that smells can stimulate, such as the smell of fresh bread baking. If, however, you find that you are overwhelmed by smells at this time, stay away from the kitchen, and have someone else prepare the cooking.
• Make your mealtimes pleasant. Your mealtime atmosphere is important to encourage eating. Set the table, perhaps adding candles, as well as wine, if permitted. Whenever possible, eat with family or friends.
• If you are finding it difficult to cook due to the symptoms of chemotherapy, consider calling organizations such as Project Open Hand at (415) 447-2300 or Meals on Wheels at (415) 920-1111 that deliver meals directly to your house.

Chewing or Swallowing Difficulties

Soreness and tenderness in the mouth and throat are not uncommon. If your swallowing difficulties are minor, the following suggestions may help. You may need to work with a dietitian or swallowing therapist or consider alternative methods of feeding if you have severe problems.

• Eat frequent small meals and snacks to ensure that you are getting enough calories.
• Cut foods into bite-sized pieces or grind them so that less chewing is required.
• Choose soft foods or foods that can be cooked until tender such as mashed potatoes, sweet potatoes, winter squashes (butternut and acorn), carrots, applesauce, ground beef or turkey and tofu.
• Consume liquid supplements such as Prosure, Ensure Plus, Boost Plus or shakes that can be made in your blender.
• Consider using a blender to puree the foods your family is eating. When adding liquid to process the foods, remember to add high-calorie liquids -- such as gravy, milk or soy milk, or broth -- instead of water.
• Drink generous amounts of nutritious liquids with meals.
• Be adventurous. Try new sauces, gravies, or different oils on foods to make swallowing easier.
• Try apple, cranberry, or grape juices or fruit nectars if you are sensitive to citrus juices.
• Keep some baby food on hand for something quick and tasty.
• Try drinking liquids through a straw or as recommended by your swallowing therapist.

• Cancer
• Cancer Resource Center
• Diet for Cancer Treatment Side Effects

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.