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Nutrition Tips for Patients Receiving Head and Neck Radiation Therapy

Radiation therapy can cause many side effects that may contribute to inadequate calorie and protein intake. These side effects include lack of appetite, taste changes or lack of taste, painful chewing and swallowing, dry mouth, early satiety, diarrhea, nausea and disinterest in food and eating. The type and severity of side effects usually depends on the location of the radiation.

Calorie and protein needs are increased in patients receiving treatments for cancer. These increased needs, combined with the many possible side effects, may lead to weight loss. It is very important to try and maintain your weight while receiving radiation. Find ideas for maintaining good nutrition here and ask your dietitian for additional advice and support.

This handout is directed toward patients with side effects preventing the intake of solid foods. If you are still able to eat solids, ask your dietitian for guidance.

Basic Principles

  • Eat small frequent meals -- six to eight times per day.
  • Make every bite and sip count by eating calorie-dense foods and add calories to foods.
  • Limit foods and beverages low in calories.
  • Eat a variety of foods -- include various colors, textures and flavors. You need a high calories and high protein diet but you still need a balanced diet with foods from all food groups. Continue to include fruits and vegetables in addition to high calorie foods.
  • Carry food with you at all times to enjoy while waiting for treatment, in the car, waiting to see the doctor, etc.
  • As side effects become worse, most patients must focus on liquids and soft foods to obtain adequate calories. Often liquids can provide more calories than solids.

Major Goals for Maintaining Good Nutrition During Treatment

  • Eat frequently. You may need to give up the idea of three main meals for the next two to three months. Instead, eat smaller amounts but frequently throughout the day. Try not to go for more than two to three hours without eating something.
  • Eat calorie-dense foods. Remember the goal is to maintain your weight and in order to do that you need to eat a lot of calories. You want to make sure that the foods and liquids you eat have a lot of calories in them. You may find that you are not able to eat the same quantities as before, so you need to get the calories in smaller amounts of high calorie foods.
  • No food is plain. Try to think of food in terms of "What can I add to this to give it more calories?"
  • Concentrate on liquids and soft foods. Many liquids -- see suggestions in the handout -- will provide a lot more calories than you will get by eating solid foods. They tend to be easier to swallow, take less time and are generally soothing the sore mouth and throat. As you move through treatment, you may find that you are having side effects that make it difficult to chew and swallow. All the more reason to use liquids to get the majority of your calories.
  • Just do it. Overall your treatment is over a short period of time. Although it may become difficult to eat, both physically and emotionally, you need to take a deep breath and do it. Your body and mind need it.

Food Examples

400 Calories or more:

Food

Calories

Protein

Scandishake packet

440

5

Scandishake packet mixed with
8 ounces whole milk

600

13

300 to 400 Calories:

Food

Calories

Protein

Boost/Ensure Plus

360

15

8 ounces half & half

320

6.5

Wendy's small chocolate Frosty

400

11

McDonald's small chocolate shake

320

12

200 to 300 Calories

Food

Calories

Protein

1 can cream of chicken soup

284

Varies

1 cup cream of broccoli soup

200

Varies

1 cup New England clam chowder

200

Varies

Boost/Ensure Regular

250

10

Carnation Instant Breakfast with 8 ounces whole milk

280

12

1/2 cup premium ice cream

200

4

McDonald's caramel or fudge sundae

270

7

Hot chocolate made with 8 ounces whole milk

270

8

100 to 200 Calories

Food

Calories

Protein

1 cup (8 ounces) whole milk

150

8

1/2 cup pudding (instant) made with whole milk

150

4

1/2 cup custard made with whole milk

160

4

1 cup yogurt

100-250

8

1/2 cup 2 percent cottage cheese

100

14

1 cup canned fruit in heavy syrup

190

0

8 ounces juice

120

0

12 ounces soda

140

0

2 scrambled eggs

180

14

Additives

These food items can dramatically increase your overall calorie intake.

Food

Calories

Butter/Margarine -- 1 tbsp

100

Mayonnaise -- 1 tbsp

100

Oil -- 1 tbsp

120

Cream Cheese -- 2 tbsp

100

Peanut Butter -- 1 tbsp

100

Salad Dressing -- 2 tbsp

170

Cheese -- 1 oz

~100

Ricotta Cheese -- 1/2 cup

216

Whipping Cream, heavy -- 1 tbsp

52

Syrup, maple -- 2 tbsp

100

Honey --1 tbsp

64

Sugar -- 1 tbsp

45

Jelly -- 1 tbsp

50

Chocolate Syrup -- 2 tbsp

100

Chocolate Fudge -- 1 tbsp

75

Carmel Sauce -- 1 tbsp

60

Frosting -- 2 tbsp

134

Whipped Topping -- 2 tbsp

30

Try these meal and snack ideas:

  • Fruit with cottage cheese, sour cream, whipped cream or mayonnaise
  • Hard boiled egg or deviled egg with regular mayonnaise (extra yolk)
  • Pie with ice cream or whipped cream
  • Chili or refried beans with cheese and sour cream
  • Pudding made with whole milk, half & half or heavy cream and topped with whipped cream
  • Oatmeal with whole milk, brown sugar and butter or margarine
  • Yogurt, ideally a variety with 200 calories per container, with added fruit pieces
  • Super milk -- add powdered milk to regular milk and drink or use it in recipes in place of milk
  • Milk with 2 tbsp chocolate powder or syrup
  • Milkshake -- buy or make, using 1 cup ice cream and 1 cup whole milk
  • Scrambled eggs cooked with butter or oil with added cheese or small pieces of ham
  • Mashed potatoes made with liberal amount of whole milk and butter and topped with gravy
  • Fresh fruit or canned fruit with added sugar and whipped topping
  • Banana and peanut butter
  • Hot chocolate made with whole milk
  • Tunafish with liberal amount of mayonnaise -- alone or on sandwich
  • Pie or pie filling with whipped cream and/or ice cream
  • Brownie, cookie or cake batter made with egg beaters
  • Frosty from Wendy's
  • Chocolate cake with chocolate pudding and whipped cream, layered
  • Spaghetti -- cook noodles, add 1 to 2 tablespoons oil add cooked ground beef to red sauce and top with parmesan cheese
  • Noodles with alfredo sauce
  • Ramen noodle packet with added tofu

Sample Menu

Breakfast

  • 1 cup oatmeal made with 8 ounces whole milk with 1 tbsp brown sugar and 1 tbsp butter (415 calories, 14 grams protein)
  • 4 ounces Ensure/Boost Plus (180 calories, 7 grams protein)

Snack

  • 4 ounces cup pudding made with whole milk (150 calories, 4 grams protein)
  • 4 ounces Ensure/Boost Plus (180 calories, 7 grams protein)

Lunch

  • 1 cup cottage cheese with 1/2 cup mandarin oranges or other fruit (260 calories, 28 grams protein)
  • 2 scrambled eggs cooked in 1 tbsp oil or butter (280 calories, 14 grams protein)

Snack

  • 8 ounces Ensure/Boost Plus (360 calories, 15 grams protein)
  • 1/2 cup canned fruit in heavy syrup with 2 tbsp whipped cream or heavy cream (280 calories, 0 protein)

Dinner

  • 1 cup cream of chicken soup with 1 tbsp added oil and 1 to 2 tbsp protein powder of powdered milk (250 calories, 7.5 grams protein)
  • 8 ounces Ensure/Boost Plus (360 calories, 14 grams of protein)

Dessert

  • 1/2 cup premium ice-cream (such as Haagen-Dazs) with 1 tbsp chocolate syrup (300 calories, 5 grams protein)
  • 8 ounces whole milk (150 calories, 8 grams protein)

Total calories for day = 3165 calories

Total protein for day = 123.5 grams

Other Ideas for Ensure and Boost

Note: Choose Ensure or Boost Plus vs. regular. It has 120 more calories and 6 more grams of protein per can.

Banana Blusher

In a blender combine 1 can cold or frozen Vanilla Plus, 1 small ripe banana and 1/4 tsp vanilla extract. Blend until smooth, pour into a class and serve.

Buckwheat Pancakes

1 8 ounce can Vanilla Ensure Plus, 1 cup buckwheat pancake or waffle mix and 1 tsp cinnamon. If desired, add 1/4 cup shredded coconut. Preheat a non-stick skillet or griddle over medium heat. In a large bowl, combine Ensure, pancake mix, coconut, and cinnamon. Using a 1/4 cup mixture, drop the batter onto the griddle or skillet. Cook until pancakes are golden brown, about 2 minutes per side. Serve with liberal amount butter/margarine, syrup, jelly and powdered sugar. This makes two pancakes, with 300 calories and 10 grams of protein before added syrup, butter, sugar, etc.

Peanut Butter Fluff

1 8 ounce can Vanilla Ensure Plus, 1/4 cup peanut butter, 1/2 3.4 ounces package instant chocolate pudding and 1/2 cup whipped topping. Using an electric mixer set at low speed, gradually combine Ensure Plus with peanut butter. Add pudding mix. Beat at low speed until well blended, about 2 minutes. Fold in whipped topping and serve. 1/2 cup = 330 calories and 10 grams protein.

Ashleigh's Recipe

1 can Ensure/Boost Plus, 8 ounces whole milk and 1/2 cup premium ice-cream = 730 calories and 28 grams of protein.

Experiment yourself with different shake recipes. Use different syrups, fruits and extracts. Add candy, nuts or granola to it. Try using protein powders or powdered milk to increase calories and protein.

Favorite Scandishake Recipes

To order Scandishakes call 1-800-4-Scandi.

Extra Extra

8 ounces whole milk
1 envelope vanilla Scandishake
Extract to taste
Shake or blend all ingredients
1 recipe = 600 calories

Try these extracts or flavorings: almond, banana, cherry, chocolate, coconut, lemon (may help stimulate saliva), maple, orange, peppermint (may soothe throat), pineapple, root beer and raspberry.

Butterscotch Supreme

1 envelope vanilla scandishake
8 ounces whole milk
1 to 2 teaspoons butterscotch powdered pudding or butterscotch syrup to taste
2 teaspoons brown sugar
Shake or blend all ingredients
1 recipe = 620 calories

Scandishake Fruitees

1/4 to 1/2 cup fresh, frozen, or canned fruit
1 envelope Scandishake, any flavor
8 ounces whole milk
Combine ingredients and mix with blender
1 recipe = 600 calories

Pina Colada Refresher

1/2 cup drained crushed pineapple
1/2 teaspoon coconut extract
1/2 teaspoon rum extract
1 envelope vanilla Scandishake
8 ounces whole milk
1/2 to 1 cup ice
Combine all ingredients and mix with blender
1 recipe = 665 calories

You should be checking in with your nutritionist at radiation oncology every week. Do not wait until you have lost weight or are having problems to speak with her. The goal is to prevent problems from happening. So, be proactive.

For more information or to request an appointment with a registered dietitian, please contact UCSF Nutrition Counseling Center at (415) 353-1461.

 

Reviewed by health care specialists at UCSF Medical Center.

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.

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