Nutrition

Overview of Cancer and Nutrition

Good nutrition is important for everyone but it is especially important for persons with cancer. Your body needs a healthy diet to function at its best. Cancer, as well as its treatments can affect your appetite and your body’s ability to tolerate certain foods and to use nutrients. In some situations poor nutritional status can affect a patient’s treatment plan, leading to potential delays of scheduled treatments.

Eating well when you are having problems related to cancer treatment is a challenge. A good way to think about maintaining good nutrition and preventing weight loss is to think of eating as though it were a medication that your oncologist has prescribed. It’s a pill you have to take because maintaining a healthy nutritional status is as important to your treatment plan as any other aspect of your treatment.

To maintain weight and good nutritional status you will need to eat a variety of foods that contain proteins, carbohydrates, fats, water and vitamins and minerals.

  • Protein helps to repair body tissue, maintain a healthy immune system and ensure cell growth. Protein is important in helping our bodies to fight off infections and recover from illness. The protein requirements for the person with cancer can be as much as twice that of persons without cancer. Good sources of protein include lean meat, fish, poultry, dairy products (if you don’t have diarrhea), nuts, dried beans, peas and lentils and soy foods.
  • Carbohydrates and fats are our primary source of calories. The amount an individual requires is based on their age, size and level of physical activity. Sources of carbohydrates include fruits, vegetables, breads, pasta, grains/cereal products, dried beans, peas and lentils. Sources of fat include butter, margarine, oils, nuts, seeds, dairy products (if you don’t have diarrhea), meats, fish and poultry.
  • Vitamins and minerals help ensure proper cell growth and allow the body to use the calories supplied in foods to create energy. If you eat a balanced diet with the proper amount of calories and protein you will normally receive plenty of vitamins and minerals. This is not an easy task for persons receiving cancer treatment. Your physician may recommend a daily multivitamin and mineral supplement. It is important that you let your physician or nurse know what supplements you may be taking, as the overuse of some vitamins and minerals can reduce the effectiveness of treatment.
  • Water and fluids are essential to good health. At birth the human body is almost 90% water. As adults, water remains the largest single component of our body composition, contributing approximately 45% - 75% of our body weight. If you do not take in enough fluids you may develop dehydration and electrolyte imbalances. Side effects of treatment such as diarrhea and vomiting can increase your risk of these problems. It is important that you drink a minimum of 80 ounces of fluids daily. This includes water, sports drinks, non-carbonated drinks, juices, nectars, soup broths and/or vegetable juices.

Why do patients with cancer lose weight?

Often, one of the factors that bring a person into a physician’s office for care is a large, unplanned weight loss that has occurred over a short period of time. Weight loss such as this can suggest cancer as a potential diagnosis.

Weight loss associated with cancer can occur through several mechanisms. Some tumors produce chemicals that can change the way the body uses nutrients. In addition, tumors of the stomach or intestines can affect the body’s ability to absorb all the nutrients from food (malabsorption). So while it seems you may be eating enough, your body may not be able to process and use the nutrients. Hypermetabolism is another mechanism by which persons with cancer may lose weight and involves the secretion of chemicals by the tumor that serve to increase the supply of nutrients to the tumor for its own growth and development, which in turn leads to lose of nutrition to normal cells.

Cancer treatments such as chemotherapy, radiation therapy and surgery can also affect patient’s nutritional status causing weight loss. Many chemotherapy treatments produce side effects such as anorexia (loss of appetite), nausea and vomiting, diarrhea or constipation, mouth or throat sores and cause dry mouth and changes in taste. Any or all of these can interfere with eating and digestion. Radiation therapy may cause similar problems, depending on the location of the area being treated. Surgery can also lead to a loss in weight. After surgery there is an increased need for nutrients to help heal wounds, fight infection and recover from surgery. In addition, the removal of all or parts of certain organs such as those of the digestive system may affect a persons’ ability to eat or digest food.

Why is maintaining weight important?

Maintaining your weight during treatment is important for several reasons. Good nutrition can help you feel better, maintain your strength and energy, fight fatigue, decrease your risk of infections and maintain your body’s stores of nutrients, as well as avoid potential interruptions in your treatment plan. It is commonly agreed upon that patients that are able to maintain their body weight tolerate treatment better and may even have better treatment outcomes.

When you are healthy, getting the proper nutrients you need is usually not a problem. Most nutrition guidelines stress eating lots of vegetables, fruits and whole grain products as well as limiting the amount of red meat you eat. However, persons being treated for cancer may find it difficult to follow standard dietary guidelines. So it is important to eat healthfully prior to start of treatment and when you feel well, but when you are going through treatment you will need to eat what you can.

Things we can do to help:

Nutritional screening (to identify existing and potential risk factors) and assessment starts on your first visit to your oncologist and continues throughout your treatment. Your oncologist or nurse will be asking questions about your weight changes over the past six months, and problems you are currently experiencing that have affected eating. We will want to know if you have had any changes in the types of foods you are eating or in the amounts of food you are eating, as well as any changes in your activities of daily living. This screening is followed by a physical exam and routine blood work.

If it is identified that you are having nutritional problems and subsequent weight loss, the next step is to determine whether there is anything we can correct. Nausea, vomiting, diarrhea, constipation, depression, anxiety and multiple other problems might contribute to your weight loss and need to be addressed. We will also refer you to a dietician trained in the management of cancer related malnutrition. Appetite stimulants, like Megace or Marinol, can also sometimes be effective.

Things you can do to help:

Your oncologist may be the first physician who has ever told you “don’t lose weight”. It is important to maintain your current weight and even to gain weight if you have had a weight loss prior to diagnosis. Eating healthy can mean many things to different people. It is not unusual at this time for a patient to decide that this is the time to become a vegetarian or to eat only salads. It is important that you discuss any dietary changes you are planning on making with your physician or nurse prior to doing so.

A positive, proactive approach can be the single most valuable tool you posses to fight against weight loss and resulting poor nutrition. You must accept that eating is as much a requirement of your treatment plan as is the chemotherapy or radiation the doctor prescribes. People who maintain their weight through therapy do better and recover faster after treatment.

Start planning for how you will eat even before treatment begins:

  • Stock the refrigerator with plenty of your favorite foods so that you will not have to shop as often. Think of foods that you know you would be able to eat if you were sick with the flu or a cold.
  • Take the time to think about every food you have ever enjoyed and make a list. Try to have some of these foods available.
  • Buy foods that are easy to prepare such as peanut butter, puddings, frozen dinners, soups, cheese and eggs.
  • Don’t be afraid to ask family members or friends for help – often they are desperate for a way to help and are more than willing to make a quick run to the grocery store to pick up your favorite food if you are too tired or even prepare a meal for you. Identify these people now.
  • Cook large portions of your favorite dishes in advance and freeze them in meal-sized portions.
  • Be open to trying new foods. Foods that you don’t normally enjoy may be just the thing you are carving.
  • During treatment some people find that most things taste sweet – keep an assortment of savory and salty snacks on hand.
  • Add leftover cooked meats to soups, casseroles, salads and omelets.
  • Keep hard-cooked eggs in the fridge. They can be chopped and added to salads, casseroles, soups and other vegetables to add more protein.
  • Add butter or margarine to potatoes, rice, pasta and cooked vegetables for added calories.
  • Keep a variety of protein-rich snacks on hand that are easy to prepare and eat.
  • Eat as healthfully as you can before and between treatments. During treatment, eat whatever works well for you.  But EAT!!!!!!
  • Eat small meals every 2-3 hours instead of 3 large meals.
  • If you are experiencing side effects such as diarrhea or nausea, review the sections below – they contain suggestions for foods that may help.
  • If you do not currently exercise – start a mild to moderate exercise program, such as a daily walk around the block. Exercise can increase your appetite and is part of an overall healthy lifestyle. If you already participate in an exercise program be sure to check with your physician or nurse to determine if any changes need to be made. You may have been running marathons before treatment but while you are going through treatment this may be too stressful on your body.
  • Drink most of your fluids between meals instead of with your meals. Drinking fluids with meals can make you feel full.
  • Remember, eating is not optional – even if you are not hungry and have no appetite you must eat.
  • Always share your concerns about weight, nutrition or side effects with your physician or nurse.

It will be important to make adjustments in your diet as you go through treatment. If you are experiencing treatment related problems that affect your appetite or ability to eat, you will need to add or avoid certain foods. Below, we have made some suggestions as to the types of foods that you might consider if you are experiencing treatment related eating problems.  In addition, we have included several websites that will take you directly to sites with actual recipes that you may find helpful.

Anorexia (loss of appetite):

  • Eat foods high in protein and calories.
  • Add extra protein and calories to foods by adding butter, honey, brown sugar or powdered milk.
  • Eat high protein and high calorie meals every 2-3 hours instead of 3 large meals a day.
  • Try new foods, experiment with new seasonings and spices.
  • Use milk instead of water for cereal and soups.
  • Add yogurt, honey, ice cream or cottage cheese to favorite fruits or blended smoothies
  • Specific foods to consider are:
    • Cheese and crackers
    • Muffins
    • Puddings
    • Supplements such as Boost or Ensure
    • Ice cream
    • Yogurt
    • Deviled eggs
    • Peanut butter and crackers

Constipation:

  • Eat foods that are high in fiber.
  • Consider adding a fiber supplement to foods and/or beverages.
  • Be sure to drink plenty of non-alcoholic and non-caffeinated fluids.
  • Consider 4 ounces of warm prune juice every morning.
  • Stay as physically active as possible.
  • Specific foods to consider are:
    • Bran muffins
    • Bran or whole-grain cereals
    • Cooked dried peas and beans
    • Whole-wheat bread
    • Whole-wheat pasta

Diarrhea:

  • Drink plenty of mild, clear liquids throughout the day.
  • Avoid mild and milk products as these may worsen diarrhea.
  • Eat foods at room temperature. Hot and/or cold foods can irritate the stomach.
  • Eat small, frequent meals and snacks.
  • Avoid greasy, fried, spicy or very sweet foods.
  • Eat foods with low fiber
  • Drink at least 8 ounces of liquid after each loose stool
  • Specific foods to consider are:
    • The Brat Diet (applesauce, bananas, toast and rice) for no longer than 2 days
    • Skinless chicken or turkey
    • Eggs
    • Cottage cheese
    • Fish
    • Noodles
    • Baked or mashed potatoes without the skin
    • White bread
    • White rice
    • Canned fruit such as peaches and pears
    • Yogurt
    • Clear fruit juice
    • Vegetable juice
    • Saltine crackers
    • Sherbet or sorbet

Nausea/Vomiting:

  • Eat small amounts of food and eat more often.
  • Dry, salty foods may help settle your stomach.
  • Let someone else cook for you if possible. Sometimes the smell of food cooking can make you feel sick.
  • Avoid greasy, fried, spicy or very sweet foods
  • Cool or room temperature foods may be easier for your stomach to handle.
  • Fresh air may help you feel better
  • Sit up or lie with the upper body raised for 1 hour after eating.
  • Suck on hard candies such as peppermints or lemon drops if your mouth has a bad taste.
  • Don’t go for treatment on an empty stomach. Eat small servings of bland foods.
  • Rinse out your mouth before and after eating.
  • Specific foods to consider are:
    • Ginger tea
    • Clear broths (chicken, vegetable or beef)
    • Clear carbonated beverages that have lost their fizz
    • Tea
    • Popsicles
    • Baked or broiled chicken without skin
    • Creamed rice
    • Instant oatmeal
    • Boiled potatoes without skins
    • Saltine crackers or pretzels
    • White rice
    • Noodles

Taste Changes:

  • Try poultry, fish, eggs and cheese instead of red meat.
  • Try marinating meat or using sauces to promote taste.
  • Avoid eating your favorite foods on the day of chemotherapy.
  • Use mints, peppermints, lemon drops or other hard candies to mask bitter or metallic tastes and to increase saliva. Use sugar free hard candies if you are a diabetic.
  • Use plastic utensils if you have a metallic taste in your mouth.
  • Moistened foods with gravies and sauces go down better with dry mouth.
  • Drink plenty of fluids.
  • Specific foods to consider are:
    • Baked chicken or turkey without the skin.
    • Citrus fruits (unless mouth sores).
    • Fruit nectars instead of fruit juices.
    • Vegetarian dishes such as you would find in a vegetarian or Chinese cookbook.

Sore Mouth or Throat:

  • Drink plenty of liquids to help keep your mouth moist.
  • Avoid hot, spicy, crunchy or acidic/citrus foods and beverages.
  • Cold or chilled foods may help your mouth feel better.
  • Soft food or food that has been put in the blender may be easier to eat.
  • Specific foods to consider are:
    • Cooked refined cereals
    • Cottage cheese
    • Eggs (soft boiled or scrambled)
    • Mac & Cheese
    • Mashed potatoes without skins
    • Pureed cooked foods
    • Soups
    • Custards, Jell-O, Pudding Cups
    • Milkshakes
    • Applesauce
    • Yogurt (plain or vanilla)

Difficulty Swallowing:

  • Drink plenty of liquids.
  • Thick liquids may be easier to swallow than thin and can be thickened with commercial or domestic (tapioca, cornstarch or flour) thickeners. Talk with your physician or nurse regarding the use of commercial products.
  • Eat soft or pureed foods; add gravies, sauces or butter to moisten foods for easier swallowing.
  • Eat small bites of food and small sips of beverages frequently.
  • Avoid dry meat, plain rice, bread, raw vegetables, dried fruits and nuts and crunchy foods.
  • Specific foods to consider are:
    • Fruit nectars (instead of juice)
    • Milkshakes
    • Yogurt
    • Cream soups (potato is a good one)
    • Puddings
    • Buttermilk
    • Smoothies

Weight Loss:

  • Keep high-calorie snacks on hand, such as ice cream, peanut butter, cheese and crackers, puddings, nuts, dried fruits or granola bars.
  • Enhance your meals by using nutritional products such as boost and ensure. These can increase calories and protein.
  • Since liquids can make you feel full, try to eat first and then drink your liquids.
  • Exercise may improve your appetite. Walking each day before meals may help.
  • If you feel full soon after you start eating, try to eat smaller amounts more often. For example, eat every 2-3 hours instead of 3 large meals.
  • Specific foods to consider are:
    • Cream soups
    • Soups with lentils or dried peas/beans
    • Milkshakes
    • Puddings
    • Smoothies
    • Yogurt (plain or vanilla)
    • Nutritional supplements such as Ensure and Boost
    • Nuts
    • Peanut butter, cheese and crackers
    • Ice cream

Links to nutrition information and recipe sites:

The websites listed below will take you directly to sites that contain recipes that you may find helpful. Some of these sites support the use of specific nutritional products. Our purpose is not to promote these products but to give you access to information that may be helpful to you. If you are considering using any of the products you see promoted, please talk with your physician or nurse prior to doing so.

You can find additional information about diet and nutrition in your New Patient Kit. It contains a copy of the National Cancer Institute’s “Chemotherapy and You” booklet as well as their “Tips for Eating During Chemotherapy” booklet.  Bon Appetite!!!

http://www.caring4cancer.com/go/cancer/nutrition/during-treatment-recipes

http://www.caring4cancer.com/go/cancer/nutrition/wellness-nutrition

http://www.cancercenter.com/after-care-services/recipe-cards.cfm

http://www.cancerbackup.org.uk/Resourcessupport/Eatingwell/Cancerbackuprecipes

http://cni.axialwebhosting.com/main.cfm

http://www.cancerrd.com/