Good nutrition is an important part of everyone’s life. Good nutrition is particularly important for cancer patients. An unfortunate paradox results when cancer, cancer treatment, or both, make eating an unpleasant or unwanted experience. The result can be a negative balance between the intake and expenditure of calories, resulting in a lowering of the basal metabolic rate (BMR) which can cause lowered energy, unwanted weight loss, or even malnutrition.

Treatment, and sometimes the disease itself, may cause conditions that interfere with normal eating and the desire to eat. This booklet contains suggestions for adapting diets to make food more palatable and for incorporating nutrition into cancer treatment.

As with any medical condition, please discuss any eating difficulties and proposed dietary modifications with your physician.

Some Drug-Specific Nutritional Advice
Carolyn F. Katzin, MSPH, CNS

EATING SUGGESTIONS IN THE EVENT OF:

• Changes in Taste
• Constipation
• Diarrhea
• Dry Mouth
• Lack of Appetite
• Mouth and Throat Sores
• Nausea and Vomiting
• Thickened Saliva
• Weight Gain
  

SOME DRUG-SPECIFIC NUTRITIONAL ADVICE

by Carolyn F. Katzin, MSPH, CNS

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©1999. Carolyn F. Katzin, MSPH, CNS. All rights reserved. Reprinted by permission of the author.

CHANGES IN TASTE

Changes in Taste of food may result from radiation therapy, some chemotherapy regimens, some pain medications and some antibiotics.
To offset this phenomenon DO try to:

• Eat and drink food and beverages either cold or at room temperature.
• Eat strongly flavored foods such as chocolate (though some patients may find chocolate hard to digest), lasagna, pasta with sauce, or barbequed foods, unless mouth sores are present.
• Eat tart or spicy foods, but not if mouth sores are present.
• Drink liquids with meals, to rinse away any unpleasant taste.
• Eat high protein foods lacking strong odors, such as dairy products, eggs and poultry.
• Add sauces to foods.
• Add something sweet such as applesauce, apple or mint jelly or cranberry sauce or jelly when eating meat.
• Use plastic utensils if a metallic taste sensation occurs.

NOTE that some patients experiencing the phenomenon of changes in taste of food and drink experience difficulty in eating bland foods. Also, some patients find red meat, chocolate, coffee and tea difficult to tolerate. Should any particular food or type of food prove difficult to tolerate, try one of the other suggested foods.

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CONSTIPATION

Constipation may occur as a result of some chemotherapy regimens or as a side effect of certain narcotic pain medications.

To offset this condition, DO try to:

• Drink as much liquid as possible.
• Drink warm beverages.
• Eat foods high in fiber content such as raw fruits and vegetables, whole grain breads and cereals, dried fruits, dried peas and beans.
• Get regular light physical exercise.

AVOID:

• Cutting back on fluids when increasing fiber intake.
  

NOTE: Should constipation persist, ask about the use of laxatives or stool softeners.

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DIARRHEA

Diarrhea may occur as a result of radiation therapy, some chemotherapy regimens, some antibiotics, gastrointestinal graft versus host disease, intestinal tract infection, lactose intolerance, and some oral medications such as magnesium salts and Reglan®
.
To alleviate this condition, DO try to:

• Eat smaller amounts of food at each meal.
• Drink plenty of fluids to prevent dehydration.
• Use Lactaid® treated dairy products or low-lactose milk and dairy products.
• Eat foods and drink liquids high in potassium and low in fiber content such as ripe bananas, potatoes (without the skin) tomato juice, orange juice, peach or pear nectar, Gatorade®, baked fish, baked chicken, ground beef, well cooked vegetables (but not beans, broccoli, cauliflower, and cabbage) canned fruits, cooked rice and white bread.
  

AVOID:

• High fiber foods such as bran, whole grain breads and cereals, raw vegetables, fresh fruits, (other than ripe bananas) popcorn, nuts and seeds.
• Milk and dairy products such as cheese and yogurt, unless treated with Lactaid®.
• Foods that can cause gas or cramping such as carbonated beverages, chewing gum, highly spiced foods, beans, broccoli, cauliflower and cabbage.
• Rich gravies and sauces.
• Caffeinated beverages including tea, coffee, colas and other soft drinks containing caffeine.
• Chocolate.
  

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DRY MOUTH

Dry mouth may result from radiation therapy, anti-nausea medications, antihistamines, oral graft versus host disease and some antibiotics.

To relieve this condition, DO try to:

• Add sauces, gravies, broth and dressings to food.
• Suck ice chips, popsicles, sugarless hard candies, or chew sugarless gum to keep the inside of your mouth moist.
• Drink fluids high in citric acid content such as oranges, orange juice, lemon, lemonade, limes and limeade to stimulate saliva production. Add lemon or lime to tea, water and sodas. Suck on sugarless lemon drops.
• Drink liquids with meals.
• Practice good oral hygiene.
• Ask about saliva substitutes such as Mouth-Kote™.

AVOID:

• Plain meats, breads, crackers, dry cake.
• Very hot foods and beverages.
• Alcoholic beverages.

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LACK OF APPETITE

Reduced appetite, or even the complete lack of desire to eat, may result from radiation therapy, some chemotherapy regimens, infection, or from depression or fatigue resulting from treatment.

To overcome a lack of appetite, DO try to:

• Eat small, frequent, high-calorie meals.
• Drink high-nutrient liquids such as juice or milk, instead of coffee, tea or sodas.
• Eat dense, high calorie foods such as cheese, whole milk, cream, whipped cream, sour cream, cottage cheese, ice cream, extra butter, eggs, oil, mayonnaise, peanut butter, wheat germ, nuts, fruits and instant breakfast beverages.
• Use carbohydrate supplements such as Polycose®, protein powders such as Promod® or Casec®, or complete nutrition supplements such as Ensure™, Carnation Instant Breakfast™, or Sustacal®, if approved by a doctor or dietitian. Nonfat dry milk powder can be added to foods such as casseroles, cooked cereals and any foods containing milk or milk products.
• Eat meals in comfortable, pleasant surroundings.
• Get regular, light exercise to stimulate your appetite.
• Keep trying to eat, despite to decreased desire for food.
• Ask for qualified assistance if a psychological problem exists.
  

AVOID:

• Foods you dislike, foods you find difficult to prepare, and foods which may be difficult to eat such as rare meats and dense raw fruits and vegetables (eg: apples and carrots).
  

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MOUTH AND THROAT SORES

Mouth and throat sores may be caused by radiation therapy, some chemotherapy regimens, methotrexate, infection, and graft versus host disease.

To relieve eating difficulties while such a condition exists, DO try to:

• Eat foods at lukewarm or cold temperatures, rather than hot.
• Cook foods until tender and soft.
• Drink through a straw.
• Eat high-protein, high-calorie foods, which may speed the healing process.
• Use a liquid or blender diet or nutrition supplements, such as Ensure™, or Carnation Instant Breakfast™.
• Eat soft foods such as cream soups, cheeses, mashed potatoes, yogurt, eggs, custards, puddings, cooked cereals, ice cream, milk shakes, pasteurized eggnog.
• Eat cold foods such as cottage cheese, watermelon, Jello™, soft canned fruits (pureed in a blender, if desired).
• Eat non-irritating frozen foods such as popsicles, slushes, and frozen yogurt.
• Drink fruit nectars and fruit flavored beverages instead of acidic juices.
• Maintain good oral hygiene.
• Ask for pain medication if discomfort becomes severe.
  

AVOID:

• Tart or acidic foods and beverages such as citrus fruits and juices and pineapple juice.
• Salty foods and beverages, including broth.
• Strong spices such as peppers, chili powder, nutmeg, and cloves.
• Rough or coarse foods such as raw fruits and vegetables, dry toast, whole grain breads and cereals and crunchy snack foods.
• Alcoholic beverages.
• Food or beverages served very hot.
  

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NAUSEA AND VOMITING

Among the most commonly reported side effects of cancer treatment, nausea and vomiting are increasingly controlled with medication. Along with any prescribed medication, DO try to:

• Eat small, frequent meals.
• Eat dry crackers or dry toast.
• Eat foods cold, rather than warm, as this tends to lessen food odors.
• Eat low fat foods such as cooked vegetables, canned fruits, baked skinless chicken, sherbets, toast, crackers, vanilla wafers, and plain angel food cake.
• Drink clear, cold beverages, such as carbonated sodas (non-caffeinated), flavored gelatin, ice cubes made from a favorite liquid.
• Sip liquids slowly and through a straw.
• Sip or drink small amounts of liquids frequently throughout the day.
  

AVOID:

• Kitchens and any other cooking areas where odors might be offensive.
• Spicy foods, overly sweet foods, high fat greasy foods, and foods with a strong odor.
• Drinking large amounts of liquids with meals.
• Drinking hot liquids.
• Lying down after meals; instead, sit or recline, with head elevated.
  

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THICKENED SALIVA

Thickened saliva may be caused by radiation therapy, and may be an indication of dehydration.

To relieve this condition, DO try to:

• Drink club soda or seltzer water or tea with lemon.
• Suck on sugarless, sour lemon drops.
• If mucous build up occurs in the morning, eat a light breakfast and larger meals later in the day.
• Drink large amounts of fluids.
• Rinse frequently with a saline solution of 1 quart water, _ teaspoon table salt, and 1 _ teaspoons baking soda.
• Eat soft, tender foods, such as cooked fish and chicken, noodles, eggs, thinned cereals, fruits and vegetables pureed and diluted in a blender.
• Drink diluted juices, broth-based soups and fruit flavored beverages such as Koolaid™, or Hi-C™.
• Switch to a liquid diet if condition becomes severe.
  

AVOID:

• Dense foods requiring considerable chewing, breads and bread products, gelatin desserts, oily foods, and hot cereals.
• Thick cream soups and fruit nectars.
  

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WEIGHT GAIN

Gaining weight in excess of normal body weight can result from use of prescribed steroids that cause the body to retain fluids.

To relieve fluid retention and to reduce excess body weight DO try to reduce salt intake.

AVOID:

• Adding salt to foods.
• Eating foods high in salt such as:
  • MEATS—bacon, bologna, cold cuts, chipped beef, corned beef, hot dogs, ham, salt pork, sausage, canned meats.
  • PREPARED FOODS—bouillon, canned or frozen soups, frozen dinners, olives, pickles, pizza.
  • SNACKS—potato chips, pretzels, corn chips, popcorn, tortilla chips.
  • SEASONINGS—salt, catsup, celery salt, onion salt, chile sauce, MSG, mustard, soy sauce, steak sauces, any seasoning mixed with salt.
  • VEGETABLES—sauerkraut, beans cooked with salt pork.
    

Material contained in this publication is presented for information and educational purposes only. It should not be used as a substitute for medical or other professional advice in the diagnosis or treatment of any disease or other health problem. If you have, or suspect you may have a health problem, please consult a qualified health care provider.

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