Finding the time and energy to plan meals can be difficult under normal circumstances. It can be particularly overwhelming for cancer patients when the act of eating itself becomes a challenge.
“During chemotherapy, I had severe taste bud changes the whole time. Nothing had much taste or it tasted awful. It was hard to eat because you just don’t want to,” said Corinna Howard, diagnosed with breast cancer in June 2013.
The 44-year-old received treatment — surgery, chemotherapy and radiation — at Everett’s Providence Regional Cancer Partnership. Medications caused chronic pancreatitis, a digestive disease, which further exacerbated eating issues. She lost upward of 50 pounds and struggled with nutrition issues.
“Especially with the pancreatitis, no one ever really advised me on what I needed to do to get better,” Howard said.
Like many patients, Howard identified palatable foods through trial and error. However, dietary tips can sometimes help ease the process. Many medical institutions offer nutrition counseling via registered dietitians and classes.
What to eat?
“I see a lot of people who start following a very restrictive diet after being diagnosed,” said Margaret Hines, registered oncology dietitian at Providence Regional Cancer Partnership.
“It’s not necessarily the time to make big changes and start eating only kale smoothies. People need to maintain weight, hydration and keep the immune system strong during treatment,” Hines said.
Common treatment side effects include taste changes and sensitivity to food temperature, mucositis characterized by sores and dryness of the mouth and digestive tract, loss of appetite, nausea, vomiting and diarrhea. Overall fatigue can also become an obstacle.
For patients with diminished appetites, large amounts can be overwhelming. Try smaller meals and snacks. Whenever possible, Hines recommends incorporating healthy, high-calorie items such as avocados, extra olive oil and nut butters. Add peanut butter to everything from shakes to toast for a calorie and protein boost.
“Both cancer itself and treatment causes the body’s metabolism to change. Try to compensate for the extra protein the body consumes for healing,” recommended Angela Merges, registered dietitian at Swedish Medical Center’s Edmonds Breast Center.
Increase protein — preferably lean — at every meal and snacks. Merges recommends additions such as an extra egg at breakfast and chicken, salmon or tuna salad for lunch. Add cheese to crackers, potatoes and sandwiches. Additionally, eat whole-grain carbohydrates for energy.
Many patients experience a change in taste, which can shift even daily. Chemotherapy often imparts a metallic flavor to food. The effect, Hines said, is sometimes lessened by eating with plastic utensils, cooking in glassware and avoiding food from cans.
“The blander the better for me,” Howard said. “Cream of Wheat was a go-to along with oatmeal, plain crackers and mashed potatoes. The less flavor, the less conflict between my taste buds and what I knew it should normally taste like.”
Well-intentioned friends and family — even businesses — sometimes pressure patients to eat “cure-all” foods. Follow your gut both literally and figuratively.
“Unfortunately, cancer patients are vulnerable to all sorts of weird diet advice,” Hines said. “There is no magic bullet, elixir or herb that you can take to make everything immediately better. If there was, we’d tell you.”
Instead, Hines recommends consulting with an oncologist, registered dietitian or reputable sources such as the American Cancer Society or National Cancer Association.
Hydration
Staying hydrated is essential to good health, but even more so during cancer treatment.
“Especially with chemo, doctors generally advise lots of fluids to help flush things through,” Hines said. “Treatment can diminish the sense of thirst, so we usually tell people to drink more than they think they need.”
If water doesn’t whet the appetite, flavor it with crushed fruit. Beverages such as Gatorade are recommended both for replenishing fluid and electrolytes. Popsicles, fruit juice and broth are also good options.
“If you don’t have much appetite or problems with nausea, separate fluid intake from meals. Don’t fill up on water so that you don’t eat food and vice versa. You don’t want to miss out on either,” Merges said.
Food preparation
Arlington native Karena Raino-Nevratakis was diagnosed with breast cancer in October 2011. After her first round of chemotherapy, she ate at a restaurant and soon after contracted pneumonia.
“I recommend staying home and out of public restaurants as much as possible when it comes to food,” the 39-year-old said. “I caught pneumonia after going to the restaurant and associate the two as possibly connected.”
Cancer patients often experience neutropenia, abnormally low counts of white blood cells, which help fight infections. Food bacteria that is safe for a healthy person can be high-risk for those with weakened immune systems. Cook meals — particularly meat — thoroughly.
“There is some controversy around eating fresh fruit and vegetables,” Merges said. “If you do, wash it really, really, really well. Some foods, like raspberries and lettuce, are hard to wash because they have little pockets where mold and dirt hides. The safest is to stick with cooked, canned or packaged versions.”
If dining out is a must, pass on raw items such as salads and sushi. Inform servers of the need for food to be cooked extra hot and well done.
Be cautious even of meals prepared by well-meaning friends and family. Ensure that proper food-safety precautions were taken. Even if a patient simply can’t tolerate the taste, feel free to decline.
“Find what works best for you so food doesn’t become another stressor,” Merges said. “You know your body best.”
Nutrition tips
- Eat smaller, more frequent meals and snacks rather than large, overwhelming servings.
- To combat weight loss, incorporate healthy, high-calorie foods such as avocados, olive oil and peanut butter.
- Eating whatever is palatable is preferable to not eating at all.
- Bright flavors, such as strawberry and lemon, sometimes offset a lack of taste.
- If food tastes unpleasant, bland items and tepid temperatures are often more tolerable.
- Boost protein by adding items such as eggs and cheese to meals.
- Soft foods, shakes, ice cream and soups are easier when dealing with mouth sores.
- Avoid fibrous foods when suffering from diarrhea. Soluble fiber in applesauce, however, helps decrease diarrhea.
- Drink lots of water. Add fruit, lemon or cucumbers for flavor. Popsicles, broth and fruit juice are also good options.
- Place eight full glasses of water in the fridge every morning as a visual reminder to hydrate.
- Separate meals and water intake — don’t fill up on one at the expense of the other.
- If you’re neutropenic, stick with cooked, canned or packaged foods that are bacteria free.
- Avoid public restaurants whenever possible.
- If cooking at home, make double batches and freeze leftovers for when you’re too tired to prepare meals.
- Prepare food in the morning when you have the most energy.
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