Author: Katherine Pett, R.D.N.
If you’re dealing with cancer, eating is probably the last thing on your mind, between doctor’s appointments, your treatment schedule, getting enough rest, and focusing your energy on getting better. Not to mention that “normal” life doesn’t stop because of cancer—there’s still work and family and errands and everything in between. But getting proper nutrition during cancer treatment is important for maintaining your energy and strength, and preventing weight loss that can lead to delays in medical treatment. So instead of thinking of food as a chore, try thinking of it as a vital part of your treatment plan.
As you well know if you’re going through treatment, chemotherapy and radiation often cause side effects that make it difficult to eat, like low appetite, nausea, taste changes, or difficulty chewing and swallowing. A key step is being prepared to combat these potential symptoms, and you can do that by arming yourself with evidence-based nutrition info, a strong support system, a well-rounded health care team, and some tips and tricks for making food easier to get (and stay) down.
“Based on data and personal experience, patients unable to stay nourished tend to do worse and are less likely to tolerate the full therapy,” says Fasyal Haroun, M.D., assistant professor in hematology and oncology at George Washington University. But there’s also not one right way to get that nourishment during cancer treatment, so “an assessment by a dietitian is a good start,” Dr. Haroun says.
As a registered dietitian, I often work with patients admitted to the hospital who have trouble maintaining sufficient energy and protein intake. They want to maintain a good intake, but they’re dealing with low appetite, nausea, or trouble with chewing and swallowing due to dry mouth or mouth sores. During their stay, I help make sure their trays are full of foods they can easily eat despite their symptoms, or I add snacks between meals. (Of course, my recommendations will vary for each patient.)
I wanted to put together a guide to make eating more enjoyable—or at least less nausea-inducing—while you’re working hard on getting better, so I pulled together some of my own tips and also spoke with Danielle Penick, R.D., a long-time oncology dietitian and blogger at Survivor’s Table, a website for evidence-based nutrition advice for cancer.
1. First of all, be prepared to temporarily hate some (or all) of your favorite foods.
One common side effect of cancer treatment is changes in taste and smell. If you usually love the smell of a BLT, you might find that it makes you gag during treatment.
One way to deal with this is by changing up flavors and avoiding foods with strong smells. Chemo and radiation can sometimes cause metallic or bitter tastes, and tart or citrus flavors can work to cover these tastes. Try adding lemon to protein dishes like chicken and fish, or marinating proteins in vinegar-based dressings. Adding fresh, pungent herbs (that don’t smell bad to you) can help make foods more palatable. (Check out one of my favorite recipes for dill-marinated blue fish featuring a lemon marinade). It might sound counterintuitive, but try foods you don’t typically care for—you might find them newly tolerable.
2. Even silverware might start tasting disgusting. If so, swap it out for plastic cutlery.
As certain medications are infused, they can cause you to experience a “metallic” or bitter taste in your mouth, which certainly does not help with appetite. One common solution to help deal with this side effect is to switch out metal knives and forks for plastic. You can also try to cover up metallic tastes by sucking on mints or chewing gum.
3. If basically all food smells are too much, eat foods chilled.
Hot food is more aromatic (think about the time someone reheated fish in the office microwave, ew) and can make smell aversions worse. So if this is happening to you, put drinks on ice, make frozen smoothies, or just stick your plate in the fridge or freezer to cool it down before you eat it. The chill can also help numb your taste buds which helps if you’re experiencing taste changes.
4. If you’re dealing with painful mouth sores or cuts, stay away from acidic foods.
Since chemotherapy and radiation target rapidly dividing cells to fight cancer, it can wind up affecting normal cells that also divide rapidly, like the ones lining your mouth. This can lead to painful cuts or mouth sores that make it difficult to eat. If a sore mouth is your problem, avoid foods like citrus and tomato as well as crunchy, potentially painful foods like tortilla chips or crackers.
For mouth sores, Penick recommends ice and frozen treats. “I would encourage people to suck on ice or frozen fruit, because that can be really helpful to sooth the mouth,” Penick tells SELF. She also says that eating a frozen food first may numb up your mouth so you can tolerate a few bites of an energy dense food, like a protein bar. Frozen bananas are great, since they are sweet and starchy, as well as a bit higher in calories than other, less dense fruits.
5. Smoothies are a great way to combat dry mouth while also getting in calories and nutrients.
A dry, cottony mouth is another common symptom of both chemotherapy and radiation. For this symptom, it’s good to work with liquidy foods and mix up textures. Penick recommends custards, bananas, applesauce, cottage cheese, and oatmeal—wetter foods that are easy to get down.
To meet energy needs, “smoothies tend to be really well tolerated, too. I like those because you can add a lot of [protein-rich] foods like peanut butter, yogurt, or milk,” she says. Peanut butter and yogurt are also energy-dense options which make them optimal if you’re having trouble getting enough calories. Again, bananas are beneficial since they are high in potassium which can help with electrolyte disturbances (which can happen as a result of chemotherapy). Avocados, ever popular on toast, are a good addition, too. “They make a smoothie creamier, add calories, and taste mild,” Penick says. One of her preferred combinations is to blend ½ cup milk, an avocado, a banana, and ½ cup pineapple chunks with about five ice cubes.
6. If you’ve got zero appetite, try adding some walking into your day if you can.
One way to combat a lost appetite is to work it back up. “I actually encourage a lot of walking,” if you’re feeling up to it, “because walking can help increase appetite,” Penick says. It can also help prevent constipation, which can be a side effect of chemotherapy or certain pain medications. As with any intervention, make sure you ask your doctor if exercise is appropriate for you. If your appetite remains low over the long term, your doctor may prescribe medication to stimulate your appetite.
7. Arm yourself with lots of high-calorie snacks if eating full meals is too intimidating.
Some people describe a sense of early satiety, or “feeling full” after just a few bites of food. Others simply feel nauseous. If you’re dealing with a low appetite, Penick points out that it might be easier to eat small amounts frequently, rather than full meals. “Sometimes larger meals can be overwhelming.”
The solution: ABS (Always Be Snacking). Keep high-calorie snacks like protein bars or packets of nut butter in a backpack or purse so you always have one handy. If just being around food seems overwhelming, keep small bottles of nutritional supplement drinks around and sip them when you can. And remember, put it on ice if you just can’t with the flavor.
8. If anyone wants to help, give them really explicit instructions on the kinds of foods you can currently stomach and how to make them freezer-friendly.
Cancer treatments are exhausting, and it’s not reasonable to expect that you’ll feel like cooking for yourself. So Penick recommends anything that’s grab-and-go, like meals from a family member that you can save, freeze, and reheat when needed. In addition to pre-prepared meals (think casseroles, soups, or even starchy foods like pancakes and waffles that freeze well), she recommends “things that are prepackaged that you can easily open, and nutrition supplements,” like the nutritional drinks Ensure, Boost, or Orgain.
For supportive friends and family, be clear about what foods you are tolerating well at the moment, and keep lines of communication open. Definitely accept help, but realize that now is a time when friends might start making “helpful” recommendations that are anything but. If someone in your circle tries to nudge you towards trying a “diet that’s great for cancer,” know that you can just politely ignore that. You don’t need the added stress, and if your friend/yoga teacher/lifestyle guru is not also an oncologist, their advice is likely not evidence-based.
9. Bookmark a few friendly resources with helpful tips.
If you or a loved one will be starting chemo or radiation soon, it’s not too early to stock up on good online resources with helpful food prep and nutrition suggestions. The American Cancer Society has clear, helpful instructions for troubleshooting eating-related side effects of cancer treatment; so does the Eating Hints guide from the National Cancer Institute. Penick also recommends Cook for Your Life, a website dedicated to recipes for people with cancer. They’re indexed by cancer-specific priority such as “easy to swallow,” “high calorie,” or “nausea” to help you find foods that can fit your needs.
Reputable sources like Cleveland Clinic’s Chemocare, the American Cancer Society, and the National Cancer Institute can help you find answers to common questions about nutrition and cancer. However, be wary of advice provided on online forums or social media, especially if it conflicts with your physician or dietitian’s advice. While seeking support is good, Penick warns that “most online forums where anyone can post are filled with an abundance of misinformation,” and while participants may mean well, they can make unsubstantiated claims that promote anxiety around eating. An oncology dietitian can work to fine-tune your eating plan if you have additional dietary needs (like those that come with diabetes or celiac disease), which brings me to the next tip…
10. Get personalized advice from an oncology dietitian.
If there’s one thing Penick always wants her patients to know, it’s this: “What works for one person may not work for another person.” Because energy and nutrient needs can vary before and during your treatment, a dietitian can follow your progress, calculate your nutrition needs, and help you troubleshoot any food-based challenges that may arise.
So much of cancer treatment can feel like it’s being done to you: chemo, surgery, radiation, etc. Nutrition can be an empowering part of your care, since you have control over your food choices. A dietitian can help by bringing subject-matter expertise to visits designed to meet your needs and preferences. They can provide meal plans, give you ideas for food replacements that fit your changing tastes, and they have a strong background knowledge of potentially helpful medical foods and supplements. As licensed clinicians, dietitians focus on evidence-based practice and will guide you to practical advice (and away from unproven or potentially harmful diet plans and practices).
While many oncologists and medical practices have dietitians on staff, not all do. If your doctor doesn’t offer nutrition support within his or her office, ask for a referral to a dietitian who specializes in oncology. To determine whether an outpatient or even home-based visit with a dietitian is covered by your healthcare, call your insurance provider.
11. Don’t worry about “optimizing” your diet—just get down what you can.
Often when I see cancer patients concerned with nutrition, they want to know exactly how much protein to get, or what foods are good sources of antioxidants, or whether they should invest in “superfoods” or other (sometimes gimmicky) supplements. While trying to get enough protein is a noble intention, our primary goal is for you to get enough to eat. Unless you have another illness that requires a specific diet, now is probably not the time to “optimize” aspects of your diet (by going all organic, for example).
These restrictions are going to make it harder for you to meet your energy needs and are unlikely to have a major effect on your outcome. And, they might cause additional weight loss, something we try to avoid as much as possible while a patient is in treatment. Definitely focus on eating mostly healthy foods, but if all you can tolerate is chocolate pudding? Add chocolate pudding to the menu! While food can seem like a minor player in the battle against cancer, it’s crucial for maintaining energy and can help you tolerate and complete treatments.
Katherine Pett is a registered dietitian with an MS in Nutrition Biochemistry and Epidemiology. She runs the website Nutrition Wonk, where the goal is to provide high-quality nutrition science news, opinions, and interactive content.