The stress put on the body while battling cancer, and the strength needed to go through treatment, makes protein an extremely important nutrient during this time. According to oncology nutritionist Carol Sullivan of Massachusetts General Hospital, “Having cancer can boost the body’s protein needs by 30 to 60 percent. Even though most Americans get plenty of protein, the decreased appetite that can come with cancer makes meeting protein needs harder.”
Margaret Ziegler, outpatient clinical dietician at Memorial Sloan-Kettering Cancer Center, further emphasizes the importance of protein. “When you see weight loss [during cancer], it’s not that extra 5 pounds you’ve been wanting to lose — it’s lean tissue. You can counteract that loss and maintain a healthy weight by including more protein in your diet — chicken, fish, beef, eggs, dairy, nuts, beans, legumes, tofu.”
Wholesome snacks such as cheese with fresh fruit, nuts and dried fruit, or peanut butter on toast, are an important way to avoid unintentional weight gain and deal with a decreased appetite. “Sometimes seeing a large amount of food can make the problem of a decreased appetite worse,” says Ziegler. “I’d rather someone eat two bites every hour than nothing at all.”
Snacking can also help manage the various symptoms that may occur during treatment. Colleen Doyle, director of nutrition and physical activity at the American Cancer Society, explains, “If you experience nausea, keep food in your stomach by eating small frequent snacks throughout the day. If having difficulty swallowing or sore mouth, it’s usually easier to eat smaller, more frequent meals and snacks.”
Fiber needs vary according to the type of cancer, treatment, and symptom. If suffering from constipation, Ziegler recommends “including higher-fiber foods, adding them in gradually, and pairing with extra liquids to avoid stomach discomfort.” However, eat low-fiber foods if experiencing diarrhea. “Include white bread, pasta, rice, potatoes, pretzels, crackers, and only well-cooked vegetables, bananas, applesauce, or smooth peanut butter,” Ziegler suggests.
Fiber is an example of a nutrient that can vary greatly in necessity based on an individual’s treatment plan. Sullivan elaborates, “Exercising and focusing on a high-fiber diet is important with prostate cancer. However, radiation in the pelvis area puts a patient at high risk for diarrhea — so in that case one should avoid fibrous foods.”
Scheduling time to eat becomes necessary if one’s appetite has decreased. Mary Eve Brown, nutrition specialist at Johns Hopkins, explains how thoughts about eating have to change when no longer associated with hunger. “If you don’t have an appetite, then food has to be considered as part of your treatment course.” Margaret Ziegler advises creating reminders to eat. “If there’s no internal hunger signals, set an alarm.”
Cancer patient Rick Shonkwiler testifies to the importance of having an eating schedule. “When my appetite was lessened, I made sure to stay on a routine. There were times I ate when I wasn’t hungry.”
According to Sullivan, a large part of a dietician’s role when assisting cancer patients is debunking myths and anecdotal theories about nutrition. “There’s this myth circulating that sugar feeds cancer cells — that is not true.” Ziegler elaborates, “All cells need sugar. We have seen that if people who are overweight or insulin-sensitive follow a sugar-filled diet, their bodies release more insulin. It’s true that insulin levels over time make cells grow, but it’s unclear what type of cells.”
Though a cancer diagnosis should never be a green light to eat whatever you want, strict avoidance of sugar or other unhealthy foods becomes less important if there is a severe loss of appetite. “Eat healthier foods if possible,” Ziegler recommends, “But if your appetite is down and all that sounds good is a milkshake, have it!”
Switching to bland foods may also help alleviate some symptoms of treatment. Says Ziegler, “For people with nausea and diarrhea, choose bland foods and pair them with lean protein — like a piece of white bread with turkey. Often breakfast foods are better tolerated, so try eating things at mealtimes such as scrambled eggs, pancakes or waffles.” According to Doyle, “Greasy, fried, spicy, or very sweet foods can irritate the digestive tract.” Other strong foods aggravate the problems of sore mouth or difficulty swallowing, such as “tart, acidic, or salty foods and drinks (citrus, tomato-based foods, pickled, and vinegar-based foods, etc.,” says Doyle.
“Your nutritional status is the cornerstone of how you do during treatment,” Brown emphasizes. With that in mind, dieticians across the board agree that every bite should count. This is especially necessary for patients with a loss of appetite. “Every bite should have nutrition in it,” Brown clarifies. “Don’t drink soda or even water — hydrate instead with fruit and vegetable juices, soups, or broth.”
“Try to make every calorie count,” Doyle insists. “Focus on calorie- and nutrient-dense foods — cheese, nuts, peanut butter, etc. Add high calorie foods to things you do feel like eating or that sound good — sour cream and/or butter to a baked potato (or even more than you might usually add), peanut butter on toast, whipped cream on hot chocolate, cream cheese on a bagel. Switch to full-fat dairy products if you tend to go for skim milk, fat-free yogurt, and reduced-fat cheese.”
Cancer patients may find that foods begin to taste differently. “Some find that foods taste bitter or metallic,” Doyle says. “Add lemon juice or vinegar to vegetables to mask these side effects. If metallic tastes are a problem, use plastic utensils, cook in glass or ceramic cookware, and avoid canned foods.”
Pay attention to what sounds good when confronting this side effect. “When experiencing taste changes, identify which tastes appeal the most (sour, sweet, etc.) and add that to what you’re eating. For example, if salty foods appeal the most, add condiments to things,” Brown suggests.
Asking for help with meeting your nutrition needs may be the most fundamental step a person with cancer can take. Shonkwiler speaks from experience. “Make sure you find a doctor or team of doctors that will talk to you, so that you’re not just another patient or number," he says. "Find a support group. You’ll get a lot of different information, but it’s better than guessing your way along.”
Doyle insists, “Recognize that even if — especially if! — you are someone who likes to ‘do it on your own,' this is a time to take care of yourself and part of that is letting some things go. Shopping for food and providing food are things that others can do — and usually really want to do — so allow yourself to let others help you out in that way.”
To find a dietician that can help you, visit the Academy of Nutrition and Dietetics’ web site EatRight.org and click their option "Find a Registered Dietician." You can search by location and expertise area.
Increasing fluid intake aids with symptoms such as constipation and dry mouth, reports Ziegler. Colleen Doyle offers tips for staying hydrated to patients experiencing diarrhea. "Try drinking a cup of liquid after each episode," she says. "Sports drinks, broth, or diluted juices can help replace electrolytes and provide fluids.
Liquids play a two-fold role when battling weight loss. If you get full quickly, drink most of your fluids between meals so that you are hungrier at meal times, Doyle suggests. On the other hand, liquids can play a vital role in adding calories if a patient has no appetite. For some people who dont feel like eating, they may feel like drinking, Doyle points out. Commercial nutrition supplements, instant breakfast drinks, or milkshakes may help.