Nutrition & exercise	Exercise may help recovery	Treatment & eating problems
Tips to help you eat well	Dealing with weight changes	Quick & easy meals
High energy drink recipes	Eating tips for kids with cancer	Eating well: general guidelines

Tips to help you eat well

Thursday 31 January, 2008

Reviewed by:
Dr Michael Jefford, Medical Oncologist, Peter MacCallum Cancer Centre
Vivian Kong, Accredited Practising Dietitian, Peter MacCallum Cancer Institute
Brooke Chapman, Dietitian, APD, Austin Health

Taken from Nutrition & Exercise booklet (515kb)

Nutrition & exercise brochure On this page:

Loss of appetite

Taste changes

Nausea and vomiting

Dry mouth and/or throat

Sore mouth and/or throat

Indigestion

Bowel problems

A word about supplements

Good nutrition is important during treatment. Sometimes the side effects of treatment or the effects of illness can make it difficult to eat and drink all that your body needs. You may have problems such as decreased appetite, nausea, vomiting, sore mouth and throat, or bowel changes. The following information provides tips to help you eat well during this very important time.

Loss of appetite

Take advantage of every opportunity to eat (e.g. if your appetite is better in the morning, plan bigger meals then and smaller snacks later in the day).
Eat small, regular meals (e.g. have six small meals instead of three large ones to avoid overloading your stomach).
During the day, have frequent sips of nourishing fluids such as milk drinks and juices, rather than tea or coffee. There are recipes for high-energy drinks on this site. Try making up a jug, keeping it in the fridge and having a small glass every hour or every time you think of it.
Avoid cooking smells that put you off eating. Ask other family members to cook for you, or use foods that are ready to eat. Foods that are cold or at room temperature may be more appealing.
Having family and friends around at meal times makes it more enjoyable. Avoid talking about your treatment at meal times.
Exercise may also help to stimulate your appetite. Try some light exercise for 10 minutes before meal times.
Choose foods with attractive colours and use garnishes. Foods that look good are more appealing.
If you are not hungry, you may find that you forget to eat. In this case you should keep to a planned meal pattern and ‘eat by the clock'.
Try to relax before meals - worry or anxiety can affect your appetite.
Eat your most nourishing meal or snacks when you are feeling the best.

If your doctor allows, have a small glass of dry wine, beer or spirits about half an hour before a meal to help stimulate your appetite. Don't drink too much. For men, the recommended limit is no more than two standard drinks a day. For women, it's one standard drink per day. A standard drink equals:

285 mL of beer (one glass of beer) or
100 mL of wine (one glass of wine) or
30 mL of spirits (one measure of spirits).

Taste changes

If you experience taste changes, and food you used to like does not taste good, try new foods.
Experiment with herbs, spices, sauces and dressings for extra flavour.
Red meat may be unappealing. Try chicken, fish, eggs, cheese, tofu or legumes such as baked beans to give you protein instead.
Always make sure your mouth feels fresh and clean before and after eating.
Try sucking on mints or sour lollies to help keep your mouth fresh (if you are not diabetic).
Use a mouth moisturising lotion. Your doctor, nurse or dietitian can recommend a suitable one for you.

Nausea and vomiting

Nausea is feeling like you may vomit or be sick. People having cancer treatment often have nausea and vomiting. This makes it difficult to eat well during treatment.

Nausea

Nausea can be caused by treatment, medication, anxiety, emotional stress or your illness. There are a number of drugs that help to control nausea and the feeling that you may vomit. It might be best to take these medications regularly, to keep nausea away. If the ones that your doctor has prescribed are not working, tell your doctor or nurse - there are others that you could try. You can also try the following until your symptoms settle.

Have only small snacks around treatment time (e.g. sandwiches, soup, biscuits and cheese, fruit or yoghurt).
Eat small amounts and regularly. For example, eat six small meals instead of three large ones to avoid overloading your stomach.
Don't go for long periods without a snack. An empty stomach can worsen nausea.
If you wake up feeling sick, keep a small snack next to the bed and have it before getting up (e.g. a dry biscuit, or fruit and nut mix).
Cold food or food at room temperature is often better as the smell of hot food can make you feel sick. If possible, ask others to cook for you and stay away from the kitchen while hot food is being prepared.
Have regular sips of cool, clear drinks (e.g. sports drinks, dry ginger ale, flat lemonade, apple juice, ice chips or icypoles).
Salty foods (e.g. dry biscuits, crisps, soup) and sour foods (e.g. lemon, pickles) may help reduce nausea. Sour or mint sweets may also help. Keep these with you.
Try having lighter, lower-fat foods. Avoid rich, heavy foods such as pastry, fried foods, creamy sauces or chocolate.
Remove bad mouth tastes by cleaning your teeth, rinsing your mouth or using a mouth moisturising lotion before eating.

Vomiting

You can avoid some situations where you are likely to feel sick, but not always. You must drink regularly when you have been vomiting in order to avoid dehydration.

After vomiting you will need to try to eat normally again. Here's some advice on how to increase your food and drink intake after vomiting.

Stage 1: Small sips

If you have been vomiting a lot do not try to force food down. Start with small sips of fluid such as water, dry ginger ale, cold flat lemonade, soda water, or diluted fruit juice. Also try ice cubes, flavoured ice or icypoles. Boiled lollies, jellied sweets, mints or citrus flavoured-sweets may also be helpful.

Stage 2: Introducing drinks

Once you feel that your vomiting is controlled, you may find that nausea and the feeling of fullness persist. Try small, frequent sips of nourishing fluids such as milk drinks and juices (e.g. every 15 minutes).

Remember: hunger can make nausea worse. Try jelly, sports drinks, full strength fruit juice, a spoonful of ice cream in lemonade, tea with honey or lemon and sugar, or clear soups.

Stage 3: Introducing solid food

Once you can manage fluids well, try small amounts of solid foods such as plain dry biscuits, thin crisp toast with honey, jam or a yeast-based spread such as vegemite, plain rice, noodles, sago, oatmeal or soft stewed fruit. Milk is nourishing but may be difficult to tolerate at first. If so, try cheese and biscuits, custards, yoghurt or yoghurt drinks, which may be better tolerated.

Stage 4: Returning to regular eating

As soon as you are able, increase your food intake until you are eating a normal, well balanced diet. Heavy, rich foods may still be difficult to digest so are best avoided. Try foods such as fruit and vegetables, plain biscuits, lean, grilled meat, fish or chicken, poached or boiled eggs, boiled, baked or mashed potato, yoghurt or small amounts of milk.

Remember that an important part of manag-ing nausea and vomiting is to take the anti-sickness medications prescribed by your doctor.

If you continue to have severe nausea or vomiting, contact your doctor or treatment nurse.

Dry mouth and/or throat

Eat moist meals and have extra gravies or sauces with them.
Drink fluids with your meals.
Sip fluids between meals to keep your mouth moist.
Cut up or mince food so you don't have to chew as much.
Talk to your doctor or nurse about oral lubricants/moisturisers.

Sore mouth and/or throat

Keep your mouth clean and use the mouthwashes your doctor or nurse recommends.
Avoid very hot or very cold food and drinks.
Avoid highly seasoned or spiced foods such as pepper, chilli, mustard, vinegar, salty foods, curries and spiced sauces.
Avoid rough, crunchy or dry foods such as potato chips, nuts, pretzels, crisp toast, dry biscuits, crust on roasts or fried foods.
Try fruit nectars or blackcurrant syrup instead of citrus fruit juices.
Effective pain relievers are available to soothe or numb the mouth. If one pain reliever is not working well enough, speak with your doctor or nurse about increasing your dose or adding an extra pain reliever. Contact your doctor or treatment nurse for more information.

Indigestion

Try six small meals rather than three large meals each day.
Avoid fried and fatty foods and highly seasoned spicy foods.
Drink between meals rather than with meals. Sips of milk or yoghurt drinks are sometimes helpful.
Relax at meal times. Eat slowly and chew food well.
Avoid alcohol, smoking, coffee, strong tea and very hot drinks.
Avoid lying down for two or three hours after meals, or use pillows to raise your head.
Avoid lying down for two or three hours after meals, use pillows to raise your head or try lifting the head of the bed by putting wood under the bed legs.
Speak to your doctor or nurse about medication that might reduce indigestion.

Bowel problems

Your treatment may cause constipation or diarrhoea. These can be caused by radiotherapy, chemotherapy, medications, anxiety, infection or a change in diet.

Constipation

Constipation is when your bowel movements are not regular and you have hard motions that are difficult to pass. Medications such as strong pain relievers are a common cause of constipation. Other common causes include a diet lacking in fibre, poor intake of fluids and lack of exercise.

Try the following:

Have more wholegrain breads and cereals.
Have more fruit and vegetables (especially raw and unpeeled).
Drink 6 to 8 cups (1.5 to 2 litres) of fluid each day. This can include water, milk, juice, cordial, tea, coffee and soups.
Try to do light exercise regularly, such as walking.
Use a fibre supplement or laxative. Ask your doctor or nurse to suggest one for you.

Constipation caused by pain relievers, such as codeine and morphine, is not always helped by eating extra fibre. Your doctor should prescribe medication to help bowel function when your pain relievers begin. Speak to your doctor about this.

Diarrhoea

Diarrhoea is frequent, watery stools. Your body loses a lot of fluid when you have diarrhoea, so you need to replace this fluid. If diarrhoea is severe, or persists for more than a couple of days, there is medication you can take to treat it - speak to your doctor or nurse. Try these suggestions until your diarrhoea is better.

Drink lots of fluids. Aim to have 8 to 12 cups (2 to 3 litres) of fluid each day. Water, sports drinks and electrolyte-replacing treatments are recommended (e.g. Gastrolyte, Hydralyte).
Eat small, frequent meals. Have 6 smaller snacks rather than 3 large meals each day.
Reduce raw fruit and vegetables. Avoid all skins and seeds. Have soft, stewed or canned fruits, such as banana and stewed apples, and soft cooked vegetables, such as potato or pumpkin.
Reduce your intake of wholegrain and wholemeal breads and cereals. Have white bread and rice, plain biscuits and refined breakfast cereals.
Have products containing ‘good' bacteria: those that have ‘active' or living bacteria, sometimes labelled ‘probiotic' (e.g. yoghurt, Yakult).
Avoid fatty foods. Have tender, lean meats with skin and fat removed.
Avoid spicy foods.
Have small amounts of dairy foods.
Avoid caffeine, alcohol and drinks that are very hot or cold.

Once your bowel function returns to normal, it is very important that you return to a balanced diet that includes fresh fruit and vegetables and wholegrain breads and cereals.

A word about supplements

Many people assume that dietary and herbal supplements can be safely taken along with prescription medication. Unfortunately, this is not always true and large doses of some vitamins and minerals may reduce the effectiveness of cancer treatment. Consult with your doctor before taking any dietary and herbal supplements.