Nutritional Tips During Chemotherapy
Below are some symptoms that you may experience during chemotherapy and how you can manage them to achieve a good diet after each cycle of chemotherapy.
Please contact a dietitian if your treatment symptoms/side-effects persist and you are unable to tolerate normal food and fluid or if you require nutrition support.
Loss of Appetite (Anorexia)
Loss of appetite is very common during cancer treatment. It could be caused by the cancer progression itself, or the prescribed chemotherapy. If chemotherapy is the cause of your loss of appetite, it will likely be reverted after the treatment.
The severity of this side effect depends on the mode of treatment and also the cancer type.
It is always important to try eating well during your cancer treatment.
Diet tips:
• Eat 6 small and regular meals throughout the day
• Plan ahead – plan daily menu in advance
• Have help with meal preparations
• Make every bite count – choose high protein, high energy foods
• Eat breakfasts that contain at least 1/3 of your calorie needs
• Have snacks on-hand at all times
• Eat foods with appealing tastes and smells
• Try new foods, as food-likes and dislikes may change from day to day
Nausea and Vomiting
Almost more than half of the patients on chemotherapy will experience nausea and vomiting. Usually, your oncologist would prescribe medications (anti-emetics) to prevent these symptoms. It is very important for patients to understand that even when the symptoms have subsided you should still continue to take these medications to prevent a recurrence.
Other than that, there are also some dietary tips to manage your symptoms better.
Diet tips:
• Eat before cancer treatment begins
• Eat dry foods such as crackers, toasted bread throughout the day
• Eat bland, soft, easy to digest foods rather than heavy meals
• Slowly sip fluids throughout the day
• Sit up or lie with the upper body raised for one hour after eating
• Rinse mouth before and after eating
• Suck on ice cubes, mints, or hard candies to keep mouth fresh
• Distractions such as TV, music, or reading may be helpful while eating
Avoid:
• Hot, spicy foods
• Deep fried and greasy foods
• Very sweet and sugary foods
• Large meals and soupy dishes
• Foods with strong smells
• Eating or drinking too quickly
• Drinking beverages with meals
• Lying down after meal
Diarrhea
During the chemotherapy, patients’ bowel movements may sometimes be affected. If you suffer from serious diarrhea, your doctor will likely prescribe anti-diarrheal medicine for you. There are also some tips on diet to help you manage the symptoms better.
Diet tips:
• Eat broth, soups, electrolytes drinks, bananas and canned fruits to help replace salt and potassium lost due to diarrhea
• Avoid cruciferous vegetables such as broccoli, cauliflower and cabbage
• Drink plenty of fluids through the day. Room temperature fluid may be better tolerated
• Limit dairy products until the problem is solved
• Limit sugar-free candies made with sorbitol
• Drink 1 cup of fluid after each loose bowel movement
Avoid:
• Hot, spicy foods
• Fatty, greasy or fried foods
• Rich desserts
• Nuts, seeds, or dried fruit
• Drinks that are very hot or cold
• Drinks containing caffeine (coffee, tea, cola, and chocolate)
• Drinks containing dairy products
Constipation
Constipation is a very common problem for cancer patients. If you have unusual bowel movement, it could possibly due to the lack of water or fibre in the diet, a lack of physical activity, or anti-cancer therapies such as chemotherapy, and consumption of medications. Do let your doctor know and there will be some medications that could be prescribed for you to help relieve the problem.
Diet tips:
• Increase the amount of fibre (e.g. fruits, vegetables, and whole grains)
• Drink plenty of fluids (at least 8 – 10 glasses)
• In some cases a low fibre diet may be appropriate with increased clear fluids
• Introduce some physical activity if allowed
• Include over the counter constipation treatments
Dry Mouth (Xerostomia)
Diet tips:
• Eat moist foods with extra sauces, gravies
• Use chewing gum to stimulate saliva production
• Eat frozen desserts or ice chips
• Keep water handy at all times to moisten the mouth
• Avoid drinks and foods that contain lots of sugar
• Use straw to drink
Mouth care:
• Try a ‘mouth wash’ solution; mix ½ -1 teaspoon of salt or baking soda with a glass of water. Do this 4-5 times daily
• Avoid commercial mouth wash that containing alcohol
Mouth Sores (Stomatitis)
Mouth sores may become infected and bleed, making eating difficult. By choosing certain foods and taking good care of your mouth, you can eat easier.
Diet tips:
• Eat soft foods, pureed or liquid diet to decrease chewing
• Avoid citrus and tomato based products
• Avoid rough, coarse or dry foods like crackers, toast, raw vegetables, etc
• Avoid foods that are spicy or salty
• Avoid foods that are acidic like vinegar, pickles, etc
• Try to maximise calories and protein with fortified nutrition supplements
Taste Changes
Patients undergoing chemotherapy often complain of changes in their sense of taste, in particular a bitter taste sensation. A sudden dislike for certain foods may occur.
Diet tips:
• Rinse mouth with water before eating
• Try citrus fruits such as oranges, tangerines, lemons, grapefruit, unless mouth sores are present
• Eat small meals and healthy snacks several times a day
• Eat meals when hungry rather than at set mealtimes
• Use plastic utensils if foods taste metallic
• Meat often tastes bitter, substitute with chicken, fish, eggs and cheese
• Try vegetarian sources of protein such as gluten, tofu, beans, etc.
• Eat meat with something sweet, such as cranberry sauce, jelly or apple sauce
Low White Blood Cell Count (Neutropenia)
Patients who have a low white blood cell count are at an increased risk of infection.
The following suggestions may help in preventing infections when white blood cells counts are low:
• Always check the expiry date of foods before purchasing and consuming them
• Thaw foods in the refrigerator, never thaw at room temperature
• Cook foods immediately after thawing
• Refrigerate all leftovers within 2 hours of cooking and eat them within 24 hours
• Keep hot foods hot and cold foods cold
• Avoid moldy and damaged fruits and vegetables
• Avoid unpacked tofu sold in open bins
• Cook all meat, poultry and fish thoroughly. Avoid raw eggs or raw fish
• Buy foods packed in single servings to avoid leftovers
• Avoid salad bars and buffets when eating out
• Avoid crowded place and people who have infections
• Practice personal hygiene
Eating by mouth is the preferred method whenever possible, but some patients may not be able to take any or enough food through oral means due to complications from cancer or cancer treatment. You may suffer from appetite changes, mucositis, fatigue, pain and fever both during and after treatment. Good nutrition is vital to help you overcome chemotherapy side-effects, maintain an adequate diet and energy level and improve your general well-being.
Please contact a dietitian if your treatment symptoms/side-effects persist and you are unable to tolerate normal food and fluid or if you require nutrition support.
Frequently Asked Questions
Understanding nutritional needs in various cancer treatments is important in caring for the patients. You may read or have been advised by well-meaning friends and family to avoid certain food or to take supplements. However, some of the information may contradict and result in confusion.
The following are some questions that are frequently asked during our encounter with cancer patients and their caregivers. The answer to each question is intended to provide clarification and allow you to make an informed choice.
Does sugar feed cancer cells?
Carbohydrate is the main source of energy for our body, and it is the only source of energy for our brain. Carbohydrate is broken down into simple sugar in the process of digestion and sugar is the simplest nutrient to be utilised by our body cells. Various carbohydrate food that we commonly take are fruits, dairy products, rice, noodles, bread, crackers, bean products, and starchy vegetables including potatoes, corn, tapioca, and also sweetened drinks and desserts.
This means that there is no need to completely avoid sugar, however excessive sugar intake is not encouraged as sugar itself has no other nutrients besides providing the needed calories. In addition, you may like to take note that excessive intake of simple sugar could increase our blood sugar more rapidly compared to intake of complex carbohydrate. When our blood sugar level is high, our pancreas will release insulin to convert the sugar. Hyperinsulinemia or excessive production of insulin is thought to cause inflammatory responses in our body that may lead to increased risk of cancer.
Is honey a better substitute to sugar? Is honey safe to be consumed?
Honey is made up of fructose (~38%), glucose (~31%), water (~17%) and the remaining carbohydrate are maltose, sucrose as well as some complex carbohydrate. It also contains traces of vitamins and minerals, like vitamin C, iron, calcium, phosphate etc.
Honey has anti-bacterial and anti-fungal properties. It also acts as an anti-oxidant. Hence, taking honey has its benefits. However, if one is on active treatment e.g. chemotherapy, radiation therapy or undergoing stem cell transplantation, honey is not safe to be consumed as most honey is not pasteurized and it may contain pollens or even bacteria that could cause allergy or infection.
You may purchase pasteurised honey as an alternative, but you would not obtain all the honey’s goodness as all active enzymes would have been destroyed under high temperature during the pasteurization process.
Is it safe to consume red meat?
Red meat, such as beef and lamb, provides nutrients that are not found in white meat, such as iron, zinc and vitamin B12. These nutrients are important in the formation of red blood cells and haemoglobin. Tainting it once or twice a week would provide sufficient nutrients. On the other hand, if too much red meat is consumed or when it is consumed too often, or in their high fat form, its intake may increase risk of coronary illness and certain cancers.
Can I take supplements during treatment?
Many types of supplements promising various health benefits and claims are available in the market. One must exercise caution when choosing supplements. Do have a good understanding of these supplements and why they need to be consumed?
Multi-vitamins and minerals pill which consists of no more than the upper limit of RDA (Recommended Daily Allowance) for all their nutrients are safe to be consumed during treatment.
Antioxidant vitamins & minerals supplements, or phyto-nutrients & phyto-chemicals that act, as antioxidants are not encouraged to be consumed during treatment. There are controversies in the benefits of taking these supplements in patients undergoing cancer treatment.
Immune enhancing supplements such as amino acids, protein powders are safe to be consumed during treatment. However, do ensure that the supplements are manufactured by a reputable pharmaceutical company.
If you are consuming any other supplement, it is best to discuss with your oncologist and/or dietitian to ensure that you are getting the benefit of these supplements and not overloading your body with unnecessary pills.
Should I go for organic produces?
Plant food are considered organic if they are produced without genetic modification, no chemical fertilizers used and with restricted used of conventional pesticides. For organic livestock, no antibiotic or growth hormones are given. Organic food can be included in the diet of cancer patients but is not always necessary. Given the limited use of food preservatives, organic food may spoil faster and they may have potentially higher amounts of biotoxins due to the lack of externally applied herbicides/fungicides. Hence, when deciding to buy organic food, we need to consider the source of the organic food, it would be ideal if the organic farm that supplies the produce is nearby to ensure shortest transportation time and therefore provide optimum nutritional quality.
What is genetically modified food (GMO)?
Genetically modified food refers to food produced from organisms that have had specific changes introduced into their DNA using genetic engineering methods. These techniques allow crops to be engineered to have increased resistance to pathogens, herbicides and/or provide better nutrient profiles. There is broad scientific consensus that food on the market derived from the genetically modified crops poses no greater risk to human health than conventional food.
Are there any food or diets that cause cancer?
There are many ‘anti-inflammatory’ diets and while each plan has its own twist, all are based on the general concept that constant or out-of-control inflammation in the body leads to ill health, and that eating to avoid constant inflammation promotes better health and can keep disease away.
Here are some examples of food that are thought to be inflammatory, or food preparation process that may increase cancer risks:
* Moulds & toxins: e.g. Aflatoxin in cereals, grains and peanuts and Fumonisin in maize
* Food preparation;
• Heterocyclic amines – cooking meat at high temperature, e.g. deep frying
• Polycyclic aromatic hydrocarbons – produced in meat and fish that has been grilled or barbecue over direct flame
• N-nitroso, formed in foods containing added nitrates/nitrities, e.g. in meat and fish preserved with salt, preservatives, smoking or drying
Is there any diet to prevent cancer recurrence?
The World Cancer Research Fund and American Institute for Cancer Research reviewed thousands of studies and provided summary of factors that help in preventing cancer and cancer recurrence.
Some lifestyle modifications that have proven to be helpful are:
• Body Fatness: Be as lean as possible within the normal range of body weight
• Physical Activity: Be physically active as part of everyday life
• Limit consumption of energy-dense food, avoid sugary drinks
• Eat mostly food of plant origin
• Limit intake of red meat and avoid processed meat
• Limit alcoholic drinks; men not more than 2 drinks per day and women not more than1 drink per day
• Limit consumption of salted foods, smoked foods, avoid mouldy cereals, grains and pulse
• Aim to meet nutritional needs through diet alone, if supplement is needed, be sure you know the reason behind the need.
Nutritional Resources
Nutritional Tips for Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Good nutrition for chemotherapy patients can be affected by poor mouth care, fatique, pain, fever, as well as the many symptoms that can occur during and after chemotherapy treatments. The goal is to know how to overcome these symptoms and maintain an adequate diet after chemotherapy.
Nutritional Tips in Managing Chemotherapy Side Effect can be downloaded here .
Food Safety Guidelines during Cancer Treatment
During cancer treatment, particularly chemotherapy and radiation therapy, patient’s immune system is often compromised, making it more susceptible to food borne illnesses. It is important for patients to observe food safety practices. Food safety practices are basically steps and measures taken during the handling, preparing and storage of food to reduce the risk of food borne illness. This leaflet includes useful tips and guidelines that will help patients and caregivers in preparing food when eating in. It is advisable to select a food that poses lower risk of food borne illness to prevent infections and further complications during cancer treatment.
Eating out is unavoidable at times, the following leaflet provides useful tips and guidelines that will help patients and caregivers in making safe food choices when eating out.
Food Safety Guidelines when Eating In can be downloaded here .
Food Safety Guidelines when Eating Out can be downloaded here .
Nutritional Tips on Texture-Modified Diet
A texture-modified diet is one in which the texture of the food has been changed to allow the food to be safely swallowed. There are different ranges of texture-modified diet, such as; smooth pureed diet, minced diet and soft diet. Selecting the right range of texture will depend on individual restrictions and swallowing abilities. You may move on to the next range of texture-modified foods as and when you are required to. It is advisable for you to consult a dietitian if your medical condition requires you to be on a long-term texture-modified diet.
The following leaflet provides a guide in preparing various textures to suit your requirement.
Nutritional Tips on Texture-Modified Diet can be downloaded here .
