Dietitian Charlotte Graydon has help for people going through one of life’s biggest challenges.
There are few families who haven’t been affected by cancer in some way. Cancer treatment and surgery are major issues to face during this time. And eating well brings yet another set of challenges into the mix.
Your body is under a lot of stress during treatment and, while maintaining a healthy diet is essential, it can be difficult. The cancer itself can cause taste changes, fatigue, anxiety, depression and the sensation of feeling full quickly. In fact, weight loss is often the first symptom patients notice when undergoing treatment, and it occurs in up to 80 per cent of those with cancer.
Treatments can also affect your ability to eat well. Some of the side effects of radiotherapy and chemotherapy can be nausea, pain, diarrhoea and mucositis (inflammation and ulceration of the lining of the digestive tract), so you may not feel like eating much. Also, depending on the location of your cancer, surgery may interfere with your body’s ability to absorb nutrients from your food.
Ditch the diet
Remember, this is not a time to deliberately lose weight or try to diet, regardless of your weight prior to being diagnosed. Your aim should be to remain the same weight throughout your treatment. You may think it won’t hurt to lose a few kilos but, when you’re unwell, any weight loss tends to be from your muscle rather than from your fat. By maintaining your weight, your body will be better able to cope with the treatments and your recovery will be faster.
Common eating problems
You can soon lose interest in food when you’re feeling fatigued, unwell or a little down as a result of your treatment.
Eat little and often. Become a ‘grazer’ and try to eat something, no matter how small, every three hours or so. Large meals will only reduce your appetite more. Choose liquids that provide kilojoules, like smoothies, milkshakes and juices, and drink these after or in between meals rather than just before.
Have food on hand that’s easy to eat such as soups, macaroni cheese and baked beans topped with grated cheese.
Taste and smell changes
These problems are usually temporary but can linger for a few weeks after treatment finishes. A common complaint is not being able to stomach meat or meat products.
Try marinating meat to alter the taste. Remember, your protein requirements are higher at this time so if this doesn’t do the trick, make sure you’re having other protein-rich foods such as cheese, yoghurt or milk, tofu, kidney beans, eggs or fish. Experiment with spices, herbs, lemon juice and marinades. Cleaning your teeth regularly and keeping mints nearby can also help to keep any bad tastes out of your mouth, making food taste better.
This can occur with or without vomiting.
Make sure you take your anti-nausea medications as directed by your doctor. Also, an empty stomach makes nausea worse, so eat small amounts regularly and keep snacks, like nuts, muesli bars and crackers, on hand if you’re going out.
If you can, avoid cooking smells — a great excuse to delegate the cooking to a family member or friend!
Try food that’s easy to heat in the microwave or oven, so there are less cooking smells from a pan or barbecue.
Lay off the fried and fatty foods, as these will often make you feel worse. Foods that are at room temperature or chilled tend to have less aroma so they can be less likely to cause nausea. Don’t worry about eating at the usual mealtimes – just have your main meal at the time of day when you’re feeling your best.
Maintaining an adequate fluid intake is often difficult during treatment, particularly if you have vomiting or diarrhoea.
It’s important to keep up your fluid intake whether it’s from water, broths, fruit juices, ice-blocks, lemonade or ginger ale. And, just as you would with eating food, try sipping smaller amounts in between meals, so there’s less effect on your appetite.
Some of the chemotherapy drugs can cause bouts of diarrhoea. It can also be a side effect of radiotherapy to the pelvic area.
Make sure you contact your nurse or doctor about the diarrhoea as there are a number of treatments that can help. Diarrhoea can rapidly affect the amounts of important salts in your bloodstream which may need monitoring or replacing.
When you are experiencing diarrhoea, it’s vital to keep up your fluid intake. In fact, you need more than usual to replace the fluid you’re losing. Aim for at least eight glasses each day of diluted juices, flat soft drink, weak tea, milk, vegetable juices, broths or nutritional supplements (see Drink in extra nutrients, below).
When you’re recovering from a bout of diarrhoea, start with bland foods such as banana, rice, toast and apples — these foods tend to be better tolerated.
Constipation can be a problem in some cancer patients. If this is you, ensure you have a good intake of both fibre and fluid.
A sore mouth, caused by mucositis, can also be problematic. You may need to alter the texture of your food to make it softer. While you’re not able to eat much, supplement drinks can also ensure you get enough kilojoules and protein.
Treatment can impact your immune system, making you more susceptible to bugs, such as listeria. For details on food safety and low immunity, visit foodsafety.asn.au.
It’s important you see an Accredited Practising Dietitian to make sure you’re getting the nutrition you need. For more information, visit daa.asn.au.
How to get optimum nutrition
Your metabolism increases when you have cancer and also if you’ve had surgery, so it’s essential to boost your protein and kilojoule intake to help your body recover and heal. Here are some simple ways to do this.
Eat more kilojoules
Add kilojoule-rich ingredients (like butter, cheese or cream) to the food you’re already eating. This may seem to go against all the healthy eating advice you’ve heard but, remember, the most important thing is to keep your weight steady.
Adding these ingredients to the food you’re already eating means you won’t need to increase the amount of food you eat, which can be difficult if your appetite is diminished. Try the following:
Add a liberal spread of margarine to your toast, vegetables or mashed potato, as well as a good dollop of oil to your cooking.
Have avocado (sliced or mashed) on your sandwiches.
Add milk, milk powder, ice-cream, yoghurts and cheese to your dishes.
Make a super milk to boost the kilojoules and protein. Just add five tablespoons of skim milk powder to a litre of milk.
Get as many kilojoules as you can from your fluids: use milky drinks such as Milo, soups, juices, cordials and soft drinks.
Have protein at each meal and snack
It’s important to give your body enough protein to heal and recover from any surgery and treatment. Include high-protein foods each time you eat:
Add peanut butter to your toast or crackers.
Make a quick and easy breakfast with baked beans or eggs and cheese on toast.
Try vegetarian patties, kidney beans or lentils if you can’t come at meat.
Keep flavoured cans of tuna to add to pasta or sandwiches.
Try creamy pastas or lasagnes instead of tomato-based versions.
Drink in extra nutrients
There are specifically designed supplement drinks available that can be used in addition to what you’re already eating. However, they are not meal replacements. High in kilojoules and protein, these drinks do not have all the nutrients you need, so it’s important to eat well, too.
Try Sustagen and Ensure Plus powders, which are available from your local pharmacy. You can simply mix them with milk or water or sprinkle on ice-cream, custard or rice puddings.
Look for supplement drinks such as Sustagen, Resource, TwoCal HN and Ensure, also available from pharmacies. Talk to your dietitian, doctor or nurse to see whether these drinks are appropriate for you and, also, if you qualify for a subsidy on the cost.
Studies show that between one-quarter to half the number of people with cancer use alternative or complementary therapy. If you have questions about a particular therapy you may have heard about, discuss this with your doctor and/or dietitian. For further details, visit Cancer Council Australia at cancer.org.au.