Side effects of cancer treatment that can affect the way you eat and strategies to overcome them

Your cancer treatment may change the way you feel about eating.  You may find that eating is uncomfortable, that you have lost your appetite, or that food just doesn’t taste the same anymore.  These side effects do not happen to everybody, and when they do occur, they usually subside after treatment.  If you do find that treatment is impacting your ability or interest in eating, consider these strategies to help you get the nutrition you need:

Poor appetite and weight loss can both be caused by depression, abdominal discomfort, and certain medications.  Decreased appetite may make large meals seem overwhelming.  If this is the case, try to eat several small meals and snacks frequently throughout the day.   If you have medication for nausea, take it before meals to minimize symptoms.  If the idea of eating is unappealing, try taking small sips of a chilled supplement such as Ensure Plus or Boost Plus through a straw. 

If weight loss is a problem, try to add fat to foods in the form of butter, cream, olive oil or cheese whenever possible.    Cream sauces, gravy, and ground beef work also work well.  Add extra calories by drinking calorie containing beverages such as milk or juice instead of water.  If you find that you become full very quickly, save your fluids for in between meals and have soups and salads after your entrée.

Altered sense of taste, also known as “mouth blindness”, is usually a short term side effect of chemotherapy or radiation.  Choose foods that have intense flavors such as olives, pickles or citrus.  One quick way to increase the flavor of many foods is by adding fresh herbs and spices.  You can also perk up your appetite by choosing brightly colored foods that have eye appeal.  Tart foods like lemons are also good appetite stimulants.  If you find that meat just doesn’t taste the same, try peanut butter, beans, cheese, cottage cheese, milk, poultry, fish and eggs for protein.  Using sweet tasting marinades like fruit juice or sweet and sour sauce for meat and chicken may also help.  If you find that you have a diminished sense of taste for salty and sweet foods, add extra salt or sugar to nutritious foods instead of eating snack foods.  To avoid offending aromas from hot foods, try eating foods at room temperature.  If all else fails, eat what sounds good to you, instead of eating what you think you should be eating. 

Mouth and throat sores, which come from bleeding and lesions, may be accompanied by pain and inflammation.  This can make eating uncomfortable and decrease your enjoyment of foods.  Try to avoid spices, salty foods, carbonated beverages, and acidic foods such as tomatoes, vinegar and citrus fruits.  You may also want to forgo foods that are rough in texture such as toast, granola, raw vegetables, grainy breads, and cereals.  Instead choose soft, bland foods that are easy to chew and swallow like custards, puddings, cottage cheese, yogurt, mashed potatoes, macaroni and cheese, scrambled eggs with cheese, bananas, and milkshakes.  When preparing foods, cook them until they are soft and cut them into small pieces.  Adding gravies and sauces can also make foods easier to swallow.  You may find that hot foods may be irritating and that cold or lukewarm foods feel better.  Popsicles and cool liquids may also be soothing.

Dry mouth may result from the breakdown of mucous membranes during chemotherapy and radiation.  This can reduce saliva production, making foods more difficult to chew and swallow and can also cause taste changes.  Pureed foods and even baby food can be soothing, as are ice chips and popsicles.  If mouth sores are not a problem, try eating foods that are very sweet or tart to increase the flow of saliva.  Eat moist, soft foods such as soups, custards and stews, taking small sips of liquid between bites.  Or cut your food into small pieces and moisten with gravy or broth.  Keep your mouth wet by making sure that you always have a drink by your side.  Lip balms, salivary substitutes, sugar-free candies, and gum can also help lubricate your mouth.

Difficulty swallowing can make it painful to eat dry, solid foods.  Instead, try moist foods with lots of gravies and sauces, sipping beverages frequently throughout meals.  Soft foods may be easier to swallow than liquids.  If swallowing liquids is difficult, speak to your doctor about a beverage thickener.

Nausea can make it difficult to get enough to eat.  If you are feeling nauseous, ice chips and small sips of soda (if you don’t have mouth sores) may help.  When you do feel up to eating, try small, frequent meals with beverages served separately, in between meals.  Cool or room temperature foods may be more appealing that hot items.  You may also find that foods that are very fatty, greasy, sweet or spicy do not agree with you.  Instead try bland foods, crackers or even potato chips.  Acidic or tart foods may also help.  Foods that are usually comfortable to eat include clear liquids, soft fruits and vegetables, yogurt, toast, pretzels, crackers, cake, and skinless broiled chicken.  Choose your eating environment carefully and make mealtime relaxing by eating in a cool, quiet room.  If odors from kitchen are bothersome, eat in another room or, if the weather permits, try eating outdoors.

Vomiting frequently accompanies nausea.  It can be caused by food odors, motion, treatment, or even certain environments, such as the hospital.  The best way to prevent vomiting is to control nausea.  During periods of vomiting, avoid eating and drinking.  After vomiting subsides, take small sips of clear liquids every 10-15 minutes.  Flat soda that is caffeine free usually works well.  Once you are able to tolerate clear liquids and soda, you can try a full liquid diet and gradually progress to a regular diet. 

Diarrhea, gas, cramps can be brought on by radiation to the abdomen, chemotherapy, infection and even emotional upset.  Because diarrhea can cause dehydration and keep the body from getting enough nutrients, make sure you are drinking plenty of caffeine-free liquids at room temperature.  You may want to limit fatty, greasy and fried foods as well as foods that cause gas such as broccoli, cauliflower, asparagus, cabbage, beans, and raw fruits and vegetables.  Instead opt for bland, binding foods at room temperature like as rice, bananas, toast, weak tea, applesauce, yogurt, cottage cheese, well cooked eggs, canned or cooked fruit without the skin, and skinless chicken or turkey.

If diarrhea is short in duration, try a clear liquid diet for about 12 hours.  During this time, you can replace lost sodium by drinking fat free broth or bouillon.  Try to avoid caffeinated drinks such as coffee, tea, and cola which can be dehydrating.

Sometimes after drug or radiation treatment, diarrhea may be caused by a deficiency in the enzyme that is needed to digest lactose, the sugar in milk.  This condition, known as lactose intolerance, is usually temporary and can be treated by avoiding milk and milk products.  If dairy products are a mainstay of your diet, you can try Lactaid milk or Lactaid drops.  Two milk products that you may be able to eat without a problem are cheese and yogurt – most of their lactose is either removed or broken down during processing. 

Constipation can be caused by certain medications.  Other culprits include insufficient fluid or roughage in the diet and even lack of exercise from being restricted to bed.  You can decrease constipation by adding fiber to your diet by increasing intake of fruits, vegetables, and whole grains such as whole wheat bread or bran cereal.  Try to drink lots of fluids, especially water. When you wake up in the morning, drink beverages that are either hot or cold to stimulate your digestive system.  Drinking prune juice before bed can also be helpful - if the taste is too strong, dilute it with one cup of crushed ice.  If you are confined to bed, speak with your doctor about a brief walking routine.

Weight gain can be caused by certain medications that cause water retention.  The extra pounds that you are carrying are most likely due to excess water weight, not fat.  This is not the time to diet - eating well is especially important now.  Instead, speak with your doctor about a low salt diet or medication that can help your body rid itself of the excess water weight.

Tooth decay, tooth loss, and increased sensitivity to heat, cold and sweets can all result from radiation to the mouth.  To prevent further decay, avoid sweets and sticky foods and pay extra attention to oral hygiene.  To make eating more comfortable, eat soft foods at room temperature.


       Next Page>>

Table Of Contents
____________________________________________________________
AUTHOR: Karen Ansel, MS, RD
The Cancer Information Network 
Date Modified: 04/20/02