Extension Nutrition & Health Specialist,
Department of Food and Nutrition
Good nutrition is important for everyone, especially for the person with cancer. A well-fed body handles the stress of cancer and cancer treatment better than a poorly-fed body. Though many people with cancer eat a fairly normal diet, cancer and its treatment can make a person not want to eat. This can cause malnutrition, weight loss and a slow recovery.
A person will not recover from severe malnutrition until the cancer is effectively treated. Patients with poor nutrition do not do as well during cancer treatment. That's why good nutrition from the start is so important.
Even with severe malnutrition, nutrition support can improve the quality of a person's life in two ways:
1. Any nutrition is better than starvation. Even a little food can help the person feel better and be better nourished.
2. Nutrition is one area where a person with cancer can actively do something to help recovery.
Weight Loss
Loss of appetite and taste changes are two of the main causes of malnutrition in people with cancer. Not eating enough protein and calories lowers the body's stores of fat and protein. The body looks very wasted or "cachexic." A person may lose 10 percent or more of his or her body weight within a few months during cancer treatment.
Weight loss is serious if the person has lost five percent of his usual body weight in one month, or seven and a half percent in three months or 10 percent in six months. Weight loss is severe if more weight than this is lost over the same amount of time.
To see how cancer has affected a person's weight, write down a "weight history" that shows the person's weight before cancer and how it has changed since. Calculate the percentage of the usual weight using the formula:
actual weight
x 100 = percent usual weight
usual weight
Compare this figure to the following guidelines to see how severe the problem is:
|
Percentage of Usual Body Weight |
Malnutrition Severity |
|
85-90% |
Mild |
|
75-84% |
Moderate |
|
74% or less |
Severe |
When weight loss and malnutrition are serious, the goals for good nutrition change. Eating a well-balanced diet low in cholesterol, saturated fat, and sugar and high in fiber becomes less important. Instead the goal is to get enough calories and protein. Foods high in sugar and fat may need to be eaten more often, especially if the person with cancer has little appetite and tires quickly.
How to Nourish the Body
The cancer patient needs to maintain a normal body weight or gain weight if needed. Use foods with more calories when weight loss begins or when cancer therapy makes weight loss likely. The person with cancer will need to eat more often, drink more fluids with calories, add fats and sugars to food if tolerated, and even give into cravings for unusual foods or drink if they help increase food intake and control nausea and vomiting.
To eat enough calories, proteins, vitamins, and minerals, the person with cancer should follow these general guidelines:
1. Drink two cups of milk, or more, per day. Cheese, yogurt, ice cream and other dairy foods may be substituted.
2. Eat two or more three-ounce servings of meat or meat substitutes daily.
3. Eat two or more 1/2 cup servings of fruit daily. One should be a citrus fruit or juice.
4. Eat three or more 1/2 cup servings of vegetables daily. One should be a dark green leafy vegetable or a deep orange vegetable. Eat vegetables after eating the higher protein and calorie foods. Vegetables are nutritious, but their fiber may fill the person up if they are eaten before other foods.
5. Eat six or more servings of bread, cereal or other starchy foods.
6. Eat other foods such as desserts, soups, and beverages as desired.
7. Include nutritious snacks such as nuts, cheese and crackers between meals and before bedtime.
Add more calories and protein in the following ways:
Boosting Calories
1. Butter or margarine - Melt butter or margarine onto hot foods such as toast, soups, vegetables, cooked cereal, rice, and eggs. One teaspoon has 45 extra calories.
2. Sour Cream - Use sour cream on baked potatoes, meats and fruits. One tablespoon contains 26 calories.
3. Mayonnaise - Use mayonnaise instead of salad dressing in meat, poultry and fish salads, deviled eggs, and on lettuce. At 100 calories per tablespoon, it has twice the calories of salad dressing.
4. Peanut Butter - Serve peanut butter with an apple banana, or pear or spread it on a sandwich with mayonnaise. It is also high in protein. One tablespoon of peanut butter has 95 calories and provide almost 5 grams of protein.
5. Whipped Cream - Use whipped cream on top of puddings, pies, hot chocolate, fruit, gelatin, and other desserts. One half cup equals 77 calories.
Foods high in sugar and starch will also add extra calories and can be used as snacks, because they leave the stomach quickly. Choose those that are easy to fix and keep them on hand. For example, float marshmallows on hot chocolate. Spread honey on bread or pour it on cereal. Snack on hard candy, popsicles, popcorn, crackers and jelly.
Boosting Protein
Try high-protein foods to boost protein and calories without increasing the amount of food eaten.
1. Milk - add skim milk powder to regular whole milk and chill well to improve flavor. Use skim milk powder to prepare sauces, gravies and creamed meat, fish or poultry. Cook cereals in milk instead of water. Make instant cocoa, canned soups, and puddings with milk, half and half or evaporated milk. Blend extra ice cream into milk shakes. One cup of whole, low fat or skim milk has eight grams of protein.
2. Meat, Fish, and Poultry - Add small pieces of meat to soups and to vegetable, noodle, or rice casseroles. A three-ounce portion of beef, pork, lamb, fish, chicken or turkey has 21 grams of protein.
3. Cheese - Add grated cheese to cream sauces, casseroles or vegetables. Melt sliced cheese over hot apple pie. Combine cottage cheese and cream cheese with fruits. Use cream cheese on hot bread and rolls. A one-ounce slice of cheese contains about seven grams of protein while 1/2 cup of creamed cottage cheese has 15 grams of protein.
4. Eggs - Blend finely chopped hard cooked eggs into sauces, gravies, and meat, poultry or fish salads. Make desserts and beverages that contain eggs such as angel food cake and eggnog. Only make eggnog from pasteurized frozen eggs or egg substitutes. Raw or undercooked eggs are not safe for the person with cancer. One egg has 7 grams of protein.
Look closely at what food the person likes and dislikes. Fix favorite mealss and snacks at the time of day when the person eats best. Some people with cancer drink liquid nutrition supplements between meals or instead of meals if they are weak or have problems with swallowing or chewing. Others need special tube feedings. A special formula for this can be recommended by the person's doctor or dietitian.
Loss of Appetite and Changes in Taste
Few people with cancer lose their sense of taste completely. Some foods just taste different. Sweet foods may be harder to taste while bitter foods may taste stronger. A person's sex, type of cancer, extent of cancer, and treatment may cause different taste changes.
Protein foods sometimes taste bitter to someone with cancer. Some people eat protein foods better when they are cold or at room temperature. Protein food easily served at these temperatures are cheese, luncheon meat, tuna, chicken, ham, or egg salad, deviled eggs, ice cream, milk shakes, puddings, custards and nuts.
Some people eat protein foods better with more salt. If salt is not restricted, try warm cured meats such as ham, bacon, sausage, corned beef, and lunch meats or meats marinated in soy sauce.
Marinating meats in sweet fruit juices or sweet wines or cooking them with fruit may also improve their taste. Fresh fruit may also improve the taste of milk shakes, ice cream, puddings, custards, and liquid nutrition supplements.
Seasonings, including lemon juice, mint and basil, will help improve the taste and smell of food. Don't try to follow any particular rule in seasoning, use imagination and experiment.
People are more tempted by food served in a pleasant place. Serve food of various colors on the plate and use garnishes. Pretty place settings and soft music can make meals more enjoyable. A calm room helps the person eat more.
Don't worry about serving the same food over and over again. Serve a food as often as the person wants it.
Look for other ways to increase appetite. Light exercise or a glass of wine may help.
Feelings of Fullness, Nausea, Vomiting
When feelings of fullness, nausea, and vomiting are a problem, the goal is to get food through the stomach as quickly as possible. Eating sweet or starchy foods more often in small amounts may help. Fatty and fried food will make the problem worse because they take longer to leave the stomach. There will be more room for food in the stomach if liquids are drunk one hour before or after eating.
Eating dry foods such as toast or crackers, particularly before getting up in the morning, seems to relieve nausea. Cold, clear liquids such as Kool-Aid or soft drinks can help.
Persons with cancer may eat more if they eat slowly and chew food well. They will also want to rest after a meal because activity slows digestion.
Just the smell of food can cause nausea. Staying out of the kitchen while meals are being prepared and opening windows to keep the eating area aired may help. Also cold or room temperature foods have less odor. If nausea becomes too severe, a doctor can prescribe medicine to help control it.
Dry or Sore Mouth and Sore Throat
If the mouth is dry, liquid or moist foods are easier to swallow. If a person is not nauseated, melted butter, gravy, or broth can moisten foods. Sauces or syrups may be helpful, too. Many people dunk food in a drink or take a swallow of liquid with each bite of food.
When the mouth or throat is sore, soft, cold food such as ice cream, popsicles, watermelon, or grapes may be easier to eat. Tilting the head back or using a straw can make swallowing more comfortable. High acid foods such as citrus juices and tomatoes may cause pain, while sweeter fruit drinks and nectars may be pleasant to drink. If pain is severe, a doctor can prescribe medicine to numb the mouth and throat.
Diarrhea and Cramps
Eating food warm instead of hot may prevent diarrhea. Diarrhea may also be controlled by drinking fluids between meals rather than with meals. Eating small amounts of food more often and more slowly may also help. Avoid things that can produce gas or cause cramps, such as carbonated drinks, beer, chewing gum, beans, cabbage, highly spiced foods, skipping meals, and swallowing air while talking and chewing at the same time.
Also lower the fiber in the diet. Fiber usually helps produce softer, more regular stools. However, normal levels of fiber are too much with diarrhea and cramps. Limit raw fruits and vegetables, wheat bran, other whole grain cereals and breads, popcorn, and nuts.
Large amounts of potassium are lost when a person has diarrhea. A doctor may suggest taking potassium supplements or eating more high potassium foods. Some foods high in potassium which will not worsen diarrhea are bananas, red meat, seafood, peeled potatoes and mushrooms. A doctor can prescribe medicine to help control severe diarrhea and cramping.
Constipation
Constipation can be a problem if a person eats or drinks very little. Drugs to dull the pain and to fight the cancer can also cause constipation. High-fiber foods and prune juice act as laxatives. If there is trouble with chewing raw fruits and vegetables, try grating them. Drinking plenty of liquids (including milk) and light exercise may also help. A doctor can prescribe medication for constipation if necessary.
Depression
Depression is common among people who have cancer. At times, good nutrition may seem the least of their problems. Even though eating right is important, the person with cancer should not become too upset if he or she cannot eat. This will only make things worse. There will be days when people with cancer cannot eat as much as they think they should. Again mild exercise and even a funny book or video that causes a healthy belly laugh may help.
Cancer is a disease and requires a total mental and physical effort on the part of the patient, the caretaker and the medical team. The person with cancer will find eating right both challenging and rewarding. Good nutrition is just as important as medicine and surgery for survival and recovery from cancer.
Sources of Information
1. "Nutrition for Health and Healing," Presentation by Cindy Gallagher, RD, LD, to the Northeast Georgia Dietetics Association, March 29, 1990.
2. Nutrition and Medicine - July 1989 - Volume 15, #7.
3. Nutrition: A Helpful Ally in Cancer Therapy - Ross Laboratories , January 1978.
4. Essentials for Dietitians from Norwich Eaton Pharmaceuticals, Inc. Vol. 10 #2.
5. The American Cancer Society Cancer Book, Arthur I. Holley, M.D., editor 1986.
6. Eating Hints, NIH Publication 80-2079, 1980.
7. Aker, S. and Lenssen, P. A Guide to Good Nutrition During and After Chemotherapy and Radiation, Third Edition, Fred Hutchinson Cancer Research Center, 1988.
Reprinted with
permission from the University of Georgia.
Crawley Connie, (1992-07-01) Helping the Person with Cancer
Eat Better Athens, GA: University of Georgia, Cooperative
Extension Service.
The Cooperative Extension Service, The University of Georgia College of Agricultural and Environmental Sciences offers educational programs, assistance and materials to all people without regard to race, color, national origin, age, sex or handicap status.
AN EQUAL OPPORTUNITY EMPLOYER
Food and Nutrition
Issued in furtherance of Cooperative Extension work, Acts of May 8 and June 30, 1914, The University of Georgia College of Agricultural and Environmental Sciences and the U.S. Department of Agriculture cooperating. C. Wayne Jordan, Director
July 1992
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