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Eating Hints Before, During and After Cancer Treatment Charles Clark People with cancer have different diet needs. People with cancer need to follow diets that are different than what they think as healthy. A healthy diet includes: • Fruits and Vegetables, whole grain breads and cereals • Modest amounts of meat and dairy products • Small amounts of fat sugar and salt • With cancer you need to eat to keep up your strength and deal with side effects. • With cancer you will need extra protein and calories. Your diet may include extra milk, cheese and eggs. With problems with swallowing there is a need for sauces and gravies. You may need low-fiber foods instead of high fiber. Cancer treatment can cause side effects that lead to eating problems • Appetite loss • Constipation • Diarrhea • Changes in sense of taste or smell • Dry mouth • Lactose intolerance • Nausea • Sore mouth • Vomiting • Weight gain or loss Ways to get the most from food and drinks • Eat plenty of protein and calories. This helps keep up energy and rebuild tissues harmed by cancer treatment. • Eat when you have the best appetite. Add extra protein shakes between meals when possible. • Eat those foods that you can. Even if it is several times a day. • Notify you doctor if you cannot eat for more than 2 days. • Drink plenty of liquid. Water and clear liquids are best choices. Take special care to avoid infections from food preparation. • Keep foods hot or cold. Put leftovers in the refrigerator as soon as you have finished eating. • Scrub all raw fruits and vegetables before you eat them. • Wash hands, kitchen utensils, cutting boards and counter tops. • Use one cutting board for meats and another for fruits and vegetables. • Thaw meat, chicken, turkey and fish in the refrigerator or defrost in the microwave Do now leave then out at room temperature. • Cook meat, chicken, turkey and eggs properly. Meat should not be pink and eggs should be hard not runny. • Do not eat raw fish or meat. • Make sure all juices and milk products are pasteurized. • Do not buy foods from bulk bins. • Do not eat at buffets, salad bars or self-service restaurants. • Do no eat foods that show signs of mold. • Do not eat foods that have spoiled. Appetite loss Appetite loss is when you do not want to eat or when you do not want to eat very much. It is common to have appetite loss for 1 or 2 days at time. We do not know why this happens. Here are some reasons Fatigue Pain Feelings such as stress, fear, depression and anxiety Cancer side effects like nausea, vomiting or changes in food taste or smell Ways to manage with food • Drink liquids or powdered meal replacement like 'instant breakfast". Get the best choices from a dietitian. • Eat 5 or 6 small meals instead of 3 large meals • Keep snacks nearby for when you feel like eating. • Add extra protein and calories to your diet. • Drink liquids throughout the day. Soups, soy-based products with protein are very good choices. • Eat a bedtime snack (a milk shake or fruit.) • Eat soft, cool or frozen foods. • Eat larger meals when you feel well and are rested. • Sip only small amounts of liquid during meals. If you drink too much you will get full and not get the amount of food you need or require. Changes in sense Taste or Smell Meats may taste bitter or metal like. Other foods you like may not smell good go you. Why this happens Cancer treatment, dental problems or the cancer itself may be the cause of this. Ways to manage less taste and smell • Choose foods that look good and smell good. • Marinate foods. • Try tart foods and drinks • Make foods sweeter. • Add extra flavor to your foods. Like bacon bits, onions, vegetables, herbs like basil, oregano, or rosemary. Use barbecue or other sauces on meat or chicken. Avoid foods and drinks with smells that bother you. Ways to reduce smells • Keeps foods covered. • Use cups with lids (travel mugs) • Use a straw. • Cook outdoors. • When cooking, lift lids away from you. • Use fans when cooking. • Serve foods at room temperature. Other ways to help Talk with a dietitian, dentist. Good oral care. Use special mouthwashes Talk with your doctor or nurse or cancer coach. Constipation Constipation happens when bowel movements become less frequent and stools become hard, dry or difficult to pass. Bowel movements may be painful, and you may have nausea. It is also common to have belching, pass a lot of gas, stomach cramps or pressure in the rectum. Chemotherapy, the location of the cancer, pain medications, and other medications may cause constipation. Less in take of fluid and less activity may also cause constipation. Ways to manage constipation • Drink plenty of liquids. • Drink hot liquids • Eat high-fiber foods • Talk with a dietitian • Keep a record of your bowel movements • Be active every day. • Notify you doctor or nurse, if you do not have a bowel movement in 2 days. Diarrhea Diarrhea occurs when you have frequent bowel movements that may be soft, loose or watery. Foods and liquids pass through the bowel so quickly that your body cannot absorb enough nutrition, vitamins, minerals and water. This can cause dehydration. Diarrhea can be mild or severe and last a short or long time. Diarrhea can be caused from cancer treatments, such as radiation therapy to the abdomen or pelvis, chemotherapy or biological therapy. These treatments can cause diarrhea because they harm healthy cells in the lining of you large and small bowel. Diarrhea can be caused from infections, medicine used to treat constipation, or antibiotics. Ways to Manage with food. • Drink plenty of fluids to replace those that are lost from diarrhea. Gatorade, sports drinks, ginger ail, water and Propel. • Soups • Bouillon • Clear Broth • Consommé • Drinks • Clear fruit juices (Apple juice, cranberry or grape) • Clear carbonated soda or water • Flavored water • Fruit-flavored drinks • Sports Drinks • Water • Weak tea with no caffeine • Jell-O • Gelatin • Honey • Jelly • Popsicles • Let carbonated drinks loose their fizz before you drink them. • Eat 5 to 6 small meals instead of 3 large meals. • Eat foods and liquids that are high in sodium and potassium. • Eat low- fiber foods. • Have drinks at room temperature. Avoid foods or drinks that can make diarrhea worse. • Foods high in fiber, such as whole wheat breads and pasta. • Drinks that have a lot of sugar. • Very hot or very cold drinks. • Foods and drinks that give you gas. (Beans, raw vegetables and fruit) • Greasy or fatty foods (French fries and hamburgers) • Milk products unless they are low-lactose or lactose-free. • Alcohol like beer, wine and hard liquors. • Spicy Foods (pepper, hot sauce, salsa and chili) • Foods or drinks with caffeine (regular coffee, some sodas, chocolate). • Apple juice if high in sobitol. • Drink only clear liquids for 12 to 14 hours after a sudden attack of diarrhea Tell your doctor if you have diarrhea for more than 24 hours. Dry Mouth Dry mouth occurs when you have less saliva than you used to. Without saliva it is harder to talk, chew and swallow food. Dry mouth will change the way food taste. Why dry mouth happens Chemotherapy and radiation therapy to head and neck area can damage the glands that make saliva. Biological therapy and some medications may also cause dry mouth. Ways to manage with food • Sip water throughout the day. This can help moisten your mouth and help with swallowing and talking. Many people carry water bottles with then. • Have very sweet or tart foods and drinks (Lemonade) do not drink anything sweet or tart if you have a sore mouth or throat. This will make these problems worse. • Chew gum or suck on hard candy, popsicles and ice chips. Choose sugar-free gum or candy. If you have diarrhea, check with your diarrhea before using sugar-free products. • Eat foods that are easy to swallow. Pureed cooked foods or soups. • Moisten food with sauce, gravy or salad dressings. • Do not drink beer, wine or any type of alcohol. Alcohol causes more dryness. • Avoid foods that can hurt your mouth. This includes foods that are very spicy, sour, salty, hard or crunchy. Others ways to manage • Talk to a dietitian. They have great information to help in problems. • Keep your lips moist with lip balm. • Rinse your mouth ever 1 to 2 hours. Mix 1/4 teaspoonful baking soda and 1/8 teaspoonful with 1 cup of warm wager. Rinse with plain water after using this mixture • Do not use mouthwashes that have alcohol. • Do not use tobacco products, and avoid second-hand smoke. Consult with a dentist for special dental care. Ways to learn more National Oral Health Information Clearinghouse. Phone 301-402-7364 Online www.nidcr.nih.gov Lactose Intolerance Lactose intolerance occurs when your body cannot digest, or absorb a milk sugar called lactose. Lactose is in milk products such as cheese, ice cream, and puddings. Symptoms of lactose intolerance may be mild or severe or may include gas, cramps, and diarrhea. These symptoms may last for weeks or months after treatment end. Sometimes this is a life-long problem. Why it happens Lactose intolerance can be caused by radiation therapy to the abdomen or pelvis or other treatments that affect the digestive system, like surgery or antibiotics. Ways to manage with food • Prepare your own low-lactose or lactose-free foods. • Choose lactose-free or low-lactose free foods. Low lactose foods may include milk, or ice cream that has the label "lactose free" or "low-lactose". • Try products made with soy or rice. People with certain types of cancer cannot eat soy products. Consult a dietitian for more information. • Choose milk products that are low in lactose. • Hard cheeses (like Cheddar) and yogurt are less likely to cause problems. Other ways to manage • Talk with your dietitian. • Talk with your nurse or doctor. Lactase tablets break down lactose. Nausea Nausea occurs when you feel queasy or sick to your stomach. Vomiting may follow, but not always. Nausea can keep you from getting the foods, vitamins and nutrients you need to maintain health. Why this happens Nausea can be a side effect of surgery, chemotherapy, biological therapy and radiation to the abdomen, small intestine, color or brain. Cancer or other types of illnesses may cause it. Ways to Manage • Eat foods that are easy on your stomach. White toast; plan yogurt, and clear broth. Lemon, lime or other tart foods also is a good choice. • Eat 5 to 6 meals a day instead of 3 large meals. • Do not skip meals and snacks. • Choose foods that appeal to you. • Sip small amounts of liquids during meals. • Have liquids throughout the day. Drink slowly and it is good to use a straw or drink from a bottle. • Have food or drinks that are not too hot or not too cold. It is best to consume foods at room temperature. • Eat dry toast or crackers before getting out of bed in you have nausea in the mornings. BE SURE TO TELL YOUR DOCTOR OR NURSE IF ANTINAUSEA MEDICATIONS DO NOT WORK. Other ways to manage. • Talk with your doctor about medications to prevent nausea. (Antiemetic or ant nausea medications) Medications may need to betaken 1 hour before treatments and a few days after. Acupuncture may also help. • Talk with a dietitian about ways to get enough to eat even if you have nausea. • Relax before each cancer treatment. Deep breathing exercises, meditation, prayer and hypnosis may help. Music and reading also will help in getting a quiet space. • Rest after meals. Try sitting up not laying down. • Wear clothes that are comfortable and loose. • Keep records of getting nausea. This information will aid in getting the proper treatment. • Avoid strong food and drink smells. This includes foods that are being cooked, coffee, fish, onions and garlic. Ask others to cook for you. • Open a window or turn on a fan, if the living area feels stuffy. Fresh air can help relieve nausea. Do not keep rooms to warm. Sore Mouth Radiation therapy to the head and neck area, chemotherapy and biological therapy can cause mouth sores (little cuts or ulcers in the mouth) and tender gums. Dental problems or mouth infections, such as thrush, may make your mouth sore. Why this happens Cancer treatments can harm the fast-growing cells in the lining or your mouth and lips. Your mouth and gums will feel better after treatment. Ways to manage with food • Choose foods that are easy to chew. Choose soft foods like milkshakes, scramble eggs and custards. • Cook food until they are soft and tender. • Cut foods into small pieces. • Drink with a straw. • Use a very small spoon. • Eat cold or room temperature foods. • Suck on ice chips. • Avoid certain foods and drinks when your mouth is sore. • Citrus foods and juices like oranges, lemons and lemonade • Spicy foods like hot sauces, curry dishes, salsa and chili peppers • Tomatoes and Ketchup • Salty foods • Raw vegetables • Sharp, crunchy foods like granola, crackers potato and tortilla chips • Drinks that contain alcohol • If you have a sore mouth do not use tobacco products or drink alcohol. Other ways to manage • Talk with a dietitian for more information. • Visit a dentist 2 weeks before starting biological therapy, chemotherapy or radiation therapy of the neck or head. • Rinse your mouth 3 to 4 times a day with a baking soda and salt mixture. • Check each day for any sores, white patches, or puffy and red areas in your mouth. • Tell your doctor if you notice any of these changes. • Do not use any items that can hurt or burn your mouth such as: • Mouthwash with any alcohol. • Toothpicks or any sharp objects. • Cigarettes, cigars, or other tobacco products. • Tell your doctor and dentist about your mouth or sore gums. • Ask your doctor for medication for pain. Ways to learn more National Oral Health Information Clearinghouse Ask for the booklet Chemotherapy and Your Mouth and Head and Neck Radiation Treatment and Your Mouth Phone: 301-402-7364 Online: www.nidcr.nih.gov Smokefree.gov Provides resources about tobacco and ways to quit. Toll-free: 1-877-44U-QUIET (1-877-448-7848) Online: www.smakefree.gov Sore Throat and Trouble Swallowing What it is Chemotherapy and radiation therapy to the head and neck can make the lining of the throat inflamed and sore (esophagitis). It may feel like a lump in your throat or in your chest or the throat is burning. This will cause problems in swallowing. This leads to weight loss Why this happens • Some types of chemotherapy and radiation to the neck and head can hare fast-growing cells, such as those in the lining of your throat. Risk factors are • How much radiation you are getting • If you are getting chemotherapy and radiation therapy at the same time • Weather you use tobacco or drink alcohol during your course of treatment Ways to manage with food • Eat 5 to 6 meals a day instead of 3 large meals. • Choose foods that are easy to swallow. • Choose foods that are high in protein and calories. • Cook foods until they are soft and tender. • Cut food into small pieces. Your can puree foods using a food blender or food processor. • Moisten and soften foods with gravy, sauces, broth or yogurt, • Sip drinks through a straw. • Do not eat or drink things that can burn or scrape your throat, like: • Hot foods and drinks • Spicy foods • Foods and juices that are high in acid like tomatoes, oranges and lemonade. • Sharp, crunchy foods, such as potato and tortilla chips • Drinks that contain alcohol Tell your doctor if your have: • Problems swallowing • Feel as if you are choking • Cough while eating or drinking Other ways to manage • Talk with a dietitian. • Sit upright and bend your head slightly forward while eating or drinking. • Do not use tobacco products. • Think about tube feedings. • Talk with your doctor or nurse. Vomiting What it is Vomiting is another way to say "throwing up". Why it happens Vomiting may follow nausea and be caused by cancer treatment, food odors, motion, an upset stomach, or bowel gas. This may happen right after treatment or even several days later. Dry heaves occur when the stomach is empty. Biological therapy, some types of chemotherapy and radiation therapy to the abdomen, small intestine, color and brain can cause nausea, vomiting or both. This also may happen because treatments harm healthy cells in the digestive system. Ways to manage with food • Do not have anything to eat or drink until your vomiting stops. • One the vomiting stops drink small amounts of clear liquids. • Once you can drink clear liquids without vomiting, try full-liquids and drinks that are easy on your stomach. • Eat 5 to 6 small meals instead of 3 large meals • Be sure you tell your doctor or nurse if your ant nausea medicine is not working. • Other ways to manage • Get a prescription to prevent or control vomiting • Prevent nausea • Call your doctor if your vomiting is severe or last more that 1 or 2 days. • Weight Gain • Weight gain occurs when you have an increase in body weight. • Why this happens • People with certain types of cancer are more likely to gain weight. • Hormone therapy, certain types of chemotherapy and medicines like steroids can cause weight gain. These treatment cause the body to retain water, which make you feel puffy and gain weight • Some treatments can also increase the appetite and you will eat more. With more calories that you need will cause weight gain. • Cancer and its treatment cause fatigue and changes in your schedule that lead to a decrease in activity. Being less active leads to weight gain. • Do not go on a diet to loose weight before talking to your doctor. Ways to manage with food • Eat lots of fruits and vegetables. • Eat foods that are high in fiber like whole grain breads, cereals and pasta. • Choose lean meats like lean beef, pork trimmed of fat or poultry without skin. • Eat less fat. • Cook with low-fat methods like broiling, steaming, grilling or roasting. • Eat small portion sizes. • Eat less salt. • Other ways to manage • Talk with a dietitian. • Exercise every day. • Talk with your doctor before going on any diets to lose weight. • Weight Loss • Weight loss is when you have a decrease in body weight. • Weight loss is caused by cancer itself or the side effects from cancer treatment, such as nausea and vomiting. Stress and worry can cause in weight loss. This is a very common problem with cancer treatment. • Ways to manage with food • Eat when it is time to eat, rather than waiting until you feel hungry. • Eat 5 to 6 small meals a day instead of 3 large meals. • Eat foods that are high in protein and calories. • Drink milkshakes, smoothies, juices, or soups if you cannot eat solid foods. • Cook with protein-fortified milk. • Other ways to manage • Talk with a dietitian. • Be as active as you can. • Think about tube feedings. Tell your doctor if you are having problems, such as nausea, vomiting, or changes in how foods taste or smell. After Cancer Treatment Many eating problems go away when treatment ends. Ways to return to healthy eating • Prepare simple meals that you like and are easy to make. • Cook 2 or 3 meals at a time. • Stock up on frozen dinners. • Make cooking easy, purchase cut-up vegetables and ready to eat items at the store. • Eat many different kinds of food. No single food has all the minerals and vitamins you need. • Eat lots of fruits and vegetables. • Eat whole wheat bread, oats, brown rice, or other whole grains and cereals. Add beans, peas, and lentils to your diet. Go easy on the fat, salt, sugar, alcohol and smoked or pickled foods Choose low-fat milk products. Eat small portions (6 to 7 ounces each day) of lean meat and poultry without skin. Use low-fat cooking methods such as broiling, steaming, grilling or roasting. Talk with a dietitian. Information on food choices can make a faster and safer return to health. This article is some of the highlights from "Eating Hints Before, During and After Cancer treatment" You can order this book from NCI by calling 1 800-4 CANCER (1-800-422-6237) PEG TUBE PEG stands for percutaneous (through the skin) endoscopic gastrostomy (Stomach tube). When patients are unable to eat or nourish themselves, a peg tube may be placed through the skin into the stomach. Here you can see the tube within the stomach. Liquid food can be infused through the tube into the stomach. I had to have a Peg tube because the radiation of the throat takes two or more years to heal. For a free coaching session a ($100 value) E- mail me at firstname.lastname@example.org
"Eating Hints Before_ During and After Cancer Treatment"