Revised : August 07
This section has a list of common questions that you may have about nutrition during your cancer treatment. The questions are listed in this order:
The eating challenges section also has information on self care strategies for coping with side-effects of treatments.
Poor Appetite
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Sore Mouth
Swallowing Problems
Taste Changes
Other
What can I do if I don’t have an appetite?
These ideas may help you cope with a poor appetite and give you more energy:
- Eat your biggest meal when your appetite is best. This may be at breakfast time rather than at the traditional evening meal.
- Eat often. Try snacking at least every 2 hours. Try a few mouthfuls even if you are not hungry
- Remember, even very small amounts eaten more often can help.
- Choose high calorie, high protein foods to get the calories you need to prevent unnecessary weight loss.
- Eat what you feel like eating. If only a few foods appeal to you at this time, eat these most often. Variety isn’t as important as quantity at this time.
- Carry energy and protein dense snacks with you if you are going to be away from home during the day.
- Take a break from eating to rest, take a walk or get some fresh air.
- If you are losing weight due to poor appetite , you may wish to consult with a dietitian for additional suggestions.
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What if I feel full after only eating a small amount?
A feeling of fullness can make it hard to eat enough to meet your nutritional needs. Try the following suggestions:
- Eat small amounts every 2 hours
- Emphasize high protein, high calorie foods such as
- Drink fluids between meals. Fluids with meals can make you feel too full.
- Limit foods that make you feel bloated or full. Some examples are: cabbage, broccoli, peppers and dried beans and peas.
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Solid foods don’t appeal to me right now. How can I get enough energy and protein?
A poor appetite sometimes does not allow you to eat regular meals. Liquids and soft foods may be easier to manage when you don’t have an appetite. You can still meet your needs by choosing high calorie, high protein fluids.
Aim for six to eight cups of fluids each day.
Try choices such as:
- Milkshakes
- Soy milk
- Tofu Shakes
- Nutritional supplements
- Fruit juice
- Cream soups
- Buttermilk
- Hot cereal with milk
- Yogurt Smoothies
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What can I do if I am too tired to cook or eat?
Fatigue is a very common side effect of cancer treatment. Eating well may help reduce fatigue.
- Drink as much as you can. Dehydration can lead to fatigue.
- Choose foods that require less effort to eat such as soft, moist or blenderized foods.
- Snack often through the day. This may be easier than trying to eat a large meal at once.
- Include a protein rich food at each meal and snack to sustain your energy levels.
- Use convenience foods such as pre-cut vegetables or prepared foods from the deli.
- Stock your freezer, refrigerator and cupboards with foods that are ready-to-eat or easily prepared.
- Ask friends and family to help prepare meals. Prepare food in bulk and freeze in single serving containers.
- Consider community meal programs or ask your local restaurants or grocery stores about home delivery.
- Try dining out. You may eat more if you don’t prepare the food.
- Eat with friends and family. The social aspect of eating often results in eating more.
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I have heard that eating fruits and vegetables are good for me. How can I eat these when my appetite is poor?
A diet rich in vegetables and fruits is recommended for cancer prevention. They are needed during treatment too. However, vegetables and fruits are low in energy and protein. They also fill you up, leaving less room for higher energy foods. You can add energy (calories) to these foods by using a cheese sauce, extra butter or gravy. Putting fruit in a milkshake/smoothie increases calorie content as does adding ice cream, whipping cream or choosing fruit pie or crisp instead of fruit on it’s own. Drinking fruit and vegetables juice also ensures getting the goodness of vegetables and fruits.
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Should I take extra vitamins and minerals if my appetite is poor?
A multivitamin with mineral may be needed if you’re appetite is poor for a long time. Choose a standard multivitamin and mineral supplement that has 100% of your daily recommended daily amounts. This will help meet your vitamin mineral needs but does not provide you calorie and protein. Most "one a day" brands sold in drugstores is appropriate.
If you would like more information on vitamin and mineral supplements, ask your dietitian or pharmacist for guidance.
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What can I do to make eating easier with chewing difficulties?
- Choose soft, moist, foods.
- Cook foods in liquid until they are soft and tender.
- Mix food with butter, thin gravies, sauces or salad dressing. This increases calories and adds extra moisture.
- Cut or mash foods into small pieces.
- Use a blender or food processor.
- Use a straw to drink liquids.
- Consume food and fluid at room temperature. Cool foods can sometimes be soothing.
- Eat smaller amounts more often.
- Try ready-made or convenience type foods that are soft and moist, such as frozen dinners, canned foods and soups, instant mashed potatoes, or baby food.
- Keep your mouth as clean as you can (see Tips for Mouth Care).
- If pain from your mouth sores is keeping you from eating, ask your doctor about pain medicine.
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Are there any foods I should avoid with a sore mouth?
Some foods may irritate an already sore mouth or throat. The following suggestions may be helpful to you:
- Limit foods that require chewing such as tough meats or poultry, raw fruits and vegetables, bagels and English muffins.
- Limit low calorie fluids such as coffee, tea, water and clear broth if you are losing weight. Instead, choose fluids that are high in calories and protein such as whole milk, hot chocolate, fruit nectars, soft drinks and cream soups.
- Avoid foods and fluids that are:
- tart or acidic
- spicy or salty
- hot or very cold
- rough or crunchy
- dry foods
- contain alcohol
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What are some tips for mouthcare?
Good mouth care will minimize discomfort and help prevent infection. Inform your doctor or dentist of mouth problems that you are experiencing.
Some helpful hints for mouth care are:
- Brush your gums, teeth and tongue with an extra soft toothbrush after every meal. Don't forget to brush the inside surface of the teeth!
- Do not use commercial mouthwashes (SCOPE® or LISTERINE®) as they can irritate your mouth and increase the discomfort.
Rinse your mouth often with a baking soda rinse to remove food and bacteria.
Baking Soda Rinse
Dissolve ½ tsp. Baking soda in 2 cups of water.
Rinse before and after meals and before going to bed.
If you wear dentures.
- Have your doctor or dentist check that they fit. They may suggest that you wear them only when you are eating or not at all.
- Remove and brush your dentures thoroughly after each meal. Rinse your mouth with the baking soda rinse and brush your gums and tongue with an extra soft toothbrush.
After treatment, continue to have regular check ups and cleanings with your family dentist.
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It is painful to swallow. What should I do?
If you have not already done so, speak to your physician about taking pain medication. Pain with swallowing can quickly lead to dehydration and poor nutrition. Choking, gagging coughing, the presence of a fever or difficulty breathing can be signs of more serious problems with your swallowing. Speak to your physician or another health care team member if you are experiencing any of these symptoms.
- Drink liquids if they are easier to swallow.
- Choose liquids that are high in protein and calories such as milk, hot chocolate, ice cream, cream soups or prepared nutritional supplements.
- Aim for 8-10 cups of high calorie fluids per day.
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How do I prepare blenderized foods?
A soft, blenderized diet allows you to continue to eat nutritious, tasty foods despite chewing and swallowing difficulty. The following tips will help you prepare tasty enjoyable meals.
- Read instructions in the equipment manual for your blender.
- Cook foods in liquids such as broth, gravy, cream soup and sauces to help soften them.
- Cut food into bite size pieces before blending.
- Put liquids in blender before solids.
- Blend a small amount of food at a time (e.g. 1 cup). Too much food in the blender will not mix properly.
- Use liquid when blending. See the chart below for general guidelines.
- Avoid blending the entire meal together – blend meat and vegetables/fruit separately. This may be more appealing.
|
Type of Food |
Amount of food |
Suggested Liquid |
Amount of Liquid |
|
Meat or or poultry |
250 ml
(1 cup) |
Gravy, cream sauce, or broth |
180 ml (3/4 cup) |
|
Vegetable (cooked with skins & seeds removed, or canned) |
250 ml
(1 cup) |
Gravy, cream sauce, vegetable/tomato juice, or broth |
45-90 ml 93-6 Tbsp) |
|
Fruits (cooked - with skins & seeds removed, or canned) |
250 ml
(1cup) |
Cream, milk, yogurt, ice cream, juice, dessert tofu |
30 - 60 ml (2-4Tbsp) |
IMPORTANT: Do not over blend!
(Over blending can result in a pasty product).
- Only remove the blender or processor container when the blade has come to a complete stop. Never stir food contents while the blade is moving.
- Use hot soapy water to clean your blender after each use and check the underside of the blade for remaining food.
Food Storage Tips:
- Store blended food in a covered container in the refrigerator no longer than 2 days or 2-3 months in the freezer.
- Store single portions using air-tight containers, such as small plastic containers or muffin tins in sealed bags.
- Thaw food in the refrigerator.
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Do I need to take nutritional supplement drinks?
Nutritional supplement drinks are often high in energy and protein with vitamins and minerals added. They are available in most drugstores and grocery stores. These drinks may be useful if you are finding it difficult to maintain your weight with regular foods or you find meal preparation difficult.
If you are unable to eat or drink anything else, you may need six or more tins of nutritional supplements per day to obtain the nutrients you need.
Other nutritious choices that cost less include: House brand nutritional supplements, instant breakfast powders, milkshakes, yogurt smoothies and tofu shakes.
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What can I do to improve the taste of nutritional supplement drinks?
Use some of the following ideas to flavour and add variety to nutritional supplements.
Too Sweet?
- Blend in soft tofu, plain yogurt or ice cream.
- Dilute the supplement with milk or soy milk.
- Add fruit, such as strawberries, bananas, papaya, mango, raspberries, blueberries, or peaches. Fruit can be fresh, frozen or canned.
- Refrigerate or partially freeze supplements prior to using them as a cold drink.
- Flavor with instant coffee (first dissolve 1 tsp of instant coffee with a small amount of hot water, then add the coffee to the supplement).
Too Thick?
- Add skim or 1% milk or soy milk.
Prefer Something Hot?
- Do not boil nutritional supplements as it will cause the ingredients to separate.
- Warm nutritional supplements in the microwave or on the stovetop.
- Unflavoured nutritional supplements can be used instead of milk or water with condensed soup (cream of mushroom, cream of broccoli)
- Add a package of instant soup powder, or 1 teaspoon bouillon mix to your heated unflavoured nutritional supplement.
- Add instant coffee to heated vanilla or chocolate nutritional supplements for a café au lait or a café mocha.
Just Want Something Different?
- Add a favorite liqueur or your choice of flavor extract (orange, rum, lemon, almond, butterscotch) to a nutritional supplement to create a whole new flavor.
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Food just doesn’t taste the same. What can I do?
- Keep a list of those foods that do taste good to you.
- Experiment with food flavours.
- Eat foods that taste good to you now, even it this means eating the same foods for a while. Your taste sensation will eventually improve.
- Avoid any foods that taste bad.
- Choose cold temperature foods and fluids.
To take away an unpleasant mouth taste:
- Rinse with baking soda and water (¼ tsp to 1 cup) before meals.
- Rinse often between meals as well.
- Try sugarless gum or mints.
- Brush your teeth and tongue often using a soft toothbrush.
- You may wish to consult with your dentist about special mouth rinses and mouthcare.
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I find foods are very strong and bitter tasting. What can I eat instead?
- choose cold or at room temperature foods and fluids
- eat mild tasting foods such as:
- baking powder biscuits
- custard
- bread soaked in milk
- perogies
- hot cereal with cream
- steamed rice
- milk - hot or cold
- tofu (bean curd)
- unsalted crackers and cream cheese
- plain noodles and butter
- potato mashed with milk and butter
- vanilla flavoured pudding
- eggnog with a sprinkle of sugar or vanilla
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What can I do to mask the bitter and metallic taste of meats?
- choose cold or at room temperature meats
- choose other protein foods such as:
- gelatin
- salads with cottage cheese
- yogurt
- cold sliced meat, chicken or ham
- sausage rolls
- canned tuna or salmon
- cheese
- quiche - hot or cold
- devilled eggs
- cottage cheese
- milk, milkshakes
- custard, pudding
- marinating meat, chicken, fish may help mask the bitter taste. Try marinades such as:
- orange juice
- lemon juice
- lemonade
- Italian dressing
- vinegar
- sweet and sour sauce
- wine
- soy sauce
- teriyaki sauce
- avoid meats that have a strong smell
- use plastic utensils
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Foods have no taste. What can I do to enhance their taste?
- enhance taste by having alternating bites of different tasting foods.
- try food combinations such as:
- cottage cheese & pineapple
- grilled cheese sandwich & tomato juice
- canned fruit & plain yogurt
- use herbs and seasonings such as:
- thyme, parsley or oregano on beans, fish, cheese, poultry, meat, vegetables
- basil on eggs, vegetables, salad or fish
- tarragon on eggs, poultry, meat or salads
- garlic on meat, cheese, poultry or salad
- seasoned salts, lemon pepper
- try strong flavoured foods, such as:
- pizza, spaghetti or lasagna
- salsa
- marinated meats
- pepperoni
- pickles, olives
- BBQ foods
- cured meats
- chocolate
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What can I do if the smells of foods are particularly bothersome?
- Try cold or room temperature foods such as:
- devilled eggs
- sandwiches
- chicken salad
- peanut butter on crackers
- ice-cream
- pasta salad
- milkshakes
- cottage cheese and fruit
- puddings
- vegetables and dip
- custard
- cottage cheese
- cream cheese on bagel
- yogurt
- deli meat or cheese on crackers
- other tips:
- use a kitchen fan when cooking
- use an outdoor barbecue
- use a microwave
- use covered pots
- sit by an open window
- order ‘take-out’
- ask for help from friends and family for cooked meals
- try deli prepared foods
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My saliva is thick and sticky. What can I do?
Thick saliva can have several causes such as radiation therapy to the head and neck area or not drinking enough fluid. Here are some suggestions to help you cope with thick and sticky saliva:
- Drink at least 8 – 10 glasses of fluid daily.
- Take sips of warm liquids such as: soups, hot chocolate, OVALTINE®, broth, tea or warm water with each mouthful of food. This may help clear your mouth and wash foods down.
- Try tart or carbonated beverages such as lemon-flavoured soda pop or soda water; ice tea, SNAPPLE®, GATORADE®, lemonade, orange flavoured drinks or popsicles. These beverages may not be well tolerated if you have a sore mouth or throat.
- Try lower fat milks (1% or skim milk) if you find that milk is sticking to your saliva. .
- Rinse your mouth frequently with club soda or baking soda and water (¼ tsp to 1 cup).
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Are there food safety concerns I should be aware of while going through treatment?
When you are going through cancer treatment, your ability to fight infections may be compromised, therefore, it is important to ensure the foods and drinks you consume are safe and free from bacterial contamination. Here are a few general rules to help minimize the chances of a food borne illness.
- Wash hands thoroughly before eating or preparing food and/or drinks.
- Keep all aspects of food preparation clean.
- Including clean dishes, utensils and washing fruits & vegetables thoroughly.
- Use special care in handling raw meats, fish, poultry and eggs.
- Thoroughly clean all utensils, countertops, cutting boards, and sponges that have contacted raw meat
- Keep raw meats and ready-to-eat foods separate.
- Meat, poultry and seafood should be thoroughly cooked
- Beverages (milk and juices) should be pasteurized.
- Store foods promptly at low temperatures to minimize bacterial growth
Below 4°C or 40° F.
- When eating in restaurants, avoid foods that may have bacterial contamination such as salad bars, sushi, and raw or undercooked meat, fish, shellfish, poultry and eggs.
- If there is any question or concern about water purity (e.g. well water) have it checked for bacterial content by contacting local public health department.
Adapted from: Nutrition and Physical Activity During
and After Cancer Treatment: An American Cancer Society
Guide for Informed Choices.
CA Cancer J Clin 2003: 53:268-291
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Is drinking fluids important during treatment?
It is very important to drink plenty of fluids when you are receiving cancer treatment. It may be necessary to drink even when you are not thirsty. Drink at least 8 to 10 cups (2 – 2 ½ litres) of fluid daily.
- Drink fluids throughout the day, such as:
- Water, sparkling water
- juice
- soups
- popsicles
- caffeine-free soft drinks
- Carry a water bottle with you.
- Limit caffeine or alcohol containing beverages.
- Drink most of your fluids between meals to ensure eating well at meals.
- Choose fluids that are high in protein and high calorie if you are losing weight. The following are examples:
- Carnation Breakfast Anytime®
- Meal replacement drinks (Boost Plus®, Ensure Plus®, Meal Cal Plus®)
- whole or chocolate milk
- Soy milk or almond milk
- Milkshakes or fruit smoothies
- Yop® (yogurt drink)
- Eggnog (store bought)
- Hot chocolate or café au lait
- Ovaltine® or Postum® made with milk
- Strained or blended soups
- Juices or nectars such as carrot, grape, apple, pear, guava, peach, apricot, cherry or lychee
- Iced tea or fruit flavoured drinks such as Kool Aid®
- Carbonated drinks (flat)
- Popsicles, sherbet, ice cream, frozen yogurt bars
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