Helpful Strategies for Managing Side Effects of Cancer Treatment Through Diet
Nausea & Vomiting Management
Nausea (feeling queasy or sick to your stomach) with or without vomiting (throwing up) can be caused by your cancer, chemotherapy, or radiation therapy. We strive to prevent nausea and vomiting by taking specific measures. These include receiving IV anti-nausea medications prior to the administration of chemotherapy and prescribing anti-nausea meds for home. Your provider and nurse will go over these medications in detail. It is important to take your anti-nausea medications at the first sign of nausea. Please notify us if your medication is not working, as there are many other medications available to treat your nausea. Sometimes nausea can be from increased anxiety and fatigue. Physical and mental relaxation techniques, as well as diet changes, can often help in this area.
Some helpful eating tips surrounding nausea include:
- Create a peaceful eating environment – A relaxed atmosphere will help to calm you and make eating easier.
- Avoid strong odors – Make sure your room is well ventilated and does not smell from strong foods or cooking odors. During these challenging times it is often helpful to have family, friends, or neighbors bring you foods prepared outside of your home.
- Eat bland foods – Keep your diet simple. Plain baked chicken, eggs, pasta, and broth-based soups are more easily tolerated. Try eating crackers, dry cereal, or toast. Avoid any extra spices or seasonings.
- Eat smaller, more frequent meals – Lower your expectations regarding how much food you can eat at a single session. By grazing on food and fluids in smaller amounts you will likely do better. Focus on having a calorie associated with everything you eat and drink.
- Try some hard candies – Peppermints, lemon drops, root beer barrels, and ginger chews are often effective in relieving nausea and eliminating bad tastes in your mouth.
Effective treatment for nausea may be different for each person. If your symptoms persist, please call the office.
Constipation Management
Constipation is defined as being unable to move your bowels, having bowel movements less often than is normal for you, or having to push harder to move your bowels than you have in the past. It causes bloating, pain, and discomfort. Being less active, eating or drinking less, or taking certain medications can cause constipation.
Tips to avoid constipation include:
- Eat a diet high in fiber – including fresh fruits and vegetables, whole grain breads, and cereals.
- Drink enough fluids – aim for sixty-four to eighty ounces daily. Helpful liquids may include: water, prune juice, warm juices, and teas.
- Take an over the counter medication to establish a more regular bowel plan – this may include Senokot S or Miralax. It is not recommended that you use enemas or suppositories. Your provider can help to recommend medications to relieve your constipation.
Diarrhea Management
Diarrhea is defined as having more than two loose or watery stools per day. It can be caused by your cancer treatments. Diarrhea can be worse if you are taking more than one kind of cancer treatment at the same time (such as radiation therapy and chemotherapy together). Uncontrolled diarrhea can lead to weakness, poor appetite, dehydration, and weight loss.
What you can do:
- Drink clear liquids – As soon as your diarrhea starts, switch to clear liquids like water, apple juice, clear broth, and popsicles. Avoid MILK and MILK PRODUCTS, as they may contribute to your diarrhea.
- Eat small, frequent meals – You will likely benefit from grazing on food and fluids throughout the day versus attempting to eat the standard three meals.
- Eat low fiber foods – As your diarrhea improves, add in some low fiber options like bananas, rice, applesauce, and toast.
- Avoid greasy and spicy foods – Deep fried foods and highly spicy foods may irritate your digestive tract and make your diarrhea worse. Stick to baked or broiled meats with limited seasonings.
- Avoid caffeine – Excessive amounts of caffeine (coffee, tea, and carbonated beverages) may worsen diarrhea.
- Eat foods high in sodium and potassium – Persistent diarrhea can lead to electrolyte losses and an emphasis on broths, soups, sport drinks (Gatorade/Propel) and pretzels can help to replace them.
- Limit sugar-free gums and candies – Items that contain sorbitol and xylitol can cause bloating, gas, and diarrhea.
- Medication considerations – It is recommended to take Imodium (over the counter) when loose stooling occurs. Dosing is one tab with the first loose stool and one tab with each subsequent loose stool up to a maximum of six tabs daily. If this is ineffective, please contact your provider for a prescription medication.
Remember, dehydration can happen very quickly if your diarrhea persists. Symptoms include lightheadedness, headache, increased weakness, and low blood pressure. If you are feeling dehydrated, please call the office early in the day. We can give you some IV fluids if necessary.
Increasing Calories in Your Diet
It is important to eat well during your cancer treatments so you can maintain your current weight. Suggestions to increase calories and protein during this challenging time include:
- Small, frequent meals
- Snacking throughout the day
- Trying commercial supplements (Carnation Instant Breakfast, Boost, Ensure, Orgain) in between meals
- Making homemade smoothies or milkshakes
- Having puddings, yogurt, and granola bars readily available to eat
- Adding gravies and/or butter to entrees, side dishes, and vegetables
- Spreading nut butters (peanut, almond, cashew) or cream cheese liberally on crackers or celery sticks
- Using whole milk or cream when cooking
- Drinking most fluids between meals instead of with meals
- Snacking on nuts, granola, and fun-sized candy bars
Remember, variety is the key to success. Try different foods on different days for the best results. Consider having smaller prepackaged snacks that are easy to carry with you during the day to snack on whenever you are hungry. If you need additional help with eating strategies or menu planning, contact the dietitian for assistance.
Hydration
It is very important to drink plenty of fluids during cancer treatments to maintain good hydration. Goal volume is at least eight to ten cups (sixty four to eighty ounces) of fluid daily. Don’t forget that fresh fruits and vegetables are also a source of fluid.
Some tips to help you stay hydrated include:
- Drink fluids throughout the day, even when you don’t feel thirsty
- Carry a water bottle with you wherever you go
- Try to drink most of your liquids in between meals, instead of with meals
- Add more foods such as broths, soups, popsicles, Italian ices, and Jello into your eating plan.
- Drinking fluids in smaller, more frequent amounts often makes it easier to reach your goals
- Drinking fluids in smaller cups more frequently during the day can be helpful in reaching your fluid goals
- Limit your use of beverages containing caffeine, as they will ultimately dehydrate you
- Avoid alcoholic beverages during treatment
- Consider using clear liquid supplements (like Boost Breeze or Ensure Clear)
- Add in Gatorade or other sport drinks for increased variety
- Infuse some flavor into your water by adding lemon, lime, orange or cucumber slices for a refreshing twist
Remember, dehydration can happen very quickly. This is especially true if you are experiencing any nausea, vomiting, or diarrhea. Symptoms may include lightheadedness, headache, increased weakness, and low blood pressure. If you are feeling dehydrated, please call the office early in the day. We can give you some IV fluids if necessary.
Coping With Dry Mouth
Your mouth can become dry as a side effect from radiation treatment, some chemotherapies, or some medications. The salivary glands can become irritated and produce less saliva or your saliva can become thicker or stringy. For some, this dryness is mild and easily managed by increasing fluid intake. For others, the dryness is more severe and can interfere with eating, talking, and sleeping.
Here are some tips to help you manage dry mouth.
- Drink eight to ten cups of fluid daily
- Keep your mouth clean
- Use a soft bristled toothbrush and floss daily
- Avoid mouthwashes that contain alcohol, such as Listerine or Scope, as they may worsen mouth dryness
- Try Biotene mouthwash which is alcohol-free
- Rinse your mouth with water before and after meals
- Try to keep foods bland and serve items at room temperature or cold as this may be more soothing
- Add moisture to meals with gravies, sauces, butter, broths, and soups
- Consider blending fruits and vegetables for ease of eating
- Avoid hard, crunchy foods, citrus fruits, spices, and seasonings
- Chew gum or suck on hard candies (lemon drops, peppermints, root beer barrels) to stimulate saliva
- Chilled foods including ice chips, popsicles, ice cream, and frozen grapes/berries may be easy to tolerate; hot foods may be very irritating to your mouth
- Some people notice that caffeine-containing beverages further compound mouth dryness; consider limiting coffee, tea, hot chocolate, and colas if you notice these bothers you
- Consider rinsing your mouth with a salt and baking soda solution of one teaspoon salt and one teaspoon baking soda mixed into 32 ounces of water. Swish gently in mouth and spit out; this can be done a few times daily
- Oral moisturizers and saliva substitutes can be helpful in adding moisture to your mouth and are available without a prescription at most pharmacies
- Moisturizers include: Mouth Kote (a moisturizing spray), Biotene Oralbalance (a moisturizing gel), and DenTek Oramoist (a self-dissolving dry mouth patch)
- Saliva Substitutes include: Xero-lube and Glandosane mouth sprays
It is important to make your provider aware of any mouth sores you may have. Sometimes white patches in the mouth or on the tongue may form. Contact your provider if this happens and a medication will be prescribed.
Sore Throat Management
Cancer and its treatments can cause your throat to become very sore making it more difficult to eat and swallow. Radiation therapy to the head, neck, and chest areas and some chemotherapy can irritate your throat, aggravate gastric reflux, and increase heartburn.
Here are some tips to help you during this challenging time.
- Try eating foods that are bland, soft, and easy to swallow
- Casseroles, cream soups, mashed potatoes, gravies, yogurt, cottage cheese, puddings, custard, and ice cream are usually easy to eat
- Smaller, more frequent meals and foods that are served at room temperature or cooler may be better tolerated
- Fruit smoothies or milkshakes may be soothing to your throat
- Drinking commercially prepared nutritional supplements such as Carnation Instant Breakfast, Boost, or Ensure may be helpful during this time
- Be sure to keep your head elevated after meals if you suffer from gastric reflux and heartburn
- Tart, acidic, or salty foods and beverages may be irritating
- Avoid citrus juices, salsa, pasta sauce, and pickled foods
- Dry or coarse foods like toast, crackers, granola, and raw fruits/vegetables may cause discomfort
Dealing with Changes in Taste and Smell
Cancer and its treatments can cause changes in your senses of taste and smell. These alterations can affect your appetite and intake. You may notice that your senses of taste and smell vary on a daily basis so it is a good idea to keep experimenting with new foods.
To get rid of bitter or metallic tastes:
- Use plastic utensils when cooking and eating
- Try hard candies, gums, and mints
- Flavor foods with spices/seasonings such as onion, garlic, chili powder, basil, oregano, rosemary, tarragon, barbecue sauce, mustard, ketchup, or mint
- Red meats may taste differently – try marinating in sweet juices, acidic dressings, or wine to improve flavor
- Consider trying other high protein foods like poultry, eggs, fish, and beans which are often better tolerated
To improve smells:
- Cover beverages and use straws when drinking
- Choose foods that don’t require cooking such as sandwiches, cheese and crackers, yogurt, fruit, or cereal and milk
- Serve foods at room temperature or cold as they tend to have less odors
- Eat in a well ventilated room; avoid eating in areas where there are strong food or cooking odors
Millkshakes & Smoothies Can Help Increase Calories and Protein
Listed below are a variety of milkshakes and smoothies that may be helpful in increasing calories and protein in your diet. To maximize your nutrition support, you may consider substituting a commercial nutrition supplement (Boost, Ensure) for the liquid listed in these drinks. Protein powders can also be added. Most powders provide at least 15g protein per serving. If you don’t care for protein powders, other options include plain greek yogurt (15-20 grams per ounce in 6 ounces) and cottage cheese (12 grams per ounce in 4 ounces).
Fortified/Double Strength Milk
1 quart whole milk
1 cup nonfat dry milk powder
Combine in blender until smooth. Refrigerate. Makes 4 servings.
210kcal/14gpro per serving
Carnation Instant Breakfast Drink
1 packet Carnation Instant Breakfast Drink
8 ounces skim milk
Stir packet into skim milk until smooth. Makes 1 serving.
220kcal/14gpro per serving
Fortified Instant Breakfast Drink
1 packet Carnation Instant Breakfast Drink
1 cup whole milk
1/4 cup nonfat dry milk powder
Combine all ingredients in blender until smooth. Makes 1 serving.
400kcal/25gpro per serving
High Calorie Breakfast Shake
1 packet Carnation Instant Breakfast Drink
1 cup half and half
3/4 cup ice cream
Combine all ingredients in blender until smooth. Makes 1 serving.
650kcal/18gpro per serving
Banana Milkshake
1 whole banana
2-3 drops of vanilla extract
1 cup whole milk
Combine all ingredients in blender until smooth. Makes 1 serving.
190kcal/9gpro per serving
Banana Flip
2 whole bananas
1 packet Carnation Instant Breakfast Drink
1 cup whole milk
1/2 cup orange juice
Combine all ingredients in blender until smooth. Makes 1 serving.
580kcal/13gpro per serving