Altered Taste

Changes in taste are common during cancer treatment. Foods that once tasted delicious may no longer be appetizing. Certain foods may have less taste, or other foods (like meat) may be bitter or taste like metal. Smell can also be affected during cancer treatments. Foods that used to smell good may no longer be tolerable. Taste and smell changes often resolve once treatment has ended, but below are suggestions for staying well-nourished when foods don’t taste or smell like normal.

Managing with Nutrition:

• Choose foods that currently appeal to you. Avoid foods that do not appeal to you.
• Try tart foods and drinks. Foods containing lime, lemon, orange, or vinegar may be more appealing. Do not eat these foods if you have mouth sores.
• Moist or naturally sweet foods often work well. Try frozen or fresh melon pieces or grapes.
• Try eating cool-temperature foods instead of hot-temperature foods. Cool-temperature foods have less aroma and typically less taste.
• Use various spices or marinades to add flavor to dishes.
• Red meat can often have a metallic or bitter taste. Replace red meat-based protein sources with chicken, fish, eggs, nut butters, or beans.
• If foods taste too salty or bitter, try adding a small amount of sugar.
• Brush your teeth and tongue and rinse your mouth regularly, especially before eating.
• Replace metal forks and spoons with plastic versions. If you have a metallic taste in your mouth, eating with plastic forks and spoons can help. Eating with chopsticks may also help.
• Try using a cup with a lid to limit aromas.
• When cooking, use a kitchen fan. If someone else is doing the cooking, try to sit in a different room/area.
• When cooking, lift lids away from you to avoid smells.

Dry Mouth

Certain cancer treatments can cause dry mouth, or “cotton mouth”. Dry mouth occurs when your body makes less spit, or saliva, than it should.  When you have dry mouth, it can be more difficult to talk, chew and swallow food. The taste of foods may also change with dry mouth.

Managing with Nutrition:

• Moisten foods with sauces, gravies, or dressings to make them easier to swallow.
• Choose foods that are easy to swallow. Try pureed foods, puddings, sorbets, or soups.
• Suck on hard candies, frozen fruit, or popsicles. These help your mouth make more saliva.
• Chew gum. Choose a sugar-free gum to prevent cavities. Some ingredients in sugar-free products, like the sugar alcohols xylitol, sorbitol, mannitol and erythritol, may cause gas, bloating, or diarrhea. Check with your dietitian about better options.
• Eat tart foods or drinks (ex: lemonade). Tart foods/beverages encourage your mouth to make more saliva. Avoid if you have a sore mouth or throat.
• Sip water often to moisten mouth.
• Eat papaya or pineapple. Certain enzymes in papaya (papain) and pineapple (amylase) may help break up “ropy” or thick saliva.

Avoid:

• Alcohol-containing mouthwashes
• Tobacco products
• Alcohol
• Dry, coarse or rough foods

Additional Tips:

• Cut food into small pieces.
• Use lip balm to keep lips moist.
• Season foods with citrus juices and herbs instead of salt.
• Always carry a bottle of water for easy access.
• Rinse mouth every 1-2 hours with a warm water rinse, such as 1/4 tsp baking soda, 1/8 tsp salt mixed into 1 cup warm water. Follow with a plain water rinse.

Trouble Swallowing

Dysphagia (pronounced dys-pha-gia) is the medical term that describes difficulty swallowing. Swallowing involves the coordinated activity of the mouth, pharynx, larynx, and esophagus. Any changes in one of these body parts can make it difficult to swallow. Below are possible causes of issues that may cause problems with swallowing.

Esophagitis (pronounced uh-saa-fuh-jai-tuhs) is the medical term that describes a sore and inflamed throat. A sore and inflamed throat can make it challenging and painful to swallow food and beverages.

Mucositis (pronounced mu-co-si-tis) is the medical term to describe inflammation in the mouth, esophagus, and other areas of the GI tract. If any of these areas are inflamed it can become painful and challenging to swallow.

Xerostomia (pronounced zir-e-sto-me-a) is the medical term for a dry mouth. Too dry of a mouth can make it difficult to pass food from the mouth down the esophagus.

Pain, inflammation, sores or lack of saliva in the mouth can all lead to swallowing challenges. It’s best to work with your health care provider and dietitian for an individualized nutritional plan. Below are general nutritional recommendations to help manage swallowing difficulties.

Managing with Nutrition:

• Eat 5 or 6 smaller meals throughout the day instead of 3 large meals. Small quantities of food may be easier to swallow.
• Include soft, easy-to-swallow foods like scrambled eggs, cooked cereal or milkshakes.
• Cook foods until they are soft and tender.
• Cut foods into small pieces or use a food processor or blender to puree food to desired consistency.
• Add sauces, gravies, broth, or yogurt to help soften foods.
• Avoid foods that can bother or irritate your throat:
  • Hot (Temperature) Foods and Drinks
  • Highly Acidic Foods – tomatoes, oranges, lemonade
  • Sharp, Crunchy Foods- potato and tortilla chips
  • Alcoholic Beverages
  • Spicy Foods
• Try sipping drinks through a straw, it may help make swallowing easier.

Constipation

Constipation occurs when bowels do not move regularly, and stools become challenging to pass. It can cause bloating, nausea, or painful bowel movements. Constipation can occur because of medication side effects, low activity levels, a low-fiber diet, or low consumption of liquids.

Managing with Nutrition:

• Stay hydrated to keep your digestive system running smoothly. It’s recommended to consume a minimum of 8 cups of liquids (64 ounces) each day. Always speak with your medical care provider or cancer care team about specific hydration recommendations.
• Try warm or hot beverages. Many people find that drinking a warm or hot beverage, such as tea, coffee, or soup, can help relieve constipation.
• Add more fiber to your diet. Fiber is important in helping the digestive system work properly, and insoluble fiber is a specific type of fiber that helps relieve constipation. If your current diet is low in fiber, it’s best to introduce fiber foods in small amounts over time while increasing water intake. See the list of Foods That Help with Constipation to learn more. Talk with your medical care provider or dietitian for specific recommendations, as certain types of cancer and cancer treatments may require a lower fiber diet.
• Try to incorporate daily physical activity. Movement can help relieve constipation. Always speak with your medical care provider before adding more activity or starting a new exercise plan.
• Keep a log of your bowel movements. Use the Side Effects Tracker to help. Bring it to medical appointments and share with your nurse or doctor to help create a more personalized bowel regimen, if necessary.
• Tell your doctor or nurse if you haven’t had a bowel movement in more than 2 days.
• Never use fiber supplements, laxatives, stool softeners, or enemas without asking your doctor or nurse.

Diarrhea

Diarrhea (frequent, loose bowel movements) is a common side effect of both cancer and cancer treatments. Diarrhea can also be caused by infections, food sensitivities, antibiotics, or emotional upset. Diarrhea occurs when foods and liquids pass through the gut so quickly that the body cannot absorb and digest it. This can also cause dehydration. Diarrhea symptoms can vary from mild to severe and last a short or long time.

Managing with Nutrition:

• To prevent dehydration, drink plenty of fluids to replace those you lose. Clear liquids are best, including water, sports drinks, clear flat soft drinks, chicken broth, or weak caffeine-free tea.
• Choose soft, bland foods. Good choices include noodles, hard-boiled eggs, white bread, pureed vegetables, lean turkey and chicken, fish, and mashed potatoes.
• Try the BRAT diet. BRAT stands for bananas, rice, applesauce, and toast. These foods are higher in water-absorbing soluble fiber.
• Include foods that are higher in potassium and sodium. Try potatoes, broth, apricots, and bananas.
• Eat small meals, more often. Eating 5-6 small meals per day may be easier on the gut than 3 large meals.
• Consume foods and drinks at room temperature.

Avoid:

• Foods high in insoluble fiber. These foods may make diarrhea worse. Avoid raw fruits and vegetables, nuts, seeds, whole grain products, and high-fiber produce (broccoli, corn, beans, cabbage, cauliflower and peas).
• Caffeine-containing products (coffee, tea, chocolate, some soda).
• High-sugar beverages, such as regular soda and fruit punch.
• Lactose-containing dairy products (milk, cheese, yogurt).
• Sugar-free products sweetened with xylitol or sorbitol. These sweeteners are mostly found in sugar-free candy and gum.
• Spicy foods (hot peppers, curries, buffalo wings, salsa, black pepper, hot sauce).
• Greasy, fatty or fried foods (fatty cuts of meat, French fries, potato chips, fast food).
• Alcohol

Additional Tips:

• Take anti-diarrheal medications as prescribed.
• Rest your gut for 12-14 hours after having diarrhea. Only drink clear liquids during this time. Use the Clear Liquids handout for a list of suggested foods and beverages.
• Call your doctor right away if you experience any of the following signs or symptoms with diarrhea:
  • Six or more loose bowel movements a day for more than two days
  • Blood in your stool or rectal area
  • Weight loss due to diarrhea
  • Fever of 100.5°F or higher
  • Inability to control bowel movements
  • Diarrhea or abdominal cramps that last more than a day
  • Diarrhea accompanied by dizziness
• For additional recommendations, check out the Foods to Help with Diarrhea

Nausea and Vomiting

Nausea happens when you feel “sick to your stomach” or queasy. You may also experience a watery mouth, dizziness, or fast heartbeat. When you don’t feel your best, it can be difficult to get the nourishment that your body needs. A weak appetite can lead to weight loss and may affect your treatment. It’s important to discuss with your doctor if you experience nausea after treatment ends.

Managing with Nutrition:

• Eat small, frequent meals throughout the day. Often this looks like 5 to 6 meals instead of 3 large meals. Small, frequent meals are typically well-tolerated.
• Do not skip meals or snacks. Even if you don’t feel hungry, you should still eat. An empty stomach can make nausea worse. Set an alarm as a reminder to eat every 2-3 hours.
• Don’t eat when you feel queasy.
• When you’re not feeling well, avoid eating your favorite foods. This may cause you to link them to feeling sick.
• Stay hydrated. Drink liquids throughout the day.
• Room-temperature foods are often well-tolerated. Allow hot foods to cool down and cool foods to warm up before consuming.
• If you have nausea in the morning, try keeping crackers next to the bed and eat a few before even getting out of bed.
• Try resting after eating.
• Wear loose and comfortable clothing.
• Use the symptom tracker to record when you feel nauseous.
• Avoid strong food and drink smells. Strong smelling foods include coffee, fish, onions, and garlic.

Lactose Intolerance

Lactose intolerance is when your body can’t digest the sugar in dairy products, called lactose. Lactose is found in foods like milk, yogurt, cheese, and ice cream. People with lactose intolerance may experience symptoms like gas, bloating, stomach pain, and diarrhea. Lactose intolerance can be the result of certain cancer treatments, as well as medications commonly prescribed during cancer treatments, like antibiotics.

Managing with Nutrition:

• Look for lactose-free or reduced-lactose products. These products, like lactose-free milk and ice cream, should be clearly marked.
• Choose dairy-free milk substitutes. A variety of options exist, including almond, oat, soy and coconut milks. Check out dairy-free yogurt, ice cream and cheeses as well.
• Make substitutions. When cooking at home, substitute lactose containing foods with dairy-free alternatives. Often, you won’t be able to tell the difference!
• Choose dairy products that are naturally lower in lactose, like hard cheeses (cheddar) and yogurt.

Additional Tips:

• Check out our Lactose Intolerance handout for more great suggestions.
• Talk to your doctor about medications that may help with lactose intolerance. Lactase tablets, like Lactaid®, may help your body break down lactose more effectively.

Weight Loss/ Low Appetite

Appetite loss is when you lose interest in eating or you don’t want to eat very much. It can occur for a lot of reasons, including fatigue, pain, certain medications, emotional issues, cancer treatment side effects (nausea, vomiting, change in taste, etc.), or the cancer itself. Appetite loss is very common and can vary in length. Longer term appetite loss can result in weight loss and malnutrition.

Managing with Nutrition:

• Try a liquid or powdered meal replacement, like Boost®, Ensure® or Carnation Instant Breakfast®.
• Instead of eating 3 large meals a day, try to eat 5-6 smaller meals throughout the day.
• Eat your largest meal when you are hungriest. For many people, this is in the morning.
• Start your meal with high-protein foods, when appetite is the strongest. See Tips for Adding Protein for ways to incorporate more protein into your meals.
• Drink high-calorie beverages, like milkshakes, smoothies, juices, or soups.
• Keep snacks handy. See Snack Ideas for Appetite Loss for some tasty and easy snack suggestions.
• Drink liquids throughout the day, especially if you don’t feel like eating. If it’s difficult for you to remember, set a timer to remind you.
• Try to eat a bedtime snack. This will provide extra calories, but not affect your appetite for the next day.
• Eat soft, cool, or frozen foods like popsicles, sorbet, or yogurt.

Avoid:

• Drinking large amounts of liquids at meals, as this could make you feel full very quickly and reduce the amount of food you are able to eat.

Additional Tips:

• Keep a normal eating schedule, eating every 2 ½ – 3 hours.
• Set an alarm to remind you to eat snacks.
• Try to be physically active, this can help to stimulate appetite.
• Your doctor may be able to prescribe medications to help improve appetite.
• Recruit the help of friends or family members to help you purchase and/or prepare food.
• Try to keep mealtimes relaxed and pleasant.
• Talk with your doctor if emotional issues, like depression or anxiety, may be affecting your appetite.

Unintended Weight Gain

Though most people think they will lose weight after a cancer diagnosis, it is also possible to gain weight. This unintended weight gain can be due to a variety of reasons, including treatments, or certain medications, like hormone therapy, that can cause weight gain or make you feel hungrier. Fatigue, from both cancer and its treatment, can lead to a decrease in activity, which can also cause weight gain. Emotional side effects, such as depression or anxiety, may lead to weight gain as well.

Managing with Nutrition:

• Eat plenty of fruits and vegetables – Fruits and vegetables are filled with nutrients and fiber, so they fill you up without a lot of calories.
• Choose lean protein – Top picks include white meat poultry, fish, shellfish, beans, eggs, and tofu.
• Make half your grains whole grains – Fiber-rich whole grain foods like whole grain breads, cereals and pastas, brown rice, and popcorn fill you up and provide valuable vitamins and minerals.
• Focus on low-fat dairy – Choose skim or 1% milk, yogurt and cheese
• Cook using low-fat cooking methods, such as baking, broiling, grilling, steaming, or roasting.
• Choose foods with less fat and sugar – Look at the nutrition label and choose food items with a low %DV.
• Keep portion sizes in check.
• Try the American Institute for Cancer Research (AICR) New American Plate method – Aim for meals made up of 2/3 (or more) vegetables, fruits, whole grains, or beans and 1/3 (or less) animal protein.

Avoid:

• Sugar-sweetened beverages
• Fried food, such as French fries and potato chips
• Enriched white flour products, like white bread, bagels, crackers, and white pasta
• Candy
• Fruit drinks
• Desserts, such as pastries, cookies, cakes and ice cream
• Alcohol
• High calorie foods and drinks like pizza, nachos, and specialty coffee drinks

Additional Tips:

• Keep a food journal – Track what you eat and drink to become more mindful of how much you’re eating and drinking.
• Be physically active – Exercise not only burns calories but may help to improve your mood as well.
• Talk with a dietitian for more ideas to keep your weight in check while undergoing cancer treatment and beyond.

Fatigue

Cancer-related fatigue (CRF) or feeling very tired, is the most common side effect for those diagnosed with cancer. It can be related to the cancer itself or a side effect from anti-cancer drugs. Fatigue can often be confused with tiredness. Everyone experiences tiredness, and typically a good night’s sleep can help a person feel refreshed in the morning. However, CRF can cause excessive tiredness throughout the entire body. Patients often refer to CRF as “paralyzing”. Although fatigue may not be avoidable, below are suggestions for how nutrition may help to better manage your CRF.

Managing with Nutrition:

• CRF can be worse if you’re not nourishing your body well. Good nutrition is an important part of keeping your energy levels up and minimizing fatigue.
• Work with a dietitian to determine your caloric needs. Generally, 15 calories per pound of body weight is recommended. If weight loss has occurred, add an additional 500 calories to your total calorie needs.
• Include lean protein or proteins with healthy fats at each meal and snack time. Protein suggestions – nuts, seeds, legumes/beans, Greek yogurt, cooked tofu, cooked chicken, cooked fish.
• Maintain hydration levels. Dehydration can increase feelings of fatigue. Good sources of fluid include juice, milk, broth, milkshakes, water, and other non-caffeinated beverages. Work with a dietitian to determine your fluid requirements. 8 cups, or 64 ounces, is the minimum requirement for most people.
• Talk with your health care provider, pharmacist, and dietitian about incorporating a multivitamin that meets 100% of the recommended daily allowances (RDA) for most nutrients.
• Ask a trusted friend or family member to help prepare meals and snacks. This includes asking them to help prepare freezer meals to easily nourish your body when energy levels are low.

Other Ways to Manage Fatigue:

• Pace yourself – alternate standing with sitting, don’t rush through activities.
• Schedule in rest time throughout your day.
• Use proper body techniques – when sitting, use a chair with good back support, adjust work height to prevent bending over, always bend at the knees and not the back.
• Keep a diary to track the times of day you are low on energy or the most fatigued.
• Avoid extreme temperature changes or long hot showers or baths.
• Prioritize important tasks and what items can be delegated.
• Store items in the home at low levels to prevent heavy lifting or strain.
• Try yoga or relaxation techniques before going to sleep.
• Implement stress management techniques.