Eating for Cancer Recovery

Changes in taste and digestion make healthful eating a challenging—but not
impossible— endeavor on the road back to strong health.

May 2011

By Linda Melone

Much research shows that the foods we eat can dramatically impact our risk of developing cancer as well as our success at surviving over the long term after a cancer diagnosis. Eating nutritious foods, however, is not always a simple solution for people who are recovering from cancer.

Haralee Weintraub, a 58-year-old breast cancer survivor from Portland, Oregon, received six chemotherapy treatments three weeks apart. “After two weeks my beloved coffee tasted like metal,” she says. Adding Half & Half and sugar did nothing to improve the taste. “Black and green tea also tasted bad, so I drank chai tea and spicy teas instead, which didn’t have the same effect.” Weintraub found she could tolerate Jolly Rancher hard candy, sour cream and both regular and frozen yogurt but smells of garlic and onion cooking made her nauseous.

Chemotherapy can cause digestive changes as well. The drugs attack both healthy and cancerous cells, particularly fast-growing cells, says Ken Weizer, ND, a naturopathic doctor with Providence Cancer Center, Portland, Oregon. Weizer, a cancer survivor himself, says that some of the fastest-growing cells include those that line the digestive tract; these cells are replaced every two or three days. “This makes it very hard for people to digest and absorb food,” he notes.

Among chemo’s other side effects are mouth sores, chronic acid reflux (GERD), nausea and vomiting (which creates loss of appetite), indigestion, painful eating and difficulty swallowing. Plus, fatigue from the treatments makes grocery shopping hard, says Weizer, so instant gratification becomes tempting.

“In general, people going through chemo need to eat easy-to-absorb, nutrient-dense foods,” Weizer advises. Every calorie counts. “It’s important to stay away from highly processed foods like refined flours and sugar and instead focus on taking in protein. Chemotherapy requires the body to rebuild the cells lost, so people are often at a protein deficit,” Weizer says.

Food and digestive challenges vary from patient to patient. “The dosage and type of chemo drug varies, so how soon the person will experience side effects depends on the treatment,” says Laura Schmitz, RD, CSO (certified specialist in oncology) at the cancer center at St. Helena Hospital in St. Helena, California.

Flavor Changes

Even water and favorite foods may suddenly become unpalatable, a condition called dysgeusia. Schmitz says that it is common for chemotherapy to change the way people in treatment experience flavor. The difficulty in finding palatable foods because of these changes can add to the problem when adequate calorie intake and preventing nutritional deficiencies and weight loss are priorities, she adds.

Small, frequent meals may help ward off nausea and bland foods are typically better tolerated than spicy food. And, like Weintraub, many people cannot tolerate the odors of certain foods, particularly onions. Schmitz says, “To avoid dealing with smells, it’s a good idea to ask other people such as family members to prepare food.” Cold- or room-temperature foods do not give off as much of a smell. “Cold foods are also less irritating if the person has mouth sores,” says Schmitz.

The metallic taste that Weintraub found in her coffee is common with a number of foods, usually red meat, as a side effect of some chemo drugs. “If meats taste metallic, I recommend eating more poultry, fish and eggs,” says Schmitz. “And use plastic utensils to avoid putting metal in your mouth.” Different marinades, seasonings, sauces and spices may also help cover the metallic flavor. “You’ll have to experiment to find what works for you,” Schmitz suggests.

Other Side Effects

As common side effects of chemo, nausea and vomiting make eating difficult, although many new anti-nausea medications help enormously, says Jeanne Barnett, RD with the Hoag Cancer Institute in Newport Beach, California. “Ginger often helps with low-grade nausea,” she says. A study published in Pediatric Blood and Cancer (2/11) showed that powdered ginger helps reduce the severity of nausea when combined with anti-nausea medications. “Ginger candy, lozenges, popsicles and tea may also help, as well as the old standby, ginger ale,” says Barnett.

Barnett adds that small, regular meals of carbohydrate-rich foods such as oatmeal, bread or toast can also help ease nausea. However, Barnett advises to “eat whatever you can tolerate, whether it’s cold pizza or ice cream. You want to eat enough to maintain your body weight; any way you can get calories into your body, do it.” To counteract queasiness that occurs when you’re away from home, always carry a package or two of oyster crackers. Maintaining body weight during cancer treatment helps keep the immune system and other tissues strong enough to fight infection, according to the National Cancer Institute (www.cancer.gov).

Cancer breaks down muscle first, which puts great stress on the body, says Barnett. “Cancer cells attack protein stores before fat reserves. Breaking down protein is a highly metabolic process, meaning it takes many more calories to break down protein than it does fat,” she explains. “So the degree of weight loss is greater than if you were just breaking down” either fat or glycogen, a form of carbohydrate stored in the liver. This occurs even if the person begins cancer treatment with an excess amount of fat, Barnett adds.

Mouth sores (mucositis) often result from cancer treatments, making it painful to eat. Choose soft-textured foods such as applesauce, yogurt or pudding served cold or at room temperature. A smoothie with fruit and protein powder makes a healthy, high-protein meal or snack. Add berries and flax seed for extra antioxidants and healthy fat. Avoid spicy and citrus foods, which can irritate the mouth.

Low-fiber foods help reduce diarrhea, another common chemo side effect. If you have diarrhea, focus on foods containing potassium and sodium—minerals that may be lost—such as broth and potatoes without the skin, says Barnett. “Nut butter, nuts, almond milk and kefir, a fermented milk drink, all provide good protein.” If diarrhea is a risk, avoid raw fruits and vegetables, caffeine and alcohol. Simple preparations that require no cooking are best; these include smoothies or nut butter on toast, which provides protein for muscle repair.

Staying active helps as well. Simply walking every day can aid people with digestive and appetite problems, says Weizer. Activity and exercise also increase appetite and elevate mood by releasing endorphins, feel-good brain chemicals, which may help with the depression that can accompany cancer.

Probiotics, healthful micro-organisms found in fermented foods such as yogurt, also help rebuild the gastrointestinal tract, says Weizer. “The gut is lined with trillions of bacteria that protect it from bad bacteria and fungus, which you want to replace.”

A study in Cancer Treatment Reviews (12/03) suggests that supplementing with the amino acid L-glutamine may decrease the incidence and severity of diarrhea and mouth sores. Chewing on ice during chemo may reduce mouth sores, as well. A couple eggs a day can also make people feel better. “Eggs are the most absorbable form of protein,” Weizer explains.

Plan Ahead

It’s important to start planning meals and food the moment you get your diagnosis, says Timothy S. Harlan, MD, internist and medical director of the Tulane University School of Medicine in New Orleans and author of Just Tell Me What to Eat (Da Capo Press). Flavor, texture and temperature create the biggest obstacles, says Harlan, a former chef (www.drgourmet.com). “Plan for light textures, frothy, whipped cream textures like chocolate mousse and puddings that you don’t have to chew,” he says.

To avoid triggering an attack of GERD, Harlan suggests the following snack and meal ideas:

• Half a plain bagel with a tablespoon of light cream cheese.

• Granola or cereal bars. “You may have to experiment to find a brand that doesn’t provoke your reflux,” says Harlan.

• Low-acid juices, such as papaya or mango juice.

• Smoothies made with fruit and non-fat yogurt.

• For sandwiches, whole grain breads and low- or non-fat sliced meats such as turkey, roast beef and chicken. Avoid smoked or cured meats and mustard.

• Olive oil-based spreads such as tapenade.

The variety of chemotherapy drugs and individual responses to those drugs makes it worthwhile to search for a doctor, nutritionist or naturopathic physician with experience in this area. Ask your oncologist if he or she knows someone who can help you plan. “You may have to push a little,” says Weizer. “You may hear, ‘What you eat doesn’t matter,’ when it absolutely makes a difference. Nutrition is essential to rebuild yourself both during and after cancer treatment.”