The eating challenge You know that a healthy diet will support your body’s fight against cancer but, right now, eating may be the last thing you want to do. Sometimes a few small adjustments to your food habits can make big improvements to how you feel.
Keeping your body fuelled with food A good diet is important at the best of times, but particularly important when your body is working hard to overcome cancer. The problem is that while you’re undergoing treatment for cancer, food can seem unappealing and the act of eating itself can become very difficult. You may feel nauseous most of the time, you may be prone to vomiting, you could be constipated or have diarrhoea, or you could be troubled by a dry or sore mouth or throat. Most of these side effects are temporary, but you still need to find ways to keep up a decent diet while you’re having treatment so your body doesn’t become malnourished.
If your appetite is poor
Think small You might find it hard to stomach three big meals a day, so instead try eating smaller meals more frequently.
Eat by the clock It’s easy to forget to eat when you’re not following the breakfast-lunch-dinner routine. Develop a new habit of eating at regular two-hour intervals. Set an alarm if that helps.
Pack a snack You’ll spend a lot of time in hospitals and clinics waiting for appointments and having treatments. Always pack yourself a snack so you don’t skip meals.
Lean on liquids Nutritious drinks such as milk and juices will nourish your body. Try drinking them through the day in place of tea and coffee which have no nutritional benefit.
Drink a toast Having a small glass of wine or beer before the evening meal can stimulate a tired appetite, but check with your care team to make sure that alcohol doesn’t conflict with your treatment.
Take a walk Doing some gentle exercise before a meal can help to stir your hunger.
If you're feeling nauseous or you're vomiting
Cool it The smell of hot food can trigger nausea. Try eating cold meals (such as salads) or hot meals that have cooled to room temperature.
Keep eating Nausea can be more intense on an empty stomach. Be firm with yourself and keep up your intake of small meals.
Sip clear drinks Cool, clear drinks, including flat lemonade and sports drinks, can help to keep nausea at bay. They also help keep you hydrated if you have been vomiting.
Grab an icy pole If you’re wary of swallowing liquids or don’t want to sip cool, clear drinks for any reason, try sucking on a lemonade icy pole instead.
Choose light meals Low-fat foods such as dry toast, plain biscuits and fruit are less likely to make you nauseous than heavy, high-fat foods like pastries or meals with creamy sauces.
Ginger things up Ginger is said to have stomach-calming properties. See how you go with ginger beer, ginger tea, gingerbread and ginger biscuits, or crystallised ginger.
Ask for help An anti-nausea medicine may work wonders for you. Ask your care team for advice.
If you have a sore mouth
Take the sting out of it Stay away from salty, spicy or acidic foods that could inflame a sore mouth: that means no chilli, no vinegar and no lemon juice for starters. If you want to drink fruit juices for nutrition but find them too harsh, try nectars instead.
Ice is nice Cold foods and drinks can be soothing when your mouth feels irritated. Try adding crushed ice to drinks and letting the cool, sweet crush sit in your mouth for a while. Ice-cream and sorbets are great, too.
Play it smooth Steer clear of rough, crunchy foods such as potato crisps and nuts as they will only irritate a sore mouth.
Brush softer Buy a soft, child’s toothbrush; it will be less tough on your gums when you’re brushing your teeth.
Ask for help Anaesthetic mouthwashes and antiseptic lotions and sprays can be soothing, but you may find the ones you get over the counter at the chemist could be too strong. Ask your care team for advice.
If you have a dry mouth
Make it moist If swallowing is a challenge because of your dry mouth, choose meals that come with lots of sauce or gravy.
Take the soft option Food that’s minced, pureed or finely chopped is much easier to chew. Try eating flaked tuna instead of chicken breast, a shepherd’s pie made with mince ahead of a beef pie, small pasta shells rather than spaghetti and so on.
Sip and slide Sit down with a drink at every meal and sip it as you go along to help food slide down.
Freshen up When your mouth is dry, you could find that your tongue gets coated with a substance that gives food an unpleasant taste. One way to freshen up is to clean your tongue with a solution of bicarbonate of soda and water. Simply mix a teaspoon of bicarbonate of soda into 450ml of warm water, then use with cotton buds or a soft toothbrush to clean your tongue.
Kick a chocolate habit Chocolate has a habit of sticking to the roof of a dry mouth, so it’s best to avoid it. The same goes for rich pastries.
Get some gum Try chewing some gum to stimulate saliva production and relieve the dryness.
Ask for help Mouthwashes, lozenges and artificial saliva sprays could help you. Ask your care team for advice.
Diarrhoea
Drink up If you’re dealing with diarrhoea, you’ll need to replenish lost fluids so drink plenty of water or sports drinks. Aim for eight to 12 glasses a day.
Be bland Certain foods can aggravate your diarrhoea, so cut down on dairy products, avoid chilli, pepper and curries and steer clear of high-fat and high-sugar foods. Instead, stick to a plain diet of foods such as rice, potatoes and toast (don’t add loads of butter or margarine).
Get on the wagon Keep away from alcohol and caffeine for as long as diarrhoea is a problem.
Ask for help If you’re really troubled by diarrhoea, you may need a prescribed remedy. Ask your care team for advice.
Constipation
Show your fibre High-fibre foods are one of the most effective ways to counteract constipation. Lean on things like muesli, wholewheat bread, brown rice and plenty of fresh fruit and vegetables.
Have a drink Taking in lots of fluids is the other key to beating constipation. Aim to drink at least 2 litres of liquid a day.
Have a fruit fix Tried-and-true home remedies for constipation include prunes and prune juice as well as other dried fruits such as figs. Give them a try, but in moderation – you don’t want to overdo it.
Go for a stroll Some light exercise will help to get your bowels working.
Ask for help Sometimes constipation is caused by the medication you’re taking. If that’s the case, you’ll probably need a prescribed laxative. Ask your care team for advice.
Words to know
Constipation difficulty passing a bowel motion regularly or often
Diarrhoea frequent, often watery bowel motions
Dietitian a health professional who specialises in nutrition
Nausea feeling sick or feeling the need to vomit
Expert's insight: Kathy Chapman Kathy Chapman was the first nutritionist ever employed by Cancer Council NSW. Now the divisional director of health strategies, she stresses that keeping up your food intake during treatment should be a priority, even if it means bending some of the usual healthy diet rules by falling back on sugars and fats.
She warns that if your body can’t get the energy it needs from food, it will start breaking down the energy reserves in your body. That can lead to a weakening of your immune system – and that’s exactly what you don’t want during treatment for cancer.
“If you’ve already got a poor appetite and you’re feeling nauseous, eating is probably the last thing you want to do. But it’s actually the time when you need to get that energy into your body even more.
“When a healthy person gets gastro and goes off their food for 24 hours, they can catch up. But when you stop eating for a period of days or weeks during cancer treatment, that’s hard to catch up with.
“You can’t afford to think ‘It’ll be alright.’ You’ve got to think about some of the simple things you can manage so that you’re not missing out altogether.
“If your appetite is poor, something like sipping lemonade is going to be better for you than drinking water because water isn’t going to give you any energy. People with cancer who are struggling to eat should remember that the usual healthy diet rules don’t necessarily apply during those periods when you’re acutely unwell.
“A lot of people don’t realise that once treatment is finished they’ve got even more motivation to follow a healthy diet than the rest of the population. We know that particularly in terms of breast cancer, aiming for a healthy weight after treatment can be one of those things that improves prospects for survival and lowers the risk of the cancer returning.”
Expert's insight: Michelle Richmond Michelle Richmond serves as a mentor for people seeking a healthier, happier lifestyle, including people going through cancer treatment. One idea that’s particularly popular among her clients is the Super Food Smoothie, a milkshake made up of ingredients that are highly nutritious and super-easy to digest.
“When you’re doing something like chemotherapy or radiation therapy which is quite harsh on your body, your body has to work really hard. As a result, people don’t always feel like eating, so it’s good to maximise the nutrition in the food that you do eat and make it as easy as possible for your body to digest and assimilate.
“People who are sick and don’t have a lot of energy can make a Super Food Smoothie in the morning. It’s full of nutrients. You can put your vitamin C powder in there because the berries and the raw cacao disguise everything. You can put your magnesium powder in there, you can put zinc in there, you can put flaxseed oil in there – you can put everything in your smoothie. Keep a jug of it in the fridge and there are more nutrients in that than if you cooked yourself a meal most of the time.
“I have clients that are very sick and they have very low energy levels and this is something they can whack together in the morning, have in the fridge and just sip throughout the day. It’s easy for them to digest. It makes them feel good. And these are people who are not necessarily health conscious when I meet them.”
Michelle Richmond's Super Food Smoothie These ingredients can be added to your chosen base of coconut milk, almond milk, coconut juice, fresh fruit juice or herbal tea.
½ to 1 cup nuts (Michelle says cashews guard against depression and almonds provide lots of sustainable energy) ¼ cup chia seeds frozen or fresh berries fresh baby spinach leaves sprouts banana and other fruits of choice eggs (but not if your immune system is weak) brazil nuts sunflower seeds dates 2 tablespoons pure raw cacao powder ½ teaspoon cayenne pepper Synergy Natural Super Greens powder 1 tablespoon flaxseed oil hemp seeds bee pollen yacon syrup magnesium powder vitamin C powder iodine
Soak nuts and chia seeds in water overnight. Drain and then place in a blender or food processor along with your choice of drink base (coconut milk, almond milk, coconut juice, fresh fruit juice or herbal tea). Add other ingredients and blend until smooth. Refrigerate and drink through the day.
Michelle says the ingredients can be put together in any combination and suggests you choose intuitively, giving your body what it needs on the day. Specialist ingredients are available at healthfood stores and online retailers including Conscious Choice (www.conscious-choice.com; call (02) 9990 9204), Raw Power Australia (www.rawpower.com.au; call (02) 6674 3449) and Synergy Natural (www.synergynatural.com; call (02) 9555 6400).
LETCHEMI PILLAI Waikerie-based nurse Letchemi Pillai was cleared of breast cancer in September 2009. But 15 months later, she was found to have stage 1 stomach cancer.
After recently undergoing surgery on the affected area, Letchemi is being treated in Adelaide. She has lost almost 20 per cent of her normal body weight, dropping from 54 kilograms to 44.5 kilograms.
“I’m having radiation and chemotherapy concurrently. I have radiation Monday to Friday and I have chemo in a little bottle, which is a 24-hour infusion. It’s like my little shadow that I take everywhere with me. Every seventh day, I get a new bottle. The treatment goes for five weeks and tomorrow will be my fifth week.
“It’s been worse lately. From yesterday on, there have been new side effects. Because of the chemo, I get skin irritation. With radiation I’ve had vomiting and nausea. I had surgery and they’ve taken 50 per cent of my stomach out, and because of that my food intake and retention is affected.
“It’s good to have a dietitian guiding you through it all, because you will lose appetite and weight pretty quickly. Swallowing is very hard and they give you anti-nausea tablets which cause constipation. Eating is very much trial and error. Small meals work for me. I can tolerate yoghurt and a cereal called Just Right. Soup also works for me. I’m eating a lot of Chinese food like dumplings, rice porridge and noodles. They’re also good for my strength. I tried baked beans, but that was no good. You can buy high-protein drinks from your chemist and some people can tolerate that, but I can’t.
“We have a lot of culturally diverse people in Adelaide and different cultures have different diets. The Western diet may not suit everyone. I love curry, I miss curry, but it’s not good for my guts. Once my guts heal, it will be the first thing I’ll eat.”
Photo by Nick Cubbin
JANE ALLIKER While working at the Sydney Cancer Foundation at RPA, Jane Alliker would often find herself talking at length with cancer patients about food. After retiring, she compiled a collection of their recipes and tips*.
“There are many books by nutritionists, books on how to beat cancer, but nothing for those at the coalface dealing with its realities. So I decided a cookbook for the patients, by the patients, should be published.
“Many patients stopped eating red meat as they found that red meat made them constipated. They ate plenty of fish and incredible amounts of vegetables. One young woman made up 2 litres of juice and drank it through the day, which helped when her appetite was not great.
“An older German woman couldn’t have the chemotherapy because her blood iron levels were too low. She remembered her mother’s recipe for borsch soup and her blood iron levels went up within a month.
“One chap said he used certified Manuka honey to stop mouth ulcers. Many patients drank ginger and lemon tea or ginger beer to help with nausea. Eating a handful of raw almonds helps with the metallic taste.
“I told the patients their contributions to the book didn’t necessarily have to be nutritious – just what got their tastebuds going and made them enjoy life. Most patients were told they shouldn’t eat spicy foods and shouldn’t drink alcohol – some did. One woman said she couldn’t sleep, but found the answer: ‘Three good gin and tonics and I’m out for the count.’
“A breast cancer patient said ‘I hadn’t eaten for days. My husband came in with bacon, egg, tomato and mushrooms. It made me drool. It set me on the path to eating again.’”
* Due to be published by HarperCollins in early 2012, The Patient Chef features recipes from cancer patients. Proceeds will go to The Chris O’Brien Lifehouse at RPA.
