Eating Well
Eating well during treatment is an important aspect of your care. Low food intake means that you will not be taking in all the energy you need, and so will lose weight and feel under the weather. But having a healthy balanced diet is not always as easy as it sounds. You may have lost your appetite, find swallowing difficult, feel sick, or find that symptoms like diarrhoea are worse after a meal, and so skip meals as a result. If you experience any of these problems, tell the health care professionals looking after you - they can advise on medication that will help, and a dietician can advise you on your food intake, and ways to overcome these problems.
Making sure that you eat enough for your energy requirements is particularly important if you have lost weight, and some experts will say that patients undergoing treatment need more food than normal. But even if you don’t need extra food you certainly need enough food – this is no time to diet.
We need a variety of different foods, including carbohydrates and fats which are both good sources of energy, proteins which provide the chemicals for us to maintain our muscles and other tissues, and vitamins and minerals which are essential for many functions within the body. A balanced diet contains the right amounts of all these ingredients.
During treatment it may be necessary to eat differently to ensure that your diet has enough energy. Normally, dieticians will tell you to eat only small amounts of high energy foods like butter, margarine and other fats, and foods with concentrated sugar like honey, because of the danger of putting on weight. But if you are not eating well you need more of these foods to maintain the right energy level in your food.
Back to top
Food Supplements
If eating enough is a struggle, food supplements are one way of boosting your energy (calorie) intake. But before you do that, there are a couple of other tricks to try. The first is to try other foods that are either easier to eat or just more appetising for you. Eating a selection of foods you fancy can build up into a balanced diet or at least go some way towards it, particularly if combined with trick two.
The second thing to try is to experiment with new meal patterns, which might mean having more smaller meals or having your main meal at the time you feel most hungry during the day. It’s just a question of trial and error until you hit on a solution that suits you.
Some people do need food supplements. There are a variety of supplements available: some are complete diets, others provide extra energy, and some contain minerals and vitamins.
Complete supplements can be used instead of food but more often they are used in combination with food. They may be savoury or sweet, and usually come as some form of liquid such as a soup or milk shake.
Energy supplements contain fats or carbohydrates or a mixture of the two. They are often powders which can be added to meals or drinks. You may need to speak to a dietician to ensure that you are using these in the easiest way possible and making sure your diet is still balanced.
Vitamin and mineral supplements are usually given as tablets or capsules. These are only required in small amounts, and it can be harmful to take too much, for example too much vitamin B6 can cause tingling in your hands and feet and there is some evidence to suggest that excess vitamin A, beta-carotene and Vitamin E are associated with more frequent recurrences of lung cancer. So it is wise only to take the vitamin and mineral supplements you need and only in the recommended dose.
Back to top
Regaining an Appetite
A lost appetite is a frequent complaint amongst patients with all sorts of illnesses. It may be associated with nausea or feeling tired or generally run down or feeling depressed. If there is a specific cause your appetite will improve with treatment. Often there isn’t an obvious cause – but that doesn’t mean that there is nothing you can do about it.
A small alcoholic drink before meals (provided that there is no good reason not to have one) does give you an appetite, but it does need to be a small drink, because large drinks of any description make you feel full and diminish your appetite.
Choosing foods you like is another obvious trick to try: eating something is better than eating nothing, so even it’s foods that are normally frowned upon a little of what you fancy does you good. But it is best to avoid low calorie soups as these fill you up without providing much nutritional benefit.
Eating little and often is another way to increase the amount you eat – small frequent snacks and meals all add up, or at least count towards the energy you need, and the more attractively the food is presented the better the chances of clearing the plate.
Some medications including small doses of steroids can also help, but as with all drugs there can be side effects, so it is best to discuss the pros and cons with your doctors and dietician.
Back to top
Feeling Full
Some people feel that they have a good appetite but feel full very soon after they start to eat. They will often feel that they are eating well but their relatives tell a different story – that they are hardly eating at all.
The best approach here is to have small meals more often than normal, so that in addition to breakfast lunch and dinner, you have a mid morning snack, something during the afternoon and at bedtime as well. Liquid foods, such as soup or broth, are best avoided as they can be filling without providing many calories.
If you continue to feel full after meals then some types of anti-sickness medicines can help deal with this problem.
Back to top
Nausea
Nausea affects a lot of patients during treatment. Ensuring that you have the right medication is important; there are many drugs which are very effective in combating nausea and there really is no point in putting up with symptoms that can be effectively treated.
But there are other things you can do as well. Avoiding cooking smells helps a lot, and for this reason cold foods are often better than hot meals. Sucking a sweet – a fruit pastille or mint - helps too, probably because of the glucose in the sweet. Small sips of carbonated drinks can also be very effective and some people swear by ginger (usually in the form of ginger beer). Ginger is an old Chinese remedy for nausea and although there may be no research evidence to back the claim, many patients will say how helpful it has been.
Relaxation therapy can also be very helpful, particularly for patients who tend to feel sick in anticipation of their treatment.
Very fatty foods such as deep fried foods should be avoided – these tend to stay in the stomach longer.
Back to top
Difficulty in Swallowing
There are a number of causes of finding it difficult to swallow foods. The gullet may be sore due to radiotherapy, or swallowing may be painful, or the gullet may be blocked or feel as if it is blocked. Finding the cause is the key to providing advice that works, and so patients with swallowing problems will usually have an assessment by a speech and language therapist.
Some patients are helped with medication that soothes the inflamed lining of the gullet, but others need to know what they can swallow and what is safe for them to swallow. Altering food to the right texture and thickness can help a great deal, and for some this will mean liquid or pureed food. Some people will find watery drinks more difficult to swallow than thicker liquids, or that more watery drinks tend to “go down the wrong way” leading to coughing, spluttering and choking. Working out the dos and don’ts of what to try makes a real difference.
Foods to avoid may include bread and some starchy foods like boiled rice, which tend to absorb the fluid in our mouth making it more difficult to swallow. Surprisingly bread that is lightly toasted may be easier to swallow and rice made into a rice pudding may be moist enough to swallow more easily.
Back to top
“Dumping” Syndromes
Dumping is a problem that sometimes occurs after stomach surgery. There are two types of dumping – one that occurs almost immediately after a meal, which is called early dumping, and late dumping that occurs about 90 minutes afterwards.
Early dumping is due to food moving quickly from the stomach into the next part of the bowel. This causes body fluids to be drawn into the gut, so your blood pressure drops and you feel faint and unwell.
Late dumping is caused by a sudden rise in blood sugar when digested food is absorbed. In response the body produces more insulin, which causes your blood sugar to drop. A low blood sugar makes you feel faint and light headed.
To reduce the effects of dumping, it is best to eat slowly and avoid very sugary foods. To compensate for foods with relatively little sugar the fat content of your food will need to be increased. Other tricks that help are eating smaller meals more often, and avoiding soup and very liquid foods.
Back to top
Stents and Eating
A stent is a tube made of a metal mesh usually with a plastic coating. It is used to help you to swallow by keeping the gullet open.
Most people with a stent find it easier to eat smaller meals more frequently, to chew their food carefully and to avoid food that tends to stick, particularly very fresh bread, hard-boiled egg, fish with bones, hard chips, some fruit and vegetables. Instead choose foods that are soft, have a sauce, gravy, cream or custard.
Drinking plenty of fluids including warm or fizzy drinks during and after a meal helps to keep your stent clean and prevent blockages.
Vomiting
Vomiting that persists for more than a few hours is a medical problem that requires investigation and treatment once the cause is known. Some anti cancer drugs cause vomiting but this can be prevented or helped to a very large extent by medication.
Once treated, the symptoms can often be helped further by following exactly the advice for patients suffering from nausea.
The danger from vomiting is dehydration, and to counter this it is best to take small sips of fluid frequently. Fluids with a small amount of sugar (5g per 100ml) and a pinch of salt are easier to absorb than plain water, and will provide a small amount of energy as well.
Back to top
Diarrhoea
Diarrhoea can be due to a number of causes, including radiotherapy to the pelvis. Fortunately this usually gets better soon after the treatment stops, but it can be distressing and embarrassing while it lasts.
Some medications do help. Some people have suggested that low residue – low fibre diets are helpful, but in fact there is no evidence to back up that claim. Attempting to eat a low residue diet may also result in eating a lower energy diet and so can be harmful. Consequently many dieticians advise patients to eat normal foods but to have smaller more frequent meals, with regular fluids to combat dehydration.
Summary
During treatment it is important to eat well, even if food is a struggle or precipitates unpleasant symptoms. Most, if not all symptoms, can be helped by a mixture of medication and dietary advice, and almost all will improve over time.
Talk to the health care professionals looking after you and tell them your symptoms - they can advise on medication that will help, or ask to speak to a dietician who can advise you on how to change your diet and the way you eat, which can make a big difference.
Back to top