CANCER TREATMENT: Nutritional Management of Side Effects

1. CANCER TREATMENT: Nutritional Management of Side Effects Lynn Goldstein, M.S., R.D., C.D.N. Nutritionist The Jay Monahan Center for Gastrointestinal Health

2. We Will Talk About: • What to do when you are feeling well • Nausea • Vomiting • Constipation • Diarrhea • Loss of appetite

3. We Will Talk About: • Taste changes • Mouth sores • Dry mouth • Weight loss/increasing calories & protein • Iron deficiency anemia • Safe food handling

4. When You Are Feeling Well • Maintain a balanced healthy diet • Eat plant-based foods • Get plenty of fruits and vegetables • Choose lean meats, fish and poultry • Avoid saturated and transfatty acids • Avoid refined, processed foods • Get plenty of water

5. Nausea • Eat 5-6 small meals – avoid an empty stomach • Eat bland and easy-to-digest foods • Eat cold foods • Suck on frozen ice pops or fruits, such as watermelon and grapes • Try sour foods, such as granny smith apples • Suck on hard candy – ginger root • Try easy foods with low odor, such as canned peaches, pears, or fruit cocktail

6. Nausea • Avoid foods with strong odors and hot foods • Avoid drinking large quantities of fluids w/ meals • Limit gas-producing foods, such as bean, cabbage, and broccoli • Avoid sweet, fatty, fried, or spicy foods • Avoid your favorite foods to limit food aversions • Avoid warm/stuffy rooms

7. Vomiting • Do not eat or drink until vomiting is under control • Drink small amounts of clear liquids • Once liquids are tolerated, try a soft diet with bland foods such as mashed potatoes, rice, pureed fruit, and yogurts • Eat potassium, magnesium-rich foods, such as bananas, potatoes, OJ, and tomatoes

8. Constipation • Have fiber with all meals • Try kidney beans, chickpeas, lentils, fruits, vegetables, oatmeal, and high-fiber cereal • Try dried fruit • Try 2 tbsp flaxseed • Drink plenty of fluids • Avoid binding foods, such as cheese and chocolate • Add exercise to your daily routine

9. Fiber Recipe for Constipation • 3 parts wheat bran cereal • 2 parts applesauce • 1 part prune juice • Mash mixture together • Eat 3 times per day as needed • Works well on toast

10. Diarrhea • Drink plenty of fluid to prevent dehydration • Drink fluid with electrolytes: Pedialyte • Consume potassium-rich foods, such as orange juice, bananas, tomatoes, and potatoes • Think BRATT: Bananas, Rice, Applesauce, Tea, and Toast • Try canned fruits, plain pasta, noodles, cream of rice cereal, eggs, potatoes, lean meats

11. Diarrhea • Avoid high-sugar beverages and snacks • Avoid “sugar-free” candies and gum • Avoid spicy, greasy foods • Avoid dairy products if they are not tolerated • Avoid insoluble fiber foods, such as raw fruit/vegetables, whole grains, nuts, seeds, popcorn, beans, lentils, and brown rice • Avoid snack foods with Olestra (WOW)

12. Rice Congee Recipe for Diarrhea • 1 cup long-cooking white rice • Combine with 6-7 cups of water and one tbsp salt • Cook for about 40 minutes • This is a sticky/soupy mixture that really helps diarrhea

13. Loss of Appetite • Eat by the clock rather than hunger • Choose high-calorie/protein snacks • Bring snacks with you when you go out • Have your favorite foods on hand • Have a friend or family member assist with meal preparation • Make foods visually appealing and avoid unpleasant odors

14. Loss of Appetite • Drink high-calorie/protein shakes • Avoid liquids with meals to keep from getting full quickly • Try a small amount of sherry or wine • Get some fresh air • Avoid stressful and unpleasant conversation during meal time • Avoid warm, stuffy environments

15. Mouth Sores (Mucositis) • Eat soft, bland, cool foods • Puree and liquify foods in a blender • Drink through a straw • Suck on frozen fruit – avoid citrus, tomato • Avoid irritating spices and seasonings • Avoid rough, dry, course foods • Avoid alcohol or tobacco • Rinse mouth often with mild mouthwash

16. Taste Changes • Season foods with tart flavors • Chew lemon drops, mints, gum • Flavor foods with onion, garlic, chili powder, basil, oregano, rosemary, BBQ sauce, mustard, or catsup • Marinate foods in sweet juices • Drink flavored instead of plain water

17. Taste Changes • Serve food cold • Rinse mouth w/ tea, ginger ale, salted water w/ baking soda before eating • Eat frozen fruits, such as cantaloupe, grapes, oranges, or watermelon • Select fresh instead of frozen/canned vegetables • Use plastic utensils instead of metal

18. Dry Mouth • Sip fluid every few minutes • Try very sweet or tart foods & beverages • Suck on hard candies, Popsicles, gum • Eat foods with sauces, gravies, dressings • Puree foods • Use lip balm

19. Weight Loss/Increasing Calories and Protein • Eat several small meals a day • Eat favorite foods any time of the day • Eat every few hours; eat on a schedule • Keep easy-to-grab snacks on hand at all times, such as granola bars, fruit, nuts, single serving- size tuna cans, trail mix, puddings, and yogurt • Focus on high-calorie foods • Take advantage of your most energetic time

20. Weight Loss/Increasing Calories and Protein • Exercise lightly to increase appetite • Drink nutritional supplements • Drink caloric fluids between meals • Add fat, such as olive or sesame oil • Add chopped nuts/seeds to meals • Avoid low-fat or “diet” foods • Add protein powders

21. Iron Deficiency Anemia • Animal (heme) products are best source; the darker the meat, the higher the iron amount • Dark green vegetables (non-heme) and dried fruit • Iron-fortified grains/nuts/seeds • Vitamin C to boost absorption of non-heme iron • Calcium decreases iron absorption • Coffee/tea/cola decrease iron absorption • Cook acidic foods (tomato sauce) in cast iron pots and pans

22. Safe Food Handling • Wash hands well with warm soapy water before preparing and eating food • Do not use same cutting surface for meat and vegetables. Sanitize cutting surface before each use • Keep hot foods hot and cold foods cold • Never thaw foods at room temperature • Eat only well cooked foods

23. Safe Food Handling • Avoid raw egg products • Avoid unpasteurized products • Avoid salad bars • Avoid fresh squeezed juices unless made at home • Avoid raw fish

24. Ask for Help When You Need It!

25. Helpful Websites • www.monahancenter.org Jay Monahan Center • www.cancer.org American Cancer Society • www.aicr.org American Institute for Cancer Research • www.cancer.gov National Cancer Institute