Nutrition Services

Good nutrition is a very important part of cancer treatment. Patients being treated at the Carole and Ray Neag Comprehensive Cancer Center have access to registered dietitians with expertise in the nutritional needs of cancer patients.

A nutritious diet can help patients feel better and stay stronger, especially if they are receiving chemotherapy or radiation treatment. The right foods not only help rebuild the body's cells and energy levels, but also nourish your emotions. The dietitian can also provide dietary techniques to help alleviate poor appetite, taste changes, diarrhea, constipation, weight loss or gain, as well as nausea and mouth sores.

Eating well means consuming a variety of foods that provide the nutrients needed to keep patients healthy while undergoing cancer treatment. Benefits of a healthy diet include:

Maintaining strength and energy
Decreasing the risk of infection
Tolerating treatment-related side effects
Replenishing the body's store of nutrients and maintaining a healthy weight
Quicker healing and recovery times

At the Neag Comprehensive Cancer Center, registered dietitians who are board-certified specialists in oncology nutrition, will work closely with patients and caregivers to give advice about nutritional needs before, during, and after cancer therapy.

Managing Side Effects

Lack of Appetite, Nausea and Vomiting

Treat as indicated with anti-nausea medications. Use exactly as prescribed by your doctor or nurse.
Ginger: add chopped dried extracts into tea two to three times daily – 940mg powdered ginger root once daily for nausea prevention; 250mg powdered ginger root four times daily for nausea management. If you are on Coumadin or other blood thinners, talk to the nutritionist about the appropriate quantity to consume.
Try small frequent snacks of bland foods such as oatmeal, plain pasta, rice, potatoes, broths (avoid ‘empty stomach’ which may worsen nausea).
Completely avoid food smells. Avoid preparing food for yourself if possible, focus on foods with minimal odors and short cooking times. Eat foods at room temperature to reduce aromas.
Avoid eating in a warm, stuffy room.
Avoid large quantities of fluids with meals/snacks.
Rinse out mouth before and immediately after meals.
Sip warm, natural ginger ale (higher ginger content) – sip ginger tea or chamomile tea.Avoid peppermint tea – this may cause more reflux.
Sit up to eat. Do not lay down after eating for at least one hour.
Avoid fatty, greasy, fried, rich foods such as fatty meats, french fries, desserts (high fat will delay stomach emptying).

Increasing Calories for Weight Gain

Constipation

Drink eight to 10 cups of fluid each day. Try water, prune juice, other warm juices, and teas.
Try drinking a warm liquid, such as soup or tea half an hour before normal time for a bowel movement.
Add other sources of liquid to the diet such as soup or popsicles.
Add two tablespoons ground flaxseed to daily diet.
Slowly add high-fiber foods to the diet, try foods such as whole-grain breads and cereals, raw and cooked fruits and vegetables with the skins and peels, and beans and peas.
- If you increase fiber in your diet, be sure to increase fluid as well or you may become more constipated.
Snack on dried fruit such as apricots, raisins, prunes, and dates.
Increase physical activity, even if by a small amount. Try taking a short walk about one hour before your normal time for a bowel movement.
Eat a good breakfast; include a hot drink and high-fiber foods.
Mix three parts wheat bran cereal, two parts applesauce, and one part prune juice. Eat this three times per day or more as needed, to promote a bowel movement. This works well on toast or in oatmeal.
If gas is a problem, avoid carbonated drinks, broccoli, cabbage, cauliflower, dried beans and peas, onions, Brussels sprouts, Swiss chard, radishes, turnips, and watercress. Limit talking at meals to avoid swallowing air, do not use a straw, and avoid chewing gum.

Diarrhea

Eat small frequent meals and snacks that are bland and low in fat. These are digested easier.
Drink plenty of fluids such as broths and diluted juices.
Drink fluids between meals, not with them.
- Choose non-carbonated, non-caffeinated fluids.
Sports drinks (such as Gatorade) or Pedialyte can help replace lost electrolytes.
- Homemade Electrolyte Replacement Recipe: 1 teaspoon salt, 1 teaspoon baking soda, 1 tablespoon corn syrup, 6 ounces can frozen orange juice, 6 cups water. Mix all ingredients together. Refrigerate.
Limit milk and milk products, these may make diarrhea worse.
- Substitute milk with Lactaid, soy milk, or rice milk.
Avoid very hot, very cold, spicy, or very sweet foods – these can exacerbate symptoms.
Avoid fatty and fried foods.
Avoid insoluble fiber. This is found in skins of fruits, vegetables, potatoes, bran, seeds and nuts, wheat germ, whole grain and wheat, and many vegetables such as corn and leafy greens.
Include soluble fiber. This is found in oatmeal, barley, rice, and the inside of apples and pears.
Benefiber is an over-the-counter soluble fiber supplement that may increase regularity and decrease frequency of bowel movements. Mix 1 Tbsp with 8 oz water and drink. Repeat twice daily.
Probiotic Supplements (Culturelle or New Chapter All-Flora): These help replenish the good bacteria that normally reside in the intestines. They also help to feed your gut cells to keep them healthy and better able to absorb nutrients.

Sore Mouth and Mucositis

Be fastidious with mouth care to prevent secondary bacterial infection of mouth lesions.
Eat soft, bland foods such as creamed soups, cooked cereals, yogurt, pudding, mashed potatoes, eggs, custards, casseroles, smoothies and shakes.
Drink liquids and semi-soft solids through a straw to bypass mouth areas with sores and lesions.
Blend or moisten foods with yogurt, tofu, pudding, soft cereals such as oatmeal and cream of wheat, warm water, juice, milk, soy milk, rice milk, etc.
Try non-acidic juices such as apple, apricot, peach or pear nectar, and grape juice (do not use grape juice if diarrhea is present).
Avoid tart, acidic, or salty beverages and foods; pickled items; tomato-based foods; alcohol; caffeine; and tobacco.
Try powdered glutamine dissolved in liquid at 10 grams three times daily, swish and swallow, may be contraindicated if renal and/or hepatic function is severely impaired.
Try anti-inflammatory approach such as capsaicin taffy recipe.
Include soft, probiotic containing foods such as yogurt and kefir (fermented milk). If you have severe immunosuppression (your white blood cell counts are very low), do not include probiotics.

Dry Mouth and Thick Saliva

Drink eight to 12 cups (8 ounce cups) of fluid each day.
Sip 100% pure, papaya juice to stimulate saliva and break up secretions.
Use lemons and lemon juice to help increase production of saliva. Be careful if you have mouth sores or mucositis, as citrus and acidic foods may irritate them and cause pain.
Use fluids other than water, such as non-acidic juices, to aid with hydration and increase calorie intake.
Try stews and casseroles that contain plenty of liquid, such as those made with soups as the base ingredient.
Try soft cooked chicken and fish; tofu; thinned cereals, such as oatmeal made with plenty of water or milk; popsicles; shakes; smoothies; and slushies; warm soups and stews; and canned fruit in its liquid.
Blend or moisten foods with yogurt; tofu; pudding; soft cereals such as oatmeal, cream of wheat and malt-o-meal; warm water; juice; milk; soy milk; rice milk, etc.
Add broth, sauces, gravy, or soup to soften and moisten foods.
Use yogurt, juice, or jelly to make foods ‘slide’ down a dry throat easier.
Avoid or limit caffeinated foods and beverages such as coffee, caffeinated tea, and colas.
Avoid alcoholic beverages including beer, wine, and mixed drinks – alcohol will dry the mouth further.
Avoid dry foods including tough meats, raw vegetables, breads, pretzels, rice, chips, muffins, and cakes.
Avoid commercial mouthwashes – these contain alcohol which will dry the mouth further.

Food, Nutrition, and Prevention of Cancer and Chronic Diseases

The general consensus held by scientists and health professionals, is that other than genetic predisposition, most common cancers may be caused by potentially controllable external factors. These include physical activity, food and nutrition, and environmental factors such as smoking and exposures in the work place. This means that cancer is a largely preventable disease.

A healthy eating plan can not only help you to lose weight, but also help protect against several common cancers and chronic diseases such as stroke, heart disease, cataract formation, diabetes, and age-related diseases. When combined with not smoking and regular exercise, this can decrease the risk of heart disease by 80 percent and some cancers by 70 percent.

The World Cancer Research Fund International along with the American Institute for Cancer Research recently published a comprehensive report that analyzed over 7,000 studies on food, nutrition, physical activity, and the prevention of cancer. The recommendations apply for cancer survivors as well as people who have not had cancer and who are striving for a healthier future.

Here are six key steps to creating a healthy lifestyle for prevention of disease and overall health.

Watch Your Weight: This was one of the report's major recommendations. They advise that people be as lean as possible within the normal body weight range – a goal of a Body Mass Index between 21 and 23. Being overweight and obese have been found to lead to several cancers including breast, prostate, endometrial, esophagus, and colon; but also other chronic diseases such as diabetes, heart disease, stroke, and osteoarthritis.

Try to weight yourself every week, always in the morning. This will allow you to stay on target with your goals – whether they are to lose or maintain weight.
For weight loss, the most important thing to concentrate on is portion sizes. Remember: Every little bit counts! If you eat 100 calories above what your body needs a day (which is only 1 slice of bread), then you’ll gain 10 pounds a year. BUT - If you do about 20 minutes of moderate activity a day, which burns about 100 calories, then you’ll lose 10 pounds a year.

Be Physically Active: Include activity as part of everyday life. Along with reduction of disease risk, studies show that people who diet and exercise lose more weight and keep it off compared with those who diet alone.

Start with moderate activity of about 30 minutes per day and as fitness improves, increase time and difficulty.
Resistance, or weight training, is just as important as aerobic exercise because it helps increase your metabolism and build bone strength.

Limit Empty Calories and Fast Foods: In other words, foods and drinks that promote weight gain without promoting health. Empty calories include sugary drinks such as sodas, fruit drinks, and coffee with lots of added sugar and cream. Beverages are a huge culprit in weight gain because the body doesn’t recognize that it’s taking in calories, so you can drink literally hundreds of extra calories a day and not realize it. Fast foods and pre-packaged foods typically have lots of added fat, sugar, and preservatives that also lead to weight gain.

Try to choose calorie free and sugar free drinks to minimize excess calories.
One way to minimize processed and fast foods is to bring your lunch to work. Also, try shopping the perimeter of the grocery store. This is where all the fresh products and minimally processed foods are kept.

Eat More Fruits and Vegetables: People whose diets are rich in plant foods have a lower risk of cancers of the mouth, larynx, esophagus, lung, and possibly lower risk of colon, pancreas, and prostate cancer.

Fruits and vegetables are nature's multivitamin. They also contain antioxidants, which are the plant’s natural immune system, protecting them against UV light and insects. Therefore, when we eat them they help protect our bodies from damage that leads to chronic diseases and cancers. Every color does something different and has a different array of vitamins and minerals.

Aim for 5 to 9 servings per day and choose fruits and vegetables of all colors.
Half your plate at dinner should be non-starchy vegetables.

Choose Whole Grains: Refined grains, such as white breads and sugary cereals, have had the outside of the grain removed during processing. This is the part that contains the fiber, B vitamins, and iron. On the other hand, unrefined grains have had nothing removed, and are called “Whole Grains.” They provide many more nutrients.

Look for cereals and breads with 3 grams of fiber or more per serving.

Reduce Red and Processed Meats: These animal products are associated with risk of colorectal cancer and possibly prostate cancer, as well as heart disease and stroke. Red meat includes beef, pork, and lamb; while processed meats include bacon, sausage, hot dogs, and cold cuts.

Stick to around 12 ounces total of red and processed meats per week.
When you do eat them, choose the leanest cuts and remove all visible fat.
Try not to char the meats during cooking as recent studies are showing that burnt meats may be carcinogenic.

Reference: World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: AICR, 2007.

Registered Dietitian

Natalie Ranelli, R.D., C.D.N.
Nutrition Services
Phone: 860-679-7558

Additional Resources

American Cancer Society

National Cancer Institute (NCI)