Working around Eating Problems

Depending on diagnosis, up to 85% of patients with cancer are at risk for losing too much weight too rapidly and developing malnutrition.  Patients can lose muscle mass, slow healing and impact the function of the immune system.

Even prior to diagnosis, many patients with cancer will complain http://www.nutrition-foundations.com/counseling/of poor appetite and notice difficulty tolerating certain foods.  Unfortunately, malnutrition can begin early, since diagnosis can be delayed due to symptoms that are shared with other more common causes.  Common complaints include lack of appetite, changes in taste and feeling full after small amounts of food.

While some patients will go directly to surgery, others undergo chemotherapy and/or radiation first ( = neoadjuvant treatment) to shrink the tumor prior to surgery.  These can also be given after surgery as well (=adjuvant treatment).  Side effects vary with different kinds of chemotherapy, but can include nausea, taste changes, sensitivity to cold, diarrhea and dehydration which can make it even more difficult to eat and maintain weight.

Recommendations and strategies that can help you eat better, avoid excess loss of weight and muscle and stay on treatment:

• Schedule 5 – 6 times to eat each day to make up for the smaller volumes of food you are able to eat. Without hunger as incentive to eat, it is critical to set up a system of reminders to eat every 2 ½ to 3 hours, or these opportunities are often missed. Unfortunately, most find it impossible to make it up at a later meal, so the opportunity to take in those calories is simply lost.  Since we typically keep our cell phones nearby, setting alarms there works very well.
• Choose softer, moist foods. Include something that lubricates the food, helping it slide down more easily and spreading taste through the mouth.  Consider foods like shredded meats, canned or cooked fruits and vegetables and add sauces or gravies where helpful.  Take advantage of foods that are already in a soft/“pureed” texture, like fish, refried beans, most dairy products, eggs, mashed potatoes, winter squash.
• Make it easy. There are many prepared foods that will work for you, so tour the aisles of the grocery store with your goals in mind. Frozen/prepared pasta dishes, mini-quiche, and microwavable mashed potatoes, soups and breakfast dishes are available. Friends and family often offer their help which can be coordinated through websites like mealtrain.com or lotsofhelpinghands.com.  Provide the recipes so you’re sure you will like the dish that arrives.
• Include liquid calories. They slip through narrow openings and are less likely to distend the walls of the stomach.  There are many options including the usual milk-like oral supplements which are usually lactose free.  Choose the “plus” versions that include an extra 100 calories and higher protein levels.  If milk itself is tolerated, many people enjoy Carnation Instant Breakfast powder, stirred in and adding 130 calories.  Scandishakes will add 440 calories and are well liked.  Clear liquid drinks include Boost Fruit Breeze and Ensure Clear, which some people mix with carbonated clear sodas.  In the produce area of the grocery store, Odwalla, Naked Juice and Bolthouse Farms make fruit-based drinks that include protein containing versions that can add some variety to your choices. All of these can be used as a base for smoothies, which should always include some source of protein.
• Create a list. It can be stressful to come up with ideas for what to eat at the moment that you need to make a choice. Creating a list of options for your refrigerator or wallet can help. It avoids problems with falling back on the same thing over and over, which can lead to “burning out” and never wanting to see that particular food again.  Including the “extras” that add calories can help make sure each bite counts, by reminding you to add the cheese when you warm up refried beans or scramble an egg, or toss walnuts or peanut butter into the oatmeal.  Include ideas for days when you struggle, so you can always choose something off the list.  Use the list when making shopping lists, so foods are available to you when you want them.
• Adjust your list by tolerance. Never cross something off your list until it has failed you more than twice.  However, if you notice that higher fat or high fiber foods cause food to “sit” on the stomach for long periods of time or increase diarrhea, you may try lowering the content of fat/fiber in the food you eat and see if that is helpful.  Journaling can help you see patterns.
• Talk to your team about anything that is getting in the way of eating. They will have some solutions if you are having problems with nausea/vomiting, constipation, diarrhea, dehydration, pain, sleeping, or anything else that is limiting your ability to eat.  They can guide you to over-the-counter medications and prescriptions that can help, or schedule you for IV fluids or other procedures to deal with the problems.  Waiting never resolves anything!