Nutrition

Nutrition During Treatment by Rita Date, Nutritionist and Author of What’s for Lunch

Eating healthy food is important when you are receiving treatment for cancer. Cancer cannot be cured by diet alone, and there is not enough evidence to prove that special diets or foods are beneficial. If you are considering drastic changes to your diet it is best to discus them with your doctor or dietician. It is crucial that you eat well to feel well and have more energy, get the best benefit from your treatment with fewer side effects, better your body’s ability to heal and maintain a healthy weight.

Nutrition During Treatment

Food Safety

When you are going through chemotherapy and/or radiation the body’s immune system is repressed and cannot fight infections as before. This is why you need to stay away from people who are ill during treatment. The body also cannot fight foodborne illnesses that are caused by eating food that contains harmful bacteria, parasites, or viruses.

Some foods have a higher risk of becoming tainted with bacteria and can be avoided during treatment. If you really cannot live without these foods, then take the utmost care in cleaning and preparing them.

Avoid

• Restaurant foods. Eat meals made at home!
• Raw salads. Unwashed vegetables, especially leafy vegetables that can hide dirt and other contaminants
• Raw sprouts. It is better to sprout them at home and steam them slightly rather than eat them raw.
• Fruits. You can eat bananas since they have a thick protective skin. Apples, pears washed well and skin peeled are also ok. Avoid most other fruits especially berries, guava.
• Fruit juices. Homemade orange, sweet lime and watermelon are allowed if made with the utmost hygiene. No fresh juice bought at a restaurant is recommended.
• Raw or undercooked fish, seafood, or meat of any kind.
• Unpasteurized milk. Always boil the milk.
• Soft cheeses made from unpasteurized milk, such as Brie, Camembert, feta, and goat cheese. Processed cheeses such as Amul and Britannia are ok.
• Undercooked eggs, such as soft boiled, over easy, and poached or foods made with raw egg, such as homemade raw cookie dough and homemade mayonnaise.
• Frozen foods unless you know how it has been frozen. Our Indian cold storage system sometimes is unreliable and foods many times get thawed and frozen again during the distribution network.  It is better to avoid these foods.

Simple steps for food safety
Prepare and clean up foods carefully.

• Rinse all fresh fruits and vegetables under running water, and dry them with a clean towel.
• Before and after preparing food, wash your hands for 20 seconds with hot water and soap.
• Clean your utensils and dishes with hot water and soap.
• Disinfect your kitchen and cutting boards with natural cleaners using 1 teaspoon of vinegar into ½ litre of water.  
• Set aside a specific cutting board for preparing uncooked meat, fish, and chicken. Never use it for uncooked fruits, vegetables, or other foods.
• Refrigerate cooked foods within 2 hours of cooking.

Dispose of old food

• Eat packaged food before its expiration date (the “use by” or “best before” date).
• Consume refrigerated leftovers within 1-2 days. Even if the food does not smell or look spoiled, it still may be unsafe. Some bacteria can grow even on foods stored in the refrigerator if they are kept for too long.
• Refrigerate food promptly. Refrigerate or freeze perishable food within 2 hours of cooking or buying it. Proper cooking destroys bacteria, but they can still grow on cooked food that is left out too long, especially in warmer weather.

Side Effects and Nutrition
You need to eat nutritious foods that are palatable while experiencing the side effects of chemo and radiation. Here are some of the most common symptoms and ways you can address them through your diet:

• Nausea:

Drink lemon tea. You can also make a mixture of lemon, sugar and ginger and keep having a taste of it before meals. Ginger helps with nausea, but do not have too much as it may cause the stomach to burn.
Eat small meals.
Eat dry foods such as khakra, toast or plain roti.
Eat foods that do not have a strong smell.
Avoid spicy and oily foods.
Cooling foods sometimes help. Curds, curd-rice, lassis.
Eat food cold or at room temperature, not hot, to reduce its smell and taste.

• Taste changes:

Try eating or seasoning foods with sour flavors such as pomegranates, citrus fruits, apples, and ginger.
Try using spices such as mint, oregano, and rosemary.
Try different foods, ones you may not have liked before.
Eat with a plastic spoon if foods taste metallic
Do not wait until you are hungry to eat. Try and eat at certain timely intervals.
Have portable snacks handy, especially if you're having trouble eating enough because of loss of appetite. Keep high-protein snacks ready so you can eat when you feel like it. Try cheese and crackers, peanuts, almonds, boiled eggs or roasted channa, peanut butter and some dry fruit.

• Mouth sores:
  • Eat soft foods, drink milkshakes and lassis.
    
  • Avoid spicy or acidic foods.
    
  • Eat lukewarm soups and dals. You can eat watery dals as soup.
    
  • Avoid sharp or rough foods such as toast and chakli.
• Constipation: Sometimes when your food intake is less constipation becomes a problem.
  • Take adequate fluids to help move the bowels.
    
  • Get enough fibre from whole grains and vegetables.
    
  • Drink warm liquids like herbal and green tea.
    
  • Dry fruits like jardaloo(dried apricot) with warm water eaten at night also help.
• Diarrhea:
  • Eat small, frequent meals and snacks.
    
  • Make sure you are adequately hydrated with electrolyte-rich fluids like clear soups and coconut water.
    
  • Avoid high fat, high fibre and high sugar foods.
    
  • Potassium is often lost through diarrhea. Eat foods that have a lot of potassium, such as coconut water, potatoes and bananas for replenishment.
    
  • Eat foods that are high in sodium, such as soups, crackers, and pickles.  Salt helps you retain water so you don't become dehydrated.
    
  • Avoid high-fat, fried, greasy, and rich foods. They can promote diarrhea.
    
  • Avoid foods that cause gas and bloating such as chewing gum and carbonated beverages. They can irritate your digestive tract.
    
  • Limit milk and milk products. They may be hard to digest and promote diarrhea.

Fatigue: Fatigue is the most common side-effect of cancer treatment. Many factors cause fatigue, and fatigue may linger even after breast cancer treatment is completed. Nausea, hot flashes, stress, and depression all may contribute to fatigue. Not getting enough food and nutrients because of treatment side effects can cause add to fatigue. If you're fighting fatigue, it's important to make sure you're getting enough protein, vitamins and minerals and hydration.

Try to eat a healthy protein food with every meal/snack. Dahi, paneer, pulses, dals, cheese and nuts are all good sources of vegetarian protein. Drink plenty of fluids, and eat lots of fruits and vegetables. Eat often throughout the day in small amounts. Try to get in some light physical activity.

Protein helps heal and rebuild tissues. During treatment, eat one gram of protein for each kilo you weigh. So if you weigh 60 kilos, try to get 60 grams of protein in your diet each day. Here is a chart for reference:

• One Egg – 6 grams
• 100g cooked Chicken – 28grams
• 100g cooked Fish --25 g
• Dal/Pulses – 12-15 gms per cup
• One cup milk – 8grams
• One cup dahi – 11 grams
• 25g cheese(1/4cup of cubed cheese) – 7 grams
• 10-12 Nuts(almonds, peanuts, cashews) – 3 grams

You should also make sure to get enough vitamins and minerals. Getting these nutrients from foods rather than from supplements is ideal, however, if you aren't eating very much because of treatment side effects, ask your doctor about taking a multivitamin.

Dehydration also plays a role in fatigue. You may be dehydrated because you've been vomiting or have had diarrhea after treatment. Or maybe you're just too tired to keep drinking liquids. This can lead to an imbalance in electrolytes and can make you feel weak.

Weight Gain During Treatment
Being overweight or obese increases your chances of relapse of your cancer. It is vital to keep a healthy weight. Many Indian women gain weight during cancer treatment. Sometimes this is due to the side effects of the medicines but most of the time it is due to lack of physical activity and the increase of fats in the diet. Breast cancer usually occurs during or after peri menopause. It is exactly at this phase of a women’s life where weight gain is common due to various hormonal factors and lifestyle changes. For example, at this age children are older and do not need to be looked after – women are no longer running after their children. Also, since there is household help in India there is less movement around the home and when a women has cancer or any illness, family members do not allow her to “work.” Many times she will quit her job and sit at home, again with little physical activity. Fatigue does occur but it is important to make an effort to be more active. This will actually help with your fatigue.

There is the notion that ghee is good for your well being. A teaspoon of ghee a day is all you need to get the benefits of ghee. Ghee is high calorie and unless you are burning those calories you will put on weight, which is worse than the possible benefits of ghee.

Eat a sensible diet during treatment without too much fat and little or no sugar.

Advice to Caregivers
Caregivers may find it frustrating at times to give the necessary nutrition to their loved ones. When a family member cannot eat because of the side-effects of treatment or when taste buds change (sometimes on a daily basis) it makes it difficult to find the right foods to make and nourish the patient. Don’t get offended if you make their favorite foods and they do not want to eat them. Again, taste buds tend to change and a person who once loved your chicken curry may not be able to stand the smell of it when on treatment.

It is important to be patient and encouraging during this time. Small meals or snacks through the day may be better than larger meals. Do not worry about having the perfect balanced diet during the chemo or radiation. Concentrate in getting enough calories so the patient does not suffer from too much weight loss.

Helpful tips:

• Prepare the biggest meal of the day when the patient is the hungriest. Each individual will be different.
  
• Offer favourite foods any time of day. Upma for dinner or roti-sabji for breakfast is fine.
  
• Add dals to sabjis or make some snacks with channa for extra protein.
  
• Spicy and oily foods may not be well tolerated so learn to cook with less spice.
  
• Make food softer as it is easy on the mouth and to swallow. Soft rice, rotis and vegetables for example.
  
• If the patient is sensitive to smell, then close the kitchen door when cooking and burn an agarbati to mask the smells.
  
• Drinking is many times easier than eating. Milkshakes, smoothies, and lassis are good options. Limit tea and coffee to 1-2 cups per day as they tend to upset the lining of the stomach. Hot cocoa or herbal tea are options if hot drinks are preferred.

Rita Date is a volunteers at Orchids Clinic giving nutrition advice to patients. For an appointment contact reception.