Why is nutrition important for people with cancer?
There are many reasons. First, when someone has cancer, there are often changes in the way their body uses food. These changes are usually caused by the cancer itself. Second, there may also be a greater need for food because of the effects of treatments like surgery, radiation, and chemotherapy. Some cancer patients need up to twenty percent more calories and fifty percent more protein than they needed before having cancer. Third, people have a much easier time tolerating their treatments for cancer when they are well nourished. They usually have less side effects, better wound healing, fewer infections, and are able to be more active.

So, what should I eat? What should I not eat? What vitamins must I take?
First of all, if you are getting treatment for cancer, this is not the time to leave out any foods. You're at a high risk of getting undernourished. You simply cannot afford to restrict your diet unless it's absolutely medically necessary. (Worrying about your cholesterol level may have to wait!) This IS the time to eat whatever appeals to you. There are no "bad foods" except the ones you don't like.

Knowing what to eat can be confusing. Your five nutrition priorities are as follows:

1. Drink enough fluids. Most adults need about six to eight, 8-ounce glasses of fluid per day. If you have fever, vomiting, or diarrhea, you will need more to replenish losses. Fluids can be gotten from water, juices, milk, sports drinks, teas, soups, gelatin, sherbet, popsicles, ices, and liquid supplements like Ensure, Boost, etc ... If most of your fluid comes from things other than water, coffee, or tea, the next step will be easier.

2. Get enough calories. Calorie needs vary a great deal from person to person. In general, if your weight is stable, it is safe to assume that you are meeting your calorie needs. If you are losing more than a few pounds during treatment, you are not getting enough calories.

A few simple changes can help increase the calories in what you eat and drink. Drinking high calorie beverages is easy, and the calories will add up quickly. Using whole milk instead of skim, and using full-fat dairy foods instead of the "lite" versions will also increase calories with minimal effort. You may wish to try adding high calorie items to your favorite foods, like butter or margarine, gravies, sauces, cheese, or nuts. All of these suggestions will give a big calorie boost to what you already eat and drink. These kinds of changes are easiest. If you do them, you won't have to force yourself to eat a greater volume, which is much more difficult. If you have tried these suggestions and are still losing weight, ask your nurse for a referral to the nutritionist.

3. Get enough protein. Like calories, protein needs are different for each person. If you notice you are losing weight and/or muscle tone, or if your doctor says your blood proteins are too low, you are not getting the protein you need. Remember that surgery, radiation, and chemotherapy all cause some degree of damage to body tissues. Protein is what is used to repair the damage, and to make new tissue. Protein is listed as number three, because without enough calories, protein will be used for energy, instead of for repairing damaged tissue.

Foods high in protein include poultry/meats/fish, dairy products, eggs, cheese, tofu, soy milk, dried beans, and nuts. Chose several servings per day from a variety of high protein foods. If you are still falling short, make an appointment with the nutritionist.

4. Get your vitamins and minerals. These are important to make sure your body has the best chance to fully use the food you are giving it. It is like the motor oil in your car. It is needed for smooth functioning, but if the gas tank is empty, it has little value in helping things "go". Although some cancer patients can meet their vitamin and mineral needs with food alone, most could probably benefit from taking a "Centrum" or "One-a-Day" type supplement. Look for a multivitamin-mineral supplement with about 100% of the USRDA for most nutrients. Take it with food. Be sure to let your doctor know you are taking a supplement. DO NOT take any higher doses of vitamins or minerals without first consulting your doctor and/or nutritionist. Supplements can be harmful at high doses and they can interfere with your treatment.

5. Be extra careful about food safety. Most cancer treatments cause temporary damage to the immune system. This is not a good time to get a food-borne infection! Be extra cautious. Always wash hands thoroughly (both thumbs and all fingers) before preparing food, before eating, after using the toilet, and after handling pets. Do not keep foods at room temperature for long periods of time. Keep cold foods cold, and hot foods hot. Take note of the smell and appearance of food that has been stored. If you think it may be spoiled, don't take a chance. As they say, "when in doubt, throw it out". Do not eat raw meats or fish, or raw eggs. If eating ground meat, be sure it is cooked to well-done. Be sure that raw eggs and meats that will be cooked are kept away from other foods that will be eaten uncooked. Use separate cookware and kitchen utensils to avoid cross-contamination (i.e. don't use the knife that just touched raw chicken to cut the cucumbers for your salad). After cooking eggs, meats, fish or poultry, put the cooked food on a clean plate. Scrub all cooking utensils with hot soapy water, rinse well, and allow to air dry.

Do nutrition supplements such as Ensure and Boost have a funny taste and smell?
The smell and "funny" taste are caused by the vitamins and minerals that are added to the supplements. If you find this unpleasant, try a homemade milk shake with your favorite ice cream. You can replace the vitamins and minerals with an oral multivitamin/mineral supplement. If swallowing is a problem, take children's chewables, and double the dose. Be sure to check with your physician before taking any supplements.

Tips For When Food Doesn't Taste Good
Chemotherapy, radiation therapy or the cancer itself may cause this problem. Sometimes people complain of a bitter or metallic taste in their mouth. Other times the food "tastes like nothing". For some people foods can taste too sweet or too salty. Taste preferences may even change from day to day. This is not only frustrating for the patient, but those who prepare meals for them. Some simple suggestions may make mealtime more enjoyable:

• Add small amount of seasonings to foods, such as oregano, basil, cinnamon or ginger. If you do not have mouth sores you may even want to try spicier foods at this time.
• Many foods including meaty and poultry taste better if they are served cold or at room temperature instead of hot.
• Marinate meats to enhance or disguise flavor. Try citrus juices, wine, and vinegar based dressings or marinades.
• Tart foods with distinctive tastes may be added to foods to help cover the metallic taste. Try adding orange, lime or lemon juice to fruit salad, salsa, sauces for pork or chicken, sir fried or cooked vegetables and oil-based salad dressing. Try vinegar, lemon juice or pickles to creamy dressings for macaroni, potato, tuna, chicken, egg or coleslaw. Lemon juice added to chicken broth, broth based soup, gazpacho and guacamole enhances the flavor.
• Rinse your mouth with fruit juice, wine, tea, ginger ale, club soda or salted water before eating. This will help clear your taste buds.
• Experiment with new foods or cuisines you may not have tried before.
• Find substitutes for foods that taste bad to you. For example substituting chicken, turkey, eggs, cottage, cheese, yogurt or tofu for red meat.
• Avoid eating no-salt-added or low salt varieties of canned soups or vegetables (unless your physician has instructed you to do so). Soups and vegetables tend to have a metallic taste if you omit salt in processing.
• If the metallic taste in your mouth persists, avoid using metal dishes and utensils. Try using plastic eating utensils.
• Suck on lemon drops, mints or chew gum after eating to get rid of undesirable tastes that linger in the mouth.
• Fruit juice, Popsicles, fruit sorbet, sherbet and fruit smoothies usually taste good and are a great source of fluids.

Feeling queasy?
Nausea is often caused by the smell of some foods. Hot foods have a stronger aroma and seem to be more of a problem. If the smell of food seems to bother you, try replacing hot meals with nourishing cold meals instead. Here are some examples of foods which are well tolerated:

• Cold salad plates; (For example, chef salad type)
• Chicken/tuna/egg salad plate
• Chicken/tuna/egg salad sandwiches
• Cold-cut sandwiches
• Cheese/egg sandwiches
• Cold soups like potato leek soup or gazpacho
• Puddings, ice cream, milk shakes
• Cottage cheese and fruit
• Cheese and crackers
• Peanut butter and crackers, peanut butter and jelly sandwiches

• If you are an inpatient at Alexian Brothers or St. Alexius Medical Centers and would like to speak to a Registered Dietitian notify your nurse.
• If you are an outpatient and would like to talk to a Registered Dietitian call the following:
  Alexian Brothers Medical Center-847-437-5500 Ext. 5823
  St. Alexius Medical Center-847-755-8603