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Julie Lanford: Getting Good Nutrition When You Don't Feel Like Eating

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Published on April 15, 2019

Julie Lanford, also known as “The Cancer Dietitian,” shares ways cancer patients with poor appetite, digestive issues, taste changes or other difficulties eating can get adequate nutrition to avoid unhealthy weight loss or prolong treatment recovery time and support the immune system and energy levels. Watch now to learn her expert advice.


Transcript | Julie Lanford: Getting Good Nutrition When You Don't Feel Like Eating

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Julie Lanford:

Hey everyone, this is Julie Lanford.  I am the cancer dietitian, and I am here over on Patient Power's page to talk about what to eat when you don't feel like eating.  

So if you're not familiar with me, my name is Julie, and I am a bona fide oncology nutrition specialist.  I am a board?certified specialist in oncology nutrition and a registered dietitian-nutritionist.  I am licensed in the state of North Carolina.  I've been a registered dietitian for over 10 years, and almost all of my time has been working with oncology patients.  And I have a master's in public health and nutrition from UNC Chapel Hill.  So I don't tell people that just an impress them, but I think in the world of nutrition it seems like everybody has advicen. Ad it's important that you're getting advice, especially people facing cancer, from somebody who has the training to know what they're talking about.  

So today we're really focusing on what kind of foods can you eat, and how can you nourish your body when you either don't feel like eating or are having digestive issues. So this is something that I deal a lot with my oncology patients.  Many of them are dealing with poor appetites.  Sometimes it's actually poor appetite that brings people in to see their doctor, and that's when they find out that they have something going on, a cancer diagnosis.  And then for other people the poor appetite is the result of their treatments.  

So what I want to talk about today is not just that but also the challenges in digestion. We will talk about some of the side effects or why you want to make sure that you're paying attention to getting enough nutrition, and then of course some tips for what to do.  

So the first thing to know is that if you do not get enough nutrition, it will result in difficulties for your body.  And so sometimes that shows up in unintentional weight loss, which why a lot of healthcare providers, we don't like it when you lose weight during cancer treatment.  In some cases, it's okay if you're losing weight in the context of you're focusing on healthy eating, you're being physically active, you generally can live sort of a normal lifestyle while you're on treatment.  That's fine.  

But for a lot of people during treatment, they are losing weight, because they don't feel like eating.  They don't have enough energy to be physically active.  They just aren't eating enough, and when their body doesn't get enough calories, it doesn't get enough protein, it doesn't get enough vitamins and minerals and other nutrients it results in weight loss that's not healthy. And so for a lot of oncology clinics, weight loss is actually one of the big indicators that a patient might need to see an oncology dietitian.  So weight loss is something we don't want.

Usually when you lose weight during treatment, it is muscle mass that you're losing, and we don't want muscle mass lost, because muscle mass gives you energy.  Muscle also does help to support your immune system. You want to keep that lean muscle tissue around as much as possible.  So, weakness is another thing.  Fatigue.  And then it does slow your healing if you're not adequately nourished, which I feel like we all kind of know that.  Our moms, you know, always told us that.  Make sure you eat if you're sick.  You don't want to lose weight.  You don't want to feel bad.  You need to get nutrition.  It's easy to say, and then when it comes down to it it's really hard to do.  

So I do have some tips to make sure.  What I like to focus on with my clients who are really struggling to get enough to eat is to help—we call it liberalizing the diet or really helping people understand that having something to eat is better than having nothing to eat.  So especially if somebody is really concerned about the quality of the foods they're eating, let's say they're really trying to get lots of fruits and vegetables, and they're trying to eat healthy fats, and then they come to a period of time, a season I say, of treatment where they just don't feel well. And they don't give themselves permission to eat some of the foods that maybe they don't usually eat.  So think milkshakes or maybe some white grains that they don't typically eat.  

And what we do as oncology dietitians is we really open up our toolbox and say, you know what, right now if what you feel like eating is a milkshake and that's all you feel like you can get down, we want you to eat a milkshake, because that is going to give your body calories and protein that you otherwise wouldn't get. So that's our top priority is first of all getting enough energy.  So calories represents energy.  We want you to get enough energy.  So we can do that.  Of course, you know, milkshakes are an easy thing.  A lot of people, they're like, well, I know how to get lots of calories, so pretty much anything works at this point.  

For a lot of people though if you're low on energy and you don't feel like eating, drinking something is almost easier to convince yourself that you can do, and so that's why we use a lot of those nutrition supplement drinks.  You don't have to use Boost or Ensure or whatever. Store brands are fine too.  You don't have to use them, you can actually make your own using some different recipes, but you can also use those same recipes with milk or with Ensure or Boost or a nutrition supplement drink, and that just gives extra calories and extra protein, and the recipes that you use might give it a better flavor than you typically would like.  So that's one way that you can add it in.  

I tend to focus on making sure people optimize their meals and snacks, and so you can optimize that by getting higher fat and higher calorie foods in your snacks, so making sure if you're going to have crackers that you have crackers with peanut butter, or you have crackers with cheese, or you have crackers with avocado or something that's going to give you extra calories.  

Something else that you can do for energy if you don't like the sweet drinks, a lot of people think that milkshakes, they get tired of that or the Boost or the Ensure is just a flavor they don't like, or they're just not sweet people.  They're more salty type of people or savory type of people.  And of course treatment can change your taste buds completely, so who knows what you're going to like, right?  

But there is a product that Nestle makes called Benecalorie, and it comes with, I can't remember, maybe 100, 200 calories, and it has some grams of protein, I can't remember the exact amount, but it is a good way for you to add calories to something like scrambled egg or to cream soups or mashed potatoes or oatmeal or grits or something like that.  It comes in a little round—I should have had one here—but it comes in a little round container.  You have to shake it up to make sure that the protein gets mixed in with the fat, but then you mix it in with your food, and it does add a boost of calories and protein that you wouldn't normally have.  So I think that's a helpful tool as well.  You can order that online or probably through your pharmacy to get that. 

The other thing with poor appetite is to eat on a schedule, so trying to make sure that you don't go too long without eating.  I always tell people to eat within an hour of getting up in the morning so that you don't miss that opportunity.  If you're supposed to take medication on an empty stomach, a lot of people I encourage, okay, when you wake up immediately take your empty?stomach medicine, then an hour later you can go ahead and have your breakfast and make sure you’re eating something or drinking something every two to three hours afterwards.  

So for caregivers sometimes that is a good—sort of a good role for the caregiver to have is to remind their loved one when it's been two or three hours since they ate last, because if you are somebody who has poor appetite, you can't rely on your body to tell you it's time to eat.  You know, those signals are kind of messed up during the treatment so you have to tell yourself, oh, time to eat.  So be sure that you either use a timer—you know, your watch or your phone can be a great timer, but your caregiver also might want a job and sometimes that's a good thing you can give them to do.  

The other thing that I'll tell you is if you have trouble digesting food, you can probably look at a variety of different options.  The milkshakes, the blended foods tend to be easier to digest.  If you're having GI symptoms like constipation or diarrhea, it's important that you talk with your nurse about any medical management that you might need to do in addition to your nutrition strategies. 

So especially for constipation if you're on pain medicines that are going to make you constipated, it's important that you stay ahead of that rather than waiting too long, and a lot of nurses are great at helping to find a regimen to make sure that you have regular bowel movements.  If you're having the opposite issue with diarrhea or loose stools, there are also medications that can help with that.  So in addition to, if you have loose stools, you want to make sure you're using a low residue diet, which is what we say is low in fiber so that you don't have anything that's really irritating your intestine.  

But the interesting thing about diarrhea is that sometimes, and this sounds counterintuitive, but sometimes it is helpful to actually include a soluble fiber supplement, and that helps to actually bind up the water that's in the intestine so that it can help form a stool.  So that's something to also talk to your medical team about if it's an ongoing issue is that maybe that's a strategy that you can use.  

So I do have some recipes for high?calorie drinks.  I have a YouTube channel.  It's the Cancer Dietitian YouTube channel where an intern of mine and I, we have several different recipes that you can make with nutrition supplement drinks. So there's an ice cream recipe.  I have a pudding, I think it's a banana pudding that we did.  And a couple of different smoothies, and actually my co?workers all thought it tasted great.  And so I do have some tips for using those nutrition supplement drinks.  

But ideally we would figure out how to make sure you're getting enough calories and enough protein in through the foods that you eat.  So that's our primary goal would be, okay, are you eating every two to three hours during the day to get that nutrition in?  That way it doesn't have to be a lot of food at once.  It can be small amounts of food throughout the day and still meet your calorie needs—but also making sure that those snacks that you're eating are giving you plenty of nutrition.  

And you need a variety of food, so make sure that at snack times you're having between two and three food groups represented.  So it could be apple with peanut butter.  That would be two food groups represented.  If you had like crackers with a cheese and an apple, then that would be three food groups.  At meal times we recommend kind of having four.  So trying to mix those in and getting enough throughout the day I think can make a big difference in how you feel and also how you tolerate treatment. 

So you might also be wondering, well, how do I know how many calories I should be eating? And I would tell you it's not a huge deal, that you don't have to count the calories.  Most of my clients are not like keeping track of, oh, am I getting enough calories or getting enough protein, at least not at first.  What I would say is you need to eat every couple of hours.  Eat something that sounds good.  Make sure you're eating enough of it, that you're feeling full, and then that a couple of hours later you’re eating again.  

Now, if you're using that strategy and you're still losing weight or you're still having problems with it, that's when you'd want to either ask for a consultation with your oncology dietitian where they can calculate exactly what your needs are. Possibly your doctor could do that, but usually they rely on the dieticians to kind of figure that out because there are some cases where we do need to get down and troubleshoot a little bit more about, well, how much calories are you getting in and how many do we think you need, and are there differences.  

I'm trying to think what else people might need to know.  I think for a lot of people who are treated with like head and neck cancer where they have to be on tube feedings they usually get their calorie needs calculated for them.  

But the other issue that often causes a lot of trouble for people is dehydration.  So you might find that you're fatigued, and that could be the result of dehydration.  You do not feel well if you're dehydrated, and your doctors usually notice, and it can affect your lab values.  So you want to also make sure that in addition to the calories and the protein that you're getting that you're staying on top of getting enough fluids. Especially a lot of chemos have sort of a dehydrating effect, so you need even more fluids to make sure that your body is able to flush out some of the things that you might be having to metabolize to get rid of and that kind of thing.  So getting enough water, getting enough fluid throughout the day. 

If you are needing to get those extra calories, you can get your fluid from things like juices. You can even, you know, us oncology dietitians even open the box of letting you have sweetened beverages if that's the only way that you can get extra calories in.  For people with taste changes, with your fluids often it's helpful if you squeeze some lemon or if you're—even if you don't have lemon, you can get like those lemon or lime juice things at the grocery store.  If you put that lemon in your water, sometimes that helps to clear your palate to make your food more palatable.  

So we have seen that that's beneficial for people especially if you have taste changes that make eating difficult where things don't taste right, they have a metallic taste in them.  If you drink your water with lemon in it especially before eating, that seems to help people to tolerate some of the more metallic flavors that are in your food. The other tip on those metal flavors is to not use metal silverware so actually using plasticware can help so that you don't have that extra metal taste in your mouth.  So, yeah.  

Is there anything else that I'm missing?  If anybody's on and has questions, I do have a few tips.  If you are somebody who needs to drink nutrition supplement drinks like Boost or Ensure or store brand whatever, I do have tips for drinking that. So I have found that most people do not tolerate it just straight out of the bottle.  What you need to do is to get it—and even out of the fridge is not cold enough.  So most people tolerate it best—unless you have a cold a version, some people don't do well with cold beverages—but for a lot of people it tastes better cold and not just out of the fridge.  

You need it to be on ice, so find like a big glass, one of those big cups.  Maybe it's a cup that you use for coffee.  Maybe it's one of those—what are those brands cups. They're the plastic ones that don't sweat.  But fill the whole thing with ice.  Pour the supplement drink on top and make sure it's all mixed in with the ice and stirred in really well, and then the biggest tip that I have for drinking those is put a lid on.  Put a lid on and use a straw, because when you—the smell of the drink, sometimes it has kind of a vitamin smell and the smell affects the flavor.  Smell is a big part of taste for us as humans. So if you can cover the lid, use a straw and get it really, really cold on ice that's a way I find that it's most tolerable.  So if you haven't tried that, that's a good tip.  

Anything else? You can always leave questions in the comments box even after this is over, and I'll monitor that, and Patient Power will help monitor that to make sure that we get your questions answered. I hope this has been helpful.  I do have an article on specifically about this, and I have tips on healthy eating. So if you're interested, you can head over that for more of that.  And I appreciate Patient Power having me on here sharing these tips, and I hope they've been helpful.  Have a great day.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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