Published on October 9, 2018
How can cancer patients get the calories and nutrition they need when they have food intake issues from their condition or treatment? Oncology dietitian Julie Lanford, from Cancer Services, discusses the factors that affect a person’s ability to eat and shares ways to overcome challenges from treatment, taste changes, difficulty swallowing and side effects like mouth sores to obtain the right amount of protein and meet their nutritional needs. What options are available for people with nausea, constipation or diarrhea? Julie also explains the proper regimen for nausea medications to help patients enjoy a meal, what kind of foods effectively reduce or contribute to nausea and gives tips for managing diarrhea and constipation.
Produced in partnership with Cancer Services.
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Transcript | Nutrition and Cancer: Advice for Patients with Difficulty Eating
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Hello and welcome to Patient Power. I'm Andrew Schorr reporting as we travel from Quebec City, Canada, and we're joined once again by my good friend, a wonderful oncology dietitian, and that is Julie Lanford who is the Wellness Director of Cancer Services, a nonprofit in Winston-Salem, North Carolina. Julie, welcome back to Patient Power.
Thanks. Glad to be here.
Okay, Julie, thank you. So, Julie, we've talked about diet and eating right and all that kind of thing, but let's face it. When somebody goes through cancer treatment it's a rough go, and there are complications that go along with medicines and sometimes surgery that affects your ability to eat and get nutrition, so let's talk about that a little bit.
So, first of all, very common when people go treatment is nausea, and we're just green. And I've been through it, and I didn't feel like eating, and I'm sure I was losing weight. What do we do now to help people with nausea so we can eat?
Yeah. So pretty common, and when I was going through school dietitians were trained in all different types of issues that someone might have related to food intake. So this was a pretty common one, and so especially around oncology I find the most effective thing for nausea is to make sure that the person is on some kind of regimen for medical management. So that means if your doctor has given you nausea medication and if you're feeling really nauseated on a regular basis, you should have some medication to help with that. But the biggest mistake people make is to not take it on a regular schedule.
And then what happens is they wait until it's time to eat. You know, their loved one prepares them a really nice meal, it sits in front of them and they start feeling sick and they can't eat it, and then they decide, oh, I'm going to get my medicine. Well, it's going to take the medicine 30 to 45 minutes to kick in. By then everybody else is done with dinner. They've already been nauseated looking at the food, they don't want to eat it, so I'm like this is a bad combination.
We want people to take their nausea medicine 30 minutes before they eat. That way by the time they sit down and their meal is in front of them it's their best chance at enjoying it. So that's the biggest tip, I think.
The other thing is to make sure that if you're nauseated or you're struggling with that, that you don't have an empty stomach, because that's when it tends to be at its worst. So keeping things in your stomach, whether it's pretzels, something salty, even if you're able to drink a little bit, you know, we talk about ginger ale. Sometimes the carbonation is not helpful, so Gatorade or even just, you know, we have sweet tea here in the South, just a little bit of something on your stomach can help.
Avoiding really high-fat foods because if they sit in your stomach for a long time, that can sometimes contribute to more nausea. So those are some kind of quick, simple things.
What about ginger? You mention ginger ale, does ginger help as something in addition to the medications we might be given?
We like to think it helps. As far as hard core data supporting it being effective, uh, maybe, maybe not. And then the other thing is if you think ginger is going to be effective, ginger ale barely has any real ginger in it. You can I think get some ginger ales that have higher percentages of ginger. I think if you really want ginger to be therapeutic and beneficial, you may want to buy the ginger root and cut off and sort of brew it in water and add honey yourself, and then it's a lot stronger, and you know it's from actual ginger.
Okay. Let's talk about some other things. So some people have aggressive head and neck surgery, and I've had friends where they've lost part of their jaw. Now, happily, there are surgical techniques now in that are helping people with plastic surgery, but there are sometimes just mechanically where you've had surgery in your mouth or on your tongue, etcetera. What about in those situations? How do you get the calories you need when it's just difficult to chew or anything like that?
Yeah. So head and neck cancer patients are very common to see in oncology dietitians, so I tell anybody if you have had head and neck cancer you should have your dietitian's number like in your phone on speed dial, because there are so many nutrition issues.
So if someone is able to swallow and they can drink their calories, liquid, then you can puree food, you can blend food, you can do Boost or Ensure, other kinds of nutrition supplement drink and take that orally. You need to absolutely make sure you're well hydrated and you're getting enough calorie and protein. And that can be calculated by your dietitian, and they'll tell you how many calories and protein, and therefore you know how many cans to drink if it is in fact that you have to take it that way.
I have had clients who, they think, well, I'm drinking Ensure, but they don't realize it's going to take them seven or eight. If they're not eating anything, it's going to take seven or eight Ensures to meet their needs, and so they're way undernourished.
The other thing for a lot of head and neck cancer patients, they cannot swallow, especially if they're having chemo and radiation at the same time, and in that case we can place a temporary feeding tube that actually just delivers the formula directly to your stomach. So it's really not very different physiologically as far as digesting and absorbing, but it bypasses your throat and your mouth, which can be a huge benefit to people who are in a lot of pain from swallowing.
So really we can try to tweak those things. Some people, they don't have those issues and they're able to just eat soft foods enough to get them by until their mouth heals back up.
Okay. I want to take about another mouth issue. So lot of people have stem cell transplants, and sometimes going along with that they have mouth sores, and so the wrong food can just send them up the wall with pain. So what should people be eating when they're going through that stage?
Yeah, so it's funny because if you have mouth sores, you might want to stay away from tart, acidic foods and vinegars and types like that. But then if you have taste changes and something is hard to taste, then we say eat stronger flavors like acidic foods and vinegar. And so it comes down to the individual in terms of what it is.
So let's say if somebody does have mouth sores, a couple of things is to avoid scratchy foods. I've burned my mouth before, and I realize how scratchy strawberries are. I wouldn't have ever guessed strawberries are scratchy, but when you have sores in your mouth you can feel every little thing. So you want to eat really smooth foods. Sometimes that means that you actually blend them, so you can eat the foods as long as they're sort of pureed to a really soft texture.
Things that you want to do for if you have taste changes is to marinate your food in something that has a lot of flavor, because it's like you need something to really draw out that flavor. So sauces, dressings can help with bringing the flavor out.
The other thing I tell people is when you have smell changes—smell is a huge part of taste, so if you're trying to eat or drink something and it smells bad to you but you want to eat it, you can do things like covering it. So if they're drinking something, a smoothie or a supplement drink, if you put a lid on and use a straw, that will help to take the smell away, and you may still be able to tolerate whatever food it is.
Okay. And you were sort of getting at something I was going to ask you about. There are some medicines that cause like a metallic taste, so that would be something I think that if it were me I could work out with you and say, well, you look at the medicines I'm taking, maybe it's a known side effect of the medicine. And then you as a dietitian would be able to say, well, let's go in this direction. Let's do that.
Yeah. Usually, I find the nurses that do the chemo teaching are pretty on top of the most common side effects. Now, some people, they seem to get like all the uncommon ones, but generally if you are on a chemo where it's likely to cause a metallic taste in your mouth, I find the nurses typically give a heads up. And then, yeah, if somebody runs into trouble with that then we encourage them to call their dietitian or their treatment team and figure out what the tips are for getting through that.
Lemon, some people find putting lemon in their water and drinking that before a meal helps to kind of clear the palate and sort of prepare it in a way where it can enjoy the flavor.
Okay. We've sort of been going from the nose down, so we'll have to get to the last part. Some people going through treatment have either constipation or diarrhea.
Or they go back and forth.
Or, right. What do we do?
So it often depends on the reason. So if somebody has diarrhea and it's because of their chemo, then oftentimes we'll say make sure you're well hydrated, because when you have diarrhea you're losing a lot of fluids and we don't want you to get dehydrated. So you need to make sure you're still taking a lot of fluids in. Sometimes for diarrhea we actually recommend soluble fiber, because it kind of acts like a sponge in your GI track to help sop up some of that excess fluid.
But if somebody's having diarrhea from, say, radiation, that doesn't always work. So really depends on the type of treatment that they're getting and what their medical team thinks would work best.