People with cancer need special nutritional planning and management.

People with cancer are at risk for developing nutritional deficiencies. The deficiencies may be the result of the cancer itself, or the side effects of common cancer treatments such as surgery, chemotherapy, and radiation therapy.

Malignancies directly compromise nutritional status by altering metabolism and causing loss of appetite. Changes in metabolism include an increased basal metabolic rate and increased spending of energy. This increase in energy use means you'll require more calories to maintain your current weight and lean body mass.

There are also individual alterations in carbohydrate, protein, and fat metabolism. These changes lead to the loss of muscle and fat stores. Cancer-associated loss of appetite is probably the result of physical changes but may also be due to a psychological response to the disease.

There are several factors that may contribute to the type and degree of nutrient deficiencies:

• The primary organ where the malignancy occurs
• The severity of the cancer at the time of diagnosis
• The symptoms experienced by the person with cancer
• The type and frequency of the cancer treatment being used and the side effects associated with that treatment (surgery, radiation, or chemotherapy)
• The effect of the malignancy or disease on food and nutrient ingestion, tolerance, and utilization

People with cancer frequently require a high-calorie diet to prevent weight loss. They may also need a diet that is high in protein to prevent muscle wasting. Foods that are high in calories and protein include peanut butter, whole milk, milkshakes, meats, and cheeses.

Some individuals with cancer develop an aversion to fats. If this happens, eat high-protein foods with a lower fat content such as low-fat shakes, yogurt, cottage cheese, lean meats.

For the diet to remain well-balanced, you must eat fruits and vegetables. To increase calories, use more fruit juices or dried fruits rather than whole fruits. Choosing calorie-dense vegetables such as corn, peas, and squashes will also increase the calories in the diet.

The side effects of common cancer therapies vary according to the treatment and the area of the body undergoing treatment. The following are some side effects and some helpful suggestions. They do not replace, but rather aid, drugs used to relieve these symptoms.

CHEWING AND SWALLOWING DIFFICULTY

Thick-consistency liquids such as milkshakes, or semi-solid foods like mashed potatoes and gravy may be easier to swallow and will not cause aspiration (inhaling food).

PAIN, NAUSEA, VOMITING, DIARRHEA

Eating a meal immediately before or after the administration of the treatment may ease these symptoms.

The patient's position while eating may also contribute to these symptoms.

TASTE ALTERATIONS AND AVERSIONS

• Eat bland foods. Avoid strong flavors like spices, acidic foods, and sour tasting foods.
• Eat cold foods. Avoid hot or warm foods.
• Avoid foods with strong odors.
• If you are experiencing severe nausea, avoid any favorite foods. Eating a food during severe bouts of nausea may cause the development of an aversion to it.

• Increase protein and calories in the diet.
• Eat smaller, but more frequent meals.
• Add powdered milk to foods and beverages.
• Drink mainly calorie-containing beverages such as juices, milk, or sweetened drinks.
• Add extra eggs or egg whites to foods. Never use raw eggs! They may contain salmonella, which would be dangerous for a person who is immune-suppressed. Raw eggs also contain a vitamin binder.
• Add diced meat or cheese to sauces, vegetables, soups, and casseroles.
• Snack throughout the day on calorie-dense foods such as nuts, hard candy, and dried fruits.
• Consider using commercially available nutrition supplements. Make your own high-calorie shake by using an instant breakfast drink mix with milk, fruit, cookies, peanut butter, or other favorite mixers.
• Increasing fats in the diet is an excellent way to increase energy consumption, if you are tolerating fats. Add margarine or butter to breads and vegetables. Add gravies and sauces to foods in liberal amounts.
• If you are unable to digest fat, consult with your physician or dietitian for alternative fat sources. Supplements containing medium-chain triglycerides are often recommended for this purpose.

LACTOSE INTOLERANCE

Some cancer patients become unable to digest dairy products, which is called lactose intolerance. Symptoms include bloating, gas, and diarrhea immediately after eating lactose-containing foods.

People with lactose intolerance have trouble digesting the sugar in milk. Lactose intolerance is due to an inability to produce lactase, the enzyme that digests milk. The wall of the gastrointestinal tract produces this enzyme. Fortunately, lactase can be synthetically produced, purchased over-the-counter, or can be taken orally with milk.

You can also buy lactose-free milk at most grocery stores. Cultured dairy products such as yogurt, cheeses, and buttermilk will have less lactose as the active cultures help to digest it. You may be able to tolerate small amounts of lactose occasionally. You may have to restrict lactose entirely from the diet until you have fully recovered from your cancer therapy.

DUMPING SYNDROME

Surgery on the stomach may cause dumping syndrome. If you have dumping syndrome, food is "dumped" into the small intestine 10 or 15 minutes after being swallowed. Ordinarily, food is partially digested in the stomach, then released gradually into the digestive tract.

The presence of undigested food in the intestine leads to abdominal fullness, nausea and crampy abdominal pain. Other symptoms include feeling warm, dizzy, and faint. You may also experience rapid pulse and cold sweats immediately after eating.

Recommendations for dumping syndrome are:

• Eat smaller, more frequent meals
• Lie down immediately after eating
• Restrict refined carbohydrates and increase protein and fat in the diet
• Drink fluids 30 minutes BEFORE a meal or 30 - 60 minutes AFTER a meal

LOSS OF APPETITE (ANOREXIA)

If you are experiencing anorexia, adjust the diet to include any foods that appeal to you. Ask your doctor about appetite-stimulating drugs.

Your local chapter of The American Cancer Society is an excellent resource for information on cancer prevention and treatment. See also cancer - support group for other resources.

A registered dietitian is a trained health professional in the area of nutrition and can assist in nutritional planning for people with cancer.

Objectives for a cancer treatment diet:

• To achieve or maintain optimal nutrition status
• To make the best of the benefits of therapy the patient is receiving
• To reduce symptoms caused by the therapy
• To prevent or reverse loss of fat layer