Integrative oncology: Nutrition during chemotherapy


Nutrition is the process through which food is ingested and utilized by the body for growth, health, and tissue replacement. Nutrition is critical to one’s overall health. It is regarded to be essential in the treatment and management of nearly all diseases, including cancer. If you have cancer, good nutrition is particularly important because the disease and its therapies, such as chemotherapy, might alter your eating habits. They can also influence how your body tolerates and utilizes nutrition. Before, during, and after cancer treatment, eating the correct foods can help the patient feel much better and stay stronger. Eating a healthy diet is one of the most common supplemental or alternative cancer treatments. Integrative oncology nutrition is an approach that recognizes the numerous influential factors that influence a cancer patient’s nutritional health, such as their macro/micronutrient needs, specific eating habits, cultural understanding of food and illness, food availability/accessibility, and so forth.

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Chemotherapy refers to the use of medications and drugs to kill cancer cells. It normally works by preventing cancer cells from growing, dividing, and proliferating. Chemotherapy has a greater effect on cancer cells because they grow and divide quicker than normal cells. Chemotherapy medications, on the other hand, are extremely potent and can still cause harm to healthy cells. Chemotherapy-related adverse effects are caused by this damage. Chemotherapy has an impact on cells all across the body. Healthy cells, which usually grow and divide rapidly, may also be harmed. Cells in the mouth and digestive tract are examples of this. Chemotherapy side effects can induce issues with eating and digestion.

Nutrition during chemotherapy

It is important to ensure healthy eating habits throughout the chemotherapy. Staying hydrated and providing adequate fluids, calories, and nutrients to muscle tissue can minimize treatment difficulties, improve your immune system, and assist prevent distressing adverse effects such as fatigue.

Calories and protein are used as fuel by the body to support healthy organs, muscle repair, and everyday activities. During most therapies, your body needs additional calories and proteins. During the chemotherapy, the extra calories and protein are utilized to mend tissues and combat infections. As a result, most cancer patients must consume more calories than they are used to. Otherwise, they risk malnourishment and weight loss.

If you have a healthy appetite and are currently managing your weight, it is a good idea to consume a well-balanced diet that includes a variety of healthful foods. Unless you do not eat on a regular basis, you will probably lose weight and then become malnourished, which means your treatment may not work as effectively and it will be more difficult to heal after surgery and therapies.

A well-balanced diet should include foods from all dietary groups, including a wide range of plant foods. This diet offers vitamins, minerals, and phytochemicals that your body requires to fight cancer.

Foods to prefer during chemotherapy: 

  • Protein rich foods: Plant proteins such as beans, lentils, and soy, as well as lean animal proteins such as chicken and eggs are all sources of protein.
  • Low fat dairy and dairy alternatives: Low fat milk, low fat yogurt, low fat cheeses, soy milk, almond milk etc. Dairy products like milk and yogurt are usually high in protein.
  • Whole grains: Oats, quinoa, barley, brown rice, popcorn, maize, potatoes, whole grain bread, pasta, and cereal. 
  • All fruits and vegetables, especially cruciferous vegetables such as broccoli, cauliflower, kale etc.
  • Healthy fats: Olive oil, nut butters (such as peanut butter or almond butter), avocado, nuts, and seeds are all good sources of healthy fats.
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Examples of some specific foods that can be preferred during chemotherapy are: 

  • Oatmeal: Oatmeal contains a variety of nutrients and is appetizing if you are suffering from chemo side effects such as dry mouth, mouth sores, and nausea. Its fiber content might also help you maintain regular bowel movements.
  • Almonds and other nuts: Almonds are high in minerals, including manganese and copper, and make an excellent snack. However, if you have mouth sores, they may be difficult to eat. In these cases, nut butters are a better option.
  • Cruciferous vegetables: Cruciferous vegetables, such as kale, broccoli, cauliflower, and cabbage, have a high nutritional value. Broccoli, particularly, contains a high amount of vitamin C. This vitamin is essential for a healthy immune system. Furthermore, it includes sulforaphane, a plant chemical that has been shown to benefit brain function.
  • Homemade smoothies: Smoothies are an excellent choice when eating is difficult. They’re also a great way to add more fruits and vegetables into your diet.
  • Avocado: Avocados are high in nutrients. They can keep you full and offer necessary calories when your appetite is low since they contain a lot of healthy fat and fiber. Avocados are a fantastic alternative if you have dry mouth, constipation, mouth sores, or are losing weight because they are filling, versatile, and gentle. 
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During treatment, you may notice that your appetite is diminished or that you are experiencing side effects that make it difficult to eat a healthy diet. When you are unable to maintain your weight with conventionally considered healthy foods, it is acceptable to choose different foods that appeal to you. However, to prevent malnutrition, make sure to include adequate fluids, protein, and calories. Consider eating to be a component of your treatment. Regardless of whether you are hungry or not, you must eat on a regular basis in order to have enough energy in your body to fight cancer and maintain muscle mass.

When more than one chemotherapy treatment is used, each medication may cause different side effects, or even the same side effect may be more severe. During chemotherapy, the following adverse effects are common: Appetite loss, nausea, vomiting, dry mouth, mouth or throat sores, difficulty swallowing, lactose intolerance, weight gain and diarrhea.  

Nutritional management of side effects due to chemotherapy

The following are some of the most prevalent symptoms associated with chemotherapy, as well as methods for treating or controlling them: 

1.) Anorexia.

Anorexia is a lack of desire to eat or loss of appetite in patients. The following suggestions may be beneficial to cancer patients who are suffering from anorexia:

  • Consume foods high in protein and calories. High-protein foods include the following: Beans, yogurt, eggs, chicken, fish, milk and milk products, nuts and seeds, and lentils.
  • Increase the protein and calorie content of your food, such as adding whey protein to foods like smoothies, or using protein-fortified milk. 
  • Some traditional herbal teas have been shown to increase appetite, such as: Ginseng tea, fennel tea, catnip tea, peppermint tea, panax ginger tea.
  • When your appetite is at its peak, start your meal with high-protein items.
  • During meals, drink just minimal amounts of liquid.
  • If you don’t feel like eating solid foods, try beverages like shakes, smoothies, juices, or soups.
  • Consume smaller meals and nutritious snacks frequently throughout the day.
  • Eat your largest meal when you’re the hungriest, whether it’s for breakfast, lunch, or dinner.
  • To ease symptoms and aftertastes, brush your teeth and rinse your mouth at least twice daily.
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2.) Nausea.

Nausea is a sick feeling, with an intense urge to vomit. It is one of the most common adverse effects experienced by cancer patients during their treatment. The following suggestions may be beneficial to cancer patients who are experiencing nausea: 

  • Choose foods that you enjoy. You should not force yourself to eat foods that make you feel ill.
  • Instead of hefty meals, eat bland, soft, and easy-to-digest foods.
  • Consume stomach-friendly meals such as bread, plain yogurt, and clear broth.
  • Consume foods and beverages at room temperature (not too hot or too cold).
  • Throughout the day, sip beverages slowly.
  • If you have a nasty taste in your mouth, suck on hard candies like peppermints or lemon drops.
  • Avoid foods and beverages with strong odors.
  • Instead of 3 large meals per day, eat 5 or 6 smaller meals.
  • Snacks and meals should not be skipped. An empty stomach may aggravate your nausea.
  • Pre and post eating, rinse your mouth.
  • Consult your doctor about using anti-nausea medications.
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3.) Vomiting.

Vomiting can occur as a result of nausea and is aggravated by some cancer treatments. Other causes, such as food odors, gas in the stomach, or movement, can aggravate vomiting. Vomiting may also occur in the absence of nausea. The following suggestions may be beneficial to cancer patients who are experiencing vomiting:

  • You should not eat or drink anything until the vomiting has stopped.
  • After the vomiting stops, sip small quantities of clear liquids.
  • Instead of three large meals per day, eat five or six little meals.
  • After you are able to consume clear liquids without vomiting, drink liquids that are gentle on your stomach, such as thinned soups or milkshakes.
  • Request medication to prevent or control vomiting from your doctor.

4.) Mouth sores.

Soreness in the mouth or throat can be caused by cancer treatment or something else too. Consult your doctor to be sure the soreness isn’t caused by an infection. If you have soreness as a result of cancer therapy, it will usually go away with time. The following tips may be beneficial to cancer patients who are experiencing mouth sores:

  • Cook food until mushy and tender.
  • Food should be cut into little pieces. To make food smooth, use a blender or food processor.
  • Foods should be eaten cold or at room temperature. Foods that are too hot might cause pain in the mouth.
  • Drink using a straw to avoid the aching parts of your mouth.
  • Avoid the following items: Spicy foods, citrus fruits such as oranges and lemons, ketchup and tomatoes, foods high in salt, raw vegetables, harsh and crispy food.
  • Rinse your mouth 3-4 times a day. Mouthwash containing alcohol should be avoided.
  • Consume soft foods such as custards, scrambled eggs, milkshakes etc.
  • Soreness can be relieved by eating cold foods like sherbet or popsicles.
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5.) Dry mouth.

Dry mouth is the most common side effect resulted from chemotherapy and radiation of the head or neck. A dry mouth, caused by a decrease in saliva flow, can make chewing and swallowing difficult, as well as alter the taste of food. The following suggestions may be helpful for cancer patients who are experiencing dry mouth: 

  • Consume foods that are easy to swallow.
  • Sauces, gravies, or salad dressings should be used to moisten the food.
  • Suck on lime-flavored, sugar-free candies, frozen cherries and grapes, unsweetened popsicles, ice chips or cubes, and try sour foods and beverages such as lemonade in tiny amounts to stimulate saliva.
  • Drink plenty of water throughout the day.
  • Avoid foods that can irritate your mouth (such as spicy, sour, salty, hard, or crunchy foods).
  • After every 1 to 2 hours, rinse your mouth. Alcohol-containing mouthwash should not be used.

6.) Lactose intolerance.

Individuals with lactose intolerance cannot completely digest lactose (sugar found in milk and milk products). As a result, they experience diarrhea, gas, discomfort, abdominal cramps and bloating after consuming dairy products. Patients who comfortably digested milk and milk products prior to radiation or chemotherapy treatment may develop intolerance. This is not a very common development. Small quantities of milk products can still be handled by most people. The following tips may be helpful for cancer patients who are experiencing symptoms due to lactose intolerance:

  • Prefer lactose-free milk products such as hard cheeses (like cheddar) and yoghurt.
  • Lactose-free or low-lactose milk products should be consumed. Many grocery stores sell foods labeled “lactose free” or “low lactose”, such as lactose free milk and low-lactose yogurt.
  • Only the dairy items that cause you difficulties should be avoided. If it is tolerable, consume tiny amounts of dairy products such as milk, yoghurt, or cheese.
  • Plant-based milks, which do not contain lactose, can be used instead of standard dairy milk. Individuals who are lactose intolerant or allergic to milk proteins usually prefer plant-based milk over cow’s milk due to their common advantages of being lactose-free, cholesterol-free, and low in calories. Examples of some plant-based milk are:  Almond milk, soy milk, coconut milk etc. 
  • Consume calcium-rich foods like broccoli and greens.
  • When eating or drinking dairy products, consider lactase pills. Lactase is an enzyme that breaks down lactose to make it simpler to digest.
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7.) Weight gain.

Weight gain is prevalent during treatments for breast and other cancers, in women undergoing hormone therapies, and as a result of chemotherapy-induced early menopause.  Weight gain may be partially caused by a change in food and exercise routines, such as eating more to cope with stress or sickness and being less active owing to fatigue. The following tips may be useful for cancer patients who have gained much weight during their cancer treatment: 

  • Consume plenty of fruits and vegetables and beans. 
  • Include fiber-rich meals such as whole-grain bread, cereals, and pasta.
  • Consider eating lean meats.
  • Select low-fat milk and its products.
  • Consume fewer saturated fats, such as butter and sweets.
  • Low-fat cooking methods should be preferred, including broiling, steaming, grilling, and roasting.
  • Consume less salt and sugar.
  • Eat only when you’re hungry. If you eat just because of boredom, consider engaging in activities that you enjoy, so that you can stop eating unnecessarily. 
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8.) Diarrhea.

Another frequent adverse effect of cancer treatments, such as chemotherapy and other drugs, is diarrhea. The following tips may be useful for cancer patients who are experiencing diarrhea as a side effect of chemotherapy:

  • Consume lots liquids every day, aiming for at least eight glasses. Water, diluted juice, broth, and decaffeinated coffee or tea are all good fluid options. 
  • Instead of three large meals, eat little amounts of food all through the day. 
  • Beverages at room temperature may be easier to tolerate. 
  • Prefer foods like rice, noodles, well cooked eggs, applesauce, bananas, pureed vegetables and yogurt. 
  • Avoid high-fiber vegetables such as broccoli, corn, beans and cabbage. 
  • Strong spices, oily, fatty, and fried foods, alcoholic beverages, and caffeine-containing beverages should all be avoided. 
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9.) Difficulty swallowing.

You may experience swallowing difficulties if you are undergoing chemotherapy for head or neck cancer. The following tips may be useful for cancer patients who are having trouble swallowing as a side effect of chemotherapy:

  • Consume soft foods that are easy to chew and swallow, such as milkshakes, oatmeal, scrambled eggs, applesauce etc. 
  • Consume protein and calorie-rich foods and beverages. 
  • Food should be moistened with gravy, sauces, broth, or yogurt. 
  • Cook food items until they are soft and tender.
  • Food should be cut into little pieces. Foods can also be blended in a blender or food processor.
  • Drink beverages through a straw.
  • Consume smaller, regular meals.
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Nutrition tips for cancer patients undergoing chemotherapy

To keep your body working efficiently during cancer treatment, it is essential to consume a healthy, balanced diet. Some of the finest selections include foods that are light in flavoring, easy on the stomach, and high in nutrients. On the day of your chemotherapy, it is advised that you eat light. Eating modest meals slowly and every several hours seemed to be the most effective. On these days, avoid skipping meals and consuming fatty, oily, or spicy foods.

What to eat before going for chemotherapy?

Light, bland foods appear to be the most effective. Here are some examples of options:

  • Plain or fruit yogurt.
  • Cottage cheese with fresh fruit.
  • Toast with a poached egg.
  • Baked bagel with a dab of peanut butter.
  • Milk and cereal (try soy milk, if lactose intolerant).

What to eat during chemotherapy?

  • Take a very small, plain snack with you during the treatment. 
  • Snack on low acid juices (apple, grape, and fruit nectars), liquid yogurts, fruits such as bananas, and crackers in addition to the foods listed above. 
  • Fill a bottle with your favorite beverage and bring it with yourself (avoid acidic foods which may be irritating to your digestive tract). 
  • Juices and supplements are typically available where you receive chemotherapy; nevertheless, inquire ahead of time if these and any other foods are provided. 
  • If you don’t feel like eating during the infusion, that’s fine; nevertheless, note that eating little amounts of bland food and beverages may help you feel better.
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What to eat after chemotherapy and for the next few days?

  • Consume smaller meals and snacks all through the day (aim for 5-6 smaller meals rather than 3 large meals). 
  • Consume blander, lower-fat foods. 
  • Try colder or cooler foods, which have less odor and aroma and are especially beneficial if you are feeling sick. Hot meals may have a stronger odor, generating a dislike for them.
  • Drink plenty of fluids to avoid dehydration and to flush out some of the byproducts of the chemotherapy. 
  • Water is the finest fluid supply, but other options include: apple and grape juice, fruit nectars, low-salt broth, clear soups, popsicles and sherbet, gelatin, herbal teas such as ginger and mint, and mild black teas.