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No Appetite?

How to Get the Nutrition You Need During Cancer Treatment

by Barbara L. Grant, MS, RD, CSO, LD, Abby S. Bloch, PhD, RD, Kathryn K. Hamilton, MA, RD, SCO, CDN, and Cynthia A. Thompson, PhD, RD, CSO

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Things like the feeling of full­ness or changes in taste and smell can cause changes in appetite. Having a decreased appe­tite can make getting the calories and nutrients you need a challenge. Do not be afraid to break the rules, try new things, and eat what you want, when you want to eat it. Try eating smaller meals and snacks more often. If breakfast foods taste best to you at night, or if you crave a hearty dinner at lunchtime, feel free to depart from tradition.

Changes in Taste and Smell
Common problems that can occur during and after your chemo­therapy or radiation therapy are changes in your senses of smell and taste. Food may taste bitter, metal­lic, or even too salty, sweet, or sour. Some people may even experience a complete loss of taste. Aversions to the odor of food and the aroma of nonfood items, such as perfumes and soap, also can happen. These changes are usually temporary and go away after your treatment is over, but they can affect your appetite and what you eat.

Changes in your sense of taste and smell can mean that your favorite foods do not taste the same to you anymore. If you are having a problem with food aversions, try foods or beverages that are different from ones you usually eat. To keep from developing additional food aversions, try new foods and nutritional drinks when you’re feeling well. Eat lightly (small portions of lower-fat, bland foods) on the morning of or sev­eral hours before receiving chemotherapy.

Do not taste new foods when you are around unpleasant odors. Also, keep your mouth clean by rinsing and brushing, which may help foods taste better to you.

Thrush (also called candidiasis), a common fungal infec­tion in the mouth and throat, can also cause taste alterations. Fortunately, once identified, thrush is easily treated.

If you are having a problem with food aversions, try foods or beverages that are different from ones you usually eat.

How to Cope When You Cannot Tolerate the Smell of Food
Try the following when food odors make you feel ill or nauseated:

  • Ask another person to cook for you. Ask them to take off any food covers to release food odors before entering your room or eating area.
  • Consider using prepared foods from a reliable, clean deli. This is not recommended if your white blood cell counts are low.
  • Avoid eating in a room that has cooking odors or other smells. To reduce cooking odors, cook outside on the grill, use boiling bags, or use a slow cooker on the back porch or in the garage. Kitchen fans and small portable fans can be used to direct food odors away from you.
  • Avoid cooking foods with strong odors, such as onions, cruciferous vegetables (cabbage, broccoli, Brussels sprouts), heavy meats, or fish.
  • Get creative; if smells from cooking appliances, such as coffeemakers or toasters, make you queasy, consider placing them in another part of the house or in the garage.
  • Order take-out food from restaurants you know to be clean to avoid preparing food and creating strong smells at home. However, avoid buffet-style restaurants or take-out foods from buffets.
  • Prepare cold foods, such as sandwiches, pasta salads, cottage cheese, or yogurt, instead of hot foods, which release odors in the rising steam.

How to Cope When Food Does Not Taste the Same
Chemotherapy, biotherapy, radiation therapy, oral surgery, or cancer itself can alter your sense of taste. You may find that food has a bitter or metallic taste or not much taste at all. You may start to dislike sweet foods, or meat and poultry may taste very different. As your tastes evolve, try these ways of coping:

  • Try using plastic utensils if you have a metallic taste in your mouth.
  • Serve foods cold or at room temperature. This can decrease the potency of flavors and smells, making foods easier to tolerate.
  • Rinse your mouth with tea, ginger ale, or a baking soda and salt rinse before eating to help cleanse your palate.
  • Add tart flavors by seasoning foods with lemon juice, lemonade, other citrus fruits, or vinegar, or eat pickled foods. (Avoid these foods if you have a sore mouth or throat, or open oral sores.)
  • Increase the sugar in foods to enhance pleasant tastes and decrease salty, bitter, or acidic ones.
  • Flavor foods with onion, garlic, chili powder, basil, oregano, rosemary, tarragon, barbecue sauce, mustard, ketchup, or mint.
  • Marinate meat or poultry in sauces, such as barbecue, soy, or teriyaki, or in oil and vinegar salad dressing to improve flavors and eliminate possible bitter tastes.
  • Suck on lemon drops, mints, or other tart hard candies or chew gum to get rid of unpleasant tastes in your mouth after eating. (If you have diarrhea, avoid sugarless candies and gums.)
  • Freeze fruits, such as grapes and cut-up pieces of cantaloupe, oranges, and watermelon. Fruit smoothies and frozen fruit desserts, such as sorbet or sherbet, may be appealing.
  • Rather than force yourself to eat foods that taste bad to you, find substitutes. If red meat tastes different or strange, try other protein sources, such as chicken, turkey, fish, eggs, cottage cheese, cheese, yogurt, or tofu.
  • Eat clean, fresh vegetables, as they are often more appealing than canned or frozen ones.
  • No-salt-added or low-salt canned soups or vegetables can have a metallic taste. You may want to avoid them unless you have high blood pressure and have been advised to eat a low-salt diet.
  • You might be able to eat mild pasta dishes and milk products.
  • Carrot peel often tastes extremely bitter to people having cancer treatment. Peeled sweet baby carrots or peeled large carrots will not have this bitter flavor. Try dipping carrots in salad dressing or hummus for extra flavor and nutrition.
  • Get a dental checkup to rule out dental problems that could be causing a bad taste in the mouth.
  • Clean your mouth, including your teeth, gums, and tongue, regularly.

Loss of Appetite
A person with a poor or no appetite (also called anorexia – not to be confused with anorexia nervosa, an eating disorder) eats much less than he or she normally would or does not eat at all. Loss of appetite or poor appetite is one of the most common problems that occur with cancer and its treatment. Sometimes loss of appetite results from treatment side effects, such as nausea, vomiting, difficulty swallowing, feeling full, or changes in senses of taste or smell. Tumor growth, depres­sion, or pain can also make you uninterested in food. Speak to your healthcare team about how best to address these causes of poor appetite.

Many people find that their appetite is greatest in the morn­ing. If this is true for you, take advantage of it. Consider having your main meal of the day early. Then have commercial nu­tritional supplements or liquid meal replacements, such as Ensure®, Boost®, or Instant Breakfast®, later on if you do not feel like eating.

How to Cope with Appetite Challenges
Most people lose their appetite for just a day or two; for others, it is an ongoing concern. There are a number of ways to cope with treatment side effects and increase appetite:

  • Ask your doctor about medications to help relieve constipation, nausea, pain, or other side effects that interfere with appetite.
  • Eat food cold or at room temperature to decrease its smell and taste.
  • Drink beverages between meals instead of with meals; drinking liquids at mealtime can lead to early fullness. Do take sips of fluids with meals to aid swallowing.

How to Eat When You Have Appetite Challenges
What­ever the reason for your loss in appetite, the following suggestions may help you cope:

  • Try to eat small meals or snacks of favorite foods throughout the day. It may be easier to eat more that way, and you won’t get so full.
    • Keep snacks within easy reach so you can have some- thing easy to eat whenever you feel like it. Cheese and crackers, muffins, nut butters, and fruit are good possibilities.
    • Take portable snacks such as granola or energy bars, peanut butter crackers, or small boxes of raisins with you when you go out.
    • Eat only as much as you want, but try to eat at least a little bit of food every two to three hours while you are awake. This means you may be eating four to six (or more) small meals or snacks a day.
    • Start the day with breakfast. Use a timer or an alarm clock to help remind you to eat. Try to eat frequently at set times each day rather than waiting until you get hungry.
  • Build up your appetite and motivate yourself to eat.
    • Make eating more enjoyable by eating with friends, setting the table with pretty dishes and flowers, playing your favorite music, or watching a television show.
    • Think of food as a necessary part of treatment.
    • With your doctor’s approval, try light exercise an hour before meals.
    • If it is all right with your doctor, try having a small glass of beer or wine before eating.
  • Increase calories and protein.
    • Try liquid or powdered meal replacements, such as in- stant breakfast drinks, when it is hard for you to eat food.
    • Try to keep easy-to-eat foods that are high in calories on hand. These could include pudding, chocolate pieces, ice cream, or yogurt. Meal replacement bars, such as PowerBar® Clif® bars, and Odawalla® bars, are also good choices for high-calorie, high-protein, easy-to-eat meals.
    • Avoid low-calorie foods that fill you up, such as lettuce, broth, and diet soda.
    • Keep high-calorie, high-protein snacks on hand, such as hard-boiled eggs, peanut butter, cheese, granola bars, and canned nutritional supplements.

Eating well and eating enough are important to your recovery from treatment. But on those days when you cannot eat at all, don’t worry. Do what you can to make yourself feel better. Come back to eating as soon as you can, and let your doctor know if your appetite does not improve within a couple of days.

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Excerpted with permission from Complete Guide to Nutrition for Cancer Survivors, by Barbara L. Grant, MS, RD, CSO, LD, Abby S. Bloch, PhD, RD, Kathryn K. Hamilton, MA, RD, SCO, CDN, and Cynthia A. Thompson, PhD, RD, CSO, copyright © 2010 by American Cancer Society. All rights reserved.

This article was published in Coping® with Cancer magazine, May/June 2012.