Cancer and Nutrition : Anorexia, Taste Changes, Dry Mouth

by National Cancer Institute

(Page 5 of 8)

Nutrition Suggestions for Symptom Relief

When side effects of cancer or cancer treatment interfere with normal eating, adjustments can be made to ensure the patient continues to get the necessary nutrition. Medications may be given to stimulate the appetite. Eating foods that are high in calories, protein, vitamins and minerals is usually advised. Meal planning, however, should be individualized to meet the patient's nutritional needs and tastes in food.

Anorexia

Anorexia (lack of appetite) is one of the most common problems for cancer patients. The following suggestions may help cancer patients manage anorexia:

• Eat small high-protein and high-calorie meals every 1-2 hours instead of 3 larger meals.
• Have help with preparing meals.
• Add extra calories and protein to food (such as butter, skim milk powder, honey, or brown sugar).
• Take liquid supplements (special drinks containing nutrients), soups, milk, juices, shakes, and smoothies when eating solid food is a problem.
• Eat snacks that contain plenty of calories and protein.
• Prepare and store small portions of favorite foods so they are ready to eat when hungry.
• Eat breakfasts that contain one third of the calories and protein needed for the day.
• Eat foods with odors that are appealing. Strong odors can be avoided by using boiling bags, cooking outdoors on the grill, using a kitchen fan when cooking, serving cold food instead of hot (since odors are in the rising steam), and taking off any food covers to release the odors before entering a patient's room. Small portable fans can be used to blow food odors away from patients. Cooking odors can be avoided by ordering take-out food.
• Try new foods. Be creative with desserts. Experiment with recipes, flavorings, spices, types, and consistencies of food. Food likes and dislikes may change from day to day.

The following high-calorie, high-protein foods are recommended:

• Cheese and crackers.
• Muffins.
• Puddings.
• Nutritional supplements.
• Milkshakes.
• Yogurt.
• Ice cream.
• Powdered milk added to foods such as pudding, milkshakes, or any recipe using milk.
• Finger foods (handy for snacking) such as deviled eggs, cream cheese or peanut butter on crackers or celery, or deviled ham on crackers.

Taste Changes

Changes in how foods taste may be caused by radiation treatment, dental problems, or medicines. Cancer patients often complain of changes in their sense of taste when undergoing chemotherapy, in particular a bitter taste sensation. A sudden dislike for certain foods may occur. This may result in food avoidance, weight loss, and anorexia, which can greatly reduce the patients' quality of life. Some or all of the sense of taste may return, but it may be a year after treatment ends before the sense of taste is normal again. Drinking plenty of fluids, changing the types of foods eaten and adding spices or flavorings to food may help.

The following suggestions may help cancer patients manage changes in taste:

• Rinse mouth with water before eating.
• Try citrus fruits (oranges, tangerines, lemons, grapefruit) unless mouth sores are present.
• Eat small meals and healthy snacks several times a day.
• Eat meals when hungry rather than at set mealtimes.
• Use plastic utensils if foods taste metallic.
• Try favorite foods.
• Eat with family and friends.
• Have others prepare the meal.
• Try new foods when feeling best.
• Substitute poultry, fish, eggs, and cheese for red meat.
• Find nonmeat, high-protein recipes in a vegetarian or Chinese cookbook.
• Use sugar-free lemon drops, gum, or mints if there is a metallic or bitter taste in the mouth.
• Add spices and sauces to foods.
• Eat meat with something sweet, such as cranberry sauce, jelly, or applesauce.

Taking zinc sulfate tablets during radiation therapy to the head and neck may speed the return of normal taste after treatment.

Dry Mouth

Dry mouth is often caused by radiation therapy to the head and neck. Some medicines may also cause dry mouth. Dry mouth may affect speech, taste, ability to swallow, and the use of dentures or braces. There is also an increased risk of cavities and gum disease because less saliva is produced to wash the teeth and gums.

The main treatment for dry mouth is drinking plenty of liquids, about ½ ounce per pound of body weight per day. Other suggestions to manage dry mouth include the following:

• Eat moist foods with extra sauces, gravies, butter, or margarine.
• Suck on hard candy or chew gum.
• Eat frozen desserts (such as frozen grapes and ice pops) or ice chips.
• Clean teeth (including dentures) and rinse mouth at least four times per day (after each meal and before bedtime).
• Keep water handy at all times to moisten the mouth.
• Avoid liquids and foods that contain a lot of sugar.
• Avoid mouth rinses containing alcohol.
• Drink fruit nectar instead of juice.
• Use a straw to drink liquids.

Mouth Sores and Infections

Mouth sores can result from chemotherapy and radiation therapy. These treatments target rapidly-growing cells because cancer cells grow rapidly. Normal cells inside the mouth may be damaged by these cancer treatments because they also grow rapidly. Mouth sores may become infected and bleed, making eating difficult. By choosing certain foods and taking good care of their mouths, patients can usually make eating easier. Suggestions to help manage mouth sores and infections include the following:

Eat soft foods that are easy to chew and swallow, such as the following:

• Soft fruits, including bananas, applesauce, and watermelon.
• Peach, pear, and apricot nectars.
• Cottage cheese.
• Mashed potatoes.
• Macaroni and cheese.
• Custards; puddings.
• Gelatin.
• Milkshakes.
• Scrambled eggs.
• Oatmeal or other cooked cereals.

Use the blender to process vegetables (such as potatoes, peas, and carrots) and meats until smooth.

Avoid rough, coarse, or dry foods, including raw vegetables, granola, toast, and crackers.

Avoid foods that are spicy or salty. Avoid foods that are acidic, such as vinegar, pickles, and olives.

Avoid citrus fruits and juices, including orange, grapefruit, and tangerine.

Cook foods until soft and tender.

Cut foods into small pieces.

Use a straw to drink liquids.

Eat foods cold or at room temperature. Hot and warm foods can irritate a tender mouth.

Clean teeth (including dentures) and rinse mouth at least four times per day (after each meal and before bedtime).

Add gravy, broth, or sauces to food.

Drink high-calorie, high-protein drinks in addition to meals.

Numb the mouth with ice chips or flavored ice pops.

Using a mouth rinse that contains glutamine may reduce the number of mouth sores. Glutamine is a substance found in plant and animal proteins.

About the Author

www.nci.nih.gov
The National Cancer Institute's research programs are extensive and contain many innovative initiatives. I invite you to explore our Web site to find out more about the exciting work being conducted here at NCI and by NCI-supported scientists throughout the country.