Cancer and Nutrition : Nausea, Diarrhea, Low White Blood Cell Count

by National Cancer Institute

(Page 6 of 8)

Nausea

Nausea caused by cancer treatment can affect the amount and kinds of food eaten. The following suggestions may help cancer patients manage nausea:

• Eat before cancer treatments.
• Avoid foods that are likely to cause nausea. For some patients, this includes spicy foods, greasy foods, and foods that have strong odors.
• Eat small meals several times a day.
• Slowly sip fluids throughout the day.
• Eat dry foods such as crackers, breadsticks, or toast throughout the day.
• Sit up or lie with the upper body raised for one hour after eating.
• Eat bland, soft, easy-to-digest foods rather than heavy meals.
• Avoid eating in a room that has cooking odors or that is overly warm. Keep the living space at a comfortable temperature and with plenty of fresh air.
• Rinse out the mouth before and after eating.
• Suck on hard candies such as peppermints or lemon drops if the mouth has a bad taste.

Diarrhea

Diarrhea may be caused by cancer treatments, surgery on the stomach or intestines, or by emotional stress. Long-term diarrhea may lead to dehydration (lack of water in the body) and/or low levels of salt and potassium, important minerals needed by the body.

The following suggestions may help cancer patients manage diarrhea:

• Eat broth, soups, sports drinks, bananas, and canned fruits to help replace salt and potassium lost by diarrhea.
• Avoid greasy foods, hot or cold liquids, and caffeine.
• Avoid high-fiber foods--especially dried beans and cruciferous vegetables (such as broccoli, cauliflower, and cabbage).
• Drink plenty of fluids through the day. Room temperature liquids may cause fewer problems than hot or cold liquids.
• Limit milk to 2 cups or eliminate milk and milk products until the source of the problem is found.
• Limit gas-forming foods and beverages such as peas, lentils, cruciferous vegetables, chewing gum, and soda.
• Limit sugar-free candies or gum made with sorbitol (sugar alcohol).
• Drink at least one cup of liquid after each loose bowel movement.

Taking oral glutamine may help keep the intestines healthy when taking the anticancer drug fluorouracil.

Low White Blood Cell Count

Cancer patients may have a low white blood cell count for a variety of reasons, some of which include radiation therapy, chemotherapy, or the cancer itself. Patients who have a low white blood cell count are at an increased risk of infection. The following suggestions may help cancer patients prevent infections when white blood cell counts are low:

• Check dates on food and do not buy or use the food if it is out of date.
• Do not buy or use food in cans that are swollen, dented, or damaged.
• Thaw foods in the refrigerator or microwave. Never thaw foods at room temperature. Cook foods immediately after thawing.
• Refrigerate all leftovers within 2 hours of cooking and eat them within 24 hours.
• Keep hot foods hot and cold foods cold.
• Avoid old, moldy, or damaged fruits and vegetables.
• Avoid unpackaged tofu sold in open bins or containers.
• Cook all meat, poultry, and fish thoroughly. Avoid raw eggs or raw fish.
• Buy foods packed as single servings to avoid leftovers.
• Avoid salad bars and buffets when eating out.
• Avoid large groups of people and people who have infections.
• Wash hands often to prevent the spread of bacteria.

Hot Flashes

Hot flashes occur in most women with breast cancer and men with prostate cancer. When caused by natural or treatment-related menopause, hot flashes can be relieved with estrogen replacement. Many women, however, (including women with breast cancer), are not able to take estrogen replacement. Eating soy foods, which contain an estrogen-like substance, is sometimes suggested to relieve hot flashes in patients who cannot take estrogen replacement, but no benefit has been proven.

Fluid Intake

The body needs plenty of water to replace the fluids lost every day. Long-term diarrhea, nausea and vomiting, and pain may prevent the patient from drinking and eating enough to get the water needed by the body. One of the first signs of dehydration (lack of water in the body) is extreme tiredness. The following suggestions may help cancer patients prevent dehydration:

• Drink 8 to 12 cups of liquids a day. This can be water, juice, milk, or foods that contain a large amount of liquid such as puddings, ice cream, ice pops, flavored ices, and gelatins.
• Take a water bottle whenever leaving home. It is important to drink even if not thirsty, as thirst is not a good sign of fluid needs.
• Limit drinks that contain caffeine, such as sodas, coffee, and tea (both hot and cold).
• Drink most liquids after and/or between meals.
• Use medicines that help relieve nausea and vomiting.

Constipation

Constipation is defined as fewer than 3 bowel movements per week. It is a very common problem for cancer patients and may result from lack of water or fiber in the diet; lack of physical activity; anticancer therapies such as chemotherapy; and medications.

Prevention of constipation is a part of cancer care. The following suggestions may help cancer patients prevent constipation:

Eat more fiber-containing foods on a regular basis. The recommended fiber intake is 25 to 35 grams per day. Increase fiber gradually and drink plenty of fluids at the same time to keep the fiber moving through the intestines.

Drink 8 to 10 cups of fluid each day. Water, prune juice, warm juices, lemonade, and teas without caffeine can be very helpful.

Take walks and exercise regularly. Proper footwear is important.

If constipation does occur, the following suggestions for diet, exercise, and medication may help correct it:

Continue to eat high-fiber foods and drink plenty of fluids. Try adding wheat bran to the diet; begin with 2 heaping tablespoons each day for 3 days, then increase by 1 tablespoon each day until constipation is relieved. Do not exceed 6 tablespoons per day.

Maintain physical activity.

Include over-the-counter constipation treatments, if necessary. This refers to bulk-forming products (such as Citrucel, Metamucil, Fiberall, FiberCon, and Fiber-Lax); stimulants (such as Dulcolax tablets or suppositories and Senokot); stool softeners (such as Colace, Surfak, and Dialose); and osmotics (such as milk of magnesia). Cottonseed and aerosol enemas can also help relieve the problem. Lubricants such as mineral oil are not recommended because they may prevent the body's use of important nutrients.

Good food sources of fiber include the following:

4 or more grams of fiber per serving

Legumes (½ cup, cooked).

• Kidney beans.
• Navy beans.
• Garbanzo beans.
• Lima beans.
• Split peas.
• Pinto beans.
• Lentils.

Vegetables and fruit

• Corn (½ cup).
• Pears with skin (one medium-sized pear).
• Popcorn (3 cups popped).

Cold cereals (1 ounce)

• Whole-grain cereals.
• Bran cereals.

Hot cereals (1/3 cup before cooking).

• Oatmeal.
• Oat bran.
• Grits.

2 or more grams of fiber per serving

Vegetables (½ cup cooked or 1 cup raw).

• Asparagus.
• Green beans.
• Broccoli.
• Cabbage.
• Carrots.
• Cauliflower.
• Greens.
• Onions.
• Peas.
• Spinach.
• Squash.
• Green peppers.
• Celery.
• Canned tomatoes.

Fruit (½ cup serving or one medium-sized fruit).

• Apples with the skin.
• Bananas.
• Oranges.
• Strawberries.
• Peaches.
• Blueberries.

Breads.

• Whole wheat bread (one slice).
• Whole grain bagel (one half of medium-sized bagel).
• Whole wheat pita (½ portion).
• Whole grain crackers (see package for serving size).

Legumes, broccoli, and cabbage may cause gas. Over-the-counter enzyme tablets may be helpful.

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