Eating Problems

Apart from a poor appetite and loss of weight, some people with cancer have other difficulties with eating. Some of these problems may be related to the cancer itself, while others may be temporary side effects of treatment.

In this section some of the possible difficulties are discussed and some suggestions are given to help you overcome them.

Sore Mouth

• Take soft, non-acid blended or liquid foods such as custards, puddings, jellies, oatmeal or other cooked cereals, mashed or pureed vegetables, poached eggs or scrambled eggs, pureed meat, milkshakes or other nourishing drinks.
• Drink plenty of nourishing fluids. If you find that fresh fruit juices sting your mouth, try drinking blackcurrant or rosehip syrup, apple juice or peach or pear nectar instead as these are less acidic. Some pre-prepared, juice-tasting drinks may also be helpful. These are available from health food shops and some supermarkets.
• Cold foods and drinks can be soothing to a sore mouth. Try adding crushed ice to drinks and eating ice cream or soft milk jellies.
• Avoid salty or spicy food which may sting your mouth.
• Avoid rough textured food like toast or raw vegetables as they can scrape at sore skin.
• Keep your food moist with sauces and gravies.
• Try drinking through a straw.
• Pineapple chunks or melon slices clean the mouth and are refreshing.
• Tell your doctor. He or she can prescribe soothing or antiseptic lotions or sprays for you.
• Ask your doctor or nurse for advice about suitable mouthwashes. Mouthwashes can be very soothing, but many that you can buy may be too strong for you. Your doctor can prescribe an anaesthetic gel or mouthwash.
• Use a child's soft toothbrush to clean your teeth gently.
• If you wear dentures, leave them soaking in a denture-cleaning solution overnight and leave them out for as long as you can during the day to prevent them chafing your gums.

Has your taste changed?

Some people with cancer find that their taste changes, although most changes are only temporary. They may no longer enjoy certain foods or find that all foods taste the same, or they notice a metallic taste in their mouths after chemotherapy. Occasionally, they can't taste anything at all.

If you do have a change in taste, here are some tips for making your food more palatable:

• Concentrate on eating the foods that you like the taste of and ignore those that do not appeal to you. However, do try them again after a few weeks, as your taste may have returned to normal.
• Use seasonings and herbs like rosemary, basil and mint, and spices to flavour your cooking.
• Try marinating meat in fruit juices or wine, or dress it in strong sauces like sweet and sour or curry. Cold meats may taste better garnished with pickle or chutney.
• Sharp-tasting foods like fresh fruit, fruit juices and bitter boiled sweets are refreshing and leave a pleasant taste in the mouth.
• Some people might go off the taste of tea or coffee. You could try a refreshing lemon or green tea instead or perhaps an ice-cold fizzy drink like lemonade.
• Some people find cold foods taste more palatable than hot foods.
• Serve fish, chicken and egg dishes with sauces.

Dry Mouth

• If your tongue is 'coated' it may make your food taste unpleasant and might discourage you from eating. You can clean your tongue with a bicarbonate of soda solution: use one teaspoonful of bicarbonate of soda (available from your chemist) dissolved in a pint (60cl) of warm water. Clean your tongue with cotton wool dipped in this solution or with a soft baby’s toothbrush.
• Frequent drinks, even taking just a few sips at a time, can greatly help to keep your mouth moist. You may find fizzy drinks the most refreshing.
• Try sucking ice cubes or ice lollies. Home-made lollies can be easily made by freezing fresh juice in ice-cube trays or in special lolly containers with sticks which can be bought from many kitchenware shops.
• Moisten your food with lots of gravy or sauce.
• Avoid chocolate and pastry; they stick to the roof of your mouth.
• Chewing gum can stimulate your saliva.
• Try drinking a glass of sherry before a meal.
• Salivix boiled sweets (available on prescription from your doctor, and from most chemists) stimulate saliva production.
• Tell your doctor about your mouth. He or she can prescribe artificial saliva sprays, or lozenges to suck, if you think they will help.
• Use lip balm for dry lips.

Too tired to cook or eat?

This is the time to rely on quick convenience foods such as frozen meals, tinned foods, boil-in- the-bag meals and takeaways. Remember, though, to defrost frozen foods thoroughly and to cook all foods properly so as to avoid all risk of food poisoning. Read cooking instructions carefully and stick to them.

If you know in advance the times you are likely to feel tired, for example after radiotherapy treatment, then you could try to plan ahead to help you through these times. If you have a freezer, you could prepare food while you are feeling active and freeze it for when you are more tired. You could stock up on some of the convenience foods mentioned above.

This is also a good opportunity to give friends and family the chance to help you by doing some shopping or cooking.

If you really cannot face eating, have one of the nourishing drinks suggested instead.

If you feel you need more help coping at home with your eating, tell your family doctor (general practitioner) or contact the dietician attached to your hospital.

Constipation

• Make sure you have plenty of fibre (roughage) in your diet. Good sources of fibre include wholewheat breakfast cereals like Weetabix, Shredded wheat, or muesli, wholemeal bread and flour, brown rice, wholemeal pasta, fresh fruit and vegetables with skins on.
• Favourite natural remedies for constipation are syrup of figs, prunes and prune juice.
• Make sure you drink plenty of fluids. Hot drinks can be helpful. Some people find coffee is a powerful laxative. Yogasana or gentle exercise will help to keep your bowels in working order.
• If the constipation is due to medicines that you are taking (such as painkillers or anti- sickness drugs) you will need to take laxatives. Your doctor can prescribe these for you.
• Eat daily 8 to 10 munnkka (remove the seeds) or raisins, 3-5 figs, 200 gm papaya, 1-2 sweet lime, 1 guava, 2 teaspoonful zizyphus (Ber) powder.
• Keep drinking water in a copper utensil, and drink 8-10 glasses of water daily.
• Flaxseed (linseed) can help to ease constipation and soften stools. One teaspoon or dessertspoon of the seeds can be taken daily with a glass of water. If you have cancer of the gullet (oesophagus) or bowel, ask your doctor before taking fibre or linseed.
• If the constipation persists, tell your doctor who can prescribe a laxative.

If you have cancer of the bowel, always ask your doctor for advice on dealing with constipation.

Diarrhoea

• While you have diarrhoea it can sometimes help if you cut down on your fibre intake from cereals, fruit and vegetables.
• Make sure you drink plenty of fluids to replace the water lost with the diarrhoea, but avoid alcohol and coffee. Limit your intake of milk and milk-containing drinks.
• Acidophilus or other bacteria found in live yoghurt can help to ease diarrhoea caused by antibiotics. Antibiotics can kill off the healthy bacteria normally found in the bowel, but the bacteria found in live yoghurt can replace them.
• Eat small, frequent meals made from light foods – dairy produce, white fish, poultry, eggs (well cooked), white bread, pasta or rice. Avoid highly spiced or fatty foods and eat your meals slowly.
• Have your fruit stewed or tinned rather than fresh or dried. Bananas are ‘binding’.
• Eat curd or buttermilk, or curd with banana.
• Avoid fried and fatty food, raw vegetables and fruits, spices and spicy foods.
• If the diarrhoea continues, tell your doctor, who can investigate the cause, and prescribe some diarrhoea-relieving medicines for you.

If your diarrhoea is caused by radiotherapy, changing your diet is unlikely to help, and it is important that you take anti-diarrhoea medicines prescribed by your doctor.

Wind

• Take care to avoid constipation (follow the instructions given above).
• Eat and drink slowly. Take small mouthfuls and chew your food well.
• Avoid food that you think gives you wind; for example, beans, pickles and fizzy drinks.
• A favourite natural remedy is to drink two teaspoonfuls of peppermint water dissolved in a small cup of hot water. If you like, sweeten it with a teaspoonful of sugar.
• Acidophilus and other bacteria found in live yoghurt can help to put healthy bacteria into your gut and remove the gas-forming bacteria.
• You could try taking charcoal tablets, available from your chemist.
• Do Yogasana (Pawan muktasan) daily.
• Gentle exercise, especially walking, can bring some relief.
• If the pain becomes severe or persistent, tell your doctor.

Feeling Sick

• If the smell of cooking makes you feel sick, eat cold meals or food from the freezer that only needs heating up (but remember to defrost it thoroughly before cooking, and to make sure it is properly cooked).
• If possible, let someone else do the cooking.
• Avoid greasy, fatty or fried foods.
• Try eating some dry food, such as toast or crackers, first thing in the morning before you get up.
• When you feel sick, start off by eating light foods like thin soups or egg custards and gradually introduce small portions of your favourite foods, slowly building up to a more substantial diet.
• Foods or drinks containing ginger can help to reduce feelings of sickness. You can use crystallised ginger, ginger tea, or ginger biscuits.
• Sipping a fizzy drink is a popular remedy for feeling sick. Try mineral water, ginger ale, lemonade or soda water and sip it slowly through a straw.
• Try having drinks between meals rather than with your food.
• Ask your doctor to prescribe some anti-sickness tablets (anti-emetics) for you. Take these regularly, as recommended, to prevent sickness from developing.
• Eating small meals frequently can be better than trying to eat large meals less often.

See also the section on nausea and sickness.

Difficulty in chewing or swallowing

Soft diets can become boring when people tend to rely on soup and ice cream. But with a little imagination and effort, a soft diet can be both appetizing and nutritious.

The golden rule is to eat your favourite foods, but make changes, which will soften them. For example, dress foods in interesting sauces and gravies, finely chop meat and vegetables and casserole or stew them, and cut the crusts off bread for softer sandwiches. If you have access to a blender you could blend or liquidize cooked foods.

There are several commercial products available that you may find helpful, both in terms of convenience and variety. These products can be obtained from your chemist. Your doctor may offer you a prescription for some of them.

SOME SOFT NUTRITIOUS FOODS

Poor Appetite

• Eat little amounts as often as possible if you cannot face big meals. Try to have a small portion of food every two hours during the day.
• Tempt your taste buds by making your food look as attractive as possible. Put small portions on your plate and garnish the food with lemon, tomato or parsley.
• A glass of sherry or brandy half an hour before a meal is a good way of stimulating your appetite. Some people find a glass of wine with their meals helps their digestion.
• Keep snacks handy to nibble whenever you can. Bags of nuts, crisps, dried fruit or a bowl of grated cheese are quite light and tasty. If these are hard for you to swallow, a yoghurt may slip down more easily.
• Sweet or savoury nourishing drinks can be used to replace small meals and can be sipped slowly over the course of a day.
• Eat your meals slowly, chew the food well and relax for a little while after each meal.
• Sometimes the smell of food cooking can be appetising, but occasionally it can put you off eating. If cooking smells ruin your appetite, keep away from the kitchen and ask your family or friends to cook, or eat cold foods attractively presented.
• Everyone's appetite fluctuates between good and bad days. Make the most of the good days by eating well and treating yourself to your favourite foods.
• Have your meals in a room where you feel relaxed and without distractions.

Special eating problems

Some people with cancer may have special eating problems that are not covered by this booklet. For example, people with a colostomy or ileostomy or laryngectomy need to follow a special diet individually designed for them. Advice about these diets can be obtained from your doctor or dietitian.