The building up diet

Many people with cancer find there are times when they cannot eat as much as usual and sometimes they lose weight. There are lots of reasons for this.

Cancer itself, or its treatments, may make you lose your appetite. Some people find that they do not feel hungry, or feel full soon after starting a meal. Others find that food makes them feel sick or they notice a change in the taste of some foods.

Some types of cancer make your body use up more energy, even if you are not very active, and this can make you lose weight even though you may still be eating well.

People who are not eating enough, especially those who are losing weight, need more energy and protein in their diet. If you have often tried to lose weight previously, it can be difficult to change your eating habits when you have cancer. However, if you have cancer and are losing weight you may need to eat differently to try and maintain your weight. Your doctor or dietitian may recommend foods that you would normally think of as unhealthy, but don’t worry, they have good reasons for doing this.

This section of the booklet shows you how to get more energy and protein without necessarily having to eat more food. Not everyone will be able to put on weight with this building-up diet, but the suggestions should help to slow down or stop weight loss.

A good diet is one that gives you everything you need to keep your body working well. The key to a good diet is variety and balance. You should try to include everyday foods from each of the following groups:

Carbohydrates

Breads, rice, pasta, potatoes, breakfast cereals, cakes, biscuits and sweets are carbohydrate sources which provide energy, fibre, vitamins and minerals. Wholemeal and whole grain varieties are especially high in fibre.

Vitamins, minerals and fibre

Fresh fruit and fresh vegetables are good sources of vitamins, minerals and fibre when eaten raw or lightly cooked. If the skins are left on, they retain more vitamins.

Protein

Meat, poultry, fish, beans, lentils, nuts, eggs, milk and cheese are protein sources which provide vitamins, minerals and energy as well.

Fats

Oil, butter, margarine, fatty meats, oily fish, eggs, cheese, cream, nuts, salad dressing and mayonnaise, full-fat milk, yoghurts and fromage frais are fat sources which also provide protein, vitamins and energy.

NB: Make sure that eggs are well-cooked, and use commercial, not home-made mayonnaise. Avoid cheeses made from unpasteurised milk: these include Brie and blue-veined cheeses because these foods carry a risk of infection.

Energy

Energy is measured in calories. A calorie is simply a unit of energy and is labelled as ‘kcal’ for kilocalories on food packaging. We all need a certain number of calories each day to provide the energy to live. We need energy even if we are not very active, just sitting in a chair we need energy to breathe. If there are too many calories in our diet we gain weight and if there are too few we start to use up our body's stores of energy and lose weight. The amount of energy each person needs per day varies and depends on how quickly their body uses the energy and their level of activity. An adult man needs approximately 2500 kcal per day and an adult woman approximately 2000 kcal.

Proteins

Proteins make up the basic building blocks of the body. Every part of the body contains protein and we need to eat protein every day to maintain and repair our body tissues. The body must have extra protein, as well as extra energy when we are ill, injured or under stress, in order to repair any damage.

Vitamins and minerals

Vitamins are essential substances which help our bodies to work normally, but we only need tiny amounts of them. If you are eating even a little of the main foods that contain vitamins, you are probably getting a good enough supply. However, if you are not able to eat well for a long period of time, you may need a multivitamin tablet to top up your body's stores. Your doctor, dietitian or the pharmacist at your local chemist can advise you about these.

There is no scientific evidence to prove that taking large amounts of vitamins is helpful. In fact it can be harmful to take excessive amounts of certain vitamins, especially Vitamins A and D.

Minerals are substances needed by the body for a variety of functions such as making bones and teeth, maintaining body fluids and tissues, maintaining healthy nerves, and building necessary chemicals (enzymes).

Some minerals are needed in larger amounts than others, such as calcium, phosphorus, magnesium, sodium, potassium and chlorine. Others are needed in smaller quantities and are called trace minerals, eg iron, zinc, iodine, fluoride, selenium and copper. Despite being needed in smaller amounts, trace minerals are no less important than other minerals.

Different foods supply different amounts of minerals. Eating a varied diet will give an adequate supply of most minerals for healthy people.

Fluids

The body needs a certain amount of fluid each day in order to function properly. If you feel unwell it may be difficult to drink enough liquid, but it is important to drink at least one and a half litres of fluid a day (two pints). This can be taken as water, fruit juice, squash or weak tea.

How to boost your energy and protein

If you have a good appetite, you should have no trouble eating the extra energy and protein foods that you may need if you are ill. However, if your appetite is not very good there are two ways to add extra energy and protein to your diet, without actually having to eat more food.

The first is to use everyday foods high in energy and protein, and the second is to use manufactured food supplements. These can be taken as nourishing drinks, which are available as milkshakes or soups. Some supplements are high protein powders that can be added to your normal food.

Manufactured food supplements

There are many supplements available which can add extra energy and/or protein to your diet. They are usually available from your chemist. Some are available on prescription from your doctor.

Some supplements are available ready to drink or use and others are powders that need to be mixed with liquid. Some can be added to food.

Important note:

High protein supplements should only be used with advice from your doctor or dietitian. Most people will need extra energy balanced with extra protein.

Many of these products can be used by diabetics. However, if you are diabetic you should always seek advice from your doctor or dietitian before using food supplements.

Complete milk-tasting supplements and powders once mixed, should be drunk slowly over a period of 20 minutes.

High-energy and juice-tasting supplements have a high carbohydrate (sugar) content and people who are diabetic should seek the supervision of a dietitian before using them.

How to add extra energy & protein to every-day foods

Fortified milk

You can make fortified milk by adding two to four tablespoons of dried milk powder to a pint (60cl) of full cream milk. Keep it in the fridge and use in drinks and cooking. Use fortified milk, Fortisip Neutral or Entera Neutral instead of water to make up soups, jellies, custard and puddings.

Most supermarkets sell dried milk powder, and it is usually stocked close to the coffee and tea section, or near the milk.

Breakfast foods

Combination of cereals and pulses or cereals with non-vegetarian foods increases quality and availability of protein from the diet. Fermentation also increases nutritive value of foods. Therefore the following recipes are suitable for cancer patients:

Idli sambar, khaman dhokla, Missi roti (thalipeeth), cheese sandwiches, chicken sandwiches, stuffed dal parantha, Dosa, Utthapam and paneer parantha. Breakfast cereals (sattu, cornflakes, rice flakes, oatmeal, ragi dalia, dalia, lapsi, sprouted germ dalia.

Sprouted germ dalia is prepared from sprouted, dried, roasted and powdered wheat and Green gram (moong) in proportion 2:1) with fortified milk and sugar.

Soups

Mix one tablespoon cooked and mashed moong dal in a bowl of any soup. Boil it and serve it with cream and soup sticks.

Nibbles

If you feel hungry between meals, try JSBD laddoo (laddoo made from Jaggery 1 kg, Til (sesame seeds) 1 kg, Bengal gram flour (besan)250 gm, dried dates 250 gm without seeds) or Garden cress seeds laddoo. These laddoos are made from Garden cress 50 gm. (Halu in Hindi, Aaliv in Marathi), tender coconut 1 (nariyal) and Jaggery 150 gm. Both laddoos are rich in proteins, iron, calcium and vitamins. A research study conducted in Indore found that these laddoos increase hemoglobin level as well weight gain.

Other suitable foods are chikki, nuts and dry foods, Milkshakes, fresh fruit juices with

ice-cream. Kheer made from Garden cress seeds is highly nutritious food (Calcium, Iron, Proteins and Calories) for those patients who have difficulty in chewing or swallowing.

Roti

Fortified wheat flour should be used to make roti. This flour is prepared by the addition of 30% roasted & de-husked soybean or Chana flour (proportion 10 kg wheat and 3 kg soybean or chana).

Rice

Addition of nutri-nuggets, or soya-nuggets or Badi during cooking of rice increases its nutritive value.

‘Khichdi’ is a good source of nutrition. In our country rice and roti are consumed along with dal or dahi or milk. This is a good practice of eating cereals with pulses or with animal protein rich foods. Cereals are low in Lysine amino acids while rich in Methionine and Cystine. Pulses are low in Mithionine and Cystine but rich in Lysine amino acid (amino acids are building blocks of protein). Animal protein rich foods contain Methionine, Cystine and Lysine and essential amino acids in sufficient quantity. Thus, this type of food combination provides amino acid supplementation.

Vegetables

To improve protein and energy value of vegetables, milk should be used instead of water to cook vegetables. Paneer, grated or shredded cheese or hard boiled egg should be used to garnish

vegetables. Use of Badi or soya / nutri-nuggets with vegetables give same effect. Marathi Patalbhaji, Sindhi Kadhi, Palak with Dal are good examples of such recipes. Sprouted grain’s Salad, Russian Salad, vegetable or sprouted grain Raita, fruit Raita (instead of plain curd) are good sources of protein and energy.

Deserts

Easy to digest and nutritious deserts are:- Bengali sweets made from Paneer, like rasagolla, rasmalai, chamcham, etc., Custard (Plain or fruit) with jelly, chinagrass jelly, bread pudding, soufflé, Ice-cream and kheer.

Sweet made from colostrums (chika) is a good source of protein, energy, vitamin A, minerals and anti-bodies. If possible eat it daily.

Tea and coffee

Use fortified milk to make tea or coffee.

Nourishing drinks

If you sometimes cannot face a meal, have a nourishing drink instead. You can also drink these between meals to help put on some weight.

• Ready Available mixes.

Add 2 tablespoons of Complan / Bournvita / Horlicks / Maltova / Milo / Proteinules / Glutameal / Tinolip / Resource to a glass of milk.

• Home Made drinks.

1. Add one tablespoon of Doodh (Milk) Masala to a glass of milk. This masala is made from 3 almonds, 1 pistachio, 1 cashew nut, a pinch of Kesar and cardamom powder.
2. Milk shakes – like mango-shake, banana-shake, chikoo-shake, etc.
3. Lassi and Shikanji. Lassi is made by mixing curd, sugar, a pinch of cardamom powder and kesar with toppings of grated pistachio. Shikanji is similar to Lassi except that the curd in this case is prepared from boiling the milk until it reduces to half the volume taken originally.
4. Flavored Soya milk. Soak soya at night, de-dusk and grind with water and then strain. Mix sugar and flavor and drink.

Your feelings about weight loss

Weight loss is something that often happens to people who have cancer and it can be upsetting because it is a reminder of your illness. It is natural to be upset by weight loss as over the years we all develop an image in our minds about what our bodies look like. Although we may not be completely satisfied with this image, most people are used to the way they see themselves.

When you lose weight, perhaps as a result of the cancer itself or maybe the treatment you are receiving, you will see a different image of yourself when you look in the mirror from the one you have developed in your mind. It can be hard for someone who has seen themselves as well-built and robust, to accept that they now look different because they have lost weight.

You may also worry that the change in your looks will affect what your partner, family and friends think of you. Weight loss can also be worrying for your friends and family. However, despite your loss of weight, you are still the same person with the characteristics for which your family and friends value you.

Some people worry that the change in their looks will affect their personal relationships. You may be worried about rejection or carrying on a sexual relationship. Many people find, once they have summoned up the courage to talk openly to their partner, their fears of rejection are unfounded.

Relationships are built on a number of things – love, trust, common experiences and many other feelings. Although weight loss can be distressing for you both, it can help to discuss this openly and talking about the problem may help you feel closer.

People who have lost their appetites may feel self-conscious about eating at home with the family or eating out with friends. Eating is usually a social event, so even if you feel you cannot manage a full meal, there is no reason for you to feel excluded. Your friends and family will understand and will enjoy being with you, even if you can't eat as much as usual.

Sometimes, perhaps when you are feeling tired or sick, you may not be able to prepare food. If you are the person in your family who usually makes the meals, it can feel strange to stand back and let someone else take charge. It is important not to feel guilty about letting someone else do your tasks when you are unwell. After all, when you feel better again you can always take up your responsibility for cooking once more.

Don't hesitate to seek professional help if you are finding it difficult to cope with your illness and your emotions. Talking about your feelings can often help to clarify your own thoughts and give others the opportunity to understand how you are feeling. You may find it helpful to talk to a professional counsellor who lives near you, or a local support group.

Don't see it as a sign of failure that you have not been able to cope on your own. Once people understand how you are feeling they can be more supportive.