ELLSWORTH — If there’s a silver lining to undergoing chemo or radiation treatment it might be this: milkshakes are encouraged.
“We try to get as much calories and protein per swallow, basically, as we can get into people,” said Donna Walsh, an oncology nutrition specialist who works at the Harold Alfond Center for Cancer Care in Belfast.
At a time when Mainers, the nation and the world are preoccupied by the COVID-19 pandemic, there are many people undergoing treatment for cancer and other life-threatening diseases under adverse, unprecedented conditions.
Undergoing cancer treatment, it can be hard to eat well. You may be nauseous or vomiting, have diarrhea or constipation, be sensitive to smell or taste, have a sore throat and mouth, or have very little appetite at all.
The best way to eat well during treatment is to consult with a dietitian who can help formulate a plan that takes into account your particular cancer and what kind of treatment you’re undergoing. Many hospitals and cancer treatment centers have one on staff who can provide free consultations to patients.
For those being treated for cancer in the head and neck area, for instance, “The bigger issue is the radiation, because it does some collateral damage to the healthy tissue,” said Walsh.
An irradiated tongue, for instance, might be inflamed, swollen or have a burning sensation. Those patients “probably have the biggest challenge,” the nutritionist said, since radiation also stays in a patient’s system, and “actually almost gets worse at the end.”
“Those folks,” she said, “We’re really worried about nutrient-dense foods” that are soft and cool and easy to swallow (that’s where the milkshakes come in), along with homemade smoothies and perhaps even supplements.
For the nausea accompanying chemotherapy, however, Walsh focuses on blander, softer, lower fat foods such as dry toast and clear broths. Eating smaller, more frequent meals and snacks throughout the day is a good rule of thumb for most cancer patients.
“As treatment goes on,” said Walsh, “many people experience more and more fatigue.” That means having readymade snacks — nuts, yogurt, real peanut butter and crackers (not the premade kind, as tasty as they are), saltines, granola bars, pudding, popcorn, Jell-O — for patients.
“I always encourage people to eat whole, unprocessed foods as much as possible,” said Walsh, but the goal is really “to get people through treatment” and keep them as healthy as they can.
“This isn’t the time to go on a diet,” she said, although there might be exceptions for those undergoing treatment for cancers related to obesity. But generally, “We want to maintain weight,” said Walsh. “We don’t want people to have a large weight loss.”
“One of the most healthy things people can eat are legumes black beans, kidney beans, lentils,” said Walsh. “Lentils are not nearly as gassy and are a great protein source.”
One of the greatest challenges for many patients, said Walsh, is getting enough to drink. That means starting early.
“If you start drinking your fluid at 3 o’clock in the afternoon, it’s going to be hard to get enough” by the end of the day,” she said. That doesn’t mean patients have to stick entirely to water. “If they have a lot of coffee they might be urinating more, and maybe it’s not the ideal thing,” she said, “But I encourage people to have tea, soup, broth, hot chocolate, Jell-O. Also canned fruit, watermelon. It’s just hard to drink for some people.”
One of the most common questions is whether eating sugar feeds cancer cells.
“It’s a little more complicated than that,” said Walsh. “For most people, if they try to have a healthy diet most of the day and they want a cookie after a meal, that’s not going to all of a sudden, cause cancer.
“It’s actually more a result of the insulin that your body produces,” she continued. “Insulin is a growth factor that can promote the growth of cells, including cancer cells.”
Patients also often wonder about the keto diet, a diet that involves drastically reducing the amount of carbohydrates and replacing them with fat.
“There’s really, at this point, no evidence — other than for people with glioblastomas — that’s really the only evidence a ketogenic diet might help,” said Walsh. It’s also a very difficult diet to follow, she added.
Another misconception? Taking megadoses of vitamin C.
“The issue with megadoses of Vitamin C,” said Walsh, is that “Some of those antioxidants help protect the integrity of cells, and we’re trying to kill cancer cells.” Some herbal supplements, such as St. John’s Wort, can also interfere with certain treatments, she added.
The National Cancer Institute at the National Institutes of Health has resources for eating well during cancer treatment, including recipes and tips on taking special care of foods to avoid infection at this link: https://www.cancer.gov/publications/patient-education/eatinghints.pdf.
The document also recommends patients stay away from raw nuts, raw fish and shellfish, moldy cheeses (like bleu and Roquefort) and warns patients not to buy food from bulk bins or buffets to avoid the risk of infection.
But, as always, the best thing to do is talk to your providers, said Walsh. “I encourage people to seek out the dietitian where they are. Everyone is different.”