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TACKLING NUTRITION:
STRATEGIES FOR STAYING STRONG AND HEALTHY
Many people living with head and neck cancer face unique challenges, and may
experience nutritional difficulties during the course of their cancer treatment.
This guide offers useful tips and advice on how to rework your meals to manage
these difficulties and challenges.
WHY NUTRITION MATTERS
Balancing your diet can be a challenge at the best of times, but when going through a cancer journey it
is even more important. The right balance of proteins and calories can help your body stay strong and
healthy — before, during, and after cancer treatment.
Watch for key changes in:
• Body weight
• Muscle mass
• Calorie intake
Eating in a healthful manner may help to keep your strength up through a treatment course,
provide more energy to spend time with family and friends, or be productive at work.
GETTING NUTRITION ADVICE
There are experts who can offer you nutrition advice. Registered dietitians are food and nutrition
experts who have studied how diet and dietary supplements affect your health. A registered
dietitian has a Bachelors or Masters degree with coursework approved by the Academy of
Nutrition and Dietetics Accreditation Council for Education in Nutrition and Dietetics.
Registered Dietitian (RD or RDN after their name) can:
• P
rovide personally tailored advice to help manage the unique nutritional
aspects of chronic disease.
• P
lan food and nutrition programs and promote healthful eating habits
to prevent and treat illness.
• W
ork in food service or as part of medical teams in hospitals, clinics,
and other healthcare facilities.
• W
ork in university settings, where they may teach, do research,
or focus on public health issues.
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Meeting with a Registered Dietitian:
During an appointment with a registered dietitian, she/he will:
• T
ry to uncover any nutrition-related issues and ask about your diet history, medical history,
medications, allergies, and nutrition-related symptoms. Questions about your height, weight,
and other things that may impact your ability to eat and absorb nutrients will also be asked;
• Design a meal plan and provide nutrition recommendations specific to your needs;
• Encourage you to keep a diary of your symptoms or of the foods that you eat.
COPING WITH CHALLENGES
During the phases of a cancer journey the types of foods and beverages you can eat, as well as
your nutritional needs, can change. That’s why it’s so important to find ways to get the nutrition
you need while still eating foods that are appealing to you.
Here are a few simple tips to consider when seeking nourishment during and after treatment:
Dry Mouth/Mouth Sores
Nutrition
Tips
• S
tay hydrated and drink plenty of fluids throughout the day. Drink fluids through a straw to divert
away from painful areas.
• S
kip foods that are salty, spicy, acidic, rough or coarse in texture, and hurt to eat. Eat foods
at room temperature.
• T
ry soft foods such as soups, smoothies, yogurt, hot cereals, casseroles, eggs, tender meats,
and well-cooked and mashed fruits and vegetables. When necessary, use pureed foods for the
smoothest texture possible. Use sauces, liquid, broth, or gravy to soften food.
• D
rink high-calorie shakes or smoothies that are homemade (with protein powder, milk, soy milk,
or rice milk, nut butter, yogurt, and/or flavorful fruits).
• Use ice chips, sugarless gums, and sucking candies to moisten your mouth.
• If you have dry mouth without mouth sores, try a tart liquid or food (lemon, lime, pickles) to
stimulate saliva production.
Other
Suggestions
• D
iscuss with your physician if you feel that you need medication to help alleviate the pain of
mouth sores.
• Your doctor may advise you to see a dentist before you start cancer treatment.
• C
ontact your doctor or nurse if you have new redness, sores, or white patches in your mouth,
bleeding of your gums or mouth, difficulty or pain when you swallow, pain that does not get
better with pain medication, or have any questions or concerns.
• U
se a small, soft-bristle toothbrush to brush your teeth and tongue gently after each meal and
at bedtime.
• Rinse your mouth every 4 to 6 hours or more often as needed.
• Avoid mouth products containing alcohol as they will dry out and irritate your mouth.
• Use a lip moisturizer after mouth care.
• Avoid alcoholic beverages and tobacco, which will irritate and dry out your mouth.
2
Changes in Taste
Nutrition
Tips
• If red meat tastes strange, replace it with chicken, turkey, fish, eggs, dairy, beans, or tofu.
Flavoring
Tips
Lack of taste
• E
at foods that smell and look good to you, but avoid favorite foods on the day of or days around
your treatment.
• If you do not have any mouth soreness and foods lack taste or taste like “cardboard,” season foods
with tart flavors, such as lemon, citrus, vinegar, pickled, or spicy ingredients.
Metallic taste
• Avoid using metal utensils; use plastic utensils instead.
• If you do not have any mouth soreness, add extra flavor to foods with spices such as onion, garlic,
chili powder, basil, oregano, rosemary, tarragon, barbecue sauce, mustard, ketchup, or mint.
• Avoid hot foods; serve food at room temperature.
• Use sugar-free lemon drops, gum, or mints.
Salty, bitter, or sour taste
• T
ry adding sweetening agents such as sugar, maple syrup, agave syrup, or honey to help
enhance the taste.
Sweet taste
• Add six drops of lemon or lime juice or enough drops until sweet taste is muted.
Other
Suggestions
• R
inse your mouth four times a day using a baking soda mixture (1 quart water, 1 tsp baking soda,
and ¾ tsp salt) after meals. Room temperature or cold water is usually best. (Baking soda reduces
acidity of saliva, thins mucous, and discourages growth of yeast.) DO NOT SWALLOW.
• Use a non-alcohol based mouthwash to rinse mouth and tongue twice a day. Floss gently.
• To prevent bacteria growth dry your toothbrush before putting it away.
Difficulty Swallowing
Nutrition
Tips
• Avoid foods that are spicy, acidic, and rough or coarse in texture.
• C
hoose foods that are soft and easy to chew, such as soups, smoothies, yogurt, hot cereals,
casseroles, eggs, tender meats, and well-cooked and mashed fruits and vegetables.
• Avoid alcohol and tobacco, which may irritate your throat.
• Use sauces, liquid, or gravy to moisten food.
• Consume foods at room temperature.
• Eat small meals frequently (5-6 times a day) instead of three large meals.
• Eat meals that are high in protein/calories or add a dietary supplement.
3
Nausea and Vomiting
Nutrition
Tips
• Eat small meals frequently (5-6 times a day) instead of three large meals.
• Eat a light meal on the day of your treatment.
• Avoid greasy, spicy foods and foods with strong odors.
• Eat foods such as crackers, toast, or broth, all of which may be easier on your stomach.
• Try ginger teas, ginger candies, ginger snaps/cookies, or ginger root steeped in soups, juice, or tea.
Other
Suggestions
• T
rack how often you feel nauseated. This may help your doctor or nurse better suggest how
to manage your side effects.
• Take anti-nausea medicines as directed by your doctor, nurse, or pharmacist.
• C
all your doctor or nurse if your anti-nausea medication is not working; you may need a
different type.
Diarrhea
Nutrition
Tips
• A
void foods high in fiber, greasy or fatty foods, raw vegetables, caffeine, alcohol and sorbitol or other
sugar-alcohol containing products.
• Limit dairy products if you’re lactose intolerant.
• Stay hydrated. Aim for 64 ounces (8 cups) of fluids per day.
• E
at foods rich in potassium, such as bananas, apricots, sports drinks, and potatoes (without skin)
to help replenish the potassium that can be depleted with diarrhea.
• E
at foods high in pectin and foods that easily dissolve in your mouth, such as applesauce,
rice, bananas, and oatmeal.
Other
Suggestions
• Try to eat small meals (5-6 times a day) instead of three large meals.
• U
se wet wipes to gently clean yourself after each bowel movement to prevent irritation, soreness,
and bleeding.
4
Constipation
Nutrition
Tips
• Stay hydrated. Drink a minimum of 8-10 8 oz. glasses of fluid per day.
• Consuming warm liquids may help to stimulate a bowel movement.
• C
onsume foods rich in dietary fiber such as bran, whole grain breads, rice, cereal and pastas,
as well as fresh fruits and vegetables, beans, and nuts.
• A
dding prune juice, hot lemon water, coffee or tea into your daily routine could help stimulate
the bowels.
• If gas is a concern, limit gas-producing foods and drinks, such as carbonated beverages, broccoli,
cauliflower, cabbage, peas, beans, onions, and raw peppers. Also, try drinking through a straw and
cut down on chewing gum to limit swallowing air.
Other
Suggestions
• Stay active. A short walk may help treat and prevent constipation.
• S
peak to your healthcare provider if the changes to your diet do not improve bowel movements,
as you may need a medicine to help promote regularity.
Appetite Loss
Nutrition
Tips
• Eat 5-6 small meals a day instead of three large meals. Aim to eat something at least every 2-3 hours.
• D
rink fluids half an hour before or after meals; some people find beverages with meals can make
them feel more full.
• A
dd extra butter, oil, mayonnaise, sauces, dressing, gravy, honey, jam, cheese, and nuts to your
meals to increase calories.
• A
dd extra protein by including poultry, meat, fish, eggs, yogurt, cheese, beans, and nuts to
your meals and snacks. Dried milk powder mixed into gravies, soups, and sauces can also add
more protein.
• K
eep nutritious snacks nearby or with you as you travel. High-protein snacks, such as peanut butter
crackers, granola bars, nuts, yogurt, pudding, and cheese can be helpful. Having quick, nutritious
snacks on hand can make it easier for you to eat.
• Drink high-calorie liquids, such as juice, milkshakes, smoothies, and protein drinks.
• Try nutritional supplements or liquid meal replacements if recommended by your healthcare team.
Other
Suggestions
• T
alk with a registered dietitian certified in oncology nutrition (CSO) about ways to add more calories
and protein to your diet.
• Exercise can help stimulate your appetite.
• Make mealtime enjoyable: invite friends or family over or play relaxing music.
• S
peak to your healthcare provider if you find that dietary management does not help to
improve your appetite or you are experiencing continued weight loss.
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Fatigue
Nutrition
Tips
• Plan meals ahead of time and make extra servings, if possible, to freeze, and have when you need it.
• Choose foods high in protein and calories.
• Instead of three large meals, eat 5-6 small, frequent meals a day to keep up your strength.
• Stay hydrated: drink a minimum of 8-10 8 oz. glasses of fluid per day.
• Try nutritional supplements or liquid meal replacements if recommended by your healthcare team.
Other
Suggestions
• Listen to your body: schedule short naps or rest periods throughout the day and get quality sleep at night.
• Keep active: a short walk or exercising for a short time daily can help you feel better.
• Relax — try exercises such as stretching, yoga, massage, or aromatherapy.
• T
rack your fatigue levels every day. This can help your healthcare provider identify things that may be
contributing to your fatigue, such as sleep/wake disturbances and other side effects.
• Plan your day so you accomplish the most important activities first.
• A
ccept help from family members and friends to shop and prepare meals for you, run errands,
or do housework.
Contact Your Healthcare Team if You Are Experiencing the Following:
• Mouth sores
• A choking sensation
• Ulcerations
• Weight loss
• Bleeding
• Nausea and vomiting
even after taking your
anti-nausea medicines
• White patches
• Pain
•D
ifficulty swallowing, eating,
drinking, or talking
• Difficulty with coughing
while eating or drinking
• Four+ watery bowel
movements in a day
• Diarrhea for more
than 24hrs
• Stomach cramping
• Bleeding from
your rectum
• Difficulties with bowel
movement in two to
three days
• Difficulties doing your
normal everyday activities
• Tiredness after resting
or sleeping
• Sadness or depression
6
HEALTHY EATS ON A BUDGET
There are lots of easy ways to save money on food and eat healthy.
Here are just a few cost-saving tips:
• Buy “in season” produce; it is usually less expensive and it is at its peak flavor.
• B
uy in bulk when you find items you like on sale and freeze for future use. Usually the unit price
per serving of a larger quantity purchase is much lower than the smaller package.
• F
rozen fruits and vegetables often retain more nutrition than fresh because they are flash frozen
at the peak of ripeness, and often cost less.
• C
anned fruits and vegetables can be good as long as you look for those labeled “100% fruit juice”
and vegetables with “low-sodium” or “no salt added”.
• R
ice, oats, barley, quinoa, and pasta are budget-friendly grain options. Also, because they can be
cooked to a soft texture, they’re easier to chew and swallow than breads and dry cereals. Try to
choose the whole-grain version, when possible — for example, choose brown rice over white rice.
• T
ry dried beans and peas. Soak overnight and mix into your favorite soups, stews, and entrees for
added protein and fiber. Canned versions are also OK but should always be rinsed before use.
• N
ut butters, eggs, and low-sodium canned meats and fish can be used as more affordable sources
of protein than fresh versions.
• C
hoose less expensive cuts of meat, such as chuck, round, flank, or brisket. Never buy prepared
burgers — buy ground meats and make your own to save money.
• B
uy the larger, economy-sized yogurt instead of individual, flavored yogurts. Then add flavors by mixing in
your own fruits or honey. Yogurt can also be used for making smoothies or shakes.
• R
echarge leftovers! Many meals can be repurposed and used for another weeknight meal. For
example, meatloaf can be made into a delicious sandwich the next day; extra oatmeal can last
for several days as a warm and hearty breakfast — just vary the toppings.
• B
ring snacks to your treatment appointments instead of buying costly and unhealthy convenience
foods found in restaurants and cafeterias.
• Avoid packaged foods — fresh foods are more cost effective.
• Keep a diary of your symptoms or of the foods that you eat.
For approximately $15 you could buy:
Or
1 bag of tortilla chips
3 lb. bag of apples
1 package of cookies
2 lb. bag of carrots
2 liters of soda
2 lb. of broccoli
1 pint of ice cream
1 jar of peanut butter
1 loaf of whole wheat bread
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KNOW WHAT YOU EAT
Some foods can help you build your strength. Others foods may be high in calories, which can be
important if you are struggling to eat regularly. Here are some terms to help make choosing the right
foods less overwhelming.
• Nutrients — Nutrients are essential for the body to grow, work, and repair. They include carbohydrates,
proteins, fats, water, vitamins, and minerals. Everyone needs nutrients, but a person’s age, gender,
and physical activity level decide how much is needed.
• Calories — Just as minutes measure time and inches measure length, calories measure the amount
of energy found in a food. The body needs energy to function, which is why food is needed to sustain
life. Calories are found in carbohydrates, proteins, and fats.
• C
arbohydrates — Carbohydrates are the body’s main source of energy. Carbohydrates are found in
most foods and come in two forms:
––
––
Simple carbohydrates or simple sugars give you quick energy and are found in foods like fruits, vegetables, and milk.
Complex carbohydrates or starches give you longer lasting energy and can be found in grains, potatoes, peas, and beans.
• Fats — Fats are used by the body to make cells, protect organs, and help absorb certain vitamins.
• Fiber — Fiber is found only in plant foods like fruits, vegetables, grains, nuts, and seeds.
• P
roteins — Proteins are found in both plant and animal sources. They’re made of amino acids,
which are used as the building blocks for the maintenance and healing of every aspect of the body.
•V
itamins and minerals — Vitamins, such as A, C, E, D, and minerals such as iron, calcium, and
magnesium, are nutrients that are needed for the body to function, grow, and repair.
8
NOW WE’RE COOKING!
Savor Health has developed a selection of helpful recipes all containing adaptations to meet the special
needs of people living with head and neck cancer. Please click here to check them out!
FOR MORE INFORMATION ABOUT
MAINTAINING PROPER NUTRITION
WITH CANCER, PLEASE VISIT:
• Y
our Cancer Game Plan
YourCancerGamePlan.com
• Head and Neck Cancer Alliance
headandneck.org
• S
avor Health
savorhealth.com
• Support for People with Oral and
Head and Neck Cancer (SPOHNC)
SPOHNC.org
Please consult your healthcare provider directly with any questions you may have
regarding your health, condition, or treatment. Your healthcare provider should be your
primary source of information regarding your medical condition and treatment.
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YourCancerGamePlan.com is intended for U.S. residents only. The information provided on YourCancerGamePlan.com is not intended to be a substitute for professional medical advice.
Please consult your healthcare provider directly with any questions you may have regarding your health, condition or treatment. Your healthcare provider should be your primary source of
information regarding your medical condition and treatment.