Like almost all living creatures, our bodies run on food — the fuel that makes life possible. When you have cancer, many things can occur that make eating — this most basic activity in our lives — less than enjoyable. At times, eating normally may feel almost impossible. Yet eat we must, and with cancer, we must eat as nutritiously as possible.

Why does nutrition matter so much to people with cancer? The National Cancer Institute, in Eating Hints for Cancer Patients, says it well:

• Patients who eat well during their treatment are able to cope better with the side effects of treatment. Patients who eat well may be able to handle a higher dose of certain treatments.
  
  
• A healthy diet can help keep up your strength, prevent body tissues from breaking down, and rebuild tissues that cancer treatments may harm.
  
  
• When you are unable to eat enough food or the right kind of food, your body uses stored nutrients as a source of energy. As a result, your natural defenses are weaker and your body cannot fight infection as well. Yet, this defense system is especially important to you now because cancer patients are often at risk of getting an infection.

A note of caution. As you begin your treatment for cancer, it is very important to talk with your health care team about everything you take for your health. This includes all medications, over-the-counter medications, and vitamins and herbal supplements. These can have an impact on your treatment, and your health care providers will give you advice about what is and is not appropriate for you at this time.

Consult with an expert. Your best ally in determining your personal nutritional needs is a registered dietician (RD). An RD is a health care professional trained in nutrition, food and biochemistry who uses this knowledge to help promote health and combat disease. In many cancer centers and hospitals, registered dieticians on staff regularly consult with cancer patients and their health care teams. If the place where you are treated does not have a registered dietician available, ask for assistance in locating an outside expert for consultation. If you cannot get a referral, contact the American Dietetic Association at their toll-free number, 1-800-366-1655.

Getting Ready for Treatment: Tips You Can Use

• For now, continue to eat your normal, healthy diet if possible. If your diet isn't particularly healthy, do what you can to incorporate healthy foods. The American Cancer Society recommends:
  
  
  • Five or more servings of a variety of vegetables and fruits each day.
    
    
  • Choosing whole grains in preference to processed (refined) grains and sugars.
    
    
  • Limiting consumption of red meats, especially those high in fat and that are processed.
    
    
  • Choosing foods that help you maintain a healthy weight.
    
    
• As you read and learn about cancer treatments and side effects of treatment, do the best you can to avoid envisioning yourself having all of the side effects. Most patients don't — and some have no side effects at all that interfere with eating.
  
  
• Develop a plan to have people help you with shopping for food and cooking, if you need this assistance. You'll find that many friends and family will be anxious to help, and these are activities that may be very useful to you as treatment progresses. It will be important to have fresh fruits, vegetables, meat, fish and poultry, and this means regular shopping.
  
  If help from friends and family is not an option, many communities have services that can assist you. Ask your hospital social worker for recommendations and help in locating these groups.
  
  
• Think about foods you like to snack on, and make sure to have these in the house, on hand, as you begin treatment. Some favorites that people with cancer enjoy eating include:
  
  
  • Dairy foods like cheese, milk, ice cream and yogurt
  • Fruit — fresh, canned and frozen
  • Canned tuna and salmon
  • Fresh vegetables
  • Simple desserts like gelatin, pudding and custards
  • Crackers
  • Ices and sherbet
  • Hard- boiled eggs
  • Fruit juices and soft drinks
  • Bottled water
    
    
• Learn the techniques of safe food handling while you are being treated for cancer. Some of the treatments you may have — notably chemotherapy — can cause your white blood count to become low. This means you are more vulnerable to infection, and it is important to minimize your contact with bacteria. Your health care team will discuss this with you, and here are some guidelines from the American Cancer Society for safe food handling when your white blood count is low:
  
  
  • Wash hands thoroughly with warm soapy water before and after preparing food and before eating.
    
    
  • Use different cutting boards for meats and vegetables. Sanitize cutting boards well after each use. To do this, wash the board with warm soapy water and rinse well. Wash the board again with a solution of 1 tablespoon bleach in 4 cups warm water. Let the solution stay on the board for at least 2 minutes and then rinse with hot clean water.
    
    
  • Keep hot foods hot (above 140ºF) and cold foods cold (below 40º F).
    
    
  • Thaw foods in the refrigerator or microwave oven and cook them immediately. Never thaw foods at room temperature.
    
    
  • Refrigerate all leftovers within 2 hours of cooking them and eat them within 24 hours.
    
    
  • Eat only well-cooked foods. Avoid raw and undercooked food.
    
    
  • Substitute frozen pasteurized eggs or powdered egg whites for raw eggs in recipes such as eggnog, Caesar salad dressing and meringues.
    
    
  • Drink bottled water and commercially bottled soft drinks.

Source: American Cancer Society

A word for caregivers: As your loved one goes through treatment, you will probably find yourself urging her or him to "eat, eat" — and even preparing special foods. Be prepared to find some of your efforts rejected — not because of anything in your control or in the control of your loved one, but because some cancer treatments cause significant eating problems. These can come in the form of mouth sores and gastrointestinal problems — but also in the form of significantly altered taste of foods. What a person once enjoyed eating may now taste awful. Similarly, the smells of cooking foods, once a source of anticipation and pleasure, may now create nausea in the cancer patient.

What to do?

• First, exercise great patience, and remember that the rejected food or drink is not about you or your effort in preparing it. For the most part, it can't be helped. The good news is that these unpleasant tastes and smells fade for most people once cancer treatment ends.
  
  
• Second, don't turn mealtime into a battleground, even a polite one, where you find yourself constantly urging your loved one to eat another bite, and so forth. This can actually result in the patient eating less than usual, because stress quickly helps to kill appetite. You can help by preparing food and making the mealtime a pleasant and relaxing experience for you both, if possible, with normal conversation and no pressure.
  
  
• Third, remember that you are helping with nutritional needs simply through your patience and willingness to try out different foods for your loved one, and making eating as pleasant as possible. Cheerful help and good company are great gifts at times like these.
  
  
• Fourth, be alert and if your loved one's consumption of food and fluids gets less and less — and if weight loss is continuing — let the health care team know at once so plans can be made to help correct the problem

Nutrition for Cancer Patients: The Basics

There are four essential components of nutrition for cancer patients: enough protein, enough calories, and enough fluids.

1. Sufficient Protein. Cancer patients need more protein every day than a well person. This is because the treatments for cancer place extraordinary demands on your body. Protein is the essential building block of body tissues, the nutrient that helps healing and helps keep your immune system functioning to prevent infection. If your treatments will include surgery, radiation or chemotherapy — or all three — sufficient protein is essential to you.
   
   Experts in nutrition recommend that cancer patients calculate their protein needs by dividing their weight in pounds by three, and multiplying by two. Translated, this means that a 150-pound person would need about 100 grams of protein a day — almost twice what a well person needs. Consult the list of foods below* and make eating choices to get enough protein in your diet. A 3-ounce serving is about the size of a deck of cards.
   
   

   Protein Source	Grams of Protein Per Serving
   Turkey, 3 oz.	26 grams
   Chicken breast, 3 oz.	26 grams
   Vegetable burger, 3 oz.	24 grams
   Hamburger, 3 oz.	23 grams
   Canned tuna, 1/2 cup	23 grams
   Beef steak, 3 oz.	20 grams
   Chick peas, soy beans, 1 cup	19 grams
   Cooked soybeans, 1/2 cup	19 grams
   Fish, 3 oz.	19 grams
   Baked ham, 3 oz.	18 grams
   Lentils, peas, 1 cup	16 grams
   Cottage cheese, 1/2 cup	15 grams
   Kidney beans, 1 cup	14 grams
   Sustacal or Ensure Plus supplement, 8oz.	12 grams
   Soy milk, 1 cup	9 grams
   Tofu, 1/2 cup	8 grams
   Peanut butter, 2 tablespoons	8 grams
   Milk, 1 cup	8 grams
   Yogurt, 1 cup	8 grams
   Ensure, 8oz.	8 grams
   Wheat germ, 1/4 cup	8 grams
   Egg, one	7 grams
   Cheese, one-inch cube	7 grams
   Cheese pizza, 1/6 of a 10" pie	7 grams
   Cooked oatmeal, 1 cup	5 grams
   Baked potato, 1 large	4 grams
   Hummus, 1/3 cup	4 grams
   Ice cream, 1/2 cup	3 grams
   Noodles/pasta, 1/2 c. cooked	3 grams
   Bread, 1 slice	2 grams
   English muffin, one-half	2 grams
   Vegetables, cooked, 1/2 cup	2 grams
   Vegetables, raw, 1 cup	2 grams

   
   *Source: National Institutes of Health Clinical Center Nutrition Department

   As you can see, it's not necessary to eat meat to obtain enough protein, and vegetarians can successfully eat the required amounts needed during treatment.

   While it might seem hard to pack all this protein into your diet every day, there are ways to eat foods together in tasty combinations. Below are some suggestions from the NIH Clinical Center's Nutrition Department, which provides advice and support to patients on clinical trials (including cancer trials):

   1. Add ice cream or frozen yogurt to beverages like ginger ale, or add them to milk to make a milk shake in the blender.
      
      
   2. Use dried peas, beans or tofu in soups, casseroles, pastas and grain dishes that also contain cheese or meat.
      
      
   3. Add nuts, seeds or wheat germ to casseroles, muffins, pancakes, cookies and waffles as you prepare them. Sprinkle on fruit, cereal, ice cream, yogurt, vegetables, salads and pasta.
      
      
   4. Keep nuts, seeds and wheat germ handy for snacking.
      
      
   5. Use milk instead of water in cooking whenever possible.
      
      
   6. Use milk in preparing hot cereal, soups, cocoa and pudding.
      
      
   7. Make cream sauces for vegetables and other dishes.
      
      
   8. Add powdered milk (1 cup) to a gallon of regular milk to make high protein milk.
      
      
   9. Sandwich ice cream or frozen yogurt between cake slices, cookies or graham crackers.
      
      
   10. Use ricotta or cottage cheese in interesting ways:
       
       
       • Mix with fruits and vegetables or use as a stuffing in fruits and vegetables
       • Add to casseroles, spaghetti, noodle and egg dishes, like omelets, scrambled eggs and soufflés
       • Use in gelatin (Jello), pudding-type desserts, cheesecake and pancake batter
       • Stuff crepes or pasta shells or manicotti
       • Use as a spread on bagels and bread
         
         
   11. Combine eggs with other food:
       
       
       • Add chopped, hard-cooked eggs to salads, vegetables, casseroles and creamed meats
       • Add extra eggs or egg whites to quiches, pancake and French toast batter
       • Make a rich custard with eggs, high-protein milk and sugar
       • Add extra hard-cooked eggs to deviled-egg filling and sandwich spreads
         
         
   12. Add chopped, cooked meat, fish, eggs or cheese to vegetables, salads, casseroles, soups and sauces and biscuit dough.
       
       
   13. Add cooked meat, fish, eggs or cheese to stuffed baked potatoes, sandwich fillings, stuffing for turkey or chicken.

   A note of caution: in general, while you are in cancer treatment, you should not eat raw seafood or raw fish or any kind, and the meats you eat should be cooked through thoroughly. The purpose here is to avoid contaminants of any kind while your immune system is not as strong as it normally might be. A rule of thumb to remember is to avoid anything that is "raw" or "rare." If you are eating eggs, remember to cook them all the way through. If you are adding raw eggs to other food, make sure that food cooks thoroughly enough to cook the eggs completely.

   Similarly, it is important to wash all fruit and vegetables you eat, and to peel the skin from fruits of all kinds. If possible, eat fruits that don't require eating the skin, such as citrus fruit. If the fruit cannot be peeled before eating, don't eat it. Talk with your dietician for more specific advice and information.

2. Sufficient Calories. Calories are basically units of energy your body receives from the food you consume. When you are being treated for cancer, your body needs extra energy to help you heal and have energy. The idea is for you to consume enough calories every day to prevent weight loss. If you don't, your body will consume its stored nutrients for energy — and in time, this will weaken your immune system, putting you at risk for infection.
   
   It will be difficult, at times, for you to eat enough extra calories to maintain your weight, if side effects from treatment make eating difficult. While you are in treatment, eat anything that tastes good to you and that agrees with you. To learn how many calories a day you need, consult the dietician who works with cancer patients.
   
   It's smart to try to pack the maximum number of calories you can into the foods you do consume. Dieticians have developed clever ways to do this. Here are a some tried-and-true ideas from the National Cancer Institute (for more details, get NCI's free booklet, Eating Hints for Cancer Patients; call 1-800-4-CANCER or online at www.cancer.gov):
   
   
   • Whenever possible, add some extra butter, margarine or milk to foods you are preparing. These are "calorie-rich" foods, and they combine well with other foods. Think about adding extra butter or margarine to soups, mashed potatoes, rice, pasta, and vegetables. And course margarine or butter makes a delicious dip for seafood like cooked lobster, scallops, crab and shrimp.
     
     
   • Milk combines well in some soups, egg dishes, mashed potatoes, and is great in hot chocolate. Consider using cream instead of milk on cereal, in puddings, or in batter for pancakes. And of course, don't forget milkshakes.
     
     
   • Melted cheese adds flavor to many things, including sandwiches, hamburger, and vegetables. Melted cheese makes a tasty snack when eaten with tortilla chips.
     
     
   • Sour cream, also rich in calories, works well as a dip for fruits and vegetables. It can also be added to many dishes, including macaroni and cheese, sauces and some soups.
     
     
   • Eggs combine well with many foods. (See the recommendations above.)
     
     
   • Granola is relatively high in calories and other nutrients. Try it sprinkled on ice cream, yogurt, and fruit. It can also be combined in cookie and muffin batter — and, of course, eaten by itself with fruit and milk.
     
     
   • Honey and sugar go well in any number of foods and drinks. Try honey in tea, and in combination with ice cream and fruit, for example.
     
     
   • Keep snacks available that are high in calories. Some ideas include cake, breads, bagels, cookies and crackers, and ice cream.
     
     
   • Some foods are relatively high in both calories and protein. Eat these frequently as good sources of both:
     
     
     • Canned tuna and salmon
     • Cottage and ricotta cheese
     • Milk and milkshakes
     • Yogurt
     • Egg, chicken or pasta salads
     • Hummus
     • Granola bars
     • Peanut butter
     • Cereal with milk or cream
     • Eggs
     • Sliced meats like turkey and roast beef
     • Cheeses
   
   If you find you are unable to get sufficient calories from foods you and eat and drink, it may be appropriate to add nutritional supplements, such as Ensure and Sustacal, to your diet. Discuss this with your health care team — notably the dietician.
   
   
3. The Right Vitamins and Minerals Vitamins and minerals play important roles in overall health. Cancer can cause a loss in vitamins and minerals, as can the inability to eat enough food to maintain the necessary amounts of these substances in your body.
   
   In general, it is best to get most of your vitamins and minerals from food. However, it may be necessary to for you to take supplements, as well. There are many variables at work in determining a person's overall nutrition level and needs while being treated for cancer — kind of cancer, treatment, severity of side effects, a person's overall health, and so forth. That's why the input of an expert — usually a registered dietician — can be very important to your well-being.
   
   Don't take vitamin or mineral supplements without talking with your health care team. They can cause interactions with your cancer treatment. Also, it's important to tell your health care team if you are taking any herbal products, such as St. John's Wort, gingko biloba, and echinacea . Just because these are sold without prescription does not mean that they are safe for you to use. These, too, can impact your treatment.
   
   Vitamins. Vitamins have different roles in health. Here is a brief overview of function and food sources for some key vitamins:
   
   

   Vitamin		Function		Food Sources
   A		Fight infection		vegetables, liver, carrots
   B1		Nervous system		health Bran, wheat germ, brown rice
   B2		Muscle tone/strength		meats like liver, tongue
   B3		Digestive system		fish, poultry, peanuts
   B5		Coping with stress		eggs, whole grain cereal
   B6		Red blood cell production		meat, vegetables, grains
   B12		Nervous system health		fish, shellfish, meat, dairy foods
   C		Healing, red blood cells		meat, vegetables, grains
   D		Builds strong bones, teeth		citrus fruit, vegetables, cantaloupe
   E		Protects lungs, helps red blood cells		eggs, fish, fish oils
   Folic Acid		Red blood cell production		green leafy vegetables, meat
   K		Blood clotting		eggs, leafy vegetables, fruit, meat

   Minerals. Here is a brief overview of key minerals and some sources of them in food.

   Mineral		Function		Food Sources
   Calcium		Strengthens bones, teeth		milk and dairy foods
   Chromium		Helps body use carbo-hydrates		meats, whole grain cereal
   Copper		Helps body use iron		shellfish, liver, green leafy vegetables
   Iron		Red blood cells		liver, meat, eggs
   Magnesium		Nerve function		whole grains, nuts
   Selenium		Boosts immune system		broccoli, onions
   Zinc		Helps in healing		fish, meat, eggs

   
   
4. Sufficient Hydration. Keeping yourself well-hydrated throughout your
   cancer treatment is very important. Having enough fluids every day helps you combat constipation and other side effects. You'll need to drink 8-10 full glasses (8 ounces) of fluid every day. This may sound like a lot of fluid, but it is necessary, especially when you are undergoing cancer treatment.

   Try some techniques to help get the fluid intake you need to prevent the serious side effect of dehydration:

   • Take a bottle of water with you everywhere. This has become common now, and attracts no attention.
     
     
   • Fluids can be found in delicious packaging: ice pops, fruit ices, ice cubes made of some of your favorite beverages.
     
     
   • If water becomes boring, try some alternatives that may be new to you — fruit juices like cranberry and raspberry juice, sports drinks like Gatorade, iced tea in a variety of flavors.

If you do become dehydrated, your health care team will probably rehydrate you with dextrose — a combination of water and sugar — administered intravenously.

Barriers to Eating Well & Ways to Help Yourself

There are a number of factors in cancer treatment that can interfere with your ability to eat normally. Side effects from surgery, chemotherapy and radiation can cause an array of problems, from aggravating side effects to weight loss and other issues.

Since eating well is such an important part of managing cancer, it's worthwhile to deal with side effects promptly and implement strategies to overcome them. Your health care team, including a registered dietician, needs to know about anything that is interfering with your ability to eat and drink, and they will work with you to solve these problems. It can't be stressed enough — but the best way to cope with dangerous weight loss if you have cancer is to head it off at the pass by doing everything possible to get the nutrition you need to remain as physically strong as possible. Your registered dietician will help you accomplish this.

You can also help yourself by being aware of the problems that may arise, and preparing to cope with them.

Several side effects common to people in cancer treatment are known to cause eating difficulties. Let's look at each of these.

Loss of appetite. This is one of the more common, and aggravating, side effects cancer patients experience. The causes can include other side effects, such as nausea and vomiting, which interfere with eating. Food may not taste the way it used to, and you may experience mouth discomfort as well.

It is, of course, important to eat anyway. Nutrition is essential to your recovery and quality of life — and cancer patients and health care providers have devised numerous strategies to help you cope. For more information, see Loss of Appetite.

Nausea and vomiting. For many cancer patients, the key to managing nausea and vomiting is to have the very best antiemetics (nausea-fighting medications) available today, and to take these medications before chemotherapy begins, as well as during it and sometimes afterward. Don't wait to see if you feel nauseous before taking these medications; they are meant to be taken in advance of the problem, when they can be most effective. A wait-and-see approach is not a good idea.

Newer medications, such as ondansetron (Zofran), granisetron (Kytril), and dolastron (Anzamet) can help the majority of people in cancer treatment conquer nausea. If you are not offered these medications by your health care team, request them. But they don't work for everyone — and if you are one of those people, you should plan to work closely with your health care team to plan strategies to manage nausea and vomiting. As with most medications, side effects are possible, such as headache, constipation and diarrhea. Ask your health care team about these and how best to manage them.

Factors other than chemotherapy can cause nausea and vomiting. To learn more, see Nausea and Vomiting.

Diarrhea is also a common side effect that can have a significant impact on your nutrition. Diarrhea that is not controlled will soon cause dehydration — meaning that your body will not have enough essential fluids and essential electrolytes like potassium, magnesium and sodium.

There are numerous causes for diarrhea — including diet — in people receiving treatment for cancer. What is very important, once the cause is identified, is to manage this condition quickly. You should report diarrhea at once to your health care team. For more information, please see Diarrhea.

Constipation is also a common side effect for some cancer patients. Causes include medications, treatments, diet, dehydration (insufficient fluids being consumed), the cancer itself and lack of physical activity. Consult with your health care team to identify the reasons for your constipation and to make a plan to help relieve the problem. Untreated constipation can cause serious problems. For detailed information on managing constipation, see Constipation.

Mouth sores, an occasional side effect of chemotherapy and radiation to the head and neck, can discourage anyone's interest in eating. Mouth sores can be a minor inconvenience that is easily treated, or much more serious. There are excellent ways to treat mouth sores, including diet management and other techniques for mouth care, as well as ways to relieve your pain. Let your health care team know at once if you have mouth pain. For more information, see Mouth Soreness.

Weight Loss

Sometimes, despite efforts to prevent it, cancer patients will begin to lose too much weight. This can be caused by the cancer itself, and by inability to eat enough food, due to side effects, to maintain body weight.

"Too much" weight loss is more than 4-5 percent of total body weight within a month. Significant weight loss leads to malnutrition — which, of course, makes it harder to cope with all aspects of your illness.

Significant weight loss is also called wasting, cancer anorexia or cancer cachexia. It is more than losing excess fat. Loss like this means loss of vital muscle tissue, and the sooner the problem is addressed, the better.

There are number of ways to get more calories and protein. Work with your dietician and health care team to determine what is best for you. Your physician may recommend medications to help stimulate your appetite, and there are other approaches as well, including:

1. Dietary Supplements. If you are able to eat and/or drink but are not able to get sufficient calories and protein from your food, dietary supplements can help. These are commercial products, usually sold in supermarkets and drugstores, that are packed with protein, vitamins, minerals, and calories. Many come in different forms, as well — liquids, powder (to be added to milk) and puddings. Most taste good to many people.
   
   These supplements should provide 9-12 grams of protein and 225-355
   calories per 8-ounce serving. Read labels carefully to make sure you are getting as much protein and calories as possible for the cost.
   
   If these taste too sweet to you, they can be diluted with other liquids, and it is also possible to buy unflavored supplements, to which you can add your own flavorings, such as fruit juices, and mix in a blender. There are also special supplements for people with diabetes and other health issues.
   
   If you don't enjoy these kinds of products, another approach is to purchase protein powder and add this to other foods, such as soup, casseroles, potatoes and oatmeal.
   
   Talk with your dietician about using supplements effectively, and for advice on which brand might work best for you.
   
   
2. Enteral Feedings. This term refers to the use of a tube to place food into person without the use of the mouth. These tactics are ways that people experiencing life-threatening difficulty in getting enough nutrition can live. It is one more approach to helping people maintain or increase their strength while fighting cancer.

There are several ways enteral feedings can be managed

• Nasogastric (NG) Tube — while you are mildly sedated, this thin tube is passed through your nose into your stomach. NG tubes are usually only used for a relatively short period of time. Once in place, this tube allows nutritional supplements to be given conveniently. Some people with NG tubes learn to manage the feeding process themselves, or with the help of a caregiver. Often patients with NG tubes can also eat and drink a bit. You can speak with an NG tube in place.
  
  
• "G" Tube — "G" stands for gastrostomy, and the term refers to a tube placed directly into the stomach. Patients can then be fed directly into the stomach through the tube. This tube can be placed in a outpatient procedure, called the PEG procedure (percutaneous endoscopic gastronstomy). Once in place, these tubes can be covered by clothing, and you are able to move about freely.
  
  
  • Sometimes PEG tubes are placed during the course of cancer surgery, if it is anticipated that a patient will have difficulty eating. If this is right for you, it should be discussed with you in advance of surgery.
    
    
  • An alternative to the "G" tube is a "J" tube — abbreviation for jejunostomy, a procedure that places a tube in the intestines, rather than the stomach, and is done if there is concern that a patient may not be able to hold fluid in the stomach without vomiting.
    
    
• Parenteral Nutrition- TPN
  TPN — which stands for total parenteral nutrition — is an approach to nourishing patients that can be used when eating is not sufficient or appropriate. This approach is often selected when a person's gastrointestinal track is not functioning.
  
  TPN is administered through a patient's vein. This is not the usual arm or hand vein, but rather a larger vein usually accessed through the chest wall, the vena cava. This is placed in a minor surgical procedure. A different vein can accessed in the usual way and used when TPN is expected to be needed for only a few days.
  
  The "food" is a liquid containing a very high concentration of protein, carbohydrates, vitamins, minerals and electrolytes that is delivered over the course of a day. This can be given at home as well as in a health care setting, once the route has been put in place.

Weight Gain

Some patients gain weight during the course of cancer treatment. There are a number of reasons, and two of the most common are retaining of fluid caused by medicines involved in your cancer treatment (edema), and an increased appetite (which can also be caused by some medicines, notably steroids).

If you're experiencing fluid retention, speak with your health care team about ways to help relieve the bloating and swelling. There are medications called diuretics that might prove helpful.

If steroid use can stop, a person's appetite usually returns to normal patterns.

Cancer experts urge people who have gained a little weight not to consider a strict weight loss diet of any kind. Instead, give consideration to altering what you are eating to reduce fats and carbohydrates, and increase lean meats and fish, for example. It will be important to maintain the amount of protein you are consuming, as this is critical to your ability to remain strong during treatment. Discuss your weight gain with your dietician, and develop an eating plan that prevents further gains.

Nutrition After Treatment Ends

It's a great sense of relief, for most people, when the final treatment for cancer is given, and it is time to resume "normal" life.

However, for most cancer survivors, the end of treatment will not mean an immediate return to full strength and energy. The aftermath of treatment can often mean lingering side effects and reduced energy.

Here are some steps to take to manage your post-treatment nutritional activities:

• Manage side effects. If you continue to experience side effects like weight loss, indifference to food, or food continues to taste bad, don't hesitate: contact your health care team for advice and assistance. Continuing weight loss is an issue of special concern.
  
  
• Consult a dietician. Arrange for a post-treatment consultation with a registered dietician used to working with cancer survivors, to discuss your post-treatment nutrition plan. Expert advice will be useful to you in making choices about what you eat.
  
  
• Reality check. Understand that there is no evidence that diet can prevent recurrence of your cancer. Eating well will help all of you feel better — body, mind, and spirit — but there is no magic diet to eat to ensure that your cancer will never return. Don't succumb to wild promises of the "anti-cancer guaranteed diet" or other wild claims you may hear.
  
  
• Eat well, following the best advice available. Registered dieticians and other health experts at the National Cancer Institute recommend:
  
  • Fruits and vegetables, cooked or raw, are a major source of antioxidant vitamins — and these are what help your cells repair themselves. Eat five or more servings every day, being sure to include citrus fruit, green and yellow vegetables.
    
    
  • Whole-grain breads and cereals are an excellent source of antioxidants, vitamins, complex carbohydrates and fiber. Consider adding a quarter cup of wheat germ to cereals and other foods for an excellent whole-grain boost every day.
    
    
  • NCI recommends going easy on fat, salt, sugar, alcohol and smoked or pickled foods, as well as using low-fat milk products. Also recommended is using lower-fat cooking methods such as broiling, steaming and poaching, as opposed to frying.
    
    
• If you continue to lack energy, and don't feel yourself gradually becoming stronger, you may have a low red blood cell level (hemoglobin and hematocrit). Have your health care team test for this. If your numbers are low, you should increase the protein in your diet, having a good source of protein at meals at least twice a day, with the goal of consuming at least eight ounces every day. Nutrition experts recommend consuming citrus at the same time as you eat protein, to boost the impact of the iron in the foods you eat. It usually takes several months before red blood count levels are increased, so some patience and diet consistency are needed.
  
  
• For recommendations for a healthy diet, consult materials produced by the US Department of Agriculture and the US Department of Health and Human Services. These are available at no cost on the Internet. See the section on Nutrition in the NCCS Resource Guide.

Questions to Ask Your Health Care Provider

1. Is my treatment likely to cause me difficulty in eating?
   
   
2. If I develop eating problems, how will these be managed?
   
   
3. How do I need to modify my diet to get enough calories and protein to stay strong?
   
   
4. I am having surgery. Will this have any impact on my ability to eat? If so, how will my nutrition needs be handled?
   
   
5. I would like a consultation with a registered dietician to advise me throughout the course of my treatment. Can you help arrange this?
   
   
6. Why do I need to eat more protein while I am being treated for cancer?
   
   
7. It sounds strange to be told I can eat anything I want. Won't eating a higher-fat diet than normal put me at risk for heart disease and other health problems?
   
   
8. I normally don't take vitamins. Should I start now? And if so, what should I take?
   
   
9. What happens if I can't get enough nourishment because I am having trouble eating?
   
   
10. If I receive nutritional supplements by tube, will I have to continue to eat this way forever?
    
    
11. I am gaining weight steadily. Can I go on a diet?
    
    
12. Now that treatment is over, I want to regain my energy and strength. What should I do to accomplish that? Can I receive some advice on my diet and supplements?

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