A good diet is especially important during any illness because the body requires nutrients to both fight the disease and to heal from the disease and treatments. However, maintaining healthy eating habits is often difficult for people with lymphoma. Many patients don’t feel like eating for a variety of reasons, such as the side effects of the treatments, emotional factors including depression and anxiety, or the chemical changes that cancer itself can cause. Nutritional services may be available and helpful if you are having trouble eating and maintaining your weight.

Nutritional Concerns with Cancer Treatments

Chemotherapy, radiation, surgery and immunotherapy are powerful tools designed to kill cancer cells, but they can also affect normal, healthy cells and cause conditions that may result in nutritional problems.

Surgery may lessen the ability of the mouth, throat and stomach to work properly, make these areas sore, and slow digestion. Radiation therapy can cause mucositis, diarrhea, nausea and vomiting, and affect the body’s ability to absorb nutrients. The effects of chemotherapy on nutrition will depend on the type of drug, dosage, duration of treatment, rates of excretion and individual factors. Chemotherapy can cause diarrhea, nausea and vomiting, loss of appetite, changes in the way food tastes and smells, sore mouth and throat, and constipation.

Nutritional Support

There are many nutritional products that can be used to supplement reduced food intake, such as high-calorie and/or high-protein liquid preparations. These products can be used along with regular meals, in between meals or instead of meals. In addition, drinking protein-fortified beverages or adding one-quarter to one-third cup of non-fat dry milk to one-cup fluid milk can increase protein and calories. Some patients have lactose intolerance, or difficulty in digesting or absorbing the milk sugar called lactose, following chemotherapy or abdominal radiation. Symptoms may include bloating, cramping or gas several hours after eating milk products. Adding an enzyme (available in tablets or liquid drops) to break down the lactose or using lactose-reduced dairy products may make it possible to use milk and other dairy products, which are an excellent source of calories and protein.

Tips to Save Time and Energy

• Let someone else do the cooking when possible. Don’t be shy about accepting gifts of food and offers of help from friends and family.
• Have as few dishes, pots and pans to wash as possible. Save time with cleaning up by using paper cups and napkins, and disposable dishes and pans.
• Cook larger batches of food to freeze for future use.
• Use shopping lists so you can shop more quickly or have someone else do it for you.
• Use mixes, frozen ready-to-eat main meals and take-out foods.

Coping with Side Effects that Affect Eating

Chewing and Swallowing Difficulties, Dry Mouth or Mouth Sores

• Food and liquids should be warm or room temperature, rather than very hot or cold.
• Avoid greasy, fatty or fried foods and strong spices.
• Limit foods and beverages that contain caffeine, such as coffee, strong tea, chocolate and some sodas.

For severe diarrhea restrict the diet to clear, warm liquids such as broth, flat ginger ale or apple juice for one day. Check with your doctor if it persists more than one day.

Loss of Appetite

If you aren’t hungry at dinnertime, make breakfast or lunch your main meal. Similarly, if you aren’t hungry first thing in the morning, eat more later in the day.

• Eat more frequently, but smaller amounts of food.
• Keep snacks readily available.
• Experiment with tastes.
• Increase the caloric intake of foods you do eat with a small amount of olive oil.

Try some of the commercially prepared food supplements, such as Ensure or Sustecal. Add fresh berries or juice for variety.

Nausea and/or Vomiting

• Eat and drink slowly.
• Try beverages such as peppermint tea, ginger ale or ginger tea.
• Eat small, frequent meals.
• Avoid greasy, fatty, fried, spicy and very sweet foods.
• Rest after meals.
• Eat crackers, toast, soft or bland fruits and vegetables, oatmeal, clear liquids and ice.
• Eat foods prepared with moist heat, such as soups, stews and casseroles.
• Add gravy, sauces, butter and salad dressings to make food easier to swallow.
• Use soft and pureed foods that are easier to swallow.
• Avoid highly seasoned, spicy, tart or acidic foods (no citrus foods or tomatoes).
• Avoid alcohol and smoking.
• Cold foods may be soothing if you have mouth sores.
• Keep your caloric intake high by using meal replacement type drinks,such as Ensure.
• Keep your lips moist with lip salves.
• Suck on sugar-free, hard candy or popsicles or chew gum to produce more saliva.
• For mouth sores, gargle with 1 teaspoon of table salt or baking soda added to 1 cup of warm water.
• Sucking on ice cubes or ice chips 10 minutes prior to getting chemotherapy through to 15 minutes afterward can sometimes prevent mouth sores.
• If cooking odors make you feel nauseated, try microwaving. Use a strong venting fan while you are cooking. Try frozen or chilled foods as they give off fewer odors.

Ask your physician about antiemetics, which are medications that can control nausea and vomiting.

Constipation

• Drink plenty of fluids – at least eight 8-ounce cups a day.
• Eat high-fiber foods, such as whole-grain breads and cereals, fresh and dried fruits, raw vegetables, dried beans and peas.
• Walk or do some form of physical exercise every day.
• Drink prune juice or take a stool softener with psillium fiber to help maintain regularity.
• Warm or hot fluids (tea, coffee, or soup) can help stimulate the bowel.

Dental Problems (Teeth and Gums)

• See your dentist regularly.
• Use a soft toothbrush and special toothpaste if your gums are sore.
• For sore gums, rinse your mouth with warm water.
• Avoid eating foods that stick to the teeth, such as dried fruits and caramels.
• Limit the amount of sugar in your diet.

Diarrhea

• Avoid high-fiber foods that contain roughage, such as whole wheat breads, raw fruits and vegetables, and dried beans.
• Eat low-fiber, nutritious foods, such as yogurt, cottage cheese, smooth peanut butter, ripe bananas, white bread, applesauce.
• Don’t drink with your meals, but drink plenty of water between.
• Eat foods and liquids high in salt and potassium (minerals often lost during diarrhea) such as bouillon, bananas, mashed potatoes and apricot nectar.
• Eat frequent, small snack type meals, rather than three large ones.
• Make up for lost calories when you feel more comfortable.

References

1. Katsen, Carolyn. The Nutrition Handbook (available online at www.cancernutrition.com)
2. National Cancer Institute. Eating Hints for Cancer Patients (brochure available by calling 1-800-4-CANCER)