What and how to eat during and after chemotherapy?

Author: Sandra Krstev Barać, Master of Nutrition

A varied diet that provides enough energy and protein is extremely important for cancer patients. A well-established nutritional foundation can help patients maintain strength and body mass, speed up recovery, and improve their quality of life. However, realistically, eating in general can become a real challenge during (chemo)therapy, let alone adhering to the postulates of nutrition for cancer patients. The task is even more difficult if serious side effects of chemotherapy occur.

With wise planning and some liberalization of the diet, it is possible to facilitate the entire process and speed up recovery after therapy. However, it should be emphasized that in cases where diet alone is not enough to maintain a state of nutrition, oral replacement preparations come to the rescue as a concentrated source of nutrients, which are prescribed by a doctor as needed.

What to eat before chemotherapy?

Light food divided into several smaller meals has proven to be the best dietary choice on the day of chemotherapy. It is also advisable to avoid spicy foods and meals high in fat, so it is best to choose snacks such as:

· Yogurt

· Fruit and cheese (but not with noble molds!)

· Chicken soup with boiled rice

· Toast with poached egg

· Crackers with a little almond butter

Many patients tend to fast for a few days before and after the therapy itself. The reason lies partly in the lack of appetite, but it is also largely due to the fact that fasting has been promoted in online communities as a way to reduce the "toxicity" of the therapy itself. Despite the popularity of this practice, clinical studies confirming the safety and effectiveness of fasting with chemotherapy, although promising, are still in their infancy. Many questions on this topic still have no answers, so the professional opinion is that at this time, we cannot recommend fasting with therapy, especially in already malnourished patients.

Nutrition in the days after chemotherapy

During this period, despite possible side effects, it is important to eat regularly and choose foods that provide enough calories and especially protein to help recovery. Many patients, if side effects such as changes in taste or appetite occur, will first eliminate protein foods, which, from a nutritional perspective, is a big mistake. Realize how important they are and when it is time to eat, first eat a few bites of protein-rich foods, and only then the rest. This way, even if you get full quickly and can't eat anymore, you will eat at least a little of that important protein.

Here are a few examples of practical and quick sources of protein:

· Canned tuna or sardines

· Hard-boiled eggs

· Nuts and seeds, and their butters

· Hummus

· Canned beans

· Greek yogurt

· Protein powder as an addition to soups, smoothies, mashed potatoes, etc

In the days following chemotherapy, your body not only needs plenty of protein, but also calories, so this is not the time to abstain from fat. Add olive oil, avocado, seeds, ghee, butter, and cheese to your meals to increase the energy value of your meals. This is also the time when a shake based on whole milk is completely justified in your diet. Once the critical period has passed, you can slowly return to a diet with plenty of fruits, vegetables, lean sources of protein, and healthy fats.

It is extremely important during this period to regularly consume enough fluids to prevent dehydration and eliminate the byproducts of chemotherapy - water is the best choice, but you can also reach for apple juice, clear bone broths, herbal teas, especially ginger and mint tea. Drink fluids between meals, not during them, as they can fill you up and thus reduce the intake of food necessary for recovery.

Outsmart lack of appetite and other side effects

For some people, chemotherapy can significantly suppress their appetite, to the point that they feel sick just thinking about food. If this is your problem, try light exercise, such as walking before meals. Distraction can also help - eat with friends or watch TV. Also, eat by the clock, not when you feel hungry, this is the period when you need to see food as therapy - something that is necessary for recovery.

It will certainly be easier for you to eat more frequent, smaller meals, so forget about the concept of 3 main meals and aim for 5-6 smaller meals spread out throughout the day. Choose cold or chilled dishes - this way you will probably eat more, because the smells and aromas will be milder, and will irritate you less, especially if you are nauseous.

In addition to a lack of appetite and changes in taste and smell, chemotherapy can be accompanied by numerous other side effects such as: nausea and vomiting, constipation, diarrhea, dry mouth, difficulty chewing and swallowing. It is neither wise nor necessary to endure side effects. Consult with a nutritionist and doctor on how to mitigate the side effects through dietary modifications and, if necessary, medication for a faster and better recovery.

What to avoid during chemotherapy?

Although the literature does not provide much insight into this topic, many experts advise that it is advisable to avoid grapefruit and grapefruit juice during chemotherapy due to potential interactions with chemotherapeutic drugs. The same applies to medicinal herbs such as echinacea, ginseng, silymarin, St. John's wort and garlic, which is why it is always necessary to consult a professional before resorting to dietary supplements.

Finally, while you are undergoing chemotherapy, you must pay special attention to ensuring that the food you eat is healthy. Be sure to cook your food thoroughly and avoid unpasteurized dairy products, cheeses with noble molds, raw fish and foods containing raw eggs. You can store leftovers in the refrigerator for 2-3 days and reheat only once.

References:

· Leser M., Ledesma N., Bergerson S., Trujillo E. Oncology Nutrition for Clinical Practice. 1st ed. Chicago: Academy of Nutrition and Dietetics, 2013.

· Plotti F, Terranova C, Luvero D, Bartolone M, Messina G, Feole L, Cianci S, Scaletta G, Marchetti C, Di Donato V, Fagotti A, Scambia G, Benedetti Panici P, Angioli R. Diet and Chemotherapy: The Effects of Fasting and Ketogenic Diet on Cancer Treatment. Chemotherapy. 2020;65(3-4):77-84.

· de Groot S, Pijl H, van der Hoeven JJM, Kroep JR. Effects of short-term fasting on cancer treatment. J Exp Clin Cancer Res. 2019 May 22;38(1):209.

· Fasinu PS, Rapp GK. Herbal Interaction With Chemotherapeutic Drugs-A Focus on Clinically Significant Findings. Front Oncol. 2019;9:1356.