Managing Nausea with Diet During Chemotherapy

Nutrition plays a crucial role during cancer treatment, extending beyond simply obtaining sufficient calories and protein. The foods you choose can significantly influence how you cope with side effects like nausea, vomiting, and loss of appetite. Nausea is a frequent side effect of both chemotherapy and radiation therapy, stemming either from the treatment itself or the cancer. It's essential to remember that each individual's response to treatment varies, with side effects ranging from mild to severe, or even absent altogether.

Understanding Nausea and Its Triggers

Nausea and vomiting are very common among chemotherapy patients. Many anti-nausea medications are used to combat these symptoms but very rarely eliminate them altogether; up to 70% of patients taking these medications still experience nausea and vomiting during their treatment. Vomiting may follow nausea and be brought on by treatment or food odors. If vomiting is severe or lasts for more than a day or two, contact your doctor.

To effectively manage nausea, it's helpful to identify its triggers. Keeping a diary of when you feel nauseated, how long it lasts, what you ate, and where you were can provide valuable insights. Track your nausea by taking note of any particular food or events that trigger it. See if there is a pattern. This information can assist your healthcare provider in tailoring a management plan to alleviate your symptoms.

Dietary Strategies for Managing Nausea

Several dietary adjustments can help alleviate nausea associated with chemotherapy. Eating smaller meals more frequently can help reduce nausea and have a greater impact on patients’ nutrition compared to eating larger meals less often. Here are some practical tips to help with nausea:

• Eat Slowly and Frequently: Eat meals slowly. Eat small portions of food frequently. Having some food in your stomach may help you feel better.
• Choose Bland, Low-Fat Foods: Low-fat, bland and salty foods usually work best. Avoid greasy, fried and strongly spiced foods. Foods that are very fatty or greasy, fried, and overly sweet are not recommended for patients prone to nausea. Spicy foods should also be avoided for other chemotherapy- induced symptoms such as a sore mouth, tongue, or throat.
• Opt for Cool, Clear Beverages: Cool, clear beverages are recommended. Drink liquids between meals, rather than with meals. Slowly drink or sip liquids throughout the day - a straw may help. Other than water, cold or chilled liquids that are good to drink between meals include apple juice, sherbet, Jell-O and broth.
• Avoid Favorite Foods When Nauseated: Don't force yourself to eat your favorite foods when you feel nauseated, as you may develop a dislike for these foods.
• Rest After Meals: Stay quiet after meals. Try to rest while sitting up for about an hour - you can watch television, read a magazine, talk with a loved one or enjoy the company of your pet. Do not lie flat for at least two hours after eating.
• Keep Crackers at Bedside: Keep crackers at your bedside if nausea is a problem in the morning or after a nap. For morning nausea, try eating crackers or toast before you get up.
• Minimize Odors: Stay away from odors. Have someone else cook if possible. Eat in the dining room or in a room other than the kitchen. In addition to choosing foods that may be served colder or at room temperature compared to those served hot, areas where foods have been prepared should also be avoided. If the smell of food makes you nauseated, avoid hot foods and liquids.

Food temperature is important for patients prone to nausea and vomiting. When food is served hot, it usually emits stronger odors.

Read also: The Hoxsey Diet

Managing Vomiting

If vomiting occurs, it's crucial to manage it carefully to prevent dehydration and further discomfort. Here’s how:

• Hold Off on Food and Drink: Do not eat or drink anything until you have the vomiting under control. Wait for the vomiting to stop before eating or drinking anything.
• Start with Clear Liquids: Try tiny amounts of clear liquids such as water or bouillon, apple or cranberry juice, fruit ices without fruit pieces, ginger ale or 7-Up, plain gelatin desserts, popsicles, sports drinks such as Gatorade, vegetable broth and teas. Begin with 1 teaspoon every 10 minutes, gradually increasing the amount to 1 tablespoon every 20 minutes, and then try 2 tablespoons every 30 minutes or as tolerated. Sip liquids slowly throughout the day. Cold, clear liquids may be the easiest on your stomach.
• Advance to Softer Foods: Once these liquids are tolerated, try a softer diet with bland foods such as mashed potatoes, rice, pureed fruits, smoothies, fruit nectars, yogurts and cereals with milk or soy if you have problems with digesting milk.

Addressing Constipation and Diarrhea

Chemotherapy can also lead to constipation or diarrhea. Here’s how to manage these issues through diet:

Constipation

Chemotherapy, certain medications, or lack of exercise may cause constipation. Adding more fiber to your diet may help. Here are some easy ways to add fiber to your diet and to help constipation.

• Increase Fiber Intake: Include high-fiber foods - such as kidney beans, chickpeas, lentils, fresh fruit and vegetables and dried fruit - to your diet. Try to include some fiber in each of your meals. Start your day eating bran cereals or shredded wheat, or foods made with whole grains such as bulgur or wheat berries. Aim for a cereal with at least 5 grams of fiber per serving. Add unprocessed wheat bran to hot cereals and yogurt.
• Increase Fiber Gradually: If you're not used to eating a lot of fiber, slowly increase your intake, as you may initially have increased flatulence (gas) until your body gets used to more fiber in the diet. You can also reduce flatulence from eating beans by soaking beans first in water and discarding the water.
• Stay Hydrated: Drink plenty of liquids - eight to 10 glasses each day. A high-fiber diet requires plenty of fluids to work effectively.
• Reduce Caffeine: Reduce your caffeine intake, as caffeine may promote constipation by causing you to lose fluids.
• Incorporate Warm Beverages: Drink a hot, non-caffeinated beverage such as lemon water in the morning upon awakening.
• Stay Active: Add exercise to your daily routine.

Diarrhea

Diarrhea can have many causes, including chemotherapy, radiation therapy to the lower abdomen, malabsorption, or use of antibiotics. It can also develop because of intolerance to milk or difficulty in absorbing fats. If you experience weight loss from diarrhea, it may be due to dehydration, which means that your body does not have enough water. Speak with your health professional to try to determine the cause of the weight loss and obtain the proper treatment.

• Stay Hydrated: Drink plenty of room-temperature liquids to help prevent dehydration. These might include water, teas, Gatorade, ginger ale, peach or apricot nectar or fruit juices. Limit caffeinated beverages. Allow carbonated beverages to lose their fizz or stir them before you drink them.
• Consume Potassium-Rich Foods: Consume more potassium-rich foods such as orange juice, tomato juice, bananas and potatoes. Potassium-rich products include bananas, potatoes, orange juice, tomatoes and apricots.
• Follow the BRAT Diet: Try the BRAT diet, which consists of bananas, rice, applesauce, tea and toast. These types of foods are good for digestion and can alleviate other symptoms of chemotherapy such as diarrhea.
• Eat Small, Frequent Meals: Try frequent, small meals.
• Avoid Certain Foods: Avoid fried, greasy foods. Have spicy or highly seasoned foods only as tolerated. Cut down on high-fiber foods such as whole grains, bran cereals and vegetables. Try breads made from oat flour or refined flour without seeds or nuts. Avoid raw vegetables and the skins, seeds, and stringy fibers of unpeeled fruits. Avoid milk, ice cream and puddings for now since they can upset your stomach.
• Consider Probiotics: The use of probiotics, l-glutamine, and/or digestive enzymes may help to improve symptoms. Please discuss the use of these supplements with a dietitian to determine if these products are appropriate and which brands you may wish to choose.
• Manage Lactose Intolerance: If you are lactose intolerant, use dairy products sparingly. Instead of regular milk, try Lactaid, yogurt or soy milk.
• Resume Fiber Gradually: Resume your consumption of higher fiber foods, fruits and vegetables once the diarrhea stops (check with your dietitian and doctor first).

Boosting Appetite and Nutrient Intake

Problems such as pain, nausea, vomiting, diarrhea or a sore or dry mouth may make eating difficult and cause you to lose interest in eating. Depression, stress, and anxiety may also cause loss of appetite. If your appetite is no longer motivating you to eat, here are some suggestions to help ensure that you are getting the nutrition that you need. It is important during cancer treatment to get enough calories, protein, and nutrients. This may be especially hard if you have nausea and vomiting. If you find you can't get enough calories in a day, your healthcare provider may advise commercially prepared liquid nutritional products for a short time until you feel better.

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• Eat Small Meals and Snacks: Eat three small meals and three snacks per day, or whatever your daily pattern becomes.
• Choose High-Calorie Foods: Choose high-calorie foods at this time, such as avocados, nuts, seeds, puddings, cooked cereals, dried fruits and vegetables dipped in hummus or prepared with olive oil. Use additional olive oil in salads.
• Snack Between Meals: Snack between meals. Choose fruit smoothies, high-calorie puddings, shakes, high-calorie and protein drink supplements, sandwiches, avocados and nuts. Also, keep snacks by your bedside.
• Plan Ahead: Plan for special circumstances. If you have to miss or delay a meal for a test or therapy, bring a snack of nuts, dried fruit or cheese and crackers. Ask your dietitian if these foods fit into your medical diet. Plan your daily menu in advance. Make a shopping list of your favorite foods and beverages and have the food available. You may want to portion out snacks and keep them in the refrigerator in Ziploc bags so that they are readily available.
• Seek Assistance: Request help in preparing your meals. Friends and relatives are often happy to help with meal preparation. Some grocery stores have shopping services that may be accessed through your computer. You are very important - ask for help when you need it, and ideally before you anticipate that you will need it. Fix several portions of your favorite foods and freeze them. This can make it easier to decide what to eat when your appetite is poor or you do not feel like cooking.
• Make food visually appealing. Eye appeal is often the first step in eating. Attractive colors and garnishes such as parsley, lemon wedges, olives and cherry tomatoes help enliven the appetite.
• Appeal to your sense of smell. Tap into the sense of well-being that smells can stimulate, such as the smell of fresh bread baking. If, however, you find that you are overwhelmed by smells at this time, stay away from the kitchen, and have someone else prepare the cooking.
• Create a Pleasant Mealtime Atmosphere: Make your mealtimes pleasant. Your mealtime atmosphere is important to encourage eating. Set the table, perhaps adding candles, as well as wine, if permitted.

Managing Mouth and Throat Soreness

Soreness and tenderness in the mouth and throat are not uncommon. If your swallowing difficulties are minor, the following suggestions may help. You may need to work with a dietitian or swallowing therapist or consider alternative methods of feeding if you have severe problems. If you find it difficult to cook due to radiation therapy or chemotherapy side effects, consider calling organizations such as Project Open Hand or Meals on Wheels.

• Eat Small, Frequent Meals: Eat frequent small meals and snacks to ensure that you are getting enough calories.
• Choose Soft, Bland Foods: Choose cool, smooth and bland foods. Soft solids and liquids work best. Cut foods into bite-sized pieces or grind them so that less chewing is required. Choose soft foods or foods that can be cooked until tender such as mashed potatoes, sweet potatoes, winter squashes (butternut and acorn), carrots, applesauce, ground beef or turkey and tofu.
• Use Liquid Supplements: Consume liquid supplements such as Prosure, Ensure Plus, Boost Plus or shakes that can be made in your blender.
• Puree Foods: Consider using a blender to puree the foods your family is eating. When adding liquid to process the foods, remember to add high-calorie liquids - such as gravy, milk or soy milk, or broth - instead of water.
• Drink Nutritious Liquids: Drink generous amounts of nutritious liquids with meals.
• Be Adventurous: Be adventurous. Avoid red meats if they taste metallic.

The Role of Ginger

Ginger is an age old remedy to fight nausea. There are a number of ways to get ginger such as ginger candies, crystallized ginger, and ginger ale. Mayo Clinic discusses the evidence to support using ginger to battle nausea during chemotherapy, “There is evidence that when taken with standard anti-nausea medications, ginger may be helpful in further reducing or eliminating nausea and vomiting during and after chemotherapy treatments. Results from two studies of adults who took ginger for nausea showed that various doses of ginger before starting chemotherapy treatments helped to reduce the severity of nausea. In these studies, participants began taking ginger orally three days prior to starting chemotherapy. A statistically significant very large positive effect of ginger tea consumption was also found on overall CINV severity; however, certainty in this effect was very low.

Additional Therapies

Taking medicine is the main part of managing nausea and vomiting. You may not feel like eating or drinking when you have nausea and vomiting. But try to drink as much fluid as you can so that you don’t get dehydrated. And eat enough so that your stomach isn’t too empty. Complementary and integrative treatments may be used alone for mild nausea or anticipatory nausea and vomiting. If you’d like to try one or more of these methods, ask your cancer care team if the methods are safe for you. Studies have found that some integrative methods can be helpful for nausea and vomiting.

• Acupuncture: Acupuncture is a traditional Chinese method in which very thin needles are put into the skin at certain points of the body. Some people have reported that acupuncture helped with their nausea. Acupuncture should only be done by a licensed, certified acupuncturist. Ask your cancer care team if it is safe for you to get acupuncture.
• Acupressure: Based on acupuncture, acupressure uses pressure rather than needles on certain points on the body. Acupressure on certain points on the body has helped some people with nausea.
• Aromatherapy: Some people find using aromatherapy with peppermint oil helpful in lowering their nausea and vomiting from cancer treatment. The oil can be inhaled, rubbed on the skin, or put on a cold cloth that is placed on the head.
• Music Therapy: Music therapists are trained to use music to help people with symptoms, such as nausea and vomiting.
• Biofeedback: Biofeedback is sometimes used to support relaxation techniques for nausea and vomiting.
• Hypnosis: Hypnosis creates a state of intense attention, willingness, and readiness to accept an idea.

The Importance of Professional Guidance

There is more to nutrition during cancer and cancer therapy than getting enough calories and protein. Be sure to talk with your cancer care team about possible side effects before the treatment begins. Talk with your healthcare provider about taking antinausea medicines at least an hour before eating. Be sure to tell your healthcare provider or registered dietitian if you have nausea or vomiting. There are a number of different things they may advise for you. Improved CINV was associated with CINV-specific nutrition education and support from health professionals.

Read also: Weight Loss with Low-FODMAP

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