Radiation Diarrhea: Dietary Guidelines for Management

Radiation therapy, while effective in destroying cancer cells, can sometimes damage healthy cells in the lining of the intestines, leading to radiation enteritis. This condition can cause a range of gastrointestinal symptoms, with diarrhea being a prominent one. Effective management often involves dietary modifications to minimize discomfort and promote healing. This article provides comprehensive dietary guidelines to help manage radiation-induced diarrhea, drawing upon available research and expert recommendations.

Understanding Radiation Enteritis and Diarrhea

Radiation enteritis occurs when radiation therapy, particularly when directed at the abdomen or pelvic area, injures the intestinal lining. People with cancers of the cervix, pancreas, prostate, uterus, colon, or rectum are at higher risk. The severity of symptoms can vary, influenced by factors such as concurrent chemotherapy, radiation dosage, and the extent of the intestinal area exposed.

Symptoms of radiation enteritis can manifest during, shortly after, or even long after treatment. Changes in bowel movements, including bleeding or mucus from the rectum, diarrhea, and rectal pain, are common. Other symptoms include loss of appetite, nausea, and vomiting. While most symptoms improve within a few months after treatment, some individuals may experience chronic, long-term issues like abdominal pain, bloody diarrhea, greasy stools, and weight loss.

General Dietary Principles During Radiation Therapy

During radiation therapy, maintaining a proper diet is crucial for supporting the body's immune system and promoting tissue regrowth. Shayna Komar, a registered dietician specializing in oncology, emphasizes that food is an integral part of medical treatment during cancer therapy, helping to decrease side effects and support the patient's immune system. Calorie and protein needs often increase to maintain weight and energy levels. Vanessa Lara, a dietician with a background in cancer biochemistry, recommends that patients aim to consume 25 to 35 calories per kilogram of body weight.

Key Dietary Components

1. Protein: Essential for maintaining muscle mass and supporting a healthy immune system. Komar stresses that protein is the most important food group during radiation. Include lean meats, poultry, fish, eggs, Greek yogurt, beans, soy products, and unsalted nuts and seeds.
2. Vitamins and Minerals: Vital for strengthening the immune system and aiding tissue repair. Discuss with your doctor whether vitamin supplements are necessary.
3. Complex Carbohydrates: Provide an energy boost. Obtain these from healthy sources like fruits, vegetables, and whole grains.
4. Healthy Fats: Help lower inflammation and support immune function. Choose unsaturated fats from sources like fish, avocados, and olive oil.

Adapting to Side Effects

Radiation therapy can alter how the body processes food and nutrients. It's important to pay attention to side effects and adjust the diet accordingly.

Read also: Eating During Radiation

• Softer Foods: If radiation is directed towards the mouth or throat, irritation and mouth sores may occur. Opt for softer foods that are easier to swallow.
• Bloating and Diarrhea: Adjust the diet to avoid gas-producing foods. A low-residue diet, consisting of lower fiber, soft, mostly cooked foods without added spices, is often recommended.

Specific Dietary Recommendations for Radiation Diarrhea

When radiation therapy leads to diarrhea, specific dietary adjustments can help manage symptoms and improve comfort.

Foods to Avoid

Certain foods can exacerbate diarrhea and should be avoided:

• Alcohol and Tobacco: These can irritate the digestive system.
• Almost All Milk Products: Lactose intolerance can worsen diarrhea. Consider lactose-free alternatives or lactase supplements.
• Coffee, Tea, Chocolate, and Sodas with Caffeine: Caffeine can stimulate bowel movements.
• Foods Containing Whole Bran: High in insoluble fiber, which can worsen diarrhea.
• Fresh and Dried Fruits: These can be high in fiber and sugars that may aggravate diarrhea.
• Fried, Greasy, or Fatty Foods: Difficult to digest and can increase bowel movements.
• Nuts and Seeds: High in fiber and fat, which can be difficult to digest.
• Popcorn, Potato Chips, and Pretzels: Often high in fat and salt, and low in nutritional value.
• Raw Vegetables: Can be difficult to digest and high in fiber.
• Rich Pastries and Baked Goods: High in fat and sugar, which can worsen diarrhea.
• Some Fruit Juices: High in sugar, which can draw water into the bowel and worsen diarrhea.
• Spicy Foods: Can irritate the digestive system.

Foods to Include

Focus on foods that are gentle on the digestive system and can help firm up stools:

• Apple or Grape Juice: Low in fiber and easy to digest.
• Applesauce, Peeled Apples, and Bananas: Part of the BRAT diet (bananas, rice, applesauce, toast), which is often recommended for diarrhea.
• Eggs, Buttermilk, and Yogurt: Good sources of protein; yogurt with live cultures can help restore gut flora.
• Fish, Poultry, and Meat (Broiled or Roasted): Lean protein sources that are easy to digest.
• Mild, Cooked Vegetables: Asparagus tips, green or black beans, carrots, spinach, and squash are good choices.
• Potatoes (Baked, Boiled, or Mashed): Easy to digest and provide carbohydrates.
• Processed Cheeses: Such as American cheese, which are generally lower in lactose.
• Smooth Peanut Butter: A good source of protein and calories.
• White Bread, Macaroni, or Noodles: Low in fiber and easy to digest.

The BRAT Diet

The BRAT diet, consisting of bananas, rice, applesauce, and toast, is frequently recommended for individuals experiencing diarrhea. These foods are gentle on the stomach, and their low fiber content can help firm up stools.

Additional Tips to Improve Eating Behavior

• Drink Plenty of Fluids: Aim for up to 12 8-ounce (240 milliliter) glasses every day to replace fluids lost through diarrhea. Water, sports drinks, and bouillon are good options.
• Eat Small, Frequent Meals: This can be easier to tolerate than large meals.
• Eat Foods at Room Temperature: Extreme temperatures can sometimes exacerbate symptoms.

The Role of Fiber

Starting a low-fiber diet on the first day of radiation treatment may help prevent problems. Fiber is the part of fruits, vegetables, beans, legumes, nuts, and grains that the body does not digest. A low-fiber diet limits the amount of undigested food moving through the digestive tract, reducing stool production and slowing its passage.

Read also: Troubleshooting Carnivore Diet Diarrhea

Foods to Choose

• Refined Grains: White bread, white rice, and pasta made with refined flour.
• Cooked Vegetables: Asparagus, green beans, and summer squash (peeled, seeded, and cooked until soft).
• Canned or Cooked Fruits: Without skin or seeds.
• Fruit Juices: Without pulp.

Foods to Avoid

• Raw Fruits and Vegetables: These are higher in fiber and more difficult to digest.
• Whole Wheat and Whole Grain Products: These are high in insoluble fiber.
• Nuts and Seeds: These are high in fiber and fat.
• Dried Fruits: These are concentrated sources of fiber.

Hydration

Adequate hydration is crucial during radiation therapy, especially when diarrhea is present. Aim for 3-4 quarts of liquid every day. Good hydration helps flush toxins out of the body and reduces treatment side effects such as nausea, weakness, bowel changes, and fatigue.

Good Hydration Sources

• Water
• Low-acid juices (apricot, peach, or pear nectars)
• Jello
• Pudding
• Popsicles

Be cautious of the sugar content in juices and other sweetened beverages.

Medical Interventions

In addition to dietary modifications, your healthcare provider may prescribe medications to help manage diarrhea and other symptoms:

• Loperamide: Helps decrease diarrhea.
• Pain Medicines: To manage discomfort.
• Steroid Foam: Coats the lining of the rectum to reduce inflammation.
• Special Enzymes: Replace enzymes from the pancreas.
• Oral 5-Aminosalicylates or Metronidazole: Reduce inflammation.
• Rectal Installation: With hydrocortisone, sucralfate, or 5-aminosalicylates.

In some cases, your provider may choose to decrease your radiation dose for a short period of time.

Research on Dietary Interventions

Recent studies have explored the role of dietary interventions in mitigating the side effects of radiation therapy. A systematic review of 16 articles, including 1567 patients, examined the acceptability, feasibility, and impact of dietary interventions on patient-reported outcomes and toxicities related to radiation therapy.

Read also: Guidelines for Puppy Diarrhea Diet

Key Findings

• Acceptability and Feasibility: The majority of patients approached regarding dietary interventions accepted and completed the prescribed diet and radiation therapy course.
• High-Fiber Diets: May improve diarrhea in patients with pelvic cancers.
• Enteral Nutrition Formulas: Formulas with proteins such as L-arginine, lipids such as eicosapentaenoic acids, glucids, and ribonucleotides may help prevent malnutrition in head and neck cancer patients undergoing radiation therapy.
• Vitamin C and β-Carotene: May reduce xerostomia (dry mouth) in head and neck cancer patients, although caution is advised due to studies suggesting vitamin E can increase all-cause mortality.

Specific Dietary Interventions

• Antioxidant Supplementation: Some studies show improved quality of life and reduced xerostomia with antioxidant supplementation, while others show no significant improvements and potential risks (e.g., increased mortality with vitamin E).
• Amino Acid Supplementation: May decrease the severity of dermatitis and improve weight loss when combined with omega-3 fatty acids.
• Fiber Intake: High-fiber diets may decrease GI toxicity in patients with mixed pelvic cancers immediately after radiation therapy, while low-fiber intake may have no long-term impact.

Recipes

Belly-Soothing Banana Smoothie

• Ingredients: 1 cup water, 1 cup frozen bananas, 1 tbsp honey, ½ tsp vanilla powder, ½ tsp cinnamon, Pinch of salt
• Instructions: Place all ingredients in a blender, process until smooth and creamy.

Pineapple Ginger Smoothie

• Ingredients: 1 frozen banana, 1 cup fresh pineapple, ½ cup 2% or nonfat plain Greek yogurt, ¼ cup unsweetened almond milk, ½ tsp fresh grated ginger or ¼ tsp ground ginger, ½ tsp ground turmeric, 2 tsp honey
• Instructions: Place all ingredients in a blender, process until smooth and creamy.

Congee Soup (Chinese Rice Soup)

• Ingredients: ¾ cup white or sushi rice, 2 ½ cups chicken or vegetable broth, Salt to taste
• Instructions: Combine rice and broth in a pot and bring to a boil. Lower the heat and half cover the pot. Cook at a slight boil. Stir every so often and scrape the bottom of the pot to prevent rice from sticking. Simmer 1 ½ to 2 hours until the grains burst and become thick (oatmeal consistency). Season with salt to taste. Can flavor as desired, e.g., ginger, soy sauce, or sesame oil.

Sample Menu

This is a sample meal plan to follow if you have diarrhea:

• Breakfast: Cream of Wheat with mashed banana
• Lunch: Grilled chicken breast with white rice and cooked carrots
• Dinner: Baked fish with mashed potatoes and cooked green beans
• Snacks: Applesauce, yogurt, crackers

When to Contact Your Healthcare Provider

Contact your provider if you are undergoing radiation therapy or have had it in the past and are experiencing significant diarrhea or stomach pain and cramping.

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