Eating well when you don't feel well

It can be difficult to eat enough during cancer treatment – here's why

Cancer and cancer treatment can affect your calorie needs. Often, this means someone with cancer will need to eat more than someone who doesn’t have cancer, Rodgers says. But cancer and its treatments may also cause side effects that make it challenging to meet those increased needs. These include:

• Appetite changes
• Ascites, or fluid buildup in the abdomen
• Bowel changes, such as constipation or diarrhea
• Difficulty chewing
• Difficulty opening the mouth
• Dry mouth
• Mental health challenges, including depression or anxiety
• Mouth sores
• Nausea
• Taste and smell changes
• Trouble swallowing

Why it’s still important to eat when you don’t have an appetite

Wondering why dietitians recommend eating even when you don’t have an appetite?

“Our main source of energy comes from the food we eat,” Rosemond explains.

Keeping your weight and muscle mass stable during cancer treatment helps you maintain the strength, balance and coordination you need to continue your normal day-to-day activities, Coleman says.

Sometimes, a brief illness makes it difficult to eat for a few days. Once you feel better, you can eat normally again. But when you don’t feel well for a longer time, not eating enough can become a bigger problem. As days pass and your calorie and nutrient intake remains low, you can enter a stage that he calls ‘prolonged starvation.’ This is when unintentional weight and lean muscle mass loss can occur, which can lead to problems.

When your body doesn’t get energy from food, its “only choice is to make energy out of stuff in your body,” Rodgers says. This can mean your body uses its own stores of sugar, fat, protein and lean muscle mass for energy.

Lean muscle mass plays an important role in recovery during cancer treatment. Cancer patients who lose lean muscle mass and weight may face treatment delays and have worse outcomes, Rodgers says.

How to eat well when you don’t feel well

Here are nine ways our experts suggest approaching food and getting the nutrients your body needs, even on days you aren’t feeling your best.

Think of food as fuel

When you don’t feel well, eating can feel less pleasurable. This might require you to change the way you think about food, Rodgers says.

“It’s kind of like a car: if you don't put gas in a car, the car won't go,” she says. “So, we need to think about it as fuel. How do we fuel our bodies to make them strong, have more energy and improve our quality of life?”

Manage side effects

Often, one of the first ways MD Anderson clinical dietitians help patients with cancer meet their nutritional needs is by treating or managing side effects. This will look different for each patient and may require combining multiple strategies. Here, our experts share examples of tips they might give for specific side effects.

If you have altered taste:

• Choose soft or moist foods to lessen how long the flavor lasts.
• Drink beverages using a straw.
• If foods taste salty, balance it out by adding sweetness.
• If foods taste metallic, use plastic or wood utensils instead of metal silverware.

If you have mouth sores or trouble chewing:

• Choose soft foods.
• Try drinkable options such as smoothies and shakes.

If you are feeling nauseous:

• Take anti-nausea medications.
• Avoid greasy, fatty options.

If you are constipated:

• Make sure you are drinking enough.
• Choose foods with more fiber.

Eat frequent meals

Dividing your calories neatly among breakfast, lunch and dinner isn’t always realistic when you don’t feel well. For example, only eating at mealtimes could mean you’re eating less than your body needs. You may also have side effects that make it hard to eat too much at a time. That’s why our experts recommend eating small meals throughout the day.

“When there’s a large plate of food and you don’t want to eat, that can cause an aversion sometimes,” Rosemond notes. Instead, she suggests small snacks and meals such as:

• An oral nutrition shake
• Fruit and yogurt
• Crackers with nut butter or hummus
• A peanut butter and jelly sandwich
• Hard-boiled eggs
• Cheese cubes
• Trail mix
• A bagel with cream cheese

If you’re struggling to remember to eat, set a timer on your phone. This might look like eating something every 2 or 3 hours that you’re awake, Coleman suggests.

Eat what you can

When you’re not feeling well for a long period of time, eating something is more important than eating healthy, Rosemond says.

“I don't want to cause any additional restrictions on what someone can eat when they're not feeling well,” she says.

During treatment, you may be told “eat what you can,” Coleman says. This is because the effects of muscle loss during cancer treatment can be more harmful than eating an unbalanced diet for a while. “Do we want patients to follow a well-balanced or healthy diet? Absolutely. That would be fantastic, but not necessarily at the cost of getting adequate nutrition.”

Make every bite count

Coleman’s mantra for eating when you don’t feel well? Make every bite count. This means choosing nutrient-dense foods that are higher in calories and protein.

Some easy ways he suggests adding calories to your meals include:

• Adding dried fruit or crushed nuts or seeds to hot cereal
• Stirring sour cream or cheese into mashed potatoes
• Dipping a banana or apple in nut butter

Rodgers encourages people in cancer treatment to add a protein source every time they eat. This helps with energy levels and muscle mass.

One quick option for boosting your calorie intake that doesn’t take much prep? Prepackaged oral nutrition shakes. These grab-and-go options are an easy way to get calories even when you don’t have much energy.

Do light activity

Sometimes, moving your body can queue hunger cues.

Staying active when you don’t feel your best can be just as challenging as eating well when you don’t feel your best. But physical activity doesn’t always mean a sweaty HIIT workout. Instead, it might mean taking a short walk, getting dressed or doing a household task.

Create a mealtime routine

While eating during cancer treatment can be challenging, you don’t have to give up the comfort, structure and company of mealtime. One small way to add a bit of normalcy? Join your family or friends at the table, even if you don’t end up eating the same dishes.

“Staying active or being in an area or place that makes you feel good can help stimulate your appetite,” Rosemond says.

Make mealtime simple

Cooking and meal prep can be a challenge even on days when you’re feeling your best. When you aren’t feeling well, your priority might go from preparing something gourmet to simply getting meal prep out of the way. Our experts have tips for that, too. Here are their suggestions.

• Meal prep before starting treatment. Store meals in the freezer and heat them up when you don’t feel up for cooking.
• Cut down on dishes by preparing one-pot or sheet pan meals. This might mean using a slow cooker or pressure cooker.
• Make large meals, so you have leftovers.
• Buy prepared meals from the grocery store.
• Stock up on ingredients for simple snacks and meals.
• Order meal delivery services or sign up to receive volunteer meal delivery.

Still struggling? Let your care team know.

While you may have to encourage yourself to eat during treatment, you shouldn’t feel like you’re forcing yourself to eat. Eating more than you can tolerate can make side effects like nausea worse, Coleman says.

If you are having trouble eating during treatment, talk to your care team. They may prescribe IV fluids or medications to help you manage your side effects, Rodgers notes. MD Anderson patients can also request to see a registered dietitian for personalized nutrition advice.

“I’ll say to patients, ‘Let's try to make it a little bit easier,’ Rodgers says. “I can't make it totally easy for you, but we can make it easier.”

Request an appointment at MD Anderson online or call 1-877-632-6789.