Healthy Nutrition and Cancer Care: Part Two

A nutritious diet can benefit cancer patients and survivors in countless ways, including increasing energy, minimizing uncomfortable side effects and promoting a greater quality of life. However, it can be challenging for cancer patients and survivors to learn what is truly most nutritious for their specific condition and goals.

During a recent episode of the Weill Cornell Medicine CancerCast podcast, two registered dieticians with certifications in cancer nutrition share their expertise about diet and nutrition during cancer and after treatment. Emily Buchholtz, RD, CDN, CSO and Stephanie Roit, MS, RD, CDN, CSO are both registered oncology dietitians at Weill Cornell Medicine and NewYork-Presbyterian Hospital.

Be sure to read part one of this series.

Is it okay to drink alcohol during or after cancer treatment?

Many patients ask if they can drink alcohol. “When you're going through treatment, if you're having side effects, it's usually best to avoid alcohol,” asserted Roit. “We say moderation when possible, and also making sure you're not currently taking any medications where alcohol might be a contraindication for that.”

What are some healthful strategies to manage weight gain or loss during treatment?

During cancer treatment, many patients experience a lot of changes in hormones and their metabolism, on top of coping with the stresses involved with their condition and treatment. For many, this can lead to weight gain.

“What I do in working with those patients is I try to touch base with them monthly at least, and just really try to make sure that they are still eating well despite these things that are happening in their bodies,” Buchholtz shared. “For example, I'll coach people on really making sure they have protein at every meal, which is going to be lower in calories, but help with satiety and help keep people full. I also promote choosing a lot of non-starchy vegetables that are packed with fiber that are also going to help keep people full.”

Buchholtz also recommended exercise during treatment in whatever capacity possible. “It is so important not only for weight maintenance, but it helps build muscle mass,” she explained. “It helps keep us strong through treatment. It helps with fatigue. It helps with our mental sanity. So, I always try to push all of my patients to do whatever exercise they can.”

Other cancer patients experience weight loss, which has been shown to exacerbate uncomfortable side effects and make it challenging for patients to tolerate their treatment regimen. Roit shared that instead of focusing on the number on the scale, patients should focus on their muscle tone and mass. She recommended eating smaller meals and snacks throughout the day that include protein. For those that feel full very easily, smoothies or other higher-calorie liquids with dense nutrition are smart options.

How can cancer patients minimize changes in taste?

“Taste changes can be really distressing for people,” Roit said. “Their normal foods suddenly don’t taste good … The bitter taste can be really common.”

Since many cancer treatment medications cause dry mouth, Roit recommended taking good care of your mouth and considering rinsing the mouth with water, baking soda and salt throughout the day. “Keeping your mouth clean and having saliva flow is really going to help enhance your taste of food,” she encouraged. Dry mouth can also be treated with over-the-counter lozenges, sprays and rinses.

Roit also encouraged adding healthy flavors to food. Maple syrup and honey can help balance out food that tastes bitter. Adding acids (such as lemon juice, vinegar or tart fruits), healthy fats, fresh herbs and sodium-free herb blends can make food much more appealing and enjoyable to eat.

Can immunosuppressed cancer patients eat raw fruits and vegetables?

Buchholtz confirmed that anyone receiving chemotherapy who is not a bone marrow transplant (BMT) patient can safely eat all raw fruits and vegetables. “You don't need any of those fancy washes. You don't need to wash them with soap. Just rinse them normally and you should be totally fine,” she said.

BMT patients experience immunosuppression, therefore need to be more careful about what they consume. Many years ago, it was believed safest to restrict raw fruits and vegetables to prevent food-borne infections or illnesses. However, this has changed based on more current evidence.

“What they saw was … that as long as people were following the USDA Food Safety Guidelines, there actually wasn't a difference in infection rates,” explained Roit. “So, it's thought that actually eating these fiber-rich foods might be supporting the immune system. What we want to do is just make sure that you're eating them in a safe way.”

Roit explained that the safest approach is to wash all foods thoroughly, including the outside or peel of the fruit or vegetable. Be sure to not eat anything with visible mold. Small fruits and vegetables with a large amount of surface area — such as berries, grapes and leafy greens — need to be washed thoroughly. With careful washing, these foods are safe to eat and provide fiber and nutrient benefits.

How can cancer survivors enhance their well-being with nutrition?

Roit observed that many patients want to make a big change in their diet and lifestyle once their cancer treatment is complete. “But,” she cautioned, “there's often a recovery period that someone might have to go through. Maybe they lost a lot of weight and muscle from surgery and chemotherapy. Maybe they have lasting mucositis … these side effects don't go away overnight.”

She encouraged focusing on getting enough nutrition for several weeks after treatment before making any changes to one’s diet. Be sure to seek care from an expert registered dietician before making significant changes. A registered dietician will be able to help create a custom plan to help you reach your specific goals.

“In general,” Roit said, “after cancer treatment, we do recommend incorporating a lot of the cancer prevention guidelines … We generally will recommend about two-thirds of your foods coming from a plant-based diet.”

Buchholtz also added that small changes can be very impactful and helpful. “I really try to work with everyone individually and really reinforce that there's no one size that fits all,” she affirmed. Cancer survivors can improve their quality of life by setting small, manageable goals for themselves. For example, exercise a few more minutes a day, eat more fruits and vegetables or start cooking and meal planning again.

She also emphasized that one’s nutritional and health goals will — and should — evolve over time. “Patients are able to work with me as much or as little as they need to just set different goals, come back and report what's working, what's not working, and we can always improvise and go back to the drawing board,” explained Buchholtz.

Be sure to read part one of this series, listen to the full podcast episode and learn more about the expert cancer care from Weill Cornell Medicine.