This section offers practical hints for coping with treatment side effects that may affect your eating. These suggestions have helped other patients manage the same eating problems that you may have. Try all the ideas to find what works best for you. Share your needs and concerns with your family and friends, particularly those who prepare meals for you.

Let them know that you appreciate their support. Tell them about Special Notes for Caregivers.

Loss of Appetite

• Try liquid or powdered meal replacements, such as "instant breakfast," during times when it is hard for you to eat food.
• Try frequent small meals throughout the day, rather than fewer big ones. It may be easier to eat more that way, and you won't get so full.
• Keep snacks within easy reach so you can have something whenever you feel like it. Cheese and crackers, muffins, ice cream, peanut butter, fruit, and pudding are good possibilities. Take a portable snack with you when you go out, such as peanut butter crackers or small boxes of raisins. Even if you don't feel like eating solid foods, try to drink beverages during the day. Juice, soup, and other fluids like them can give you important calories and nutrients. Milk-based drinks also provide protein. Tables 2 and 3 give lots of examples of fluids.
• If possible, try having something at bedtime. It won't affect your appetite for the next meal.
• Sometimes, changing the form of a food will make it more appetizing and help you eat better. For example, if eating whole, fresh fruit is a problem, try mixing fruit into a milkshake. (Banana Milkshake Recipe)
• Try softer, cool, or frozen foods, such as yogurt, milkshakes, or Popsicles.
• Take advantage of times when you do feel well, and have a larger meal then. Many people have a better appetite first thing in the morning, when they are well rested.
• During meals, sip only small amounts because drinking may make you feel full. If you want to have more than just a small amount to drink, have it 30-60 minutes before or after a meal.
• Make mealtimes as relaxed and pleasant as possible. Presenting food or meals in an attractive way may also help.
• If your doctor allows, have a small glass of wine or beer during a meal. It may help to stimulate your appetite.
• Regular exercise may help your appetite. Check with your doctor to see what options are open to you.

Weight Loss

Here are three simple recipes that show you how to increase the calories and protein of familiar foods:

• Fortified Milk
• High-Protein Milkshake
• Peanut Butter Snack Spread
• Instant Dry Milk as a Protein Powder

For extra protein in dishes, consider adding a little nonfat instant dry milk to scrambled eggs, soup, cereal, sauces, and gravies.

Weight Gain

Breast cancer patients with a primary diagnosis of cancer may be different. Over half of them may actually gain weight rather than lose during treatment. Because of this, many of the recommendations for breast cancer patients do emphasize a lower fat, reduced calorie diet similar to those provided to patients after cancer treatment has been completed.

Weight gain may also be the result of increased appetite and eating extra food and calories. If this is the case and you want to stop gaining weight, here are some tips that can help. Talk to a registered dietitian for more guidance:

• Emphasize fruits, vegetables, and breads and cereals.
• Choose lean meats (lean beef or pork trimmed of fat, chicken without skin) and low-fat dairy products (skim or 1% milk, light yogurt).
• Cut back on added butter, mayonnaise, sweets, and other extras.
• Choose low-fat and low-calorie cooking methods (broiling, steaming).
• Avoid eating high-calorie snacks between meals.
• If you feel up to it, increase the amount of exercise you get.

Sore Mouth or Throat

Mouth sores, tender gums, and a sore throat or esophagus often result from radiation therapy, chemotherapy, or infection. If you have a sore mouth or gums, see your doctor to be sure the soreness is a treatment side effect and not an unrelated dental problem. The doctor may be able to give you medicine that will control mouth and throat pain. Your dentist also can give you tips for the care of your mouth. Certain foods will irritate an already tender mouth and make chewing and swallowing difficult. By carefully choosing the foods you eat and by taking good care of your mouth, teeth, and gums, you can usually make eating easier. Here are some suggestions that may help:

Try soft foods that are easy to chew and swallow, such as:

• Milkshakes
• Bananas, applesauce, and other soft fruits
• Peach, pear, and apricot nectars
• Watermelon
• Cottage cheese, yogurt
• Mashed potatoes, noodles
• Macaroni and cheese
• Custards, puddings, and gelatin
• Scrambled eggs
• Oatmeal or other cooked cereals
• Pureed or mashed vegetables, such as peas and carrots
• Pureed meats

Avoid foods or liquids that can irritate your mouth. These include:

• Oranges, grapefruits, lemons, or other citrus fruit or juice
• Tomato sauces or juice
• Spicy or salty foods
• Raw vegetables, granola, toast, crackers, or other rough, coarse, or dry foods
• Commercial mouthwashes that contain alcohol
• Cook foods until they are soft and tender.
• Cut foods into small pieces.
• Use a blender or food processor to puree your food.
• Mix food with butter, margarine, thin gravy, or sauce to make it easier to swallow.
• Use a straw to drink liquids.
• Use a smaller-than-usual spoon, such as a baby spoon.
• Try foods cold or at room temperature. Hot foods can irritate a tender mouth and throat.
• Try drinking warm bouillon or salty broth; it can soothe throat pain.
• Try sucking on ice chips.
• If swallowing is hard, tilting your head back or moving it forward may help.
• If your teeth and gums are sore, your dentist may be able to recommend a special product for cleaning your teeth.
• Rinse your mouth often with water to remove food and bacteria and to promote healing.
• Ask your doctor about anesthetic lozenges and sprays that can numb your mouth and throat long enough for you to eat meals.

Dry Mouth

Chemotherapy and radiation therapy in the head or neck area can reduce the flow of saliva and cause dry mouth. When this happens, foods are harder to chew and swallow. Dry mouth also can change the way foods taste. Some of the ideas for sore mouth and throat may help. The suggestions below also may help you deal with dry mouth.

• Have a sip of water every few minutes to help you swallow and talk more easily. Consider carrying a water bottle with you so you always have some handy.
• Try very sweet or tart foods and beverages, such as lemonade; these foods may help your mouth make more saliva. (Do not try this if you also have a tender mouth or sore throat and the sweet or tart foods make it worse.)
• Suck on hard candy or Popsicles or chew gum. These can help make more saliva.
• Eat soft and pureed foods, which may be easier to swallow.
• Keep your lips moist with lip salves.
• Moisten food with sauces, gravies, and salad dressings to make it easier to swallow.
• If your dry mouth problem is severe, ask your doctor or dentist about products that coat, protect, and moisten your mouth and throat. These are sometimes called "artificial saliva."

Dental and Gum Problems

• Be sure to let your doctor know about any dental problems you are having.
• Be sure to see your dentist regularly. Patients who are receiving treatment that affects the mouth - for example, radiation to the head and neck - may need to see the dentist more often than usual.
• Use a soft toothbrush. Ask your doctor, nurse, or dentist to suggest a special kind of toothbrush and/or toothpaste if your gums are very sensitive.
• Rinse your mouth with warm water when your gums and mouth are sore.
• If you are eating foods high in sugar or foods that stick to your teeth, be sure to brush or rinse your mouth afterward so that the sugar won't damage your teeth, or use sugar-free varieties. (Sorbitol, a sugar substitute that is contained in many sugar-free foods, can cause diarrhea in many people. If diarrhea is a problem for you, check the labels of sugar-free foods before you buy them and limit your use of them.)

Changed Sense of Taste or Smell

There is no foolproof way to prevent changes to your sense of taste or smell because each person is affected differently by illness and treatments. However, the tips below should help if you have this problem. (If you also have a sore mouth, sore gums, or a sore throat, talk to your doctor, nurse, or registered dietitian. They can suggest ways to help you without hurting the sore areas.)

• Choose and prepare foods that look and smell good to you.
• If red meat, such as beef, tastes or smells strange, try chicken, turkey, eggs, dairy products, or mild-tasting fish instead.
• Help the flavor of meat, chicken, or fish by marinating it in sweet fruit juices, sweet wine, Italian dressing, or sweet-and-sour sauce.
• Try using small amounts of flavorful seasonings, such as basil, oregano, or rosemary.
• Try tart foods, such as oranges or lemonade that may have more taste. Tart lemon custard might taste good and will also provide needed protein and calories. (If you have a sore mouth or throat, tart or citrus foods might cause pain or discomfort.)
• · If smells bother you, try serving foods at room temperature, turning on a kitchen fan, covering foods when cooking, and cooking outdoors in good weather.
• Try using bacon, ham, or onion to add flavor to vegetables.
• Visit your dentist to rule out dental problems that may affect the taste or smell of food.
• Ask your dentist or doctor about special mouthwashes and good mouth care.

Nausea

Whatever the cause, nausea can keep you from getting enough food and needed nutrients. Here are some ideas that can help:

• Ask your doctor about ant emetics that might help you control nausea and vomiting.
• Try foods that are easy on your stomach, such as:
• Toast, crackers, and pretzels
• Yogurt
• Sherbet
• Angel food cake
• Cream of wheat, rice, or oatmeal
• Boiled potatoes, rice, or noodles
• Skinned chicken that is baked or broiled, not fried
• Canned peaches or other soft, bland fruits and vegetables
• Clear liquids
• Ice chips
• Carbonated drinks
• Avoid foods that:
• Are fatty, greasy, or fried
• Are very sweet, such as candy, cookies, or cake
• Are spicy or hot
• Have strong odors
• Eat small amounts, often and slowly. Eat before you get hungry, because hunger can make feelings of nausea stronger.
• If nausea makes certain foods unappealing, then eat more of the foods you find easier to handle.
• Avoid eating in a room that's stuffy, too warm, or has cooking odors that might disagree with you.
• Drink fewer liquids with meals. Drinking liquids can cause a full, bloated feeling.
• Slowly drink or sip liquids throughout the day. A straw may help.
• Have foods and drinks at room temperature or cooler; hot foods may add to nausea.
• Don't force yourself to eat favorite foods when you feel nauseated. This may cause a permanent dislike for those foods.
• Rest after meals, because activity may slow digestion. It's best to rest sitting up for about an hour after meals.
• If nausea is a problem in the morning, try eating dry toast or crackers before getting up.
• Wear loose-fitting clothes.
• If nausea occurs during radiation therapy or chemotherapy, avoid eating for 1 to 2 hours before treatment.
• Try to keep track of when your nausea occurs and what causes it (specific foods, events, surroundings). (See chart) If possible and if it helps, change your diet or schedule. Share the information with your doctor or nurse.

Vomiting

If vomiting is severe or lasts for more than a day or two, contact your doctor. He or she may give you an ant emetic medication to control nausea and vomiting.

Very often, if you can control nausea, you can prevent vomiting. At times, though, you may not be able to prevent either. Relaxation exercises or meditation may help you. These usually involve deep rhythmic breathing and quiet concentration, and can be done almost anywhere. If vomiting does occur, try these suggestions to help prevent further episodes:

• Do not eat or drink anything until you have the vomiting under control.
• Once the vomiting is under control, try small amounts of clear liquids, such as water or bouillon. Table 2 gives you more examples of clear liquids. Begin with 1 teaspoonful every 10 minutes, gradually increasing the amount to 1 tablespoon every 20 minutes. Finally, try 2 tablespoons every 30 minutes.
• When you are able to keep down clear liquids, try a full-liquid diet or a soft diet. Table 3 gives examples of full-liquid foods. Continue taking small amounts as often as you can keep them down. If you feel okay, gradually work up to your regular diet. If you have a hard time digesting milk, you may want to try a soft diet instead of a full-liquid diet, because a full-liquid diet includes a lot of milk products. Ask a registered dietitian for information about a soft diet.

Diarrhea

During diarrhea, food passes quickly through the bowel before your body has a chance to absorb enough vitamins, minerals, and water. This may cause dehydration, which means that your body does not have enough water to work well. Long-term or severe diarrhea may cause problems, so contact your doctor if the diarrhea is severe or lasts for more than a couple of days. Here are some ideas for coping with diarrhea:

• Drink plenty of fluids to replenish what you lose with the diarrhea
• Eat small amounts of food throughout the day instead of three large meals.
• Eat plenty of foods and liquids that contain sodium and potassium, two important minerals that help your bodywork properly. These minerals are often lost during diarrhea. Good high-sodium liquids include bouillon or fat-free broth. Foods high in potassium that don't cause diarrhea include bananas, peach and apricot nectar, and boiled or mashed potatoes. Sports drinks contain both sodium and potassium and have easily absorbable forms of carbohydrates.
• Try these foods:
• Yogurt, cottage cheese
• Rice, noodles, or potatoes
• Farina or cream of wheat
• Eggs (cooked until the whites are solid; not fried)
• Smooth peanut butter
• White bread
• Canned, peeled fruits and well-cooked vegetables
• Skinned chicken or turkey, lean beef, or fish (broiled or baked, not fried)
• Avoid :
• Greasy, fatty, or fried foods if they make your diarrhea worse
• Raw vegetables and the skins, seeds, and stringy fibers of unpeeled fruits
• High-fiber vegetables, such as broccoli, corn, dried beans, cabbage, peas, and cauliflower
• Avoid very hot or cold food or beverages. Drink liquids that are at room temperature.
• Limit foods and drinks that contain caffeine, such as coffee, some sodas, and chocolate.
• If you have a sudden, short-term attack of diarrhea, try having nothing but clear liquids for the next 12 to 14 hours. (See chart) This lets your bowel rest and replaces the important fluids lost during the diarrhea. Make sure your doctor or nurse knows about this problem.
• Be careful when using milk and milk products. The lactose they contain can make diarrhea worse. Most people, though, can handle small amounts (about 1-1/2 cups) of milk or milk products.