Eating well during cancer treatment is an important part of your overall treatment plan. Keeping up with your nutrition can have many benefits, as maintaining healthy body weight and keeping strength up can even help mitigate the side effects of treatment.

In a perfect world, it would be easy to ensure you eat enough calories and protein to meet your daily needs. But the reality of cancer care is that your ability to eat can vary greatly from day to day. Some days, you’ll find it easier to eat enough food; but on others, you might find that food isn’t at all appealing. On hard days, we encourage you to be gentle with yourself yet push yourself to eat whatever you can tolerate based on your symptoms. It’s helpful to have both a “Plan A” and “Plan B” approach to eating depending on how you’re feeling.

Why nutrition matters during cancer treatment
Having proper nutrition during cancer treatment can positively affect your quality of life. Some benefits of eating a balanced diet include:

• The ability to better maintain your muscle mass
• The ability to maintain your energy so you can do the things you enjoy
• Eating a balanced diet can also help to support your immune system, which promotes healing and can help you better tolerate treatment and its side effects

A “balanced” diet
What is a “balanced” diet? In short, it just means that your food intake includes calories and protein from a variety of sources. That way, you get the nutrients your body needs when it’s under stress, and treatment can be stressful. Here are some tips to maintain a balanced diet:

• Ensure that healthy fats, whole grains, nuts, nut butters, and seeds make up more of your caloric intake than sweets and snack foods
• Ensure that poultry, seafood, lean meat, eggs, dairy foods, nuts, seeds, and legumes represent most of your protein intake, rather than fast foods and processed meats
• Include large quantities of fruits and vegetables in whatever form is most appealing to boost your intake of fiber, vitamins, minerals, and anti-inflammatory compounds found naturally in produce — a plant-forward or plant-based diet has been proven to greatly support overall wellness
• Drink enough fluids (80 ounces or more — the equivalent of 10 cups or 5 large glasses) regularly over the day to stay well hydrated

As part of your “Plan A” on the days that you feel well enough to eat, your balanced diet starts with balanced meals. We like this visual of what a nutritionally balanced meal looks like from the Harvard School of Public Health to represent which food groups should be included in your average meal.

Aiming to eat 3 meals and 2-3 snacks – or 4-6 mini-meals and protein shakes if full meals are hard to stomach —provides regular opportunities to get your nutritional needs met over the day.

“Plan B”
No matter how well you keep up your nutrition on days that you’re feeling well, you can probably expect to have some (or a lot) of days during treatment where eating is harder than usual. An upset stomach and stress might make food seem unappealing, and side effects might affect your ability to eat over the course of treatment. Even though eating might feel impossible, it’s important to gently push yourself to keep up your nutrition. Maintaining your nutrition and strength is crucial in tolerating and coping with treatment.

Here are some clever hacks and workarounds to make sure your caloric needs are being met, even when you don’t feel like eating.

Eat smaller amounts, more frequently
When you’re not feeling well or are dealing with nausea, you might find it easier to eat smaller amounts more frequently throughout the day. We call these “mini-meals, and they include a source of carbs plus a source of protein. Here are a few examples to get you started:

• Crackers with cheese or nut butter
• Half of a sandwich (cold cut, cheese, tuna, chicken, or egg salad)
• Greek yogurt mixed with chopped nuts
• Cottage cheese with crackers or fruit
• Cheese or lentil soup
• An egg on a slice of buttered toast
• Cheese melted on toast with soup
• Small portion of leftovers
• Small bowl of hot or cold cereal with milk, berries, and chopped nuts
• Homemade or store-bought protein shake
• Protein bar

Additionally, make sure to keep snacks on hand at home, work, and in your car so you’ll have easy access to food whenever you feel able to eat.

Add healthy fats and proteins to bulk up foods
Getting more calories doesn’t always mean eating a greater quantity of food. Instead, you can choose high-calorie foods (that are still nutritionally balanced), or full-calorie or boosted-calorie versions of foods you already tolerate well. You can also add low-volume fats to meals and snacks whenever possible. Here are some of our favorites:

• Cook eggs in butter or oil
• Drizzle olive, canola, or avocado oil on vegetables
• Mix extra oil or butter into casseroles and stews
• Add sour cream and butter to potatoes
• Toss pasta with olive oil
• Spread peanut butter on apples or bananas
• Cook grilled cheese sandwiches in extra butter
• Spread avocado on sandwiches
• Spread nut butter on toast
• Add Trail Mix with nuts and dried fruit to yogurt
• Use cream instead of half-and-half or milk in beverages and sauces
• Avoid purchasing “diet” or “lite” foods
• Add cheese to foods
• Add hummus to sandwiches or veggies

Drink your calories instead of eating them
You might find it easier to meet your caloric needs by supplementing your food intake with high-calorie liquids. Store-bought protein shakes are an easy option — look for those that contain at least 300 calories per serving. Here are some good options:

• Ensure/Ensure Plus/Ensure Enlive/Ensure Complete
• Boost/Boost Plus/Boost Soothe
• Orgain organic protein shakes
• Naked Protein Zone smoothie
• Carnation Instant Breakfast

Muscle Milk, Premier Protein, and Fairlife Core Power shakes are 160-170 calories per serving and can be mixed with ice cream, nut butter, or avocado to boost the calories.

Homemade protein shakes are also an option if you prefer to choose your own ingredients. Blend milk, Greek yogurt, frozen fruit, and nut butter — and for more protein, consider adding a powder supplement to the mix.

Other examples of liquid calories include:

• Yogurt/frozen yogurt
• Ice cream
• Pudding
• Custard
• Smoothies

Another tactic is to make sure at least half of your beverages throughout the day contain calories. You can meet your hydration needs at the same time as providing a caloric boost if you’re having a hard time getting enough nutrition. Liquids that provide calories include:

• Electrolyte beverages (like Pedialyte and Gatorade)
• Frozen fruit bars (Popsicles)
• Milk
• Sweetened teas
• Juices

Adjust temperature
Sometimes we don’t realize how much temperature can directly impact our enjoyment of foods. When you’re feeling cold or are experiencing chills as a side effect, hot foods may be more appealing. Or, if you’re struggling with an aversion to foods that have strong scents, cold foods may be more appetizing as they tend to have less odor. Experiment with foods of different temperatures until you find what works best for you.

Stay on a schedule
It may be difficult to make sure that you’re meeting your nutritional needs throughout the day. Taking a round-the-clock approach to eating during treatment can help encourage better digestion and symptom relief which can make it easier to eat throughout the day. This often means eating at specific times, regardless of whether you’re hungry or not. It’s a good idea to identify how much food you can handle at a time on the hard days, and then plan out your meals/mini-meals and snacks. Setting alarms and timers to remind yourself to eat might help you stay on top of your caloric intake.

Prioritize convenience
When you’re already struggling to eat, the last thing you want to worry about is meal prep. Before treatment begins (or at the beginning of treatment), set aside a half-day for meal prepping and grocery shopping. Select easy-to-prepare frozen and nonperishable foods to keep on hand during treatment. You can also make a large batch of meals and freeze individual portions ahead of time, so “cooking” a meal on the hard days is as easy as throwing a container in the microwave.

Socialize at meals
You might find it easier to eat if you’re eating with others. Be mindful that you’re eating in a relaxed environment when possible.

Use smaller plates
If larger portions feel overwhelming to you, try plating your food on smaller plates. Even though it’s the same amount of food, the way it appears on the plate has big psychological impact. Seeing your food as “smaller” in amount can make it easier to finish.

Be kind to yourself
Some days are just harder than others — and that’s OK. On the days that are really hard to eat, prioritize calories over healthfulness. While not all calories are created equal, sometimes it’s more important to make sure you’re getting enough of them than to worry about their source.

Dietary supplements
In general, try to get your vitamins and minerals from a balanced diet whenever possible. Dietary supplements are usually not recommended (unless you’ve been instructed specifically by your doctor to take one) and should be avoided in case they interfere with your treatment. Before adding any supplements to your diet, speak to your treatment team to make sure you’re good to go.

A note on food safety
Practicing good food safety is important during cancer treatment as you may be more susceptible to food-borne illnesses. Avoid raw eggs or seafood and unpasteurized cheese/dairy. All fruits and vegetables should be washed well before eating.

If you’re experiencing side effects severe enough to significantly impact the number of calories, you’re able to eat per day, we recommend that you speak to your medical team and ask to meet with an oncology dietitian for symptom management help. There are clinical measures that can be taken to help make eating easier. The Iris Care Team is available to support you, too. Chat with one of our nurses — any day, any time — to get help meeting your nutritional needs.

More resources for eating well during treatment:

• https://www.mskcc.org/cancer-care/patient-education/eating-well-during-your-treatment
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/cancer/cancer-diet-foods-to-add-and-avoid-during-cancer-treatment
• https://www.cancer.org/treatment/survivorship-during-and-after-treatment/coping/nutrition/once-treatment-starts.html
• https://www.mskcc.org/cancer-care/patient-education/food-safety-during-cancer-treatment