East Lancashire Hospitals NHS Trust (2024)

Introduction

Difficulties in eating may occur due to your diagnosis or the side effects of any treatment you may be receiving. However if you have no difficulties you can return to a varied and balanced diet.

This booklet can be used as a guide for the following symptoms:

Poor appetite.
Nausea and vomiting.
Dry mouth.
Sore mouth.
Taste changes.
Chewing and swallowing difficulties.
Constipation.
Wind.
Diarrhoea.
When the smell of food puts you off eating.

Some of the advice in this booklet suggests that you include foods high in sugar. If you have diabetes please consult your Doctor, Dietitian or Diabetes Nurse.

Poor Appetite

It is very common to lose your appetite when you are ill or having treatment. If you find your appetite is poor, healthy eating is not a priority. It’s important to keep eating as much as possible to maintain your weight and energy levels:

Eat when you are hungry and when your appetite is better
Try different foods as taste and preferences change
Do not over face yourself. Try using a smaller plate or have six small nourishing meals or snacks per day
Save energy for eating meals
Let friends, family and carers do the shopping and cooking or try online delivery shopping
Use tinned, frozen foods and ready meals
Meals on Wheels/Wiltshire Farm Foods/Oakhouse Foods
Cook and freeze batches of food when feeling well
Alcohol can help boost appetite. A small glass of sherry, wine or beer at your meal can stimulate appetite, but check with your Doctor if this is allowed
A short walk and fresh air can help stimulate appetite before meals
Avoid drinking liquids near or at meal times, as they may fill you up and prevent you from eating your meal.

Fortifying food

Try and make the food you eat as nourishing as possible.

Use full fat milk and dairy products e.g. whole milk, full fat yoghurts, full fat cheese.

Use full sugar versions of all drinks and pure fruit juices⃰. Fortify all milk with milk powder. Use 4 tablespoon per 1 pint. Use as normal e.g. on cereal and in drinks.

Fortifying with fats and fatty foods: Use the following on toast, cake, scones, vegetables, potatoes, pasta, rice and stir into puddings and soups:

Butter and margarine.
Full fat mayonnaise and salad dressings.
Cream, cream cheese, crème fraiche.
Chocolate spread or peanut butter.
Grated cheese.
Add extra paneer, cream, full fat yoghurt to curries.

Fortifying with sugars and sweet foods⃰: To be added to drinks, desserts and cereals:

Nourishing Meal and pudding ideas

Meal ideas:

Omelette or frittatas filled with cheese, ham or mushroom.
Well cooked eggs – scrambled, poached, boiled or fried – try having with fingers of toast.
Beans or tinned spaghetti on toast topped with grated cheese.
Sardines or pilchards on buttered toast.
Casseroles, stews or hotpots made using meat.
Cottage pie, Shepherd’s pie, lasagne or moussaka. Try topping with extra grated cheese to make even more nourishing.
Fish poached, grilled or fried also fish fingers, fish in batter, fish cakes and fisherman’s pie – have maybe with chips or bread and butter.
Korma, tikka masala, channa curry or dahl served with rice, naan breador chapatti – even tastier if served with brinjal pickle or mango chutney.
Meat, fish, tofu or Quorn – stir fried and served with noodles or rice and maybe a stir fry sauce.
Quiches, flans or pies.
Pizza topped with extra cheese.

Pudding:

Milky pudding e.g. custard, rice pudding, semolina, Angel Delight and instant whip.
Egg custard.
Soft consistency desserts e.g. yoghurt, crème caramel, trifle and cheesecake.
Tinned or fresh fruit with cream, ice cream or evaporated milk.
Sponge pudding, sticky toffee pudding or bread and butter pudding.

Snack and Drink ideas

Have nourishing snacks and drinks available whenever possible. This is important when travelling to and from hospitals and clinics.

Ideal snacks:

Crisps or nuts.
Small sandwiches or rolls.
Biscuits, cakes, fruit loaf.
Cream cheese, cheese slices or triangles with crackers, oatcakes or toast.
Dried fruit and nuts.
Chocolate biscuits or chocolate bars.
Flap jacks, chewy oat bars or cereal bars.
Party sausage rolls, co*cktail sausages or mini pork pies.
Toast, crumpets, mini pancakes.
Baked potato with cheese/chilli/tuna mayonnaise.
Samosas, pakoras or onion bhajis.
Sweets e.g. mints, toffees, jelly babies.

Ideal drinks:

Replace cups of tea and glasses of water with more nourishing drinks such as:

Hot milky drinks with whole milk: Horlicks, Ovaltine, hot chocolate, milky coffee.
Cold milk shakes with added ice-cream and flavouring.
Pure fruit juice.
Instant soups made with milk and cream.
Smoothies – made with milk, fruit, cream and sugar added.
Powdered drinks e.g. Complan and Build Up – can be bought from pharmacies and supermarkets and come in a range of sweet and savoury options and are best made with milk.

Nausea and Vomiting

You may experience nausea (feeling sick), particularly during chemotherapy. If this happens try the following:

Nausea:

Try cold foods to avoid smells putting you off food and let someone else cook.
Try dry foods such as toast and crackers.
Try salty foods such as crisps, crackers and cheese cubes.
Have light foods such as soups and egg custards.
Keep portion sizes small and build up slowly.
Ensure frequent snacking instead of big meals and avoid going long periods without food.
Sometimes ginger ale, ginger nut biscuits, crystallised ginger or lemon and ginger tea may help.
Avoid fatty foods as they stay in stomach for longer e.g. greasy and fried foods.
Avoid lying down after eating.
If nausea persists, anti-sickness drugs can be prescribed from your Doctor/Nurse.

Vomiting:

It is important that you keep drinking plenty of fluids. Aim for 10-12 cups per day of clear fluids such as water or squash. You may find it easier to sip through a straw.
When vomiting settles try nourishing milky drinks and gradually move to lighter meals and snacks such as soup and scrambled egg.

Mouth Care

You may experience problems with your mouth.

If this happens speak to your Doctor or Specialist Nurse who will check for problems such as infection or ulcers and they may prescribe treatment to help. You could also try the following advice.

Dry mouth:

Have frequent nourishing fluids and fizzy drinks. Aim for 10-12 glasses/mugs of fluid a day.
Suck on ice-cubes or ice-lollies.
Add gravy, sauces or butter to foods to make them moist.
Avoid dry foods such as bread, crackers.
Suck boiled sweets and chewing gum.
Have pineapple chunks and juice (not if you have a sore mouth).
Artificial saliva spray is available on prescription from your Doctor.
Eat soft, moist foods such as soups/stews.
Keep your mouth fresh and clean.
If you have thrush see your Doctor/Nurse for medication.

Sore mouth

Avoid acidic fruits and juices e.g. oranges, tomatoes, grapefruit, pineapple, lemon and vinegar.
Avoid very hot and very cold foods.
Avoid rough textured food e.g. toast, dry biscuits and raw vegetables.
Avoid spicy and salty foods.
Avoid neat alcohol such as spirits.
Try drinking through a straw.
Try antiseptic mouthwash from your Doctor. Do not use alcohol based mouthwash.
Try salt or bicarbonate mouthwash. Add 1 teaspoon of either salt or bicarbonate to 1 pint of cold or warm water and rinse regularly throughout the day (make up a fresh mouthwash everyday).
Use a child’s soft toothbrush and brush more often.
If you have thrush see your Doctor/Nurse for medication.

Taste Changes

Concentrate on foods you enjoy. You may find you like either savoury or sweet foods so focus on the foods that taste better. Keep trying different foods and flavours as your tastes may keep changing.

To help with taste changes try the following:

Keep your mouth fresh and clean with good mouth care and by drinking plenty of fluids.
Try sucking on mints⃰, fruit sweets or sugar-free chewing gum.
Use seasoning, such as herbs and spices, lemon or lime juice, vinegar, brown sauce or chutney⃰.
Marinate foods with fruit juices and wine.
Try cold meats with chutney and garnish.
Sharp flavoured fruits or drinks maystimulate taste buds e.g. pineapple, grapefruit or lemonade⃰.
If tea or coffee tastes unpleasant consider alternate drinks such as fruit juices, fruit teas.
Serve fish, chicken and egg with sauces, try cured meats.
If red meat tastes unpleasant try fish, chicken, eggs or dairy.
Be aware of thrush in your mouth and contact your Doctor or Nurse for appropriate treatment if needed.
Drink regularly to wash away bitter taste and sip drinks through a straw to avoid taste buds.
If you are experiencing a metallic taste; use plastic cutlery.

⃰ If you have had radiotherapy to your mouth or throat, or if you experiencing a sore mouth, you may want to avoid these foods

Chewing and Swallowing Difficulties

Radiotherapy near your mouth or throat, and some types of chemotherapy can make your throat sore. It can be hard to swallow therefore concentrate on soft, moist foods such as:

Savoury:

Creamy soups and broth.
Fish in a soft sauce or fisherman’s pie.
Cooked pulses and lentils such as baked beans or dhal.
Tender meats or Quorn in stews, casseroles or tagines.
Minced meat made in bolognaise sauce, cottage pie, chilli con carne or curry.
Tuna or hard-boiled egg mashed with mayonnaise.

Sweet:

Milky puddings such as rice, semolina, sago or custard.
Mousses, crème caramel, yoghurt, fromage frais.
Egg custard, trifle, fruit fool or soft sponge cake.
Ice cream or sorbet.
Jelly made with milk or fruit juices.
Porridge or other soft cereals.

Constipation

Constipation may be caused by the disease, treatment or medications such as some pain killers. If this happens try the following:

Drink at least 10-12 glasses or mugs of fluid per day.

You made need to alter the fibre content of your diet or your medication. Please speak to your Doctor or Dietitian about this.

Wind

Wind can make you feel very full and bloated. If this happens try the following:

Eat slowly, chew well, have small mouthfuls.
Avoid foods that give excess wind e.g. beans, cucumber, fizzy drinks, brassica vegetables (broccoli, spinach, cauliflower, Brussel sprouts, peas, sweetcorn).
Try peppermint tea, cordial or mints.
Gentle exercise.

Diarrhoea

Certain treatments, especially radiotherapy to your abdomen or pelvis may affect your bowels resulting in loose stools. If this happens try the following:

Avoid high fibre foods e.g. bran cereals, fruit with skin, dried fruit, unpeeled vegetables, pulses, nuts and seeds. Replace with low fibre foods e.g. white bread, cornflakes, Rice Krispies, peeled fruit and vegetables.
Drink plenty of nourishing fluids, aim for 10-12 drinks per day.
Some people find avoiding high fat foods help e.g. fried foods, pastries, rich cakes. Re-introduce fibre slowly when the diarrhoea has settled.

If persists see your Doctor for anti-diarrhoeal medication.

Food Odours

You may experience smells putting you off eating. If this happens try the following:

Cold foods (cereals, milk puddings, sandwiches, crackers).
Get someone else to cook and keep the kitchen door shut and windows open. Do not eat in the kitchen.
Try neutralising air freshener.

Frequently asked questions

Should I take a vitamin and mineral supplement?

If your appetite is poor you may need a standard complete multivitamin to meet your daily needs however please be aware that high doses of vitamin and minerals can be harmful and interfere with certain treatments and medications. Please speak to your Doctor, Dietitian or Pharmacist for more advice.

What should I do if I follow a diabetic diet or cholesterol lowering diet?

If your appetite is poor it may be appropriate to relax your diabetic or cholesterol lowering diet and include some food and drinks you do not normally eat. Ask your Dietitian or Doctor for advice.

Should I be following an alternative diet for treating my cancer?

There are a few alternative diets claiming to treat or even cure cancer via avoiding certain foods or taking large doses of vitamins or minerals. There is no scientific evidence to confirm these claims. As well as this, the effects of such diets on your general health are not known as these diets have often not been researched properly. If you are thinking of following a special diet please discuss this with your Consultant, Specialist Nurse or Dietitian.

Should I be eating organic foods?

There is no evidence to suggest that eating organic foods will either help recovery or reduce the risk of reoccurrence. Organic foods contain the same vitamin and minerals as conventionally grown products and can be more expensive to buy.

If you want more information about cancer:

Macmillan Cancer Support

89 Albert Embankment

LONDON

SE1 7UQ

Tel 0808 808 0000 (freephone)

www.macmillan.org.uk

Cancer Research Angel Building

407 St John Street

London

EC1V 4AD

Tel: 0808 800 4040

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