By Dena McDowell, MS, RD

When undergoing cancer treatment, it can be very difficult to maintain your weight. Lack of appetite, problems with nausea, vomiting, constipation, and diarrhea are just some of the potential reasons for the problem. To maintain your immune system and lessen the fatigue commonly experienced during treatment, it is important to stabilize your weight. Another benefit is that you will recover faster.

Working with a registered dietitian at your cancer center is a good way to ensure you are consuming enough calories and protein during treatment. Conversely, if being overweight is an issue, your dietitian can assist you with weight loss after you have completed your treatment and are fully recovered.

If you are losing weight during your treatment, your dietitian can assess your calorie needs and create a meal plan to stabilize your weight. To achieve this, you may be instructed to eat higher calorie foods. If you are following a specific diet for heart health or diabetes, inform your dietitian or doctor; often these restrictive diets will be lifted during treatment.

Tips for improving your diet

Here are some helpful hints to promote adequate calorie and protein intake:

• Eat several small meals a day, rather than 3 large ones. Aim to eat or drink something every 1-2 hours during the day.

• Eat your favorite foods at any time of the day. For example, if breakfast foods are more appealing, eat them for dinner.
• Take advantage of when you feel hungriest. For example, if you are hungrier in the morning, make breakfast your biggest meal. Eat a light snack or have a shake for dinner instead of a full meal.
• Drink nutritious drinks such as milkshakes and commercial liquid supplements. Cold drinks are usually tolerated well. Try serving supplements over ice, or blend them with ice cream to improve their flavor.
• Read labels and compare calories of your favorite foods. Select foods that are highest in calories.
• Drink fluids between meals instead of with them. Drinking fluids during meals can make you feel too full.
• Keep high calorie snacks readily available. Leave them on countertops or on the coffee table to remind you to eat.

Focus on quality, not quantity

When you do not feel hungry, eating more can be a daunting task. An easy way to increase the calories and protein in your diet is by fortifying the foods you eat. Instead of focusing on eating a lot of food, concentrate on the quality instead. See the list below for some tips on how to increase the calories and protein in common foods.

Food Group	High Calorie/Protein Food Choices
Fruit	Bananas, pineapple, and dried fruit are higher in calories than grapes, melons, or peaches. Dried fruit is a calorie dense snack. Make frozen juice with half the water or use it in smoothies.
Dairy	Use high protein, fortified milk (see recipe below). Add Carnation Instant Breakfast, Ovaltine, and Nestle Quik. Add cheese to sandwiches and casseroles.
Cereal	Try granola and cereal containing nuts and dried fruit. Mix with other favorite ingredients to make a trail mix, using raisins, nuts, chocolate chips, dried fruit, seeds, etc. Try oatmeal, cream of wheat, or grits. Add fortified milk, butter, or dried fruit.
Bread, Rice & Pasta	Use margarine, peanut butter, almond butter, soy nut butter, and jelly to add calories. Eat cheese on toast or with crackers. Add grated cheese, butter, diced meats, or cream sauces to noodles and rice.
Sandwiches	Using higher calorie bread (e.g. wheat, bran, rye, pumpernickel), add generous amounts of lunch meats or tuna. Add mayonnaise, margarine and cheese. Peanut butter and jelly is high in protein and calories.
Soups	Adding 1 cup of soup to meals for snacks increases calories. Try bean, split pea, or cream-based soups. Add leftovers or diced meats to canned or homemade soups. Use fortified milk to make soups or chowders. Top off chili with cheese and add a slice of hearty bread instead of crackers to complete the meal.
Meats	Salmon, tuna, chicken, and turkey are relatively lean and low in saturated fats. Beef, pork, and lamb are usually higher in calories due to high saturated fat content. Eat these meats in moderation. To add calories, cook in canola or olive oil. Adding breadcrumb crust or grated cheese also increases calories. Add leftover meats to casseroles, omelets, and salads.
Eggs	Keep hard-boiled eggs in the refrigerator. Chop eggs and add to salads, casseroles, soups, and vegetables. Make a quick egg salad. Add cheese, meats, or veggies to omelets. All eggs should be well-cooked to avoid the risk of harmful bacteria.
Beans/Legumes/Nuts/Seeds	Incorporating more beans and lentils into your diet can increase the calories and enhance the flavor of your meals. Try adding chickpeas or kidney beans to salads, humus to pita bread, and beans to chili. Sprinkle seeds on desserts such as fruit, ice cream, pudding, and custard. Also serve nuts or seeds on vegetables, salads, and pasta. Spread peanut butter on toast and fruit or blend in a milkshake.
Vegetables	Add parmesan cheese, shredded cheese, olive oil, or margarine to your favorite vegetables.
Salads	Adding cheese, cottage cheese, chickpeas, sunflower seeds, nuts, raisins, lean meats, hard-boiled eggs and croutons can really add calories. Use oil-based salad dressings.
Potatoes	Make the most of your mashed potatoes by adding fortified milk and extra margarine. Add low fat gravy, sour cream, and cheese for extra calories.
Desserts	Try lower fat ice creams, frozen yogurts, animal crackers, angel food cake, low fat brownies, or oatmeal raisin cookies. Fig/fruit newton cookies, Italian ice, fruit yogurt, and hot chocolate are also good choices. Top fruit, pies, muffins, and sweet breads with light whipped cream to make the meal complete. Try adding whipping cream to pancakes, waffles, jell-o, fruit, and hot chocolate.
Honey, Jam & Sugar	These additives can enhance the flavor of any food. Add to bread, cereal, fruit, and shakes to increase calories.

Recipe for high protein milk

1 quart milk
1 cup instant non-fat dried milk

Pour milk into a deep bowl or blender
Add non-fat dried milk
Beat slowly with beater until dry milk is dissolved (usually less than 5 minutes)
Refrigerate

The flavor improves if left overnight. Makes 1 quart.

Conclusion: proper eating is an essential part of your cancer treatment

Following a balanced diet is vitally important to provide the energy needed to get through cancer treatment. Eating adequate amounts of calories and protein will help maintain the immune system during treatment. A nutritious diet will also lend a quicker healing and recovery time after treatment has ended. Remember that eating is a part of treatment. Without proper eating habits, treatment may be affected in a negative way.

For more information on managing your weight during cancer treatment see the following articles from TheDietChannel: Guidelines for Effective Weight Loss and Weight Gain during Cancer Treatment and Weight Loss & Cancer: When Dieting Could Threaten Your Life.