Eating well during cancer treatment is an important part of your overall treatment plan. Optimal nutrition helps you maintain a healthy body weight, keep your strength up, and minimize side effects of treatment.

During cancer treatment, your ability to eat can vary greatly from day to day. Some days, you’ll find it relatively easy to eat enough food; but on other days, you might find that food isn’t appealing. On the tough days, we encourage you to be gentle with yourself and eat whatever you can tolerate. It can be 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 and help you to:  

• Maintain your muscle mass

• Keep your energy up so you can do the things you enjoy

• 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 means that your food intake includes calories and protein from a variety of sources. That way, you get most of the nutrients your body needs. Here are some tips to maintain a balanced diet:

• Choose whole grains and healthy fats like nuts, nut butters, and seeds more often than packaged snacks and foods with added sugar.

• Make skinless poultry, seafood, lean meat, eggs, tofu, legumes, and dairy foods (or non-dairy equivalents), most of your protein intake, rather than processed meats or fast foods.

• Include fruits and vegetables several times each day boost your intake of fiber, vitamins, minerals, and phytonutrients. Plant-rich patterns of eating provide antioxidant and anti-inflammatory benefits and have been shown to greatly support overall wellness.

• Drink enough fluids (8-10 cups per day) to stay well hydrated.

As part of your “Plan A” for the days  you feel well enough to eat, aim for 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:

Aim to eat 3 meals and 2-3 snacks per day or 4-6 mini-meals (supplemented with protein shakes) daily.

"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 from treatment might impact your ability to eat. Even though eating might feel impossible, it’s important to establish a food and fluid routine so you continue to meet your nutrition needs.

Here are some hacks and workarounds to help you get food in 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 carbohydrate, and a protein. For example:

• Crackers with cheese or nut butter

• Half of a sandwich (sliced roast turkey, cheese, tuna, chicken, egg or tofu salad)

• Greek yogurt mixed with nuts

• Cottage cheese with crackers or fruit

• Lentil soup

• An egg and a slice of 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 or energy bites (we love this recipe!)

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

Eating more 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 a small quantity of fat to meals and snacks whenever possible.

Here are some ideas:

• Cook eggs in olive or avocado oil

• Drizzle olive, canola or avocado oil on vegetables, and add to casseroles and stews

• Add sour cream to potatoes

• Toss pasta with olive oil

• Spread peanut butter on apples or bananas

• Spread non-hydrogenated tub margarine (like Earth Balance) on both the inside and outside of bread when making grilled cheese sandwiches

• Spread avocado on sandwiches

• Brush avocado oil on toast before adding a spreads like peanut butter

• Add Trail Mix with nuts and dried fruit to yogurt

• Avoid purchasing “diet” or “lite” foods

• Add cheese to foods

• Add hummus to sandwiches or veggies

Drink your nutrition

You might find it easier to meet your nutrition 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 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

Adjust temperature

Sometimes temperature impacts 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 aversion to foods that have strong smells, cold foods may be more appetizing because they have less odor. Experiment with foods of different temperatures to 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, but creating an eating schedule can help. This often means eating at specific times, even if you’re not especially hungry. Set an alarm or timer every 2-3 hours as a reminder to eat and remember that small and steady is the mantra for hard days. If possible, plan out your meals/mini-meals and snacks so you don’t have to try to think of something to eat. And if folks in your support network ask how they can help, maybe share a list of foods you’re tolerating lately so they can take care of buying and prepping some mini meals or snacks for you.

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 (in person or a virtual setting!). Be mindful that you’re eating in a relaxed environment when possible.

Use smaller plates

If your usual sized plate of food feels overwhelming to you, try eating off smaller plates and bowls. Seeing your food as “smaller” in amount can make it easier to finish.

Dietary supplements

In general, try to get your vitamins and minerals from food whenever possible. If you’re wondering if dietary supplements are the right approach for you, speak to your treatment team.  

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 that make it hard for you to eat, we recommend that you speak to your medical team and ask to meet with an oncology dietitian for individualized help. 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.