Eating during radiation therapy and chemo

A cancer diagnosis. Treatments cause multiple side effects. There’s a vital need: to eat. But how?

Based on available data, 40% of women and 45% of men in Canada will develop cancer during their lifetime. Many of them will face days, weeks, months, even years of chemotherapy and/or radiation therapy.

Dealing with side effects

The side effects of these treatments are practically unavoidable. They can appear at any stage, in varying degrees; some are temporary, others permanent. Despite a widely held belief, their presence or absence does not mean the treatment is effective or not.

Many side effects of radiation and chemo influence diet: fatigue, appetite and weight loss, difficulty swallowing, changes to taste and smell, nausea, vomiting, dry mouth and throat, thick saliva, ulcers, diarrhea, constipation, heartburn and acid reflux, food aversions… and to top it all off, there are even more to add to the list, effects linked to medication, surgery, lack of exercise, stress and anxiety about cancer, even depression. There are so many conditions that can affect the nutritional state of people living with cancer.

Nutritionist Daniel Lavoie has specialized for more than 10 years in radiation oncology at CHUM-Notre-Dame Hospital in Montreal, working primarily with people suffering from cancers of the mouth, throat and neck. “These are the places where you eat, speak and breathe, very important!” he explains. “A person eating normally will swallow between 2,000 and 3,000 times a day. After receiving radiation, it hurts to swallow every single time. The body eventually sends a message to protect itself against pain: stop eating.”

Calories, life essentials

The human body runs on calories. They provide energy required for the body’s vital functions, such as breathing, movement, digestion, etc. When the body is under stress and dealing with a disease, its energy needs are more important than ever. It is important to nourish it in the best way possible. But, for people with cancer, the nutritional state ends up being affected by poor nutrition. A chain of events follows: weight loss, increased fatigue, weakened immune system, less resistance to the treatment’s side effects and reduced quality of life.

Something surprising for Daniel Lavoie, you never know how someone will react to treatment. A larger, heftier patient can lose a lot of strength, while a smaller and slighter patient may have surprising endurance. Every case is unique and must be monitored daily, often hour by hour, by hanging on to small victories.

Chemotherapy: cancer treatment with drugs whose effects spread throughout the body. It’s taken orally (pill, liquid or capsule) or by injection.

Radiation therapy: cancer treatment using radiation (X-rays, gamma rays, electrons) to destroy cancer cells in an affected part of the body.

Sure, you want to eat during chemo, but how do you manage under such difficult conditions? Nutritionist Caroline Tran, a nutritionist specialized in oncology at CHUM-Notre-Dame Hospital, is categorical: food is an integral part of cancer treatment. “Chemo is no fun for anyone, but it must be done. At the same time, eating can prove difficult, but your body needs to stay nourished to fight this disease!”

Protein: a top priority

The immune system needs protein to regenerate and heal tissue. Protein also helps the body regain its strength and protects against infection. Add protein-rich foods to your meal and snack menu as soon as possible.

To add protein to your meals and snacks

  • Add grated cheese (pasteurized) to soups, mashed potatoes, vegetables, sauces, meatloaf, casseroles, breads
  • Add whole milk to hot cereal, soups, casseroles, hot chocolate (instead of water)
  • Add skim milk powder (2 to 4 tbsp. for each 250 ml/1 cup of liquid or semi-solid food to regular milk & milk drinks, mashed potatoes, hot cereal, cream soups, recipes for casseroles, meatloaf, breads, muffins, sauces, puddings, custards
  • Add tofu to soups, casseroles, stir-fries
  • Add peanut butter or other nut butters to fruit slices, toast, muffins, crackers, ice cream, milkshakes
  • Add nuts and seeds to casseroles, bread recipes, muffins, cookies, salads, ice cream sundaes
  • Add chopped cooked meat, poultry or fish to salads, soups, scrambled eggs, quiches, baked potatoes, pasta
  • Add hard-boiled eggs to salads, sandwiches, vegetables, potatoes
  • Add legumes, lentils to salads, dips, soups, pasta, rice, casseroles

You’ve lost your appetite (and some pounds) Adapted from: Eating Well When You Have Cancer, Canadian Cancer Society (2009)

Loss of appetite is very common. Fear, stress, fatigue, treatments and medications that slow down your digestion affect your appetite.

Try to eat…

  • By breaking your day up into several small meals and snacks
  • By enjoying a food you crave, even if it is not part of the food guide!
  • By choosing a liquid that hydrates you and adds some calories: fruit or vegetable juice, milkshake, slushie, pop, popsicles, jello, lemonade, sweetened iced tea, ice cream, broth or cream soup
  • By forcing yourself to eat something anyway
  • By getting a little fresh air to work up an appetite
  • By drinking a complete nutritional supplement (such as Boost or Ensure). One box provides 25% of your daily vitamin and mineral needs, two boxes provides 50%, and so on. A real helping hand that is hard to match with something homemade.

Everything tastes awful

Many people discover a new situation and a new word: dysgeusia, or distortion of the sense of taste. Everything tastes awful in the mouth, even water. Think about a food you hate the most… and imagine everything you eat for breakfast, lunch and dinner having the same horrible taste as this food. Result: gagging at the thought of eating, you lose all interest in food, you reduce your portions and you skip meals. Sometimes a sick person must be fed through a nasogastric tube (from the nose to the stomach), simply because they find it unbearable to put such awful-tasting food into their mouth.

If a food has a bitter, metallic or downright gross taste, try:

  • Smooth and soft foods that require less chewing
  • Liquid food that is faster to swallow
  • Make food in a non-metallic pan or dish (glass, cast iron, plastic)
  • Use plastic, wooden or horn-handled utensils to mix, serve and eat
  • Alleviate the pronounced taste by serving food cold or at room temperature
  • Suck on a mint or sugar-free candy to get rid of the bad taste

You don’t feel like cooking

  • Ask those around you for help
  • Buy fresh or frozen prepared meals
  • Order from a neighbourhood restaurant
  • Stock up on off-the-shelf nutritional supplements that are calorie and protein rich, available in different forms: liquid, tablet or pudding
  • Join Meals-on-Wheels or another service offered in your community

Precious resources

Too many people with cancer neglect to add food to their list of priorities, and eat less and less. Here are some ideas to help them and inspire their loved ones.

Eating well when you have cancer - A guide to good nutrition. Also Chemotherapy and other drug therapies: practical guide, and Radiation Therapy: A guide for people with cancer. Three free publications offered by the Canadian Cancer Society, available at For a printed copy, call toll free at 1-888-939-3333.

Healthy Eating during Chemotherapy – José van Mil and Christine Archer-Mackenzie; Kyle Cathie, publisher, 2009. A book of recipes devised by a chef and based on nutritional advice. There are 100 recipes classified by texture (ex. smooth, tender, crispy, liquid) that have been created to excite the palate without over-stimulating it, together with helpful advice and practical information.

Hélène Laurendeau

A nutrition and health enthusiast who loves to share: this description fits Hélène Laurendeau to a tee. She has been active for more than 25 years in the media and communications field. Nutritionist, host, columnist, author and speaker, Hélène holds a Bachelor degree in Nutrition and a Master degree in Epidemiology. She has spread her knowledge alongside Ricardo every week since 2005, as part of his daily show broadcast on ICI Radio-Canada Télé, as well as in Ricardo magazine, where she pens the Bien se nourrir (Eating Well) column.