Barriers to receiving adequate nutrient intake in brain or spinal cord patients can be broken down into two main categories: tumor-related and treatment-related. Tumor-related challenges include neurological symptoms (e.g., headaches, seizures, weakness, confusion, etc.), nausea/vomiting, fatigue and Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)-which results in the body retaining too much water. Treatment-related challenges oftentimes include inflammation or high blood sugar levels from steroids, nausea/vomiting, fatigue, diarrhea and constipation and mouth sores. See below for listed strategies aimed at minimizing both sets of side effects all while working to achieve adequate nutrient intake.
Decreased appetite
- Small, frequent meals with regular meal/snack times
- Calorie-containing fluids
- Nutrient-dense foods
- Fluids between meals
- High Calorie, High Protein oral supplements such as Ensure or Boost or make your own
- Take medications with calorie-containing fluids as able
Nausea & Vomiting
- Limit odors
- Carbohydrate-containing foods
- Small, frequent meals
- Bland foods (cereal, potatoes, cheese sticks, hard boiled eggs, yogurts, applesauce)
- Avoid overly spicy, greasy or sweetened foods and fluids
- Try ginger (ginger tea, Ginger-ale)
- Stay upright >30 minutes after eating
Diarrhea
- Small, frequent meals
- Include foods with bulking fiber such as bananas, rice, applesauce, toast
- Drink plenty of fluid (non-carbonated and caffeine-free)
Constipation
- Drink plenty of fluids, try prune juice (non-carbonated); try drinking a warm beverage
- Establish a bowel regimen
- Introduce physical activity (consult with your doctor first)
- Gradually add fiber to diet as tolerated
- If bloated, avoid gas-forming foods (beans, broccoli, cauliflower, onions, garlic, etc.)
Fatigue
- Simplify meal prep (convenience food items, frozen meals, prep extra meals when feeling well
- Have ready-to-eat snacks available (trail mix, string cheese, dried fruits, pudding, peanut butter/crackers)
- Use oral nutrition shakes as needed
- Be physically active as appropriate
Sore Mouth
- Cool or room-temperature foods are often easier to tolerate than hot/warm
- Soft, tender foods
- Use a straw
- Non-acidic foods and fluids
- Avoid alcohol-containing mouth rinses all while practicing good oral hygiene
- Consider use of mouth numbing rinses prior to eating
- Foods/Beverages to try: applesauce, cottage cheese, mashed vegetables, milkshakes, smoothies and/or cooked cereals
Elevated Blood Sugars
- Choose whole grains such as wheat bread, brown rice, whole wheat pasta over highly processed grains
- Avoid sugary beverages such as juice and regular soda
- Minimize intake of simple carbohydrates such as cookies, cakes, baked goods
- Aim for evenly spaced meals or snacks (every 2-3 hours)
Tips for Reducing Thirst during Fluid Restriction
- Chew gum or suck on hard candy
- Rinse or gargle with mouthwash. Do not swallow.
- Limit salt intake. High salt intake might make you thirstier.
- Space your liquids out throughout the day.
- Consider ice chips or popsicles to help quench thirst.
For those patients with minimal side effects before, during and/or after treatment, one’s focus shifts to improving overall survival with lifestyle changes. When performing nutrition research on your own, the key is to make sure recommendations are evidenced-based. Avoid “googling” as this will only increase your chances of misinformation. One topic that your likely to stumble upon is the the use of the Ketogenic Diet. The Ketogenic Diet is a high fat, moderate protein, low carbohydrate diet whose role in slowing down tumor growth in brain cancer patients has been the source of much debate in recent years. Overall, the diet is very restrictive and eliminates key nutrients. Study results are mixed, with most demonstrating little to no benefit in reducing overall tumor growth. For answers to other FAQ’s that relate to not only patients with brain or spinal cord cancer, but also other cancers visit The Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics.
Meanwhile, concentrate on maximizing foods that you are able to eat to maintain your strength, maintain a healthy weight and aim to incorporate all food groups in your diet-especially when feeling well. Talk to your doctor and request a referral to meet with a registered dietitian, ideally one that is also a Board Certified Specialist in Oncology Nutrition (CSO). When it comes to navigating research-based information and avoiding false nutrition claims related to brain and spinal cord cancers, a registered dietitian is key to keeping you on track!
