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Nourish Thyself
by Bernadette Festa, MS, RD

Why Does My Food Taste Different
What Diet for Low White Blood Cell Count

What Foods Should I Eat After Finishing Treatment

How do I choose a multi-vitamin
What internet sites do you recommend?

Why Does My Food Taste Different
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Since I started chemotherapy, food just doesn't taste the same, is there anything that I can do?

It's not uncommon to have taste changes with chemotherapy and some types of radiation therapy. People may experience changes in smell as well as taste perception. Both smell receptor and taste bud cells are rapidly dividing cells. Many cancer chemotherapy agents act by killing off rapidly dividing cells, including these receptor cells. We tend to be more sensitive to metallic and bitter tastes, but not to sweet tastes. Bitter and metallic tastes are intensified possibly causing food aversions whereas sweet tastes tend to be tolerated well. Metallic and bitter tastes are usually perceived in foods such as meat (from the amino acids) and flavors like soy sauce.

Here are some tips to enhance the taste of food while undergoing therapy:

- Sweeten the food that you eat with healthy alternatives such as fruit juices, fruit sauces or dessert baby food.
- Use fruit sauces to accompany meats
- Serve fruit nectars with meals.
- Enhance the flavor of meat, chicken or fish by marinating with fruit juice or sweet wine. Serve with a fruit sauce as papaya, mango, applesauce or sweetened cranberry sauce.
- Try colder foods to eliminate smells; cold foods can be good sources of protein and calories, can help if you have mouth sores (mucositis) and act as a local anesthetic.

Try some of these delicious cold sources of protein:

- Cottage cheese with pineapple or your favorite fruit
- Fruited tofu - mash tofu then add a banana and berries for a festive treat
- Vanilla yogurt with bananas or your favorite fruit
- Shakes with milk or soymilk

What Diet for Low White Blood Cell Count
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I've been told that I have a low white blood cell count and that I should avoid raw fruits and vegetables. Why do I need to do this and is there any other foods that I should avoid?

Your immune system will not be as strong when your white cell count is low, a condition called neutropenia. Neutropenia can occur during or shortly after chemotherapy or radiation therapy. So, during this time, while your body's immune system may not have the ability to fight infection and foreign substances, it is important to take precautions with food to lessen your exposure to infection-causing organisms. Some people will only need to avoid raw fruits and vegetables while others may need a stricter approach. Check with your medical team to determine the best eating plan for this time.

Here are some tips and suggestions:

Eating Out

- Avoid Sushi, raw fish, smoked fish
- Avoid salad bars, delicatessens, buffets and smorgasbords, potlucks, sidewalk vendors
- Fast Foods - ask that food be prepared fresh
- Use only single-serving condiment packages; avoid self-serve bulk condiment containers
- Avoid free food samples

Grocery Shopping

- Use fresh meats, poultry and seafood with packaging dates only. If they are out of date, do not purchase.
- Check Sell By and Use by dates.
- Inspect cans for any damage, swelling, rust, or denting, choose intact cans only.
- Do not purchase cracked or unrefrigerated eggs
- Select unblemished fruits and vegetables, buy them with a skin which can be peeled as oranges, bananas, winter squash.
- Don't use foods from self-service bins, as bulk foods
- Purchase frozen and refrigerated foods last
- Store groceries promptly

Foods to Avoid

- Raw and undercooked meat, fish, sushi, shellfish, poultry, eggs
- Cold, smoked fish (salmon) and lox
- Any food which contain raw eggs
- Unpasteurized juices, milk, cheese, yogurt, and honey
- Miso products
- Soft-serve ice cream, milkshakes, and frozen yogurt from yogurt machines
- All moldy and out-dated food products
- Aged or moldy cheeses as certain sharp cheeses, blue cheese
- All raw vegetable sprouts such as alfalfa and mung beans
- Herbal preparations
Use Food Safety Strategies

- Always wash hands with warm soapy water, for 15 seconds, before and after preparing food and before eating
- Use separate cutting boards for meat and vegetables
- Thaw meat, fish, or poultry in the refrigerator. Use defrosted foods right away; do not refreeze.
- Never leave perishable food out of the refrigerator for more than two hours. Dishes containing egg, cream or mayonnaise should not be left out of the refrigerator for more than one hour.
- Cook eggs until the white are completely hard and the yolks begin to thicken
- Wash the tops of cans and the can opener before using
- Cook meats until well-done and no remaining pink
- Never taste food that looks or smells strange
- Always wash fruits and vegetables under running water before peeling and/or cutting.

These recommendations have been adapted from patient guidelines provided at the Fred Hutchinson Cancer Research Center.

What Foods Should I Eat After Finishing Treatment
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I've just finished chemotherapy treatment, feel very weak and have been told that my red blood cell level (Hemoglobin and Hematocrit), is low, what foods/supplements should I be eating to feel better and to be healthier.

Low hemoglobin and hematocrit are common after treatment. It is important to give your body nutrients that it needs during this time to provide the foundation to build your red blood cells. Iron and Vitamin B12 can help. The meat group (beef, chicken and fish) is especially high in these nutrients. Have about 3-4 oz of lean meat at both lunch and dinner daily. Other things that can help is cooking in cast-iron pots which contribute iron to the diet. Having a Vitamin C food source at meals will also boost iron consumption from the vegetable and bean group. So, have a small glass of orange juice, or a fruit such as an orange, grapefruit, melon, tangerine or raw bell pepper with your meals. The amount of iron in a multi-vitamin should be adequate for your needs, I wouldn't encourage supplemental iron unless your doctor recommends it. As your blood count goes up you will start to feel better and have more energy. The lifespan of a red blood cell (RBC) is about 120 days, therefore it may take up to 3 months to see your red blood cell level return to normal range.

The main goal at this time is to give your body adequate calories and protein that it needs. In the long-term, you want to aim for more fruits and vegetables and a more vegetarian-like diet. However right now, you may find that your digestion is sensitive so go slowly in increasing the fruit, vegetable and legume (bean) group. The decision to take additional antioxidants (Vitamin C, E, beta-carotene and selenium )is a personal one. Check with your medical team if you plan on using these to ensure safety after your chemotherapy or radiation treatment.

How do I choose a multi-vitamin
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How do I choose a multi-vitamin?

It is always best to meet your needs through proper food choices however it may not always be possible if you have had

- Loss of appetite, taste or smell
- Surgery to the head and neck areas with swallowing difficulty
- Cancer of the digestive tract
- Impaired digestion or absorption of nutrients
- Low calorie intake, especially under 1200 calories per day

Reading the Label
Check the daily value. The Daily Value (DV) is a government standard that specifies the minimum daily requirements to prevent deficiency disease in healthy people. The DV is based on an intake of a least 2,000 calories per day.

Look for USP on a label. This specifies that the supplement meets the standards of the U.S. Pharmacopoeia.

Read specialized formulas (those for women, men, seniors, etc.) carefully. Claims aren't regulated; each company sets its own standards. For example, women's formulas have additional calcium, but may lack the DV for Vitamin D, which is a helper for calcium absorption.

Check the expiration date!

Look for 100% of the Daily Value for Vitamins B1 (thiamin), B2 (riboflavin), niacin, Vitamin B6, B12, C, D, E, and folic acid. If you do intend to have additional supplementation of the antioxidants such as Vitamin C or E it may be advantageous to take these separately. Most of the multi-vitamins do not provide adequate supplemental amounts of these.

Check the Serving Size
In some instances you have need to swallow up to six tablets daily to get the requirements listed on the label.

Skip the iron in a multi-vitamin
For cancer patients, it is advisable to ask your medical team about whether or not you should take iron in a multi-vitamin. Usually, unless you have iron-deficient anemia, are at risk of anemia, or have had recent surgery, your may not desire to take additional iron. Iron supplements can also cause constipation and you will need to increase your fiber and fluid intake.

Additional tips
It is advisable to take the vitamin with food to assist with absorption. MVI's as a rule, work better when taken with food. Determine which is the best form for you to take. Supplements are available in liquid form as well as chewable tablets for those with problems swallowing.

If you are presently on chemotherapy or radiation therapy or awaiting surgery, always check with your medical team before taking any supplement.

What internet sites do you recommend
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Question: I want to find out more information about nutrition and cancer. What internet sites do you recommend?

Answer Nutrition Resources for the Cancer Patient


- - National cancer institute
- - Good nutrition is needed for general good health and is particularly important when you are ill..
- - general nutrition eating tips; website of the American Dietetics Association
- - Food and nutrition information center
- - National Center for Complementary and Alternative Medicine website, information on supplements/herbs

Nutritional Supplements

- - Ross Products Division Home Page
- - Mead Johnson Nutritionals

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