Much has been written about eating a healthy diet to lower your risk of breast cancer. But what kind of diet should you eat once you already have breast cancer? That same healthy diet; you’re now trying to avoid a recurrence. But you may not be able to stick to that healthy diet when chemotherapy robs you of your sense of taste and/or smell; and not only takes away your appetite, but makes even the thought of food well, sickening. What kind of diet do you follow when you can barely eat?
It’s one of your biggest and most immediate fears when you hear you have breast cancer. Right after you think, “I’m going to die. I’ll never see my kids grow up” never hold my first grandchild," you think, “Oh, no — does this mean I’ll have to have chemo?”
Horror stories around the ravages of chemo are ubiquitous. Everyone knows someone whose aunt, or cousin, or best friend had chemo, and how bad it was. How sick it made your mother-in-law. How your boss’ wife lost her hair. Even how a friend of a friend of a friend died not from cancer, but from chemo.
First of all, ignore the second-hand stories. Millions of people undergo chemotherapy as part of cancer treatment, and live to tell the tale — the key word being “live.” Chemo has been proven to save lives; potentially yours. So if your oncologist urges you to have chemo, think hard before letting its side effects — and yes, they’re real and negative — scare you off.
Not everyone gets every chemo side effect. And not every side effect, even if you get it, lives up to its worst potential. Many women go through chemotherapy for breast cancer with minimal disruption to their lives; I was one of them.
Yes, chemo was hard. I lost my hair; my mouth tasted like a rusty tin can; I was queasy much of the time (think mild morning sickness). I got sores in my mouth and throat. I was tired.
But I never missed a day of work, beyond the actual days when I got treatment. And 11 years later, I’m still NED (no evidence of disease) — apparently cancer-free.
I learned some lessons about food and chemo, and I’d like to share them with you — along with some of the common (sense) wisdom around what to eat when you don’t feel like eating.
You might consider NOT eating your favorite foods while undergoing chemo. Once you’re finished treatment, you’ll forever associate the foods you ate, on a visceral level, with the chemo experience — and you’ll probably no longer enjoy the blue Gatorade you sipped to hydrate yourself, or those butter-rum Lifesavers you sucked on to try to get the metallic taste out of your mouth. To this day, I can’t stand the thought of the ham-and-cheese sandwiches on white bread passed out by cheerful volunteers while I was getting my chemo infusion.
Ice — yes
Many women have told me that sucking on ice chips the first 5 minutes of your chemo infusion cuts down on potential mouth and throat sores. There’s little to back this up in the research literature, except in the case of one particular chemo drug: 5-FU (fluorouracil), where ice did seem to help. Nevertheless, it’s easy to suck on ice chips (or an ice pop) — so why not give it a try?
Spicy foods — no
Chemotherapy does a number on your mucous membranes. You may find yourself more prone to nosebleeds (or bleeding from other “delicate” parts of you anatomy); you’re at risk of mouth/throat sores; and your tongue, throat, esophagus, and stomach will be more sensitive than normal. Don’t challenge your digestive system when you don’t have to; eliminate spicy foods for the duration of treatment. Even if you crave buffalo chicken wings, don’t go there; you might be sorry.
Have a little something
You may be tempted to eat nothing at all before your infusion. If there’s nothing in your stomach, then you don’t have to worry about nausea — right?
Wrong. Eating nothing is just as prone to make you feel sick as too much (or the wrong things) in your stomach. Strike the perfect balance by eating just a little bit: some crackers, a piece of toast, maybe a scrambled egg. Also, stay hydrated: plain water is completely unobjectionable to your stomach, but you may find you can tolerate clear broth, tea, juice, or even a fruit smoothie. Once you’re home, go easy on the food for the first 24 to 36 hours, or whatever the time period for nausea onset is for your particular chemo regimen (the nurse will let you know). But again, don’t eat nothing; small amounts of easy-to-digest food on a regular basis — say, 4 to 6 times a day, or more - are better than nothing; and certainly better than a huge meal.
Flat (de-carbonated) ginger ale, ginger tea, plain water with ginger syrup: ginger is a natural anti-nausea agent. If you like ginger, now’s the time to keep it handy, in all its many forms. However, the ginger in that big slice of pumpkin pie á la mode doesn’t make it a good choice for your queasy belly
Avoid greasy foods; higher-fat is OK
Deep-fried anything? Don’t go there; too hard to digest. But other higher-fat foods will add needed calories to your diet at a time when you need to keep your strength up, yet probably don’t feel like eating.
Full-fat dairy products are usually easy to tolerate, and add protein to your diet. Ice cream, yogurt, milk, cheese (cream cheese, cottage cheese), sour cream, butter — all can be enjoyed in small amounts, and will increase your calorie count. Other bland-yet-higher-calorie, non-greasy foods like eggs, tuna, and peanut butter are also a good choice.
If you’re a mom, you may be familiar with this acronym: it stands for bananas, rice, applesauce, and toast, the mildest possible foods for kids’ upset tummies. During chemo, you may find yourself turning to the BRAT diet for sustenance, on those days when nothing at all sounds appealing. A piece of lightly buttered cinnamon toast; a banana, cut in small slices; rice pudding; applesauce with a drizzle of maple syrup your stomach needs something in it, and you need the calories.
Obey your doctor’s orders
Finally, listen carefully to anything your oncologist has to say about eating during chemo. Some foods react adversely with some chemo drugs; your doctor will tell you which, if any, to avoid. Second, if s/he recommends an anti-nausea drug, take it. And take it on the recommended schedule; don’t wait until you feel sick, because by then, it’s probably too late for it to work.
Chemo is tough. There’s nothing you can do about some of its side effects (hair loss, neuropathy); and little you can do about nausea that resists all the drugs and eating strategies. But if you simply find yourself not hungry, or turned off by food, be proactive about eating the right things, on the right schedule. Dietary diligence will pay off — both in how you feel during chemo, and how quickly you recover afterwards.
PJ Hamel is senior digital content editor and food writer at King Arthur Flour, and a James Beard award-winning author. A 16-year breast cancer survivor, her passion is helping women through this devastating disease. She manages a large and active online survivor support network based at her local hospital and shares her wisdom and experience with the greater community via HealthCentral.com.