TIPS FOR CONQUERING EATING PROBLEMS

MOUTH AND THROAT SORES

POSSIBLE CAUSE: TBI, chemotherapy, methotrexate, oral infections, GVHD

DO:

• Eat foods lukewarm or cold, rather than hot.
• Cook foods until tender and soft.
• Drink through a straw to bypass mouth sores.
• Eat high protein, high calorie foods to speed healing of the sores.
• Try a liquid or blenderized diet, or a complete nutrition supplement such as Ensure® or Carnation Instant Breakfast®.
• Eat soft foods such as cream soups, cheeses, mashed potatoes, yogurt, eggs, custards, puddings, cooked cereals, ice cream, milk shakes and pasteurized eggnog.
• Eat cold foods such as milk shakes, cottage cheese, yogurt, watermelon, gelatin and soft, canned fruit (blenderized, if necessary).
• Eat soft, non-irritating frozen foods such as popsicles, ice cream, frozen yogurt, and slushes.
• Drink fruit nectars and fruit flavored beverages instead of acidic juices.
• Maintain good mouth care.
• Request pain medications if discomfort is severe.

DON’T:

• Eat or drink tart or acidic foods and beverages such as citrus fruits and juices, and pineapple juice.
• Eat or drink salty foods and drinks, including broth.
• Use strong spices such as peppers, chili powder, nutmeg and cloves.
• Eat rough or coarse foods such as raw fruits and vegetables, dry toast, grainy cereals and breads, and crunchy snacks.
• Drink alcoholic beverages.
• Eat or drink extremely hot foods or beverages.

DRY MOUTH

POSSIBLE CAUSE: TBI, Anti-nausea medications, antihistamines, chronic oral GVHD

DO:

• Add sauces, gravies, broth and dressings to foods.
• Suck ice chips, popsicles, gum or sugarless hard candies to keep the mouth moist.
• Try including citric acid in your diet to stimulate saliva production. Citric acid is present in oranges, orange juice, lemon, lemonade and sugarless lemon drops. You can also add lemon to tea, water and soda.
• Drink liquids with your meals.
• Practice good mouth care.
• Ask your dietitian or doctor about commercial saliva substitutes such as Salivart®, Mouth-Kote®, Saliva Substitute®, and Xerolube®.

DON’T:

• Eat plain meats, bread products, crackers, or dry cake.
• Eat or drink very hot foods or beverages.
• Drink alcohol.

CHANGES IN TASTE

POSSIBLE CAUSE: TBI, chemotherapy, some pain medications, some antibiotics

DO:

• Eat and drink foods and beverages cold or at room temperature.
• Eat strongly flavored foods such as chocolate, lasagna, spaghetti or barbequed foods, unless you have mouth or throat sores.
• Eat tart or spicy foods, unless you have mouth or throat sores.
• Select foods that smell appetizing.
• Drink fluids with your meal to rinse away any bad taste.
• Eat protein foods without strong odors, such as poultry, eggs, and dairy products rather than those with strong odors such as beef and fish.
• Use plastic utensils if foods seem to have a metallic taste.
• Add sauces to foods.
• Try eating meat with something sweet, such as cranberry sauce, jelly or applesauce.

NOTE:

· Some patients have trouble eating bland foods such as casseroles, custards, puddings, unsalted chips and crackers, overcooked vegetables, plain meats and plain fish. Red meat, chocolate, coffee and tea may also be difficult to tolerate.

THICK SALIVA

POSSIBLE CAUSE: TBI, dehydration

DO:

• Drink club soda (seltzer) or hot tea with lemon.
• Try sucking sugarless, sour lemon drops.
• Eat a lighter breakfast if you have mucous build up in the morning, and bigger meals in the afternoon and evening.
• Rinse frequently with a saline solution (1 quart water to 3/4 tsp. salt, and 1 teaspoon to 1 tablespoon baking soda).
• Drink lots of fluids.
• Eat soft, tender foods such as cooked fish and chicken, eggs, noodles, thinned cereals, blenderized fruits and vegetables diluted to a very thin consistency.
• Eat small, frequent meals.
• Drink diluted juices, broth-based soups, and fruit flavored beverages such as Koolaid® or Hi-C®.
• Switch to a liquid diet if problem is severe.

DON’T:

• Eat meats that require chewing, bread products, gelatin desserts, oily foods, and hot cereals.
• Drink thick cream soups or nectars.

NAUSEA AND VOMITING

POSSIBLE CAUSES: Chemotherapy, TBI, drugs to control GVHD such as cyclosporine, methotrexate, drugs to control infections such as trimethoprim-sulfamethoxazole (Bactrim® or Septra®), pain control medications (narcotics), interferon, interleukin-2, gastrointestinal GVHD, infection, mucous drainage from mouth and sinuses

DO:

• Eat small, frequent meals.
• Eat dry crackers or toast.
• Eat cold foods, rather than warm foods, because they tend to have less food odor.
• Eat low fat foods such as cooked vegetables, canned fruit, baked skinless chicken, sherbet, fruit ice, pretzels, toast, crackers, vanilla wafers, and angel food cake.
• Drink clear cool beverages such as carbonated beverages, flavored gelatin, popsicles, and ice cubes made of a favorite liquid.
• Sip liquids slowly through a straw.
• Sip or drink small amounts of liquid frequently throughout the day.
• Request that food trays be brought to you without covers on the plates to avoid being overwhelmed by the smell.
• Request medications to control the nausea if it is severe.

DON’T:

• Go near cooking areas where smells might be offensive.
• Eat spicy foods.
• Eat overly sweet foods.
• Eat foods with strong odor.
• Eat high fat, greasy foods.
• Drink a lot of liquids with meals.
• Drink hot liquids.
• Lie flat on your back after eating. If you need rest, sit or recline with your head elevated.

LACK OF APPETITE/WEIGHT LOSS

POSSIBLE CAUSE: TBI, chemotherapy, infection, psychological problems such as depression, fatigue

DO:

• Eat small, frequent, high-calorie meals.
• Drink high-nutrient liquids such as juice or milk, instead of low-calorie drinks like coffee, tea or diet soda.
• Eat dense, high-calorie foods such as cheese, whole milk, cream, whipped cream, sour cream, cottage cheese, ice cream, extra butter or powdered milk, eggs, oil, mayonnaise, peanut butter, wheat germ, nuts, instant breakfast beverages and fruits.
• Use carbohydrate supplements such as Polycose®, protein powders such as Promod® or Casec®, or complete nutrition supplements such as Ensure®, Boost®, Carnation Instant Breakfast® or Sustacal®, provided they’ve been approved by your dietitian. Alternatively, nonfat dry milk powder can be added to casseroles, cooked cereals and mixed dishes.
• Create a pleasant, mealtime atmosphere, eg. colorful place settings, varied food colors and textures, soft music, enhancing food aromas.
• Engage in light exercise to stimulate your appetite.
• Keep trying to eat. Eating well is as important as some of your medications. It’s important you keep trying to eat, even if you don’t have much of an appetite.
• Address the psychological problem, if one exists, with the help of a psychologist or social worker.

DIARRHEA

POSSIBLE CAUSE: TBI, chemotherapy, some antibiotics, gastrointestinal GVHD, intestinal infections, oral medications such as magnesium salts, metoclopramide (Reglan®), lactose intolerance

DO:

• Eat smaller amounts of food at each meal.
• Increase your intake of fluids to prevent dehydration.
• Drink fluids between meals, rather than with meals.
• Eat and drink foods and beverages high in potassium and low in fiber such as ripe bananas, potatoes without the skin, tomato juice, Gatorade®, orange juice, peach and pear nectar, baked fish and chicken, ground beef, eggs, well cooked vegetables (excluding beans, broccoli, cauliflower and cabbage), canned fruit, rice and white bread.
• Use Lactaid® treated dairy products or low-lactose milk and dairy products.

DON’T:

• Eat high fiber foods such as bran, whole grain cereals and bread, vegetables, fruits, popcorn, nuts and seeds.
• Eat or drink dairy products such as milk, cheese and yogurt, unless they are treated with Lactaid®.
• Eat foods that can cause gas or cramps such as carbonated beverages, beans, broccoli, cauliflower, cabbage, chewing gum, and highly spiced foods.
• Eat rich gravies and sauces.
• Eat or drink foods and beverages containing caffeine such as tea, coffee, chocolate and colas and other caffeinated soft drinks.

CONSTIPATION

POSSIBLE CAUSE: Narcotics, chemotherapy

DO:

• Increase fluid intake.
• Drink warm beverages.
• Eat high fiber foods such as raw fruits and vegetables, whole wheat bread and cereals, dried fruit, dried peas and beans.
• Engage in light exercise.
• Ask your doctor about stool softeners or laxatives if the problem persists.

DON’T:

· Skimp on fluid when increasing your fiber intake.

WEIGHT GAIN

POSSIBLE CAUSE: Steroids, such as prednisone, that cause fluid retention

DON’T EAT/OR REDUCE INTAKE OF:

· Salt. Don’t salt foods and avoid foods that are high in salt such as the following:

Meats: bacon, bologna, cold cuts, chipped beef, corned beef, hot dogs, ham, salt pork, sausage, canned and salted meats.

Prepared Foods: bouillon, canned or frozen soups, frozen dinners, olives, pickles, pizza.

Salted Snacks: potato chips, pretzels, corn chips, pop corn, etc.

Seasonings: Salt, catsup, celery salt, onion salt, chile sauce, monosodium glutamate (MSG), mustard, soy sauce, steak sauces, any seasoning mixed with salt..

Vegetables: sauerkraut, beans cooked with salt pork.

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