What to Eat During Chemotherapy

By Meredy Birdi, Cancer Dietitian and Nutritional Therapist

You may have asked your healthcare team what you should eat during chemotherapy and been told something along the lines of “just eat healthily”.

It’s absolutely well-intended. It’s often meant to reassure you that there isn’t a special diet you need to follow, or another set of rules to get right and another layer of stress to add.

But on the flip side, it can feel really underpowered when you know there must be more you can do to nourish and support yourself through treatment. And there is.

Good nutrition can support you in so many ways during chemotherapy.

An important part of this is recognising that eating well can sometimes feel a little like a moving target. Food might taste different, nausea might come and go, your appetite or digestion might change, your mouth might become sore or dry, or you might be too tired to think about what to eat, let alone make it.

This is why good nutrition during chemotherapy needs to flex around you.

You can absolutely nourish yourself well while adapting what and how you eat around your treatment, your symptoms, your appetite and the reality of how you’re feeling.

How can good nutrition help during chemotherapy?

Here are just some of the ways good nutrition cam support you:

• Maintaining muscle mass and strength. Keeping your muscles nourished, alongside moving your body, is one of the most important things you can do during treatment and beyond. I camt stres this enough.

• Supporting your immune system and reducing your risk of infection. Your immune system relies on adequate energy, protein and a wide range of vitamins and minerals to function well.

• Supporting your strength and energy. Eating well helps provide the energy and nutrients you need through treatment and recovery.

• Supporting gut and digestive health. A varied, nourishing diet can support your digestive health and gut microbiome.

• Helping you tolerate treatment and its side effects. Being well nourished can help put you in a stronger position to cope with treatment, tolerate side effects and recover between treatments.

• Maintaining a healthy weight and good nutritional status. For some people, this will mean preventing unintentional weight or muscle loss. For others, treatment can lead to weight gain and the focus may be on supporting a healthy weight.

• Supporting healing and recovery. Good nutrition provides the energy, protein, vitamins, minerals and other nutrients needed for repair and recovery during treatment.

The American Institute for Cancer Research (AICR) captures the wider picture really well in this infographic:

Credit: American Institute for Cancer Research

I think this is such a powerful message because it reflects what I’ve seen throughout my years working in cancer care: nutrition isn’t an optional extra. It should be part of your cancer treatment plan from day one.

Should I wait until after chemotherapy has finished to focus on nutrition?

This is something people sometimes ask when they get in touch with my office. They’re trying to get the timing right. There is already so much going on during treatment, and they wonder whether they might have more time, energy and headspace to focus on nutrition afterwards.

My answer is: please don’t wait.

If you leave nutrition until chemotherapy has finished, you’re missing out on all the ways it can support you while you’re actually going through treatment.

And an important point is that eating well shouldn’t, and doesn’t need to, become another full-time job. Good nutrition should reduce the load, not add to it.

It’s about getting some good foundations and patterns in place, with enough flexibility to work around treatment and how you’re feeling. You can nourish yourself really well without every plate needing to be perfect.

How can I stay hydrated during chemotherapy?

Drinking enough can sometimes feel difficult during chemotherapy. Water might not taste right, you might not fancy drinking very much, or nausea or a sore or dry mouth can make it harder. And when fatigue sets in, even the thought of getting up to fill your glass can feel like more than you have energy for.

A few small changes can make drinking easier:

• Make drinks more appealing. Adding lemon, lime, orange, berries, mint or ginger to water can add flavour and make it look more inviting too. Herbal teas are another option and can be enjoyed warm or chilled.

• Play around with temperature. Cold, room-temperature or warm drinks can all feel different, particularly if your taste has changed. You might also find you prefer sparkling water to still, or vice versa.

• Make drinks easy to reach. Keep a bottle or glass beside you and take drinks with you when you go out. A straw can sometimes make drinking easier too.

• Drink little and often. If a full glass feels like too much, regular smaller amounts can be easier to manage.

If you’re not managing to eat as much as usual, your drinks can also help you get some extra nutrition on board. Milk, fortified plant-based alternatives, smoothies and milkshakes can all contribute, and you can add things like yoghurt, nut butter, oats or avocado to top up nutrition. Soups can be another useful option if you prefer something savoury.

If you’re struggling to eat and drink enough, nutritional supplement drinks can sometimes be helpful. Some are available to buy and others can be prescribed by your healthcare team. You can read more about nutritional supplement drinks here.

Why is protein important during chemotherapy?

Protein is particularly important during chemotherapy because it helps you maintain muscle mass and strength, supports your immune system and provides the building blocks your body needs for repair and recovery.

Your protein needs may also be higher during cancer treatment, particularly if you have lost weight or muscle, are recovering from surgery or infection, or your body is under additional stress.

Rather than having most of your protein in one meal, I usually encourage people to include a good source of protein with each meal. This helps to spread your protein across the day and makes it easier to meet your protein needs.

Good sources of protein

Examples of protein-rich foods include:

• Fish and seafood

• Eggs

• Meat and poultry

• Milk, yoghurt and cheese

• Tofu, tempeh and edamame

• Beans, lentils and chickpeas

• Nuts, seeds and nut or seed butters

Making protein easier when eating feels difficult

When your appetite is smaller or you don’t feel like eating very much, a large protein-rich meal can feel like a lot. Smaller amounts across the day can be much easier.

Some ideas include:

• Greek yoghurt with fruit, nuts or seeds

• Eggs on toast or a boiled egg as a snack

• Hummus with pitta

• Cheese with crackers

• A small bowl or mug of soup with lentils, beans or grated cheese added

• A smoothie with yoghurt, milk or fortified soya milk and nut butter

• A handful of nuts or some edamame

• Tinned fish on toast or crackers

You can also top up foods you’re already eating. Try adding Greek yoghurt to soup, ground nuts or nut butter to porridge, grated cheese to vegetables, or an egg to soup or noodles.

Small additions like these can help you get more protein in without making the amount you need to eat much bigger.

Get to know your treatment pattern and manage symptoms early

Before your first chemotherapy treatment, there can be so many unknowns. You don't yet know how you're going to feel, which symptoms you might experience or what eating is going to look like.

After the first cycle, many people I support start to notice a pattern. You might have a few days when your appetite is better, followed by days when eating feels harder. Your energy, taste, bowels and other symptoms can change across the cycle too.

It can be really helpful to keep a note of how you're feeling and when symptoms happen. You could use your diary or calendar, or the notes on your phone, whatever works best for you. You don't need to track every little detail, but noting when symptoms start, how long they last and which days tend to be more difficult can give your treatment team a much clearer picture of what's happening. This can help them advise you more specifically and look at whether any of your medications need adjusting, or whether something else could be added to help.

Importantly, please don't feel you just have to put up with side effects. Good symptom management is a key part of supporting you through chemotherapy. When symptoms are better managed, it can make a really big difference to eating and drinking, but also to moving your body, sleeping and how you're feeling more generally.

You can find lots more practical ideas for managing nausea, appetite changes, taste changes, a sore or dry mouth, constipation, diarrhoea and other treatment side effects in Nutrition tips to help manage cancer treatment side effects.

How can I make eating easier during chemotherapy?

Food can sometimes feel harder to manage during chemotherapy. Your appetite might be low, foods you usually enjoy might not taste the same, you might be feeling really tired, and then, on top of all that, there’s deciding what to eat and finding the energy to make it.

This is where a little planning can really help. Look for quick wins that make eating well easier and take some of the thinking and effort out of it.

• Keep some easy snacks within reach. Things like oatcakes with hummus or nut butter, cheese and crackers, a boiled egg, fruit with a handful of nuts or seeds, or yoghurt with fruit and a sprinkle of nuts or seeds can give you something nourishing without needing much preparation.

  
  

• Plan ahead for long appointment days. Having a couple of portable options in your bag can be really helpful when you’re at the hospital for longer than expected. A small bag of nuts or trail mix, oatcakes, fruit, or individual sachets of nut or seed butter can all travel well. I’ve shared more ideas in my blog on convenient non-refrigerated snack options for hospital.

  
  

• Make a little extra while you’re cooking. If you’re roasting a chicken, use the leftovers for sandwiches, pittas or an easy meal over the next few days. If you’re cooking salmon, put an extra fillet in the oven and use it cold the following day. Boil a few eggs rather than one so there are some ready in the fridge.

  
  

• Make the most of better days. If you have a day when you have a bit more energy, cooking an extra portion of soup, stew or Bolognese can give you something to put in the fridge or freezer for a day when cooking feels like too much. You might also find my blog on simple meal planning strategies for cancer treatment and recovery helpful.

• Stock up on handy staples. Keeping a few longer-life basics in your cupboard can be a lifeline when shopping or cooking feels like too much. Tinned fish, chickpeas, beans and lentils, pouches of ready-to-go grains like quinoa, oatcakes or wholegrain crackers mean there’s always something you can pull together without too much effort. I’ve shared more ideas in my blog on 10 pantry staples for supporting nutrition during cancer treatment.

Should I take supplements during chemotherapy?

This is something I’m asked a lot - should I be taking any supplements during chemotherapy, and are there any I should avoid?

My starting point is always food first. Supplements can be useful, but they can’t recreate everything you get from food. Foods contain complex combinations of vitamins, minerals, fibre and thousands of other naturally occurring compounds that work together in ways we just can’t reproduce in a pill.

That doesn’t mean there isn’t a role for supplements. There absolutely can be. What is helpful will depend on your diet, your nutritional needs, your blood results, the treatment you’re having and any other medications or supplements you’re taking.

It’s important to let your treatment team know about any supplements you already take, and to check before starting anything new during chemotherapy. Some vitamins, minerals, herbal products and other supplements may interact with cancer treatments or medications.

A multivitamin and mineral supplement

If someone isn’t eating very well, perhaps because their appetite is poor or treatment is making it difficult to eat a varied diet, I may consider an A–Z multivitamin and mineral supplement providing around 100% of the recommended daily amount of vitamins and minerals.

Vitamin D

Vitamin D is something I pay particular attention to. It’s difficult to get enough from food alone, and in the UK we rely on sunlight on our skin to make much of the vitamin D we need.

Ideally, I prefer to know someone’s vitamin D level rather than guess what dose of supplement they need. If a blood test shows that vitamin D is low, supplementation can then be tailored accordingly.

Food safety during chemotherapy

Food safety advice during chemotherapy has changed quite a bit over the years. Having worked in cancer care for more than 25 years, I remember when people having chemotherapy were routinely given advice to avoid certain foods thought to carry a higher risk of foodborne infection. You might have heard this described as a ‘neutropenic diet’ or ‘clean diet’.

The approach has evolved. We now know that blanket restrictive neutropenic diets haven’t been shown to reduce the risk of infection. For most people having chemotherapy, the emphasis is much more on good food hygiene and handling food safely.

Some simple food safety measures are worth paying particular attention to:

• Wash your hands before preparing or eating food.

• Keep kitchen surfaces and utensils clean.

• Wash fruit, vegetables and salad well.

• Store food safely in the fridge - for example, don’t store raw meat above other foods where juices could drip onto them.

• Store chilled foods at the correct temperature and follow use-by dates.

• Take extra care with food that has been sitting out for a while, such as at buffets.

There are situations where additional precautions may be needed, particularly if your immunity is very low, you’re having high-dose chemotherapy, some haematological treatments, or a stem cell or bone marrow transplant. You may be advised to avoid particular foods for a period of time.

Check with your treatment team about whether any additional food safety advice applies to you and follow the guidance they give you.

A final thought

You can nourish yourself really well during treatment, even when what and how you eat needs to change along the way.

If eating or drinking becomes difficult, or you’re losing weight or strength, please let your healthcare team know. They can advise you and make sure you get additional support if you need it.

If you're looking for more personalised nutrition support during chemotherapy, you can read about how I can help through my nutrition programmes.

Written by Meredy Birdi, a dual-qualified Registered Dietitian and Nutritional Therapist specialising in supporting people affected by cancer.

This blog is for general information only and is not a substitute for individual medical or dietetic advice.