Keeping your gut healthy during and after cancer treatment

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March is National Nutrition Month so AICR’s blog today focuses on proper dietary care for digestive concerns during cancer treatment and rehabilitation. Patients and survivors experience digestive issues during and after treatment for many types of cancer due. Here, Angela Hummel offers food and nutrition tips and advice on managing digestive side effects due to the disease and treatment.  Hummel is a specialist in oncology nutrition and is a consulting dietitian with AICR.

I interact with people undergoing cancer treatment. In the process, I have learned a lot about nutritional counseling to patients and their families/caregivers at different stages of their cancer treatment and rehabilitation. Most people experience digestive problems related to their cancer or cancer treatment. As a certified specialist in oncology nutrition, I have the opportunity to guide people on strategies to maximize nutrition impact during their period of treatment and beyond.

Caring for your digestive tract during cancer treatment
The health of the digestive tract is imperative for good nutritional status. As an oncology nutrition specialist, I help people with digestive problems, such as gas, bloating, diarrhea, and constipation, ranging from mild to severe for all different cancer types and their treatments. I find it interesting how side effects range from person to person.

• Increase fiber intake to around 25-35 grams
• Increase fluid intake to 8 cups spread throughout the day
• Raise physical activity to at least 30 minutes

Prebiotics and Probiotics
I often talk with patients about prebiotics and probiotics during treatment. Probiotics are the healthy bacteria that live in our digestive tract and prebiotics are the food required by the healthy bacteria. Pre- and probiotics can help cancer patients, particularly colorectal cancer patients, because they are more likely to suffer from the problem of gas, bloating and diarrhea.

Prebiotics include many healthy plant fibers from choices like bananas, onions, asparagus, oatmeal, beans, and legumes. Foods that naturally contain healthy, living bacteria (probiotics) are yogurt, kefir, buttermilk, kombucha tea, sauerkraut, kimichi, and tempeh.

Choosing prebiotic and probiotic foods daily during and after cancer treatment can promote a healthy digestive tract. Many probiotic supplements are available over-the-counter. However, during cancer treatment, it is important to discuss their use with your healthcare team due to the risk of immune suppression from some treatments.

Constipation
Changes in bowel habits are common during cancer treatment and I have helped many patients deal with significant constipation. Constipation can interfere with appetite and nutritional status. Many factors related and unrelated to cancer can contribute to constipation, such as medications used to help with cancer treatment, inadequate fluid intake, changes in eating habits and a decrease in activity.

I often discuss techniques to manage constipation. Some general guidelines to improve constipation include:
• Increase fiber intake to around 25-35 grams
• Increase fluid intake to 8 cups spread throughout the day
• Raise physical activity to at least 30 minutes
I know from experience that the above normal strategies for managing constipation may not be feasible during cancer treatment due to cancer location, poor appetite, and fatigue.

• Choose small, frequent meals throughout the day instead of large meals
• Choose low fiber foods and especially limit insoluble fiber from foods such as cruciferous vegetables, leafy greens and hearty grains
• Choose fruits like bananas, and other canned fruits like applesauce, peaches and pears
• Drink beverages between meals instead of with meals
• Avoid digestive stimulants like caffeine, ginger, peppermints

Additional strategies include:
• Eating at consistent times throughout the day
• Sipping a hot beverage like warmed prune juice or decaffeinated tea around the time you would normally have a bowel movement
• Increasing fluids by sucking on ice chips, frozen fruit or by including soups with meals
• Taking a short walk for 10-15 minutes prior to eating

Talk with your healthcare team regarding your bowel habits. Medical intervention can help relieve constipation and help you achieve better nutritional status.

Diarrhea
During cancer treatment, diarrhea can occur and deplete the body of necessary fluids and nutrients. Chemotherapy, radiation, bone marrow transplant, medications used for side effect management and cancer itself can contribute to diarrhea. Without normal bowel function, nutritional status can suffer.

It may be uncomfortable discussing your bowel habits with your healthcare team but resolving any problems can improve your tolerance for treatment.
Strategies that I suggest to people to help improve diarrhea include:
• Choose small, frequent meals throughout the day instead of large meals
• Choose low fiber foods and especially limit insoluble fiber from foods such as cruciferous vegetables, leafy greens, and hearty grains
• Choose fruits like bananas, and other canned fruits like applesauce, peaches, and pears
• Drink beverages between meals instead of with meals
• Avoid digestive stimulants like caffeine, ginger, peppermint

Need more insight? Ask your healthcare team for a referral to a registered dietitian or search The Academy of Nutrition and Dietetics for a local dietitian. See AICR’s information and resources for cancer survivorship and healthy living, including Recharge, our monthly newsletter for survivors.

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    Author: Angela Hummel

    Angela Hummel, MS, RD, CSO, LDN, is a consulting dietitian with AICR. She is passionate about helping people make positive diet and physical activity changes for reducing cancer risk and for healthier survivorship. She initiated and developed two oncology nutrition programs in cancer centers. Angela also uses her expertise with two AICR programs – the New American Plate Challenge, and the Nutrition hotline.

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