1. How to Gain Weight: Making the Most of Every Bite Presented by Tammy Petrossian and Mary Beth Belcastro

2. Overview  What you should know about cancer treatment...eating well…and possible challenges.  How you are feeling can affect your appetite  Managing those eating challenges  Tips on making the most of every bite!!!  Questions  Quiz Questions

3. INTRODUCTION  Who are you???? Name Diagnosis Where are you in treatment

4. I am eating everything in sight!! Why am I not gaining weight??  Answer:  Cancer changes the way your body is using the food you eat  The rate at which your body burns calories is increased  Your muscle is broken down at an increased rate  Your body now needs EXTRA CALORIES & PROTEIN !!

5. How Does Treatment Work?  How you are feeling can affect your appetite!  Treatment destroys cancer cells but also healthy cells and can lead to side effects.

6. Loss of Appetite  Cancer diagnosis  Fatigue  Pain  Feelings such as stress, fear, depression, and anxiety  From side effects of treatment: Nausea, Vomiting, or changes in how foods taste or smell  Ways to Manage with Nutrition:  Eating is a challenge  Try drinking a liquid/powdered meal replacement  Exercise  Keep snacks nearby for when you do feel hungry  Try eating a small meal or snack even if you don’t feel hungry

7. Possible Side Effects Nausea/Vomiting Diarrhea Lack Of Appetite Early Satiety Taste Changes Chewing/Swallowing Issues SORE MOUTH CONSTIPATION Dry Mouth

8. First Things First! Manage your Side Effects  Nausea: There are many reasons why it occurs  Can occur after treatment or days following  It may be from taking pain medication on an empty stomach  Triggered by a strong food or drink smells  Keeping a record of when and why can help determine a plan of action to combat it.

9. Ways to Combat Nausea  Include smaller more frequent meals  Eat 5-6 small meals each day  Choose foods that appeal to you  Don’t skip meals, try carbohydrate rich foods  Only sip small amounts of liquids during meals (separate main liquids from meal times)  Eat a light meal or snack before treatment  Try clear liquid diet if solid foods are not tolerated.

10. Eat foods Easy on the stomach

11. Vomiting  Can come after Nausea  Caused By  Treatment  Food odors  Motion  Upset Stomach  Bowel gas  Pain  DO NOT eat or drink until vomiting has stopped  After episode drink small amounts of Clear liquids  Suck on ice chips  Then slowly add back solid foods

12. Taste & Smell Changes  Why they Happen?  Cancer Treatment  Dental Problems  Cancer Diagnosis  Ways to manage with Nutrition :  Choose foods that smell good  Avoid foods/drinks with smells that bother you  Make foods sweeter or more savory  Try cold foods  Try tart food and drinks  Add extra flavor to food  Marinate foods

13. Other Ways to Manage Taste Side Effects:  Eat with plastic utensils  Reduces metallic taste  Keep mouth clean with:  Brushing, flossing, use special mouthwash  Visit dentist regularly

14. Constipation Causes:  Chemotherapy  Location of Cancer  Pain medication/other medications  Not drinking enough fluids  Not eating enough fiber  Decreased activity level

15. Constipation  Ways to Manage:  Prune Juice  Laxatives  Keep a record of bowel movements

16. Diarrhea : Why it Happens  Infection  Antibiotics  Medication used to treat constipation Ways to Manage with Nutrition o Drink plenty of fluids to replace those lost from diarrhea: -water, ginger ale, and sports drinks taken 12 to 14 hrs after sudden diarrhea o Eat 5-6 small meals each instead of 3 large ones o Eat foods and liquids high in sodium and potassium o Eat low fiber foods: yogurt, white toast, white rice o Food and drinks should be at room temperature

17. Avoid foods that can worsen diarrhea!! Food/Drinks to Avoid:Examples: High in FiberWhole wheat breads/pasta/raw vegetables and fruits Drinks with lots of sugarSoda, fruit punch Drinks very hot or coldHot tea, coffee, smoothies, shakes Greasy, fatty, fried foodsHamburger, french fries, fast food Milk products(containing lactose)Yogurt, cheese, milk, ice cream AlcoholBeer, wine, hard liquor Spicy foodsPepper, hot sauce, salsa, chili Foods/drinks with caffeineCoffee, tea, some sodas, chocolate Sugar free products sweetened with xylitol/sorbitol Sugar free gum and candy, apple juice

18.  Avoid alcoholic beverages!  Eat foods that are easy to swallow-moist cooked soft foods or soups!  Moisten foods with sauce, gravy, broth or salad dressing! Sip water through out the day Chew gum, suck on hard candy, popsicles, or ice chips to increase saliva Drink/Eat tart or sweet foods to increase saliva

19. Sore Mouth: Tips  Choose foods that are easy to chew: soft, cooked  Cut food into smaller pieces  Drink with a straw (avoids certain areas)  Use small or plastic spoon for smaller bites  Eat cold or room temperature foods  Suck on ice chips  Rinse mouth 3-4 x per day with baking soda rinse  Visit dentist @ least 2 weeks prior to treatment  Check mouth each day for any sores, white patches, or red areas

20. Foods to Avoid with Sore Mouth Citrus fruits/juices : lemon, lime, orange Spicy foods: Hot sauce, curry dishes, salsa, chili peppers Tomato products: Ketchup Salty Foods: Chips, pretzels, salted nuts Raw vegetables Sharp, crunchy foods: granola, cracker, potato/tortilla chips Drinks that contain alcohol-including mouth wash Tobacco products

21. Difficulty Swallowing  Why it happens?  Can be due to radiation treatment or compression from tumor site.  Causing lining of the throat to become inflamed and sore  Possibility of problems swallowing due to pain  Use of tobacco or alcohol during course of treatment

22. Easy To Swallow Foods Easy to Swallow Foods Main Meals Baby food, Casseroles, Chicken salad, Cooked refined cereal, Cottage cheese, Eggs, Mac & Cheese, Mashed potatoes, Creamy Peanut Butter, Pureed Cooked food, Soups, stew, Custard Dessert/Snack Flan, Soft fruit, gelatin, Ice Cream, Milkshake, Pudding, Sherbet, Smoothies, Sorbet, Yogurt Meal replacement Instant breakfast drink, Nutrition supplement

23. Ways to Help with Swallowing Issues  Cook foods until soft & tender  Moisten foods with gravy, sauces, broth, yogurt  Sip drinks through straw  Be sure to follow texture modifications made by SLP  Don’t eat/drink things that can burn or scrape throat  AVOID : Sharp, crunchy foods  Spicy foods  Acidic food/juice  Hot food & drinks Cut food into small pieces

24. Why it is Sooo Important to Maintain a Healthy Weight  Research shows you will have a better response to treatment  Staying active will preserve lean muscle mass needed for everyday activities  Research shows maintaining muscle mass improves quality of life

25. Bottom Line  Make the Most of EVERY BITE !!! Sounds easy Righhhtttt???

26. Soooooo……

27. Tips to gain weight  Don’t wait until your hungry to eat  Eat on a schedule  Eat 5-6 small meals vs 3 large meals  Include a good protein source at each meal  Eat foods high in CALORIES & PROTEIN  If unable to eat solid foods include a supplement drink  Use Protein Fortified Milk When cooking:  1 cup Non-fat dry Milk  4 cups of Whole Milk

28. Ways to add Protein Melt on/Grate to any food items Mix with fruits/vegetables Add to: Casseroles, noodles, egg dishes Use milk instead of water in drinks,hot cereal, soups, cocoa, and pudding Add dairy products to blenderized drinks Casseroles, breads, pancakes, cookies, Sprinkle on: Fruit, cereal, ice cream, yogurt, vegetables, salads, sauces, pasta

29. Ways to Add Protein Eggs added to salads, casseroles, creamed meat, custard and sauces Powder: add to milk drinks and desserts Mix with ice cream, milk, fruit flavoring Add Chopped, cooked meat to: vegetables, salads, casseroles, soups, sauces, biscuit dough, omelets, souffles, stuffing, stuffed baked potato Add soy protein/beans to casseroles, pasta, soup, salad, and grain dishes

30. Getting those Needed Extra Calories TYPES OF FOOD: HOW TO USE: ADD TO Milk Use Whole milk instead of low fat Use instead of water Mix in hamburgers, meatloaf, creamed soups Cheese Melt on top of casseroles, potatoes, vegetables Omelets sandwiches Granola Use in cookie, muffin, bread batters Sprinkle on: Veggies, Yogurt, Ice Cream, Pudding, Custard, Fruit, put in trail mix Dried Fruits Plump in warm water and eat throughout day Add to: Breads, Muffins, Cookies, Cakes, Cereals, Stuffings, Cooked vegetables Eggs/Egg Whites Salads, casseroles, creamed meat, custard, sandwich, sauces Add extra to custard, pudding, pancake/french toast batter Condiments Adding sauces, gravies, sour cream, butter, half/half, whipped cream, hollandaise sauce

31. Question: TRUE or FALSE  Diarrhea can cause dehydration Answer: True

32. Quiz Question: When should you eat your favorite foods?? A. Days you have treatment B. Before you go to treatment C. On days you don’t have your treatment D. Right after you have treatment Answer: C

33. Quiz Question: TRUE or FALSE  Being active can increase your appetite Answer: True

34. Quiz Question: TRUE or FALSE  To get the most out of your meal you drink your fluid A. While you eat B. Before you eat C. After you eat D. All of the above Answer: C

35. Quiz Question  Which foods/drinks would be appropriate following a bout of vomiting?  A. Clear broth, Fruit punch, gelatin, Boost Breeze  B. Milk, Ice Cream, Tea, coffee  C. Sprite, Honey, Popsicle, apple juice  D. Both A & C Answer: D

36. Quiz Question:  Who would be the best person to ask if you are having issues with swallowing, losing weight, loss of appetite  A. Your dad or mom  B. Your Registered Dietitian  C. Your knowledgeable neighbor  D. Your Doctor  E. B & D Answer: E