Maintaining healthy nutrition post-treatment is incredibly important, but can often be difficult when the appetite has been diminished during chemo and taste buds have been affected during prolonged treatment. Ronnie Fortunato, a nutritionist from God's Love We Deliver, addresses maintaining healthy nutrition and suggests easy to prepare meals. She also gices advice and tips, so that you can help your loved one maintain healthy nutrition during their cancer diagnosis. This program will take place during the Caregiver Support Group.

1. J U LY 0 6 , 2 0 21
R O N NIE F O RTUNATO, M S , R D N
S E NIOR R E GIS TERED D I ETITIA N
N U TRITIO NIST
Maintaining Healthy Nutrition During
a Cancer Diagnosis

2. 7 / 1 3 / 2 0
2 1
2
Food is Medicine
Food is Love
M I S S IO N
We prepare and deliver nutritious meals for
people in the greater NYC metropolitan
area living with severe illness.
Free of charge and full of love.

3. Who We Serve:
People who are too sick to shop and cook for themselves
Medical eligibility:
• Diagnosis that requires nutrition intervention, such as HIV,
cancer, chronic kidney disease, CHF, COPD, and Alzheimer's
• Limited ADLs related to shopping and cooking
Referrals:
• Many sources: self-referral, healthcare providers, care
managers, discharge planners, family, etc.
Client & family:
• Serve the family – children in the household through age 19,
caregivers 60+
3

4. 01 Side Effects of Cancer
Treatments
02 Tips for Loss of Appetite
03 Tips for Nausea/Vomiting
04 Tips for Fatigue
Contents
05 Tips for Diarrhea
06 Tips for Mouth Sores/Dry
Mouth
07 Tips for Preventing Weight
Loss
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5. Side Effects of Cancer Treatments
W H AT TO E X PECT

6. • Loss of appetite, weight loss
• Nausea/vomiting
• Flu-like symptoms
• Fatigue
• Diarrhea/constipation
• Mouth sores/dry mouth
• Skin changes/rashes
• Alopecia
• Insomnia, dizziness
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Chemotherapy can be associated with many
side effects, including:

7. • Fever, chills, headache, flushing
• Fatigue
• Nausea/vomiting
• Diarrhea or constipation
• Abdominal pain
• Decreased appetite
• Skin rash and skin problems
• Hyper- or hypotension
• Bleeding from nose, urine, GI tract, vagina
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The various types of biotherapy also have
side effects, such as

8. • Hot flashes, sweating, fever, headache
• Nausea/vomiting
• Skin changes/rashes
• Joint ache/pain or bone pain
• Muscle weakness
• Weight gain
• Mood changes, malaise
• Menstrual irregularities, vaginal dryness
• Decreased libido, impotence
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Hormone therapy is associated with
various side effects, such as

9. • Diarrhea
• Fatigue
• Headache, blurry vision, earaches
• Hair loss
• Mouth changes, cough
• Skin changes/rashes
• Nausea/vomiting
• Sexuality and fertility changes
• Urinary frequency, incontinence
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Radiation therapy comes along with
ACUTE side effects, including:

10. • Headache
• Changes in memory and attention, dementia
• Osteopenia
• Pericarditis, congestive heart failure
• Diarrhea, malabsorption, intestinal changes
• Alterations in taste and smell, cough
• Infertility
• Skin pigmentation changes, fibrosis, atrophy
• Cataracts
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Radiation therapy comes along with LATE
side effects, including:

11. • Pain, cramping
• Abnormal transit of food
• Maldigestion, malabsorption, heartburn
• Bowel obstruction
• Nutritional deficiencies
• Anorexia, unintentional weight loss
• Nausea/vomiting
• Diarrhea, constipation
• Dysphagia
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Cancer surgery is associated with side
effects, such as:

12. Tips for Managing Loss of Appetite
+ R E CIPES

13. 1. Eat small, frequent meals of calorie dense foods
and drinks.
2. Eat in pleasant surroundings.
• Avoid stress or conflict at meals.
3. Eat by the clock rather than waiting for appetite
or hunger cues
• View eating as part of treatment
4. Preserve energy by using foods that are easy to
prepare and serve
5. Consume liquids between meals rather than
during meals.
6. Maximize intake when most hungry.
7. Engage in light physical activity.
• This will help to stimulate appetite and move food through
the GI tract
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Loss of Appetite
Eating Tips

14. Peanut Butter and Banana onToast:
• 1 slice bread
• 2 tbsp peanut butter
• 1 banana
Tuna Salad on Crackers:
• ½ cup tuna salad
• 5 crackers
High Calorie-High Protein Snack Ideas
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Trail Mix:
• 1 cup cereal
• 12 almonds
• 2 tbsp peanuts
• 1/3 cup raisins
• ¼ cup chocolate
chips
Yogurt Smoothie:
• 8 oz yogurt
• ½ cup half and half
• 1 cup frozen
strawberries
Egg and Cheese:
• 1 egg
• 1 oz cheese
• 1 English muffin
https://stanfordhealthcare.org/medical-clinics/cancer-nutrition-services.html

15. Tips for Managing Nausea/Vomiting
+ R E CIPES

16. Feeling nauseous for a long time can affect your appetite and can cause you to lose weight.To
manage your nausea or vomiting, it’s important to know what is causing the problem. If nausea
and vomiting are caused by your cancer treatment, symptoms may happen the day of treatment
and last for 3 or more days. Medication can be used to manage these symptoms. Remember to
take your medication as prescribed. If your nausea is occurring due to anxiety or stress, relaxation
techniques and simple changes to your diet will be helpful.
Cancer therapies
Intense pain
Fatigue
Stress
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Nausea/Vomiting
Some causes for these side effects

17. 1. Clear liquids first!
• If you have been vomiting, start by drinking a spoonful of
clear liquids such as sports drinks, water, or clear broth. Mint
or ginger tea are well tolerated
• Once you can drink clear liquids without vomiting, try full-
liquid foods and drinks like smoothies, soups, or those that
are easy on your stomach
• You can slowly add back solid foods when you start feeling
better.
2. Have small, frequent meals and snacks.
• Eat 6 to 8 small meals or snacks a day instead of 3 large
meals
3. Eat bland foods and foods served cool or at room
temperature.
• Foods that are hot, very sweet, fatty, or spicy can aggravate
nausea
4. A hard candy may relieve nausea and get rid of
any bad taste in the mouth.
• Choose peppermints, lemon drops, root beer barrels, or
ginger candies
5. Remove bad taste by rinsing mouth before
eating.
• Use a solution made of 1 tsp baking soda, ¾ tsp salt + 1 qt
warm/cool water
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Nausea/Vomiting
Eating Tips

18. 1. Sip water throughout the day to keep you
hydrated.
2. If you are vomiting, dehydration is a serious
concern.
• While it may be very difficult, you need to drink clear liquids
as often as possible during this time.
3. After vomiting, rinse your mouth and spit out the
water.
• Try not to drink for 30 minutes.
• Then try to consume sips of apple juice, cranberry juice, flat
soda, broth, or bites of frozen flavored ice.
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Nausea/Vomiting
Other Recommendations

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P R E S E N T A T I O N T I T L E 1 9
P E AC E F U L E AT I N G P L AC E
Create a relaxed atmosphere.
This will make eating easier.
T H E R O O M I T S E L F
The room should be well
ventilated and not smell of
strong food or cooking
odors.
T H I N G S TO AV O I D
Avoid wearing perfume,
aftershave, and scented
body lotions. Avoid strong-
smelling cleaning agents and
room fresheners.
Nausea/Vomiting
Your Environment

20. Lemon-Ginger Cornmeal Cookies
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• 1 cup (4.5 oz) all-purpose flour
• 1/3 cup yellow cornmeal
• ½ tsp baking soda
• ¼ tsp salt
• ½ tsp ground ginger
• ¾ cup + 2 tbsp sugar
• 6 tbsp butter, softened
• 1 large egg
• 1 tbsp grated lemon rind
Ingredients: Prep time: 10 minutes
Cook time: 20 minutes
Total time: 30 minutes
Serving size: 3 dozen
https://universitycancercenters.com/fight-nausea-lemon-cornmeal-cookies/

21. Lemon-Ginger Cornmeal Cookies
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1. Preheat oven to 350˚F
2. Lightly spoon flour into dry measuring cup
and level off with a knife
3. Combine flour, cornmeal, baking soda, salt,
and ground ginger and stir with whisk
4. Combine sugar and butter in bowl, beat
with mixer for ~5 minutes or until light and
fluffy
5. Add egg to sugar-butter mixture and beat
well
6. Beat lemon rind into egg-sugar-butter
mixture
7. Beat flour and butter mixtures together at
medium speed until blended
8. Spoon ~1.5 tsp batter 2 inches apart on 2
parchment-lined baking sheets
9. Bake for 12 minutes or until lightly browned
and almost firm
10. Remove from oven and cool for 2 minutes,
then remove and cool on wire racks
Directions:

22. Tips for Managing Fatigue
+ R E CIPES

23. Fatigue is a lingering tiredness that is constant and limiting. With fatigue, you have persistent and relapsing
exhaustion and experience a similar feeling to having the flu or lacking sleep.
Causes of fatigue can be psychological, physiological, and physical:
• Psychological: stress, anxiety, and depression
• Physical: diabetes, cancer, anemia, and glandular fever
• Physiological: pregnancy, breastfeeding, and inadequate sleep
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Fatigue
Why it happens

24. 1. Improve your sleep habits and ensure adequate
sleep.
2. Cut out caffeine.
3. Drink plenty of water.
4. Exercise regularly and balance rest and activity.
5. Eat healthy to avoid becoming overweight or
underweight.
6. Take time to relax, perhaps trying meditation or
yoga.
7. Limit alcohol use.
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Fatigue
Tips for Dealing with Fatigue

25. Anti-Inflammatory Overnight Oats
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• 2 tbsp ground flax
• 1 tbsp hemp seeds
• 1/3 cup rolled oats
• 1 tsp chia seeds
• 2 tbsp peanut butter powder
• 1 scoop protein powder
• 1 tsp coconut sugar or brown sugar,
optional
• 1/3 cup unsweetened vanilla almond milk
or water
• 1 cup frozen strawberries
Ingredients: Directions:
1. Combine all dry ingredients in bowl
2. Add almond milk and strawberries to
bowl
3. Combine ingredients well and let “cook”
overnight in the refrigerator
**To make instant oats, combine ingredients,
put into microwave for 1.5-2 minutes, and
eat!
https://hungryhobby.net/anti-inflammatory-instant-oats-2/

26. Tips for Managing Diarrhea
+ R E CIPES

27. Diarrhea occurs when you have frequent bowel movements that may be soft, loose, or watery. Foods and
liquids pass through the bowel so quickly that your body cannot absorb enough nutrition, vitamins, minerals,
from them. This can cause dehydration (which occurs when your body has too little water). Diarrhea can be
severe and last a short or long time.
Cancer treatments can cause diarrhea because they can harm healthy cells in the lining of your large and
intestines.
Diarrhea can also be caused by infections, medicine used to treat constipation, or antibiotics.
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Diarrhea
Why it happens

28. 1. Drink plenty of fluids to replace the fluid you lose
from diarrhea.
• These include water, ginger ale, coconut water, and sports
drinks such as Gatorade and Propel.
2. Drink only clear liquids for 12 to 14 hours after.
• This lets your bowels rest and helps replace lost fluids.
3. Let carbonated drinks lose their fizz before you
drink them.
• Add extra water if drinks make you thirsty or if they cause
nausea.
4. Eat 5 or 6 meals each day instead of 3 large
meals.
5. Eat foods and liquids that are high in sodium and
potassium.
• When you have diarrhea, your body loses these substances,
and it is important to replace them.
• Liquids high in sodium: bouillon or fat-free broth
• Foods high in potassium: bananas, canned apricots, and
baked/boiled/mashed potatoes
6. Eat low-fiber foods.
• Foods high in fiber can make diarrhea worse.
• Low-fiber foods include: plain or vanilla yogurt, white toast,
applesauce, bananas, and white rice.
7. Have foods and drinks at room temperature,
neither too hot nor too cold.
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Diarrhea
Eating/Drinking Tips

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Diarrhea
Foods and Drinks to Avoid
• High-fiber foods such as whole wheat breads and
pasta
• Sugary drinks, such as regular soda and fruit punch
• Very hot or very cold drinks
• Greasy or fatty foods, such as French fries and
hamburgers
• Foods and drinks that can cause gas, including
cooked dried beans and fruits and vegetables
• Milk products, unless they are low-lactose or
lactose-free
• Alcohol, such as beer, wine or hard liquor
• Spicy foods, such as pepper, hot sauce, salsa,
and chili
• Foods or drinks with caffeine, such as regular
coffee, tea, some sodas, and chocolate
• Sugar-free products that are sweetened with
xylitol or sorbitol, such as sugar-free gums and
candy
• Apple juice, since it is high in sorbitol

30. • Be gentle when wiping yourself after a bowel movement. Instead of toilet paper, clean yourself with wet wipes.
• Tell your doctor or nurse if your rectal area is sore or bleeds or if you have hemorrhoids.
• Tell your doctor if you have had diarrhea for more than 24 hours.They also need to know if you have pain or
cramping.
• Your doctor may prescribe you medicine to help control these problems.
• You may also need IV fluids to replace lost water and nutrients.
• Do not take medicine for diarrhea without asking your doctor or nurse.
3 0
Diarrhea
Other Recommendations
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31. Easy Electrolyte-Replacing Popsicles!
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12 oz Pedialyte, 4 oz clear juice  4
popsicles
Grape: grape Pedialyte + white grape juice
Orange-apple: orange Pedialyte + apple
juice
Lemon-grape: lemon Pedialyte + white
grape juice
OR make your own Pedialyte!
4 cups water
½ tsp baking soda
3 tbsp sugar or honey
½ tsp salt
Mix Pedialyte + clear fruit juice, then freeze in ice cube tray with toothpick stuck in it or in
popsicle trays!
http://www.suesnutritionbuzz.com/2012/02/23/homemade-pedialyte-pops-feeding-the-
stomach-bug/

32. Tips for Mouth Sores/Dry Mouth
+ R E CIPES

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Mouth Sores/Dry Mouth
Eating tips
• Milkshakes, custards, puddings, cottage cheese,
yogurt, and smoothies
• Mashed potatoes, mashed peas and carrots, or
other mashed vegetables
• Tender fish or chicken
• Watermelon, cantaloupe, or honeydew
• Peach, pear or apricot nectars
• Macaroni and cheese, buttered noodles
• Cooked cereals (oatmeal, grits, cream of wheat)
• Creamy soups and stews
• Scrambled eggs or omelets
• Canned fruits (pears, peaches, bananas,
applesauce)
• Nutritional supplements such as Boost, Ensure,
Enlive, Resource, and NuBasic.
Choose foods that are soft and easy to chew and swallow:

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Mouth Sores/Dry Mouth
Foods to Avoid
• Citrus fruits or juices
• Tomato products
• Dry food without sauce
• Spicy or salty foods
• Rough or raw foods, such as apples or granola
• Sticky or chewy foods, such as peanut butter or
raisins
• Commercial mouthwashes with alcohol
Avoid foods that may irritate the mouth:

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Mouth Sores/Dry Mouth
General Recommendations
1. Add extra sauce such as gravy, melted butter,
or sour cream.
2. Puree or blenderize your food.
3. Cut your food into small pieces.
4. Use a straw to drink liquids.
5. Cook all food until soft and tender.
6. Mix food with gravy, sauce, butter, or
margarine to make it easier to swallow.
7. Use a smaller or baby-sized spoon.
8. Hot food can irritate the mouth. Cool or
room temperature is best.
9. Try sucking on ice chips or popsicles.
10. Rinse your mouth frequently with water to
promote healing and remove bacteria
11. Ask your doctor or dentist about using
anesthetic lozenges or spray to help numb
your mouth or throat while you eat

36. No Blender Smoothie:
• 1 cup milk or milk alternative
• 1 generous scoop ice cream or sorbet
• 2 tablespoons butterscotch or chocolate syrup
• 3 tablespoons powdered milk
Put in a cup with a lid and shake!
Soothing Shake Recipes
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Strawberry Cream:
• ½ cup frozen strawberries
• 1 generous scoop ice cream or sorbet
• ½ cup milk or milk alternative
• 3 tablespoons powdered milk
Mix at high speed in a blender until smooth.

37. Tips for Preventing Weight Loss
+ R E CIPES

38. 1. Eat 5 or 6 small meals each day instead of 3 large
meals.
• You may find it easier to eat smaller amounts at one time.
2. Eat something every 2-3 hours.
• Treat food like medication and make a schedule for eating – don’t
wait for your body to tell you it’s hungry
3. Eat larger meals when you feel well and are rested.
4. Eat foods high in protein and calories.
• This includes: meat, eggs, cheese, full-fat dairy, peanut butter,
and ice cream
• You can also add protein and calories to foods, such as gravies,
butter, oil, cream, nuts, granola, and dried fruits.
5. Cook with protein-fortified milk.
• Use it instead of regular milk when cooking macaroni and cheese,
pudding, cream sauce, mased potatoes, cocoa, soup, or pancakes.
6. Keep snacks nearby for when you feel like eating.
• Take easy-to-carry snacks such as crackers, nuts, granola bars, or
dried fruit when you go out.
7. Eat a bedtime snack.
8. Change the form of a food to make them easier to
eat: chop, grind, or puree.
9. Eat soft, cool, or frozen foods
• These include yogurt, milkshakes, smoothies, and popsicles.
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Preventing Weight Loss
Eating Tips

39. 1. Drink liquids throughout the day – even when
you don’t want to eat
• Choose liquids that add calories and other nutrients.These
include juice, soup, milk, milkshakes, and smoothies.
2. Sip only small amounts of liquids during meals.
• Many people feel too full if they eat and drink at the same
time.
• If you want more than just small sips, have a larger drink at
least 30 minutes before or after meals.
3. If you have lost a significant amount of weight
unintentionally, drink 1 or 2 liquid supplements
• These include Ensure and Boost.
• These should be consumed as snacks.
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Preventing Weight Loss
Drinking Tips

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Preventing Weight Loss
Other Recommendations
BE AS ACTIVE AS YOU CAN.
You might have more appetite if you take a
short walk or do other light exercise. Studies
show many people feel better after exercising
each day.
TALK TO YOUR DOCTOR.
Tell your doctor if you have eating problems,
such as nausea, vomiting, or changes in how
foods taste and smell. They can help control
these so you can eat better.

41. Meal Additions
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Cheese (grated or cream cheese): add to mashed potatoes, pureed soups, grits, sauces, meatloaf, casseroles
Dry milk powder: add to meatloaf, cooked cereal, yogurt, milkshakes
Peanut butter: add to milkshakes, muffins, cooked cereal, yogurt
Nuts, banana, and/or pureed fruits: add to yogurt, cooked cereals, purees, milkshakes
Whole milk: add to prepare hot cereals, cocoa, soups, puddings
Sauces: add your favorite to meatloaf, pasta, purees, casseroles
Hard cooked eggs and avocado: add to salads or sandwiches
Granola, muesli, wheat germ, or flax: sprinkle on yogurt, pudding, ice cream

42. Questions?

43. Contacts
7 / 6 / 2 0 2 1 M A I N T A I N I N G H E A L T H Y N U T R I T I O N D U R I N G A C A N C E R D I A G N O S I S 4 3
God’s Love We Deliver
166 Avenue of the Americas
New York, NY 10013
Godslovewedeliver.org
Nutrition Department
nutrition@glwd.org
212.294.8103
Ronnie Fortunato, MS, RDN
Senior Registered Dietitian Nutritionist
rfortunato@glwd.org
212.294.8103
Lisa Zullig, MS, RDN
Director, Nutrition Services
lzullig@glwd.org
212.294.8103

44. Thank You