For patients and relatives

Nutrition & Cancer

Eating and drinking with cancer: what is important?

Tumour disease can lead to weight loss and malnutrition. The cause of weight loss is a reduction in food and energy intake over a longer period of time - in other words, less is eaten than the body needs. This can be triggered by tumour-related metabolic changes, side effects of therapy, digestive disorders, pain or psychological stress.

A diet adapted to your situation gives you the strength to cope with the demands of the disease and the therapy. But food can do even more: food provides comfort, brings joy and helps to strengthen relationships with friends and family.

The goals of nutritional therapy are

  • Maintain weight in order to create good conditions for therapy
  • Increase the effect of the therapy
  • Maintain quality of life
  • Maintain performance and mobility
  • Reduce side effects
  • Maintain the pleasure of eating


However, eating and drinking cannot do what many cancer diets promise: An existing tumour cannot be directly influenced or even cured by diet!

In order to be able to counteract unwanted weight gain or loss in good time, you should weigh yourself regularly: Weigh yourself once a week at the same time. It is best to do this in the morning before breakfast and without clothes on.

Please note: Malnutrition can also occur if you are overweight! Therefore, always consult your doctor or nutritionist if your weight changes.

 

If eating and drinking does not cause you any discomfort and your weight is stable, stick to the general dietary recommendations of the German Nutrition Society (DGE). This means

  1. Eat 3 portions of vegetables and 2 portions of fruit a day, e.g. as salad, vegetable soup, steamed/roasted/roasted vegetables, home-made fruit quark, raw vegetables with bread, Bircher muesli, ...

  2. Eat plenty of fibre. These are contained in

    • Wholemeal products: e.g. wholemeal bread/rolls, wholemeal pasta or rice, oatmeal or other cereal flakes
      Please note: Dark bread does not necessarily contain wholemeal flour! Bread is often coloured to make it look "healthy". Therefore, look for the label "wholemeal flour" or the name "wholemeal bread" on the list of ingredients

    • Fruit and vegetables

    • Seeds, grains, nuts: e.g. linseed, sunflower seeds, walnuts

    • Pulses: e.g. beans, chickpeas, lentils, peas, soya beans

  3. Eat preferably white meat (chicken, turkey) once or twice a week. Avoid processed meat such as sausage, ham, cured or smoked meat as much as possible. Red meat (beef, pork, lamb, veal, goat, sheep) should also only be included in your diet once a week.

  4. Eat fish once or twice a week, both low-fat and high-fat (sea) fish.

  5. Eat milk and dairy products every day, e.g. yoghurt, quark, buttermilk, cheese. These contain a lot of protein, but also calcium, which strengthens the bones and protects against osteoporosis. Hard cheese has a lot of energy, so you should pay attention to the portion size: One portion is about the size of two thumbs placed together.

  6. Three to four eggs a week offer variety in your diet and provide you with protein, vitamins and minerals.

  7. Choose vegetable oils in preference to animal fat. Rapeseed, linseed and walnut oil are the most suitable, as they contain many unsaturated, "good" fatty acids. Olive oil is good for heart function. Rapeseed oil can also be used for cooking, whereas linseed and walnut oil can only be used in cold dishes such as salads or herb quark.

  8. Prepare dishes with little salt. Herbs, spices and flavourful oils add flavour instead.

  9. Only enjoy very high-sugar foods on special occasions.

  10. Drink at least 1.5 - 2 litres of water or unsweetened tea every day. If you do sport, have a fever or it is very hot, you should drink even more to compensate for fluid loss.

  11. Alcoholic drinks should only be consumed in moderation and on a maximum of five days per week. For women, 10 g of alcohol per day is tolerated (this corresponds to 250 ml of beer or 125 ml of wine), for men 20 g of alcohol.
    Caution: Taking medication in combination with alcohol can lead to side effects or interactions. This also applies to medication and treatments prescribed as part of anti-tumour therapy.

If you have already lost weight or can no longer eat as much as you used to, it is often necessary to deviate from the recommendations for a "healthy" diet. In this case, a diet is healthy if it prevents further loss of muscle and weight: A personalised diet is then the best choice.

Do not force yourself to eat particularly large portions at once. This can lead to frustration, a feeling of fullness or nausea. Several small meals in "manageable" portions throughout the day are better tolerated and allow you to cover your energy and nutrient requirements.

The aim when losing weight is to eat as much energy-rich food as possible in order to stabilise body weight. If, for example, you can only eat small amounts due to a loss of appetite, the individual meals must be correspondingly high in energy and protein. You can achieve this by including foods in each meal such as

  • Cream quark, cream yoghurt, Greek yoghurt, pudding, cheese, milk porridge (e.g. rice pudding, semolina porridge, porridge), cream, crème fraîche, sour cream, cream cheese, ...
  • Eggs
  • Meat and sausage, fish (also smoked or pickled), poultry
  • Vegetable oils, especially rapeseed, linseed, walnut and olive oil
  • Nuts or nut butter
  • Dried fruit

 

General recommendations to stop weight loss:

  • Eat 5 - 8 small meals regularly throughout the day, including at night if necessary
  • Eat when and what you feel like - spaghetti also tastes good for breakfast
  • Use plenty of oil, cream, butter, sour cream or crème fraîche when cooking, e.g. in soups, sauces, mashed potatoes
  • Choose dishes with a lot of energy and little volume, e.g. roast potatoes instead of boiled potatoes, chips, cream soups instead of broths, cream instead of low-fat quark
  • Avoid light products or low-fat foods
  • Prefer high-fat milk and dairy products with at least 3.5% fat, cheese from 45% fat in dry matter, cream yoghurt/quark
  • Choose high-fat types of sausage, e.g. tea sausage, sausage and liver sausage, salami, cold cuts,
  • Eat fatty fish: salmon, herring, mackerel, trout
  • Choose high-energy drinks, e.g. juice, malt beer, cocoa, Ovaltine, milkshakes
  • Make sure you have enough to eat when you are away from home for a long time

 

High-energy snacks are: Pudding, rice pudding, semolina porridge, cream, quark and yoghurt dishes with cream, ice cream, nuts, trail mix, dried fruit, cheese cubes, crackers, biscuits, muesli bars, chocolate bars, fruit with cream and/or nuts, cakes, filled pancakes, waffles, ...

Your protein requirements increase when you lose weight. Eating plenty of protein - in combination with exercise - helps to prevent or slow down muscle loss. This allows you to stay active and productive. Make sure you include at least one source of protein with every meal and exercise regularly. At least 30 minutes of moderate physical activity per day (cycling, a brisk walk, dancing, etc.) is ideal.

Protein-rich foods and drinks include lentils with spaetzle and sausage, chilli con carne, scrambled eggs with ham, roast meat, salmon quiche, cheese spaetzle, cheesecake, fruit quark, milk, cocoa, soya drink, tofu, nuts, ...

Oral nutritional supplements

If you are unable to eat enough to cover your protein or energy requirements, oral nutritional supplements can be used. These are available ready to drink (drinkable food, "astronaut food"), for spooning in the form of pudding and soup or as a powder for mixing. Oral nutritional supplements are available from pharmacies and can be prescribed by your doctor if required.

There are also protein powders that are specially made to fulfil protein requirements, e.g. Fresubin Protein Powder from Fresenius Kabi or AdPro104 from metaX. Pure protein powders of high quality are available from pharmacies. However, they are not available on prescription.

 

Other options

Sometimes it is not possible to meet the energy, protein and nutrient requirements adequately through daily food and drink or through fortification and supplementation. In this case, additional tube feeding (so-called enteral nutrition) or nutrition via the vein (so-called parenteral nutrition) can be given.

No. A balanced diet provides you with all the nutrients you need. Food supplements are therefore not necessary. In addition, even seemingly harmless herbal or food extracts can have side effects and reduce the effectiveness of the therapy (e.g. St John's wort). You should therefore only take food supplements on medical advice.

Books and magazines, the internet or relatives and acquaintances spread a great deal of often contradictory and scientifically unfounded nutritional advice. These recommendations often contain prohibitions and restrictions whose benefits have not been proven or even refuted.

These so-called cancer diets often have side effects: They are usually one-sided and severely restrict food choices. This can result in malnutrition. This, in turn, can impair your quality of life, your general condition and the success of your treatment. If you have any questions about your diet, consult a nutritionist. They will provide you with professionally correct nutritional recommendations tailored to your needs.

Sometimes cancer treatment can lead to side effects that make it difficult to eat a balanced diet. If you notice that your sense of taste changes, you suffer from nausea or loss of appetite, you gain or lose weight unintentionally or have other complaints, please talk to your doctor and your dietician. Together you can decide what you can do about side effects and their consequences.

Results of the workshop "Eating with cancer - can it be fun?", which took place as part of the patient information event on 29 March 2023.

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Helpful addresses and contacts

Eat what you need e.V.
www.was-essen-bei-krebs.de

German Cancer Aid Foundation
www.krebshilfe.de

Cancer Information Service
www.krebsinformationsdienst.de

German Society for Nutrition DGE
www.dge.de

Psychosocial Cancer Counselling Centre Ulm
www.uniklinik-ulm.de/krebsberatungsstelle-ulm.html

KORN self-help office (regional network coordination centre)
www.selbsthilfebuero-korn.de

Association of Dietitians - German Federal Association e.V.
www.vdd.de