Nutrition

Nutrition and Gastric Cancer

It can be hard to eat well when you have gastric cancer.  Symptoms such as nausea, low appetite and diarrhea are common and can make it hard to get enough nutrition.

Eating nutritious food is important to give your body strength and energy. Changing the way you eat can help manage symptoms of cancer and cancer treatment.

Below you will find information about common nutrition challenges and ways to help you eat well.

A dietitian and your health care team can give you more advice and tips.

Management of Symptoms

Nausea, vomiting, low appetite, diarrhea, feeling tired, and reflux are common symptoms of gastric cancer and cancer treatment. What you eat and the way you eat can help you manage these symptoms.

These tips may be a good starting point to help you eat well when you are feeling these symptoms. Keep in mind that everyone’s body and needs are different. Consider talking to a dietitian to help find a way of eating that works well for you.

Low Appetite

Low appetite may be caused by cancer, side effects from cancer treatment, medications, or feelings of sadness and anxiety. It is important to eat enough to give your body strength and energy.

Tips to manage low appetite

  • Eat small amounts of food during the day, even when you don’t feel like eating.
  • Eat your biggest meal when you’re feeling best.
  • Prepare meals and snacks so they are ready whenever you feel like eating. Bring snacks with you when you leave the house.
  • Make every bite count by eating foods that are high in protein and calories.
    • High protein foods: peanut butter, cheese, nuts, meat, beans
    • High calorie foods: butter, margarine, sour cream
  • Eat solid foods first. Have your drinks later so they don’t fill up your stomach.
  • Make eating more enjoyable by asking friends and family to eat with you. They can also help you with grocery shopping and cooking.
  • Eat in a relaxed and comfortable environment.
  • If you can, try some light exercise, such as walking, before meal times to help boost your appetite.
  • Nutritional supplement drinks like Ensure® or Boost® can help you get more calories if you feel that you are not eating enough.

When to contact your health care team

Speak with you health care team if:

  • You are losing weight.
  • You feel that you cannot eat enough food.
  • You feel weak or dizzy.

Nausea and Vomiting

People with gastric cancer often feel nausea (the feeling of being “sick to your stomach”) and vomiting. Nausea and vomiting can be caused by many things, including cancer, side effects of cancer treatments, medications, pain, and anxiety.

Tips to manage nausea and vomiting

  • Eat a small amount of food every 2-3 hours. Having an empty stomach can make you feel more nauseous.
  • Dry foods such as crackers, toast, and cereal can be easier on the stomach.
  • Avoid food and drinks with strong smells. Open a window to get some fresh air and decrease food smells in the room. If you can, ask someone to prepare meals for you to avoid the smell of cooking food.
  • Avoid spicy foods and foods that are overly sweet.
  • Eat solid foods first, then have your drinks after.
  • Sip small amounts of liquids throughout the day to stay hydrated. You may find that cool liquids are better than hot or cold liquids.
  • Wear loose-fitting clothing.
  • Brush your teeth before and after eating to get rid of tastes in your mouth.
  • Try not to lie down for at least one hour after eating. If you need to lie down, try to keep your head and shoulders raised with a pillow.
  • Nutritional supplement drinks like Ensure® or Boost® can help you get more calories if you feel that you are not eating enough.

When to contact your health care team

Speak with your health care team if:

  • You are feeling severe nausea and/or you cannot hold down food and drinks.
  • You are feeling weak or dizzy.

Diarrhea

Diarrhea (frequent loose, watery poo) is common for people with gastric cancer. Cancer treatments, infection, medications, and stress can cause diarrhea. If diarrhea is ongoing, it can lead to dehydration, weight loss, weakness, and poor nutrition.

If you have had stomach surgery, diarrhea may be caused by Dumping Syndrome. More information about Dumping Syndrome can be found in the After Surgery section.

Tips to manage diarrhea

  • Sip lots of fluids throughout the day to stay hydrated.
  • Eat small meals and snacks.
  • Limit greasy, fried, and spicy foods.
  • Avoid sugary foods, such as candy, desserts, fruit juices, and soda.
  • Eat salty foods like crackers, pretzels, and soups to replace the salt lost in diarrhea.
  • Eat foods that are high in soluble fibre, including bananas, barley, bran, and oats.
  • Choose white bread or pasta, and white rice to help thicken poo.
  • Avoid prunes, prune juice, rhubarb, papaya, and sugarless gums and candies. These foods can worsen diarrhea.

When to contact your health care team

Speak to your health care team if:

  • You have new diarrhea for multiple days.
  • You feel weak, dizzy, or confused.

Sometimes, a doctor may prescribe medications to help your diarrhea. Ask your health care team for more information about medications.

Constipation

Constipation (going poo less often, having hard or difficult to pass poo) is common for people with cancer. Constipation may be caused by cancer, cancer medications and treatments, not drinking or eating enough, or stress.

Tips to manage constipation

  • Drink lots of fluids to help keep your poo soft.
  • Eat foods that are high in fibre, such as vegetables, fruit, whole grains, and legumes (beans, peas, lentils). Slowly increase the amount of these foods that you eat. Make sure to drink lots of water too.
  • Prunes, prune juice, papayas, pears, apples, and dried apricots may help you go poo.
  • Do some light exercise or stretching after eating.

When to contact your health care team

Speak with your health care team if:

  • You are going poo less than normal.
  • You see bright red blood in your stool.
  • You have very dark or black stool.

Sometimes, a doctor may recommend stool softeners or laxatives to help you manage constipation. Ask your health team for more information about taking these medications.

Fatigue

Fatigue is a feeling of having low energy or being worn out. The feeling often does not go away with sleep. You may feel that you have no energy to do things that help you eat well, such as groceries, preparing food, and eating meals. These feelings may last for a long time, but it is important to continue to eat well during times of fatigue.

Tips to manage fatigue

  • Stock up on foods and snacks so that you always have them ready to eat.
  • Freeze extra portions of food for days when you don’t feel like cooking.
  • Have small snacks throughout the day and eat whenever you start to feel hungry.
  • Have your meals in a relaxed and comfortable environment.
  • Ask friends or family to help you with grocery shopping and meal preparation.
  • Have softer foods or liquid foods that require less energy to eat. Examples include soups, stews, scrambled eggs, yogurt, hot cereals, and smoothies.
  • Buy healthy but convenient foods, such as pre-cut fruits and vegetables.
  • Nutritional supplement drinks like Ensure® or Boost® can help you get more calories if you feel that you are not eating enough.

When to contact your health care team

Speak to your health care team if:

  • You are losing weight.
  • Fatigue is impacting your ability to eat well.

Reflux

Reflux is a burning feeling in your throat and chest when the food that you eat comes back up. It can be uncomfortable and stops you from eating well. What you eat and how you eat can help you manage reflux.

Tips to manage reflux

  • Have smaller meals and eat slowly.
  • Avoid lying down right after eating.
  • Avoid fried and spicy foods.
  • Avoid acidic foods, such as lemon, lime, oranges, grapefruit and tomatoes.
  • Avoid chocolate, peppermint, garlic and onions.
  • Limit alcohol, carbonated and caffeinated drinks (coffee, tea, colas).
  • Wear loose fitting clothes.

When to contact your health care team

Speak with your health care team if:

  • You have reflux regularly, even after following these tips.
  • Your symptoms are affecting your daily activities and your sleep.

Considerations for Surgery

Gastric cancer may be treated with surgery. Eating well before and after surgery will help maintain your weight and improve recovery.

Before Surgery

Eating well before surgery

Eating well before surgery is important because it will help you gain or maintain weight, give your body strength, boost your immune system, and help you recover after surgery.

Leading up to surgery:

  • Eat well by:
    • Having regular meals and snacks.
    • Having protein, such as chicken, fish, meat, eggs, nuts, nut butters, tofu, beans, cheese, and milk, with meals and snacks.
    • Including lots of fruits and vegetables.
    • Eat whole grains, such as whole grain bread and pasta, oats, barley, and brown rice.
  • Drink plenty of fluids.
  • Limit alcohol.

Many people have trouble eating well before surgery because they feel sick, have low appetite, and get full very quickly. Follow the tips under  Management of Symptoms  for more ideas on how to eat well when you have these symptoms.

Speak to your health care team if:

  • You are losing weight.
  • You feel that you are not eating enough.

Preparing for surgery

In the days after surgery, you may be too tired to do everyday tasks. Getting your home ready before surgery can help you be prepared for this.

  • Stock up your kitchen with ready-to-eat foods, such as frozen entrees, canned foods, and prepared foods from grocery stores.
  • Cook and freeze meals so that you don’t have to worry about cooking.
  • Buy nutritious snacks, such as cheese and crackers, peanut butter, trail mix, dried/fresh fruits, and yogurt.
  • Ask friends and family to help you buy groceries and prepare meals.

After Surgery

Eating well after surgery

After surgery, it is important to eat well to help your body heal and regain strength.

Eat well after surgery by:

  • Eat well by:
    • Eating small, frequent meals throughout the day.
    • Having protein, such as chicken, fish, meat, eggs, nuts, nut butters, tofu, beans, cheese, and milk, with meals and snacks.
    • Including lots of fruits and vegetables.
    • Eat whole grains, such as whole grain bread and pasta, oats, barley, and brown rice.
  • Drink plenty of fluids.
  • Limit alcohol.
  • Cook and freeze meals when you have energy
  • Buy nutritious snacks such as cheese and crackers, peanut butter, trail mix, dried/fresh fruits, and yogurt.
  • Ask friends and family to help you buy groceries and prepare meals.

Dumping Syndrome

People who have had part or all of their stomach removed may experience dumping syndrome. It happens when food goes into your small intestine too quickly, causing you to feel any combination of the following:

  • Stomach cramps and bloating
  • Nausea and vomiting
  • Diarrhea
  • Sweating
  • Feeling tired
  • Dizziness
  • Fast heart rate
  • Shakiness
  • Weakness
  • Hunger

If you are experiencing these symptoms, the tips below can help.

Tips to manage dumping syndrome:

  • Eat smaller and more frequent meals. Eat slowly and chew your food thoroughly.
  • Eat solid foods during meal times and drink fluids 30-45 minutes before or after your meal.
  • Limit foods/drinks that have a lot of sugar such as juice, pop, supplements (regular Ensure®, Boost®, etc.), candies, desserts, jams, syrup, and honey.
  • Have protein foods at every meal. These include chicken, fish, meat, eggs, nuts, nut butters, tofu, beans, cheese, and unsweetened yogurt.
  • Have high fibre foods, such as whole grains, oat bran, fruits and vegetables, and beans.
  • Lie down for 30 minutes after eating.
  • Avoid foods that make you feel uncomfortable.

When to contact your health care team

Speak to your health care team if:

  • You are losing weight.
  • You are experiencing dumping syndrome even after making changes to the way you eat.

Vitamin and Mineral Deficiencies

It may be difficult to absorb certain vitamins and minerals if your stomach is removed during surgery. As a result, people who have stomach surgery can have low levels of some vitamins and minerals. Nutrients that may be affected include:

  • Vitamin B12
  • Iron
  • Folate
  • Calcium
  • Vitamin D

Anemia (not enough healthy red blood cells) and osteoporosis (weak bones) can be the result of constantly low vitamin and minerals levels.

If you have had stomach surgery, speak to your health care team to decide if you need blood tests to monitor nutrient levels or need to take vitamin supplements. Your health care team can tell you how much of the vitamin you need and the best way to take it.

When Eating isn’t Enough

Sometimes, you may not be able to get all of the nutrition you need by eating food.  Other options, such as tube or IV feeding, may help slow weight loss and manage your symptoms.  Your health care team can help you figure out if tube or IV feeding would benefit you.

Connect with a Dietitian

A dietitian is someone who is trained to give advice about eating well. He/she can give you more ideas on how to eat well based on your personal needs.

Speak to your health care team about how to connect with a Registered Dietitian, or contact your local cancer centre to make an appointment with a Registered Dietitian.

Resources

Check out the following resources for more information on good nutrition and gastric cancer

McGill University Health Center: Stomach Cancer Nutrition

The information on this website was developed and compiled by Sunnybrook Health Sciences Centre Registered Dietitians.