About this ebook

This eBook is for people who may be finding it difficult to maintain their weight during and after cancer treatment. It explains the different food types and has suggestions on how to get more energy and protein in your diet. It also includes some meal ideas and some shopping list suggestions. These may help you when preparing meals.

This eBook is part of a series of booklets on diet and cancer. The other booklets in the series are Recipes for people affected by cancer, Eating problems and cancer, Healthy eating and cancer and Managing weight gain after cancer treatment.

Check with your cancer doctor, nurse or dietitian that this is the right booklet for you, and whether you need more information.

How to use this eBook

This eBook is split into sections to help you find what you need. You do not have to read it from start to finish. You can use the contents list to help you.

At the end of the eBook, there are details of other organisations that can help.

If you find this eBook helpful, you could pass it on to your family and friends. They may also want information to help them support you.

Quotes

In this eBook, we have included quotes which you may find helpful. Some are from our Online Community. The others are from people who have chosen to share their story with us. To share your experience, visit macmillan.org.uk/shareyourstory

For more information

If you have more questions or would like to talk to someone, call the Macmillan Support Line free on 0808 808 00 00, 7 days a week, 8am to 8pm, or visit macmillan.org.uk

If you would prefer to speak to us in another language, interpreters are available. Please tell us, in English, the language you want to use.

If you are deaf or hard of hearing, call us using NGT (Text Relay) on 18001 0808 808 00 00, or use the NGT Lite app.

We have some information in different languages and formats, including audio, eBooks, easy read, Braille, large print and translations. To order these, visit macmillan.org.uk/otherformats or call 0808 808 00 00.

How the building-up diet can help

Changes to your appetite and weight

Many people with cancer find there are times when they cannot eat as much as usual. Sometimes this leads to weight loss.

There are lots of reasons for this. It can be caused by cancer or the side effects of cancer treatments. Some people do not feel hungry at all. Others may feel full soon after starting a meal. Others find that food makes them feel sick (nauseous) or that treatment makes some foods taste different.

Some types of cancer make your body use up more energy, even if you are not very active. The cancer may produce chemicals that make your body work more quickly than normal. It may also produce chemicals that make your body break down fat and protein more quickly. This can make you lose weight, even though you may still be eating well.

If you lose too much weight, it is important to talk to a dietitian. They can suggest changes to your diet. They may suggest you take nutritional supplements to help prevent further weight loss and help you gain weight.

Try to keep active

It is important to try to keep active, even if you are losing weight. Without some activity, your muscles can get weak quickly. Activity should be done at your own pace. Gentle exercise, such as going for a short walk, may be all you need. Your doctor, nurse or physiotherapist can advise you on how much and which types of exercise would be helpful for. You may find our Move More pack helpful.

Know your food types

Fruit and vegetables

Fruit and vegetables are a good source of vitamins, minerals and fibre. They are also usually low in fat.

Starchy foods (carbohydrates)

Starchy foods (carbohydrates) are an important part of a healthy diet. They are a good source of energy and contain nutrients, including fibre, calcium, iron and B vitamins.

Starchy foods are broken down in the body to become glucose. Glucose is a type of sugar that gives us energy. Energy is measured in calories. We all need a certain number of calories each day for energy, even if we are not being very active. For example, you need energy to breathe, even when you are sitting down.

The amount of energy you need each day varies. It depends on how quickly your body uses the energy, and on your level of activity. An adult man needs about 2,500 calories a day. An adult woman needs about 2,000 calories a day. If you eat and drink too many calories, you put on weight. If you do not have enough, you use up your body’s energy stores and lose weight.

Fibre

The main role of fibre (roughage) is to keep the digestive system and bowels healthy and prevent constipation. Fibre is the part of cereals, fruits and vegetables that is not digested and passes down into the gut.

Sugar

Sugar is a good source of energy. It is found naturally in some food and drinks, such as fruit and milk. The body also gets glucose (a type of sugar needed for energy) by breaking down carbohydrates.

Fats

Having some fat in our diet helps us to absorb vitamins A, D, E and K. Foods that are high in fat are also high in energy (calories). This means eating a lot of fat can help you to put on weight or prevent further weight loss.

There are two types of fat:

- Saturated fats are found mainly in meat, pies, sausages, butter, cheese, ghee, coconut oil, cakes and biscuits.

- Unsaturated fats are found mainly in vegetable-based cooking oils and spreads, nuts, avocado, seeds and oily fish such as salmon, sardines and mackerel.

Unsaturated fats are still high-energy (high-calorie) foods. Generally, it is important to try to eat less fat, and to choose foods that contain unsaturated fats instead of saturated fats. But if you are trying to gain weight, you may need to have more fat in your diet.

Protein

Your body needs protein to do things like building and repairing muscles and other body tissues. When we are ill, injured or stressed, we need extra protein (as well as extra energy) to repair any damage.

Protein-rich foods can also be a good source of vitamins and minerals. There is protein in:

- red meat

- poultry, such as chicken and turkey

- fish

- dairy products, such as milk and eggs

- pulses, such as peas, beans and lentils

- some plant-based meat alternatives, such as soya, tofu and mycoprotein (Quorn).

Vitamins and minerals

The body needs minerals for various functions, such as maintaining healthy nerves, bones and teeth. Vitamins are essential to help our bodies work normally, but we only need tiny mounts of them. If you are eating a healthy balanced diet with plenty of fruit and vegetables, you are probably getting enough vitamins. But if you are not able to eat well for a long period of time, you may need multivitamins and mineral supplements. Your doctor, dietitian or pharmacist can give you more advice about these.

High-dose vitamin and mineral supplements are not recommended during cancer treatment. It is not known if they will affect how your treatment works.

Fluids

Your body needs fluid to work properly. You should aim to drink about at least 2 litres (31/2 pints) of fluids each day. You will need to drink more if:

- you are more active than normal

- it is warm

- you are losing fluid through sweat.

Water is the best fluid to drink to keep your body hydrated. It contains no calories and no sugars. If you do not like the taste of plain water, you could add a slice of lemon or lime.

If your appetite is poor, you can get more energy by choosing more nourishing drinks such as milk, milkshakes and smoothies.

Milk is a good source of calcium, which is good for bone health. It also contains other vitamins and minerals. If you are trying to gain weight or prevent further weight loss, you should choose whole milk where possible.

Fruit and vegetable juices and smoothies contain a variety of nutrients. Juice drinks, squashes and fizzy drinks can be high in sugar and calories. They contain very few nutrients, so you should avoid drinking them where possible.

Drinks that contain caffeine may dehydrate you. This is because they make you pee (pass urine) more. Caffeine drinks include coffee, tea, some fizzy drinks and energy drinks. You can include them when you are adding up how much you drink each day. But try to have other fluids that do not contain caffeine as well.

The building-up diet

People who find it difficult to eat enough need to find ways to get more energy and protein in their diet. This is also important if they are losing weight.

The building-up diet is high in energy and protein. It is for people who have lost or are losing weight, or who can only manage to eat small amounts. Not everyone will be able to put on weight with this diet. But it should help to slow down or stop further weight loss.

Your doctor or dietitian may recommend foods that you may normally think of as unhealthy. If you do not have a dietitian, you can ask your cancer doctor, nurse or GP to refer you to one. Qualified dietitians are experts in assessing the nutritional needs of people who are ill. They can review your diet and consider any specialist dietary needs you may have, such as food intolerances or allergies. They can give you advice about which foods are best for you and whether nutritional supplements may be helpful.

‘The dietitian at the hospital told me to forget the low-fat stuff as I needed energy. I made loads of homemade soup which is really good for you. Try swirling a little bit of cream through it too.’ Shelley

Adding energy and protein to everyday foods

If you have a good appetite, you should not have trouble eating the extra calories and protein you may need if you are ill. But if you do not have a good appetite, there are ways to add extra energy and protein to your diet without having to eat more food.

Many foods that help add energy and protein are animal products, such as cream and cheese. It can sometimes be difficult to gain weight if you eat a plant-based diet (for example, if you are vegetarian or vegan). Meat-free sources of energy and protein include:

- nuts and nut butters

- avocados, lentils, beans and chickpeas

- quinoa

- tahini

- dried fruits

- sweet potatoes and rice

- vegan cheeses, spreads and cream.

Talk to your cancer doctor, specialist nurse or a dietitian if you are still struggling. They may encourage you to eat everyday foods that are high in energy and protein. They may also recommend or prescribe food (nutritional) supplements, such as milkshakes or juices.

If you do not already have a dietitian, your doctor at the hospital can refer you to one. In some hospitals, you can refer yourself. You can contact the hospital’s dietetic department for more information. If you are not in hospital, your GP can refer you to a community dietitian. They may visit you at home or see you at your local GP surgery or health centre.

If you have any dietary limitations, such as a lactose intolerance or diabetes, it is important to talk to a dietitian, GP or specialist doctor at the hospital for advice.

Fortified milk

You can add extra energy and protein to your diet without having to eat more. This is called fortifying your food. You can fortify milk by adding 2 to 4 tablespoons of dried milk powder to 570ml (1 pint) of full-fat milk and mixing it together. Keep it in the fridge and use it in drinks or on cereals. You can also use fortified milk, or milk-based supplements, instead of water when cooking. For example, you can use it to make soups, jellies, custards and puddings.

You can fortify plant-based milks, such as oat or coconut milk, by mixing in ground nuts or powdered peanut butter.

Many producers of nutritional supplements can give you recipes that use their products. Read the packet or visit the product website for details.

Cereals and porridge

Pour fortified milk or a milk-based supplement in your cereal. Make porridge with full-fat milk or cream. Add golden syrup, maple syrup, honey or sugar to your cereal or porridge. Try adding chopped nuts, mashed banana and stewed or dried fruit too.

Casseroles and soups

Add lentils, beans or noodles to casseroles and soups. Stir a tablespoon of cream into canned soups or add energy and protein supplements. You can also grate some cheese over the heated soup or drizzle some olive oil over the top. Try making packet soups using fortified milk.

Mashed potato

Add butter or cream to mashed potato, and sprinkle grated cheese on top.

Vegetables

Choose vegetables that are rich in protein and energy, such as spinach, sweetcorn, beans and lentils. Melt butter on hot vegetables and top with grated cheese or a chopped, hard-boiled egg. Or add a sauce made with fortified milk or cream.

Sandwiches

Use plenty of butter or spread. Add a dessert spoon of mayonnaise or salad cream to sandwich fillings such as tuna, chicken, avocado, egg or cheese.

Tips to add energy and protein to meals

- When you are shopping, choose full-fat foods instead of ‘diet’ or ‘light’ foods.

- Fry your foods in oil, ghee or butter.

- Add extra butter, margarine or oil to bread, potatoes, pasta and cooked vegetables.

- Add extra cheese or plant-based cheese to sauces and extra paneer to curries.

- Add cream, sour cream, plain yoghurt, mascarpone or crème fraiche to sauces, soups and meat dishes. Plant-based alternatives can be used too.

- Add whole or blended beans, lentils or peas to curries and stews.

- Add evaporated milk, condensed milk, cream or soya cream to desserts and hot drinks.

- Have cream, custard, ice cream or dairy-free ice cream with desserts.

- Add peanut butter (or other nut spreads), chocolate spread, tahini, honey or jam to bread, toast, crackers and biscuits.

- Add nut butters, avocado, Greek yogurt or plant-based alternatives to smoothies.

Manufactured food (nutritional) supplements

The best way to get more energy and protein is by eating a healthy, balanced diet. If you are still having eating problems or are losing weight, talk to your cancer doctor, specialist nurse, dietitian or GP. They can give you more advice.

There are many nutritional supplements available that can add extra energy or protein (or both) to your diet. You can add them to your everyday foods, or have them in addition to your normal diet. Sometimes they can be used to replace meals.

The types of nutritional supplements available include:

- milk-based supplements

- juice-tasting supplements

- soups

- powders that are made into drinks with water or milk

- ready-made puddings

- concentrated liquids.

They come in many different flavours. You can sometimes get these products from your chemist or supermarket. But sometimes your doctor, nurse or dietitian needs to prescribe them for you. You should only use high-protein or high-energy supplements as your doctor or dietitian tells you.

If you are vegetarian or vegan, or if you have a dietary intolerance, such as to dairy (lactose) or gluten, ask your GP, specialist nurse or dietitian to prescribe suitable food supplements.

If you are diabetic, it is important to get advice from your GP, specialist nurse or dietitian before using nutritional supplements.

Powdered drinks

Some powdered drink supplements can be used to replace a meal. You can mix them with fortified milk, regular milk or water. Sometimes your doctor will prescribe these supplements. Or you can buy them from a chemist or supermarket

You can mix some powder supplements into food. You can add them to soup, custards or milk puddings. Sometimes companies that make the powders have recipes on their websites.

Milk-based supplements

Milk-based supplements are available on prescription in a range of flavours including sweet, savoury and neutral flavours. They usually need to be used within 24 hours. If you can only manage small amounts at a time, you can pour some into a glass and keep the rest in the fridge.

Juice-tasting supplements

These ready-made, flavoured supplements are available on prescription.

If you find them too sweet, you can dilute them with water or fizzy drinks such as soda or tonic water. You can also put them into jellies or puddings.

High-energy and juice-tasting supplements have a high sugar content. If you are diabetic, talk to your dietitian before using them. These drinks may not be suitable if you have a sore mouth or throat, as they may sting.

If you have had radiotherapy for certain types of head and neck cancer, you may be more at risk of tooth decay. It is best to avoid having sugar too often.

It is a good idea to clean your teeth or use a mouthwash after any sugary snacks. Make sure you have your teeth regularly checked by a dentist. Your GP, nurse or dietitian can give you more advice about this.

Fat-based liquids

You can take fat-based liquids separately in small doses. Or you can add them to some foods. Your doctor or dietitian will give you advice on how and when you should use this type of supplement.

Energy and protein powders and gels

Unflavoured powders and gels are available on prescription from your GP or dietitian. These are almost tasteless. You can add them to drinks, soups, sauces and gravies, casseroles, milk puddings and desserts.

Your dietitian can explain how much powder to use in different meals or drinks.

‘Nearly every type of fruit and vegetables can be blended together to make smoothies. They can be frozen in ice lolly moulds. And you can add protein powder to bulk them up.’ Ian

Planning your meals

Shopping list

Here is a list of items you might want to stock up on. This list means you have foods available which are high in energy and protein. We have listed foods that last for longer. But you will still need to shop for fresh fruit and vegetables. If you eat meat and fish, you will need to buy these fresh or frozen.

For the cupboard

You might want to buy:

- porridge or oatmeal

- sugar, maple syrup, golden syrup or honey

- bread, paratha, chapatis, naan, pitta, muffins, crumpets or tortillas

- biscuits and crackers

- nuts, seeds, Sev or Bombay mix

- evaporated milk or dried milk powder

- drinking chocolate or malted drinks

- fresh, dried, tinned or stewed fruit

- tinned vegetables

- peanut butter, jam or marmalade

- jelly

- puddings, such as custard, instant desserts or rice pudding

- oil or ghee

- gravy

- mayonnaise or salad cream

- tins, cartons or packets of soup

- tins of fish, such as mackerel or sardines.

For the fridge

You might want to buy:

- full-fat milk or a dairy-free milk such as coconut milk

- cream or crème fraiche

- butter or margarine

- pasteurised cheese

- eggs

- full-fat hummus

- full-fat yoghurt, fromage frais or lassi, or soya or coconut yoghurts

- ready-made smoothies or milkshakes

- ready-made puddings, for example trifle, crème caramel, fruit crumble or steamed puddings

- ready-made custard.

For the freezer

You might want to buy:

- ice cream, ice lollies or sorbet

- kulfi

- frozen ready meals

- frozen fruit, such as raspberries, mango or blueberries

- frozen vegetables, such as peas or vegetable mixes

- cheese, which you can grate and then freeze.

Meal ideas

Here are some ideas for breakfast, lunch, dinner and pudding. They show you how to get more protein and energy into your diet, without having to eat more food. We hope these give you some ideas for ways to adapt your usual meals.

Between meals, you can keep up your energy intake with nourishing snacks and drinks.

We have recipes for people affected by cancer with more suggestions of meals suitable for people with weight loss. The recipes have information about how much protein and energy is in each meal.

Breakfast

Here are some suggestions:

- A fried egg with bacon and a slice of fried bread.

- Scrambled eggs or an omelette with grated cheese. Add toast with butter, dairy-free spread or ghee.

- Scrambled tofu with spinach and grilled tomatoes.

- An English muffin, crumpet or toast with lots of butter or dairy-free spread, and honey, jam, peanut butter or a sliced banana.

- Stewed fruit, such as prunes, rhubarb, apples or apricots, with Greek or full-fat yoghurt. Dairy-free yoghurt can also be used. You can also add cereal, seeds or nuts.

- Porridge made with fortified or plant-based milk. Add sugar, honey, toasted seeds, fresh fruit or jam.

- Yoghurt with nuts, seeds and dried fruit, or dalia (wheat porridge) with butter.

- Cornmeal porridge and Caribbean hard-dough bread with butter.

- Minced-beef congee or assorted dumplings. Add some deep-fried peanuts.

- A whole-wheat cereal such as Weetabix®, cornflakes or bran flakes with fortified milk or coconut milk and sugar.

- A fruit smoothie with added avocado and full-fat yoghurt.

Lunch

Here are some suggestions:

- A tuna and cucumber sandwich with butter, mayonnaise or salad cream.

- Mashed avocado on toast and a bowl of thick vegetable or lentil soup, drizzled with extra olive oil or sprinkled with cheese.

- A hard-boiled egg sandwich or a chicken sandwich, with mayonnaise.

- A baked potato with grated cheese. Mash extra butter or dairy-free spread into the inside of the potato. Add baked beans or tuna with mayonnaise or salad cream.

- A cheese and salad sandwich. Be generous with the filling and add mayonnaise.

- A warm salad, made with quinoa and sautéed vegetables, such as broccoli, kale, onion, garlic, and tempeh. Add feta cheese or a vegan alternative and drizzle with olive oil.

- A mixed bean chilli or stew with rice or potatoes, sprinkled with cheddar or vegan cheese.

- Stuffed paratha or chapati with vegetables or rice, vegetable curry or hard-boiled egg and potato curry. Use ghee, butter or extra oil for cooking.

- Steamed red mullet with vegetables, topped with some olive oil or butter and served with rice or potatoes.

- Noodles, plain rice or fried rice with mixed seafood or meat and vegetables.

- Chicken soup and a hard-boiled egg sandwich.

- Try having rice pudding or some fruit after lunch too. We have more ideas for puddings.

Dinner

Here are some suggestions:

- Lasagne or spaghetti bolognese with cheese. For a vegetarian option you could use a meat substitute, such as soya mince, Quorn or lentils. Add a side salad with dressing, mayonnaise or salad cream.

- Grilled salmon or trout, with new potatoes and green beans. Add butter to the vegetables and a white sauce to the fish.

- Roast chicken with potatoes and fresh vegetables. Add butter to the vegetables and potatoes.

- Lamb curry with pulses (or use soya mince, Quorn or lentils) and salad. Add coconut milk or cream

- Khichari (lentils and rice), lentil soup or shorba (lamb and chicken soup).

- Caribbean chicken with mashed potato, callaloo and sweetcorn. Add butter to the vegetables and butter, cream and cheese to the potatoes.

- Steamed fish with black bean sauce and plain rice.

- Shepherd’s pie with carrots and peas (or use soya mince, Quorn or lentils). Use fortified milk and butter in the mashed potato, or grated cheese on top.

Puddings

Here are some suggestions:

- Stewed fruit with fresh cream or dairy-free yoghurt.

- Fruit crumble with fresh cream, custard or soya cream.

- Fruit yogurt or fromage frais – choose a full-fat variety.

- Fresh custard – ready-made or made with fresh cream.

- Fresh fruit such as mango, orange, banana, lychee or pineapple with cream, ice-cream or dairy-free alternative.

- Fruit or chocolate trifle – choose a full-fat variety.

- Rice pudding.

- Microwave or ready-puddings with custard – vegan choices are often available.

Try adding ice cream, cream or evaporated milk to cold puddings. Try adding custard made with fortified milk to hot puddings. You could add sugar or syrup to puddings too. Try making instant desserts with fortified milk or a dairy-free alternative, such as oat cream or nut butters.

You could also try some pudding recipes using different ready-made or powdered supplements. Manufacturers of nutritional products often have recipe booklets. Check the packets or their websites for more information.

Snacks

Keep snacks handy if you feel hungry between meals. For example, you could try:

- unsalted nuts

- pasteurised cheese

- dried fruit

- biscuits

- fruit loaf with butter

- cakes or scones with jam and cream

- breadsticks and dips

- full-fat yoghurts or fromage frais

- a bowl of cereal with milk

- mini pork pies, quiche or egg-bites.

Think about taking snacks or a nourishing drink, with you if you are out of the house for some time during the day. For example, if you have a radiotherapy appointment.

Drinks

Add energy and protein to coffee, tea or bedtime drinks. You can do this by using fortified or full-fat milk instead of water. Or add 3 teaspoons of a high-energy powder (prescribed by your doctor or dietitian) to hot or cold drinks. Ready-made nutritional supplement drinks can be drunk straight from the packet, gently heated or used in recipes.

If you do not want to eat a meal, you could try a nourishing drink instead. You can also drink these between meals to help you put on weight.

You might want to make your own drinks, such as fruit milkshakes or smoothies. Here are some examples:

- Fruit smoothie – blend fresh banana, peaches, strawberries or other soft fruit (fresh or frozen) with fortified milk, fruit juice, ice cream, yoghurt or a non-dairy alternative. Add avocado for extra calories.

- Milk smoothie – blend 200ml of full-fat milk, 2 tablespoons of milk powder, 2 scoops of ice cream and some milkshake syrup or powder. Blend until well-mixed and frothy. You can change the flavour of the ice cream to match the milkshake syrup or powder.

- Nutritious milkshake – mix fortified milk with puréed fruit or a fruit yoghurt and add 2 to 3 teaspoons of a high-energy powder supplement (prescribed by your GP or dietitian). A scoop of ice cream will add extra energy. Use non-dairy products for a vegan alternative.

Substituting ingredients

Feel free to use different ingredients from those we have suggested.

If you do not eat dairy products, you can replace:

- milk with soya, oat, rice, hazelnut, almond or coconut milk

- cream with coconut or soya cream

- butter with olive oil, rapeseed oil, vegetable or coconut oil, or dairy-free spreads

- yoghurt with soya or coconut yoghurt.

Spices can help if you have lost some sense of taste or smell and want something with strong flavours. Check the packaging to see how hot or spicy it is. But if highly flavoured foods do not appeal to you, make these dishes milder by swapping ingredients or adding natural yoghurt.

Coping with weight loss

Your feelings about weight loss

Weight loss can be upsetting and difficult to cope with. This is because it can be a visible reminder of your illness. It can also affect your body image. Body image is the picture you have in your mind of how you look. It is how we think and feel about our bodies and how we believe others see us. We have more information in our booklet Body image and cancer.

If you lose weight because of cancer or its treatment, you will see a different image of yourself from the one you are used to. You may find it hard to accept that you look different because you have lost weight. You may feel angry, anxious or sad. It is natural to feel like this. It is part of adapting to the way you see yourself. You may meet other people who have similar thoughts and feelings. We have more information on coping with your emotions in our booklet How are you feeling? The emotional effects of cancer.

You may worry that the change in your appearance will affect relationships with a partner, family and friends. You may be anxious about what people think of you or about being rejected. Or you may feel self-conscious about eating at home or out with your family and friends.

‘I lost about a stone and a half during treatment and 4 months post treatment, I am only now putting it back on. I am finding that I have a very different relationship with food now though. I’m eating healthier food and smaller portions.’ Debbie

Talking about how you feel

People often keep their thoughts and feelings about their bodies to themselves. But keeping your worries hidden can make them grow into something bigger. So, it is important to talk to someone.

Many people find it help to talk to someone close to them. If you find it difficult to talk about your feelings with a partner, family member or a friend, you could talk to your doctor or specialist nurse. You may also find it helpful to speak to a counsellor. Your GP or nurse can give you advice on how to contact one.

If you are close to someone who has had physical changes, it may take you time to adjust and accept the changes. You may need to talk about your feelings too.

Getting help with meals

You may not always feel well enough to cook food for yourself or others. If you usually prepare meals for your family, it may feel strange to let someone else take charge. Try not to feel guilty about letting someone else do the things you usually do. When you feel better, you can return to your normal routine.

If you find ready meals or pre-prepared meals easier than cooking, use them on days when you do not feel like cooking.

If you live on your own and need help with cooking or shopping, contact your GP, district nurse or social worker. They may be able to arrange for a home helper, meals on wheels or a local organisation to help you with cooking or shopping.

Caring for someone with eating problems or weight loss

If you are the main carer for someone with cancer, it can be upsetting and difficult to know how to deal with eating problems, such as lack of appetite or weight loss. People who are ill often do not feel like eating. Cancer, cancer treatments and other medicines can all affect someone’s appetite. Feeling sick and having diarrhoea or constipation can stop people eating. Or they may feel too tired to eat, have a sore or dry throat or mouth, or find chewing and swallowing difficult.

Mealtimes are often an enjoyable and important part of family and social life. It can be frustrating and worrying when someone you care for cannot eat very much.

The amount someone can eat may change each day, and their likes and dislikes may also change. Try not to put pressure on someone to eat. This can sometimes cause arguments. If you know when their appetite is at its best, you can make the most of it. For example, you could treat them to their favourite foods.

If the person you are caring for continues to struggle with food and is losing weight, speak to their doctor or nurse. They can refer them to a dietitian. The dietitian can advise on using nutritional supplement drinks if this is appropriate.

Tips to help build up someone’s diet

Ask the person for what they would like to eat.

- Try to talk openly about their weight loss and the different ways you could both manage it. This can help you both feel more in control of the situation.

- Try to give them smaller meals and snacks, whenever they feel like eating. This might be better than eating at set times of the day.

- Try not to offer drinks before a meal. This can make them feel too full to eat.

- Offer their favourite foods at the times when you know their appetite is at its best.

- Make batches of their favourite meal and freeze some to have as a quick meal at another time.

- Keep snacks in easy reach so they are ready whenever the person feels hungry. Have a look at the shopping list we suggest and stock up on some items you know they prefer. You can then prepare meals and snacks easily.

- Avoid low-fat or diet products. For example, choose whole milk rather than skimmed milk.

- Try offering a small amount of alcohol just before, or with, food. Some people find this helps their appetite. Check with the doctor or specialist nurse that the person can have alcohol.

- Add extra energy to everyday meals and drinks. For example, you could try adding fortified milk to tea or coffee. We have more information on how to build up your diet with extra energy.

- Encourage the person to do regular activity, if possible. This can help increase their appetite. Start gently with something that is easy to manage.

- The person you are caring for may have nausea, vomiting, a sore mouth or changes to their taste or bowel habits. If they do, speak to their doctor or nurse. They can either prescribe something to help, or refer them to a dietitian.

- Make sure you have support. It is also important that you take time to look after yourself and ensure you are eating well. We have more information in our booklet Looking after someone with cancer.
‘My husband has challenges eating. He hates the thought, smell and taste of almost everything. The only thing he does tolerate is sweet stuff. Chocolate, custard, yoghurt and rice pudding. Though not an ideal diet at least it’s something.’ Sue

Serving food

- The person you are caring for may find that some cooking smells make them feel sick. Prepare food in a different room if possible. Serve food in a well-ventilated room.

- Try to create a comfortable eating environment.

- Present meals so they look appetising.

- Keep servings small. Offer extra helpings rather than putting too much food on the plate to begin with. Too much food can be overwhelming and off-putting.

- The person you are caring for may want to go out to a cafe or restaurant for food. You can call ahead and ask if they can prepare softer, easier-to-eat foods. You can also ask if they can provide smaller portions.

- Try not to worry if the person you are caring for cannot always eat what you have cooked. Gently encourage them to eat but try not to push them too much.

Further information

About our information

We provide expert, up-to-date information about cancer. And all our information is free for everyone.

Order what you need

You may want to order more booklets or leaflets, or download more eBooks like this one. Visit be.macmillan.org.uk or call us on 0808 808 00 00.

We have booklets on different cancer types, treatments and side effects. We also have information about work, financial issues, diet, life after cancer and information for carers, family and friends.

Online information

All of our information is also available online at macmillan.org.uk/information-and-support There you’ll also find videos featuring real-life stories from people affected by cancer, and information from health and social care professionals.

Other formats

We also provide information in different languages and formats, including:

- audiobooks

- Braille

- British Sign Language

- Easy Read booklets

- large print

- translations.

Find out more at macmillan.org.uk/otherformats If you’d like us to produce information in a different format for you, email us at cancerinformationteam@macmillan.org.uk or call us on 0808 808 00 00.

Help us improve our information

We know that the people who use our information are the real experts. That’s why we always involve them in our work. If you’ve been affected by cancer, you can help us improve our information.

We give you the chance to comment on a variety of information including booklets, leaflets and fact sheets.

If you’d like to hear more about becoming a reviewer, email reviewing@macmillan.org.uk You can get involved from home whenever you like, and we don’t ask for any special skills – just an interest in our cancer information.

Other ways we can help you

At Macmillan, we know how a cancer diagnosis can affect everything, and we are here to support you.

Talk to us

If you or someone you know is affected by cancer, talking about how you feel and sharing your concerns can really help.

Macmillan Support Line

Our free, confidential phone line is open 7 days a week, 8am–8pm. Our cancer support specialists can:

- help with any medical questions you have about your cancer or treatment

- help you access benefits and give you financial advice

- be there to listen if you need someone to talk to

- tell you about services that can help you in your area.

Call us on 0808 808 00 00 or email us via our website, macmillan.org.uk/talktous

Information centres

Our information and support centres are based in hospitals, libraries and mobile centres. There, you can speak with someone face to face.

Visit one to get the information you need, or if you’d like a private chat, most centres have a room where you can speak with someone alone and in confidence.

Find your nearest centre at macmillan.org.uk/informationcentres or call us on 0808 808 00 00.

Talk to others

No one knows more about the impact cancer can have on your life than those who have been through it themselves. That’s why we help to bring people together in their communities and online.

Support groups

Whether you are someone living with cancer or a carer, we can help you find support in your local area, so you can speak face to face with people who understand. Find out about support groups in your area by calling us or by visiting macmillan.org.uk/selfhelpandsupport

Online community

Thousands of people use our online community to make friends, blog about their experiences and join groups to meet other people going through the same things. You can access it any time of day or night. Share your experiences, ask questions, or just read through people’s posts at community.macmillan.org.uk

The Macmillan healthcare team

Our nurses, doctors and other health and social care professionals give expert care and support to individuals and their families. Call us or ask your GP, consultant, district nurse or hospital ward sister if there are any Macmillan professionals near you.

Help with money worries

Having cancer can bring extra costs such as hospital parking, travel fares and higher heating bills. If you’ve been affected in this way, we can help.

Financial guidance

Our financial guidance team can give you advice on mortgages, pensions, insurance, borrowing and savings.

Help accessing benefits

Our benefits advisers can offer advice and information on benefits, tax credits, grants and loans. They can help you work out what financial help you could be entitled to. They can also help you complete your forms and apply for benefits.

Macmillan Grants

Macmillan offers one-off payments to people with cancer. A grant can be for anything from heating bills or extra clothing to a much-needed break.

Call us on 0808 808 00 00 to speak to a financial guide or benefits adviser, or to find out more about Macmillan Grants. We can also tell you about benefits advisers in your area.

Visit macmillan.org.uk/financialsupport to find out more about how we can help you with your finances.

Help with work and cancer

Whether you’re an employee, a carer, an employer or are self-employed, we can provide support and information to help you manage cancer at work. Visit macmillan.org.uk/work

Other useful organisations

There are lots of other organisations that can give you information or support.

Nutrition and diet information and support

British Dietetic Association (BDA)

Tel 0121 200 8080

Email info@bda.uk.com

www.bda.uk.com

Provides training and facilities for registered dietitians. The website includes food facts, and has information on the role of dietitians and how to find one.

British Nutrition Foundation

Tel 020 7557 7930

Email postbox@nutrition.org.uk

www.nutrition.org.uk

The website has information about healthy eating and lifestyle choices.

Diabetes UK

Tel 0345 123 2399 (Mon to Fri, 9am to 6pm)

Email helpline@diabetes.org.uk

Tel (Scotland) 0141 212 8710 (Mon to Fri, 9am to 6pm)

Email (Scotland) helpline.scotland@diabetes.org.uk

www.diabetes.org.uk

Gives information and support on any aspects of managing diabetes, including medication, diet and exercise.

General cancer support organisations

Cancer Black Care

Tel 020 8961 4151

www.cancerblackcare.org.uk

Offers UK-wide information and support for people from Black and ethnic minority communities who have cancer. Also supports their friends, carers and families.

Cancer Focus Northern Ireland

Helpline 0800 783 3339 (Mon to Fri, 9am to 1pm)

Email nurseline@cancerfocusni.org

www.cancerfocusni.org

Offers a variety of services to people affected by cancer in Northern Ireland.

Cancer Support Scotland

Tel 0800 652 4531 (Mon to Fri, 9am to 5pm)

Email info@cancersupportscotland.org

www.cancersupportscotland.org

Runs cancer support groups throughout Scotland. Also offers free complementary therapies and counselling to anyone affected by cancer.

Macmillan Cancer Voices

www.macmillan.org.uk/cancervoices

A UK-wide network that enables people who have or have had cancer, and those close to them such as family and carers, to speak out about their experience of cancer.

Counselling

British Association for Counselling and Psychotherapy (BACP)

Tel 0145 588 3300 (Mon to Thu, 10am to 4pm)

Email bacp@bacp.co.uk

www.bacp.co.uk

Promotes awareness of counselling and signposts people to appropriate services across the UK. You can search for a qualified counsellor.

UK Council for Psychotherapy (UKCP)

Tel 020 7014 9955

Email info@ukcp.org.uk

www.psychotherapy.org.uk

Holds the national register of psychotherapists and psychotherapeutic counsellors, listing practitioners who meet exacting standards and training requirements.

Emotional and mental health support

Mind

Helpline 0300 123 3393 (Mon to Fri, 9am to 6pm)

Text 86463

Email info@mind.org.uk

www.mind.org.uk

Provides information, advice and support to anyone with a mental health problem through its helpline and website.

Samaritans

Helpline 116 123

Email jo@samaritans.org

www.samaritans.org

Provides confidential and non-judgemental emotional support, 24 hours a day, 365 days a year, for people experiencing feelings of distress or despair.

LGBT-specific support

LGBT Foundation

Tel 0345 330 3030 (Mon to Fri, 9am to 9pm, and Sat to Sun, 10am to 6pm)

Email info@lgbt.foundation

www.lgbt.foundation

Provides a range of services to the LGBT community, including a helpline, email advice and counselling. The website has information on various topics including sexual health, relationships, mental health, community groups and events.

Support for carers

Carers UK

Helpline (England, Scotland, Wales) 0808 808 7777 (Mon to Fri, 9am to 6pm)

Helpline (Northern Ireland) 028 9043 9843(Mon to Fri, 9am to 5pm)

Email advice@carersuk.org

www.carersuk.org

Offers information and support to carers across the UK. Has an online forum and can put people in contact with local

Disclaimer, thanks and sources

Disclaimer

We make every effort to ensure that the information we provide is accurate and up to date, but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Some photos are of models.

Thanks

This eBook has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been approved by Prof Tim Iveson, Consultant Medical Oncologist and Macmillan Chief Medical Editor.

With thanks to: Claire Donnelly, Dietitian; Rosie Hill, Macmillan Specialist Dietitian; and Jo Pain, Oncology Dietitian.

Thanks also to the people affected by cancer who reviewed this edition, and those who shared their stories.

We welcome feedback on our information. If you have any, please contact cancerinformationteam@macmillan.org.uk

Sources

Below is a sample of the sources used in our building-up diet information.

If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

European Society for Clinical Nutrition and Metabolism (ESPEN). ESPEN guidelines on nutrition in cancer patients. February 2017 www.espen.org [accessed Jan 2020]

European Society for Clinical Nutrition and Metabolism (ESPEN). ESPEN expert group recommendations for action against cancer related malnutrition. June 2017 www.espen.org [accessed Jan 2020]

World Cancer Research Fund (WCRF). Healthy living after cancer. 2016. www.wcrf-uk.org [accessed Jan 2020]

Can you do something to help?

We hope this eBook has been useful to you. It’s just one of our many publications that are available free to anyone affected by cancer. They’re produced by our cancer information specialists who, along with our nurses, benefits advisers, campaigners and volunteers, are part of the Macmillan team. When people are facing the toughest fight of their lives, we’re there to support them every step of the way.

We want to make sure no one has to go through cancer alone, so we need more people to help us. When the time is right for you, here are some ways in which you can become a part of our team.

5 ways you can help someone with cancer

Share your cancer experience

Support people living with cancer by telling your story, online, in the media or face to face.

Campaign for change

We need your help to make sure everyone gets the right support. Take an action, big or small, for better cancer care.

Help someone in your community

A lift to an appointment. Help with the shopping. Or just a cup of tea and a chat. Could you lend a hand?

Raise money

Whatever you like doing you can raise money to help. Take part in one of our events or create your own.

Give money

Big or small, every penny helps.

Call us to find out more 0300 1000 200

macmillan.org.uk/getinvolved