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The building-up diet

cancerbackup.org.uk

Many people with cancer find there are times when they cannot eat as much as usual, and sometimes they lose weight. There are lots of reasons for this.

Cancer itself, or its treatments, may make you lose your appetite. Some people find that they do not feel hungry, or feel full soon after starting a meal. Other people find that food makes them feel sick or that their treatment makes some foods taste different.

Some types of cancer make your body use up more energy, even if you are not very active. This can make you lose weight even though you may still be eating well.

People who are not eating enough, especially if they are losing weight, need more energy and protein in their diet. If you have often tried to lose weight previously, it can be difficult to change your eating habits when you have cancer. However, if you have cancer and are losing weight you may need to eat differently to try and maintain your weight. Your doctor or dietitian may recommend foods that you would normally think of as unhealthy, but they have good reasons for doing this.


Your feelings about weight loss
People with cancer often have weight loss and it can be upsetting because it is a reminder of your illness. It is natural to be upset by weight loss. We all have an image in our minds about what our bodies look like. Although we may not be completely satisfied with this image, most people are used to the way they see themselves.

When you lose weight, perhaps due to the cancer itself or maybe the treatment you are having, you will see a different image of yourself when you look in the mirror from the one you have developed in your mind. It can be hard for someone who has seen themselves as well-built and healthy, to accept that they now look different because they have lost weight.

You may also worry that the change in your looks will affect what your partner, family and friends think of you. Weight loss can also be worrying for your friends and family. However, despite your loss of weight, you are still the same person with the characteristics for which your family and friends value you.

Some people worry that the change in their looks will affect their personal relationships. You may be worried about rejection or carrying on a sexual relationship. Many people find, once they have summoned up the courage to talk openly to their partner, their fears of rejection are unfounded. Relationships are built on a number of things – love, trust, common experiences and many other feelings. Although weight loss can be upsetting for you both, it can help to discuss this openly and talking about the problem may help you feel closer.

Boosting your energy and protein
If you have a good appetite, you should have no trouble eating the extra energy and protein foods that you may need if you are ill. However, if your appetite is not very good there are two ways to add extra energy and protein to your diet, without actually having to eat more food.

The first is to use everyday foods that are high in energy and protein. The second is to use manufactured food supplements. These can be taken as nourishing drinks, which are available as milkshakes or soups. Some supplements are high-protein powders that can be added to your normal food.

Manufactured food supplements
Many supplements are available to add extra energy and/or protein to your diet. They are usually available from your chemist.

Some are available on prescription from your doctor. Some supplements are available ready to drink or use, and others are powders that need to be mixed with liquid. Some can be added to food.Important note: High-protein supplements should only be used with advice from your doctor or dietitian. Most people will need extra energy balanced with extra protein.

Many of these products can be used by diabetics. However, if you are diabetic you should always get advice from your doctor or dietitian before using food supplements.

Once mixed, complete milk-tasting supplements and powders should be drunk slowly over a period of 20 minutes.

High-energy and juice-tasting supplements have a high carbohydrate (sugar) content, and people who are diabetic should talk to their dietitian before using them.

People who have had radiotherapy for certain types of head and neck cancers may be at more risk of tooth decay, and so should avoid having sugar too often during the day. It is a good idea to clean your teeth or use a mouthwash after any sugary snacks. Your doctor or dietitian can give you more advice about this.

Supplements
Ready to drink
Complete high-energy,
milk-tasting (1*)
Fortisip Bottle 200ml bottle (sweet and neutral)  Nutricia Clinical Care
Clinutren 1.5 200ml cup (sweet) Nestlé Clinical Nutrition
Ensure Plus 220ml carton (sweet and neutral) Abbott Nutrition
Fresubin Energy Drink 200ml carton (sweet, savoury and neutral) Fresenius Kabi
Resource Shake 175ml carton (sweet) Novartis Consumer Health
Complete high-energy,
milk-tasting with fibre (1a*)
Fortisip MultiFibre 200ml bottle (sweet and savoury)  Nutricia Clinical Care 
FortiCare 125ml carton (sweet)  Nutricia Clinical Care 
Fresubin Energy Fibre Drink  200ml carton (sweet)  Fresenius Kabi 
Enrich Plus  200ml carton (sweet)  Abbott Nutrition 
ProSure  240ml carton (sweet)  Abbott Nutrition 
Yoghurt-tasting (1*) Fortifresh  200ml bottle or carton (sweet)  Nutricia Clinical Care 
Ensure Plus Yoghurt-style  200ml carton (sweet)  Abbott Nutrition 
Balanced, juice-tasting (1*) Fortijuce  200ml bottle  Nutricia Clinical Care 
Clinutren Fruit  200ml bottle  Nestlé Clinical Nutrition
Enlive Plus  220ml carton  Abbott Nutrition 
Provide Xtra  200ml carton  Fresenius Kabi 
Resource Fruit Flavour  200ml carton  Novartis Consumer Health 
Balanced, high-protein,
 milk-tasting (1*)
Fortisip Protein  200ml bottle (sweet)  Nutricia Clinical Care 
Fortimel  200ml bottle (sweet)  Nutricia Clinical Care
Resource Protein Extra  200ml carton (sweet) Novartis Consumer Health 
Powders
Complete, milk-tasting (1*)
Complan  Box 4 x 57g sachet (sweet and savoury) H J Heinz & Co Ltd 
Build-Up  Box 4 x 38g sachet  Nestlé Clinical Nutrition 
Energy-only (2*) Polycal Powder  400g tin  Nutricia Clinical Care 
Maxijul  200g tin  SHS International Ltd 
Polycose  350g tin  Abbott Nutrition 
Vitajoule  200g tin  Vitaflo Ltd 
Caloreen  500g tin  Nestlé Clinical Nutrition
Nutritionally balanced powders (3*) Scandishake Mix  Box 6 x 85g sachet (sweet and unflavoured)  Nutricia Clinical Care 
Calshake  Box 7 x 87g sachet (sweet flavours)  Fresenius Kabi 
Enshake  Box 6 x 96.5g sachets (sweet)  Abbott Nutrition 
Protein-only powders (4*) Protifar  225g tub  Nutricia Clinical Care 
Maxipro  200g tub  SHS International Ltd 
Vitapro  250g tub  Vitaflo Ltd 
Energy-only liquids (5*) Polycal Liquid 200ml bottle Nutricia Clinical Care
Maxijul Liquid 200ml carton SHS International Ltd
Calogen 250ml and 500ml bottles (sweet and unflavoured) Nutricia Clinical Care 
Fortified puddings (6*) Forticreme/Forticream complete 125g pot (sweet flavours) Nutricia Clinical Care
Maxisorb 30g sachet (to make up) SHS International Ltd
Clinutren Dessert 125g pot Nestlé Clinical Nutrition
Resource Energy Dessert 125g cup Novartis Consumer Health
Powders to thicken food (7*) Nutilis 225g tin and 9g sachets Nutricia Clinical Care
Thick and Easy 225g tin Fresenius Kabi
Thixo-D 375g tin Sutherland Health Ltd
Vitaquick 300g pot Vitaflo Ltd
*Commercial supplements key 1 These contain energy, protein and vitamins and minerals in various amounts. Available in a variety of flavours they can be used as additional nutrition or added to recipes 
1a As (1) above, but with added fibre.
2 These contain energy only and have no taste. They can be added to normal foods.
3 These contain energy, protein, vitamins and minerals. They can be flavourless or sweet, and can be added to normal foods.
4 These contain protein only and have no taste. They can be added to normal foods.
5 These contain energy only and are available in a variety of flavours to suit individual tastes. Can be used as additional nutrition or added to recipes etc.
6 These can be used to add extra energy and protein instead of ordinary puddings.
7 These can be used to thicken drinks and foods for people who have difficulty in swallowing fluids. Follow the instructions carefully or the products can become lumpy.
See also
Bowel cancer rates
Conditions of the oesophagus
Cancer drug approved

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