The Benefits of Proper Nutrition: Dealing with Oral Side Effects from Cancer Treatment

by Jessica Iannotta, MS, RD, CSO, CDN and Angela Hummel, MS, RDN, CSO, LDN

mouthTreatment-related side effects that impact the oral cavity can be the most unpleasant effects to deal with.  These side effects can impact nutritional status more than some other side effects.  It is important to make changes in your eating habits to help improve your ability to consume healthy, nutritious food.

Changes in your taste: During treatment the foods you usually like may become unappealing. Foods may taste bland, bitter or metallic.

  • Try rinsing with 1-2 ounces of baking-soda rinse before and after meals. (Recipe for baking soda rinse: 1 quart water, ¾ teaspoon salt and 1 teaspoon baking soda).
  • If red meats taste strange, try substituting other proteins such as chicken, turkey, fish, eggs, dairy, beans or tofu.
  • Eat foods that smell and look good to you.
  • Avoid using metal utensils; use plastic ones instead.
  • Avoid hot foods to reduce strong odors; serve food at cold or at room temperature.

A simple acronym called “FASS”, standing for fat, acid, salt, and sweet, can be very helpful for individuals with taste changes.

  • Lack of taste, “cardboard” without mouth sores:
    • Season foods with acidic flavors, such as lemon, citrus, vinegar, or pickled foods
  • Metallic taste
    • Add a fat source like extra virgin olive oil or sea salt
    • Avoid metal utensils; use plastic utensils instead
    • Add extra flavor to foods with spices such as onion, garlic, chili powder, basil, oregano, rosemary, tarragon, barbecue sauce, mustard, ketchup, or mint
  • Salty, Bitter or Sour taste
    • Try adding sweetening agents such as sugar, maple syrup, or honey to help enhance the taste
    • Sweet taste
    • Add six drops of lemon or lime juice or vinegar until sweet taste is muted

Mouth soreness: Many patients treated with high-dose chemotherapy drugs can develop mucositis and mouth soreness.

  • Avoid acidic and spicy foods along with rough and coarse foods that can irritate the oral cavity.
  • It is helpful to eat nutrient-dense, soft foods such as creamed soups, broth, pudding, scrambled eggs, yogurt, mashed potatoes, cottage cheese, shakes, smoothies and nutritional drinks.
  • Using a straw can divert liquids away from painful areas.
  • Some people may require prescription-numbing rinses before mealtime to reduce pain.
  • Strive for proper oral care and schedule an appointment with your dentist for suggestions.

Dry Mouth: Dry mouth can be a side effect from radiation to the oral cavity, medications or chemotherapy.

  • Stay hydrated and drink plenty of fluids.  Sip on fluids throughout the day.
  • Include sauces, liquid, broth, or gravy to moisten food.
  • Use ice chips, sugarless gums and sucking candies to moisten mouth.
  • For dry mouth, without mouth sores, try a tart liquid or food (lemon, lime, pickles).
  • Avoid using alcohol-based mouthwashes.
  • Talk with your healthcare team about using saliva substitutes.

Swallowing difficulty: Often this is the result of sores or irritation in the throat or esophagus.  It can be mild and require the consumption or softer foods, or more severe in which case it requires a modified consistency diet or alternate means of nutrition support to meet a patient’s nutritional needs.

  • Avoid foods that are spicy, acidic, and rough or coarse in texture
  • Choose foods that are soft and easy to chew such as soups, smoothies, yogurt, hot cereals, casseroles, eggs, tender meats, and well-cooked and mashed fruits and vegetables
  • Use sauces, liquid, or gravy to moisten food
  • Consume foods at room temperature
  • Eat small frequent meals (5-6 times a day) instead of 3 large meals
  • Eat meals high in protein/calories or add a liquid dietary supplement
  • Sit upright while eating or drinking
  • Do not lie down immediately after eating or drinking

For more information about nutrition and cancer, please check out the first two installments in this series:

The Benefits of Nutrition During Cancer Treatment: Prevent Fatigue and Improve Your Immunity

The Benefits of Proper Nutrition: Dealing with Gastrointestinal Side Effects from Cancer Treatment

Reference: Oncology Nutrition Dietetics Practice Group of the Academy of Nutrition and Dietetics.  Lesser M, Ledesma N, Bergerson S, Truillo E. Oncology Nutrition for Clinical Practice.  Oncology Nutrition Dietetics Practice Group of the Academy of Nutrition and Dietetics: 2013.