Food and nutrition

When you’re coping with blood cancer, it can be harder to eat well. You may have symptoms, side effects or late effects of treatment that affect your appetite. You may feel tired and unwell. You may lack energy and interest in food shopping and meal prepping.

Some people gain weight as a result. Or, more often, you may lose weight without intending to and become less healthy and weaker than you’d normally be. It’s important to recognise if this is happening to you.

If you’re not eating and drinking well, you’re:

• More likely to lose muscle and strength as well as fat, especially if you’re older (60 or over)
• Less likely to cope well with treatment, if you need it, and to recover well
• Less likely to have a good quality of life

If you are underweight due to your condition or because you’re struggling to eat due to treatment side effects or late effects, you’re not alone. It’s a common problem for people with blood cancer. Some people are already underweight before they’re diagnosed with blood cancer.

Try to gain weight if you can, as you’ll be stronger, healthier and better able to cope if you do. The NHS has information on ways to gain weight.

Your haematology team may offer you specialist support with a registered dietitian. They can give you individualised advice.

You may be living with blood cancer while you’re carrying more weight than is healthy for you. You may also be coping with other lifestyle and weight-related conditions, such as type 2 diabetes or heart disease. Some supportive treatments, like steroids, can also lead to weight gain.

If you don’t need treatment straightaway, it’s a good idea to lose weight if you can. You can try to lose weight while you’re on active monitoring, for example. You’re likely to have more energy, be healthier, and better able to cope with your condition and with treatment, if you need it. The NHS has information on:

• Tips to help you lose weight
• How to lose weight in a wheelchair
• Treatment for obesity

Your haematology team may offer you specialist support with a registered dietitian or suggest you join a weight management group.

Depending on the type of blood cancer you have and the treatment you need, it may be safe to lose weight during treatment too. Talk to your haematology team for individual advice.

If you’re feeling anxious, fearful or depressed, it can be hard to enjoy mealtimes and eat well. However, a lack of good food and regular mealtimes can worsen poor mental health. Paying attention to your food can help you feel better.

Some people with blood cancer think of what they eat and drink as one of the things in their lives that’s in their control.

Tips for eating well for your mental health:

• Make your mealtimes as calm and relaxed as you can, in a peaceful part of your home.
• Choose healthy convenience foods, easy meals or snacks if they help you to eat in the short term. Pre-prepped meals may be easier than starting a meal from scratch.
• When you feel like eating or preparing food for later, follow the Eatwell Guide, so you have a good balance of foods on your plate.
• Try to keep hydrated. Aim for six to eight glasses or cups of water or other fluids a day.
• Avoid or limit alcohol, as this can make your mood worse rather than better.
• Get your food shopping delivered or ask a friend or relative to help make sure you have healthy food in the house.
• Think of your diet as therapy. It’s something you can do to help yourself. Cooking regular meals can bring purpose and structure to your day.
• You may benefit from counselling or psychological support if your mental health is stopping you from eating well.

The British Nutrition Foundation has more information on food and your brain.

Talk to your haematology team or contact our support services if anxiety or depression continues to affect your eating.

You may notice changes to your sense of smell during or after treatment for blood cancer. It’s a side effect of some medicines. If this happens, it may affect your appetite and your desire to eat certain foods.

Try these tips to help overcome changes to your sense of smell:

• Keep your meals covered until you’re ready eat.
• Drink from beakers or cups with lids that let you drink through a straw or a small opening.
• While you’re cooking, open a window or use an extractor fan. In nice weather, you could barbecue outside if you have an outdoor space.
• Avoid foods with strong smells, such as fish or strong-smelling vegetables like brussels sprouts or garlic.
• Choose foods that don’t need cooking, like sandwiches or wraps, salads made with pasta, beans, chickpeas or quinoa or cold noodles. Other options include cold puddings, crackers and hard cheese, protein bars and shakes.

It’s common to experience changes in taste as a side effect of some treatments for blood cancer. You may find foods taste odd, bland or unpleasant. You might find that meat tastes metallic. Or that some foods don’t have any flavour, taste bitter, or feel like cardboard in your mouth. Some people have a strange taste in their mouth all the time.

Try these tips to help overcome changes to your sense of taste:

• Brush your teeth and tongue before eating, including in between your teeth.
• Choose foods with lots of flavour, like dishes that have been marinated or that come with a tasty sauce or gravy. Or add sauces, herbs and spices, pickles or sweet condiments to your meals. These help disguise unpleasant tastes.
• Make your meals more interesting by including different textures or temperatures. You could sprinkle crisps or chopped nuts over your dish, or add ice cream to a hot pudding.
• Fresh produce, like fruit and vegetables, can help counteract some tastes.
• Experiment with sweet, salty, tart or sour foods and flavours to see what works for you.
• If a metallic taste is bothering you, avoid tinned foods. Instead of metal cups, tableware or cutlery, use ceramic, plastic, wood or bamboo.
• Between meals, sucking sweets or mints, or chewing gum can help mask unusual tastes.

Make sure you don’t have any gum or dental issues that might also be affecting your sense of taste. Make an appointment with your dentist if you’re due for a check-up and update them on your medical history.

This is usually a side effect of treatment for blood cancer rather than a symptom of the condition itself. Some supportive treatments, like painkillers and anti-sickness medicines, can also make it difficult to poo.

Try these tips to help get your bowels moving regularly:

• Drink six to eight glasses or cups of water or other clear liquids throughout the day. Choose drinks that you enjoy.
• Try hot drinks that have a laxative effect, such as coffee, prune juice, other warmed juices like apple juice, or hot lemonade.
• Eat high-fibre foods, like whole grains, fruit, vegetables, pulses and seeds. If you don’t like cooked fruit or vegetables, try raw options, like carrot, celery, cucumber or radishes, and dried or tinned fruit.
• Get into a routine with when you eat. This can help your bowels get back to a normal routine, too.
• Keep as active as you can. Exercise can help you poo.

Sometimes constipation caused by a treatment won’t be helped through diet alone. Talk to your haematology team about other options, like laxatives or medicines to soften your poo.

This is usually a side effect of treatment for blood cancer rather than a symptom of the condition itself. Medicines, such as chemotherapy, targeted treatments and immunotherapy, can all cause you to have frequent loose, watery poos.

You may also have a weakened immune system due to blood cancer, and this can make you more likely to get infections that cause diarrhoea.

Try these tips to help you eat well while you have the runs, and to settle diarrhoea:

• Drink 10 to 12 cups of water or other clear liquids throughout the day. This helps you stay hydrated. Good options include clear diluted juices, clear soups and broth, sports drinks, jellies and rehydration solutions.
• Choose soft, bland foods, like bananas, white rice or noodles, white bread or toast, chapatis, roti or naan.
• Eat small meals throughout the day.
• Avoid high-fibre foods such as whole grains, raw vegetables, nuts and seeds. These might make an upset tummy worse.
• Avoid fatty foods that may be too rich for you while you have diarrhoea.

Talk to your haematology team if diarrhoea persists. They may offer you individual advice and medicines to help.

You might have a dry mouth if you’re making less saliva than normal. This can happen as a side effect of some treatments for your blood cancer, such as chemotherapy and immunotherapy. If your mouth is dry, you may find it hard to talk, chew or swallow your food. It may affect how food tastes too.

If your mouth is dry, it can lead to other problems, like a thrush infection in your mouth or tooth decay. These can also make it harder to eat.

Try these tips for coping with a dry mouth:

• Sip water or other fluids throughout the day. Aim for at least eight cups of fluid a day.
• If it helps, try sucking ice cubes, lollies or frozen yoghurts.
• Choose soft, moist foods like pasta, noodles, jasmine rice, scrambled egg, casserole, custard, jelly or blancmange. Add extra sauces, cream, dressings or gravies to help moisten your food and make it easier to swallow.
• Avoid foods that might hurt your mouth, like dry, crunchy, chewy or sticky foods. Spicy or salty foods can also be painful.
• Avoid alcoholic drinks, like wine and spirits. These can hurt your mouth.
• Dip bread, crackers and biscuits in liquids like soup, broth, tea or milk to make them easier to swallow.
• Try chewing gum, sucking tart sweets or drinking lemonade. Or eating pineapple or citrus fruits, like oranges or lemons, as long as they don’t interact with treatment you may be on. These may help you make more saliva. If your mouth is sore, though, you may find tart and citrus foods uncomfortable.
• If your mouth is getting gummed up with dry or thick saliva, try swishing and spitting with a fizzy drink.

Talk to your haematology team about medicines, mouthwashes, gels or sprays that can help you produce saliva and prevent a thrush infection in your mouth.

It’s very common to have extreme tiredness or lack of energy that doesn’t get better with rest. This can be a symptom of blood cancer and a side effect of treatments. It can leave you feeling so low in energy that you can’t be bothered to eat, let alone prepare a meal.

However, regular food and physical activity can both help ease fatigue and make you feel better.

Try these tips for managing fatigue:

• Drink six to eight cups of water or other fluids like sports drinks, fruit juice, broth or herbal teas daily. Keeping yourself hydrated will help.
• It’s OK to use ready meals, ready-to-eat foods like frozen dinners or pre-prepped meals to get you through.
• Occasional takeaways can be helpful too. Try to choose meals that include fresh ingredients like some Thai, Vietnamese or Indian dishes, or add veggies and lean meats to your thin-crust pizza.
• Prepare your meal in advance. Cook when your energy levels are at their best, so you only need to heat your food up at mealtimes.
• When you do have energy to cook, make extra portions to freeze.
• Keep stocked up with healthy snacks that you can grab when you feel like it, like fresh fruit, protein bars, beef jerky, halva, small pots of fruity Greek yoghurt, or veggie batons and dips.
• If you can’t face a meal, try a nutrient-rich meal supplement drink.

If you have friends and family who want to help, say yes. It can be hard to accept that you need help, or to ask for it. But people usually want to help, and they may feel good about shopping or prepping food for you.

A swollen spleen is a common symptom of some blood cancers. It can make you feel full after eating a small amount, because your spleen pushes against your stomach.

Try these tips for eating well when you feel full early:

• Eat small, frequent meals or snacks throughout the day instead of fewer, larger meals.
• Include high-protein or high-energy foods on your plate and eat these first. This includes things like meat, chicken, fish, eggs, beans, tofu and tempeh.
• If you enjoy a pudding, wait a while after the savoury part of your meal to give the full feeling time to ease off.
• Have your drinks in between meals, so you avoid filling up on liquid at meal times.
• If you can’t face a meal, try a nutrient-rich, supplementary build-up drink.
• Try sitting upright to eat or going for a walk after a meal to see if it helps. Avoid lying down just after you’ve eaten.

This is usually a side effect of treatment for blood cancer rather than a symptom of the condition itself. If you’re feeling sick or being sick, it can affect your appetite, and you’re likely to eat and drink less than you usually would.

Try these tips for eating while you have nausea or vomiting:

• Drink small amounts of clear fluids throughout the day and between meals or snacks, if you can manage them. Good options include water, diluted juices, ginger ale or soda water, ginger-based herbal teas, sports drinks, and jellies.
• Try to eat five or six small meals or snacks across the day rather than fewer, larger meals. If you’re being sick, you may need to wait for the vomiting to ease before you can eat.
• When you feel like eating, nibble on bland foods, like white rice, plain pasta, crackers or white toast. If you’ve found that ginger-based drinks help you feel less sick, try a ginger biscuit.
• Foods that don’t have a strong smell may be easier to manage. Food and drink that’s chilled or room temperature, like yoghurt, ice cream, plain biscuits or cereal, often smells less. Or see if someone else can cook your main meal, then let it cool down a bit before you eat it.
• Try sucking on sweets, fruit pastilles or mints.
• Avoid fatty, greasy, sweet or spicy foods, if they make you feel worse.
• Try to eat in as calm and relaxed a way as you can, where you feel peaceful and there is fresh air.
• After you’ve eaten, try to sit up for at least 30 minutes. If you need to lie down, try to keep your head raised for a while.

Your haematology team will prescribe you anti-sickness medicine if your blood cancer treatment is likely to make you feel or be sick. If it’s not working well for you, ask if there’s another option that may work better for you.

Anti-sickness medicines are more effective the sooner you take them, so tell your team straight away.

You may go off some foods when you have blood cancer. Sometimes this is linked to treatments that can make you feel sick or be sick. You may have a temporary aversion to meat, for example, as a side effect of some chemotherapy medicines.

Some people find they go off some foods as soon as they start treatment, but it doesn’t last too long. Other people may develop food aversions later and for longer.

Try these tips for preventing and coping with food aversions:

• If you’re due to have treatment that might make you feel sick, talk to your haematology team about preventing food aversion. It may help to avoid your favourite foods before treatment and eat an unfamiliar food instead. You could try sweets, unusual-flavoured ice cream or halva, if you don’t usually eat it. That way, you’re more likely to go off the unfamiliar food, which you won’t miss, rather than foods you like.
• If you’ve gone off something you don’t eat or drink often, you could just avoid it. Concentrate on the foods and drinks you still enjoy instead.
• If you’ve gone off something you usually have often, try to swap it for something else. For example, you could swap meat for another source of protein, like eggs, cheese, beans, tofu, or fish. If you’ve gone off tea or coffee, try milk, herbal or green tea, or hot blackcurrant squash instead.

If you’ve gone off lots of different foods and are struggling to eat a balanced diet, ask your haematology team to refer you to a dietitian.

It’s common to lose your appetite when you have blood cancer. It may be due to symptoms that improve with treatment, or a side effect of treatment.

If you’ve lost your appetite, try these tips to help you eat well:

• Have five or six smaller meals or snacks each day.
• Use a smaller plate to help you feel less overwhelmed.
• If you’re still hungry after a small portion, have seconds or add a pudding.
• Eat your largest meal when your appetite is strongest in the day.
• Include high-protein foods in your meals. Eat them first and then move on to lower-energy foods like fruit and vegetables.
• Choose full-fat versions of foods over low-fat or diet products.
• Add high-calorie foods to your meals. A knob of butter with your potatoes or vegetables, or ghee on your rice or porridge, a spoonful of mayonnaise, a dollop of sour cream, or a sprinkling of grated cheese can all help.
• Have your favourite high-calorie foods and drinks nearby so you can snack easily. Peanut butter, cheese or chocolate spread on crackers, halva, crisps with dips can all help.

Keep as active as you can. Exercise of any sort can help boost your appetite.

It’s common to have a sore mouth or throat when you have blood cancer. You may get ulcers, sore gums or a sore throat as a side effect of chemotherapy, immunotherapy or other medicines. If your immune system is low, you may also get a thrush infection in your mouth. Understandably, you may find it difficult to eat or swallow if you have a sore mouth or throat.

Try these tips to help you eat well:

• Eat soft, moist foods that are easier to chew and swallow, like creamy pasta, soft rice or noodle dishes, tofu, scrambled egg, casserole, custard or blancmange.
• Cook food for longer or add extra sauces, dressings or gravies so your meals are tender and soft.
• Cut your food into smaller pieces or try using a blender or food processor to make your meals more manageable. Or try eating with a small spoon so you have less to swallow.
• Try different food temperatures to see which is most comfortable for you. You may find that warm, cool or frozen foods are more soothing than very hot foods.
• Drink plenty of fluids, like water, ‘flat’ fizzy drinks or low-acidity fruit drinks, like banana smoothies or juices made with blueberries, mango or papaya. Include higher calorie options too, like warm or cool milky drinks, creamy soups or broths.
• Drink through a straw if it helps bypass the sore parts of your mouth.
• Suck on ice chips, milk, ice lollies or frozen yoghurt to soothe your mouth.
• If you’re struggling to eat enough at mealtimes, add a build-up, supplement drink to help keep your calories up.
• Avoid food that might hurt your mouth or throat, like dry, rough or sticky foods, including crisps, toast, crackers and raw vegetables. Dipping bread, crackers and biscuits in liquids can make them easier to swallow.
• Avoid acidic, spicy or salty foods, such as tomatoes, vinegar, curry and chilli.
• Avoid drinks that are likely to irritate your sore patches. Examples include wines and spirits and citrus fruit drinks, like orange, lime or grapefruit, pineapple juice and tomato juice.
• Rinse your mouth several times a day using a homemade mouthwash: 1 cup of warm water, ¼ teaspoon of baking soda and 1/8 teaspoon of salt. Or try a shop-bought alcohol-free mouthwash.

Talk to your haematology team about medicines to numb or soothe your mouth or throat.

You don’t usually need to take a dietary supplement unless you’re unable to eat a healthy, balanced diet.

However, in the winter months, you may benefit from taking a vitamin D supplement. From September to March, the sun is not strong enough in the UK for your body to make vitamin D, so you get it from your diet instead. If you take a vitamin D supplement, it can help with this.

If you’re eating a range of healthy, nutritious foods, you should be able to get nearly all the nutrients you need from your diet.

Probiotics are ‘good bugs’, such as live bacteria or yeasts, that may support gut health. You can buy probiotics as tablets, capsules or powders. Yoghurts that are labelled ‘contains live or active cultures’ are also probiotic. Probiotics may have general health benefits, but we need more evidence to be sure.

Probiotics may help with side effects of treatment, such as constipation or diarrhoea. They may also rebalance your gut bacteria during and after a course of antibiotics. But they may not be recommended if your immune system is not working well, particularly if you are low on white blood cells called neutrophils (neutropenic).

The NHS has more information on probiotics.

Talk to your haematology team or a registered dietitian before including probiotics in your diet.

Fermented foods can add flavour to your diet. Animal studies and lab research suggest they may have immune benefits. But we need more research on healthy people to be sure. We don’t know yet if they are safe for people with blood cancer, particularly if their immune system is not working well.

Talk to your haematology team or a registered dietitian before including fermented foods in your diet.

Fasting is not usually recommended for people with blood cancer. This applies to intermittent fasting, such as the 5:2 diet, and fasting for religious reasons, such as Ramadan. The main concerns are around weight loss and taking medicines for blood cancer while you’re fasting:

• While you’re fasting, you may not get enough calories or nutrients. If you’re already underweight, frail, or at risk of weight or muscle loss, then it’s best not to fast.
• If you’re on treatment, you may find it difficult to take your medicine at the right time, particularly if you should have your doses with food. You may also find that side effects from treatment get worse if you fast.

The British Islamic Medical Association has more information on the risks of fasting when you have blood cancer in their Ramadan compendium.

If you want to fast for health or religious reasons, check with your haematology team first. They may refer you to a dietitian for individual advice.

It may help you be healthier in the long term to limit your sugar intake. High sugar intake is linked to health problems like inflammation, obesity, and type-2 diabetes. But, if you want to reduce your risk of developing another cancer, the evidence for a direct link with sugar intake is less clear.

Remember, it’s recommended to limit added sugars as part of a healthy, balanced diet. But, if you’re underweight or losing more weight than is healthy for you, it may be beneficial to include sweet treats in your diet.

Talk to your haematology team about the benefits or risks of cutting back on sugar for you as an individual.

It’s unlikely that eating organic food will benefit your health. There’s a lack of evidence that organic foods are healthier than foods grown by conventional farming methods. Or that they are less likely to cause allergic reactions or infections.

Some people choose to eat organic foods because of how they look or taste, or to support sustainable farming. Organic foods are usually more expensive than non-organic foods.

You should still follow steps to reduce your risk of food poisoning when handling, storing and preparing organic foods.

There’s not enough evidence that special diets, like low-fat, ketogenic or low-carbohydrate diets, are beneficial. Experts have not found that they lead to clear improvements in quality of life, treatment side effects or cancer control.

It’s best to follow a balanced and varied diet.

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