How to Manage Diarrhea During Cancer Treatment

HOW TO MANAGE DIARRHEA DURING CANCER TREATMENT

Angela Martens, RD, a registered dietitian from CancerCare Manitoba answers:

When you are experiencing diarrhea, eating well can be a challenge. Diarrhea caused by cancer treatment is best managed with prescription medications. You should speak to a member of your healthcare team if you experience fever, strong abdominal pain, blood in your stool or if you have diarrhea more than three times a day. Here are some tips what you can do:

Stay hydrated

Drink 1.5 to 2 litres of liquid per day, taking small sips at room temperature. Sipping on fluids between meals may also help lessen diarrhea. See BOX 1

Replenish electrolytes, if needed

Excessive diarrhea may lower electrolytes (e.g. sodium and potassium) in your blood which may lead to dizziness. Sports drinks or a homemade electrolyte drink can help replace electrolytes. (BOX 2)

Choose foods that provide soluble fiber

Soluble fibre can help absorb fluid and thicken your stool. (BOX 1)

Consume well-tolerated foods in frequent, regular, small portions

Eat small meals because large amounts of food may trigger diarrhea. Try our meal plan. (BOX 3, 4)

BOX 1: : FLUID AND FOOD CHOICES TO MANAGE DIARRHEA

images of bananas, applesauce, rice, and toast which is part of the BRAT Diet

CHOOSE

  • Non-caffeinated beverages, low lactose * milk or soy beverage, and “plain” foods (BOX 3)
    • Drinking a broth is also good option (any fluid with water, sugar, salt)
  • Foods that contain soluble fiber which may help manage diarrhea:
    • Barley, oats, oat bran, chia seeds
    • Cooked root vegetables, such as peeled potato, sweet potato, carrots
    • Cooked green or yellow beans, asparagus tips, mushrooms
    • Peeled and seedless fruits, such as apples, banana, pear, peaches, oranges, seedless melon, avocado
  • Consider following a BRAT diet (banana, rice, applesauce, toast)

AVOID

  • Caffeinated beverages, highly sweetened drinks, spicy or greasy foods
  • Wheat bran, corn bran, whole grain breads and cereals, whole nuts, raw vegetables, popcorn, berries, grapes, dried fruit
  • milk containing lactose *

* During treatment, some individuals may develop lactose intolerance which can be a temporary inability to digest lactose, a natural sugar found in some milk products. This may worsen diarrhea. Try using lactose-free products or milk alternatives such as soy beverage for a few days to see if your diarrhea improves, then re-introduce once diarrhea resolves.

BOX 2: HOMEMADE ELECTROLYTE DRINK

Mix: 360 mL orange juice (no pulp) + 600 mL water + ½ teaspoon salt

Drink:  60mL (1/4 cup) every 2 hours until diarrhea stops.

BOX 3: FOOD SUGGESTIONS TO MANAGE DIARRHEA

Scroll over the image to see snack and meal suggestions

MEALS

- Egg salad sandwich on white bread
- Chicken noodle soup
- Grilled chicken or fish with white rice and cooked carrots
- Overnight oats (try our recipe)

SNACKS

Cheese and plain crackers
- Fruits you can easily peel (such as bananas)
- Oatmeal cookies
- Rice pudding
- Yogurt

BOX 4: SAMPLE MEAL PLAN FOR DIARRHEA

BREAKFAST

Toast (white bread) with smooth peanut butter
Yogurt with sliced banana
Orange juice no pulp*

SNACK

Pudding made with lactose-free milk
Apple juice*

LUNCH

Chicken noodle soup*
Egg sandwich (white bread, mayo)
Plain crackers
Canned fruit

SNACK

Cheese
Plain crackers
Tomato juice*

DINNER

Grilled Fish with little oil and lemon juice White rice
Cooked carrots
Apple juice*

SNACK

Lactose free milk*
Oatmeal  cookies

*Contains fluid, but don’t forget to sip on additional fluids throughout the day between meals. You can dilute your juices by adding water (half juice and half water).

image of glass containing rolled oats smoothie with banana slices

Enjoy this recipe
Overnight oats

A nutritious breakfast or snack for any time of day

  • Preparation: 5 minutes
  • 2 servings

INGREDIENTS

  • ¾ cup rolled oats
  • 1 tbsp honey or maple syrup (optional)
  • ¾ cup whole milk or milk alternative
  • 1 tbsp chia seeds

PREPARATION

Place all ingredients in a mason jar, stir and place in fridge overnight. Enjoy cold or heat the oats in the microwave. Add some liquid, if needed.

RECIPE MODIFIER TO INCREASE PROTEIN

  • Add 1 tbsp of protein or skim milk powder to the milk.
  • Replace milk with high protein yogurt.
  • Add liquid pasteurized eggs, ground nuts or almond flour.

Nutrition facts: for ½ of recipe when prepared with whole milk: 228 calories, 7g fat, 3g saturated fat, 8g protein, 5g sugar, 5.5g fibre

MANAGING FATIGUE

Cancer-related fatigue is the most common and often the most distressing side effect experienced by people with cancer. Learn tips on how to manage fatigue.

HOW TO STAY WELL NOURISHED AND HYDRATED

Getting all of the nutrients your body needs can help you maintain your weight and strength, stay active and support your recovery

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Source:

NOURISH: The healthy gut guide part 2. Managing GI distress. By Megan Morrison, RD and Karine Rondeau, P.Dt. https://www.nourishonline.ca

For more information: UHN: Eating tips for people with diarrhea https://www.uhn.ca/PatientsFamilies/Health_Information/Health_Topics/Documents/Eating_Hints_for_People_with_Diarrhea.pdf

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