Many things can cause fatigue during treatment for mesothelioma. The treatments themselves can cause tiredness. If you are living with mesothelioma and it is making it difficult to breathe, this can make fatigue worse.

Some people experience anemia during treatment. Anemia reduces the ability of your blood to carry oxygen throughout the body. With less oxygen to fuel muscles, you feel tired and weary.

If you are so tired that you can’t complete your daily activities at all, talk to your doctor. If your fatigue is due to an underlying medical cause, your doctor can help.

Nutrition Helps

Even with the best medical management, fatigue can be worsened by not eating enough or eating the wrong foods. By focusing on good nutrition, you can give your body the energy it needs to function at it’s best. The following ideas will get you on track for fueling your body right.

Nutrition Tips for Energy

• Drink plenty of fluids. Dehydration worsens fatigue.
• Aim for at least 8 cups of fluid each day. Try water, tea, or water 100% fruit juice diluted with a bit of water. If you have a fluid restriction, ask your doctor how much fluid you should have each day.
• Avoid drinking regular soda. It is loaded with sugar. This may give you “quick energy,” but it will make you more tired in the long run.
• If you are not losing weight, do not overeat for energy. This can cause excess weight gain. Carrying around extra weight will worsen fatigue
• If you find you cannot eat due to stress, depression, anxiety, or other emotions talk to your medical team right away. They can give you information on how to manage stress. Your medical team can put you in contact with a counselor, a support group, or another mental health care provider if you’d like.
• Avoid snacking on candy, soda pop, cakes, donuts, baked goods, cookies, pies and other dessert foods. These high-sugar foods may give a quick “energy boost”, but you will feel worse once this wears off.
• Have some protein or some healthy fat, such as nuts or seeds, with each meal and snack. Protein and fat give you longer-lasting energy. For example, try eating a piece of fruit plus a handful of nuts. Or try fruit with cottage cheese.
• Focus on protein. Your body needs protein to repair and heal itself. Protein also is needed to build up your immune system and your blood cells. Protein-rich foods include eggs, chicken, fish, meat, yogurt, cottage cheese, nuts and seeds, and peanut butter.

And don’t forget to talk to your health care team about extreme tiredness. If your fatigue has a medical cause, such as anemia, there may be medications that can help!

Many people with mesothelioma will continue to eat and enjoy their favorite foods. This is a time when food should be viewed as something joyful to be shared and to nourish the body and the spirit. Focusing on healthy, nourishing foods is important, but enjoying favorite foods, even if they aren’t considered “nutritious”, is important too.

Food Can Be Stressful

I don’t know too many people who see food strictly as fuel. We use food to celebrate, to mourn, when we are bored, to socialize, to express love, and more. Food represents so many things in our culture. When food no longer is wanted or enjoyed, everyone struggles to cope with the changes.

For anyone with a disease that is considered incurable, such as mesothelioma, there will come a time when food simply isn’t appealing. This is normal and it is to be expected, but it can be very distressing for everyone.

The person with mesothelioma may feel like they aren’t “trying hard enough” to eat. Friends and family members will worry that a person is suffering from not eating enough. This is a time when questions about nutrition support often arise.

What is Nutrition Support?

As a natural part of the process of “winding down”, the body needs fewer calories and less fluid to be satisfied. Sometimes this process occurs “in time” with the disease process: people naturally eat and drink less as they get closer to death.

At other times, however, a person may lose the ability or desire to eat long before their disease becomes advanced. In these cases, nutrition support can be an important part of medical care.

Nutrition support comes in several forms:

• Liquid supplements that are high in calories and protein. These can be consumed in addition to food that is being eaten or replace food that is not being eaten.
• Liquid supplements that are delivered into the body through tube feeding, placed directly into the stomach or into the upper portion of the intestinal tract.
• Parenteral nutrition, in which nutrition is given intravenously, into a vein in the arm or chest.

The When and Why of Nutrition Support

When a mesothelioma patient loses the desire or ability to eat, yet still has a lot of life left, nutrition support can improve quality of life. Nutrition support can give a mesothelioma patient the energy to do what is most important. This might include spending time with family and friends, playing with grand kids, and attending weddings, graduations, and other meaningful events.

Drinkable Liquid Supplements

Liquid supplements that you drink have the advantage of being relatively inexpensive. You don’t need a prescription to get them and you can buy them at most pharmacies or grocery stores. You can order them online too. They come in a variety of flavors.

The major disadvantage of this type of supplement is that if you aren’t able to eat enough food to maintain your energy and strength, you may not be able to drink enough supplements either.

Tube Feeding

Tube feeding has the advantage of being “almost like eating”. If the tube is in your stomach, you can “take in” the liquid nutrition that you need in the same way that you would eat. You can have “3 meals and 2 snacks” per day using your feeding tube. This frees you to do other things you enjoy.

Another advantage is that tube feeding uses your normal digestive processes. This may not seem important for your health, but it is. The GI tract regulates a large portion of the body’s immune system. When the GI tract is no longer used, this can create problems with immunity. Not using the GI tract can increase risk of infections and contribute to feeling weak and fatigued as well.

Sometimes, a feeding tube is placed into your intestinal tract instead of your stomach. If this is the case, you cannot put large volumes of nutritional formula into the tube at one time. You will have a special pump to get nutrition into the tube slowly. This can take more time, which is a disadvantage. Many people are able to complete most of their tube feeding at night, while they are sleeping, which can alleviate this problem.

The type of tube can be a disadvantage as well. If you have a nasogastric, or NG, tube, this means a short end of the tube will hang out of your nose at all times. This can seriously decrease quality of life for many people.

A better option is to have a percutaneous endoscopic gastrostomy, or PEG, tube. This means you will have a short bit of tube directly into your stomach. This is clamped off when not in use. This is not visible under your clothes, which is why a PEG tube is preferred over an NG tube.

Parenteral Nutrition

The advantage of parenteral nutrition is that it can provide nutrition to someone who no longer has a functioning GI tract. If a person has a blockage in their stomach or intestine due to a tumor, for example, parenteral nutrition can provide needed nutrition.

Parenteral nutrition has many disadvantages, however. It is only used as a last resort in most cases. Parenteral nutrition requires a prescription. It is very expensive and may not be covered by insurance.

Parenteral nutrition can be tough to manage for someone who is not comfortable with medical procedures. The risk of serious infection can be high with parenteral nutrition. These infections can be life threatening.

Putting It All Together

In the end, whether you use nutrition support is completely up to you. Your dietitian or doctor may recommend nutrition support. You will make the final decision as to whether you would like to follow through on the recommendation.

Be sure you get all of the information you need. A dietitian can answer your questions. You may be given videos to watch or handouts to read that will help you understand the process as well. This will help you feel ready to use nutrition support, if that is what you decide.

With a little bit of education and coaching, anyone can learn how to use tube feeding or parenteral nutrition. There is no reason for fear to prevent you from getting the nutrition you need.

Once you understand all of your options, you can make the best decision for you!

Changes in taste and smell may not be life threatening, but you shouldn’t ignore these side effects if they happen to you. If food smells and tastes funny or bad to you, eating can become difficult or unpleasant. This can lead to not eating enough, which leads to weight loss.

Weight loss during treatment isn’t a good thing, and it’s important to do your best to keep your weight stable. Losing weight can worsen side effects, decrease immune function, and make it harder for your body to bounce back between treatments.

Fortunately, there are some steps you can take to keep eating well despite changes in taste and smell. With some creative food choices, you can work around taste changes and get the nutrition you need during mesothelioma treatment.

Tips for Coping with Changes in Smell and Taste

Follow the instructions your health care team gives you for mouth care. Use any mouth care medications or solutions exactly as your doctor or nurse has instructed. Use mouth rinses as prescribed too.

• Try to avoid strong food smells. Smells can kill your appetite and make food taste worse when you do eat. If possible, have others help you prepare food, so you can steer clear of the kitchen and the food smells.
• If you experience a metallic taste when going through mesothelioma treatment, try using plastic utensils to eat.
• If you don’t have mouth sores, try flavoring your foods with tart flavors such as lemon, citrus, vinegar, and pickled items. Avoid these foods and flavors if you do have mouth sores, because they will make the pain worse.
• Try different temperatures of food to see what works best. For example, you may find cold foods such as frozen grapes or watermelon, frozen juices and fruit nectars, cottage cheese, and smoothies or shakes work well. Or you may find that you prefer soups, stews, casseroles and other warm foods. Experiment to find what you like best.
• If things taste too sweet, try sour and tart flavors. For example, try a smoothie made with frozen cranberries.
• Some people find that liquid nutritional supplements taste too sweet. You can cut the sweet taste by combining one-to-two teaspoons of finely ground decaffeinated coffee, ice cubes, and a chocolate or vanilla liquid nutritional in a blender.
• Try rinsing your mouth with cool black or green tea, lightly salted water, or baking soda and water. These liquids can “freshen” and cleanse your taste buds before eating.
• Try flavoring items such as chicken, fish, beef, or pork with savory or sweet spices, such as rosemary, thyme, mint, basil, oregano, or cumin.
• Be open to new foods and flavors. Foods you normally don’t like may taste good to you now. Things you normally like may not be appealing. Try different foods and flavors to find what works best.

Finally, be sure you address other symptoms or side effects that may be contributing to difficulty eating. For example, if you have uncontrolled nausea or vomiting, you need to better manage these symptoms before you’ll be able to eat anything. Keep the lines of communication open with your doctor and ask for help if you need it.

To tackle nausea, you need to be creative with nutrition. By picking the right foods and eating them in certain ways, you can lessen your nausea and make meals and snacks more appealing again.

Medical Management is Key

The most important thing to remember when dealing with nausea is that medication is your first-line defense. Nutrition works best, in conjunction with proper medical management of nausea and vomiting. Plus, it’s much easier to prevent nausea and vomiting than it is to treat them once they occur. It really is true that “an ounce of prevention is worth a pound of cure”.

If your doctor or nurse gives you a set schedule for taking your medication, stick to it. Even if you don’t feel nauseous, take your medications to prevent the symptom from occurring.

If something is stopping you from taking your medications as prescribed, ask your medical team for help. There is no reason to suffer in silence. Your doctor can try different medications or different formulas and dosing schedules.

For example, some anti-nausea medications are taken as pills, while other are given as an injection. What works best for one person may not work well for another. Keep the lines of communication open and keep trying until you get the symptom relief you need.

Soothing Foods

Once you’ve worked with your doctor to find the right medicine or combination of medications to manage vomiting, you can address any remaining nausea with good nutrition The following tips will get you started.

•    If possible, avoid the kitchen when food is being prepared, so that you can avoid strong food smells.
•    Try low-odor, quick-cooking foods such as scrambled eggs; French toast; pancakes; oatmeal; cream of wheat; cold cereal; canned peaches, pears, or fruit cocktail; and shakes and smoothies.
•    Experiment with food temperatures to find what works best. For example, try warm foods such as oatmeal, cream of wheat, or soup, and cold foods such as frozen fruit, popsicles, frozen fruit bars, or shakes and smoothies.
•    Try different or unusual flavors. What you normally like may not be appealing now. For example, try making a sour, tart, or mildly sweet shake or smoothie by adding frozen cranberries.
•    To cut the overly sweet taste of liquid nutritional products such as Ensure®, try adding 1 to 2 teaspoons of finely ground, decaffeinated coffee to chocolate or vanilla flavors.
•    Use a “to-go” cup or travel mug with a lid to avoid unnecessary smells that can worsen nausea.
•    Keep snacks handy, because hunger may last only a few minutes.
•    Try keeping a little food in your stomach at all times. Having a completely empty stomach may worsen nausea.
•    Try sucking on candied ginger root or sipping ginger tea.
•    Stay upright, either in a chair or propped up with pillows for at least 30-60 minutes after eating. Lying flat after meals and snacks can worsen nausea and heartburn.

Here’s how it works. Some mesothelioma and cancer treatments have the unfortunate side effect of breaking down tissue in your body. Tissue can be anything, from your skin, to your muscles, to your white blood cells. That’s the bad news.

The good news is that keeping yourself well nourished will give your body the tools needed to rebuild tissues that treatment can break down. And above all else, keeping your body weight stable is the way to do this. Avoiding weight loss is the goal.

In order to rebuild tissue, you need to give your body energy, in the form of food. In other words, you can’t build “something out of nothing.”  If you are losing weight, it means your body is using up its own tissue simply to function. And if your body is dipping into itself simply to keep your heart beating and your blood pumping, it won’t have the materials and tools needed to rebuild itself.

In order to rebuild the tissue that treatment can breakdown, things like your white blood cells, skin, muscle, and gastrointestinal (GI) tract, you need to give your body enough calories and protein to prevent, or at least minimize, weight loss. That way, the energy and materials from the food you eat will go into rebuilding tissue.

Focus on Quality

To keep your weight up, focus on foods that provide a lot of “bang for your buck”. You need to eat things that give you as many calories as possible, in as little volume as possible. Use the following list and recipe to help yourself get the nutrition you need to best manage mesothelioma and its treatments.

Be sure to check back with the blog in a couple of weeks, when I’ll have more ideas and tips for using nutrition to deal with a common mesothelioma treatment side effect.

High Calorie Foods to Keep on Hand

•    Hard boiled eggs
•    Pre-cooked pasta that can be reheated easily for a quick meal or snack
•    Peanut butter, almond butter, or other nut butters, which provide 100 calories and 5 grams of protein in a single spoonful
•    High calorie, ready-to-eat cereal, such as granola, which can provide up to 300 calories per ½ cup
•    Yogurt, pudding, and other quick snacks; you don’t need the low-calorie, low-fat, low-sugar
•    Dried fruit, such as raisins, apricots, or dried cherries and cranberries
•    Pre-cooked chicken breast
•    Granola bars, power bars or other food to carry with you when you go out

Powered Up Sweet Potatoes

Preparation time: 10 minutes. Cook time: 10 to 15 minutes.
Serves one.

Ingredients

•    1 medium-size sweet potato
•    1½ cups apricot nectar (juice)
•    4 ounces silken (soft) tofu
•    2 tablespoons maple syrup or honey (or more to taste)

Instructions

Peel sweet potato and cube into ½-inch pieces. Steam sweet potato pieces for approximately 10 minutes, until soft. Carefully move steamed sweet potato into a mixing bowl and add apricot nectar, tofu, and maple syrup or honey. Use a blender to combine ingredients until they have a smooth consistency. Enjoy warm.

Per serving: 500 calories; 9 grams protein; 108 grams carbohydrates; 3.5 grams fat; 6 grams fiber; 1,255 milligrams potassium; 62 milligrams sodium

The goal is to eat a healthy, balanced diet in order to feel better and remain stronger.  A mesothelioma diet may differ from a suggested diet for a non-meso patient, which can be confusing.  Rather than focusing on large portions of fruits, vegetables, and whole grains with moderate amounts of meats and dairy products and limited fats, sugar, and salt; the mesothelioma diet recommends a higher calorie and protein intake.

Here are some diet tips for you to consider.  Ask your medical professionals about the right diet for you.

• Drink plenty of fluids – drinking between meals rather than with meals can help you avoid feeling full
• Focus on eating high calorie and high protein foods (nuts, eggs, cheese, peanut butter, milk shakes, etc.) – use butter, margarine, creams, and gravies to boost calories
• Try adding protein powders to drinks
• Liquids and soft foods may be better tolerated than solids, especially if you are nauseous
• Snack frequently throughout the day or whenever you feel you can
• Vary your mealtime routine
• Try new foods and/or recipes (your tastes may change during treatment)
• Use plastic utensils if food tastes metallic
• Eat with friends and family, with the television or the radio on, which can stimulate your appetite
• Let others prepare your food to save energy and avoid cooking odors
• If possible, engage in light exercise one hour prior to meals to stimulate appetite
• Use food supplements, such as liquid drinks and powder
• Ask your doctor if you need a nutritional supplement, such as a multivitamin or another supplement
• Plan ahead:  stock pantry and freezer, keep foods that need little or no preparation handy, cook in advance and freeze meals, and/or ask for help with shopping/cooking

If you have nutritional questions or need assistance planning your diet, talk to a dietician.  They can work with your specific symptoms and needs to individualize a plan for good nutrition.

You can also share your personal tips and recipes on the MesoRC discussion board!

- Protein is a vital dietary component. In general, proteins provide structure, help transport nutrients, and are responsible for repair within our bodies. Lean chicken and turkey are great sources of helpful protein.

- Try to keep protein in your diet and reduce (but not eliminate!) your intake of carbohydrates. Carbs provide our bodies with energy, but do not take an active role in repairing tissue. Try to get most of your carbs from fiber-rich vegetables or fruit.

- Stay hydrated. Drink a lot of water, especially during treatment periods, to flush out toxins from the body.

- If you experience a loss of appetite, try to eat foods high in calories. This way, you are providing your body without engery, without having to eat a large meal. Butter, cheese, honey, and sugars are very high in calories.

- Sometimes, solid foods can be difficult to ingest. Try soft, blended drinks like fruit smoothies instead.

For more guidelines on diet and for other mesothelioma advice, please visit this MesoRC page, or read this entry by our social worker.

Their findings were incredible. After locating fifty-eight people with mesothelioma and fifty-eight people with similar asbestos exposure and use of tobacco (but had escaped the disease), the researchers attempted to find a connection between the prevalence of mesothelioma and eating habits. Using popular snacks, sweets, different seafoods, meats and vegetables, the researchers found interesting results. People who had developed mesothelioma ate more cake, candy, and pie than those who were cancer-free. In contrast, the participants who were free of mesothelioma ate about twice as many servings of vegetables or fruit. The one element of a diet that increased the risk of cancer more than anything else was sugar. Those who participated and developed mesothelioma were eight times more likely to have eaten dessert every day compared to those who did not. It seems that sugar somehow accelerates the progress of cancer.

Eating a Healthy Diet will:

• Help patient to maintain weight, keep strength and energy

• Increase protein level needed to help build and repair body tissues

• Allow patient to tolerate treatment better

• Strengthen your immune system, allowing the body to fight infection more easily

• Raise patient’s outlook and quality of life

Tips for Maintaining a Healthy Diet:

• Drink plenty of fluids – try drinking between meals rather than with meals, to avoid feeling full

• Focus on eating high calorie and high protein foods (nuts, eggs, cheese, peanut butter, milkshakes, etc.) – use butter, margarine, creams, and gravies to boost calories

• Try adding protein powders to drinks

• Liquids and soft foods may be better tolerated than solids, especially if you are nauseous

• Snack frequently throughout the day or whenever you feel you can

• Vary your mealtime routine

• Try new foods and/or recipes (your tastes may change)

• Use plastic utensils if food tastes metallic

• Eat with friends and family, with the television or the radio on, which can stimulate your appetite

• Let others prepare your food to save energy and avoid cooking odors

• If possible, engage in light exercise one hour prior to meals to stimulate appetite

• Use food supplements, such as liquid drinks and powder

• Ask your doctor if you need a nutritional supplement, such as a multivitamin or another supplement

• Plan ahead: stock pantry and freezer, keep foods that need little or no preparation handy, cook in advance and freeze meals, and/or ask for help with shopping/cooking

If you have nutritional questions or need assistance planning your diet, talk to a dietitian. They can work with your specific symptoms and needs to individualize a plan.