General nutritional interventions

1. We increase our intake of protein*, carbohydrates, energy and fluids to maintain a healthy body weight.
2. If we are experiencing weight loss, decreased appetite, dehydration or electrolyte disturbances, feeding through feeding tube is recommended.
3. We adjust the diet depending on the side effects of the treatment, making sure we get enough vitamins and minerals. Vitamin C inhibits the proliferation of lung cancer cells, causing cell cycle arrest and apoptosis, while vitamin A and retinoids have been shown to strongly inhibit cancer promotion and progression.
4. We prefer small and frequent meals.
5. It is considered a good choice, if possible, to consume citrus fruits, vegetables, sesame, walnuts (due to the content of gamma-tocopherol), apples and onions (due to the content of quercetin) and other flavonoids.
6. Selenium, lycopene, carotenoids, as well as natural estrogens (such as soy foods) and curcumin as a spice, have significant benefits.
7. We consume phytosterols (sunflower seeds, peanuts, sesame, and wheat germ) and omega-3 fatty acids (fish, shellfish, flaxseed, walnuts).
8. Resveratrol from red wine and berries has been shown to be beneficial, however we should consider whether it is tolerated by our system.
9. Each patient’s nutritional needs are different. They are based on your treatment plan and side effects that may occur, your current height and weight, and any other underlying conditions that may be present, such as diabetes or heart disease.

Herbs and nutritional supplements

The use of complementary and alternative medicine by lung cancer patients is widespread. In general, it is recommended to get all the nutrients through a healthy diet and take supplements only in case of deficiency.

Doctors should make decisions each time to avoid possible side effects and interactions with conventional treatments. They may recommend a multivitamin for patients who suffer from side effects of treatment and cannot get the nutrients through food. Beta-carotene supplements should be avoided. Nutrition has more protective properties. Research data examines the garlic consumption and the intake of selenium, N-acetyl-cysteine, vitamins B6 and C.

Don’t forget to inform your doctor about any vitamins, minerals, nutritional supplements, or herbs you already consume or plan to. You should also contact him before starting a special diet plan.

Practical tips for organizing our diet include:

• Eating small, frequent meals and snacks throughout the day, opting for smaller portions on salad plates.
• Keeping favorite snacks readily available at home and work for consumption anytime.
• Choosing softer, easy-to-swallow foods like soups, scrambled eggs, pasta with cheese sauce, and grilled vegetables.
• Limiting liquid intake before meals to avoid reducing appetite.
• Incorporating food supplements into shakes, soups, juices, yogurt, and creams for added nutrition.
• Consuming calorie- and protein-rich foods, such as adding butter, olive oil, or cream cheese to meals.
• Including protein in every meal to maintain strength and support tissue repair during cancer treatment.
• Eating preferred foods, even if repetitive, until broader variety can be tolerated.
• Listening to hunger cues and eating when feeling hungry, regardless of conventional meal times.
• Stimulating appetite by taking walks outside or sitting near open windows before meals.
• Accepting help with cooking from friends and relatives on days when too tired.
• Utilizing ready-cooked meals or food delivery services for convenience and rest.
• Opting for energy drinks or milk-based supplements if unable to eat anything.
• Seeking advice from a nutritionist or doctor for nutritional supplements if experiencing significant appetite and nutrition difficulties.

* Tips for adding more protein to our diet

• Spread bread, crackers and fruit with nut butters (peanut butter, cashew butter, almond butter).
• Spread hummus on bread or add a spoonful to salad.
• Eat desserts that contain eggs, such as cakes, puddings, creams and cheesecakes.
• Consume foods rich in protein.
• Add extra eggs or egg whites to creams, puddings, pies, pancake batter, egg fritters, scrambled eggs or omelets.
• Add some nut butter (peanut butter, cashew butter, almond butter) to milkshakes or smoothies.
• Add nuts and seeds to breads, muffins, pancakes, cookies and waffles.
• Add chickpeas, red beans, tofu, hard-boiled eggs, nuts, seeds and fish to salads.
• Add grated cheese to sauces, vegetables and soups.
• Add cottage cheese or ricotta cheese to baked goods, pasta dishes or egg dishes.
• Add cheese to the omelet.
• Add wheat germ, ground nuts, chia seeds or ground flax seeds to cereals, baked goods and yogurt.

Tips for adding more calories to our diet

• Mix muesli with yogurt or put it on ice cream or fruit. Use muesli in cookie dough, muffins and bread.
• Avoid foods and drinks with ‘low-fat’, ‘fat-free’ or ‘diet’ labels.
• Eat snacks with dried fruits, nuts or dried seeds.
• Drink homemade drinks like smoothies.
• Add avocado to smoothies, soups, salads, omelets and as a spread on toast.
• Add croutons to salads.
• Add margarine or oils to potatoes, rice and pasta.
• Add jam or honey or nut butter (peanut butter, cashew butter, almond butter) to bread, crackers, toast and bagels.
• Make vegetables or pasta with creamy sauces or sprinkle with olive oil.
• Use dressings of high caloric value on salads, baked potatoes and vegetables. 

Sources:

1. Polanski, J., et al. (2023). Diet as a Factor Supporting Lung Cancer Treatment—A Systematic Review. Nutrients, 15 (6), 1477. doi: 10.3390/nu15061477
2. American Lung Association (2022).Nutrition and Lung Cancer Treatment. Ανακτήθηκε από: https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/treatment/stay-healthy/treatment
3. Porro, C., et al. (2022). The Potential Role of Nutrition in Lung Cancer Establishment and Progression. Life (Basel), 12 (2), 270. doi: 10.3390/life12020270
4. National Cancer Institute (2022). Eating Hints: Before, during, and after Cancer Treatment. Ανακτήθηκε από:

   https://www.cancer.gov/publications/patient-education/eating-hints

Appetite loss

• Create a pleasant environment in the meal area and limit interruptions during meal time as much as possible.
• Serve food in realistic quantities. The sight of large portions creates anxiety – inhibits appetite.
• If there is short satisfaction or if meals are not well tolerated, try small, frequent meals or intermediate meals.
• Eat meals and snacks rich in calories and protein.
• Add healthy fats to foods, such as avocado, nut butter (peanut butter, cashew butter, almond butter) and olive oil.
• Drink a protein-rich drink (smoothie or milkshake) when we find it difficult to eat.
• Choose liquids rich in calories and other nutrients.
• Meals can have a variety of colors, textures and tastes.
• Enhance the flavors with spices.
• Marinate the meat in sauces or fruit juices.
• Drink fluids throughout the day— especially when you don’t want to eat.
• Avoid exposure to cooking odors before meals.
• Exercise. Physical activity helps improve appetite. Studies show that many people with cancer feel better when they exercise every day.

Change in taste and smell

• Rinse your mouths with soda and water (1/4 teaspoon of soda in a cup of water) before meals.
• Choose foods with a mild taste (mashed potatoes, bread and butter, warm cereals, rice, simple pasta and milk).
• Choose foods that look and smell good.
• Marinate foods with ready-made marinades or fruit juices, wine or salad dressings.
• Add extra flavor to foods by adding onion, vegetables or herbs, including basil, oregano and rosemary.
• Smoking cessation is recommended.
• Some ways to reduce food odors:
  • Serve the food at room temperature.
  • Keep food covered.
  • Drink with a straw.
  • Cook outdoors.

Inflammation of the mucous membrane/Stomatitis (mouth sores)

• Avoid foods at extreme temperatures.
• Eat foods that are soft, gentle and mild.
• Cook foods until they are soft.
• Add sauce, dressing, broth, oils to moisten the food.
• Cut the food into small pieces.
• To facilitate eating, use a small spoon to take smaller, manageable bites.
• Drink liquids through a straw to prevent irritation of mouth sores, particularly in the front of the mouth.
• Avoid foods and drinks that may irritate mouth sores, such as:
  • Salty foods
  • Citrus fruits and juices, such as oranges, lemons and lemonade
  • Dry, dehydrated and hot foods
  • Spicy foods such as hot sauces, curry dishes, gravy and chili peppers
  • Beverages containing alcohol
  • Tomatoes and ketchup
  • Raw vegetables

Dry mouth

• Rinse your mouth every 1 to 2 hours with sea water (1/8 teaspoon of salt in 1 cup of warm water). Then, rinse with clean water.
• Drink water throughout the day to keep the mouth moist and to be able to swallow and speak better.
• Chew gum or suck on sugar-free hard candies, frozen fruit and ice cubes. These help make saliva, which moistens our mouth.
• Eat foods that are easy to swallow, such as pureed cooked foods or soups.
• Add sauce to the food to aid swallowing ease.

Avoid the following:

• Drinking alcohol, including beer and wine, as alcohol dries the mouth.
• Tobacco products.
• Mouthwash containing alcohol.
• Foods that can harm your mouth, including very spicy, sour, bitter, salty, hard or crunchy foods.

Nausea

• Drink fluids throughout the day. Drink slowly.
• Drink only small amounts of liquids during meals.
• Eat small and frequent meals.
• Choose foods you like.
• Make your personal nutrition plan. Some people feel better when they eat a small meal or snack before treatment. Others feel better when they don’t eat for a few hours before treatment.
• Consume easily digestible foods.
• Eat and drink foods and drinks at room temperature.
• Eat pretzels or crackers with your morning medicines in case of morning nausea, unless they need to be taken on an empty stomach.
• Keep a record of when you feel nauseous and why, and inform your doctor or nutritionist.
• Rest after meals in a sitting and not lying position.
• Wear comfortable and lose clothes.
• Avoid strong smells of food and drinks.
• Open a window or a fan in the living room when eating. Fresh air relieves the feeling of nausea.

Vomiting

• Do not consume food and drinks until the vomiting stops.
• As soon as the vomiting stops, drink small amounts of clear liquids.
• Once you can drink clear liquids without vomiting, try drinks and foods with a high liquid content or foods that are easy on the stomach (banana, white bread, crackers, white rice, white spaghetti, cheese, eggs, chicken).
• Eat small and frequent meals.

Diarrhea

• Drink only clear liquids for 12 to 14 hours after a period of severe diarrhea.
• Drink plenty of fluids to keep hydrated.
• Eat small and frequent meals.
• Consume foods and liquids with a high sodium and potassium content.
• Consume foods low in fiber.
• Consume food and drinks at room temperature, neither too hot nor too cold.
• Avoid:
  • Foods or drinks that can worsen diarrhea:
  • Dairy products, unless they are low-lactose or lactose-free.
  • Fatty or fried foods.
  • Beer, wine and other types of alcohol.
  • Spicy foods, such as pepper, hot sauce and chili.
  • Very hot or very cold drinks.
  • Drinks that have a lot of sugar.
  • Sugar-free products containing sweeteners (xylitol or sorbitol), which are mainly found in sugar-free chewing gum and candies, apple juice.
  • Foods or drinks with caffeine, including regular coffee, tea, some soft drinks and chocolate.
  • Foods and drinks that can cause gas, including cooked dried beans, raw fruits and vegetables.
  • Foods rich in fiber.

Constipation

• Drink plenty of fluids (at least 8 cups of fluids daily).
• Gradually introduce fiber into your diet if you’re not accustomed to it, starting with small amounts each day.
• Stay physically active every day.

Fatigue

• Opt for frozen or ready-to-eat meals to simplify food preparation, leaving you with more energy to focus on eating.
• Let family or friends help with the preparation of food.
• Eat regularly when possible.
• Choose soft foods or liquids, which require less effort to chew and swallow.
• Stay hydrated.
• Limit liquids before bed, if using the bathroom interrupts your sleep.
• Exercise when possible. Try 10-15 minutes of walking three times a day.

Weight gain

• Choose low-fat dairy products.
• Eat high-fiber foods.
• Consume a lot of fruits and vegetables. They are high in fiber and low in calories and help us feel full without high calorie intake.
• Choose lean meats, such as lean beef, lean pork, fish or skinless poultry.
• Choose plant-based proteins.
• Eat less fat, only small amounts of butter, mayonnaise, desserts, pancakes and other high-calorie foods.
• Change the way you cook food. Prefer steaming or grilling.
• Eat less salt to deal with fluid retention.
• Keep a food diary.Track what you eat and when you eat it. Doing so can help you recognize habits that might be causing you to gain weight.
• Practice every day.

Weight loss

• Eat small and frequent meals.
• Consume foods with a high protein and calorie content.
• Add toppings like peanut butter, olive oil, nuts, seeds, avocado, honey and jam to all foods.
• Drink milkshakes, smoothies, juices or soups if you do not prefer solid food. These can provide the protein, vitamins and calories we need.
• Stay physically active. Exercise stimulates hunger.

Sources:

1. American Lung Association (2022).Nutrition and Lung Cancer Side Effects. Ανακτήθηκε από: https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/treatment/stay-healthy/side-effects
2. National Cancer Institute (2022). Eating Hints: Before, during, and after Cancer Treatment.Ανακτήθηκεαπό: https://www.cancer.gov/publications/patient-education/eating-hints
3. Ζαμπέλας, Α., (2011). Κλινική διαιτολογία και διατροφή με στοιχεία παθολογίας. Εκδόσεις Πασχαλίδης

When undergoing lung cancer treatment, our weakened immune system increases the risk of infection. It’s advisable to follow the food preparation instructions below: 

• Wash your hands thoroughly before eating.
• Wash the fruits and vegetables thoroughly.
• Handle raw meat, fish, poultry and eggs with special care.
• Wash your hands, knives, utensils before and after preparing food. This step is most important when preparing raw meat, chicken, turkey and fish.
• Wash your hands each time you touch raw meat, chicken, turkey or fish.
• Use one cutting board for meat and another for fruit and vegetables.
• Defrost meat, chicken, turkey and fish in the refrigerator or in the microwave on the appropriate program.
• Cook meat, chicken, turkey and eggs thoroughly. The eggs should be hard, not runny. The meats must not be raw or partially cooked.
• Store food at low temperatures to minimize bacterial growth.

Sources:

1. American Lung Association (2022).Nutrition and Lung Cancer Treatment. Ανακτήθηκε από: https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/treatment/stay-healthy/treatment

Foods rich in fiber:

Starchy foods

• peas
• whole grain breakfast cereals
• whole wheat pasta
• corn
• brown rice
• legumes (lentils, beans, chickpeas)
• potato / sweet potato with skin
• oat bran
• green beans
• wholemeal bread

Vegetables

• cucumber with the peel
• artichoke
• turnip
• sweet potato
• carrot
• corn
• red pepper
• cauliflower
• onions
• cabbage
• lettuce
• okra
• beets
• broccoli
• celery
• spinach
• asparagus
• tomato with skin
• greens

Fruits

• kiwi
• pear
• blueberries
• apricots
• plums
• cherries
• tangerine
• apple with peel
• banana
• blueberries
• orange
• peaches
• figs
• gooseberry
• strawberries
• passion fruits

Nuts

Low fiber foods

• white rice
• white bread
• eggs
• turkey
• yoghurt
• olive oil
• canned fruit
• chicken
• mushrooms
• potatoes without skin
• vegetable juices
• fruit juices
• fish
• baked carrot

Foods rich in protein:

• lamb
• egg
• milk
• turkey
• yoghurt
• seafood
• chicken
• rabbit
• beef
• duck
• tuna in water
• cheese
• pork
• fish

Plant foods rich in protein:

• peas
• almond milk
• rice milk
• soy milk
• cereals
• pasta
• corn
• broccoli
• nuts
• legumes (beans, lentils, chickpeas)
• potato
• green beans
• rice
• soybeans
• seeds
• tofu
• wholemeal bread

Foods containing omega-3 fatty acids:

• walnuts
• flaxseed (which should be consumed within 24 hours of grinding)
• fatty fish and seafood, such as salmon, mackerel, tuna, herring, trout, sardines
• dark green vegetables
• soybeans
• soybean oil
• seed oil
• pumpkin seeds

Foods rich in saturated fat:

• sausages
• pastries
• butter
• coconut milk and coconut cream
• full fat milk
• coconut oils
• whipping cream
• fatty cuts of meat
• sausage
• ice cream
• chocolate
• fried foods
• full fat cheese
• palm oil

Foods rich in tryptophan (an amino acid with relaxing properties):

• almonds
• pineapple
• lean meat
• eggs
• oats
• turkey, skinless chicken
• yoghurt
• gruyere
• plums
• brown rice
• pumpkin seeds
• cabbage
• banana
• watercress
• nuts
• chickpeas (hummus)
• soybeans
• sesame
• spinach
• figs
• cottage cheese
• lentils
• peanuts
• hazelnuts

Foods rich in tyrosine:

• avocado
• lean meat
• dairy Products
• turkey
• gruyere
• plums
• yeast extract (marmite)
• Swiss cheese
• emmental
• canned figs
• veal liver
• mozzarella
• bananas
• Parmesan cheese
• green beans
• soy sauce
• spinach
• dried grapes
• chicken liver
• tomatoes
• tuna fish
• cheddar

Foods rich in potassium:

• avocado
• almonds
• dried fruits (raisins, apricots)
• dairy products and plant milks (soy, almond)
• cashews
• chicken
• bananas
• broccoli
• potatoes
• melon
• oranges, orange juice
• green beets
• salmon
• spinach
• tomatoes
• lentils
• beans

What is “red meat”?

The term “red meat” refers to beef, pork, lamb, and goat meat from farmed herds of animals, as well as the meat found in processed foods and most beef patties.

What is ‘processed meat’?

The term “processed meat” refers to meat which is preserved by the method of smoking, drying with salts, salted, or by adding chemical preservatives. This category includes, for example, ham, bacon, salami and some sausages (e.g. Frankfurt).

What are bland foods?

A bland diet consists of foods that are bland, not too spicy and low in fiber. Some examples:

• Low-fat dairy products
• Cooked vegetables
• Fruit and vegetable juices
• Cooked fruit where the skin and seeds have been removed
• Bread, crackers and pasta made with refined white flour
• Rice
• Oatmeal and porridge
• Poultry, lean fish and shellfish that are steamed, grilled or broiled without added fat
• Creamy peanut butter
• Eggs
• Tofu
• Soup (American Lung Association, 2022)

Clear liquids

• Sports drinks
• Carbonated drinks
• Clear fat-free stock, such as meat stock
• Gelatin
• Water
• Fruit-flavored drinks, such as fruit punch or lemonade
• Tea, chamomile, or coffee without milk, cream or non-dairy creamer
• Fruit juices without pulp, such as apple or white grape juice