Stomach Problems and Cancer: How to Feel Better
Gastrointestinal (GI) upset is a common source of discomfort for patients with cancer and can have a large effect on overall quality of life if not tended to appropriately. GI upset can be related to dysfunction of the GI tract because of the cancer or as a result of treatment. Different types of GI upset include loss of appetite, nausea, pain, constipation, diarrhea, and acid reflux. If these issues are not addressed, serious complications may ensue, such as dehydration and malnutrition.
Treatment and Prevention of GI Upset:
Working with the multidisciplinary care team to create an individualized plan that delineates how to prevent and treat GI upset can be essential to minimizing discomfort and optimizing overall quality of life. Open communication can facilitate many useful methods of treatment, including appropriate medication. There are a number of medications that can help reduce GI upset including medications to prevent symptoms and medications that address symptoms as they are happening. On-going communication with the multidisciplinary care team can ensure that proper medications and dosages are being prescribed.
Working with a registered dietitian can also be immensely helpful in reducing GI distress. The role of a registered dietitian includes helping patients become or stay adequately nourished and hydrated by working closely with the patient to set individualized goals and create treatment plans that are tailored to the patient’s specific needs. These plans are based on the best available research. As a safety precaution, it should be noted that anyone can call themselves a nutritionist, however a master’s degree, over 1,000 hours of supervised training, and passing a board examination are just a few of the current requirements to become a registered dietitian. These standards guarantee that the person providing nutrition recommendations has been thoroughly trained and committed to staying up to date with the best available research in order to provide safe and effective care. This is especially important for patients with cancer who are at risk for malnutrition and dehydration.
When it comes to nutrition while undergoing cancer treatment, restricting intake and avoiding food that is typically categorized as unhealthy, can be particularly harmful. This is because tolerated foods are often very limited, and getting enough calories is better than being in a deficit. Choosing calorie-dense foods that the patient can tolerate is often very helpful for ensuring adequate nourishment.
Many patients with cancer experience loss of appetite. When this happens, it can be very important to prevent the stomach from becoming empty. This is because an empty stomach can produce hypersecretion of acid within the stomach that can not only cause nausea and make nausea worse but can also cause pain from heartburn and stomachache. Starting the day with food in the stomach can be incredibly helpful as it sets the tone for the rest of the day and can help ease symptoms and prevent them from getting worse. Figuring out which foods the person is able to tolerate more easily is also important for increasing intake. This can look very different from person to person, though there are some foods which tend to be more soothing and some which tend to trigger GI upset more frequently. For patients who struggle with symptoms from a fuller stomach, it can be very helpful to eat and drink smaller more frequent amounts throughout the day. It can also be helpful to eat and drink separately.
Emotional distress can also add to or cause GI upset so working with the multidisciplinary care team to find other methods to cope with emotions such as meditation, yoga, and therapy can also aid in alleviating GI upset.
Movement is another factor that can play a large role in reducing GI discomfort. Activity facilitates movement of the bowels and can greatly improve anxiety which can make GI upset worse.
Staying Hydrated
Staying hydrated is one of the most important considerations for patients who have lost their appetite or have difficulty with adequate intake for any reason. This is because dehydration can lead to dangerous complications including kidney failure. Finding ways to increase fluid intake while minimizing nausea is often key to staying hydrated for patients with cancer. Things like popsicles and shakes can offer nutrition and flavor while also offering water content. It is important to pay attention to how frequently urination is occurring and to notify the doctor if infrequent urination is noticed. This is because infrequent urination can be a symptom of dehydration and other problems.
Healthcare providers can create plans with patients to make sure they are getting enough water throughout the day. This can look like a schedule to drink water or additional fluids provided intravenously. Intravenous fluid can often be administered with treatment, which is a great option for patients having difficulty consuming enough fluid during the day. The average person who does not have diarrhea needs close to 2L of fluid per day. Breaking this down into portioned amounts throughout the day can make consuming recommended amounts a lot less overwhelming and triggering for those who have difficulty drinking a lot at one time.
When to See the Doctor
When patients present with GI upset that is so severe it is causing dehydration or high risk for dehydration, it is important to make sure the correct cause is determined. While many cancer treatments can cause GI upset, assuming the treatment is the cause can lead to other problems being overlooked. It can also lead to symptoms persisting unnecessarily when the issue could have been treated. It is important to work with the gastroenterologist and the oncologist to determine the cause, as each field offers a unique perspective and training that can be helpful in diagnosing.
Supplementing with Poor Intake
Many patients with poor intake use supplements in hopes to improve their nutrition, however supplements in the United States are not regulated for safety and efficacy. There is no guarantee that what is on the label is what is being consumed. Supplements can also interact with medications and may be contraindicated with certain medical conditions. Serious and harmful effects have occurred from taking supplements, and the risk is increased for patients with cancer who are on a variety of medications and have multiple medical conditions.
Using the Internet
It’s important to proceed with caution when using the internet to get information about remedies of any type. Unfortunately, there is a lot of misinformation on the internet, and even if the information is accurate, it may not be safe for each individual patient.
Nutrition and Recovery
Muscle loss is often a byproduct of weight loss. In recovery, gaining back lost muscle is very important. Muscle mass helps prevent falls, protect bones, and improve metabolism. Getting enough calories and the appropriate amount of the macronutrients (protein, fat, and carbohydrates) is important in recovery.
10 Tips for Managing GI-related Symptoms
- Avoid eating and drinking at the same time if a full stomach trigger symptoms.
- Consult with your oncologist and GI doctor if symptoms are unmanageable.
- Work with a registered dietitian to come up with a plan that is tailored to your needs and includes foods you can tolerate and a schedule you can maintain.
- Small, frequent meals can be helpful for nausea.
- There are a variety of medications that can help with GI distress including anti-nausea medication.
- Movement is important for all areas of health including emotional health.
- Try to eat in an environment where eating is comfortable for you.
- Music and meditation can be very helpful to reduce GI symptoms that are enhanced by anxiety.
- Consume foods that are nutrient-dense when possible.
- Surround yourself with people that lift up your spirits!
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Meet the Panelists:
Dara Kurtz
Dara is a cancer survivor, creator of Crazy Perfect Life, author of Crush Cancer, and founder of The Thrive Podcast with Dara Kurtz and Garth Callaghan. She speaks regularly around the country leading Crush Cancer, Thrive and Self Care Workshops.
Dr. Moshe Shike
Dr. Shike is a gastroenterologist, internist, and nutritionist with a particular interest in cancer prevention at Memorial Sloan Kettering.