DIETARY ADVICE

DIETARY ADVICE

Dietary advice for liver cancer patients Provided by Aisling Snedker, RD, Clinical & Sports Nutrition Dietitian, Galway, Ireland

“A small bite of nutrition”

You may have lots of things to think about at this time, diet may not even come onto your “to do list”. You, your carers and family can often take eating well, as a positive sign that you are keeping well. Poor appetite can be a source of stress for you but there may be obstacles in your way preventing you from feeling like eating. Cancer in your liver can disrupt the flow of bile and other digestive enzymes into your food which can affect how well you digest and can cause physical discomfort. Your liver may be swollen or enlarged causing you to feel a sensation of upward pressure on your stomach or downward pressure onto your bowel. Both can have the effect of creating a rapid feeling of fullness when trying to eat or actually having no appetite at all. This information is intended to be a gentle support to try to optimise your dietary intake at this time. Everybody is different so you can use the information to dip in and out of, picking what is pertinent and useful to you.

First off do you need to actually do anything about how you’re eating at the moment? Let’s check this out.

1. Have you suffered any weight loss? Check your BMI

2. And is the weight you have lost significant? >5%-10%

What is your current body mass index (BMI)? Your body mass index gives a basic guide to whether you are a healthy weight for your height. Enter your weight (kg) and your height (cm) into the boxes below and click the 'calculate BMI' button to get yours.

Your Weight (kg):
Your Height (cm):

Formula: BMI = mass (kg) divided by (Height (m) )2 i.e. 70 kg divided by (1.7 x 1.7)
Your BMI:
This Means:
Note: People of South Asian origin may be at greater risk of ill-health at lower BMI ranges than those shown above, with a BMI of greater than 23 suggested as being overweight.

If you are somebody who weighs yourself regularly and you have lost 5% - 10% or more of your usual weight or 2 Kg (4lb) unintentionally, you should bring this to the attention of your doctor and carers. It is indicating that you may need support with your nutritional intake.

Is it important right now to try to support your nutritional status?

If there are changes you can make in your diet that are easy, then why not try? You might find that even slight improvements in managing symptoms associated with your illness will make you feel that bit better.

Malnutrition can worsen the side effects of treatments such as surgery, chemotherapy and radiotherapy. Your cancer alone can already be causing any of the following symptoms which can be exacerbated by becoming malnourished.

Signs of malnutrition

  • Tiredness and lethargy
  • Frequent illnesses and infections
  • Slow wound healing
  • Difficulty in keeping warm
  • Lack of strength and low energy when it comes to doing your normal daily activities.
  • Changes in your skin and nails.
  • Loss of appetite
  • Low mood and poor concentration.

Let’s do a little behaviour, social and environmental modification! To support your appetite and gain weight if necessary.

1Eating little and often. This may sound a little regimented but really means “eat what you can, when you like”. So if for example you want to eat breakfast cereal later in the evening or yoghurt at a main meal time then why not!

2How often does “Eat little and often” mean? Ideally three small meals and three snacks each day. Try not to leave long gaps between your meals and eat something small even if it is just a few bites every two or three hours. Don’t forget to sip your fluids.

3Try to stay out of the kitchen as cooking smells can affect your appetite. If you are catering for yourself it is fine to eat out a little more often or use some convenience meals to do this.

4Being asked to choose from a long list can also put you off eating. It can be helpful to have a small list of choices that your family can pick from that they know you can normally manage without having to ask you.

5Eat when you feel your best. Trying to eat when you are tired can make feelings of nausea and poor appetite worse. Remember food gives us energy so if you are tired frequently try to have a couple of bites you may find you feel more able to eat later.

6Use small plates and have small portions throughout the day, eating two or three bites of something you fancy is much more productive than forcing yourself through a meal once and then not being able to face another one again.

7Favourite foods may no longer be your favourite foods so it can be easier to just keep it simple plain pasta cheese and chicken soups yoghurts and desserts that you enjoy.

8Blue sky time: Try and get a little bit of fresh air before you eat and if at all possible get up and move about.

Let’s get snacking

Note: Avoid using low fat diet or reduced calorie foods from now. If you have been following a specialist diet for high cholesterol, diabetes, liver or renal disease then please speak to your Registered Dietitian (RD) who can advise you more individually on changes you can make to support your appetite. Some people find that snacking regularly rather than having formal hot meals can be just as nutritious and easier to face.

Sweet Snack

  • Scone with jam and butter and milky coffee
  • Milky coffee with a slice of cake
  • Hot chocolate and toast with butter and jam
  • One bar of chocolate with milky coffee
  • Sponge with full fat custard
  • Pot of thick and creamy yoghurt and a glass of fruit juice
  • Rice pudding with jam
  • Muffin or cereal bar
  • Stewed, chopped or tinned fruit with thick and creamy yoghurt
  • Nutritious drink/or milkshake
  • Protein enriched ice cream
  • Flapjack with a glass of milk

Savoury Snack

  • Small bowl of cereal with milk
  • 2 plain digestive biscuits
  • Handful of nuts - any kind you enjoy
  • A packet of raisins or handful of figs or dates
  • Rice cakes or crackers with cheese, peanut butter or hummus, pate
  • Milky coffee with cheese on toast or beans, scrambled eggs or peanut butter
  • Sandwich with egg or tuna with mayonnaise
  • Bowl of lentil, bean or creamy soup with 2 slices of bread and butter.

Let’s do a little behaviour, social and environmental modification! To support your appetite and gain weight if necessary.

What a day's intake could look like?

Mealtime Eating little and often and adding in extra calories Simple but healthy balanced intake
Breakfast 1 bowl of porridge made with fortified milk add a little bit of honey or golden syrup Or full fat yoghurt with berries, honey and a sprinkle of oats. 1 glass fruit juice 1 portion of fruit if possible milky coffee made with fortified milk or a milkshake 1 bowl of porridge made with low-fat milk. Add flaxseeds milled mix seeds 1 glass of fruit juice 1 portion of fruit e.g. handful of Blueberries, 1 Satsuma Cup of tea/coffee/water
Mid morning snack A pot of thick and creamy yoghurt and chopped/stewed apple. Tea /coffee or Nutritious drink. A portion of fruit or low-fat yoghurt Hot drink or cold drink
Lunchtime/main meal of the day Chicken casserole with potatoes and frozen veg. Dessert: Rice pudding with raisins and jam on top Shepherds pie with mushrooms, carrots and peas Dessert: fruit or a low fat yoghurt or low-fat custards
Afternoon snack Fortified cup of soup with crackers and cheese Small handful of nuts or a portion of fruit hot or cold drink
Evening meals/teatime Scrambled eggs made with fortified milk. Add butter and cream to taste. with grilled tomatoes or a little baked beans +2 slices of toast, wholemeal if possible. Cake and custard with chopped banana Small bowl of cereal and hot milky drink Baked beans or scrambled eggs on toast with grilled tomatoes drink of water with meal and another hot or cold drink 1 portion of fruit with sugar-free jelly or low-fat yoghurt. Hot or cold drink

Fortifying your diet

If you need to fortify your diet to help support your weight you should seek professional advice from a Registered Dietitian. Here are a few starting tips.

Fortifying your diet involves adding small quantities of everyday foods, such as cream, skimmed milk powder or butter or sugar to a food or drink so that every mouthful you eat has more calories in it than usual.

Tips for fortified drinks

  • Use full cream milk
  • Use double whipping cream, not single cream
  • Use fortified milk and skimmed milk powder to add extra nutrition.
  • Try to have 2 fortified drinks each day. This is particularly important if you have recently been on prescribed nutritional supplements.
  • 4 tablespoons of dried skimmed milk powder
  • 600 mls/1 pint of full fat milk
  • Mix the milk powder into the milk.
  • Keep in the fridge and use in hot drinks, sauces, puddings and on cereal.
  • 200 mls of full fat milk
  • 2 heaped tablespoons of dried milk powder
  • Milkshake powder to taste
  • Mix together with a hand whisk or fork.

    This makes two portions:

  • 150 ml of milk
  • 1 heaped tablespoon of milk powder
  • Pot of thick and creamy yoghurt
  • Mix everything together with a hand whisk or fork

    This makes two portions:

  • 300ml of milk
  • 1 heaped tablespoon milk powder
  • 1 pot of thick and creamy yoghurt
  • 10 strawberries or 1 banana (or fruit of choice) Liquidise all your ingredients together.
  • 200ml of milk
  • 1 packet of cup-a- soup.
  • 1 heaped tablespoon of milk powder.
  • Add hot water and mix as usual.
  • 150 ml of milk
  • 1 tablespoon of milk powder
  • 1 teaspoon of your usual coffee powder
  • Mix with 2 tablespoons of cream
  • 150 mls of milk
  • 1 heaped tablespoon of milk powder
  • 3 tablespoons of hot chocolate
  • 2 tablespoons of cream.
Liver Cancer Dietary Advice Chart
Liver Cancer Dietary Advice Chart

Tick your nutritional boxes

  • Fats: Choose healthy fats such as flaxseed, walnut, olive oil, or rapeseed oil for cooking and salad dressings.
  • Dairy : three portions each day, such as cheese, milk or yoghurt, if you prefer to you can also use dairy free milk and yoghurts
  • Carbohydrate: Include in each of your three main meals, for example 2 slices of bread, 1 bowl of cereal, 1 medium or two egg size potatoes, 1 cup of cooked pasta or rice. Or have a little bit each time you snack.
  • Fruit and vegetables: try to eat these every day, if possible aim for 5 portions.
  • Protein foods in at least 2-3 of your meals or snacks each day.
  • Fluid: 6 to 8 glasses or mugs of fluid each day. This includes all types of fluids such as water, herbal teas, tea and coffee, juices and milkshakes. If you find you drink slowly use an insulated bottle or cup to keep your drink chilled or hot.