Let’s talk lymphoma, food and nutrition

A healthy diet should include:

• fruit and vegetables for fibre, vitamins and minerals. The recommendations are to eat at least 5 portions (of around 80g each) of different fruits and vegetables each day. A 30g portion (1 tablespoon) of dried fruit also counts as one portion.
• carbohydrates, which are the main way the body gets energy. Carbohydrates provide fibre, vitamins and minerals. They should make up around a third of the daily food intake. Foods high in carbohydrates include rice, potatoes, bread, pasta and grains.
• protein (including dairy or dairy alternatives as a source of protein) allows the body to grow and repair itself, as well as improving muscle strength and immune system function. You might need more protein than usual to help recover during and after lymphoma treatment. Foods that are high in protein include meat, fish, eggs and dairy products. Plant-based foods that contain protein include beans, lentils, nuts and seeds.
• fat, which is important for energy and vitamins. People often think fat means saturated fat, which should be limited in intake. However, there are different types of fat. Unsaturated fats help to keep your heart healthy and lower cholesterol. These often come from plant-based foods such as seeds, nuts, olives and avocados. You can include them in your diet by using spreads or oils made from corn, olive, rapeseed, sunflower, soya or sesame. Our bodies need essential fatty acids (omega-3 and omega-6 fats) to work well. Omega-3 is found in oily fish, walnuts, flaxseeds, linseeds and green leafy vegetables. Omega-6 is found in nuts, seeds, vegetable oils or spreads.
• fibre, which helps to keep the heart and digestive system healthy. Plant-based foods are usually high in fibre, for example vegetables, cereals and potatoes. The recommendation is to eat 30g of fibre each day.
• fluids, where the general recommendation is to drink around 1.5 to 2 litres (roughly 6 to 8 glasses) each day, unless specified by a healthcare professional. This is particularly important in hot weather or if you have symptoms of lymphoma such as sweating, sickness or diarrhoea. Water is the best form of hydration, but other fluids are counted in the daily fluid intake, except for alcohol. It’s important to not just drink tea or coffee as caffeinated drinks can dehydrate the body.

What are the recommendations on healthy eating?

The UK Government sets out recommendations on healthy eating in their Eatwell Guide (pictured). You can find the Vegetarian Eatwell Guide at the Vegetarian Society UK and The Vegan Eatwell Guide at The Vegan Society websites.

How lymphoma might affect eating

Some lymphoma treatments can cause side effects that make it difficult to eat and drink as normal. For example, sickness, bowel problems, changes in taste, a lowered appetite or feeling full after eating only a little, can make it difficult to meet nutritional needs.

Dry, sore mouth (oral mucositis) or mouth ulcers as a side effect can also make it difficult to eat and drink. If this is the case, it can be helpful to try to reduce irritation by eating soft foods and avoiding citrus fruits.

In some cases, the position of the lymphoma (for example in the spleen or tummy) might result in feeling full more quickly than usual. Some people who have had an allogeneic (donor) stem cell transplant have a lower appetite if graft-vs-host disease develops in the gut. Lower appetite can also be a side effect of chemotherapy, radiotherapy to your gut, or due to the emotional impact of lymphoma, like heightened stress and anxiety.

What to do if eating or drinking is a struggle

Speak to a member of your medical team who can offer help and advice. Do not take any supplements without seeking medical advice, as some could interact with lymphoma treatments and other medications in an unwanted way. This could include potentially making lymphoma treatment less effective.

If food doesn’t taste of much, you could try:

• adding herbs, spices, sauces, dressings, pickles, yeast extract and chutneys
• drizzling fruit sauces onto desserts or adding berries.

If changes in taste affect enjoyment of drinks you could try:

• ‘sharp’ tasting fizzy drinks, such as lemonade or ginger beer
• herbal teas if regular black tea and coffee is no longer enjoyable.

Tips if your appetite is low or you feel full up soon after you start to eat

• Eat little and often with snacks between meals.
• Try not to drink too much too soon before you eat (around 30 minutes).
• Choose food high in energy and protein which is helpful if you are losing weight due to lymphoma and its treatment.
• If eating out, order a smaller portion.
• If you are struggling to eat enough, talk to a member of your medical team.

What can I do if I’m gaining weight?

Weight gain can be a side effect of some steroid treatments and can happen whether you eat more than usual or not. In general, it’s best to avoid dieting during treatment as it can make it harder for the immune system to recover. Height and weight are also important in calculating treatment doses. Instead of dieting, focus on eating a healthy diet, doing exercise, and giving your body energy to help with recovery.

Acknowledgements

With thanks to Chrissie Kirby, Haematology & Transfusion Clinical Nurse Specialist.

Our webpage ‘Diet and nutrition’ has recently been updated and includes much more information on this topic. It includes frequently asked questions and answers about lymphoma, food and nutrition