Diagnosed
Nutrition

Getting the Most from Food

There are many treatment side effects that can affect your food intake and your appetite. A lot of time can be spent travelling to the hospital, waiting around for appointments and staying in temporary accommodation with limited cooking facilities. Having a range of quick and easy snacks that are suitable to eat when you're away from home, or when you don't feel like preparing a meal is important to prevent weight loss and malnutrition.

If you're not able to eat your usual amount of food, or you need to gain or maintain your weight, it's helpful to take in more energy (calories) without having to eat more. Try adding extras to your basic food at mealtimes, such as protein, fats and sugar.
Increasing the amount of energy or calories (e.g. protein, fat and sugar) in your diet is usually a temporary measure to keep you eating well during and after treatment. It's important to understand that eating extra fat and sugar while you're underweight, or struggling to maintain your weight because of treatment side effects won't hurt you and is often only needed for a small period of time.

Speak with your doctor and dietitian about relaxing low-cholesterol or diabetes dietary restrictions that may prevent you from eating extra fat and sugar.

Tips:
  • Treat food like medicine: something you have to have. Set times for meals and snacks.
  • Make sure your meal or drink is nourishing, for example drink milk or juices rather than water and choose cheese, biscuits and local kuihs over lollies.
  • Aim to have a small snack and/or nourishing drink, such as a milkshake or smoothie, if you can't manage larger quantities.
  • Use full cream milk and dairy products, or enrich milk with milk powder.
  • Add milk, coconut milk, cream, butter, margarine or yoghurt to dessert
  • Add cheese and corn starch to sauces or gravy 
  • Add oil, mayonnaise, salad dressing to salads and sandwiches
  • Add blended potato, meat to soup
  • Fry or roast meat, chicken, seafood and vegetables in oil, butter or margarine.
  • Prepare fried rice and noodles, add egg and oil to porridge
  • Spread bread, toast, biscuits or bun with butter or margarine and add honey, kaya or jam for extra energy. You can also use avocado, hummus or lite cream cheese if you prefer a low fat option.
  • Use egg or mayonnaise, cheese, canned tuna or sardine, peanut butter, banana, baked beans, avocado on bread, toasted muffins.
  • Carry snacks such as hard boiled eggs, chocolate bars, muesli bars, sweet biscuits, cakes, and local kuihs. Look for those with fruits and nuts for added energy.
  • Ready-to-use drinks are handy for travel and are useful if preparation is difficult. 
If you can't manage to eat a balanced and varied diet, or are experiencing unintentional weight loss, then it's recommended that you use nourishing fluids and/or nutritional supplements.

Nutritional supplements contain energy, protein and other nutrients in a concentrated source. Glucose powder supplements can also provide energy, but they don't provide protein, vitamins or minerals, so they have a particular function and shouldn't be used as a meal replacement. You may include protein powder supplements such as Myotein to provide protein and energy. You can sprinkle glucose and protein powder on food or stir it through to give meals and snacks extra energy. 

Nutritional supplements and/or nourishing fluids should be taken in addition to eating your usual meals, for example try them as between meal snacks. A dietitian can suggest the most appropriate supplement for you, and where it can be purchased. Your choice of supplement should be based on your nutritional needs, on availability and on the cost of the supplement.
If you've been assessed by a speech pathologist as having swallowing difficulties and need thickened fluids the nutritional supplements need to be thickened to the advised consistency. Discuss this with your speech pathologist.

The following tables provide some suggestions of nutritional supplements which you may be able to try (however, it shouldn't be considered a complete list of those available). 

Standard formula - adult
Product name Flavour Description
Ensure Powder FOS™ 
(400g & 850g a can)
Vanilla, chocolate Complete, balanced nutrition for meal replacement; low residue; contain prebiotic FOS, omega 3 & omega 6.
Suitable for people at nutrition risk, experiencing involuntary weight loss, recovering from illness or surgery, on low-residue diet, gluten and lactose intolerant; adults and children of 4 years of age and above.
Ensure Plus 
(237 ml)
Vanilla Ready-to-drink; gluten-free; lactose-free; low residue.
Suitable for people who are on modified diets, at nutrition risk, experiencing involuntary weight loss, recovering from illness or surgery, on low residue diets, fluid-restricted or volume-limited patients.
Ensure RTD 
(250ml)
Vanilla, chocolate Ready-to-drink; gluten-free; lactose-free.
Suitable for people who are on modified diets, at nutrition risk, experiencing involuntary weight loss, recovering from illness or surgery, or on low residue diets,
Nutren Optimum
(400g)
Vanilla Complete and balanced nutrition to help enhance immunity and support recovery during illness.
Contains prebiotic fibre blend and probiotic; lactose-free; gluten-free.
Suitable for people preparing for surgery or post-surgery, loss of appetite and insufficient oral intake. 
Not suitable for children below 4 years of age.
Wellness Recovery
(450g & 900g a can)
Vanilla Specially formulated with lactium to help to recover after surgery, illness or hospitalization.
Suitable for people preparing for surgery or post-surgery, loss of appetite and insufficient oral intake; 
Suitable for adult, elderly and teenagers aged 12 years and above.
Wellness 60+
(450g and 900g)
Vanilla Complete and balanced nutritional food for seniors 60+.
Suitable for those suffering from malnutrition, geriatric patients and convalescent patients.
Valens Calco 
( 56 g per sachet or 1 box with 7 sachets)
Malt flavour Complete, balanced nutrition for meal replacement. Contains whey protein; prebiotic fibre; lactose free; gluten free.
Suitable for people suffering from malnutrition, poor oral intake, loss of appetite, pre or post-surgery, unintended weight loss and cardiovascular disease.
Enercal Plus
(400g (can) and 900g (can) )
Vanilla Contains 50% whey protein and 50% soy protein.
Suitable for people who are recovering from a critical illness, chronically ill, convalescing, pre and post-surgical patients. 
Resource Fruit Beverage 
( Orange and peach)
(237 ml)
Fruit flavour (Orange/ Peach) Fruit flavoured beverage designed for dietary management in malnutrition and peri-operative to enhance outcome and recovery.
Ready to drink. Contains high quality whey protein; clear liquid; low residue; fat free.
Suitable for pre and post operation patients, people with lack of appetite/ insufficient intake, cancer patient undergoing therapy, fat intolerance/ malabsorption, on clear liquid diet and fat free diet.
Not suitable for children below 4 years of age
Isosource 1.5 cal
(237 ml)
Unflavoured Complete and balanced nutrition specially designed for the management of patients with malnutrition and increased nutritional needs.
Ready to drink. High energy density, high protein, contains healthy fibre blend, prebiotic of fructooligosaccharide (FOS), MCT and restricted electrolytes that place less strain on stressed kidney function.
Suitable for patients on long term and short term tube feeding, pre and postoperative, frail elderly, trauma, burn, volume intolerance, fluid restriction, elevated energy and protein needs
Not suitable for children below 4 years of age
Nutren Fibre
(400g)
Vanilla Complete and balanced nutrition with unique fibre blend for long term nourishment and healthy gut function.
Contains dietary fibre ( 50% soluble fibre, 50% insoluble fibre, 4.8 g fructooligosaccharide (FOS) per litre ); lactose free; gluten free
Suitable for stroke patients, frail elderly, long term tube feeding, diarrhoea and constipation.
Not suitable for children below 4 years of age
Peptamen
(430 g)
Vanilla Complete balanced semi-elemental nutrition to provide optimal tolerance to critically ill patients.
100% hydrolysed high quality whey protein, peptide-based formula; contains 70% MCT, 30% LCT; lactose-free and gluten-free
Suitable for people with critical illness, malabsorption, chronic diarrhoea, pancreatitis, high gastric residual, hypoalbuminemia, short bowel syndrome and cancer with treatment. 
Suitable for adult and children aged 10 years and above.
NB: When using powders, prepare as per directions on the can.

Standard Formula - Paediatrics
Product name Flavour Description
Nutren Junior
(400 g)
Vanilla Complete and balanced nutrition for prevention and correction of malnutrition in children.
Contains prebiotic and probiotics; DHA and EPA; 50% whey protein; lactose-free and gluten-free.
Suitable for patients with malnutrition, loss of appetite, recovering from illnesses, burns, trauma, growth failure, neurological disorders, congenital abnormalities, mouth and oesophageal injury, diarrhea and cancer ( not suitable for children on bone marrow transplant and with low white cell count due to side effect of cancer treatment). 
Suitable for children aged 1- 10 years old.
Pediasure (400g, 850g and 1.6 kg) Vanilla and chocolate Complete and balanced nutrition for children with feeding concerns. 
Contains probiotics; lactose and gluten-free (not for children with galactosemia). 
Suitable for children with poor appetite, recovering or have recovered from medical conditions.

Suitable for children aged 1- 10 years old.
Peptamen Junior
(400 g)
Vanilla Complete balanced semi elemental nutrition to provide optimal tolerance for children.
100% whey, peptide-based formula; lactose-free and gluten-free.
Suitable for patients with critical illness, malabsorption, chronic diarrhea, Cerebral palsy, high gastric residual, pancreatic insufficiency, cancer with treatment.
Suitable for children aged 1- 10 years old.
NB: When using powders, prepare as per directions on the can.

Specialised Formula 
Product name Flavour Description
CANCER
PROSURE 
(380 g)
Vanilla, Orange An energy dense, high protein formula enriched with EPA, which specially designed to help normalize metabolism and promote weight gain and help build lean body mass (LBM) in people experiencing cancer induced weight loss..
Contains EPA, dietary fibre, fructooligosaccharides. Recommended dosage: 18 scoops per day.
Suitable for people at risk of or experiencing cancer induced weight loss, adults and children of 4 years of age and above.
Not suitable as sole source of nutrition.
DIABETIC
Wellness 60+ Diabetic
(450g and 900g)
Vanilla Complete, balanced nutritional food, specially formulated for seniors 60+ who are either diabetic or pre-diabetic.
Suitable for pre-diabetic and diabetic seniors who need a supplementary nutritional intake.
Glucerna Triple Care 
(400g and 850g)
Vanilla Complete and balanced formula for diabetics that helps in blood glucose, cholesterol and weight management
Suitable for patients with Type I or Type II diabetics; gestational diabetics; impaired glucose tolerance and stress-induced hyperglycemia.
Glucerna RTD 
( 250 ml in a can)
Vanilla Reduced-carbohydrate, complete and balanced formula with beneficial monounsaturated lipids and fiber designed to improve blood glucose response in people with abnormal glucose tolerance compared to standard products. Provides dietary fibre and useful in the dietary management of diarrhea and constipation.
Suitable for patients with Type I or Type II diabetics; gestational diabetics; impaired glucose tolerance and stress-induced hyperglycemia.
Nutren Diabetik
(400g)
Vanilla Complete and balanced nutrition designed for impaired glucose metabolism.
Unique fibre blend that helps in blood sugar management; lactose-free; gluten-free.
Suitable for patients with Type I or Type II diabetics; gestational diabetics; impaired glucose tolerance and stress-induced hyperglycemia.
Not suitable for children below 4 years of age
Diabetasol
(180g and 600g paper box pack )
Vanilla, chocolate, cappucino Complete and balanced nutrition with low GI, specially formulated for diabetics. High in fiber; low in salt.
Suitable for patients with Type I or Type II diabetics; gestational diabetics; Impaired glucose tolerance.
RENAL
Nepro HD (220 ml) Vanilla Formula that replaces protein loss during dialysis. 
Contains carbohydrate blend designed to help manage blood glucose response, Omega-3, low calcium and low phosphorus to meet dialysis nutritional needs. 
Suitable for patient on dialysis, poor appetite and low albumin level (<3.8 g/dL).
It is used as supplemental or sole-source nutrition and for oral or tube feeding
Novasource Renal

(237 ml)
Vanilla Complete and balanced nutrition specially designed to meet the needs of renal patients.
Ready to drink. High energy density, moderate high protein, restricted electrolytes that place less strain on stressed kidney function; unique protein blends with soy protein for heart protective function.
Suitable for patients with Chronic Kidney Diseases (CKD) with dialysis, Acute Kidney Injury (AKI), electrolytes and fluid restriction due to CKD/ specific condition.
Not suitable for children below 4 years of age
NB: When using powders, prepare as per directions on the can.

Modular Formula 
Product name Flavour Description
Valens Myotein 
( 300 g per can or 1 box - 30 x 6.3 g sachet)
Clean flavour
(does not alter flavour of formula, beverages and food)
A protein module/ medical nutrition supplement suitable for providing extra protein to persons with increase protein needs.
Contains whey protein concentrate and soy lecithin. Mixes readily with most enteral feeding formula and beverages.
Suitable for patients at pre and post-operative, trauma, burn, cancer, patient with additional protein in a mineral and electrolyte-restricted diet.
Not suitable to be used as sole source of nutrition and use as directed by dietitian or other medical professional.
Valens Carborie (350 g per can) Clean flavour
(does not alter flavour of formula, beverages and food)
A glucose polymer module/ medical nutrition supplement suitable for providing extra calories to persons with increase energy needs and/or to persons who are unable to achieve sufficient energy requirements with normal diet.
low in mineral & electrolytes, with low osmolality, provides higher caloric density without exceeding osmotic balance with lower risk of osmotic diarrhea. It mixes readily with most feeding formula, food and beverages.
Suitable for patients who require additional energy in carbohydrate form, in protein, fat and/or mineral and electrolyte-restricted diet, and lower risk of osmotic diarrhea.
Not suitable to be used as sole source of nutrition and use as directed by dietitian or other medical professional.
NB: When using powders, prepare as per directions on the can.
Vitamins and minerals are an essential part of a healthy diet and play an important role in the body’s immune system. If you're managing to eat a balanced diet through eating a variety of food then the use of vitamin and mineral supplements isn't usually necessary.

Some people believe that taking high–dose vitamin supplements will strengthen the body’s immune system, but there's little evidence to support this. In fact, many vitamins and herb compounds can be toxic at high levels, and may interfere with chemotherapy, radiotherapy and other medications. Therefore high doses of vitamin or mineral supplements are usually not recommended for use during treatment.

Dietary supplements can't replace whole food, which are still the best source of vitamins and minerals. Many dietary supplements contain levels of antioxidants (such as vitamins C and E) that are much higher than the Malaysian Recommended Nutrient Intakes (RNI) for optimal health.

Whether antioxidants or other vitamin supplements are helpful or harmful during chemotherapy or radiation treatment is a major question without a clear science–based answer right now. Until more evidence is available, it’s best for people having these treatments to avoid dietary supplements, except to treat a known deficiency of a certain nutrient, and to avoid supplements that exceed the recommended daily intake.

Talking to your doctor, dietitian or cancer pharmacist before taking vitamin and mineral supplements or before starting treatment is encouraged.
Complementary therapies are treatments that may help you cope better with side effects such as pain. They may also increase your sense of control over what's happening to you, decrease your stress and anxiety, and improve your mood. There are many types of complementary therapies, such as herbal medicine, acupuncture, massage, relaxation and meditation.

By contrast, alternative therapies, which include unproven diets, are often defined as those used instead of conventional medical treatments. These therapies may be harmful if people with cancer delay or stop using medical treatment in favour of them.

There are no special food, diets or vitamin and mineral supplements that have been scientifically proven to cure cancer or to stop it from recurring. Unproven diets are often expensive, restrictive and repetitive. It's important to enjoy a wide variety of food to keep you well nourished.

Many unproven dietary treatments, particularly those that cut out food groups such as meat or dairy products are likely to be low in energy (calories), protein, fat, iron, calcium and zinc as well as vitamins. This can cause unwanted weight loss, tiredness and decrease your immune function. Your recovery and quality of life can improve if your diet includes adequate amounts from each food group.

Some alternative therapies can be harmful even when used in combination with conventional therapy. It's important that your doctor, dietitian, nurses and pharmacist are aware of all the treatments you're taking.

Juice Therapies
Juice therapies involve using fresh fruit and vegetable juices as the main source of food. Supporters of juice therapy believe it strengthens the immune system, reduces blood pressure and helps to clean out (detoxify) the body.

However, while the health benefits of fruit and vegetables are well documented, the benefits of juice therapy are not. Juice only contains a fraction of the fibre of whole fruit or vegetables. The protective effect of fruit and vegetables may be related to many factors in the whole fruit and vegetables, not just the juice. Use fresh fruit and vegetable juices as part of a varied eating plan.

The questions below will help you assess any diet therapy you're thinking of undertaking. Is the diet likely to:
  • Exclude one or more of the basic food groups?
  • Include large amounts of specific fruits, vegetables or their juices?
  • Exclude cooked food or limit the cooking methods allowed?
  • Exclude or limit protein food like meat, fish and chicken?
  • Completely change the way you choose, prepare and cook your food?
  • Result in weight loss during your cancer therapy?
  • Prevent you enjoying social occasions with family and friends?
  • Include large amounts of special supplements?
  • Cost you a lot of money and time?
If you answer yes to any of these questions, the diet could affect your recovery and compromise your health. Some eating patterns and nutrition supplements or pills can be harmful and may interfere with the success of your medical treatment. Before radically changing the food you eat, or taking vitamin/mineral pills or herbal remedies talk to your doctor or dietitian.
Reviewed by: 
Jenelle Loeliger, Head - Nutrition Department, Peter MacCallum Cancer Centre, VIC; Kate Aigner, Cancer Information Consultant, Cancer Council Helpline ACT; Ian Anderson, Consumer; Anna Boltong, PhD Candidate (Dietitian), Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, VIC; Clare Hughes, Nutrition Program Manager, Cancer Council NSW; Bridget Kehoe, Public Health Coordinator (Nutrition and Physical Activity), Cancer Council QLD; Steve Pratt, Nutrition and Physical Activity Manager, Cancer Council WA; and Roswitha Stegmann, Helpline Nurse, Cancer Council WA.
It's often difficult to eat well when you don’t feel like shopping for food or cooking because you're tired or unwell. You may miss meals while having treatment or waiting for appointments. The following meal and snack ideas may not all seem like healthy choices, but if you have a poor appetite it’s important to boost your intake of food and focus on high protein and energy food and fluids.

Meal and snack ideas
  • Fried rice with egg/ chicken/ fish/ meat/fish ball
  • White rice cooked with margarine or butter
  • Mashed potato with margarine or butter
  • Fried plain bread with egg or spread with margarine/ peanut butter/ chocolate/ jam/ tuna in oil
  • Fried chicken or fish that are coated in flour 
  • Milk shake or fruit smoothies
  • Fruit yoghurt or ice cream
  • Fruits and vegetables 
  • Cream of mushroom soup
  • Stuffed tofu ( tauhu sumbat)
  • Mixed milk/ caramel/ canned fruit with pudding
  • Baked beans on toast with grated cheese
  • Grilled chicken or lamb cutlets, mashed potato with margarine or butter, and peas and carrots
  • A sandwich and a glass of high–protein milk with Milo or Horlicks
  • Pasta with cheese or a ready–made sauce
  • Scrambled or poached egg on toast and a glass of orange juice
  • Tuna or sardines on buttered toast with fresh tomato
  • A ham and cheese omelette with buttered bread
  • Toast with cheese or peanut butter, followed by sliced banana and yoghurt
  • Frozen prepared dishes, dessert and soup that can be defrosted in portions and eaten on days you don’t feel like cooking
  • Cheese and crackers
  • Cheese or peanut butter on toast or bread
  • Hard–boiled eggs
  • Fruit cake, muesli and health food bars, sweet biscuits, cakes and slices
  • Fresh or tinned fruit with custard, yoghurt, jelly, ice cream or cream
  • Food–type nutritional supplements.
Fluids are an essential part of any diet. They allow you to stay hydrated and help your kidneys function. As a general guide, you should aim for at least eight to twelve glasses (2–3 litres) of fluid per day. The quantity of fluid you need may vary depending on your type of treatment. Your doctor or dietitian will give you guidelines about how much fluid you should drink per day.

As well as drinking water you can get fluid from soups, milkshakes or smoothies, fruit juices, fruit or ice cubes. For more information speak to your dietitian.

Nourishing drinks are drinks high in protein, energy, vitamins and minerals. These fluids include ready–to–drink commercial supplements, as well as nourishing drinks you can make at home. Use these drinks when:
  • You're underweight or losing weight – to assist with weight gain or weight maintenance
  • Your overall food intake is decreased due to poor appetite or nausea
  • You're relying mainly on a fluid diet.
These drinks can be used to replace fluids such as water, tea, coffee, soft drinks and cordials, which are generally a poor source of nutrients. Milk is a common base for nourishing drinks, as it's a high protein and energy fluid itself. Full cream milk has more energy than low fat milk and so is preferable to use at this time.

If you're lactose intolerant, then milk may give you diarrhoea. Lactose intolerance may also occur as a result of some types of cancer treatment. In this situation ordinary milk can be substituted with low lactose milks (e.g. soy milk). Speak to your dietitian who can advise you about what lactose-free supplements are available, and for advice about making alternative recipes.
Soups can be easy to eat, easy to digest and nourishing. Clear soups may stimulate the appetite and can provide extra fluid but be careful not to include clear soups in the diet on a regular basis as these will provide extra fluid but little nourishment (i.e. protein or energy). Be sure to add meat, legumes, cereals (rice, pasta, noodles) and cream, butter, margarine and oil to boost energy and/or protein content. Try adding local herbs and spices to vary the taste of soups.

Soup can be pureed or blended for people not able to swallow pieces of food, or strained and only the broth served. Thicker soups can be made with added puréed vegetables, blended potato, cream, egg yolk, fortified milk or arrowroot. If a puréed soup is too thick add a little more milk.
Marinating helps to tenderise, add flavour or change the taste of meat or tofu. 
Reviewed by:
Jenelle Loeliger, Head - Nutrition Department, Peter MacCallum Cancer Centre, VIC; Kate Aigner, Cancer Information Consultant, Cancer Council Helpline ACT; Ian Anderson, Consumer; Dr Anna Boltong, (Clinical Dietitian), Unit Head, Cancer Information and Support Service, Cancer Council Victoria, VIC; Clare Hughes, Nutrition Program Manager, Cancer Council NSW; Bridget Kehoe, Public Health Coordinator (Nutrition and Physical Activity), Cancer Council QLD; Steve Pratt, Nutrition and Physical Activity Manager, Cancer Council WA; and Roswitha Stegmann, Helpline Nurse, Cancer Council WA. Reviewed by Chan Wan Thung, dietitian, NCSM.