Where to start in managing diet problems

What you can do

One of the ways you can help yourself is by keeping an eye on your diet problems. You should let someone know if:

• you have lost your appetite

• you worry about your weight

• you are finding eating or drinking difficult for any reason (such as sickness, constipation or difficulty swallowing)

Check what support is available to you. Ask questions and get your healthcare team to explain things to you in simple terms.

You might cope better with your situation if you understand your diet problems. 

Find nutrition and cancer booklets on our reading list

Who to talk to about your diet problems

Speak to your healthcare team if you have a problem with diet, digestion or weight loss. There are specialists who can help you. These include a:

• doctor or specialist nurse

• dietitian

• speech and language therapist

• pharmacist

• nutritionist

Take your diet problems to whomever you feel most comfortable talking to. They work as a team and will pass on any information about your diet problems.

Other people who can help support you to manage your diet problems include:

• your family and friends

• support groups

• social workers

• religious or spiritual leaders

How specialists can help you

Specialists can help you with your diet problems in different ways.

Your doctors and specialist nurses

Your specialist cancer doctors and nurses are there to help you. They have the skills to treat all problems related to cancer and treatment. Your GP can also help.

What they suggest will depend on:

• any treatments that you are having

• what the problem is

• how long you have had the problem

• how bad it is

• what is causing it

• if the problem is likely to be temporary

Dieticians

Your doctor will most likely refer you to the hospital dietitian for help. Many cancer units and hospitals have dietitians for people with cancer. They work with your doctor to decide together on the best way to manage your diet problems.

Dietitians play an essential role in helping you with diet problems. They have the training and skills to look after people with cancer. They can answer your questions and help you deal with any problems you have with eating.

They can suggest specific meals, snacks, and food. They can also tell you how to prepare food to help you eat. For example, a pureed diet may help if you are having problems swallowing.

Your dietitian can also plan a special diet to make sure you get all the calories and nutrients you need.

They may suggest special drinks that can replace a meal if you can't face eating. You can buy the drinks from a chemist, or they are available on prescription. There are many other types of nutritional supplements. They can help to boost your intake of nutrients. Your dietitian can tell you more about these.

Your dietitian will see you regularly if you have a more severe problem or need drip or tube feeds.

They can also help arrange for any specific dietary needs while you are in hospital.

Speech and language therapist

Speech therapists help people with speech problems. They also help people who have difficulty swallowing. This can be as a result of surgery or radiotherapy to the head and neck area. Or swallowing difficulties could be due to cancer itself.

They assess you and tell you about the right texture of food or fluid to help you swallow safely. They can also give you exercises to help make swallowing easier.

Pharmacist

A pharmacist checks that the type and dose of any drug prescribed for you are safe. They will check how safe it is for you to take drugs that help with eating and weight loss with your other medicines. They will also make sure it is safe to take with tube feeds.

If you have trouble swallowing, they might be able to give your medicines as a liquid or powder so they are easier for you to take.

Nutritionist

A nutritionist is a specialist who knows about food and nutritional science. They also know about using nutrients to help people recover from illness. They can’t give advice about special diets for medical problems.

Nutritionists don’t usually work in the NHS, although some might work alongside dietitians. You might choose to see a nutritionist privately and pay for their advice. Some nutritionists work in non clinical roles in the government, food industry, research, teaching, sports and exercise settings.

Nutritionists have different levels of education. It varies from little education to a bachelor's, master's or doctoral degree.

The term nutritionist or nutritional therapist is not protected by law. That means anyone can use it. So it is important to check that you see a trained nutritionist. Trained nutritionists have a qualification that is recognised by the Association for Nutrition (AfN).

You can check if a nutritionist is registered by contacting the AfN.

Visit the Association for Nutrition website

Assessing your dietary needs

Before your healthcare team can do anything, they need to know about your illness and diet. They will ask you a lot of questions about the history of your illness, your appetite and weight. This is called a nutritional assessment. Your doctor will also examine you and might arrange for further tests.

This may feel like too much to deal with if you are very tired, weak or sick. But your healthcare team must assess you. By understanding your diet problems, they can offer you the right treatment.

Nutritional assessment

Below are some of the questions your healthcare team might ask:

• What is your normal weight?

• Have you been on any type of diet or lost or gained weight over the past 6 months, and if so, how much?

• What do you eat in a typical day and has this changed over the last 6 months?

• Do you ever have diarrhoea or constipation or feel sick or vomit?

• Have you lost your appetite?

• Do you have any problems with eating, such as a sore or dry mouth?

• Does food taste any different to you since you were diagnosed with cancer?

• Do you have problems with swallowing or chewing?

• Do you often feel tired, dizzy or confused?

• What medicines are you taking?

Your healthcare team also consider any other medical conditions you have. A condition such as diabetes may affect your nutritional needs.

Physical assessment

Your doctor will also examine you. This involves checking your body for signs of poor nutrition, including:

• examining your tummy area, mouth (gums and tongue) and skin

• taking your blood pressure and pulse

• checking your weight

• looking for loss of fat and muscle tissue

• looking for signs of dehydration (dry skin, thirst, low urine output) or fluid build up (swollen ankles or abdomen)

Your doctor may also recommend that you have urine and blood tests. This might give them more information about your body and how it is absorbing food.

Malnutrition

Malnutrition means getting too little of the types of food necessary for good health. About 3 million people in Britain have malnutrition or are at risk of it. This can affect their health and ability to work.

Some people and cancer types have more at risk of malnutrition than others. You can be malnourished or at risk of being malnourished regardless of how much you weigh. 

The National Institute for Health and Care Excellence (NICE) has guidance on support with nutrition for adults. This guidance says that patients should have screening for signs of malnutrition. Screening should also assess if they are at risk of becoming malnourished. 

This screening should happen on admission to hospital or at your first outpatient appointment. You should be screened again if there is any concern that you could become malnourished.

The MUST screening tool for malnutrition

BAPEN is the British Association for Parenteral and Enteral Nutrition. They developed a tool called the Malnutrition Universal Screening Tool (MUST). It is available to all health professionals.

The MUST tool helps to identify people who are:

• at risk of malnutrition

• already malnourished

The results from the screening tool will show if you need more support with your diet. Your doctor or another health professional can then refer you to a dietitian.

Find out more on the BAPEN website

Self screening

BAPEN also has a self screening tool for malnutrition. They based it on the MUST tool. Research showed that self screening for malnutrition works well.

Talk to your doctor about the results of the self screening tool if you are worried.

Read more about the self screening tool on the BAPEN website