What are nutritional problems and how can they affect me?
A variety of medical problems can affect your appetite. Your illness, medicines or surgery can cause these problems. Many people become frustrated when they know they need to eat to get well but they aren't hungry, or when they gain weight because they are fatigued and unable to exercise.
Each of the following sections describes a nutritional problem and suggests possible solutions. Not all solutions will work for everyone. Talk with your healthcare provider if you have questions.
Lack of appetite, or decreased hunger, is one of the most troublesome nutrition problems you can experience. Although it's a common problem, its cause is often unknown. Appetite-stimulating medicines are available. Ask your provider if such medicines would help you.
- Eat smaller meals and snacks more frequently. Eating six or seven or eight times a day might be more easily tolerated than eating the same amount of food in three meals.
- Talk to your provider. Sometimes, poor appetite is due to depression, which can be treated. Your appetite is likely to improve after depression is treated.
- Avoid non-nutritious beverages such as black coffee and tea; instead choose milk and juices.
- Try to eat more protein and fat, and less simple sugars.
- Walk or participate in light activity to stimulate your appetite.
- Drink beverages after a meal instead of before or during a meal so you do not feel as full.
- Plan meals to include your favorite foods.
- Try eating the high-calorie foods in your meal first.
- Use your imagination to increase the variety of food you're eating.
- Take advantage of times of the day when your appetite is best. For example, some people have a better appetite in the morning and can eat a larger breakfast.
- Don't waste your energy eating foods that provide little or no nutritional value (such as potato chips, candy bars, colas and other snack foods).
- Choose high-protein and high-calorie snacks.
- Make food preparation an easy task. Choose foods that are easy to prepare and eat.
- Make eating a pleasurable experience, not a chore.
- Liven up your meals by using colorful place settings.
- Play background music during meals.
- Eat with others. Invite a guest to share your meal or go out to dinner.
- Use colorful garnishes such as parsley and red or yellow peppers to make food look more appealing and appetizing.
If your doctor tells you that you have lost too much weight, or if you are having difficulty maintaining a healthy weight, here are some tips:
- Drink milk or try one of the "high-calorie recipes" listed below instead of drinking low-calorie beverages.
- Ask your doctor or dietitian about nutritional supplements. Sometimes, supplements in the form of snacks, drinks (such as Ensure® or Boost®), or vitamins might be prescribed to eat between meals. These supplements help you increase your calories and get the right amount of nutrients every day. Note: Do not use supplements in place of your meals.
- Avoid low-fat or low-calorie products unless you have been given other dietary guidelines. Use whole milk, whole milk cheese and yogurt.
- Use the "Calorie Boosters" listed below to add calories to your favorite foods.
- Ice cream.
- Granola bars.
- Nachos with cheese.
- Crackers with peanut butter.
- Bagels with peanut butter or cream cheese.
- Cereal with half and half.
- Fruit or vegetables with dips.
- Yogurt with granola.
- Popcorn with margarine and parmesan cheese.
- Bread sticks with cheese sauce.
Chocolate Peanut Butter Shake
1/2 cup heavy whipping cream
3 tablespoons creamy peanut butter
3 tablespoons chocolate syrup
1 1/2 cups chocolate ice cream
Put all ingredients into a blender. Mix well.
Makes one serving; 1090 calories per serving.
1 cup whole milk
1 cup ice cream (1-2 scoops)
1 package Carnation Breakfast Essentials® (formerly Carnation Instant Breakfast)
Put all ingredients into a blender. Mix well.
Makes one serving; 550 calories per serving.
2 cups whole milk
2 tablespoons vegetable oil
1 package instant pudding
3/4 cup non-fat dry milk powder
Blend milk and oil. Add pudding mix and mix well. Pour into dishes (1/2 cup servings).
Makes four 1/2 cup servings; 250 calories per serving.
Great Grape Slush
2 grape juice bars
1/2 cup grape juice or 7-Up
2 tablespoons corn syrup
1 tablespoon corn oil
Put all ingredients into a blender. Mix well.
Makes one serving; 490 calories per serving.
Egg yolk or whole egg
Before cooking, add egg yolk or whole egg to foods such as meat loaf, rice pudding or macaroni and cheese.
(To prevent illness, avoid the use of uncooked eggs.)
Non-fat powdered milk or undiluted evaporated milk
Add to beverages (including milk) or to these foods:
- Creamed soups, yogurt.
- Scrambled eggs, casseroles.
- Pudding mashed potatoes.
- Custard gravies.
- Hot cereal sauces.
Cream cheese or shredded, melted, sliced, cubed or grated cheese
Add to sandwiches, snacks, casseroles, crackers, eggs, soups, toast, pasta, potatoes, rice or vegetables, or serve as a snack.
Vegetable oils, mayonnaise, butter, margarine or sour cream
Add margarine or mayonnaise to sandwiches. Add any of these items to bread, casseroles, soups, eggs, cooked cereals, pasta, potatoes, rice, vegetables or pudding.
Peanut butter (creamy or crunchy)
Spread on bread, crackers, apples, bananas or celery. Or add to cereal, custard, cookies or milk shakes.
Nut "dust" (Grind any type of nuts in a blender or food processor.)
Add to puddings, gravy, mashed potatoes, casseroles, salad or yogurt cereals.
Miscellaneous foods (Limit to one serving per day.)
- Sugar, jelly, jam, preserves.
- Corn syrup.
- Maple syrup.
- Hot cereal.
- Sweet potatoes.
- Winter squash, cold cereal, fruit salad.
Heartburn can occur for many reasons, including overeating, eating certain foods, taking medicines or as a result of surgery.
- Avoid foods that have caused heartburn before. Some foods commonly associated with heartburn are highly seasoned foods, greasy or fried foods, chocolate, alcohol and beverages that contain caffeine (coffee, tea and soft drinks).
- Eat five or six smaller meals a day instead of three large meals. Decreasing the amount of food in your stomach eases digestion and reduces the chances of heartburn.
- Remain standing or sitting for at least two hours after eating. If you lie down, keep your upper body raised at a 45-degree angle.
- Eat your last meal several hours before going to bed.
- Take an antacid one hour after meals to relieve heartburn. You can also try taking antacids before going to bed. If you take antacids frequently, tell your doctor or dietitian.
Changes in how food tastes
How food tastes often determines what you like to eat. If food begins to taste different — if it becomes too sweet, too bland, bitter or metallic-tasting — your appetite can be affected. Medicines often cause these taste changes.
- Brush your teeth after meals and snacks. Good oral hygiene helps control bad taste. Ask your doctor or dietitian if using a mouthwash would help.
- Cold or room-temperature food might taste better.
- Eat alternatives to red meat. Try turkey, chicken, fish, eggs or dairy products such as yogurt, cheese or cottage cheese.
- Use marinades to add flavor to poultry, red meat or fish. Fruit juice, teriyaki sauce, Italian dressing, beer or wine will also add flavor.
- Add spices, such as herbs, onions, bacon bits or almonds to flavor plain foods.
- Use strong seasonings to improve the flavor of meats and vegetables. Rosemary, oregano, basil, tarragon or mint are good options.
- Eat snacks that leave a refreshing, pleasing aftertaste: fresh fruit, chewing gum, hard candy or cinnamon, or mint-flavored foods or beverages.
Sore mouth or throat
A sore mouth or throat can make eating difficult. Medicines or mouth infections can cause soreness.
- Eat bland, mild-flavored foods. Spicy or salty foods can irritate soreness.
- Eat lukewarm or cold foods. Hot food can irritate soreness.
- Puree foods before you eat them. Most cooked foods can be pureed in a blender or food processor.
- Avoid carbonated beverages or drink them only after they have gone flat. Carbonation can irritate soreness.
- Drink soups or other liquids from a straw or a cup instead of a spoon to keep foods away from sore spots in your mouth.
- Talk with your provider about using an anesthetic mouthwash to help relieve discomfort.
- Have your provider examine your mouth to see whether you have a fungal infection. Such infections are treatable and often occur in people who are ill, especially those taking steroids or antibiotics.
- Avoid rough foods that might be hard to swallow, such as hard breads, toast, popcorn, raw vegetables, nuts and seeds.
- Eat soft foods that are easy to chew. Try casseroles, meat with gravy, mashed potatoes, cooked cereal, ice cream, eggs, pudding or cottage cheese.
- Eat foods that are less acidic. Try bananas, canned pears and peaches, applesauce or fruit nectars. Avoid tomatoes, oranges, grapefruits and pineapples.
- Drink plenty of liquids all day to keep your throat moist and to help prevent dehydration. Try milk shakes, eggnog, juices and soups.
Dryness in the mouth
Dryness in the mouth can make certain foods more difficult to eat. Fever, medicines, or mouth infections can cause dryness.
- Drink eight or more cups of liquid each day; 10 or more cups if you are feverish.
- Dunk or moisten breads, toast, cookies, or crackers in milk, hot chocolate, or coffee to soften them.
- Take a drink after each bite of food to moisten your mouth and to help you swallow.
- Add sauces to foods to make them softer and more moist. Try gravy, broth, sauce, or melted butter.
- Eat sour candy or fruit ice to help increase saliva and moisten your mouth.
- Don't use a commercial mouthwash. Commercial mouthwashes often contain alcohol that can dry your mouth. Ask your doctor or dentist about alternative mouthwash products.
- Ask your doctor or dentist about artificial saliva products. These products are available by prescription.
Nausea (an upset or "queasy" stomach) is a feeling of sickness that is sometimes accompanied by vomiting. Medicines, pain, constipation or the flu can cause nausea. Many medicines are available to treat nausea. Ask your provider if there is a medicine that can help you.
- Eat dry foods when you wake up and every few hours during the day. Nausea is often worse on an empty stomach, and dry foods can relieve some of the discomfort. Try pretzels, plain crackers or cookies, dry cereal or toast.
- Drinking liquids on an empty stomach can add to the feeling of nausea. Try sipping beverages slowly during your meals or drinking 30 to 60 minutes after eating solid foods.
- If the smell of food bothers you, avoid foods with unpleasant or strong odors. Eat somewhere other than the kitchen, where the odors might be strongest.
- Avoid greasy, fried or spicy foods. These foods take longer to digest and can make you feel bloated, uncomfortable and more nauseous.
- Avoid large meals and infrequent meals. The smaller and more frequent your meals and snacks are, the more comfortable you will be.
- Eat foods and supplements that are high in calories and protein to maintain your nutrition when you cannot eat a lot.
- It is important to replace liquids if vomiting occurs. If you can, drink eight or more cups of liquid each day. Add an additional 1/2 cup to 1 cup of liquid for each episode of vomiting.
- Fresh ginger is sometimes helpful in reducing nausea. Do not eat fresh ginger if you are taking anti-coagulant (blood-thinning) medicines, such as warfarin (Coumadin®). Also do not eat fresh ginger prior to surgery.
- Avoid your favorite food when you have nausea so you don’t create an aversion to that food.
Diarrhea is an increase in either the number of stools, the amount of liquid in the stools, or both. Medicines, a reaction to certain foods, stress, and ordinary colds or flu can cause diarrhea.
Prolonged diarrhea can cause dehydration, weakness, fatigue and weight loss. When you have diarrhea, important nutrients such as calories, protein, vitamins, water, sodium and potassium are lost. This loss can be serious if you are already ill or trying to recover from an illness. Your provider must know the cause of diarrhea to treat it correctly.
Try the following solutions for two days. If after that time you are still having diarrhea, call your provider. Liquids and nutrients are lost quickly, and treatment must begin before prolonged diarrhea causes harm.
- Drink eight or more cups of liquids per day.
- Add one to two cups of liquids to the daily eight cups for every episode of loose, watery stool to replace losses.
- Talk with your doctor or dietitian about increasing or decreasing the amount of fiber you eat.
- Drink a variety of beverages to help replace lost liquids and nutrients. Try water, coffee, tea, iced tea, lemonade or fruit-flavored drinks, fruit or vegetable juice, broth, milk, cream soup or a sports drink with electrolytes.
- Eat soft foods that contain large amounts of liquid, such as sherbet, gelatin, yogurt and pudding.
- Use less sugar and fat. Limiting sugar and fat might decrease the amount of water in the intestine and reduce the number of episodes of diarrhea.
- Ask your provider whether adjusting your medicines might help relieve the diarrhea. Do not change your medicines without first talking to your provider.
- Don't take over-the-counter (non-prescription) drugs for diarrhea without talking to your provider.
Constipation occurs when bowel movements become difficult or infrequent, usually more than 48 hours apart. Constipation can be caused by medicines and by not drinking or eating enough liquids or food, and inactivity.
- Drink eight or more cups of fluids per day, such as water, coffee, tea, juice or flavored beverages.
- Drink something hot as the first beverage in the morning, such as hot water, coffee, tea or hot apple cider. Hot liquids might stimulate a bowel movement.
- Drink 1/2 to 1 cup of prune juice in the morning to stimulate a bowel movement.
- Increase the fiber in your foods. Try whole grain breads, fresh fruits, whole grain cereals and fresh vegetables.
- Emphasize fruits that stimulate the bowels, such as watermelon, plums and other summer fruits, and avoid fruits that constipate, such as bananas.
- Add two to four tablespoons of unprocessed wheat bran to foods and drink plenty of liquids. (Liquids help bran to be effective.) Try bran sprinkled over hot or cold cereal, casseroles, or mixed with applesauce, pancake batter, pudding, muffin batter, milk shakes or cookie dough.
- Activity such as walking helps normalize bowel function.
- Plan trips to the bathroom immediately after meals since eating is a natural stimulus for having a bowel movement.
- If constipation continues, call your provider, who might prescribe a stool softener or laxative. Don't take any medicines, including over-the-counter (non-prescription) medicines, to treat constipation without talking to your provider.
Weakness in the muscles of your mouth might make it difficult for you to chew and manage solid foods. A delay in the swallowing process in either your throat or pharynx (the digestive tube between the esophagus and mouth) might also make it difficult for you to swallow without coughing or choking.
- Swallow evaluation: Ask your provider about a swallowing evaluation to determine safest swallow techniques.
- Positioning: Sit upright at a 90-degree angle, tilt your head slightly forward, and/or remain sitting or standing upright for 45 to 60 minutes after eating a meal.
- Dining environment: Minimize distractions in the area where you eat. Stay focused on the tasks of eating and drinking. Do not talk with food in your mouth.
- Amount and rate: Eat slowly. Cut your food into small pieces and chew it thoroughly. Do not try to eat more than 1/2 teaspoon of your food at a time.
- Swallowing: You might need to swallow two or three times per bite or sip. If food or liquid catches in your throat, cough gently or clear your throat, and swallow again before taking a breath. Repeat if necessary.
- Concentrate on swallowing frequently: It might help to alternate a bite of food with a sip of liquid. If you have difficulty sucking liquid all the way up a straw, cut the straw down so there is less distance for the liquid to travel. Change the temperature and texture of liquids. (Make the liquids colder. Try carbonated beverages.)
- Saliva management: Drink plenty of fluids. Periodically suck on popsicles, ice chips, lemon ice or lemon-flavored water to increase saliva, which will increase swallowing frequency.
- Difficulty chewing: If chewing is difficult or tiring, minimize (or eliminate) foods that require chewing, and eat more soft foods. Puree your foods in a blender.
- Coughing: If thin liquids cause you to cough, use a liquid thickener. (Your speech pathologist can recommend one for you.) You can also substitute thin liquids with thicker liquid choices such as nectars for juices and cream soups for plain broths.
- Taking medicines: Crush your pills and mix them with applesauce or pudding. Ask your pharmacist for recommendations on which pills should not be crushed and which medicines can be purchased in a liquid form.
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