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How to eat well with lymphoma
Eating a well-balanced diet is essential for everybody to maintain good health and
tness, but it is all the more important when you have lymphoma. If you are already
eating healthily, you might not need to make many changes to your diet and you
should continue to eat as normal.
However, having lymphoma might change how you feel about food or your ability to
eat normally. There may be times when side effects of treatment or the lymphoma
itself make eating and drinking more difcult. It is always a good idea to discuss your
nutritional needs with your healthcare team.
In this article we aim to answer the following questions:
What does a healthy diet look like? (see below)
Why is nutrition important during treatment for my lymphoma? (page 2)
How will my treatment affect my eating and drinking? (page 3)
What can I do to eat well and eat the right amount for me? (page 5)
What can I do to make it easier for myself? (page 5)
Will nutritional supplements help me? (page 6)
What happens if I am unable to maintain my weight through eating and drinking
alone? (page 7)
How can I ensure the food I eat is safe? (page 7)
What does a healthy diet look like?
Eating a healthy, balanced diet will provide you with all the nutrients you need, as well
as help you maintain a healthy weight. A healthy diet includes eating foods from a
number of different food groups, including:
fruit and vegetables
bread, pasta, rice, potatoes and other starches
meat, sh, eggs, beans and other non-dairy proteins
milk and dairy foods
fatty and sugary foods.
A balanced diet contains carbohydrates, protein, vitamins and minerals, fat and bre.
Carbohydrates provide us with energy. Protein is essential for growth and repair of the
body. Vitamins and minerals play a major part in the healthy functioning of our bodies.
Fat provides us with energy and also helps us to absorb certain vitamins, but it is
important not to have too much of the wrong sort of fat. Fibre helps with bowel health
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(especially important for those who have slower bowel movements as a result of not
being able to exercise or taking certain medications).
The eatwell plate shows you the different types of foods you need to eat and in what
sizes of portions.
Why is nutrition important during treatment for my
lymphoma?
Treatments for lymphoma, particularly chemotherapy, can be easier to cope with if
you are well nourished and continue to eat and drink well. You are likely to be able to
tolerate higher doses of chemotherapy with fewer delays and fewer infections if your
dietary intake remains adequate. Becoming malnourished not following a nutritious
diet can lead you to feel down, both emotionally and physically.
Healthy eating is always important and never more so than during treatment for
lymphoma. If you are able to continue eating a normal diet and your appetite remains
good you should aim to maintain your weight throughout treatment, no matter what
your starting weight is. If you start to struggle with eating and drinking at any time of
your treatment, it is important to let your healthcare team know they can quickly start
to help and support you in nding ways to prevent further weight loss.
During the times when your lymphoma affects how you feel about food, you may be
encouraged to make changes to your normal diet. If you think though that you could
make some changes to improve what you eat anyway, it would be a good idea to make
plans for how to achieve this.

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The eatwell plate
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It is important to remember that there is no specic diet for lymphoma and so the
information in this article is suitable for the whole family as long as they are t and well.
Energy (calories)
It is important to eat just the right amount each day. If your energy intake becomes
too low you will start to lose weight, which can lead to increased tiredness and slower
recovery of blood counts.
You may nd that you need more energy than usual, particularly if your lymphoma
is associated with night sweats and fever. At other times, your energy needs will be
increased if you have an infection or a raised temperature and during chemotherapy.
If you feel that you are eating normally but continue to lose weight, discuss this with
your medical team or dietitian. It may be that you need to consider some strategies
for increasing the amount of energy in your everyday diet.
If your appetite is very good and you are eating large portion sizes, aim to ll up
on foods that are lower in calories, such as fruit and vegetables or starchy foods.
However, if your appetite is poor and you are only managing small portions, increase
the energy density of your meals with foods such as butter, cream or cheese, which
are much higher in energy. This way you can regulate your energy intake depending on
your appetite at different times.
Protein
During treatment you may need more protein, particularly if your body needs
additional healing following treatment. Many people worry about their protein intake
during chemotherapy as some protein-rich foods, such as red meat, can become
difcult to eat. There are several other good sources of protein, such as sh, milk,
cheese, eggs, nuts, seeds, beans and pulses. If you are not eating your usual sources
of protein, try to supplement with another source from the list in Table 2 (see page 6).
Vitamins and minerals
Our daily requirements for vitamins and minerals are relatively small so, generally,
there is no need to supplement the diet if you are not restricting any particular food
group or type. Occasionally, if your eating and drinking have decreased or if you are
unwell, it may become more difcult to meet your daily vitamin and mineral needs.
If you are concerned about whether you are getting enough, you should discuss this
with your healthcare team or dietitian as some supplements can react with other
medication and should be avoided. High doses of some vitamins and minerals can be
dangerous - only take supplements if recommended to do so by your doctor.
How will my treatment affect my eating and drinking?
How you might be affected is very individual and will depend on the type of lymphoma
you have and your particular treatment plan. Even if people are on the same treatment,
everyone will have different side effects to different degrees. Table 1 (see page 4)
highlights some of the more common side effects of lymphoma treatments. It has
some simple ideas to help if you are experiencing these side effects.
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If you have diabetes, talk to your doctor or dietitian about any impact treatment could
have on that condition.
Table 1: Problems that may affect food intake and some helpful suggestions
Problem Likely cause Possible solution
Poor appetite Chemotherapy
Radiotherapy
Other
medication
Eat little and often
Have nutritious drinks
Have an aperitif (an aperitif before dinner might
improve your appetite but check with your doctor rst
whether an alcoholic drink is permitted)
Ask your doctor about appetite stimulant tablets
Nausea and
vomiting
Chemotherapy
Radiotherapy
Other
medication
Take regular anti-sickness medication
Eat dry plain foods
Have nutritious drinks
Ginger drinks, ginger biscuits and zzy drinks
might help
Feeling full
quickly
Chemotherapy
Lymphoma in
the gut
Radiotherapy to
the gut
Eat little and often
Separate drinks from food (ie have drinks 30 minutes
before or an hour after food)
Avoid lling up on bulky, low-energy foods such as
beans and salads
Sore mouth/
sore throat
Chemotherapy
Radiotherapy to
the mouth and
throat area
Have a soft/liquid diet
Take nutritious drinks
Avoid spicy and rough foods
Ask for medication for mouth care and painkillers
from your doctor
Taste
changes
Chemotherapy
Other
medication
Brush your teeth regularly and use prescribed
mouthwashes
Concentrate on foods that taste good
Use strong avours such as citrus and strong-
avoured sauces and chutneys
Diarrhoea Chemotherapy
Radiotherapy to
the gut
Ask your doctor for anti-diarrhoea medication
Drink plenty of uids to avoid dehydration
If medication is not controlling your diarrhoea, speak
to your doctor or dietitian for further advice
Constipation Painkillers
Chemotherapy
Anti-sickness
medication
Ask your doctor for laxatives
Make sure you are drinking plenty of uids
Keep as active as possible
Try a high-bre diet
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What can I do to eat well and eat the right amount for me?
While it is very normal for the side effects from lymphoma or the treatment to affect
your desire to eat and drink, it is possible that you will continue to have a good appetite
throughout treatment and there will be no need to make any changes. However, if you
feel that the amount you eat has decreased, it is time to start making some simple
changes to increase your daily intake:
Eat little and often, aiming to include small snacks between your meals.
Be positive about what you do eat and remember that every mouthful counts.
Do not use diet, light, low-fat or reduced-sugar products as these are lower in
energy.
Try adding extra butter, cream, cheese, honey or sugar to foods to increase the
energy in everything you eat.
Add high-fat dressings and sauces to meals wherever possible. Examples include
French dressing to salads, mayonnaise and butter to jacket potatoes, cheese sauce
to vegetables or ice cream and custard to desserts.
If you are feeling too tired to prepare meals, then ready-made and convenience
foods can be a useful standby. Alternatively, when you prepare meals yourself, cook
more than you need and freeze a portion for another day.
Eat more of the foods you do enjoy, whatever time it is. For example, you may nd
the idea of having a bowl of porridge or cereal easier to face in the evening than a
cooked meal.
Make the most of your best times. You may nd early mornings easier, so make sure
you have a good breakfast or consider having a cooked breakfast in the morning.
You may nd it easier to have your main meal in the middle of the day, rather than in
the evening when you may be feeling more tired.
What can I do to make it easier for myself?
Depending on where you are with your treatment and how it might be affecting you
some of the following tips might be very useful:
Serving smaller portions of food can be more appetising, perhaps using a smaller
plate so that your meal does not look overwhelming. If your portion sizes are smaller
than usual, eat six small meals or nourishing snacks spaced out throughout the day.
Sometimes the smell of food being cooked can be off-putting. If other people are
able to cook for you this might be helpful. Keep the kitchen door closed and maybe
get some fresh air while the meal is being prepared.
Food served cool or cold has less aroma and is just as nourishing.
Try not to ll up on salads and vegetables which add bulk to your meal but provide
few calories.
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Make sure you have food in your fridge or cupboard that is quick and easy to
prepare, such as pasta with a sauce or ready-made puddings.
Vary the consistency and avour of food from meal to meal by simply adding a
sauce. This can also add valuable calories too.
Accept offers from friends and family to help with cooking and shopping if you are
feeling too tired to prepare meals yourself. Many supermarkets offer home delivery
services if you don't feel up to a trip to the shops.
Consider using a meals on wheels or a meal delivery service for times when
preparing food is particularly difcult.
Will nutritional supplements help me?
Sometimes you might be advised to take some nutritional supplements to help keep
your weight up. These come in a range of forms. A registered dietitian will be able to
help you decide which are best for you and how to take them.
Some supplements are available to buy in the supermarket without a prescription and
are designed as a meal replacement, while others are suitable as a drink in addition to
your usual meals.
Other supplements are available on prescription from your doctor. Some are designed
to fortify your regular food and drink, and to increase the energy or protein content,
while others are taken as a supplementary drink. There is also a range of supplements
that are nutritionally complete, meaning that they can provide all the nutrients you
need each day, if taken in sufcient quantity.
Table 2 (see below) shows some of the more common supplements that you may
be advised to try. This list is not exhaustive and you should always discuss the most
appropriate choices for you with your doctor or dietitian.
Table 2: Nutritional supplements
Type of supplement Examples of supplements available
Milky avoured drink (without bre) Ensure Plus, Fresubin Energy, Fortisip Bottle,
Fortisip Compact, Complan Shake, Calshake,
Scandishake, Enshake
Milky avoured drink (with bre) Ensure Plus with Fibre, Fortisip Multi Fibre,
Fresubin energy bre, Buildup
Juice/squash avoured drinks Ensure Plus Ju-ce Style, Provide Xtra,
Fortijuice, Complan Smoothie
Yoghurt avoured drinks Fortisip yoghurt style, Ensure Plus yoghurt
style
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What happens if I am unable to maintain my weight
through eating and drinking alone?
Sometimes the side effects of treatment or the lymphoma itself might mean you
develop difculties swallowing or are unable to eat or drink in sufcient quantities. If
this happens, you may need to consider an alternative method of nutrition support.
There are several options available, and your medical team and your dietitian will talk
you through the details and advise you of the most appropriate options for you, should
the need arise.
Generally, nutrition support can be considered in two categories and will largely
depend on whether your digestive system is functioning normally.
1. Tube feeding (enteral nutrition) involves the insertion of a soft, narrow tube
directly into your stomach or intestine. It will not stop you from eating and
drinking, and is usually only a temporary measure to ensure you get sufcient
nutrients.
2. Intravenous nutrition (parenteral nutrition) involves providing a carefully
balanced formula of nutrients directly into your bloodstream via a central venous
catheter. It is usually only given in a hospital setting when your digestive system
is not functioning properly or if it is impossible or unsafe to access your digestive
system.
Speak to your dietitian if you are having problems or want to nd out more details
about your options.
How can I ensure the food I eat is safe?
Food safety is always important no one, however healthy, wants to get food
poisoning. High-dose chemotherapy or a stem cell transplant mean you may be
particularly vulnerable to infection from food-borne bacteria. This is for two reasons:
The white blood cells, that usually ght bacteria, are at a low level. This is called
neutropenia or immunosuppression.
The gut lining acts as a barrier between bacteria and the bloodstream. Chemotherapy
and radiotherapy damage the gut lining, making it easier for any bacteria to cross
this barrier. During this time you may be advised to follow a clean or neutropenic'
diet. You should contact your treatment centre for further details on specic foods
to avoid at this time.
The information in Table 3 (see page 8) is a general guide for all people whose immune
system is compromised in this way. If you become severely neutropenic it is likely
that you will be given additional restrictions to follow.
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Following any type of chemotherapy, care should be taken with the preparation and
handling of any food or drink. In addition to the preparation guidelines in Table 3 (above),
certain foods should also be avoided if you are at risk of neutropenia (see Table 4).
Table 3: Food safety guidelines
Shopping Avoid buying food with damaged packaging
Avoid fridges and freezers that are overloaded
Buy chilled and frozen food last and take it home as soon as
possible
Only buy fresh products where raw and cooked foods are
displayed separately
Storage Fridges should be kept between -0C and 5C
Freezers should be kept below -18C
Store cooked food at the top of the fridge and raw food at the
bottom
Never refreeze thawed food
Defrost food in the bottom of the fridge
Always consume food according to manufacturers guidelines
and before their best-before date
Preparation Wash your hands with warm soapy water before preparing food
and again after touching any uncooked food, rubbish, pets, dirty
washing or after sneezing or using the toilet
Do not dry your hands on the kitchen tea towel but use a separate
towel for hands
Cover any cuts or grazes
Ensure any cloths and towels are regularly bleached, disinfected or
changed
Disinfect worktops regularly
Avoid cross-contamination by using different coloured chopping
boards for raw and cooked foods, and wash utensils between uses
Cooking Cook all food thoroughly and ensure it is piping hot all the way
through
Cook meat until the juices run clear
Pre-heat the oven to ensure food is cooked at the desired
temperature
Always follow manufacturers guidelines
Never reheat cooked food
Do not put hot food in the fridge as this raises the temperature of
all the food in the fridge leave to cool rst
Only use a microwave for defrosting or heating prepared foods
according to the pack instructions
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The information in this article is designed as a guide only. If you have any specic
questions about your diet and diagnosis, you should contact your medical team or
dietitian who will be able to provide you with individual advice.
As a general rule, there is no special diet that you need to follow. Whenever possible,
try to enjoy a wide variety of different foods and drinks. Aim to make mealtimes
relaxed, making the most of the times you feel at your best. If youre not able to
manage a full meal, try changing your meal pattern so you graze throughout the day,
with small but regular snacks. Remember too that regular, gentle exercise can help
you maintain a healthy weight.
Now you have a better understanding of how to eat well with lymphoma, you should
be able to nd solutions which suit you. You might also feel better prepared for times
when you might need to make some adjustments.
If you would like further information about any aspect of lymphoma and its treatment
or information about neutropenic diets please ring the helpline (0808 808 5555) or
email information@lymphomas.org.uk. Please also visit our website
(www.lymphomas.org.uk).
Acknowledgement
We are grateful to the Committee of the Haematology Sub Group of the Oncology
Group of the British Dietetic Association for its assistance in the reviewing of this
information.
Further information
Healthy eating and cancer and Eating problems and cancer
Both booklets are published by Macmillan and are available free of charge from
their website: www.macmillan.org.uk/HowWeCanHelp/Publications/Macmillan_
Publications.aspx http://be.macmillan.org.uk
Table 4: High-risk foods to be avoided by all immunocompromised people
All unpasteurised dairy products such as farm-fresh milk, parmesan
Soft mould-ripened cheese, such as Brie, Camembert, goats cheese
Raw or under-cooked eggs such as homemade mayonnaise, mousse, egg nog,
meringue or hollandaise sauce
Raw or undercooked shellsh
Raw or undercooked meat, poultry or sh, such as rare meat, sushi, smoked meats/
sh (eg Parma ham, salmon pat and sh paste)
Probiotics or bio products, such as probiotic-containing supplements or drinks
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Eating well when you have cancer
Available from the Rehabilitation Secretary, the Royal Marsden NHS Trust, Fulham
Road, London SW3 6JJ.
020 7808 2811 or through their website
www.royalmarsden.nhs.uk/cancer-information/patient-information/pages/booklets.aspx
After treatment: a guide for cancer patients
Available from the Rehabilitation Secretary, the Royal Marsden
NHS Trust, Fulham Road, London SW3 6JJ.
020 7808 2811 or through their website
www.royalmarsden.nhs.uk/cancer-information/patient-information/pages/booklets.aspx
Dietary advice for patients with neutropenia
Published by Leukaemia & Lymphoma Research
020 7504 2200
www.leukaemialymphomaresearch.org.uk
Penny Brohn Cancer Care
www.pennybrohncancercare.org/eating-well
Recipe ideas from Macmillan
www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Eatingwell/
Recipes/Recipes.aspx
Meals on Wheels
www.gov.uk/meals-home
Selected references
The full list of references is available on request. Please contact us via email
(publications@lymphomas.org.uk) or telephone 01296 619 409 if you would like a copy.
Wilson R. Optimising nutrition for patients with cancer. Clinical Journal of Oncology
Nursing, 2000. 4: 2328.
National Cancer Institute: http://www.cancer.gov/cancertopics/pdq/supportivecare/
nutrition/HealthProfessional/Page4#Section_117
NHS Choices:http://www.nhs.uk/Livewell/Goodfood/Pages/Healthyeating.aspx
World Cancer Research Fund / American Institute for Cancer Research. Food,
Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective.
Washington DC: AICR, 2007 (http://eprints.ucl.ac.uk/4841/1/4841.pdf)
Macmillan. The importance of physical activity for people living with and beyond
cancer: a concise evidence review, 2012 (http://www.macmillan.org.uk/Documents/
AboutUs/Commissioners/Physicalactivityevidencereview.pdf)
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We make every effort to ensure that the information we provide is accurate but it
should not be relied upon to reect the current state of medical research, which is
constantly changing. If you are concerned about your health, you should consult
your doctor.
The Lymphoma Association cannot accept liability for any loss or damage resulting
from any inaccuracy in this information or third party information such as
information on websites which we link to. Please see
our website (www.lymphomas.org.uk) for more
information about how we produce our information.
Lymphoma Association
PO Box 386, Aylesbury, Bucks, HP20 2GA
Registered charity no. 1068395
Updated: August 2013
Next planned review: 2015
How we can help you
We provide:

a freephone helpline providing information and emotional support 0808 808 5555
(9am6pm MondaysThursdays; 9am5pm Fridays) or information@lymphomas.org.uk

information sheets and booklets about lymphoma (free of charge)

a website with forums www.lymphomas.org.uk

the opportunity to be put in touch with others affected by lymphoma through our
buddy scheme

a nationwide network of lymphoma support groups.

How you can help us
We continually strive to improve our information resources for people affected by lymphoma
and we would be interested in any feedback you might have on this article. Please visit
www.lymphomas.org.uk/feedback or email publications@lymphomas.org.uk if you have
any comments. Alternatively please phone our helpline on 0808 808 5555.