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Vegetarian Journal Cover

Vegetarian Journal


July/August 1996
Volume XV, Number 4

Vegetarian Diets During Cancer Treatment

By Donna Paglia, M.S., R.D.

Editors' Note: The purpose of this article is to assist individuals who are trying to follow a vegetarian or vegan diet while undergoing cancer treatment. We are not recommending one form of cancer treatment over another. We leave that up to patients and their medical adviser(s).

Donna Paglia is a clinical nutrition specialist at the Johns Hopkins Hospital Oncology Center in Baltimore.

By now most of us have heard of the association between a vegetarian diet and cancer prevention. A multitude of antioxidants and phytochemicals in fruits, vegetables, and legumes are being studied intensely as a result of some promising studies showing these foods' anti-cancer properties. This research is leading us to believe that a vegetarian diet may be one of the best preventive measures against certain cancers. However, there is no clear consensus on the type of diet that is most beneficial after a diagnosis of cancer. There are those who advocate macrobiotic diets and various "nutritional therapies" as forms of cancer treatment, but there is not enough scientific evidence to back up these claims, and severe dietary restrictions can be detrimental to those already at risk for malnutrition. So, is vegetarianism a wise choice for someone with cancer?

A vegetarian diet can be both safe and beneficial for people undergoing cancer treatment, provided they know how to make appropriate food choices. In fact, vegetarian foods may even help people get through difficult times during cancer treatment when their diets may be suffering. However, the guidance of a registered dietitian is recommended for any vegetarian undergoing cancer treatment, even if this diet is not new to them. This article provides information for planning a vegetarian diet that will satisfy the special nutritional needs of the cancer patient, whether that person is yourself, a friend or family member, or a client.

Those who have been diagnosed with cancer and endured its treatment can attest to the nutritional deficiencies and weight loss which can be a difficult part of this experience. The foundation of this predicament is the increased calorie and protein requirements that often result from the presence of a tumor as well as from the need for repair of healthy tissues damaged by chemotherapy and radiation therapy. To complicate matters, these cancer treatments can challenge one's normal eating habits because of a variety of potential side effects. Chemotherapy, for example, works by attacking rapidly growing cells. This, unfortunately, targets not only the tumor, but some healthy tissues as well, including the lining of the gastrointestinal (GI) tract. While some of these drugs produce only mild side effects, others can severely impact quality of life. The effects of radiation therapy can be similar to those of chemotherapy, but are usually related to the part of the body that is being treated. Consequently, radiation to the head, neck, chest, and abdomen can induce significant GI distress and a decreased tolerance to many foods.

Following is a list of some of the more common problems experienced during cancer treatment which can influence the ability to eat regularly:

  • Decreased Appetite (Anorexia)
  • Feeling of Fullness (Early Satiety)
  • Nausea and Vomiting
  • Loss of Taste (Taste Blindness), or Taste Distortions (Dysgeusia)
  • Dry Mouth (Xerostomia)
  • Sore Mouth or Throat (Mucositis)
  • Constipation
  • Diarrhea

    During cancer treatment, you may be counseled on a diet that is high in both calories and protein in order to meet the body's increased demands, as well as to maximize the value of a reduced volume of food. Small, frequent, high calorie snacks may be helpful. The table below compares a variety of foods which are relatively high in protein. If you are unable to eat large amounts of foods, choose those which have more calories per serving.

    Foods Supplying Approximately 7 grams of Protein Per Serving

    Food Serving Size Calories
    Meat, Poultry, or Fish 1 oz. 55-100
    Cottage Cheese 1 cup 50
    Cheese 1 oz. 100
    Milk, Yogurt 7 oz. 80-140
    Egg Noodles 1 cup 160
    Legumes 1 cup 80-100
    Peanut Butter 2 Tbs 180-100
    Nuts or Seeds 1-2 oz. 175-200
    Tofu 1 cup 75
    Rice 1 cup 300
    Broccoli 1 cup, cooked 50
    Tempeh 2.5 oz. 120

    Vegetarian Foods for the Non-Vegetarian

    Any of the treatment side effects mentioned can cause a change in food preferences. Your favorite foods may now be less appealing. You may develop an aversion to meat, poultry, fish, sweets, or coffee. Taste distortions often occur so that strongly flavored (or strong smelling), bitter, and sweet foods taste "off." From my experience counseling cancer patients, I have found that red meat is commonly among the first foods to be rejected, as well as coffee and highly acidic foods. This aversion to meat may be due to a heightened sense of bitterness or a metallic taste after the proteins are broken down in the mouth. Poultry may or may not have this effect. Dairy products and eggs are generally better tolerated. Smell sensitivity can also lead to a rejection of meat, fish, and poultry, as the odors produced while cooking can trigger nausea. In these situations, the adoption of vegetarian substitutes for these foods can help make up for potential calorie and protein deficiencies that could result from omission of these foods from your diet.

    Lacto-Ovo Vegetarian Diet

    For the lacto-ovo vegetarian, the choices of nourishing foods are many . Dairy products supply protein and are a good source of calories, as well as calcium, vitamin B12, riboflavin, and vitamin D. It is relatively easy to meet high calorie and protein needs with the use of foods such as milkshakes, cream soups, cheeses, and commercial nutritional supplements. Although these foods may be high in fat, the diet is often recommended only temporarily, and can also be adjusted according to individual fat tolerance. Eggs, egg substitutes, and legumes can be incorporated into the diet as additional protein and calorie sources.

    Lactose intolerance is common in the general population, and even more prevalent in people receiving cancer treatment, even if only temporarily. This is especially true when diarrhea is a problem, as it can temporarily "wash" away the lactase enzyme, thus creating an inability to digest lactose. Fortunately, there are lactose-reduced and lactose-free dairy products available now, as well as lactase tablets and drops. These products may help some people digest milk products without developing abdominal discomfort, excess gas, or diarrhea. However, I have found that there are some people who just cannot tolerate any dairy products, no matter what, and for those with chronic diarrhea, dairy products may only worsen the condition. In these cases, vegan foods can be extremely helpful in filling in dietary gaps.

    Vegan Diet

    Although it probably would be easiest for most non-vegetarians to make the transition to a lacto-ovo vegetarian diet, a vegan diet can be appropriate for the well-informed patient. If a vegan diet is new to you , it should initially include as many familiar foods as possible, with "new" foods to fill in the gaps. The trick is to use products that are quick and simple to prepare, and can be easily exchanged for animal products in familiar dishes. (If you were a vegan before diagnosis of cancer, you should eat more of the most calorie- and protein-rich food s in your diet.)

    My personal opinion is that macrobiotic diets are generally too restrictive for people with cancer, especially during treatment. The more limitations placed on the diet of a person who is experiencing eating difficulties or who may already be malnourished can set the stage for additional problems. If you wish to follow a macrobiotic diet during can cer treatment, you should consult a nutritionist who is familiar with both the diet as well as the specific cancer-related nutritional problems you may face.

    The chart below lists several vegan substitutions for some common dairy products.

    Vegan Food Substitutions

    cow's milk
    fortified soy milk
    butter vegtable oil margarine
    ice cream frozen yogurt,
    soy/rice frozen deserts,
    sour cream soy "sour cream"
    cream cheese soy "cream chees"
    yogurt soy yogurt
    eggs tofu, egg replacer

    Meeting the Special Needs of the Cancer Patient with a Vegan Diet

    Coping with taste changes:

    Nutrient-Dense Snacks:

    Quick and Easy High Calorie Snacks:


    Pizza, Bean Tacos/Burritos
    Milk Shakes
    Ice Cream
    Yogurt, Puddings and Custards
    Cheese and Crackers or Frui
    Creamed Vegetable Soups;
    Dried Fruit, Nuts and Seeds;


    Bean Tacos/Burritos
    Fruit Shakes
    Non-Dairy Frozen Desserts
    Puddings and CustardsSoy Yogurt and Puddings
    Peanut Butter on Crackers or Fruit
    Bean and Chunky Vegetable Soups;
    Dried Fruit, Nuts and Seeds;

    What About Micronutrients?

    Iron, calcium, and vitamin B12 are of particular concern with vegan diets. Following is a list of vegan sources:

    Calcium: Lacto-ovo vegetarians should be able to meet their calcium requirements with approximately three servings of dairy products per day , or combine them with some of the following non-dairy sources: tofu processed with calcium sulfate, soybeans, figs, greens, blackstrap molasses, fortified soy milk or orange juice, almonds, tahini.

    Iron: legumes, blackstrap molasses.

    Vitamin B12: Fortified cereals and soy milk, vitamin supplement.

    A multivitamin/mineral supplement is often recommended for patients undergoing cancer treatment, as you may not be able to eat a variety of foods in sufficient amounts to meet your needs, whether following a vegetarian diet or not.


    Dwyer, J.T., 1991. Nutritional Consequences of Vegetarianism. Ann Rev Nutr Vol. 11, pp. 61-91.

    Dollinger, M., Rosenbaum, E.H., Cable, G. 1994.
    Everyone's Guide to Cancer Therapy, 2nd ed. Kansas City: Andrews and McMeel.

    Pennington, J.A.T. 1994. Food Values of Portions Commonly Used, 16th ed. Philadelphia: J.B. Lippincott.

    Zeman, F.J. 1991. Clinical Nutrition and Dietetics, 2nd ed. New York: Macmillan.

    This article originally appeared in the July/August 1996 issue of the Vegetarian Journal. We encourage you to subscribe to the magazine.

    Thanks to volunteer Jeanie Freeman for converting this article to HTML

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