Selecting Menus for Vegan Cancer Patients

A vegetarian diet can be safe for anyone undergoing cancer treatment; however, working with a registered dietitian to develop the right meal plan for you is recommended. We hope the information in this article will help in the planning of a vegetarian diet that meets the special nutritional needs of patients with cancer.

Challenges of Feeding Cancer Patients

A diagnosis of cancer and subsequent treatment can result in irregular food and fluid intake, weight loss, and nutritional deficiencies. There is frequently an increased need for calories and protein while there is usually a decreased appetite.

Side Effects That Cancer Patients Experience

  • Dry mouth
  • Sore throat
  • Open, sore areas in the mouth and/or throat
  • Loss or change of taste perception
  • Nausea with or without vomiting
  • Decreased appetite
  • Constipation or diarrhea
  • Feeling of fullness after eating or drinking very small portions

Chemotherapy, for example, works by killing or disabling cancer cells. Unfortunately, this 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 pack a wallop. The effects of radiation therapy can be similar to those of chemotherapy, but these are usually related to the part of the body that is being treated. This means that radiation to the head, neck, chest, and abdomen can result in a lot of GI distress.

One of the most important aspects of food preparation for cancer patients is to recognize that we need to be hyper-attentive to the patients' requests. Food preferences can change from meal to meal, as can the ability to chew or swallow. The patient should have access to the type and amount of food and fluid desired as often as desired.

If the patient is in a clinical setting, such as a hospital, there should be a system in place to communicate with the patient several times a day. Perhaps a small pantry on the patient's floor can be stocked with small portions of perishable foods and fluids that the patient has indicated that he or she can tolerate. If possible, non-perishable bedside snacks should be available at all times.

It is not unusual for a patient undergoing chemotherapy or radiation therapy to experience the following:

  • Only be able to tolerate uncooked foods. Taste abilities can be heightened, and what may be bland to other patients may have an overpowering taste for cancer patients. Cooking increases flavor, so uncooked foods may be better tolerated.
  • Only be able to tolerate hot foods or cold foods. This may be caused by physical discomfort from a sore throat or a sore mouth or may be due to heightened taste abilities.
  • Desire totally bland foods or highly spiced foods.
  • Want to eat one type of food, such as a banana smoothie or applesauce, for several meals in a row.
  • Feel more comfortable eating multiple small meals.

With this in mind, remember that we need to offer high-protein, high-calorie foods in a form that can be tolerated. Below are some tips for helping to meet the needs of a vegetarian cancer patient:

To Accommodate Temperature Tolerances

  • Prepare ingredients separately so they can be steamed, grilled, or stir-fried or served chilled, as the patient would like.
  • For example, carrots, mushrooms, celery, and onions can be thinly sliced; spinach and cabbage can be thinly shredded; and tofu can be cubed. Flavorings such as chopped nuts, nutritional yeast, fresh or dried herbs, salsa, vegan sour cream, shredded vegan cheese, or soy sauce can be offered. This combination can be quickly cooked, if the patient favors a hot meal, or tossed and served cold.

To Accommodate Taste Changes

  • If there is a heightened sense of taste, mild flavors and smooth textures, such as silken tofu flavored with a small amount of orange juice concentrate or maple syrup or with a very small amount of nutritional yeast, might work well.
  • If there is a decreased sense of taste - sometimes called 'taste blindness' - then extra firm or firm tofu or tempeh marinated in Italian dressing with additional oregano and basil might work well.

If the patient is uncertain as to what might taste good, you might steam firm tofu cubes and offer condiments, such as chutneys, salsa, maple syrup, orange juice concentrate, mustard, nutritional yeast, and powdered dried herbs in salt shakers so the patient can experiment.

To Accommodate Patients with Sore Throats or Tender Mouths

  • Avoid 'sharp' foods, such as crispy noodles, nuts, or croutons. These can irritate a sore mouth or throat.
  • Don't serve acidy foods, such as those that are tomato- or citrus-based or prepared with vinegar.
  • Pass on overtly salty foods, as salt can irritate a sore mouth or throat.
  • Avoid 'hot' foods, such as those made with fresh or dried chilies and white or black pepper.
  • Offer cool, not cold, green or herbal teas; very mild ginger tea; or peach, pear, mango, or apricot nectars, possibly diluted with sparkling water.
  • Cut up very ripe fresh fruit, such as pears, bananas, peaches, apricots, or mangos.
  • Serve sorbets topped with mashed bananas, peaches, apricots, or mangos.
  • Offer sweet or savory firm silken tofu.
  • Dole out warm - not hot - broths, such as miso or mushroom broth.
  • Try mashed potatoes seasoned with broth or soymilk, vegan margarine, nutritional yeast, and dried parsley.
  • Purée mild fruit, combine with soy yogurt, and freeze in individual cups to be eaten like a popsicle or as a frozen dessert.

Laurel's Kitchen Caring

Laurel's Kitchen Caring is a wonderful book for vegetarian caregiving. The recipes are generally written for 2-3 portions, but they can be extended for quantity preparation. Many of the recipes contain eggs or dairy, but they can be easily 'translated' into vegan recipes.


Cooking Tips to Increase Calories and Protein

  • Add nutritional yeast to smoothies, hot cereals, soups, salad dressings, and baking mixes (such as muffins).
  • Purée! For example, purée cooked beans and stir into vegetable soup for additional nutrition; purée cooked veggies, such as green beans, and stir into salad dressing; or purée fruit and add to yogurt.
  • There are vegan pudding mixes that require only water. Instead of water, use soy, rice, or almond milk. Top with puré ed fruit.
  • Don't serve anything plain. For instance, add a spritz of fruit juice to ice water or iced tea, top cereal with fruit, add a dollop of vegan sour cream to top soups, serve cake or muffins with applesauce or frozen vegan ice cream, etc. Even if a small amount is eaten, every calorie or gram of protein counts.
  • If baking, blackstrap molasses is a source for iron.
  • Avocados are creamy and high in 'good' calories and nutrients; try to include them as tolerated. On days when intake is not going to be too large, a combination of silken tofu and avocado can pack a lot of nutrition into a small amount of food.

Here are some ideas for nutrient-dense foods that can be offered as snacks or combined to form small meals:

  • Smoothies: Remember to pack nutrition into every ounce. Add apple juice concentrate, applesauce, or sorbet to a base of soy or almond milk and soft silken tofu, and if tolerated, add ripe bananas or nutritional yeast to smoothies as well. The smoothie can be a small snack, made into a frozen dessert, or served as a sauce for vegan pound cake or cupcakes.
  • Hummus: Nutritional yeast can be added to hummus, as can vegan sour cream. Use hummus as a dip, a salad dressing, or a sauce for baked tofu or seitan.
  • If tolerated, granola mixes can contain dried fruit, nuts, and coconut for extra calories and protein.
  • Bagels: Select bagels with add-ins, such as raisins. Top with vegan cream cheese that has had chopped dried or frozen fruit or chopped fresh vegetables added to it. Peanut butter can be 'enhanced' with chopped dried fruit or additional chopped nuts, if tolerated.
  • Frozen vegan desserts, such as Tofutti, can be 'enhanced' with shredded coconut, carob chips, and chopped dried fruit.
  • Fruit nectars, such as peach, apricot, pear, or mango, can be served at room temperature, over ice, or frozen as a snack, depending on patient preference.
  • Coconut milk or macaroons with lots of coconut add some calories and fat.
  • Vegetable soups: If chewing is an issue, purée vegetable, bean, and pasta soup. For additional calories, replace part of the water with silken tofu and cooked beans that have been puréed together. Use nutritional yeast as a seasoning for additional protein and vitamins.
  • Soy yogurt: Serve with chopped fresh or dried fruit, or purée fruit with yogurt. Serve as a snack or freeze for a frozen dessert.
  • Nut butters: Peanut, soy, sunflower, or hazelnut butters can add extra protein and nutrients to frozen desserts, baked goods, or toast.
  • 'Stealth' nutrition: Add nutritional yeast, maple syrup, apple juice concentrate, or silken tofu to cooked hot cereal. Cook rice or pasta with broth, rather than with water. Mashed potatoes or puréed winter squash can be 'ramped up' with margarine, vegan sour cream, nutritional yeast, or soymilk. Fortified cereals or mashed potato mix can be used as 'secret' ingredients in lentil loaves, cornbread, and bean soups.

Almond Latte

(Serves 1)

  • 1 cup brewed coffee
  • 2/3 cup almond milk (or soymilk with ¼ teaspoon almond extract)
  • 1 Tablespoon sugar (Use your favorite vegan variety.)
  • ½ teaspoon almond extract
  • 1 teaspoon maple syrup
  • 1 teaspoon chopped almonds, if desired

Combine coffee, milk, sugar, almond extract, and syrup and mix together. For a hot beverage, either heat in the microwave or on the stove. For a cold beverage, pour over ice or freeze for an almond-coffee slush. Top with almonds, if desired.

Total calories per serving: 112 Fat: 2 grams
Carbohydrates: 23 grams Protein: 1 gram
Sodium: 105 milligrams Fiber: < 1

Chocolate Plus Smoothie

(Serves 1)

  • 2 Tablespoons unflavored soy yogurt or silken tofu
  • 1 cup soy or almond milk
  • 1 Tablespoon maple syrup
  • 2 Tablespoons unsweetened cocoa powder
  • ½ slice whole wheat bread
  • 3 ice cubes

Place all ingredients in the canister of a blender. Blend on high for 15 seconds or until mixture is slushy. Drink right away or place in freezer until ready to drink.

Note: This breakfast drink will start 'falling apart' after approximately 10 minutes and will need to be stirred or blended again before serving.

Total calories per serving: 204 Fat: 7 grams
Carbohydrates: 32 grams Protein: 11 grams
Sodium: 102 milligrams Fiber: 7 grams

Bean and Pasta Soup

(Serves 10)

  • 4 Tablespoons olive oil
  • ½ cup chopped vegan bacon
  • 1 cup chopped onions
  • ½ cup chopped celery
  • 1 clove garlic, minced
  • 1 Tablespoon red pepper flakes (optional)
  • 1 Tablespoon dried sage
  • 4 cups mushroom broth
  • 2 pounds (approximately 5 cups) chopped canned tomatoes, not drained
  • 1 pound (approximately 2½ cups) cooked white beans
  • 10 ounces (approximately 1 small box) uncooked pasta

In a medium stockpot, heat oil and sauté bacon for 5 minutes to soften. Add onions and celery and cook until vegetables are soft. Add garlic, red pepper flakes, and sage and cook for 1 minute.

Add broth, tomatoes, and beans. Bring to a boil over high heat. Break pasta into small pieces as you add it to the stock and reduce heat to medium. Cook uncovered for 10 minutes or until pasta is al dente (just tender). If desired, continue to cook the soup awhile longer, but don't let the pasta absorb all of the liquid.

Note: This soup can be puréed.

Total calories per serving: 253 Fat: 7 grams
Carbohydrates: 39 grams Protein: 10 grams
Sodium: 463 milligrams Fiber: 2 grams

Vegan Meal Replacements

At this time, there are not many vegan meal replacements. Ensure™ and Sustacal™, two popular liquid supplements, contain dairy protein. Nephro™ is eggand dairy-free but does contain sugar. Also, Nephro™ is a product designed for patients with kidney disease, so it is not particularly high in protein.

We have found two products that caregivers have been using occasionally for preparing meals for vegetarian cancer patients. The labels should be shown to the patient's health care professional before using so he or she can ascertain if it is appropriate and the amounts to be used:

  • Vegan Essentials (www.veganessentials.com) sells several vegan protein- and nutrient-rich powders, based on quinoa and brown rice; some are gluten-free and some contain organic ingredients.
  • Vega Complete Meal Replacement is a powder that was formulated by a vegan triathlete. This product is available from online retailers, such as www.pureprescriptions.com.

Carrot Mushroom Soup

(Serves 20)

This hearty soup is almost a meal in itself. It can be partially or totally puréed for a smoother texture. Make a batch and freeze in single portions.

  • Vegetable oil spray
  • 1 pound (approximately 2 cups) vegan ground round or vegan soy crumbles
  • 2 cups diced celery
  • 2 cups diced onions
  • 3 cups diced fresh mushrooms
  • 1 gallon (approximately 8 cups) vegetable stock
  • 2 bay leaves
  • 1 cup thawed frozen diced carrots
  • 10 ounces (approximately 1¼ cups) uncooked pearl barley

Spray a medium pot with oil and brown ground round. Add celery, onions, and mushrooms and sauté until vegetables are soft, approximately 3 minutes. Add remaining ingredients. Bring to a fast boil, lower heat, cover, and allow soup to simmer until barley is soft and desired texture is achieved, approximately 45 minutes.

Total calories per serving: 105 Fat: 1 gram
Carbohydrates: 19 grams Protein: 7 grams
Sodium: 369 milligrams Fiber: 5 grams

Savory Sweet Potato Soup

(Serves 20)

  • 1 cup chopped celery
  • 1 cup chopped onions
  • ¾ cup chopped carrots
  • 2 cloves minced garlic
  • 1 gallon (approximately 8 cups) vegetable stock, divided
  • 3 pounds (approximately 7 cups) fresh sweet potatoes, peeled and diced
  • 1 Tablespoon ground cinnamon
  • 1 teaspoon ground nutmeg
  • 1 teaspoon ground ginger
  • 2 Tablespoons maple syrup
  • 1 cup silken tofu

Place celery, onions, carrots, and garlic in a large pot with a small amount of the stock. Sauté until vegetables are soft, approximately 2 minutes. Add the rest of the stock, sweet potatoes, and spices. Simmer, covered, until potatoes are very soft, approximately 45 minutes.

In batches, place soup in a blender or food processor and purée until smooth. Return to stove, add syrup and tofu, stir, and remove from heat.

Total calories per serving: 104 Fat: 1 gram
Carbohydrates: 21 grams Protein: 2 grams
Sodium: 250 milligrams Fiber: 3 grams

Pumpkin Soup

(Makes twelve 4-ounce servings)

The pumpkin gives this recipe a 'creamy' appearance and taste.

  • 3 cups canned pumpkin (not sweetened or spiced) or stewed and puréed fresh pumpkin
  • 2 cups vegetable stock
  • 1 Tablespoon nonhydrogenated vegan margarine
  • 1 Tablespoon flour
  • 1 Tablespoon vegan brown sugar
  • 1 teaspoon black pepper
  • ½ teaspoon lemon zest

Combine pumpkin and stock together in a medium pot and allow mixture to simmer. Combine margarine and flour to make a roux (thickening agent). Slowly beat the roux into the pumpkin, stirring until smooth. Add sugar, pepper, and zest. Stir and allow soup to simmer until heated.

Total calories per serving: 39 Fat: 1 gram
Carbohydrates: 7 grams Protein: 1 gram
Sodium: 110 milligrams Fiber: 2 grams

Pumpkin Bread

(Makes two 8-inch loaves or twenty-four 2-Tablespoon muffins)

Pumpkin has lots of fiber and nutrients and adds a pleasant texture to many foods.

This pumpkin bread is just sweet enough to serve toasted for breakfast or for dessert, yet it is savory enough to serve at lunch or dinner.

  • Vegetable oil spray
  • 3 cups unbleached flour
  • ½ teaspoon baking powder
  • 1 teaspoon baking soda
  • 1 teaspoon cinnamon
  • 1 teaspoon nutmeg
  • 1 teaspoon cloves
  • 1 teaspoon ginger
  • 2 cups sugar (Use your favorite vegan variety.)
  • 1 cup brown sugar (Use your favorite vegan variety.)
  • ¾ cup oil or mashed bananas
  • ½ cup soft tofu
  • 2 cups canned pumpkin (not sweetened or spiced) or 2 cups stewed and puréed fresh pumpkin
  • 1 cup raisins
  • ½ cup chopped walnuts (optional)

Preheat oven to 350 degrees. Spray two small loaf pans or place insert paper into 24 muffin cups.

Sift together flour, baking powder, baking soda, and spices. In a mixer bowl, mix together sugars, oil or bananas, and tofu. Add pumpkin and mix well. Mixing on slow speed, gradually add flour and mix until well combined. Add in raisins and nuts.

Pour into prepared pans. Bake for 45 minutes or until a knife inserted in the center comes out clean. Allow to cool completely before removing from pan.

Total calories per serving: 229 Fat: 7 grams
Carbohydrates: 40 grams Protein: 2 grams
Sodium: 65 milligrams Fiber: 1 gram

Pumpkin Cookies

(Makes approximately 48 cookies)

These unique cookies are great any time but particularly in autumn.

  • Vegetable oil spray
  • 1 cup nonhydrogenated vegan margarine
  • 1 cup sugar (Use your favorite vegan variety.)
  • 1 cup canned or cooked pumpkin
  • 3 Tablespoons mashed banana
  • 1 teaspoon vanilla extract
  • 2 cups unbleached flour
  • 1 teaspoon baking powder
  • 1 teaspoon cinnamon
  • 1 teaspoon ground ginger
  • ½ teaspoon cloves
  • ½ teaspoon allspice
  • ½ cup chopped raisins
  • ½ cup chopped dates

Preheat oven to 375 degrees. Spray a baking sheet with oil.

In a large bowl, combine margarine and sugar until well mixed. Add pumpkin, banana, and vanilla and stir to combine.

In a separate bowl, mix together the flour, baking powder, and spices. Add to pumpkin mixture and stir. Mix in raisins and dates. Drop by teaspoonfuls onto the baking sheet. Bake cookies for 15 minutes or until just crisp on the edges.

Note: Do not overbake these cookies, as they can be rather dry. These go well with hot or cold tea, milk, or coffee. The cookies can also be crumbled over cooked hot cereal.

Total calories per serving: 80 Fat: 4 grams
Carbohydrates: 11 grams Protein: 1 gram
Sodium: 48 milligrams Fiber: < 1 gram

Eggless Pumpkin Custard

(Serves 8)

  • 2 cups canned pumpkin (not spiced or sweetened)
  • 1½ cups silken tofu
  • 1 cup soy or almond milk
  • 4 Tablespoons sugar (Use your favorite vegan variety.)
  • 1 Tablespoon maple syrup
  • 2 teaspoons cinnamon
  • 1 teaspoon cloves
  • 1 teaspoon nutmeg
  • ½ teaspoon orange zest

Preheat oven to 375 degrees.

Combine pumpkin, tofu, and milk in a blender or food processor and blend until smooth. Add remaining ingredients and mix well to combine.

Pour into individual custard cups or a baking dish and bake for 20 minutes or until custard is set.

Total calories per serving: 74 Fat: 1 gram
Carbohydrates 14 grams: Protein: 3 grams
Sodium: 8 milligrams Fiber: 2 grams

Orange Swirl

(Serves 1)

The combination of milk, sorbet, and vegan ice cream gives this dessert its amazing creamy texture.

  • ¾ cup almond milk (or soymilk with 1/4 teaspoon almond extract)
  • ½ cup orange sorbet
  • ¼ cup vanilla vegan ice cream
  • 1 Tablespoon orange juice concentrate
  • ¼ cup canned mandarin orange segments, drained

Place milk, sorbet, ice cream, and juice concentrate into a blender. Blend on high until smooth. Pour mixture over ice and serve, or freeze for an orange slush. Garnish with mandarin oranges.

Variation: This can be made with lemon sorbet and lemonade or with lime sorbet and limeade.

Total calories per serving: 296 Fat: 8 grams
Carbohydrates: 52 grams Protein: 3 grams
Sodium: 189 milligrams Fiber: 1 gram

Fruit Salad with Avocado Dessert Salsa

(Serves 6-8)

Salsa

  • 1 cup peeled and chopped ripe avocado
  • ½ cup plain soy yogurt
  • 3 Tablespoons apple juice
  • ½ cup drained, crushed canned pineapple or canned apricots

Combine all ingredients in a medium, non-reactive bowl and toss. Allow to chill.

Salad

  • Romaine or red leaf lettuce for underliner
  • 1 cup mashed bananas
  • 3 Tablespoons peach nectar
  • 1 cup diced ripe mango
  • 1 cup diced ripe papaya

To prepare salad, first line serving platter or individual plates with lettuce. Combine bananas with peach nectar and then arrange banana mixture in single layer on top of lettuce. Arrange mangos and papayas on top of bananas. Right before serving, top with avocado salsa. Serve immediately.

Total calories per serving: 131 Fat: 4 grams
Carbohydrates: 24 grams Protein: 2 grams
Sodium: 5 milligrams Fiber: 4 grams

Cold Tropical Fruit Sauce

(Serves 3)

  • 1/3 cup chilled mango nectar
  • ¼ cup chopped thawed frozen strawberries or peaches
  • 2 Tablespoons mashed banana

Blend all ingredients and chill before serving.

Total calories per serving: 27 Fat: < 1 gram
Carbohydrates: 7 grams Protein: < 1 gram
Sodium: 2 milligrams Fiber: 1 gram

Blueberry Sauce

(Makes 1 pint or seventeen 2-Tablespoon servings)

  • 1½ cups frozen blueberries
  • 2 Tablespoons cane or rice syrup
  • 2 Tablespoons apple juice
  • 2 Tablespoons soft silken tofu

Blend all ingredients together in a blender or food processor. Chill before serving.

Total calories per serving: 18 Fat: < 1 gram
Carbohydrates: 4 grams Protein: < 1 gram
Sodium: 5 milligrams Fiber: < 1 gram

For more ideas, see "Texture Alterations for Vegans," also by Nancy Berkoff, in Issue 2, 2009, of Vegetarian Journal. This article is available online at www. vrg.org/journal/vj2009issue2/texture.htm.

Note: This article is not intended to provide medical advice. Medical advice should be obtained from a qualified health professional.