Nutrition during treatment

The two simple goals

During cancer treatment, nutrition has two main jobs: preserve your weight and muscle, and support your body's recovery between treatment cycles. Everything else — the latest superfood, the fashionable detox, the diet your neighbour swears by — is secondary. Most patients who lose significant weight or muscle during treatment have harder side effects, more dose reductions, and slower recovery. Most patients who eat reasonably well do better.

"Forget the magic foods. The patients who do best are the ones who eat enough protein, drink enough water, and don't lose weight. That is the entire prescription, and it sounds boring because it works."

Protein matters more than ever

Protein is the raw material your body uses to repair tissue, rebuild blood cells, and maintain muscle. During treatment, your protein requirement is higher than usual — roughly 1.2 to 1.5 grams per kilogram of body weight per day for most patients. For a 60 kg adult, that is around 75 to 90 grams of protein per day.

Hydration

Aim for two to two and a half litres of fluid per day — more if you have fever, vomiting or diarrhoea. Plain water is the foundation, but variety helps: lemon water, weak tea, lassi, fresh fruit juice (diluted), milk, soups, and electrolyte drinks (ORS). Avoid heavy reliance on sugary fizzy drinks.

If you are receiving chemotherapy that can affect the kidneys (cisplatin and a few others), good hydration the day before, the day of, and the day after treatment is particularly important. We'll tell you specifically.

Food safety when blood counts are low

Between days seven and fourteen of a chemotherapy cycle, your white blood cell count is often at its lowest. During this window, your defence against food-borne infection is reduced, and a little extra care matters.

• Avoid raw or undercooked meat, fish, eggs and seafood. No kebabs that are pink in the middle, no soft-boiled eggs, no sushi, no raw oysters.
• Avoid unpasteurised dairy products. Stick to packaged milk (Olper's, Nestlé, Haleeb, Dayfresh — all pasteurised) and packaged yoghurt. Avoid raw milk, lassi made from raw milk, and traditional unpasteurised paneer.
• Wash all fruits and vegetables thoroughly in clean water. Peel fruits where possible. Be cautious with leafy salads from outside.
• Avoid street food and roadside chaat during the nadir week. The risk of food poisoning is too high.
• Eat food fresh. Don't eat leftovers more than 24 hours old, especially in summer. Reheat thoroughly.
• Avoid buffets and food that has been sitting out. Order freshly cooked dishes when you eat at restaurants.
• Be cautious with cut fruit sold outside — it is often a source of infection in our climate.
• Avoid unpasteurised honey, unpasteurised juices, and raw sprouts.
• Wash your hands — and have whoever cooks for you wash theirs — before food preparation and eating.

When nothing tastes good

Taste changes are one of the most common — and frustrating — side effects. Food may taste metallic, bland, too sweet, too salty, or simply "off". This usually improves within a few weeks of finishing treatment.

• Experiment. The foods you used to love may not appeal; foods you didn't care about may suddenly taste fine. Don't force what isn't working.
• Cold or room-temperature foods have less smell and often taste better than hot ones.
• Sour and tangy flavours often work well — lemon, tamarind, yoghurt, pickled vegetables (if your mouth is not sore).
• Marinate meats well — yoghurt-based marinades, lemon, ginger and garlic improve taste.
• Avoid your favourite dishes during chemotherapy weeks. If pulao becomes associated with nausea, you may not enjoy it again for a long time. Save the dishes you love for the good weeks.
• If meat tastes metallic, switch to eggs, daal, paneer, milk-based dishes, fish, or chicken (which often tolerates better than red meat).
• Use plastic cutlery if metal cutlery worsens the metallic taste.
• Rinse your mouth before meals with a mild saline rinse — half a teaspoon of salt and baking soda in a glass of water — to freshen the palate.

Weight management — both directions

Most patients worry about losing weight during treatment, and many do. But some patients — particularly those on steroids, hormone therapy, or certain chemotherapy regimens — actually gain weight. Both are worth paying attention to.

Common myths and honest answers

"Sugar feeds cancer"

This claim is widespread and largely untrue. All cells in your body use glucose (sugar) for energy, including cancer cells, but also healthy cells, your brain, your immune system. Cutting sugar out completely does not "starve" cancer; it simply causes weight loss, which during treatment is harmful. That said, an excessive sugar diet — sweets, biscuits, mithai, sugary drinks every day — is bad for general health and contributes to obesity and diabetes, which affect cancer outcomes. The honest answer: moderate sugar intake (sweets occasionally, not several times a day) is fine. Don't fear fruit. Focus on the whole pattern of eating, not on one ingredient.

"Antioxidant supplements help cancer treatment"

The opposite may be true during active treatment. Many chemotherapy drugs and radiation work partly through oxidative stress on cancer cells. High doses of antioxidant supplements (vitamin C, vitamin E, beta-carotene, selenium in large doses) may interfere with this and reduce the effect of treatment. We recommend avoiding high-dose antioxidant supplements during chemotherapy and radiation unless we specifically prescribe them. Antioxidants from food (fruits, vegetables, spices) in normal amounts are fine — encouraged, in fact.

"Turmeric (haldi) cures cancer"

Curcumin (the active compound in turmeric) has been studied extensively in laboratory and animal models, where it shows interesting anti-cancer activity. In humans, the evidence is much weaker — partly because curcumin is poorly absorbed when eaten. Turmeric in normal dietary amounts (as you use in salan, daal, and other dishes) is healthy and harmless. High-dose curcumin supplements during chemotherapy are not recommended — they can interfere with some chemotherapy drugs and increase bleeding risk.

"Green tea prevents recurrence"

Green tea contains polyphenols that have shown anti-cancer activity in laboratory studies. In humans, drinking green tea as a beverage (one to three cups a day) is harmless and may have a modest benefit for general health. Concentrated green tea extract supplements, on the other hand, can cause liver injury at high doses and may interact with certain chemotherapy drugs — avoid these.

"Cancer patients should avoid all dairy / all wheat / all meat"

There is no scientific basis for blanket elimination diets during cancer treatment. Restrictive diets usually cause weight loss and reduced protein intake, both of which are harmful. Unless you have a specific medical reason (lactose intolerance, coeliac disease, religious preference), eat a normal balanced diet.

"Alkaline diets and lemon water cure cancer"

Your body tightly regulates its blood pH — what you eat does not change it. Lemon water is a pleasant, hydrating drink; it has no special anti-cancer effect, and the underlying claim about "alkaline" diets has been thoroughly disproved. By all means drink lemon water if you enjoy it, but do not skip your treatment in favour of it.

"Hakim or homeopathic medicines are safe because they're natural"

"Natural" is not the same as "safe". Several traditional remedies sold for cancer in Pakistan contain unlisted ingredients — sometimes heavy metals, sometimes steroids, sometimes drugs that interact dangerously with chemotherapy. Please tell us about any herbal or alternative medicine you are taking or considering. We will not judge you; we just need to know to keep you safe.

Local Pakistani diet — what works well

The traditional Pakistani diet — when balanced — is well-suited to cancer treatment.

• Daal-roti-sabzi with a small portion of meat or yoghurt is a balanced, protein-containing meal.
• Khichdi (rice and daal cooked together) is gentle, easy to digest, and high in protein — excellent on bad-appetite days.
• Chicken yakhni (broth) is hydrating, nourishing, and easy to tolerate.
• Dahi with every meal — pasteurised — supports gut health and is easy to digest.
• Boiled eggs, omelettes, anda paratha (with controlled oil) make a high-protein breakfast.
• Halwa, kheer, custard, firni are useful calorie-dense options when appetite is poor.
• Fresh seasonal fruit — washed and peeled where possible — provides vitamins and fibre.

Avoid heavy oily food, deep-fried snacks (pakoras, samosas), excessive chillies on treatment days, and street food during the nadir week.

Ramadan and fasting

Fasting during active cancer treatment is generally not recommended — it interferes with hydration, medication schedules, and energy reserves. Islam provides a clear exemption for illness, and accepting this exemption is the right and religiously permissible choice for most patients undergoing chemotherapy. If fasting is very important to you, please discuss it with us in advance — for some patients on stable hormone therapy or in long-term follow-up, fasting may be reasonable. We will work through it honestly with you.

Should I see a dietitian?

Some patients benefit from formal nutrition counselling — particularly those who are losing significant weight, those with head-and-neck cancers, those struggling to eat after surgery, or those with multiple food restrictions. We can refer you. For most patients, the principles on this page, combined with conversations during your visits, are enough.