What to Eat When You Don’t Feel Like Eating

Do you find yourself saying, "I know I should eat, but I just don’t want to"? If eating has become another exhausting task on your to-do list, you aren't alone. This episode explores the science behind low appetite (cancer-related anorexia) and practical strategies to stay nourished when food feels like a chore.

In this episode, we discuss:

• Why cancer and cancer treatment turn down your appetite.
• Practical Strategies and Tips and tips to boost intake
• Appetite Stimulants
• And how caregivers can support their loved one without mealtime pressure

Learn why "something is better than nothing" and how to keep yourself fueled even when your body isn't sending the right signals.

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Transcript

SPEAKER_00 0:17

Hello, and welcome back to Cancer Nutrition HQ. I'm your host, oncology dietitian Crystal Zuniga. Now, today we're talking about something that many cancer survivors struggle with during treatment: low appetite. I know I should eat, I just don't want to. I hear this all the time. This can be a new and incredibly frustrating experience. You're used to the body telling you when and what to eat. And then suddenly it's gone. And eating has now become a chore. Because you know you need to eat. Listening to this podcast, you clearly understand the importance of good nutrition. But it can feel like an immense task to eat when nothing sounds good, you're tired, nauseated, or managing other side effects. Food becomes one more thing on the to-do list, and for some, a source of real anxiety. Why is it that something as basic as eating becomes such a monumental struggle during cancer? This episode is going to walk you through why you may lose your appetite and how you can keep yourself nourished when eating is the last thing on your mind. Before we jump into what to do, you know I always like to start with the science to give you a better understanding of what's going on. Because this lack of appetite is not about a lack of effort or that you don't care about your health. There are real physiological changes happening that affect appetite. It's a combination of things, but one of the biggest drivers is inflammation. During cancer and even more so during treatment, the body releases inflammatory signals called cytokines, including IL6 and TNF alpha. These cytokines can travel to the hypothalamus in your brain, which is your hunger thermostat. They essentially signal the switch to off, indicating that you're full even when you haven't eaten anything. Even though your body absolutely needs nutrition, your brain is saying, nope, we're not hungry right now. Now, layer on top of that, nausea, taste changes, fatigue that makes it hard to grocery shop or prepare food, getting full quickly. And if the tumor is in the digestive tract, there can be physical barriers like obstructions or gut motility slowing down, which makes you feel bloated and disinterested in food. And finally, psychological factors like, well, the last time I ate, I felt worse afterward. So now your brain starts to associate food with more discomfort. And when you look at all of that together, it makes complete sense why eating feels so hard. It's not your fault. So give yourself some grace about this challenge. This lack of appetite actually has a clinical diagnosis called cancer-associated anorexia. Sometimes patients freak out when they see this in their chart, but anorexia is just the medical term for loss of appetite, not due to psychiatric conditions. It is not the same thing as the eating disorder anorexia nervosa. So now that you know this low appetite is actually stemming from altered signals in your body, you can start to understand that just waiting for that signal to eat is not a reliable strategy. Those hunger signals just aren't there or they're very muted. So to tackle this, your approach to eating will need to change and you'll need to try some new strategies. But before I get into the strategies, let's set the foundation with a core message. You need to make a significant mindset shift. Lower the bar. The goal is not to eat perfectly, the goal is to eat something. Because what I see happen a lot is people hold themselves to their usual standards of eating, or sometimes an even more perfect way of eating than they ever did. Three meals a day, balanced plates, fresh vegetables at every meal. And when they can't meet that, it feels like a failure. So they eat nothing. But when appetite is low, you need to shift your expectations. Success might look like a few spoonfuls of yogurt, half a sandwich, a smoothie, a handful of crackers. It all counts because something is better than nothing. And this matters because even small amounts of intake help preserve muscle mass, maintain energy, support tolerance to treatment, because now that fuel is coming from food, and less fuel needs to come from your reserves. Now, would it be better to eat the most nutritionally balanced diet, hitting all your fiber, protein, fruit, and veggie goals? Sure. But you can't get there if you are losing weight and struggling with side effects that have worsened because of malnutrition. Something now can help you get to where you want to be with your diet. You're navigating something really difficult. You're not failing if you're not eating perfectly. But there is no perfect way of eating anyway, but I digress. Okay, so you on board now? Agree that something is better than nothing? Great. Now let's get your game plan together. The first strategy is don't wait for hunger. I know this seems odd because it's the complete opposite of what we usually recommend for weight management. Eat when you're hungry, stop when you're full, but this isn't a usual circumstance. During treatment, your body is not sending those hunger cues. So if you wait until you feel hungry, you might be waiting all day. Instead, think of eating more like a schedule or even like the way you take your medications. You don't wait until you feel like taking your medication. You take it because your body needs it. It's a non-negotiable. Same idea here. Set a timer every two to three hours and aim to have something even if it's small, like a few bites, a sip of a smoothie, a small snack. Those small moments of intake add up over the course of the day. So instead of asking, am I hungry, ask, when is the next time I'm supposed to eat? The next strategy is to think small. When appetite is low, the idea of large meals can feel overwhelming before you even start to take that first bite. You look at a full plate and think, there's no way I'm going to eat all of that. And that alone can just shut things down. Or even if you do eat some, the plate looks like you haven't touched it and you feel disappointed in yourself. So instead, we want to make eating feel approachable and successful. So that could mean using smaller plates, serving yourself less food. Thinking in terms of snacks instead of meals. A protein, carb, and veggie don't have to be at every single meal. You can have a protein and a carb in one snack and maybe veggies and fruit in another a couple hours later. Smaller, more frequent eating can improve overall intake. Because while a full plate can feel like a mountain, a snack can feel more manageable. So make it easier to say yes to eating and to feeling successful when you do get a few bites in. The next strategy is to reduce the effort required to eat. Maybe you actually do have a little bit of an appetite, but you're too exhausted to make food, so you talk yourself out of it. Eh, I'm not that hungry. Because even if you want to eat, you might not have the energy to cook, prep, clean, or even decide what to eat. That alone takes brain power. So to reduce effort, use frozen meals, grocery store ready-made options, easy snacks like yogurt, peanut butter and crackers, trail mix, snack bars. Because if it takes too much effort to eat, it's probably not going to happen. Which leads me into strategy four: drink your nutrition. Liquids are often easier to tolerate and require less effort to prepare. Things like smoothies, milk or plant-based milks, soups, or oral nutrition supplements like insure our boost. Now, these are not my first choice, but not because they're bad, but because I know patients can often do better. I just find that patients often get sick of them quickly and they can have off flavors because they have so many vitamins and minerals added. And through some good strategies, you can actually pack in more calories and nutrition with whole foods through homemade smoothies. But ready-to-drink smoothies or oral nutrition supplements can work for on the go. Liquids are also a good option because they empty from the stomach quicker than solids. So you may find yourself hungry again sooner, which is definitely a win. The next strategy is to modify your environment. Now we're getting into a little psychology to help you out. The joy of eating can be taken when things you used to love to eat you now can't tolerate or they just taste weird. Or maybe you loved dining out, and that social activity and eating in fun new environments is less frequent. So this strategy is meant to bring some joy back into your eating. Eating with someone, someone you like, key thing there, even if they aren't eating, that having company is a helpful distraction. Have a pleasurable eating environment. See if you can keep at least a corner of that kitchen table clean for you to eat. Maybe have some fresh flowers or a pretty centerpiece, setting the table to have a nice meal. Make your meal look nice, even if it's a snack. Put it on a nice plate. Pour your smoothie into a cocktail glass and add a little fresh fruit garnish or a dollop of whipped cream. Bring out that nice dinnerware you only use on a special occasion. This is a special occasion. Look bougie. Why not? That environment can make eating feel less like a task and more like an enjoyable experience. Hey friends, I really appreciate you listening to my podcast. If you're enjoying it, could you do me a favor? Could you leave me a review or share your favorite episode with someone you think could benefit? A friend, a family member, or maybe your support group. I want this information to reach more people, and word of mouth is the best way to share. Let's drown out that misinformation by sharing the science. Now, back to the podcast. So those are just a few tips, and I don't want to overwhelm you, but just pick one that you will try this week. Take action with the information that you're learning. Now I'm not a doctor or pharmacist, but I do want to touch on the topic of appetite stimulants because this topic comes up a lot. There are some options available, and they each come with their own side effects and different levels of evidence on their efficacy. A choice to use an appetite stimulant is best discussed with your provider. I'm just going to briefly review a few of the options that are available. Megastrol acetate, the brand name is Megase, is a progesterone analog that is still used, but it carries a high risk of blood clots. Corticosteroids like dexamethasone give a quick boost of energy and appetite, but they can have other side effects when used long term, so they aren't typically prescribed for long-term use. I also get a lot of people ask about medical marijuana. Now, depending on where you live, you may have access to this tool. Is it actually the miracle for the munchies that people say it is? Well, very simply, THC can bind to a receptor in the brain, triggering the release of a hormone that can increase appetite. Through inhalation, that effect can kick in pretty quickly. I hear from patients some mixed reviews, and even the research shows that waking with cannabis is still mixed. Now, it's not my expertise, so I'm gonna leave it there, but I am adding this to my list to find an expert who can better discuss this with us. Now, if someone doesn't want to smoke or deal with dispensaries, dronabinol, and the name brand in the US is Marinol, is a synthetic FDA-approved version of THC. It's a pill, legal, and can be picked up at a pharmacy with a prescription. Now, with all of these appetite stimulant options, the main thing I want to hit home is that increasing appetite is not enough to prevent weight loss or malnutrition. If the reason you're not eating is nausea, fatigue, taste changes, increasing appetite alone isn't going to solve those problems. You'll be hungry, but you're still too tired to make anything, or you won't eat because everything tastes gross. So what we want to do first is make sure that things like nausea are being managed, pain is controlled, fatigue is addressed as much as possible. And if you are able to eat more, nutritional guidance can help you make the most nutritious choices and get the most bang for your bite. A dietitian can help you find strategies to get the most calories, protein, and essential nutrients through less volume of food. So stimulants are just one tool in addressing low appetite, they should not be looked at as a single solution. And finally, I want to share some tips for caregivers that are listening. It's so hard to watch a loved one not eat. But stop the conflict around the table. If you push too hard, you may create a psychological aversion to food, and both of you end up stressed and upset at each other. Nobody wins. So what's the best way to support them? Let them join the table for the social connection, even if they only have a few sips of a shake. Don't pressure them to eat more. When they want to eat, maybe sit next to them to keep some positive company. Help reduce some of their cognitive burden instead of asking, what do you want to eat? Because the answer is likely nothing or I don't know. Try offering just a couple of simple choices. Hey, it's time for a snack. Do you want yogurt or a smoothie? Do you want soup or a sandwich? Or just make a little extra of what you made for yourself and offer it. Hey, I'm gonna eat this for lunch. I made a little extra for you if you want to try, but no pressure if you don't want it. And that's the key. Lay off the pressure. Don't turn eating into a battle. The goal is to reduce stress, not add to it. So to recap, don't wait for hunger, think small and frequent meals, reduce effort in the kitchen, use liquid nutrition options, create a positive eating environment, manage symptoms that are interfering with your appetite, and know that there are potential medications that can be a tool too. But most importantly, remember, every bite and every sip counts. Something is better than nothing. So even if the biology is stacked against you, you have multiple tools in your toolbox to stay nourished. If this episode was helpful, share it with someone who's going through treatment or supporting someone who is. Thank you for listening and remember to eat your fruits and veggies.