Q: One thing that people don't realize about cancer is just how hard the treatment makes it to keep weight on. Between chemotherapy and two surgeries, I've lost nearly 10 pounds off of my old 5'11”, 145-pound frame. I would like to put on weight but  I don't know how to put weight on in a healthy manner. What would you recommend?

A: You're right. It is hard, especially since your body and mind are at war against a cancer. And, given the situation at hand, you are caught in an energy drain because the nutrition and calories you're getting are just enough to maintain your current state of function. That's why it is important to meet with your healthcare team, including a registered dietitian. In this way, a well-designed nutritional and activity program will be integrated to suit your body’s abilities and needs.

OK, let’s talk about your caloric requirements. Given that your activity level is currently limited, you would require 13–15 calories per pound just to maintain your 145-lb. baseline weight. This calculates to 1,885–2,175 calories per day. Also, since your body is recovering from illness, your need for calories may be greater than normal. In any case, the best approach is a well-balanced eating plan that includes complex carbohydrates (baked potatoes, fruits, whole grain breads, rice, others), healthy fats (including omega-3 fatty acids) and protein sources (to repair damaged tissues) such as meats, fish and poultry, as well as alternatives such as cheese, beans, eggs, nuts and yogurt. Additionally, a multivitamin may be suggested, but choose wisely (no more than 100% of the recommended dietary allowance) and only after clearance from your doctor (some vitamins and minerals may interfere with your treatment).

That said, I do not know if you have barriers to improved nutrition. For example, both cancer and chemotherapy can suppress your urge to eat. If this is a problem, some higher calorie suggestions include:

• Adding brown sugar, dried fruit or honey to hot oatmeal
• Topping off bananas, crackers, bread or even apples with a tablespoon or two of peanut butter
• Milk or milk shakes, eggnog, yogurt smoothies with protein powder and orange juice
• Adding powdered creamer to sauces, puddings or cream soups
• A scoop of ice cream on top of canned fruit packed in heavy syrup
• Nutritional supplements such as Ensure, Carnation Instant Breakfast or Boost

If the above measures don’t work, there are medications that may stimulate your interest and bring you back to the dinner table. This needs to be discussed with, as well as prescribed by, your personal physician. Potential options include but aren’t limited to Megace (megestrol acetate), steroids such as prednisone or decadron, and Marinol (dronabinol). Even one glass of wine or beer may stimulate appetite, but it is important to first get clearance from your physician.

As you know, appetite can wax and wane, and it’s best to take advantage of your urge to eat while you can. That’s why keeping snacks (cheese, peanut butter crackers, nuts, raisins, apple sauce) at home, in your car, at work or in a bag is very helpful. Other suggestions that may help include:

• Eating frequent (five to six times per day) but small meals
• Eating with friends or family
• Avoiding smells or odors that make you nauseous or take away your appetite
• Increase your physical activity (under the guidance of your physician and physical therapist) to stimulate appetite
• Experiment with foods (those you didn’t used to like may now be more appealing)
• Add spice (not salt) for added flavor

Additionally, the combination of cancer and chemotherapy has the potential to increase your risk for painful mouth ulcers, as well as experience: difficulty in swallowing, an early feeling of fullness (even if eating small amounts of food), loss of taste, nausea, vomiting, diarrhea, depression and lack of interest or the energy to purchase, as well as to prepare, the ingredients that would provide healthier and more nutritious meals. Needless to say, if any of the above is affecting your ability to eat, help is around the corner at the address of your physician and registered dietitian.

Lastly, it is important to speak with your doctor about your lack of energy. This may be due to a host of reasons, including your cancer, chemotherapy, anemia (low blood count), medications