Managing Fatigue, Anemia, and GI CLL Side Effects with Nutrition

Registered dietitian Stephanie Wiese from the Colorado Blood Cancer Institute shared ways patients can use nutrition to manage common cancer-related side effects such as nausea, diarrhea, constipation, fatigue, and anemia. 

Chronic lymphocytic leukemia (CLL) patients may experience these side effects as a result of their disease, its treatment, or emotional stress. Read Stephanie’s tips below about how nutrition may help you manage nausea, gastrointestinal (GI) side effects, fatigue, and anemia. 

4 Ways to Manage Nausea and Vomiting with Nutrition 

        1. Take Medications at the Right Time and With Food as Directed 

Stephanie stated that one of the top reasons for nausea and vomiting is taking your medications at the wrong time. It's vital to pay attention to the timing of your medications. Are you taking them at the time the label directs? Are you taking them on an empty stomach? 

Take the medications with liquids and food when directed. If you aren't sure what the ideal pill-taking timing should be, contact your treating physician, who prescribed them to you. This will eliminate or significantly reduce nausea/vomiting caused by medication. 

        2. Eat Small Frequent Meals

By eating smaller, more frequent meals, you are giving your stomach enough time to digest your food while staying consistently fed. Too big of meals might alter your gut's ability to absorb and digest the proper nutrients from your meals. Smaller meals could mean more energy and better nutritional absorption. 

        3. Reduce High-Fat Foods

Fat takes longer to digest, so if it slows our digestion down and sits in our stomach, that might exacerbate already-existing gastrointestinal issues. 

        4. Eat Ginger 

Consuming foods that contain ginger can help calm your stomach. Ginger is a naturally occurring antiemetic that can alleviate nausea and vomiting. So, if you're feeling queasy, try incorporating ginger-containing foods into your diet to help soothe your stomach. 

3 Ways to Manage Diarrhea and Constipation with Nutrition 

Diarrhea and constipation are common side effects within the CLL community but are rarely discussed. It can be embarrassing to talk about these kinds of side effects with your doctor (although we highly recommend you do!), but in the meantime, here are some suggestions that might be helpful to you: 

        1. Keep a Food Journal

Record what you eat and how your stomach feels about an hour after you eat it. Also, include the medications that you are taking. With all of this information, it becomes clear what foods, drinks, or medications trigger your diarrhea and constipation. A registered dietitian can also help you interpret this. Eliminate the foods or food groups that seem to be causing problems and see if your symptoms improve. 

        2. Stay Hydrated 

If you are constipated, adding water to your body will increase the level of fluids in your stomach and intestines and can help move things along. 

If you are losing an important amount of liquid due to diarrhea, you should consider adding electrolytes to your hydration plan for the day. Try to avoid electrolytes with artificial sweeteners, as this can damage the inner layer of your gut. 

        3. Consider Natural Laxatives

Consider consuming natural laxatives such as prune juice or coffee. These can help with your constipation and increase your vitamin intake. A fiber supplement may also help if natural laxatives don't seem to work. 

Remember, none of these recommendations have to be lifelong or long-term. Simply use them until side effects pass, and then you can resume your normal diet. 

3 Ways to Manage Anemia and Fatigue with Nutrition 

Anemia (low red blood cell count) is quite common in CLL and can be caused by the disease itself or its treatment. A primary symptom of anemia is fatigue. 

Try the following tips to help manage anemia and fatigue: 

        1. Increase Iron Consumption

Avoid taking iron-containing supplements unless recommended by your healthcare team because it's not digested and absorbed as efficiently as food-based iron. 

There are two different kinds of food-based iron: heme iron (from red meat, poultry, and fish) and non-heme iron (beans, lentils, spinach, kale, apricots, etc.). To maximize iron intake, make sure that you get both of them in your diet. 

Include vitamin C sources such as strawberries and citrus fruits when you eat iron-containing food to increase the absorption of said iron. Don't drink milk, coffee or tea within 30 minutes before or after meal time, as those drinks can decrease the absorption of iron. 

        2. Increase Vitamin B12 in Your Diet

The body needs vitamin B12 to make healthy red blood cells, white blood cells, and platelets. Increasing this in your diet can also help with anemia. It is found in red meat, fish and shellfish, eggs, and dairy products. 

        3. Get Sufficient Calories and Protein

Make sure that you are eating enough calories and protein in order to fight fatigue and other side effects. Your body is expending a lot of energy trying to recover and repair your healthy cells during treatment. Eating enough calories and protein can help reduce fatigue and chronic pain. 

Protein is going to provide energy for your muscles. Although protein needs may vary, it should equal 1 gram of protein to 1 kg of weight. To convert lbs to kg, divide the number of lbs by 2.205. 

For example, if you weigh 75 kilograms, you should strive for 75 grams of protein per day. If you are trying to build muscle, multiply your weight in kilograms by 1.5. If you weigh 75 kilograms but are wanting to gain muscle, 112.5 grams should be ideal. 

Consult your dietitian before determining your caloric and protein needs. Your health history, weight, and kidney function could vary these results. 

12 Easy Snack Ideas

Keep easy-to-prepare snacks on hand so you are able to fuel your body all day long. Try to avoid ultra-processed foods and those with added sugars.

Some ideas are:

• String cheese 
• Guacamole with vegetables
• Yogurt with fruits
• Granola bars
• Trail mix
• Egg salad
• Tuna salad
• Smoothies
• Boiled eggs
• Rotisserie chicken
• Protein bars
• Fruit with peanut butter 

Don't Forget Physical Activity! 

Physical activity can be a great way to help manage your side effects. Even moving your body around the house can give your mind clarity and provide your body with more energy and strength to manage your CLL. Movement aids in constipation symptoms and combats fatigue. 

Aim for 150 minutes of moderate exercise per week. You can move in a way that inspires you, whether it's looking up exercise videos on YouTube, talking walks outside, or gardening. 

We hope that as you apply this advice with the support of a registered dietitian, you will see improvements in your side effects. Your quality of life is important, and you deserve to live a life that is as normal as possible and not defined by your CLL. 

Find Upcoming CLL Webinars! 

We invite you to join the HealthTree CLL Chapter by clicking on the button below to gain the benefit of participating in virtual events that cover various CLL topics with experts. 

CLICK HERE TO JOIN THE CLL CHAPTER

Upcoming HealthTree for CLL Events Include:

• How Can CLL Clinical Trials Help Me? Learn from Dr. Danielle Brander of Duke Cancer Institute on May 6th at 2:00 PM ET 
• Tracking Your CLL Labs in HealthTree Cure Hub on May 7th at 1:00 PM ET
• A Personalized CLL Vaccine: NeoVax with Inhye Ahn, MD Dana-Farber Cancer Institute on May 10th at 2:30 PM ET 
• All About Bispecific Antibodies for CLL with Dr. Adam Kittai on May 13th at 1:00 PM ET
• Dietary Guidelines for Cancer Prevention After Treatment on May 30th at 1:00 PM ET 
• Relapsed/Refractory CLL Treatment Options with Dr. Kerry Rogers on Jun 25 at 1:00 PM ET