The building-up diet

This information is an extract from the booklet, Diet

and cancer. You may find the full booklet helpful.
We can send you a copy free – see page 16.

The building-up diet is high in energy and protein and has

been designed specifically for people with cancer who have
lost, or are losing, weight or can only manage to eat a little.
This diet is not recommended for people with cancer who are
eating well and have not lost weight.

Many people with cancer find there are times when they can’t
eat as much as usual, and sometimes they lose weight. There
are lots of reasons for this.

Cancer itself, or its treatments, may make you lose your

appetite. Some people find that they do not feel hungry, or
feel full soon after starting a meal. Other people find that
food makes them feel sick or that their treatment makes some
foods taste different.

Some types of cancer make your body use up more energy,

even if you are not very active. This can make you lose weight
even though you may still be eating well.

People who are not eating enough, especially if they are losing
weight, need more energy and protein in their diet. If you
have often tried to lose weight previously, it can be difficult to
change your eating habits when you have cancer. However,
if you have cancer and are losing weight you may need to
eat differently to try to maintain your weight. Your doctor or
dietitian may recommend foods that you would normally think
of as unhealthy, but they have good reasons for doing this.

Macmillan and Cancerbackup have merged.

Together we provide free, high quality information for all.

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The building-up diet

This information shows you how to get more energy and

protein without necessarily having to eat more food. Not
everyone will be able to put on weight with this building-up
diet, but the suggestions should help to slow down, or stop,
further weight loss.

A good diet is one that gives you everything you need to keep
your body working well. Variety and balance are key to a
good diet.

You should try to include everyday foods from each of the

following groups:

Carbohydrates
Breads, rice, pasta, noodles, couscous, potatoes, breakfast
cereals, cakes, biscuits and sweets contain carbohydrate and
also provide energy, fibre, vitamins and minerals. Wholemeal
and whole-grain varieties are especially high in fibre.

Vitamins, minerals and fibre

Fresh fruit and fresh vegetables are good sources of vitamins,
minerals and fibre when eaten raw or lightly cooked, or made
into juices. If the skins are left on, they contain more vitamins.

Dried and frozen fruit and vegetables can also be good

sources of vitamins.

Protein
Meat, poultry, fish, beans, lentils, nuts, eggs, milk and cheese
are protein sources which also provide vitamins, minerals and
energy.

Fats
Sources of fat include: oil, ghee, butter, margarine, fatty
meats, oily fish, eggs, cheese, cream, nuts, salad dressing and
mayonnaise, full-fat milk, yoghurts and fromage frais. Some
of these also provide protein, vitamins and energy.

Make sure that eggs are well-cooked, and use commercial, not
home-made mayonnaise. If your immunity is low, avoid paté,
raw eggs and cheeses made from unpasteurised milk, such
as Brie and blue-veined cheeses, as these foods may contain
harmful bacteria.

If you are on high-dose chemotherapy, then your hospital may

suggest you avoid additional foods – do ask them for advice.

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 The building-up diet

How foods are used in our bodies

Energy
Energy is measured in calories. A calorie is simply a unit
of energy and on food packaging is labelled as ‘kcal’ for
kilocalories. We all need a certain number of calories each
day to give us the energy to live, even if we are not very active:
just sitting in a chair we need energy to breathe. If there are
too many calories in our diet we put on weight, and if there
are too few we use up our body’s stores of energy and lose
weight. The amount of energy each person needs each day
varies. It depends on how quickly their body uses the energy
and their level of activity. An adult man needs about 2,500
calories per day and an adult woman about 2,000 calories.

Proteins
Proteins make up the basic building blocks of the body. Every
part of the body contains protein and we need to eat protein
every day to maintain and repair our body tissues. The body
must have extra protein, as well as extra energy when we are
ill, injured or under stress, to repair any damage.

Vitamins and minerals

Vitamins are essential substances which help our bodies to
work normally, but we only need tiny amounts of them. If you
are eating even a little of the main foods that contain vitamins,
you are probably getting a good enough supply. However, if
you’re not able to eat well for a long period of time, you may
need a multivitamin to top up your body’s stores. Your doctor,
dietitian or pharmacist can advise you about these. There is
no scientific evidence to prove that taking large amounts of
vitamins is helpful. In fact it can be harmful to take excessive
amounts of certain vitamins, especially vitamins A and D.

Minerals are substances needed by the body for various

functions: such as making bones and teeth; maintaining body
fluids and tissues; maintaining healthy nerves; and building
necessary chemicals (enzymes).

Some minerals are needed in larger amounts than others,

such as calcium, phosphorus, magnesium, sodium, potassium
and chlorine. Others are needed in smaller quantities and are
called trace minerals, eg iron, zinc, iodine, fluoride, selenium
and copper. Despite being needed in smaller amounts, trace
minerals are just as important as other minerals. Different
foods supply different amounts of minerals. Eating a varied
diet will give enough of most minerals. However, if you’re

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The building-up diet

unable to eat normally, you may need to talk to your doctor or

dietitian about whether or not you need a mineral supplement.

Fluids
The body needs a certain amount of fluid each day in order to
work properly. If you don’t feel well it may be difficult to drink
enough liquid, but it is important to drink at least 1½ litres of
fluid a day (2 pints). This can be drunk as water, fruit juice or
squash. Drinks that contain caffeine (such as coffee, tea and
some fizzy drinks) may make you dehydrated because they
make you produce more urine. You can include them in your
daily fluid allowance but have other fluids that don’t contain
caffeine as well.

Boosting your energy and protein

If you have a good appetite, you should have no trouble

eating the extra energy and protein foods that you may need if
you are ill. However, if your appetite is not very good there are
two ways to add extra energy and protein to your diet, without
actually having to eat more food.

The first is to use everyday foods that are high in energy and
protein (see pages 11–14). The second is to use manufactured
food supplements. These can be taken as nourishing
drinks, which are available as milkshakes or soups. Some
supplements are high-protein powders that can be added to
your normal food. Pages 8–10 give you some simple ideas on
how to do this.

Manufactured food supplements

Many supplements are available to add extra energy and/

or protein to your diet. They are usually available from your
chemist.
• Some are available on prescription from your doctor.
• Some supplements are available ready to drink or use, and
others are powders that need to be mixed with liquid.
• Some can be added to food.

A list of these products can be found on pages 16–19.

Important note: High-protein supplements should only

be used with advice from your doctor or dietitian. Most
people will need extra energy balanced with extra

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 The building-up diet

protein. Many of these products can be used by people

with diabetes. However, if you are diabetic, seek advice
from your doctor, specialist nurse or dietitian before using
food supplements.

Once mixed, complete milk-tasting supplements and powders

should be drunk slowly over a period of 20 minutes.

High-energy and juice-tasting supplements have a high

carbohydrate (sugar) content, and people who are diabetic
should talk to their dietitian before using them.

People who have had radiotherapy for certain types of head

and neck cancers may be more at risk of tooth decay, and so
should avoid having sugar too often during the day. It’s a good
idea to clean your teeth or use a mouthwash after any sugary
snacks. Your doctor or dietitian can give you more advice about
this.

Adding energy and protein to everyday foods

Fortified milk
You can make fortified milk by adding 2–4 tablespoons of dried
milk powder to a pint (450mls) of full cream milk. Keep it in the
fridge and use in drinks and cooking. Use fortified milk, Fortisip
Bottle Neutral, Fresubin Energy or Ensure Plus milkshake-style
Neutral instead of water to make up soups, jellies, custard and
puddings. Many of the makers of nutritional supplements (see
pages 16–19) can give you recipes that use their products.

Most supermarkets sell dried milk powder, and it is usually on

shelves close to the coffee and tea section, or near the milk.

Breakfast cereals
Use fortified milk, Fortisip Bottle Neutral, Fresubin Energy or
Ensure Plus milkshake-style Neutral. Add syrup or honey to
porridge or use 2–3 teaspoons of a high-energy supplement
such as Polycal powder, Vitajoule, Maxijul powder or Polycose
powder instead of sugar. Make porridge with full cream milk or
cream.

Casseroles and soups

Add lentils, beans and noodles. Stir a tablespoon of cream into
canned soups or add energy and protein supplements. Make
up packet soups with fortified milk or a milk-tasting supplement
such as Fortisip Bottle Neutral, Fresubin Energy or Ensure Plus
milkshake-style Neutral.

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The building-up diet

Nibbles
Keep snacks like nuts, pasteurised cheese, fresh and dried
fruit, biscuits, crackers, yoghurts or fromage frais handy to
nibble if you feel hungry between meals.

Puddings
Add ice cream, cream or evaporated milk to cold puddings,
and custard made with fortified milk to hot puddings. Make up
instant desserts with fortified milk. Try adding sugar or syrup
to puddings. You could also try some pudding recipes for use
with Fortisip Bottle, Scandishake Mix, Calshake, Enshake, or
Fresubin Energy.

Mashed potato
Mashed potato can be enriched by adding a dessert spoon
of butter or cream, or a supplement such as Polycal powder,
Calogen Unflavoured, Caloreen, Vitajoule, Maxijul powder or
Polycose powder, and by sprinkling grated cheese on top.
High-energy and protein supplements can be added.

Vegetables
Melt butter on top of hot vegetables or garnish them with
grated cheese or chopped hard-boiled egg. Alternatively,
serve them with a sauce made with fortified milk.

Sandwiches
Always use plenty of butter or margarine. Spread fillings
thickly. Add a dessert spoon of mayonnaise to sandwich
fillings like hard-boiled egg or tuna fish.

Drinks
Use fortified milk, or half-fat milk instead of water, when
making coffee and bedtime drinks. Add 3 teaspoons of a
high-energy supplement to hot or cold drinks. Commercial
drinks can be drunk straight from the pack, gently heated or
incorporated into recipes.

Nourishing drinks

If you cannot face a meal, have a nourishing drink instead.

You can also drink these between meals to help you put on
some weight. Some people like an occasional glass of stout to
boost their appetite. You might like to make your own drinks
such as fruit milkshakes or smoothies. Make a smoothie by
blending fresh apple, strawberries, banana or other soft

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 The building-up diet

fruit with fortified milk, fruit juice, ice cream or yoghurt in a

liquidiser or blender.

To make a nutritious milkshake, mix fortified milk with either

puréed fruit or a fruit yoghurt and add 2–3 teaspoonfuls of a
high-energy powder supplement. A scoop of ice cream will top
it off tastily, and add extra energy.

Ready to drink/use supplements

You may find it easier to buy a ready-to-drink, flavoured
supplement from your chemist. Your doctor may also give you
a prescription for them. Supplements such as Fortisip Bottle,
Ensure Plus and Fresubin Energy, or Fortijuce, Ensure Plus juice
and Provide Xtra are juice-style alternatives. Occasionally you
can have one of these instead of a meal if you do not feel
like eating. Supplements such as Calogen, Polycal Liquid or
Maxijul Liquid are energy-only drinks. You can find the full list
in the table on pages 8–10.

Powdered drinks
Balanced and flavoured meal drinks are also available as
powders, which can be mixed with milk or water. Some
can be prescribed by your doctor; others, eg Build-Up or
Complan, can be bought from your chemist and from some
supermarkets.

Powders that can be added to food

Unflavoured powders are also available. You can buy these or
get them on prescription. High-energy powders include Polycal
Powder, Maxijul, Caloreen or Polycose. Protein-only powders
include Protifar, Maxipro or Vitapro. You can find the full list
in the tables on pages 8–10. As these powders are virtually
tasteless you can add them to drinks, soups, sauces, gravies,
casseroles, flan fillings, milk puddings and instant desserts.

You will probably need to experiment a little to find out how

much you can add to each particular dish without changing
the flavour or texture of your food. A good way to start is
to add 2–3 tablespoons of a powdered protein supplement
such as Protifar, Maxipro or Vitapro to a pint (450mls) of full
cream milk. Instead, you could add 2–3 teaspoons of an
energy supplement such as Polycal Powder, Vitajoule, Maxijul
or Caloreen to a cup of tea or coffee. Energy supplements are
almost flavourless and are not as sweet as sugar.

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The building-up diet

Commercial supplements

Ready to drink
Complete high-energy, milk-tasting (1*)
Fortisip Bottle 200ml bottle (sweet and Nutricia Clinical Care
neutral)
Clinutren 1.5 200ml cup (sweet) Nestlé Healthcare Nutrition
Ensure Plus 220ml carton (sweet and Abbott Nutrition
milkshake style neutral)
Fresubin Energy Drink 200ml carton (sweet, Fresenius Kabi
savoury and neutral)
Resource shake 175ml carton (sweet) Nestlé Healthcare Nutrition

Complete high-energy, milk-tasting with fibre (1a*)

200ml bottle (sweet and
Fortisip MultiFibre Nutricia Clinical Care
savoury)
FortiCare 125ml carton (sweet) Nutricia Clinical Care
Fresubin Energy Fibre
200ml carton (sweet) Fresenius Kabi
Drink
Ensure Plus fibre 220ml carton (sweet) Abbott Nutrition
Clinutren 1.5 fibre 200ml cup (sweet) Nestlé Healthcare Nutrition

Yoghurt-tasting (1*)
200ml bottle or carton
Fortisip Yoghurt style Nutricia Clinical Care
(sweet)
Ensure Plus Yoghurt
220ml carton (sweet) Abbott Nutrition
style

Balanced, juice-tasting (1*)

Fortijuce 200ml bottle Nutricia Clinical Care
Clinutren Fruit 200ml bottle Nestlé Healthcare Nutrition
Ensure Plus juice 220ml bottle Abbott Nutrition
Provide Xtra 200ml carton Fresenius Kabi
Resource Fruit Flavour 200ml carton Nestlé Healthcare Nutrition

Balanced, high-protein, milk-tasting (1*)

Fortisip Extra 200ml bottle (sweet) Nutricia Clinical Care
Fortimel 200ml bottle (sweet) Nutricia Clinical Care
Resource Protein Extra 200ml carton (sweet) Nestlé Healthcare Nutrition

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 The building-up diet

Powders
Complete, milk-tasting (1*)

Complan Box 4 x 57g sachet Complan Nutritional Products

(sweet and savoury)
Build-Up Original 400g box (neutral) Nestlé Healthcare Nutrition

Energy-only (2*)
Polycal Powder 400g tin Nutricia Clinical Care
Maxijul 200g tin SHS International Ltd
Polycose 350g tin Abbott Nutrition
Vitajoule 200g tin Vitaflo Ltd
Caloreen 500g tin Nestlé Healthcare Nutrition

Nutritionally balanced powders (3*)

Scandishake Mix Box 6 x 85g sachet Nutricia Clinical Care
(sweet and unflavoured)
Calshake Box 7 x 87g sachet Fresenius Kabi
(sweet and neutral)
Enshake Box 6 x 96.5g sachet Abbott Nutrition
(sweet)

Protein-only powders (4*)

Protifar 225g tub Nutricia Clinical Care
Maxipro 200g tub SHS International Ltd
Vitapro 250g tub Vitaflo Ltd

Energy-only liquids (5*)

Polycal Liquid 200ml bottle (sweet and Nutricia Clinical Care

neutral)
Maxijul Liquid 200ml carton SHS International Ltd
Calogen 250ml and 500ml Nutricia Clinical Care
bottles (sweet and
unflavoured)

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The building-up diet

Fortified puddings (6*)

Forticreme/Forticream 125g pot (sweet Nutricia Clinical Care

complete flavours)
Maxisorb 30g sachet (to make up) SHS International Ltd
Clinutren Dessert 125g pot Nestlé Healthcare
Nutrition
Resource Energy Dessert 125g cup Nestlé Healthcare
Nutrition
Fortisip fruit dessert 150g pot (sweet) Nutricia Clinical Care

Powders to thicken food (7*)

Nutilis 225g tin and 9g sachet Nutricia Clinical Care
Thick and Easy 225g tin Fresenius Kabi
Thixo-D 375g tin Sutherland Health Ltd
Vitaquick 300g pot Vitaflo Ltd

Recipe ideas, leaflets and booklets are available for many of

these products from the manufacturers. Most of the drinks
listed above are available on prescription, but Build-up and
Complan are not.

Sample menus

In the following pages we have taken some everyday foods

and put them into sample menus to show how you can boost
your protein and energy intake without having to eat more
food. These are only suggestions, but we hope they will give
you some ideas for ways you can adapt the meals you usually
eat.

Our booklet of recipes contains other suggestions for

appetising meals.

Between meals you can keep up your energy intake with

snacks and drinks such as nuts, seeds, cheese, biscuits,
crackers, Ovaltine or milkshakes. Fortified milk or supplements
such as Fortisip Bottle Neutral or Fresubin Neutral can be
added to tea and coffee, or bedtime drinks such as Horlicks,
Ovaltine or drinking chocolate. Energy supplements can also
be added to hot drinks.

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 The building-up diet

Breakfast
Fresh fruit or fruit juice
fry the egg and Bacon and egg
perhaps try a slice of
Wholemeal toast with butter spread thickly
fried bread
Midday meal
spread butter thickly Tuna and cucumber sandwich
add full
or use mayonnaise
Banana fat yoghurt
or Greek
Evening meal
yoghurt
Lasagne or spaghetti bolognaise
Side salad add salad
add ice cream or dressing
Stewed fruit
custard

Breakfast
top with full fat or Stewed fruit (eg prunes or apricots)
Greek yoghurt
English muffin or crumpet with butter and
honey or jam spread thickly
Midday meal
mash the centre of the Jacket potato with filling (eg grated
potato with extra butter cheese, baked beans, tuna, chicken)
Side salad add dressing,
mayonnaise or
choose full-fat Fruit trifle
salad cream
variety
Evening meal
Grilled salmon or trout, new potatoes use tartar
and green beans sauce and add
serve with ice
butter to the
cream, cream or Fruit crumble
vegetables
custard

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The building-up diet

Breakfast
Fresh fruit or fruit juice
make with fortified milk, Porridge
add sugar or honey Toast with butter and jam or honey spread thickly
Midday meal
be generous with Cheese and salad sandwich with
the filling and add wholemeal bread
mayonnaise use full-fat
Fruit yoghurt or fromage frais variety and
Evening meal add energy
supplement
Roast chicken with potatoes and
fresh vegetables add butter to
with syrup and ice Fruit salad vegetables
cream or custard made
with fortified milk

Breakfast
Fruit juice
Yoghurt with nuts, seeds and dried fruit or
dalia (wheat) porridge add butter
Midday meal
use ghee or Stuffed paratha or chapati with vegetables
butter for or rice and chapati, vegetable curry,
cooking hard-boiled egg and potato curry
Fruit or rice pudding make with
fortified milk
Evening meal
and energy
Lamb curry with pulses and salad or supplement
khichari (lentils and rice), lentil soup or
shorba (lamb and chicken soup)
Fresh custard with fresh cream

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 The building-up diet

Breakfast
Fruit juice
Cornmeal porridge
Caribbean hard dough bread and butter spread thickly
Midday meal
add butter to Steamed red mullet with vegetables
vegetables
Banana or other fruit
Evening meal
add butter to Caribbean chicken with mashed
vegetables potatoes, callaloo and sweetcorn
Mango and ice cream

Breakfast
use fortified milk and Weetabix
sprinkle with sugar Toast with butter and jam spread thickly
Midday meal
add cream or Chicken soup
energy and protein
Hard-boiled egg sandwich be generous with
supplement
Fruit or full-fat yoghurt the filling and
add mayonnaise
Evening meal
serve with butter Shepherd's pie with carrots
and peas use fortified
Stewed fruit mashed potato
serve with cream
or grated cheese
or custard made
on top
with fortified milk

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The building-up diet

Breakfast
Minced-beef congee
or assorted dumplings and Chinese tea
Midday meal
Noodles or plain rice with mixed
seafood/meat and vegetables,
Lychees and pineapples
Green tea
Evening meal
Winter-melon soup with spare ribs
Plain rice and steamed fish with
black bean sauce. Chicken with
cashew nuts, celery and carrots
Orange wedges

Your feelings about weight loss

People with cancer often have weight loss and it may be

upsetting because it can be a reminder of your illness. It’s
natural to be upset by weight loss. We all have an image in
our minds about what our bodies look like. Although we may
not be completely satisfied with this image, most people are
used to the way they see themselves.

When you lose weight, perhaps due to the cancer itself or

maybe the treatment you are having, you’ll see a different
image of yourself when you look in the mirror from the one
you have developed in your mind. It can be hard for someone
who has seen themselves as well-built and healthy to accept
that they now look different because they have lost weight.

You may also worry that the change in your looks will affect
what your partner, family and friends think of you. Weight loss
can also be worrying for your friends and family. However,
despite your loss of weight, you are still the same person with
the characteristics for which your family and friends value you.

Some people worry that the change in their looks will affect

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 The building-up diet

their personal relationships. You may be worried about

rejection or carrying on a sexual relationship. Many people
find, once they have summoned up the courage to talk
openly to their partner, their fears of rejection are unfounded.
Relationships are built on a number of things – love, trust,
common experiences and many other feelings. Although
weight loss can be upsetting for you both, it can help to
discuss this openly and talking about the problem may help
you feel closer.

People who have lost their appetites may feel self-conscious

about eating at home with the family or eating out with
friends. Eating is usually a social event, so even if you feel you
can’t manage a full meal, there is no reason for you to feel
excluded. Your friends and family will usually understand and
will enjoy being with you, even if you can’t eat as much as
usual.

Sometimes, perhaps when you are feeling tired or sick, you

may not be able to prepare food. If you are the person in your
family who usually prepares the meals, it can feel strange to
stand back and let someone else take charge. It is important
not to feel guilty about letting someone else do things you
usually do, when you’re unwell. After all, when you feel better
again you can always take up your responsibility for cooking
once more.

If you live on your own and need help with cooking, or

around the house generally, contact your GP, district
nurse or social worker, so that they can arrange for a
home help, meals-on-wheels or a local organisation to
help you with cooking or shopping.

Don’t hesitate to ask for professional help if you are finding

it difficult to cope with your illness and your emotions. Our
booklet The emotional effects of cancer, may be helpful to
read.

Talking about your feelings can often help to make things

clearer for you, and give other people the chance to
understand how you are feeling. You may find it helpful to talk

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The building-up diet

to a professional counsellor or a local support group. You can

find a counsellor by contacting the Cancer Counselling Trust.

Don’t see it as a sign of failure that you have not been able
to cope on your own. Once people understand how you are
feeling they can be more supportive.

More information and support

If you have any questions about cancer, ask Macmillan.
If you need support, ask Macmillan. Or if you just want
someone to talk to, ask Macmillan.

Our cancer support specialists are here for everyone

living with cancer, whatever you need.

Call free on 0808 808 00 00, Monday–Friday, 9am–8pm

www.macmillan.org.uk

We make every effort to ensure that the information we provide is accurate but it
should not be relied upon to reflect the current state of medical research, which is
constantly changing. If you are concerned about your health, you should consult
your doctor. Macmillan cannot accept liability for any loss or damage resulting from
any inaccuracy in this information or third party information such as information on
websites to which we link. © Macmillan Cancer Support 2010. Registered charity
in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604).
Registered office 89 Albert Embankment, London, SE1 7UQ

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