High-Protein Snacks During Cancer Treatment

Protein is what your body uses to repair tissue and build immune cells. During treatment it is also what stands between you and lost muscle. And it is usually the first thing that stops appealing: meat smells wrong, and a full plate feels like a chore.

Snacks get around that problem. A snack is small, needs no cooking, and can be eaten at 2 a.m. or in an infusion chair. The National Cancer Institute suggests small meals every two to three hours, about five or six a day, in place of three large ones. It also suggests eating within an hour of waking, and eating the protein on your plate first, while your appetite is at its best.

Grams of protein are hard to picture, but ounces are easier.

MedlinePlus gives a rule that makes this simple. One ounce, about 30 grams, of most protein-rich food holds about 7 grams of protein. That gives you a set of rough equals:

• One large egg: about 7 grams
• One ounce of chicken, fish, or beef: about 7 grams
• Half a cup of cooked beans or lentils: about 7 grams
• A quarter cup of tofu: about 7 grams

MyPlate, the federal food guide, counts protein foods in ounce-equivalents. For general health, women aged 19 to 59 are told to aim for about 5 to 6 and a half ounce-equivalents a day. Men in that age range are told to aim for about 6 and a half to 7. One ounce-equivalent is one egg, an ounce of cooked meat or fish, a tablespoon of peanut butter, half an ounce of nuts such as 12 almonds or 7 walnut halves, a quarter cup of cooked beans, six tablespoons of hummus, or a quarter cup of tofu.

Those figures are for healthy adults. Illness and healing can raise what you need, and no public chart can set your number. Ask a dietitian for yours. Even so, the ounce rule tells you what any snack is worth.

Cold food gives off less aroma, which helps considerably when nausea or taste changes are the problem.

• Hard-boiled eggs. Two eggs give you roughly 14 grams. Cook them until the yolk and white are firm.
• Cottage cheese or plain yogurt with canned peaches. Sweet, soft, and cold.
• Cheese and crackers. An ounce of cheddar counts as about an ounce of protein food.
• Peanut butter. One tablespoon on toast, crackers, or apple slices is an ounce-equivalent. Two make it worth the effort.
• Hummus with pita bread. Six tablespoons of hummus is one ounce-equivalent.
• Nuts and seeds. Buy them roasted. The NCI booklet Eating Hints says to skip raw nuts during treatment.

• Scrambled eggs. Two minutes of work, and soft enough for a sore mouth.
• Cream soup made with milk instead of water. More protein, same volume in the bowl.
• Oatmeal cooked in milk, with a spoon of peanut butter stirred through.
• Macaroni and cheese from a box, with extra shredded cheese melted in.

The overnight oats recipe in Eating Hints is worth keeping on the counter. Half a cup of rolled oats, a quarter cup of Greek yogurt, half a cup of whole milk, a tablespoon of chia seeds, a quarter teaspoon of cinnamon, a tablespoon of maple syrup, a quarter cup of fruit, and a tablespoon of nuts. Mix it at night, chill it 8 to 10 hours, and eat it cold. NCI puts that bowl at 482 calories and 18 grams of protein.

On the worst days, liquid protein becomes the entire plan.

The NCI banana milkshake is one sliced ripe banana, one cup of milk, and a few drops of vanilla, blended smooth. Made with whole milk, that is 255 calories and 9 grams of protein.

Its high-protein milkshake goes further. Use one cup of whole milk, two tablespoons of chocolate or butterscotch sauce, half a cup of ice cream, half a teaspoon of vanilla, and a third of a cup of instant dry milk powder. That comes to 600 calories and 22 grams of protein.

Dry milk powder is the quiet workhorse here. Eating Hints suggests stirring it into soups, sauces, mashed potatoes, and puddings. It adds protein without adding much to the bowl.

Ready-made drinks such as Ensure and Boost have a place too. NCI suggests sipping them between meals rather than with meals, so they add to what you eat instead of replacing it.

• Meat tastes metallic. Switch to eggs, cheese, beans, peanut butter, or tofu. Serve it cold and use plastic forks.
• Sore mouth. Soft and bland wins: custard, scrambled eggs, pudding, milkshakes. Skip citrus, tomato, vinegar, spice, and chips.
• Nausea. Dry, bland, room temperature. Sip liquids between meals rather than during them.
• Full after four bites. Drink your protein, and keep liquids at meals down to small sips.

Many cancer treatments lower the white blood cells that fight infection, which means an ordinary stomach bug can become a hospital admission. The rules below come from federal food safety guidance.

Bacteria grow fastest between 40°F and 140°F. That range is called the danger zone. Keep the refrigerator at 40°F or below and the freezer at 0°F or below. Do not leave perishable food out for more than 2 hours, or more than 1 hour if the car or room is above 90°F. Thaw and marinate food in the refrigerator, never on the counter.

Tape these safe cooking temperatures inside a cabinet door:

• Poultry: 165°F
• Ground beef and pork: 160°F
• Steaks, chops, roasts, and fish: 145°F, with a 3-minute rest for whole cuts
• Egg dishes such as quiche: 160°F. Plain eggs go until the yolk and white are firm
• Leftovers and casseroles: reheated to 165°F

Leave these alone while your counts are low: unpasteurized (raw) milk, soft cheese made from raw milk, raw sprouts, runny or raw eggs, cold deli meats and hot dogs, raw fish and shellfish, and refrigerated smoked seafood. Eating Hints adds moldy cheese, buffets, salad bars, and bulk bins, and says to eat refrigerated leftovers within 3 days.

Snacking has limits, and these signs mean the plan needs a clinician rather than another recipe.

• Call 911 or go to an emergency department if a bite of food lodges in your throat and you cannot speak, cough or draw breath. Go in straight away, too, if your temperature reaches 100.4°F (38°C) or higher while you are on chemotherapy or your counts are low. CDC puts a fever in that window in the emergency category, ahead of any phone call, since an infection can outrun a depleted immune system in hours.
• Call your care team the same day if nothing you eat or drink has stayed down for a full 24 hours, or you go light-headed on standing and are passing far less urine than usual.
• Call your care team within a day or two if the scale drops more than 3 to 5 pounds inside one week, which NCI says to report right away, or if mouth pain stops you finishing a snack, or if food starts sticking on the way down and drinks make you cough.

• How much protein should I get each day, in foods I can picture?
• Should I be gaining weight, holding steady, or slowing a loss right now?
• Do my kidney results change how much protein is safe for me?
• I have diabetes. Which snacks fit my plan?
• Are supplement drinks worth the cost in my case, and which one?
• Which foods should I avoid while my counts are low, and for how long?

Helpful next pages include Getting Enough Protein During Cancer Treatment, Smoothies and Liquid Nutrition During Treatment, Hydration Plan During Cancer Treatment, and Meal Ideas When Food Tastes Metallic.

• https://www.cancer.gov/publications/patient-education/eatinghints.pdf
• https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss
• https://medlineplus.gov/ency/article/002467.htm
• https://www.myplate.gov/eat-healthy/protein-foods
• https://www.foodsafety.gov/keep-food-safe/4-steps-to-food-safety
• https://www.foodsafety.gov/food-safety-charts/safe-minimum-internal-temperatures
• https://www.fsis.usda.gov/sites/default/files/media_file/2021-04/at-risk-booklet.pdf
• https://www.cancer.gov/about-cancer/treatment/side-effects/infection
• https://www.cdc.gov/cancer-preventing-infections/patients/fever.html