Bad day mode is on. Only the essentials are showing — antiemetics, fluid, mouth care, and food that goes down cold. Turn it off to see everything.

A practical eating guide

Chemotherapy is hard on the body. Food is how you stay standing.

This isn't a diet, and it isn't an alternative to treatment. It's a support plan for getting through a course of chemotherapy at full dose, on schedule, without a delay — because weight loss and poor nutrition are among the most common reasons cycles get postponed or reduced.

Two things do most of the work: enough protein and not losing weight. Everything else here supports those.

Before you use any of this. Every regimen is different, and some of the foods and supplements below interact with specific drugs. Nothing here replaces advice from your oncology team — take it to them, not around them. Ask for a referral to an oncology dietitian, and have an oncology pharmacist review every supplement you take.

Avoid Important Do this Ask your team

01The two numbers

If nothing else gets done in a day, these two do.

Work out your targets

Both targets scale with body weight. Enter yours to get the numbers to aim for.

Body weight

Protein each day

84–105 g

1.2–1.5 g per kg. Spread across every meal and snack, not loaded at dinner.

Fluid each day

2.1–2.5 L

30–35 ml per kg. More on infusion day and the two days after — the kidneys are clearing the drugs.

The thing to watch hardest

Weight loss — specifically muscle, not the number on the scales. Losing weight during chemotherapy is linked to dose reductions, treatment delays and worse outcomes. If appetite drops, the answer isn't to eat less. It's to change the food to something denser and easier to get down.

Weigh weekly — same day, same time, same clothes, written down. Losing 5% of body weight is the line that matters; that's the point where teams start discussing dose reductions. Two weeks trending down is a conversation with the dietitian, not a wait-and-see.

What a full day of protein looks like

Breakfast — oats with yoghurt or a scoop of protein	30 g
Mid-morning — boiled egg and cheese	15 g
Lunch — egg slice, or meat and potatoes	35 g
Afternoon — nuts, milk, or half a smoothie	15 g
Dinner — soup or slow-cooked meat	20 g
Total, without trying hard	115 g

Miss a single snack and that drops to 80 g — which is why the snacks aren't optional. On a bad day, one full smoothie covers roughly a third of the target in one glass.

02What to cross off, and why

Raw and undercooked meat, fish and eggs

Roughly days 7 to 14 after each infusion, white cell counts bottom out and the body can't contain ordinary bacteria. Raw liver, kidney, mince, shellfish and runny eggs carry campylobacter, salmonella and listeria.

In a neutropenic patient that isn't an upset stomach. It's sepsis, a hospital admission, and a delayed cycle. This applies no matter what a raw-food protocol promises.

But cooked offal is genuinely worth eating

Cooking it through keeps nearly all the nutritional value. Liver once or twice a week gives iron, B12, retinol and protein in a very small volume — useful when appetite is small. Just cook it properly.

Turmeric and curcumin supplements — check first

Curcumin at supplement strength inhibits the liver enzymes (CYP3A4 and others) that clear many chemotherapy drugs — the same mechanism behind the grapefruit warning. Inhibit them and drug levels run higher than intended. That sounds like more anti-cancer effect; in practice it means more marrow suppression and more toxicity, and it's a common route to a dose reduction.

Turmeric used as a cooking spice is fine. It's concentrated supplements that need clearing.

CBD — useful, but it belongs on the medication list

CBD is used in oncology for nausea and pain and may well help. It also inhibits the same enzyme pathways as above. That's not a reason to stop it — it's a reason for the team to know about it, so an unexpected blood result or a dose adjustment can be interpreted correctly.

Don't cut carbohydrates or fruit

The pancreas and liver hold blood sugar within a narrow band regardless of what's on the plate, and the kidneys and lungs hold blood pH between 7.35 and 7.45 no matter what's eaten. You can't starve a tumour by skipping fruit, and you can't alkalise blood through food.

What restriction can do is create a calorie deficit during the exact months it's least affordable. On a rough day, fruit is often the only thing that goes down. Keep it.

The one place alkalinity genuinely matters is the mouth — see the bicarbonate rinse below. That effect is real and significant.

03Mouth care

Mucositis is what wrecks eating from the second cycle onward. Once ulcers are established, everything gets harder. Prevent rather than treat.

From day one of every cycle — not when it starts hurting

Bicarbonate rinse, four times a day. Half a teaspoon of bicarb soda plus half a teaspoon of salt in a cup of warm water. Swish and spit — don't swallow it.
Then a teaspoon of honey — let it sit and coat the tissue rather than washing it straight down. Manuka honey has trial evidence for reducing mucositis severity.
Soft toothbrush. Gently.

Pasteurised honey only while counts are low

Raw, local and home-harvested honey carries bacterial and mould spores that are harmless to a normal immune system and are not harmless during neutropenia. Use commercial or medical-grade honey through treatment.

04The shape of a day

On waking

Warm water. Bicarbonate rinse. Honey.

Breakfast — the oat bowl

The workhorse of the whole plan.

Makes 1 bowl · 25–30 g protein

In the bowl

Rolled oats, soaked overnight with 1 tbsp chia
2 tbsp freshly ground pepitas
Full-fat milk or cream
A spoon of honey
Unsweetened cranberries or frozen berries
Greek yoghurt or a scoop of protein powder

Notes

Toast pepitas lightly before grinding, and grind in small batches — the oils go rancid quickly, and toasting kills surface mould, which is the reason some units restrict raw seeds during neutropenia.

Oats alone won't reach 25–30 g. The yoghurt or scoop isn't optional.

Sore mouth version: cook it soft, serve warm rather than hot, skip the cranberries, add more honey and cream.

Through the rest of the day

Mid-morning — nuts, cheese, a boiled egg, or a milk smoothie.
Lunch is the main protein meal. Eat it while appetite is best, which on chemotherapy is usually earlier in the day. Cooked vegetables rather than raw salad during the low-count window.
Dinner — lighter and earlier. Soups, congee, slow-cooked meat, mash.
Evening — rinse, honey, dark room, consistent bedtime.

Afternoon — 20 to 30 minutes of walking

This sits above every supplement on this page, because the evidence behind it is better than the evidence for any of them: less fatigue, muscle preserved, and a better chance of completing the full course. On a bad day, five minutes around the house still counts.

05The bad days

Roughly days two to five after an infusion. Abandon the structure — different rules apply.

The single change that matters most

Take antiemetics on schedule, before nausea starts — not as a rescue once vomiting has begun. Prophylactic dosing is the difference between a manageable week and a miserable one.

Cold food. Less smell, less trigger. Custard, yoghurt, jelly, smoothies, cold chicken.
Small amounts every hour beats three meals.
Ginger — fresh tea or chews. Real trial evidence for chemotherapy nausea, and safe.
Cold peppermint tea often goes down when nothing else will.
Dry crackers before getting out of bed.
Ground seeds can go into a smoothie when chewing is too much.

Two catches worth knowing

Peppermint relaxes the lower oesophageal sphincter, so if reflux is a problem — common with steroids and antiemetics — switch to ginger. And not scalding hot when the mouth is sore.

Chia needs fluid to work. Pre-soak it rather than adding it dry, or it can worsen constipation instead of easing it. Useful against the constipation ondansetron causes; back off if diarrhoea sets in instead.

06Citrus and acidic food

Two different instructions often get blurred together, and they have different consequences.

Find out which one you've been given

The grapefruit interaction is real and specific. Grapefruit and Seville orange inhibit CYP3A4 and can raise drug levels. It does not extend to ordinary oranges, lemons or mandarins.
"Nothing acidic" is a mucositis instruction. It's about not burning open ulcers and putting you off eating — comfort, not chemistry. If that's the one you've been given, then tomato, vinegar, pineapple and cranberry sit in the same bucket as citrus.

Worth asking directly, because the two answers produce very different shopping lists.

Vitamin C without citrus

Capsicum, kiwifruit, berries, cooked broccoli, and potato with the skin on.

Cranberry and blood thinners

If you're on any anticoagulant — warfarin especially, but check enoxaparin and apixaban too — clear cranberry with the pharmacist first. With a port in place and cancer-related clot risk, many patients are on something.

07Food safety during the low-count window

Days 7–14 after each infusion

No raw or rare meat, fish or eggs
No unpasteurised dairy, no soft cheeses — no blue, brie, camembert, or deli-counter feta
No deli counters, buffets, or raw sprouts
Wash and peel produce
Reheat leftovers to steaming hot, within two days, once only
Pasteurised honey only

08Two things to arrange early

Both are usually free, and both are underused

A referral to an oncology dietitian. They'll set a protein target for your body and treatment, and stay ahead of the mouth and gut problems as they appear.
A supplement review with an oncology pharmacist. Fifteen minutes with everything on the table removes all the interaction guesswork — including anything that could distort a blood result.

09Jellies

Gelatine jelly is the most useful thing to have in the fridge on a bad day. Cold, no cooking smell, goes down when nothing else will, and it's fluid nobody has to think about drinking.

Straight about gelatine

It's protein, but not a complete protein — it lacks tryptophan, so it doesn't count toward a daily target the way meat or whey does. Its job is calories, fluid, comfort and a sore mouth. For jelly that does count, see the milk jelly below.

One cooking rule

Fresh pineapple, kiwi, paw paw, figs and large amounts of fresh ginger contain enzymes that break down gelatine and stop it setting. If using fresh ginger, simmer it first — heat destroys the enzyme — then strain and cool.

Ginger and cranberry jelly

Makes 6 small cups.

Serves 6 · not a protein source

Ingredients

500 ml unsweetened cranberry juice
250 ml water
A thumb of fresh ginger, sliced thin
3 tbsp pasteurised honey
4 tsp powdered gelatine, or 5 leaves

Method

Simmer the water with the ginger for 10 minutes, then strain out the ginger. Don't skip the simmer.
Sprinkle gelatine over 100 ml of the hot ginger water. Bloom 5 minutes, then stir until completely clear.
Stir in the honey while warm.
Add the cranberry juice, cold. Stir.
Pour into small individual cups — a small cup gets eaten, a large bowl doesn't.
Refrigerate 4 hours.

Gentler version for a sore mouth: half cranberry juice, half water or pear juice. Cranberry is sharp and will sting an ulcer.

Variations — same method throughout

Pear and ginger — the gentlest, best when the mouth is bad.
Apple and cinnamon — a cinnamon stick simmered with the ginger.
Berry — frozen raspberries or blueberries dropped in as it starts to set.
Dark grape — sweet and easy when everything tastes metallic.
Watermelon — blitzed and strained. Refreshing on a taste-change day.

Not pineapple, kiwi or fresh paw paw. They won't set.

Creamy milk jelly

The one that does count as protein. Tastes like set custard.

Makes 4 cups · 12–14 g protein each

Ingredients

500 ml full-cream milk
3 tbsp honey
3 tsp powdered gelatine
1 scoop vanilla protein powder
Splash of cream

Method

Warm 150 ml of the milk. Sprinkle gelatine over, bloom 5 minutes, stir until clear.
Whisk the protein powder into the remaining cold milk first, before anything hot goes near it — heat makes it clump.
Combine, add honey and cream, stir.
Small cups. Refrigerate 4 hours.

The one to lean on when chewing isn't possible but the numbers still need hitting.

10Smoothies

The fastest protein in the house, and a full meal replacement on a day when a plate is out of the question.

The base smoothie

Roughly a third of a day's protein in one glass.

Makes 1 large glass · 35–40 g protein

Ingredients

300 ml full-cream milk, or milk and cream for more calories
1 scoop whey or plant blend
200 g Greek yoghurt
1 banana
1 tbsp ground pepitas
1 tbsp honey
Ice

Variations

Chocolate malt — cocoa and malt powder. Best when everything tastes of metal.
Berry — frozen berries, vanilla protein, extra yoghurt.
Green — a handful of baby spinach with banana. Tastes of banana.
Peanut butter — highest calorie of the set.
Oat — 3 tbsp rolled oats blended hard. Thicker and more filling.

Choosing a protein powder

Sealed commercial tubs only. Bulk-bin scooping is out while counts are low.
Avoid greens blends, herbal extracts and mushroom complexes. Not because they're harmful — because nobody can tell you what's interacting with what. Plain whey, plain isolate, or a plain pea and rice blend.
Nothing with added probiotics or live cultures. Live-culture supplements during neutropenia are a genuine bacteraemia risk. Ordinary pasteurised yoghurt is fine.
Whey isolate if dairy sits heavily — lower lactose and gentler on a treatment-affected gut.

11Two supplements worth understanding

Ground pepitas — 2 tbsp daily

Around 20 g of seed, giving roughly 150 mg of magnesium plus zinc, iron and about 6 g of protein.

Magnesium is one of the few supplements with real trial evidence for migraine prevention — it appears in prevention guidelines alongside riboflavin and CoQ10. Headaches arrive from several directions during treatment: the drugs, the antiemetics, dehydration, poor sleep, and the steroid drop-off a few days after each infusion.

How: buy raw, toast lightly, grind in small batches, store the powder in the fridge, and use it within a few days before the oils turn.

No ceiling. Two bowls of porridge means two servings of seeds. Reduce to 1 tbsp if diarrhoea sets in — magnesium in quantity loosens the bowels, which is often welcome given how constipating antiemetics are.

Creatine — 5 g, once a day

The trials testing creatine for muscle mass in cancer patients have come back flat, with no significant benefit over placebo. Where some people report a benefit is mental clarity — creatine is used in the brain as well as muscle, and effects are most consistent when the brain is under load. That question hasn't been settled by trial yet.

If you use it: it holds a baseline rather than rescuing a bad day, and more doesn't help. One dose daily is the ceiling, regardless of how many meals. It also draws water into muscle, so the fluid target needs to be met for it to do anything.

If you take creatine, the team must know — this one matters

Creatine raises the creatinine level in blood. Creatinine is the marker used to assess kidney function, and it's checked before every cycle — particularly with platinum drugs, which are nephrotoxic. Daily dosing keeps that number elevated on every blood draw.

If creatinine comes back raised and nobody knows creatine is being taken, it can be read as kidney injury and cost a cycle that didn't need to be lost.

Say it at every cycle

"I take 5 g of creatine daily."

Don't assume it carried over from last time. Different nurse, different day, different registrar reading the bloods.

12Protein meals

Cook these on the good days and freeze them. The bad days aren't for cooking.

Cheesy egg, spinach and zucchini slice

Cold the next day, warm on the day, eats standing at the bench.

Makes 8 slices · 18–20 g protein each

Ingredients

8 eggs
250 g grated tasty cheese
100 g grated parmesan
2 zucchini, grated and squeezed dry
200 g baby spinach, wilted and squeezed dry
1 onion, diced and softened
200 g cottage cheese or ricotta — adds ~25 g protein across the slice and changes nothing about the taste
½ cup self-raising flour
1 tsp chicken stock powder
Pepper, nutmeg

Method

Oven 180°C. Line a slice tin.
Squeeze the zucchini and spinach properly dry — skip this and it weeps.
Beat the eggs, add everything else, mix.
Into the tin, more cheese on top, 35–40 minutes until set and golden.
Cool fully before cutting or it crumbles.

Keeps 3 days refrigerated. Reheat to steaming hot, not warm.

More protein: 200 g cooked chicken, a tin of drained tuna, or 150 g bacon cooked through.

Smashed baked potatoes with meat sauce

Freezes in portions — double the batch on a good week.

Serves 4 · 45–50 g protein each

The sauce

750 g beef mince, or half beef and half lamb
1 onion, 2 carrots, 2 sticks celery — blitzed to a puree
1 tin baked beans, mashed — thickens it and adds protein and fibre invisibly
1 tin crushed tomatoes
2 tbsp tomato paste
1 tbsp beef stock powder
Bay leaf, oregano, pepper

Method

Bake whole potatoes at 200°C for an hour until soft through.
Onto an oiled tray and squash flat with a masher — about 2 cm thick, edges cracking open. Brush with oil, salt, then 220°C for 20 minutes until crisp.
Brown the mince hard — that's where the flavour is.
Add the pureed vegetables, cook down 10 minutes until the raw smell goes.
Add beans, tomatoes, paste, stock and herbs. Simmer 45 minutes minimum until thick.

To serve: sauce over the potatoes, then a generous spoon of sour cream and a heavy handful of grated cheese while hot. Those aren't garnish — they're calories and protein doing a job.

Creamy potato bake

Reheats well, steaming hot.

Serves 6 · 25 g each, 35 g+ loaded

Ingredients

1.5 kg potatoes, sliced thin
300 ml cream, 200 ml full-cream milk
2 tbsp chicken stock powder
300 g tasty cheese, 100 g parmesan, 100 g mozzarella
2 cloves garlic, crushed
Pepper, nutmeg

Protein additions

400 g shredded cooked chicken between layers
250 g ham or bacon, cooked through
250 g cottage cheese whisked into the cream — disappears completely, adds ~30 g
A scoop of unflavoured protein powder whisked into the cold milk first

Method

Oven 180°C.
Warm the cream, milk, stock powder and garlic together without boiling.
Layer the potatoes in a deep dish with cheese between every layer.
Pour the cream over and press down so everything is submerged.
Foil on, 45 minutes. Foil off, remaining cheese on top, 25–30 minutes until brown and bubbling.
Rest 15 minutes before serving or it runs.

13Eggs and broccoli

Broccoli is worth leaning on — nutrient-dense with no interaction issues at normal food amounts. Cook it properly during the low-count window; no raw florets or raw slaw.

Broccoli, cheese and bacon frittata

Cold the next day makes an excellent breakfast.

Serves 4 · 30 g protein each

Ingredients

10 eggs
1 large head broccoli, cut small, steamed 4 minutes
200 g bacon, cooked through
150 g grated cheese and 50 g parmesan
150 ml cream
1 tsp chicken stock powder, spring onion

Method

Beat the eggs, cream and stock powder. In an ovenproof pan, spread the bacon and broccoli evenly, pour the egg over, cheese on top.

180°C for 25–30 minutes until just set — pull it slightly early, it keeps cooking.

Broccoli and cheese bake

A side dish. How to get broccoli into someone who doesn't want vegetables.

Serves 4 · 15 g protein each

Steamed broccoli in a dish. Melt 200 ml cream, 1 tsp chicken stock powder and 150 g cheese together and pour over. Breadcrumbs and parmesan on top. 180°C for 20 minutes.

Cheesy scrambled eggs

The sore-mouth version. Four minutes, for a morning when nothing else is possible.

Serves 1 · 25 g protein

4 eggs, a splash of cream, 50 g cheese. Low heat, stirred constantly, pulled off while still soft and wet. Salt lightly, no pepper if the mouth is sore. Serve warm rather than hot.

Broccoli and cheese soup

Bad day, blended completely smooth — no pieces when the mouth is sore.

Makes 4 bowls · 12 g each, 30 g boosted

Steam a head of broccoli soft. Blend with 500 ml chicken stock, 200 ml cream, 200 g cheese and a boiled potato to thicken.

To lift it from 12 g to 30 g a serve, whisk a scoop of unflavoured protein powder into a little cold stock and stir it in at the end, off the heat.

Two last things to check

Spinach and warfarin. Not "avoid spinach" — keep the amount steady week to week so INR doesn't swing. Doesn't apply to enoxaparin or apixaban.
Baked beans and vegetable purees are good fibre but can be gassy. Halve them in a week when the gut is already unhappy.