Why do taste buds change during cancer treatment?

Taste changes during cancer can happen for a few reasons, but the biggest culprit is usually cancer treatment.

Chemotherapy and targeted therapies can directly damage taste bud cells and alter the way taste signals are sent to the brain. Radiation therapy, especially for head and neck cancers, can have an even more direct impact because radiation may damage taste buds, salivary glands and soft tissues of the mouth, causing dry mouth and altering overall taste perception. “Many patients say foods start to taste like cardboard, and dry foods such as bread can be especially difficult to eat,” says May.

The type of taste change varies widely from person to person. Some patients experience:

• A metallic taste, especially with certain chemotherapy drugs
• Foods tasting overly salty or overly sweet
• Bitter or unpleasant flavors
• Meat tasting "off" or rancid
• Foods lacking flavor

"Two people can receive the exact same treatment and have completely different experiences," May says.

Why do taste changes matter?

It may seem like a minor inconvenience, but taste changes can have serious consequences.

“When food doesn't taste good, people often lose interest in eating,” says May. “That can lead to reduced appetite, lower calorie intake, weight loss and even malnutrition.”

For cancer patients, nutrition provides the building blocks needed to repair tissues, recover from treatment and maintain strength. When the body isn't getting enough nourishment, recovery becomes harder.

"We want to prevent patients from running on empty," May explains. "If weight loss becomes significant, treatment plans may need to be adjusted. Sometimes treatment doses have to be reduced, delayed or postponed because the body hasn't been able to recover adequately."

Is there a treatment for taste changes?

Unfortunately, there are no medications that reliably fix taste changes.

Instead, the focus turns to finding foods that still taste good to the patient and building from there.

May uses the FASS model, which stands for:

• Fats
• Acidic foods
• Salt and seasonings
• Sweet flavors

"The goal is to first figure out what your taste buds are still responding well to and then enhance those flavors," she says.

How the FASS approach works

If higher-fat foods seem appealing to a patient, May recommends adding oils and nut butters to food: The fat will carry flavor throughout the mouth and add valuable calories.

If acidic foods taste best, a patient should lean into citrus fruits, tart snacks like (lemon) yogurt and vinegar-based dressings or condiments. Marinating meat or tofu in pineapple or orange juice will brighten flavors and make the food more enjoyable.

If foods seem bland, adding herbs and spices can enhance flavor, while adding a small amount of salt to naturally sweet foods, such as melon, can elevate it.

If foods taste bitter, adding sweetness to dishes with maple syrup, honey or fruit preserves can make them more appealing.

"It's all about asking, 'How can we make this taste better?' while also helping patients get the calories and nutrients they need," May says.

What strategies can help patients eat better?

May recommends a few practical approaches that patients can try at home.

Keep a list of foods that taste good

Write down foods that taste good or flavors that seem easier to tolerate and post the list on the refrigerator. "When taste changes are frustrating, it's easy to focus on what isn't working," says May. "Keeping track helps you focus on what is working."

Make foods easier to eat

Texture can matter just as much as flavor. Consider foods that require less chewing, like smoothies, soups and yogurts. “Sometimes, the less time food spends in your mouth, the easier eating feels,” says May.

Try the "Three-Bite Rule"

Many patients notice something unusual: The first few bites taste fine, then suddenly the flavor changes or becomes unpleasant. When that happens, May recommends the "three-bite rule."

Instead of one large serving of a single food, try small portions of several foods, served as a snack board or charcuterie-style plate. A variety of flavors and textures allows you to switch foods before taste fatigue sets in.

Rethink favorite foods

One of the most surprising aspects of treatment-related taste changes is that long-held food preferences may disappear.

"Things people used to love can suddenly taste terrible," May says. "And foods they never liked before can become favorites."

Her advice? Keep an open mind.

“If your usual comfort foods no longer appeal to you, don't be afraid to experiment with new flavors, recipes and ingredients,” says May.

A final thought

Taste changes can be frustrating, but they are also common and manageable. The key is flexibility.

"Don't assume that because something didn't work last week, it won't work this week," May says. "Keep trying different foods and flavors. Sometimes small adjustments can make a big difference."

If taste changes are affecting your appetite or causing weight loss, talk with your care team about setting up an appointment with an oncology dietitian who can identify strategies that keep food enjoyable and nourishing throughout treatment.

Resources

• Cookbook: One Bite at a Timeby Rebecca Katz
• Online Resource: Fred Hutch Cook For Your Life features recipes for Taste Changes.
• Recipes for Managing Metallic or Bitter Flavors: Lemony Berry Parfait and Baked Spiced Chickpeas