Nutrition Before During and After Cancer

Information on nutritional needs for cancer patients


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Cancer and Altered taste

Taste is a stimulus for appetite.  The most common taste disorder is the distortion of the sense of taste or dysgeusia.  Taste acuity declines with age but people more often  report dysgeusia (distortion of taste) when they experience an abrupt alteration resulting in an overly strong/weak taste. Among the seriously ill, dysgeusia can adversely influence nutrition and quality of life as well as lead to food aversions, distorted smells, and loss of eating pleasure.

Taste

 In cancer, dysguesia is most associated with chemotherapy and radiation; yet there is considerable intra-individual variability regarding the intensity of impact.  Patients with head and neck cancer and those exposed to tyrosine kinase inhibitors or taxane based regimens are most at risk.  Common non-malignancy causes of dysgeusia in the seriously ill include, infections, zinc deficiency, hypothyroidism, Cushing ’s syndrome, liver disease, sequelae from ENT operations, and medications such as psychotropics, opioids, and antihypertensives.

Patients often fail to volunteer symptoms of dysguesia. Hence, patients with cancer or other described risk factors should be routinely asked about distorted smell and taste.

Chemotherapy induced dysgeusia most often resolves within months. However, in that time, it can have a devastating effect. Because eating habits are shaped by life experiences and life experiences are shaped by eating habits, dysgeusia can alter customs within the family unit and lead to a reduction in socialization around meals.

Many with taste alterations try home remedies such as lemon juice, candy before meals, sweet drinks, plastic utensils, drinking from a straw, brushing teeth and tongue before meals, and using salt, soda or antibacterial mouthwashes. There is weak evidence for flavor enhancers (e.g. salt, sugar, monosodium glutamate, monopotassium glutamate) during chemotherapy.

There are a multitude of ineffective drugs: corticosteroids, vitamin A, gabapentin, gingko biloba, glutamine, and amifostine have all been shown to be non-beneficial, other medications may help, however the data are not fully convincing.  A randomized trial demonstrated taste improvement with alpha lipoic acid (available over the counter); however, other studies did not reproduce this finding. Dronabinol at low doses such as 2.5 mg twice daily may improve dysguesia in advanced cancer without improving appetite. Multiple randomized trials of zinc supplementation at doses between 30 to 50 mg three times a day demonstrated a modest improvement in taste acuity and taste quality among individuals undergoing chemotherapy and/or radiation. This benefit was not observed in a non-cancer population.

Patients with taste distortion must try a variety of foods to pick the one that works for them, this time could be used to try various other cuisines that have multiple flavor’s, experimentation is the best option.

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What’s the problem with eating sugar?

sugar-spoon

The federal government’s decision to update food labels marked a change for consumers. For the first time, beginning in 2018, nutrition labels will be required to list a breakdown of both the total sugars and the added sugars in packaged foods.

added-sugar

Why are food labels being revised?

The shift came after years of urging by many nutrition experts, who say that excess sugar is a primary cause of obesity and heart disease. Many in the food industry opposed the emphasis on added sugars, arguing that the focus should be on calories rather than sugar. They say that highlighting added sugar on labels is unscientific, and that the sugar that occurs naturally in foods like fruits and vegetables is essentially no different than the sugar commonly added to packaged foods.

natural-sweeteners

What about “natural” sweeteners?

Food companies like to market agave nectar, beet sugar, evaporated cane juice and many other “natural” sweeteners as healthier alternatives to high-fructose corn syrup. But whatever their source, they are all very similar. To suggest one is healthier than another is a stretch. In fact, the F.D.A. urged food companies to stop using the term evaporated cane juice because it is “false or misleading” and “does not reveal that the ingredient’s basic nature and characterizing properties are those of a sugar.”

 What’s the issue with added sugars?

It mainly comes down to the way they’re packaged.

Naturally occurring sugar is almost always found in foods that contain fiber, which slows the rate at which the sugar is digested and absorbed. (One exception to that rule is honey, which has no fiber.) Fiber also limits the amount of sugar you can consume in one sitting.

sugar-in-nature

A medium apple contains about 19 grams of sugar and four grams of fiber, or roughly 20 percent of a day’s worth of fiber. Not many people would eat three apples at one time. But plenty of children and adults can drink a 16-ounce bottle of Pepsi, which has 55 grams of added sugar – roughly the amount in three medium apples – and no fiber. Fiber not only limits how much you can eat, but how quickly sugar leaves the intestine and reaches the liver.

Why is it a problem to have too much sugar?

Many nutrition experts say that sugar in moderation is fine for most people. But in excess it can lead to metabolic problems beyond its effects on weight gain. The reason, studies suggest, is fructose. Any fructose you eat is sent straight to your liver, which specializes in turning it into droplets of fat called triglycerides.

While many health organizations – including AICR – recommend avoiding sugary drinks, this highlights the powerful affect that cutting out one single part of the diet may have, independent of other healthy changes.

sweet_graphic

A study focused on non-alcoholic fatty liver disease (NAFLD), a condition that can eventually cause cirrhosis and even liver cancer, suggests that a daily sugary drink increases the risk for NAFLD, especially – but not only – among overweight individuals.

Obesity and overweight are key risk factors for NAFLD, when there is extra fat in liver cells not caused by alcohol. AICR’s latest report on liver cancer, found that obesity increases the risk of this cancer. And research currently links sugary beverages to weight gain and obesity.

How much sugar is too much?

One of the largest studies of added sugar consumption, which was led by the Centers for Disease Control and Prevention, found that adults who got more than 15 percent of their daily calories from added sugar had a higher risk of cardiovascular disease. The biggest sources for adults were soft drinks, fruit juices, desserts and candy.

While those might seem like obvious junk foods, about half of the sugar Americans consume is “hidden” in less obvious places like salad dressings, bread, low-fat yogurt and ketchup. In fact, of the 600,000 food items for sale in America, about 80 percent contain added sugar.

 Follow the World Health Organization’s guidelines, which recommend that adults and children consume no more than about six teaspoons daily of added sugar.

too-much-sugar


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Weakened Immune Systems III

Cancer and its treatment can weaken your body’s immune system. As a result, your body cannot fight infection well. While your immune system is recovering, you are advised to avoid being exposed to possible infection-causing germs. This is the third blog in this series.

Cook foods well

cooking thermometer

Put a meat thermometer into the middle of the thickest part of the food to test for doneness. Test a thermometer’s accuracy by putting it into boiling water. It should read 212° F.

Cook meat until it is no longer pink and the juices run clear. The only way to know for sure that the meat has been cooked to the right temperature is to use a food thermometer. Meats should be cooked to 160° F and poultry to 180° F.

Microwave cooking

Rotate the dish a quarter turn once or twice during cooking if there is no turntable in the microwave oven. This helps prevent cold spots in food where bacteria can survive.

Use a lid or vented plastic wrap to thoroughly heat leftovers. Stir often during reheating.

Grocery shopping

sell by date

Check “sell-by” and “use-by” dates. Pick only the freshest products.

Check the packaging date on fresh meats, poultry, and seafood. Do not buy products that are out of date.

Do not use damaged, swollen, rusted, or deeply dented cans. Be sure that packaged and boxed foods are properly sealed.

Choose unblemished fruits and vegetables.

Do not eat deli foods. In the bakery, avoid unrefrigerated cream- and custard-containing desserts and pastries.

Do not eat foods from self-serve or bulk containers.

Do not eat yogurt and ice cream products from soft-serve machines.

Do not eat free food samples.

Get your frozen and refrigerated foods just before you check out at the grocery store, especially during the summer months.

Refrigerate groceries right away. Never leave food in a hot car.