Nutrition in the battle against cancer

To eat smart when your appetite is zero and your body energy is depleted,is indeed a challenge:

By Jeewanadee Hettiarachchi

Why nutrition for cancer?

Cancer affects patients physiologically as well as psychologically. The metabolic changes associated with rapid cell division in cancer, increase the body's demand for energy while the impact of illness and treatment method diminish the appetite. Cancer-associated loss of appetite can also be due to a psychological response to the disease. However, the consequential inadequacy of energy and nutrients leads the patient towards weight loss and weaknesses.

Proper nutritional care helps the body to be strong and withstand the side effects of the treatment regimen. Patients who receive adequate nourishment during treatment are recorded to have better chances of speedy recovery. In addition, good nutrition restores the immunological functions of the body weakened by the cancer and enhances the response to medication and the ability to fight against infections. Current research evidence suggests a strong association between uncontrolled weight loss and shortened survival in cancer patients.

Undergoing treatments?

Whether it's chemotherapy, radiation therapy, surgery or any other therapeutic method, almost all of them have a considerable impact on one's eating habits and nutrition. Studies show that up to 80% of persons with cancer and going through treatment may become malnourished. This has a serious negative effect on the efficacy and continuance of the treatments.

Though food is important, the million dollar question is how do you manage to eat sufficiently and smoothly with the disturbing side effects of treatment plans.

Managing the big issues!!!

Depending on treatment routine, medication type, tumor or surgery site, and physiological conditions, side effects may vary from patient to patient. However, most commonly observed symptoms with nutritional impact are loss of appetite, nausea, vomiting, taste and smell changes, constipation and diarrhoea. The article focuses to address some of the strategies regarding the management of these commonly observed symptoms.

Loss of appetite is the biggest issue to be handled. It is not necessary for a patient with this symptom to eat all three meals at the proper time of the day. It is better to try eating smaller amounts every 1 -2 hours and to encourage favorite foods for comfort and ability to enjoy eating. When selecting foods, the priority should be given to high calorie foods such as rice, bread, string hoppers, noodles, cakes, puddings, ice creams etc. Try to incorporate more gravies and soups to your meal, they add extra calories as well as taste. Make a habit of snacking throughout the day. Biscuits with butter, hand full of roasted nuts, potato chips are choices for high amount of nutrition from a small amount of food. Surprisingly, foods like salads, vegetables and fruits containing high amounts of water such as cabbage, cucumber, watermelons are to be limited.

Even though they are healthy foods, they make you feel full without adding much energy and nutrients. When you are having problems of eating, the most important is eating to get energy, not what is good to eat. Once the treatment finishes and you are feeling better, you can go back to healthy eating. Similarly, it is better to select liquids containing high amount of calories rather than plain water, plain coffee or plain tea. Sweetened fruit juices and milks are good choices of liquid for patients going through treatments.

Take time and eat slowly. It is better to have the biggest meal when you are most hungry. If possible, it is better to go for a walk before meal since it increases your appetite.

Another frequent complaint is the taste changes, commonly the feeling of a metallic taste in mouth. For the management of this symptom, it is better to use plastic utensils and dining ware instead of metal. Rinsing mouth before and after eating, consumption of cold foods and foods in room temperature, and sucking on candies flavoured with lemon, mints or chewing sweetened gums help to manage the condition for a certain extent. In addition, your meals can be flavoured with spices such as pepper, onion, garlic, ginger, and mustard. Tart flavours like lemons, citrus fruit, vinegar and pickled foods may help, unless you have a sore mouth. Different types of food items and beverages with different flavours can be tried, until your tongue finds comfort with some.

Nausea and vomiting are the most common symptoms identified among all types of cancer patients. This can be managed through several measures. Eating smaller frequent meals, nibbling on dry snacks such as crackers, savoury biscuits, toasted bread and bread sticks and eating frozen fruit pieces such as grapes and apples are some of the choices to overcome the situation. Sucking on flavoured ice cubes (popsicles), hard candies such as peppermint or lemon and rinsing mouth with club soda are some of the alternatives to reduce the nauseating sensation. It is better to avoid foods that are overly sweet, greasy, fried, spicy or having strong odours since they promote the queasiness.

Dine in a pleasant setting where rooms with strong odours and too warm atmospheres are avoided. It is not good to lie down soon after a meal, bed resting is advised at least one hour after eating.

In addition to the above symptoms, constipation and diarrhoea are the other usual disorders reported. Dietary management of constipation can be done via incorporation of fibre rich food items into the diet.

Snacking on fruits and vegetables, nuts and seeds and frequent consumption of liquids (Ex: water, fruit juices, porridges) are some of the strategies that can be used. When selecting fruits go for natural laxatives such as papaw and banana. If you are capable, engage in simple physical activities, it can improve bowel function and relieve constipation.

For the management of diarrhoea, intake of small and frequent meals, avoiding greasy, fried and very sweet foods, and staying away from natural laxatives are recommended. Drinking plenty of non carbonated, caffeine free liquids such as water, sports drinks, and fruit juices helps to prevent from dehydration. Lost ions can be replaced by consuming salty foods and potassium rich foods such as soups, crackers, fruit juices and nectars, and fruits and veggies like bananas and potatoes. Bananas and potato varieties have an ability to reabsorb the excess fluid in stools and hence assist in managing dehydration.

Fatigue and weaknesses due to treatment side effects and illness can be handled with proper energy and nutrient intake. The key to manage this is the balanced diet.

If you are undergoing treatment, you may become immune compromised due to the powerful medications and weaknesses in the body. Hence careful attention should be paid for food safety to prevent diseases associated with bacterial and fungal contamination of food. Prepare foods in clean environments and to minimize the consumption of raw food items like salads. In addition it is better to avoid foods processed with micro organism activity such as curd and yoghurt to avoid possible infections.

The presence and severity of the above discussed symptoms vary from person to person depending on many factors. However, regardless of this variation, you should consume a nutritionally adequate diet in order to ride out the treatment regimen successfully while maintaining an acceptable quality of life.

Patients can benefit from individualized nutrition interventions to ensure adequate nutrition intake and weight maintenance. As mentioned above, proper nutritional care keeps your body strong to handle the side effects of the treatment regimen, while enhancing the efficacy medical care. Hence, nutrition plays a major role in the battle against cancer.

If medication is the sword to attack the enemy, nutrition acts as the shield to defend. So better be armed with both sword and shield to win against the battle!

(The writer is a third-year undergraduate of the Department of Applied Nutrition, Wayamba University of Sri Lanka.