Liquid Nutritional Supplement

Encouraged to eat ...

By: Lim Wey Wen

I USED to think that the habit of dishing out dietary advice to people who are ill was an Asian one, because every time we fell sick, we would receive advice on foods to take or avoid to get well. Such advice are particularly common for those living with cancer, as the link between diet and cancer often leads to speculation about what special dietary measures can do to the cancer.

"There are lots of pantang - taboos or restrictions people with cancer hear from their relatives, neighbours and friends - that do not come from the medical profession," says president of the Malaysian Oncological Society Datuk Dr Mohamed Ibrahim Abdul Wahid at the launch of ProSure, Abbott's therapeutic nutrition drink for cancer patients.

"Many people have their friends and relatives tell them 'don't eat this, don't eat that', or 'eat this, eat that'. They get confused, and they turn to the Internet. But the problem is that a lot of the information available on the Net is not regulated," he says.

The problem is universal, says Dr Isabel Correia, assistant professor of surgery at the Federal University of Minas Gerais in Brazil. "In Brazil, cancer patients are told the same," she adds.

But these unfounded beliefs can be harmful, particularly when it results in extreme dietary restrictions and excessive weight loss. "Information from different literature shows that about 20% of cancer deaths are not due to the cancer itself, but rather, due to weight loss," says Dr Correia. "So, if the patients do not lose so much weight, they would probably live longer."

That is why oncologists like Datuk Ibrahim are now paying more attention to the nutritional status of their patients. "Many doctors don't realise that nutrition is one of the most important areas in cancer treatment. Now, the first thing we talk about is diet, even before treatment."

Cancer: the changes

When we have cancer, our bodies have cells that are replicating very fast and burning up more calories than usual. And when the body's immune system catches up with the cancer cells, it will try to get rid of them by producing an inflammatory response, leading to poor appetite and fatigue.

It's like having a cold (which is an acute inflammation). Our bodies use energy to fight the infection, leaving us feeling tired and with no desire to eat. If we have cancer, this feeling may last for much longer, as long as the cancer cells are still actively replicating in our bodies.

For some types of cancer, particularly those that affect the digestive tract (the mouth, throat, oesophagus, stomach and gut), eating may be painful and the absorption of food may be affected. At the same time, some tumours also secrete proteolysis-inducing factors, which break down protein in the body.

What happens then is the body has increased demands for calories to burn, and does not get enough supply because we do not eat enough or do not absorb nutrients very well. It then looks within itself for fuel to burn, which it will find in body fat stores (adipose tissues) and in later stages, muscles.

So, what we have in the end, is cachexia - the progressive physical wasting of our bodies characterised by the loss of weight, muscle mass and body fat.

"In fact, about one-third of cancer patients lose more than 5% of their usual weight. At the end, most of them lose too much," says Dr Correia. This is because when we lose muscles, other complications may arise.

"When we breathe, we depend on respiratory muscles and our diaphragm (a sheet of muscle extending across the bottom of the rib cage). If these muscles get weakened, we don't get muscles to help us breathe," she says.

Sneezing or coughing to remove bugs, dust or mucous in our airways will also become difficult, and it may result in infections we could die from.

Another muscle that could be affected is the heart. "The heart is a big muscle," Dr Correia explains. "So, if we lose muscle, we also lose heart muscle. The heart then becomes weak and does not beat adequately. Again, we are at a higher risk of mortality," she adds.

Food: The fuel to cope with cancer

To prevent cancer, the second expert report by the World Cancer Research Fund (WCRF) recommends that we be as lean as possible without becoming underweight. But, what if the newly diagnosed patient is grossly overweight?

Dr Ibrahim says that while losing some weight is good for such people, he does not encourage a drastic weight loss. "If a patient has problems swallowing and could not eat, we still have to give him liquid supplements, even when he is overweight. This is because he needs to eat," he says.

"The problem is that some patients starve themselves because they think that by eating too much they will give their bodies too much sugar, and that will in turn feed the cancer. But they forget that we need sugar to survive, because glucose (in sugar) gives us energy and is food for our brains."

As he recalled the case of his patient who lost 20kg in half a month after being diagnosed with nasopharyngeal cancer, he explains the danger of such weight loss. "It was not the cancer which made him lose weight, but he thought he could starve the cancer to death. He felt weak and had no energy to go for treatment. I referred him to a nutritionist for counselling."

According to Dr Ibrahim, a patient's nutritional status and weight is a good predictor of his or her prognosis. "To check whether they are doing well, you don't need a CT scan or even an MRI. Just put them on a weighing scale," he says.

But, even though weight loss is inevitable in cancer and some even experience cachexia, some control weight loss better than others. "Patients who maintain or gain weight (within the normal range) increase their chances of doing well," says Dr Ibrahim.

While this is not the cue for us to start forcing cancer patients to eat, it indicates that drastic dietary changes that further affect patients' appetite often do not help - even if their diets before diagnosis is not very healthy.

"This is the only time I tell my patients: 'don't change your eating habits'," says Dr Correia. "Because they have been eating badly all their lives, how can I teach them how to eat well, and eat food they do not like when they are sick?" she asked.

"This is the time to stimulate the patient to eat whatever he can, even if it's junk food," she adds. So, instead of trying to change her patients' dietary habits, she tries to encourage them to eat the food they like and supplement them with low-fat, good quality protein that is rich in vitamins and fibre.

Even then, Dr Ibrahim emphasises a well-balanced diet. "You must eat enough protein, carbohydrate, fat, and everything else in proportion - not changing your diet from a reasonably balanced diet to an unbalanced diet, which is often only vegetables and fruits - with lots of calcium and vitamin B (supplements)," he explains.

Tips to keep patients nourished

How do we encourage patients to eat? The US National Cancer Institute (NCI) has the following suggestions.

If they lack appetite, encouraging them to eat small high-protein and high-calorie meals every one to two hours (instead of three larger meals per day) may help.

Liquid supplements (that contain nutrients), soups, milk, juices, shakes and smoothies can also help when eating solid food is a problem.

We can even consider storing small portions of their favourite foods so they would be ready to eat when they are hungry.

Small details, like preparing foods with odours that are appealing, trying new foods and being creative with desserts could also increase their appetite for food.

If nausea has become a problem, we could encourage them to eat before cancer treatments, avoid foods or smells that make them throw up, and ask them to sit up or lie with the upper body raised for one hour after eating.

For taste changes, they could rinse their mouths with water before eating, try citrus fruits (unless mouth sores are present) and use sugar-free lemon drops, gums or mints if there is a metallic or bitter taste in the mouth.

With simple measures such as keeping water handy and eating moist foods with extra sauces or gravy, they could also alleviate dry mouth, which can be a result of some medications and radiation therapy to the head and neck.

And those are just some of the many suggestions we could find at the NCI website (www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/Patient).

"The more malnourished the patient is, the more nauseated he usually is. And many of the drug-related side-effects are worsened by the patient's (poor) nutritional status," says Dr Correia.

Therefore, it is important for us to include good nutrition as part of cancer treatment plans. It may not cure us of cancer, but it will help us get all the energy we need to survive, reap the benefits of treatment and improve our quality of life. -The Star/ANN


Taking Liquid Nutritional Supplement has faster advantage, than taking non-liquid supplement.