The Wellness Chef’s Assessment on Malnutrition: A Case Study

Betty: 55 y/o female, Stage III Cancer of the Larynx
Treatment: Active Chemotherapy combined with Radiation

Symptom: Nausea/Vomiting – with the use of Cisplatin, but not limited to.

Strategies:

• Hydration: If you are feeling nauseated or actually vomiting, it is so important that you get adequately hydrated. The more dehydrated you get, the worse your symptoms become and the worse you feel. If you are able to take oral hydration that’s great, but if you can’t it may be prudent to go to the hospital to get a few liters of fluid, it doesn’t mean you have to stay in the hospital overnight. When on the chemotherapy drug cisplatin it is very important for you to watch your hydration level to protect kidney function, as Betty is stating her second week on this and kidney toxicity is a possible side effect, but is reversible.

• Liquefied Foods: When foods are in liquefied form, they will pass more readily from the stomach into the small intestine. And in fact, foods that are very solid fibrous foods like, salads, raw fruit, and raw vegetables, even though they are healthy for us, if you are feeling nauseated, these are not the best things for you to be eating in solid form. I advise clients to focus on small multiple meals and use a blender. The blender does the work of your stomach for you.

Another thing that can help with nausea and vomiting is ginger. It is very helpful and often people with these symptoms can tolerate ginger. You can take encapsulated ginger, add fresh ginger root to foods, make ginger tea, candied ginger, add it to smoothies, and suck on ginger lozenges.

Lastly, it is very important to avoid greasy and fat rich foods. The reason why is that for all of us, when we eat greasy and fat rich foods, they take longer to be digested by our stomach. If you are already feeling nauseated, and you eat greasy food, it will sit in your stomach longer, and then our bodies create more stomach acids to help break down the foods, which can lead to heartburn. So it is better to stay away from greasy and fat rich foods despite the fact that they could potentially give you more calories, and eat multiple small meals throughout the day (grazing, if you will).

Symptom: Pain/ Taste and Small Perception/ Swallowing

Strategies:

• There are many causes of pain in patients who have cancer and they stem from multiple things: having undergone surgery, radiation, chemotherapy, a variety of medications, as well as depression. So a loss of appetite, a multitude of digestive symptoms, and a loss of taste and smell perception can be results that will interfere with a patient’s ability of eat.

Taste is really, really important to address as so many patients suffer with taste disturbances. Taste is detected by taste buds located on the tongue and throat. All of the taste qualities (sweet, sour, bitter, and salty) can be sensed by all areas of the tongue.

So what are the causes of taste perception?

Well, not only can you get injury to the taste buds as a result of therapy, but you can also have reduced saliva production.

If you don’t have enough saliva, you are not able to push the food and flavors around on your taste buds and saliva is very important for the dissemination of flavors around your tongue so that they can be detected. In addition, saliva contains compament which is something your immune system uses to fight bacterial infections, if there is insufficient amounts, you may be at risk of getting infections in your mouth which also will impair your taste. If you have oral ulcers or sinus issues this will also affect your sense of smell, as smell is one of our senses that affect how we perceive taste.

The good news is that taste and smell receptors proliferate every 10 to 30 days respectively, so the chances of recovery are good.

Dietary strategies include:

• Including citrus enhanced foods, lemon being at the top of the list, as citrus stimulates saliva production and is an astringent that will help to keep bacteria at bay. (Not in direct contact with the mouth, rather incorporated into foods, just prior to consumption).
• A diet low in fat and high in fruits (including tomatoes) and vegetables.
• Omega-3 fatty acids found in fish, berries, mushrooms and Brussels sprouts.
• Fiber containing foods, legumes and soy –  (1 SERVING PER DAY)
• Foods containing beta-carotene (sweet potatoes, kale, carrots, turnip, mustard, collard greens, spinach, dark leaf lettuces, butternut squash, dried herbs – basil, parsley, marjoram, oregano, sage, coriander, thyme).
• Try to avoid spicy foods, as they can often cause pain.
• Let’s not forget about proteins, as they are important to help regenerate, rebalance and rebuild your body on the outside as well as within. Protein rich foods will help to heal your skin that may have been damaged during radiation therapy. Good proteins to include in your diet are – fish, chicken, beans, eggs, and low fat cheeses, that contain vitamin C and zinc.

Symptom: Swelling/ Inflammation/ Bloating/ Decreased Appetite/ Stomach Fullness

Strategies:

Bloating is the sense of fullness or stomach distention that typically is experienced after eating a meal. So let’s take a look at some of the causes of bloating.

• One cause of bloating and decreased appetite is delayed emptying of the stomach, which affects many patients. What does this mean? Well in plain and practical language it means that you cannot empty your stomach as promptly as you as you normally did. And as a result, as you go to eat a meal, often some of the food that you ate at your last meal is still sitting in your stomach. Food should be cleared from our stomach with 4 hours after we eat. But this case, you may still have food in your stomach from 4 hour earlier. So in this case you would want to stay away from whole form, fibrous foods because they are much harder for the stomach to process and push into the intestine. (Using a blender will help to break down the fiber and do the work of the stomach for you).

• Other causes of bloating are that you develop an inability to digest certain carbohydrates, like lactose (which is the main sugar or carbohydrate found in milk). So if you were never lactose intolerant before, you may become lactose intolerant in the course of going through therapy. The reason why is that you may not produce the enzyme in your small intestine that you need to digest lactose properly (lactase).

• Next, you might develop deficiencies in pancreatic enzymes. This can be a result of an inflammation of the pancreas, which can be a result of radiation, surgery, or even chemotherapy. This is really important for your doctor to assess because collectively we can help someone with these issues. On The Wellness Chef’s end, we advise patients who are actively undergoing therapy, and even in the weeks to months afterwards, that they go on a lactose free diet, because after ingesting lactose it may exacerbate their bloating and perhaps give them diarrhea, until their small intestine has the chance to recover.

• Fructose Intolerance is another malabsorption that can occur. Our intestines can only handle a small amount of fructose each day, so minimizing your intake of sweetened beverages, soft drinks (bubbles have to go up or down), desserts, candies, etc. may help to reduce bloating and gassiness.

• Gassy Vegetables: Some of the healthy vegetables that we consume contain a starch called Raffinose. Sometimes we have a hard time digesting it because we lack the enzyme called Galac-to-si-dase which helps to break raffinose down. So a few tricks we can use are: add 1/8th of a teaspoon of baking soda when you are soaking your dried beans in water, as it will draw out the raffinose. Always discard the water that your beans have been soaking in because the raffinose is in the water. Similarly, if you use canned beans, you want to rinse and drain them, because they have been floating in that fluid in the jar or can. Other vegetables to monitor consumption with are Brussels sprouts, peppers, cabbage and asparagus.

Symptom: Fatigue

Strategies:

• Again, there are many causes of fatigue in patients who have cancer and they stem from multiple things. One that often occurs is reduced energy intake, or simply: the patient is just not eating. This is also known as increased resting energy. Just as you are sitting here, you are burning a certain number of calories, but with cancer patients, they actually burn more calories at rest than someone who does not have cancer. This is a result of the kinds of chemicals your body is producing to try to fight the tumor. As a result, because your body is producing these chemicals it leads to increased breakdown of protein and fat. So it is very important to consume clean proteins and fats with medium levels of purines (the building blocks of DNA and RNA) like chicken, fish, beans, eggs to increase energy levels.

Symptom: High blood pressure/ High cholesterol

Strategies:

It is important to distinguish between serum cholesterol and dietary cholesterol. Serum cholesterol is the cholesterol in the bloodstream. Dietary cholesterol is the cholesterol found in food. While eating foods high in dietary cholesterol can raise serum cholesterol, it is not the only source of serum cholesterol. The body produces its own serum cholesterol.

• For individuals diagnosed with high serum cholesterol, we recommend consuming cholesterol lowering foods in your diet, such as: apples, bananas, carrots, fish, dried beans, grapefruit and olive oil, whole grains, barley, brown rice, oats, and oat bran.
• Drink plenty of fresh juices, especially carrot, celery, and beet. These help to flush out the bile in the liver and help lower cholesterol.
• Only eat raw, unsalted walnuts and almonds. Almonds are rich in the amino acid Arginine.
• Most meat and dairy products are the primary sources of dietary cholesterol. Vegetables and fruits are cholesterol free. So it is important to consume meat, oils and fat, and dairy on a minimal basis (caution foods), especially heated fats, or processed oils, pork products and fried, fatty foods.
• Avoid alcohol, cakes, candy, carbonated drinks, coffee, gravies, non-dairy creamers, processed or refined foods.
• Follow a salt-free diet, which is essential for lowering blood pressure. Lowering your salt intake is not enough, eliminate all added salt from your diet.
• Avoid all aged cheeses, aged meats, anchovies, chocolate, fava beans, pickled herring, sour cream, and yogurt.

Symptom: Arthritis

Strategies:

Arthritis is the inflammation of one or more joints.

• Eat more sulfur containing foods such as asparagus, eggs, garlic, and onions. Sulfur is needed for the repair and rebuilding of bone, cartilage,  and connective tissue, and it also aids in the absorption of calcium. Other beneficial foods include fresh vegetables (especially leafy greens that supply vitamin K), non-acidic fresh fruits, whole grains, oatmeal, brown rice, fish, soy products (1 serving daily), and avocados. Also tart red cherries can relieve pain and inflammation due to arthritis. Eat about 20 cherries each day either fresh or frozen.
• Eat fresh pineapple frequently. Bromelain, an enzyme found in pineapple, is excellent for reducing inflammation associated with arthritis.
• Reduce the amount of fat, milk, dairy products, red meat, caffeine, paprika, salt and added sugars.
• Avoid nightshade vegetables (peppers, eggplant, tomatoes, white potatoes). These foods contain a substance called solanine, which interferes with enzymes in the muscles, and may cause pain and discomfort.
• Food allergies like gluten intolerance, lactose and fructose intolerance may be the cause of inflammation and swelling.

Symptom: Overweight

Strategy:

With the correct combination and types of carbohydrates, proteins, and fats your body will begin to level-out at a proper weight over time; this is the healthy way to lose weight.

Symptom: Heartburn and Gas

Strategy:

With the elimination of fatty and greasy foods, this will help with reducing the amount of acid in the stomach and help to rid the stomach of food more rapidly.

Have friends over to get involved with both of your diets and help with preparation of foods. Choose restaurants that prepare whole foods and ask them to put all sauces in separate containers.