The importance of diet and nutrition in cancer patients

Starve a cold, feed a fever.  Eat a balanced diet, don’t overeat, he is so thin he should fatten up before he wastes away, avoid junk food, she needs to keep her weight down. Our society is obsessed with food and food advice, and nowhere is that more true than when dealing with cancer.

Nearly 100% of the time when an oncologist sees a new patient, they are asked about nutrition.  This is a natural extension of the rest of life since from the time of birth the drive to feed our children is an expression of protection and love.  Every meal delivers not only food, but emotional commitment and support, often cooked with a slice of advice, inquiry and correction.

As we age meals provide not only sustenance for the body but give us the chance to share precious moments and experience.  Whether a backyard picnic, a wedding feast or the Thanksgiving turkey, it is no just about calories; Food is part of our bond to each other.  Finally, as we age, and when we are ill, food is a vehicle to mend both body and soul.

Part of the diet conversation with the doctor has to do with personal control and the desire to do everything to stop the cancer.  There is a common belief that certain diets kill cancer. Therefore, we turn to something we can change, what we eat.

Gurus recommend less sugar, more vitamins, less carbs, more or less protein, vegetarian, macrobiotic or purging dietary plans.  Liquefied asparagus, Kelp, algae, mushrooms and complex organic brews promise to clean out the cancer, if we can swallow them down. These ideas bombard us and patients or families desperate to turn every stone are tempted to make radical changes in consumption.

A basic biologic concept is in order; Cancer is the out of control growth that occurs when one of our own cells starts to divide.  It starts to divide because of genetic damage. This damage may occur because of heredity, outside injury (i.e. smoking, chemicals or radiation) or just as a matter of age. The genetic mutation happens years before the cancer is evident.  Once that genetic injury occurs the cancer cell is on autopilot and does not require any outside stimulation to grow.  The damaged genetic switch controls the cell’s growth and it will not stop.

The key statement above is in italics …. Our own cells.  It is not foreign; it was originally an important and healthy part of us.  That means that a cancer cell eats what we eat, needs the exact same sugars, protein, fats and vitamins as every other cell in our bodies and has no special nutritional needs.  It is not possible to artificially change one’s diet so radically that a cancer will stop growing, unless we literally starve the patient to death.  Therefore, the goal of nutrition during cancer care cannot be to directly attack the cancer.  That approach will fail.

None-the-less proper nutrition during cancer care is vital.  Malignancy and treatment can significantly affect both the ability to eat and the body’s nutritional needs.  Maintaining adequate protein, calorie, fat, vitamin and fluid intake is vital for healing and for tolerating therapy.  For the average cancer patient who has a treatable or curable condition, the focus of nutritional need is not around directly defeating the cancer, but around maintaining the individual so that their body and the treatment itself can succeed.

Discussions of diet are important to have with the oncologist and often with a nutritionist.  The key is to find a diet that the patient can ingest easily, whether just because it is familiar or because easy to swallow and digest.  If the patient cannot eat because of physical problems, such as pain on swallowing or nausea from chemotherapy, than focus on fixing or working around those problems.  Loss of appetite can often be addressed and if needed medications can be used to stimulate eating.

Experimentation is needed by changing texture, food type, and temperature, perhaps with different soups, vegetables, meats or pasta. The answer may be to eat multiple small meals or nutrient dense foods. Many patients find juicing an excellent technique to take in natural foods in an easy to consume way.  In extreme situations, it may be advisable to provide nutritional support via tube feeding or even by intravenous alimentation. Experimentation is important, as is communication with the health care staff.

People have been successfully eating for millions of years and thus the body knows what it needs.  Often during cancer care certain foods will take on a noxious flavor. This is the body saying, “No, I do not need or want that.”  Other times there may be odd cravings.  Within reason, listen to those desires.  The body is trying to heal.

After a patient has survived a battle with cancer, nutrition is important to rebuild and prevent cancer recurrence.  A recent article in the Journal of the American Dietetic Association supported diets high in fruit, vegetables, whole grains and fish, noting increased cancer recurrence from diets based on refined grains, red meats, desserts and high-fat dairy products. The article also emphasized exercise in preventing new disease in cancer survivors.  With 12 million American cancer survivors it is time to focus on their long-term health and diet is certainly part of that prescription.

Complex manipulations of diet in a cancer patient cannot slow or kill the disease.  Our goal should be to support basic nutritional needs to help the patient maintain strength, immune function and healing.  The wonderful part of this natural nutritional remedy is that we can achieve health benefits not only by what we cook, but because we serve it with a giant helping of love.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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