Mesothelioma Nutrition How to maintain a healthy diet during mesothelioma treatment
Table of Contents Eating Well with Cancer 3 Sensory Changes Caused by Therapy That Affect the Patient’s Eating Habits 4 Coping with the Patient’s Changed Eating Habits
6
Using Nutritional Supplements to Treat Cachexia
7
Recipe Resource List 9 Table for Two 10
If you are in mesothelioma treatment, you already know how important a healthy and nutritious diet is to the success of your treatment plan. You also know that eating well while undergoing cancer treatment can be a real struggle. In this book, you will find helpful information on how to keep healthy eating habits while undergoing treatment for malignant mesothelioma cancer. For more information on eating healthy with mesothelioma, we encourage you to visit the blog at http://www.YourMesotheliomaLawFirm.com/blog. To join our mesothelioma community and to share your own tips and ideas, visit our Facebook page at http://www.facebook.com/pages/Your-Mesothelioma-Law-Firm/180164548696218.
YourMesotheliomaLawFirm.com (877) 637-6374
Page 2 of 11
• Eating Well with Cancer A healthy, nutritious diet is important for everybody, but people who are fighting cancer such as mesothelioma often have special dietary needs. When people have cancer, it is important to eat foods that will help them keep up their strength and fight infection during treatment. This can become a challenge when certain cancer treatments lead to the development of eating problems in some patients. If you or someone you love has cancer and is about to begin treatment, or is currently in treatment, this eating guide may be helpful.
Cancer Treatment and Eating Problems A person never knows how cancer treatment will affect his eating habits until he begins that treatment. Many patients have no trouble with eating healthy during cancer treatment, while others may experience some of the following treatment side effects that may make eating a struggle: • Dry mouth and mouth sores • Nausea and vomiting • Constipation or diarrhea • Inability to properly digest foods and absorb all nutrients • Loss of appetite
Preparing to Eat Well During Treatment Fighting cancer is just that: a fight. When a person is undergoing cancer treatment, it is crucial that he fortifies his body with the right foods in order to stay strong and fend off infection. Unfortunately, many cancer treatments make eating difficult for patients, and malnutrition is very common amongst mesothelioma cancer patients. Before beginning cancer treatment, it’s a good idea to prepare for eating well by taking the following steps: • Stock up. Fill your home with healthy foods that you can eat even when you aren’t feeling your best. Also purchase foods that are easy to prepare, such as frozen meals, for when you may not feel well enough to cook. Many patients also prepare meals ahead then freeze them for later use. • Talk to your doctor about your current nutritional habits, to learn whether there are some changes you need to make before beginning treatment. Your doctor may be able to refer you to a dietician, and you may be able to get a list of foods that other cancer patients have found helpful or appealing during treatment. • Build your community of care. Speak with friends and family members about your treatment and how the side effects may affect your nutrition. Perhaps a friend can do your shopping, or can bring meals a few times a week.
YourMesotheliomaLawFirm.com (877) 637-6374
Mesothelioma Nutrition Page 3 of 11
How to Manage Eating Problems during Cancer Treatment During cancer treatment, many patients have “good food days” and bad days. By preparing yourself and your pantry for this possibility, you may make it easier to find foods that you can tolerate during those more difficult days. Here are some other tips to help you keep your body fueled during cancer treatment: • Some days, you may not be able to eat at all. This is normal. If you can’t eat for more than 2 days, however, you need to let your doctor know. When you can’t eat, try to focus on other ways you can make yourself feel better. • Eating lots of protein and calories will should strengthen your body and help to rebuild tissues damaged by cancer treatment • It is very important to keep drinking lots of liquids, especially on those days when you are unable to eat. Many patients find it easier to stay hydrated when they keep a water bottle near them at all times. • On those more difficult days, eat whatever you can. Liquid meal replacements are often an easier way for patients to get some food into their bodies. Even if you just eat a small snack, it is important to eat whenever you are able to.
• Sensory Changes Caused by Therapy That Affect the Patient’s Eating Habits Maintaining good nutrition for mesothelioma patients undergoing radiation or chemotherapy is a complex issue that needs to be addressed from several different perspectives. While it is common knowledge that good nutrition is important to help patients withstand the rigors of treatment, it is difficult for many to do so because of the effect these treatments have the sense of taste and smell. In a study titled Taste and Odor Abnormalities in Cancer Patients published in the March/ April 2009 edition of the Journal of Supportive Oncology, researchers reviewed a variety of existing studies that examined changes to taste and smell in patients receiving cancer treatments. They observed that problems with taste and smell are daily concerns for these patients that can affect their quality of life and possibly lead to malnutrition, or the onset of other medical conditions. The most common problem patients experience is taste acuity, meaning the ability to differentiate between the four different tastes of sweetness, bitterness, sourness and saltiness. In some cases, sensitivity of taste is decreased, but many patients report an increased sensitivity, especially those receiving chemotherapy and radiation. YourMesotheliomaLawFirm.com (877) 637-6374
Mesothelioma Nutrition Page 4 of 11
Bitterness seems to be the taste most significantly affected by treatment. It is especially common in patients who have experienced weight loss. The findings from some studies reviewed by these researchers suggest that an increased sensitivity to bitterness can lead to a loss of appetite, which could possibly lead to malnutrition. Another change in sense perception is taste quality. This usually manifests as a metallic aftertaste, most closely associated with eating red meat. The reason for this is believed to be the high amount of iron compounds in red meat, such as hemoglobin. The researchers noted that studies indicated that 77 percent of patients undergoing chemotherapy with cisplatin alone, the standard of treatment for mesothelioma patients; or cisplatin combined with other chemotherapeutic drugs reported experiencing this metallic aftertaste. Changes in the way food smells is another side effect of both radiation and chemotherapy. Aromas of foods the patient once enjoyed can now be unpleasant or offensive, causing them to avoid them. Avoiding foods can also be the result of an association with nausea or vomiting while undergoing treatment. The researchers reported that this type of food aversion happens to 30 to 55 percent of patients who receive chemotherapy and radiation. It can lead to poor nutrition because the patient does not vary the foods consumed and in the extreme cases, malnutrition. So what can be done to help eliminate some of the problems associated with taste and smell disorders? The researchers suggested that when preparing foods for the patient, you should avoid foods that have been shown to be poorly tolerated, such as: red meat, vegetables, caffeinated drinks, chocolate and foods high in fat content. Instead, use foods like chicken, fish, eggs and cheese. These foods are high in protein but have mild flavors that are well tolerated. Here are some other recommendations they made to help encourage the patient to eat: • Avoid using metallic silverware to decrease the risk of a metallic aftertaste • Add seasonings and spice to enhance flavors, especially in patients with a decreased sensitivity to taste or smell • Serve foods at cold temperatures to reduce unpleasant flavors or aromas • Be sure the patient practices good oral hygiene by frequently brushing their teeth and rinsing with mouthwash to remove any carryover unpleasant tastes • Encourage the patient to chew sugar-free gum or suck on sour-tasting hard candy. These will stimulate saliva secretion, increasing taste perception.
YourMesotheliomaLawFirm.com (877) 637-6374
Mesothelioma Nutrition Page 5 of 11
• Coping with the Patient’s Changed Eating Habits Changes in sense perception are just one part of the problem of poor appetite in patients receiving chemotherapy and radiation. Oftentimes these patients will experience a feeling of being bloated or fullness even though they haven’t really eaten enough to cause these sensations. The reasons for this can be attributed to lack of exercise, which aids in digestion, eating foods that have a high fat content or that produce gas, or digestion irregularities resulting from the food’s inability to properly move through the gastrointestinal tract, which can be a side effect of treatment. There are ways to help alleviate the problem of bloating, such as: • Encouraging the patient to chew foods slowly. This helps delay the feeling of fullness. • Providing them with small meals every 2 to 3 hours instead of the traditional three large ones. • Avoiding food that is deep fat fried, or cooked in heavy oils, a lot of butter or shortening and foods that create gas. • Eliminating high fiber fruits and vegetables from their diet. • Limiting their liquid intake during the meal. • Eliminating carbonated beverages from their diet. Loss of appetite in cancer patients can also be attributed to pain and depression. These can be harder factors to overcome when trying to stimulate appetite. However, there are some things you can do. Encourage the patient to eat larger amounts when they are feeling more upbeat. The increased calorie intake may compensate for decreased appetite when they are not willing to eat. Make meal time more of a fine dining experience with an attractive table setting, good conversation, and relaxing music. If the patient’s doctor approves, you may even provide a glass of wine to stimulate appetite. Here are some other general tips you can try to get the patient to eat more: • Providing snacks throughout the day and at bedtime. These should be high-calorie and high-protein like a milkshake or smoothie, cheese and crackers, or a peanut butter and jelly sandwich. • Engaging the patient to participate in some form of light exercise, like walking, about 15 minutes before eating.
YourMesotheliomaLawFirm.com (877) 637-6374
Mesothelioma Nutrition Page 6 of 11
• Experimenting with the seasonings to find the flavorings that are pleasing to changes in taste resulting from therapy. • Creating more meals around eggs, cold salads with diced chicken or fish or fruit plates with a protein source like cheese. • Tempting appetite by preparing the patient’s favorite foods, especially when they are experiencing diminished appetite. • Adding desserts to meals that contain eggs like custard or rice pudding. • Incorporating prepared foods from the deli counter at the local supermarket into the meal that the patient enjoys. • Stocking pantry items or refrigerated items that can be easily prepared whenever the patient expresses a desire to eat. There are some important things you should avoid as well. Don’t force the patient to try to eat, especially if they are feeling nauseated. Don’t give into the temptation to try fad diets. Many of these have no scientific evidence to substantiate their claims and may even be harmful.
• Using Nutritional Supplements to Treat Cachexia “Cachexia” is a complicated word that describes a complicated medical condition. The simplest definition is the physical wasting away of the patient that leads to weight loss and loss of muscle mass. It usually goes hand-in-hand with anorexia, meaning a significant appetite loss. When a patient is experiencing cachexia, it manifests itself with symptoms that include: weight loss of more than two pounds a week, a visible wasting away of muscles in the arms or legs, loss of strength and general fatigue. It develops because the patient’s protein intake is too low to support the body’s needs. The body will stop at nothing to provide organs and tissues the energy they need to perform their jobs. When a patient stops taking in the necessary amount of protein in the form of calories, which is approximately 1.8 grams of protein per kilogram of body weight daily, then the body will break down muscle to get the amino acids that are necessary to maintain the protein mass of organs and tissues. Those amino acids will also keep blood sugar at the correct level to ensure that organs have energy for future needs. This breakdown process results in the loss of muscle mass. If the body uses 40 percent of the protein reserves inside muscle, then it increases the risk of death from pneumonia infection.
YourMesotheliomaLawFirm.com (877) 637-6374
Mesothelioma Nutrition Page 7 of 11
To prevent this from happening, you can add oral nutritional supplements to the patient’s diet. The critical factor in choosing a supplement is that it not only supports weight gain, but it also increases muscle mass. The first type of supplement that accomplished this is called eicosapentaenoic acid (EPA)-containing supplement. EPA is the omega-3 fatty acid found in fish and fish oil. In a study titled The effect of an oral nutritional supplement enriched with fish oil on weight-loss in patients with pancreatic cancer published online August 13, 1999 in the British Journal of Cancer, researchers showed that 20 patients with pancreatic cancer who were losing an average rate of 2.9 kilograms (approximately six pounds) a month gained an average of 1 kilogram (about two pounds) after three weeks and 2 kilograms (about four pounds) after seven weeks as a result of consuming two cans of a fish oil-enriched nutritional supplement per day in addition to their normal food intake. Just as importantly, their resting energy expenditure per kilogram of lean body mass (muscle), which is the energy taken from muscle to promote organ function, dropped dramatically. The brands of natural supplements that contain EPA include: ProSure manufactured by Abbott Laboratories and Resource 2.0 manufactured by Nestle Nutrition. The other type of supplement that accomplishes the dual role of promoting weight gain and increasing muscle mass is one that has the combination of Bhydroxy-B-methyl butyrate (a byproduct of the amino acid leucine), arginine (an essential amino acid), and glutamine (an essential amino acid). In a study titled Reversal of cancer-related wasting using oral supplementation with a combination of ß-hydroxy-ß-methylbutyrate, arginine, and glutamine published in the April 2002 edition of the American Journal of Surgery, researchers showed that 32 patients with solid cancer tumors (like those found in mesothelioma), who drank two servings daily of this type of supplement gained 2.5 pounds of lean body mass in four weeks in addition to a significant weight gain. The brand of nutritional supplement that contains bhydroxy-B-methyl butyrate, arginine, and glutamine is called Juven manufactured by Abbott Laboratories. There is one important thing to remember before putting the patient on any kind of supplement, and that is talk to their doctor. The patient’s physician will be able to tell you if supplements are right for the patient and if they can help.
YourMesotheliomaLawFirm.com (877) 637-6374
Mesothelioma Nutrition Page 8 of 11
• Recipe Resource List Coming up with new ways to use familiar ingredients isn’t always easy, especially if time is limited. So to help you find interesting ways to prepare foods that are well tolerated by the patient, we have gathered these links to easy, inexpensive recipes that will feed the family:
Tuscan Tuna Sandwich
http://find.myrecipes.com/recipes/recipefinder.dyn?action=displayRecipe&recipe_ id=10000001599585 This recipe from Cooking Light requires no cooking time and yields enough for four sandwiches. You can substitute celery for the fennel bulb.
Pesto Halibut Kebabs
http://find.myrecipes.com/recipes/recipefinder.dyn?action=displayRecipe&recipe_ id=10000001611651 Cooking Light provides this main dish recipe that can be served with rice or couscous. It takes eight minutes to cook and yields dinner for four. You can substitute any firm, white fish for the halibut.
Ham ‘N Cheese Omelet
http://www.backofthebox.com/recipes/eggs-cheese/ham-n-cheese-omelet-g.html This recipe was created by Kraft Foods. It takes minutes to prepare and yields servings for 3-4.
Easy Garden Bake
http://www.backofthebox.com/recipes/eggs-cheese/easy-garden-bake-g.html General Mills created this recipe that takes a few minutes to assemble but takes 35 minutes to bake. It yields enough for six servings. Eggplant can be substituted for the zucchini.
Fig Salad with Goat’s Milk Yogurt and Pepper Cress
http://www.epicurious.com/recipes/food/views/Fig-Salad-with-Goats-Milk-Yogurt-andPepper-Cress-354871 A recipe from Bon Appétit magazine, it provides substitutions for some of the more exotic ingredients. It takes minutes to prepare and yields six servings. If goat cheese isn’t palatable, the recipe works with a mild cheddar cheese.
Waldorf Salad
http://www.epicurious.com/recipes/food/views/Waldorf-Salad-360790 This comes from The Joy of Cooking, 75th Anniversary Edition and takes a few minutes to prepare. It yields four servings.
YourMesotheliomaLawFirm.com (877) 637-6374
Mesothelioma Nutrition Page 9 of 11
Apple Chicken Quesadilla
http://simplyrecipes.com/recipes/apple_chicken_quesadilla/ The recipe, provided by Simply Recipes, is actually created for kids. However, it can be a great adult protein snack or a light lunch. The preparation is simple and its yields 12 quesadilla triangles.
ProSure
http://prosure.com/Recipes/Default.aspx The site provides recipes for creating hot and cold drinks as well as desserts.
• Table for Two Avocado and Pink Grapefruit
http://www.epicurious.com/recipes/food/views/Avocado-and-Pink-Grapefruit-Salad-withCoriander-350397 Bon Appétit magazine created this dish in its test kitchen and it only takes 20 minutes to prepare. The recipe makes a great light lunch, but adding diced chicken or tuna will make it a nice dinner salad.
California Pizza
http://www.pillsbury.com/recipes/california-pizzas/f9ebecd2-b343-4d37-b213b7336b3e94a1/ Pillsbury created this recipe that uses Grands® Frozen Biscuits for a main dish. It takes 30 minutes to prepare.
Cheese Strata
http://www.recipegoldmine.com/cooktwo/cheese-strata.html Recipe Goldmine provided this 40 minute dish that turns bread, eggs and cheese into a main meal. You can substitute other cheeses that melt easily for the American cheese.
Tuna Melt
http://www.recipegoldmine.com/cooktwo/tuna-melts.html This dish provided by Recipe Goldmine has almost no cooking time except for the time needed to heat the filling and melt the cheese.
Pear-Walnut Salad
http://my.hearthealthyonline.com/recipe/salads/pear-walnut-salad/ Heart-Healthy Living created this dish that takes only a short time to prepare. You can substitute apple cider for the pear nectar.
YourMesotheliomaLawFirm.com (877) 637-6374
Mesothelioma Nutrition Page 10 of 11