Role of diet in cancer, renal failure and Diabetes

Role of diet in cancer, renal failure and Diabetes

Dr. Gangadhar Chatterjee

JR II, MD Biochemistry

GGMC & JJH, Mumbai

GOOD NUTRITION IS IMPORTANT FOR CANCER PATIENTS

Eating habits, good for cancer patients can be very different from the usual healthy eating guidelines.

Cancer can change the way the body uses food

--especially by tumors of the stomach or intestine

Cancer and cancer treatments may affect nutrition

Cancer treatments that affect nutrition include:

Surgery. Chemotherapy. Radiation therapy. Immunotherapy. Stem cell transplant. When the head, neck, esophagus, stomach, or

intestines are affected by the cancer treatment, it is very hard to take in enough nutrients to stay healthy

The side effects of cancer and cancer treatment that can affect eating include: Anorexia (loss of appetite). Mouth sores. Dry mouth. Trouble swallowing. Nausea. Vomiting. Diarrhea. Constipation. Pain. Depression. Anxiety.

ANOREXIA AND CACHEXIA ARE COMMON CAUSES OF MALNUTRITION IN CANCER PATIENTS

may affect taste, smell, appetite, and the ability to eat enough food or absorb the nutrients from food

Eating too little protein and calories is a very common problem for cancer patients.

Anorexia is the most common cause of malnutrition .

It is important to watch for and treat cachexia early in cancer treatment because it is hard to correct.

IT IS IMPORTANT TO TREAT WEIGHT LOSS CAUSED BY CANCER AND ITS TREATMENT

Both nutrition therapy and medicines are required To help increase appetite. To help digest food. To help the muscles of the stomach and intestines

contract (to keep food moving along). To prevent or treat nausea and vomiting. To prevent or treat diarrhea. To prevent or treat constipation. To prevent and treat mouth problems (such as dry

mouth, infection, pain, and sores). To prevent and treat pain.

Screening and assessment may include questions about the following: Weight changes over the past year.

Changes in the amount and type of food eaten compared to what is usual for the patient.

Problems that have affected eating.

Ability to walk and do other activities of daily living.

The goals of nutrition therapy for patients who have advanced cancer include the following: Control side effects.

Lower the risk of infection.

Keep up strength and energy.

Improve or maintain quality of life.

NUTRITION SUPPORT FOR PATIENTS WHO CANNOT EAT CAN BE GIVEN IN DIFFERENT WAYS

Enteral Nutrition

A nasogastric tube inserted through nose, can be kept only for a few weeks.

A gastrostomy tube inserted into the stomach or a jejunostomy tube is inserted into the small intestine, usually used for long-term enteral feeding.

Formula may be given through the tube as a constant drip (continuous feeding) or 1 to 2 cups of formula can be given 3 to 6 times a day (bolus feeding).

PARENTERAL NUTRITION

central venous catheter

peripheral venous catheter

Parenteral nutrition support may continue after the patient leaves the hospital.

Ending parenteral nutrition support must be done under medical supervision.

SURGERY INCREASES THE BODY'S NEED FOR NUTRIENTS AND ENERGY.

needs extra energy and nutrients to heal wounds, fight infection, and recover from surgery. Stay away from carbonated drinks (such as sodas) and foods that cause gas, such as Beans. Peas. Broccoli. Cabbage. Brussels sprouts. Green peppers. Radishes. Cucumbers.

Increase calories by frying foods and using gravies, mayonnaise, and salad dressings.

Choose high-protein and high-calorie foods to increase energy and help wounds heal. Good choices include: Eggs. Cheese. Whole milk. Ice cream. Nuts. Peanut butter. Meat. Poultry. Fish.

If constipation is a problem, increase fiber by small amounts and drink lots of water. Good sources of fiber include: Whole-grain cereals (such as oatmeal and bran). Beans. Vegetables. Fruit. Whole-grain breads.

Chemotherapy may affect nutrition Nutrition supplement drinks between meals. Enteral nutrition (tube feedings). Changes in the diet, such as eating small meals throughout the day.

Nutrition therapy during transplant treatment may include the following: A diet of cooked and processed foods only, because raw

vegetables and fresh fruit may carry harmful bacteria. Guidelines on safe food handling. A specific diet based on the type of transplant and the part of

the body affected by cancer. Parenteral nutrition during the first few weeks after the

transplant, to give the patient the calories, protein, vitamins, minerals, and fluids they need to recover.

TACKLING ANOREXIA Eat small high-protein and high-calorie meals every 1-2 hours instead of three large meals. The following are high-calorie, high-protein food choices: Cheese and crackers.

Muffins. Puddings. Nutritional supplements. Milkshakes. Yogurt. Ice cream. Powdered milk added to foods such as pudding, milkshakes, or any recipe using milk. Finger foods (handy for snacking) such as deviled eggs, deviled ham on crackers, or cream cheese or peanut

butter on crackers or celery. Chocolate.

Add extra calories and protein to food by using butter, skim milk powder, honey, or brown sugar.

Drink liquid supplements (special drinks that have nutrients), soups, milk, juices, shakes, and smoothies, if eating solid food is a problem.

Eat breakfasts that have one third of the calories and protein needed for the day.

TACKLING MOUTH SORES AND INFECTIONS

Eat soft foods that are easy to chew and swallow, such as the following: Soft fruits, including bananas, applesauce, and watermelon. Peach, pear, and apricot nectars. Cottage cheese. Mashed potatoes. Macaroni and cheese. Custards and puddings. Gelatin. Milkshakes. Scrambled eggs. Oatmeal or other cooked cereals.

Stay away from the following : Citrus fruits and juices, (such as oranges, tangerines, lemons, and grapefruit). Spicy or salty foods. Rough, coarse, or dry foods, including raw vegetables, granola, toast, and crackers. Add gravy, broth, or sauces to food. Drink high-calorie, high-protein drinks in addition to meals. Eat foods cold or at room temperature. Hot and warm foods can irritate a tender mouth. Cut foods into small pieces. Use a straw to drink liquids.

FOOD AND DRUG INTERACTIONS

Brand Name Generic Name Food Interactions

Targretin Bexarotene Grapefruit juice may increase the drug's effects.

Folex Methotrexate Alcohol may cause liver damage.

Rheumatrex

Mithracin Plicamycin Supplements of calcium and vitamin D may decrease the drug's effect.

Matulane Procarbazine Alcohol may cause headache, trouble breathing, flushed skin, nausea, or vomiting, Caffeine may raise blood pressure.

Temodar Temozolomide Food may slow or decrease the drug's effect.

DIETARY GUIDELINES MAY HELP PREVENT CANCER

The American Cancer Society and the American Institute for Cancer Research both have dietary guidelines that may help prevent cancer. Eat a plant-based diet, with at least 5 servings of fruit and vegetables

a day. Have several servings a day of beans and grain products (such as cereals, breads, and pasta). Eat less meat.

Eat foods low in fat. Eat foods low in salt. Get to and stay at a healthy weight. Be active for 30 minutes on most days of the week. Drink few alcoholic drinks or don't drink at all. Prepare and store food safely. Do not use tobacco in any form.

CHANGING DIET

KEY CONCEPT recommended diet may change over time, depending

on how much kidney function left.

GFR calculated from the results of creatinine along with age, sex and body size by the physician

If kidney disease progresses and GFR continues to decrease, the amount of protein, calories and other nutrients will be adjusted

If dialysis or a kidney transplant is needed eventually, diet will be based on the treatment option chosen.

DIET IN ACUTE RENAL FAILURE

critical role in the care of patients with acute renal failure

diets with an eye toward the possibility of uremia, metabolic acidosis, fluid and electrolyte imbalances, infection, and tissue destruction

Protein: A low-protein diet (0.5-0.6 grams per

kilogram) is recommended initially If dialysis is initiated, the protein level may be

increased to 1.0-1.5 grams per kilogram per day if necessary to compensate for protein losses in the dialysate.

Calories: Calorie needs are generally elevated (35-50 kilocalories per kilogram) in order to provide positive nitrogen balance under stressful conditions.

calorie needs may be met by providing greater amounts of carbohydrate and fat in the diet.

Sodium and Fluid: Sodium is restricted depending

on urinary excretion, edema, serum sodium levels, and dialysis needs.

During the oliguric phase, sodium may be restricted to 500-1000 milligrams per day.

fluid requirements are based on replacing losses plus approximately 500 milliliters per day.

Potassium: Potassium requirements vary depending on hemodynamic status and the degree of hypermetabolism due to stress, infection, or fever.

High potassium levels are treated by dialysis or with kayexalate, an exchange resin which substitutes sodium for potassium in the gastrointestinal tract.

During the oliguric phase, potassium may be restricted to 1,000 milligrams per day.

DIET IN CHRONIC KIDNEY DISEASE

Hemodialysis Patients should monitor and limit their intake of the following:

• Potassium

• Phosphate

• Sodium

• Fluids

CONTROLLING PHOSPHORUS

In CKD, phosphorus builds up in the blood and may cause many problems including muscle aches and pains, brittle, easily broken bones, calcification of the heart, skin, joints, and blood vessels.

1. Limit high phosphorus foods such as: • Meats, poultry, dairy and fish (should have 1 serving of 7-8 ounces) • Milk and other dairy products like cheese ( should have one 4 oz. serving)

2. Avoid high phosphorus foods such as: • Black Beans, Red Beans, Black eyed Peas, White Beans • Dark, whole or unrefined grains • Refrigerator doughs like Pillsbury • Dried vegetables and fruits • Chocolate • Dark colored sodas 3.take phosphate binders with meals and snacks --phosphate binder which will be some type of polymer gel or calcium medication. 4. Usually diet is limited to 1000 mg of phosphorus per day.

CONTROLLING POTASSIUM

Kidneys that are not functioning properly cannot remove the potassium in the urine, so it builds up in the blood.

High potassium can cause irregular heart beats and can even cause the heart to stop if the potassium levels get to high.

• Usually a renal patient’s diet should be limited to 2000 mg of potassium each day.

• The following foods are high in potassium:

CONTROLLING SODIUM Usually a sodium restriction comes in the form of “No Added Salt.” greater intake of sodium will result in poorly controlled blood pressure and excessive thirst which can lead to difficulty adhering to the fluid restrictions in your diet. • Avoid table salt • Avoid salt substitutes (they contain potassium) • Avoid salty meats such as bacon, ham, sausage, hot dogs, lunchmeats, canned meats, or bologna • Avoid salty snacks such as cheese curls, salted crackers, nuts, and chips • Avoid canned soups, frozen dinners, and instant noodles • Avoid bottled sauces, pickles, olives

CONTROLLING PROTEIN

Protein from food is needed for growth, repair of muscle and tissues, and fighting infection.

Healthy kidneys get rid of the waste product of protein – urea – in the urine.

CONTROLLING FLUID INTAKE

People on dialysis often have

decreased urine output, so

increased fluid in the body can put unnecessary pressure on the person’s heart and lungs.

• A fluid allowance for individual patients is

calculated on the basis of ‘urine plus 500ml.’ The 500 ml covers the loss of fluids through the skin and lungs.

• Between each dialysis treatment, patients are expected to gain a little weight due to the water content in foods (fruits and vegetables). • The amount of fluid in a typical day’s meal (excluding fluids such as water, tea, etc.) is at least 500 ml and therefore expected daily weight gain is between 0.4 – 0.5kg. • To control fluid intake, patients should:

Not drink more than what physician prescribes (usually 4 cups of fluid each day)

Count all foods that will melt at room temperature as fluids

ALCOHOL IN MODERATION

Certain types of alcohol contain more potassium than others. Dietician to be consulted for more details about the types and amounts of alcohol to have per week. Alcohol contains a lot of energy, and no vitamins or minerals. An excessive alcohol intake might result in unnecessary weight gain.

DIABETES DIET

GOALS OF MEDICAL NUTRITION THERAPY THAT APPLY TO ALL PERSONS WITH DIABETES ARE AS FOLLOWS:

1. Attain and maintain optimal metabolic outcomes including ● Blood glucose levels in the normal range or as close to normal as is safely possible to prevent or reduce the risk for complications of diabetes. ● A lipid and lipoprotein profile that reduces the risk for macrovascular disease. ● Blood pressure levels that reduce the risk for vascular disease.

2. Prevent and treat the chronic complications of diabetes. 3. Improve health through healthy food choices and physical activity.

DIET FOR TYPE 1 AND TYPE 2 DIABETES A number of factors influence glycemic responses to foods, including the -amount of carbohydrate -type of sugar (glucose, fructose, sucrose, lactose) -Nature of the starch (amylose, amylopectin, resistant starch) -cooking and food processing (degree of starch gelantinization, particle size, cellular form) Glycemic index. Although low glycemic index diets may reduce postprandial glycemia, the ability of individuals to maintain these diets long-term (and therefore achieve glycemic benefit) has not been established.

Fiber. As for the general population, people with diabetes are encouraged to choose a variety of fiber-containing foods, such as whole grains, fruits, and vegetables. Sweeteners. The available evidence from clinical studies demonstrates that dietary sucrose does not increase glycemia more than isocaloric amounts of starch. Sugar alcohols produce a lower postprandial glucose response than fructose, sucrose, or glucose and have lower available energy values. The use of sugar alcohols appears to be safe; however, they may cause diarrhea, especially in children.

The Food and Drug Administration has approved four non-nutritive sweeteners for use in the U.S.—saccharin, aspartame, acesulfame potassium, and sucralose.

Resistant starch: foods containing naturally occurring resistant starch (cornstarch) or foods modified to contain more resistant starch (high amylose cornstarch) may modify postprandial glycemic response, prevent hypoglycemia, reduce hyperglycemia, and explain differences in the glycemic index of some foods.

RECOMMENDATIONS ● Foods containing carbohydrate from whole grains, fruits, vegetables, and low-fat milk should be included in a healthy diet.

● With regard to the glycemic effects of carbohydrates, the total amount of carbohydrate in meals or snacks is more important than the source or type.

● Non-nutritive sweeteners are safe when consumed within the acceptable daily intake levels

Making the glycemic index easy Fire foods have a high GI, and are low in fiber and protein. They

include “white foods”(white rice, white pasta, white bread, potatoes, most baked goods), sweets, chips, and many processed foods. They should be limited in diet.

Water foods are free foods—means one can eat as much want. They include all vegetables and most types of fruit (fruit juice, dried fruit, and canned fruit packed in syrup spike blood sugar quickly and are not considered water foods).

Coal foods have a low GI and are high in fiber and protein. They include nuts and seeds, lean meats, seafood, whole grains, and beans. They also include “white food” replacements such as brown rice, whole-wheat bread, and whole-wheat pasta.

BE SMART ABOUT SWEETS How to include sweets in a diabetes-friendly diet Hold the bread (or rice or pasta) if dessert to be taken.

Eating sweets at a meal adds extra carbohydrates. Add some healthy fat to dessert. Fat slows down the

digestive process, meaning blood sugar levels don’t spike as quickly. Think healthy fats, such as peanut butter, ricotta cheese, yogurt, or some nuts.

Eat sweets with a meal, rather than as a stand-alone snack.

When to eat dessert, truly savor each bite. Make indulgence count by eating slowly and paying attention to the flavors and textures to enjoy the food and prevent overeating.

CHOOSE FATS WISELY

EAT REGULARLY Eat at regularly set times

Body is better able to regulate blood sugar levels—and weight—when a regular meal schedule is maintained. Aim for moderate and consistent portion sizes for each meal or snack. Don’t skip breakfast. Starting day off with a good breakfast. Eating

breakfast every day will help to have energy as well as steady blood sugar levels.

Eat regular small meals—up to 6 per day. People tend to eat larger portions when they are overly hungry, so eating regularly will help to keep portions in check.

Keep calorie intake the same. Regulating the amount of calories to eat on a day-to-day basis has an impact on the regularity of blood sugar levels. Try to eat roughly the same amount of calories every day.

WHAT ABOUT EXERCISE?

it comes to preventing, controlling, or reversing diabetes

Exercise can help to weight loss efforts, and is especially important in maintaining weight loss. There is also evidence that regular exercise can improve insulin sensitivity even if there is no weight loss

Easiest ways is to start walking for 30 minutes five or more times a week.

swimming, biking, or any other moderate-intensity activities can be tried—meaning to work up a light sweat and start to breathe harder.

DIET IN GESTATIONAL DIABETES MELLITUS

Carbohydrate is distributed throughout the day into three small-to-moderate sized meals and 2–4 snacks. An evening snack may be needed to prevent accelerated

ketosis overnight.

Hypocaloric diets in obese women with gestational diabetes result in ketonemia and ketonuria.

modest energy restriction (30% calorie-restriction of

estimated energy needs) appears to reduce mean blood glucose levels without elevation in plasma free fatty acids or ketonuria.

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