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Ways of Improving Nutrition During Cancer Therapy
Ernest H. Rosenbaum, MD

Nutrition Advice
Antioxidant Supplements

Nutrition Advice
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Nutrition is a vital component of cancer treatment, as patients who are malnourished have increased side effects from cancer therapy, with decreased energy, fatigue, slower healing and recovery, and may have a decreased immune system.

Controlling the side effects of nausea, vomiting, loss of appetite, diarrhea, constipation and mucositis are common problems following cancer therapy in many patients. Appropriate advice on how to improve nutrition is very helpful and requires patient acceptance and adaptation. These include improving caloric and protein intake during and after therapy, such as maintaining a healthy weight.

There are many tricks that can be helpful:
1. Eating smaller feedings more frequently. Often eating four to six times a day is more successful than larger meals.
2. Eating frequently, especially when hungry, with snacks and calorie and protein-dense foods. Snacks are very helpful, including caloric protein-dense nutritious foods and supplementary drinks, enriching malts with powdered protein, ice cream, using snacks with cheese or granola bars and nuts. Carnation Instant Breakfast provides a cheaper way for extra calories and protein and should be enriched with ice cream, powdered milk, etc.
3. There are two actions that help promote better nutrient absorption. The first is not dining alone, but dining with friends and relatives. Secondly, chewing slower and longer helps promote digestion and nutrient absorption.
4. The visual presentation of meals with a brighter set of napkins, plates, and using visual colors promote better appetite.
5. Sometimes patients have problems using knives and forks, and often, finger foods with sandwiches, burritos, and snacks can help promote better nutrition.
6. A daily vitamin supplement with vitamin D (400-2000 IU) and B12 (25 mcg) can be very supportive to better nutrition.

In general, for people over age 70, fewer calories may be needed, as they are exercising less, but at the same time for cancer treatment, one should increase both calories and protein, as the need is greater, especially during cancer treatment.

Your eating patterns will vary, depending on your therapy, how you feel, and the effects of cancer on your body. On good days, you can promote improved nutrition, allowing reductions on bad days.

A recent report from the American Heart Association, 2007, showed that those who ate whole-grain breakfast cereals (at least 25% oat from bran content was classified as whole-grain cereals) had a 28% lower risk of heart failure. (Luc Djousse, Brigham and Women's Hospital.)

Antioxidant Supplements
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The vitamin and supplement industry - 2005 report - noted that Americans spend $23 billion per year.

Recent reports in JAMA 2007 noted that people taking vitamins and supplements instead of boosting their immune systems and preventing disease, the antioxidant supplements actually increased risk of death. This included vitamin E, vitamin A, and beta-carotene supplements. Vitamin C was not implicated (no effect), and there was a small decrease in mortality from selenium.

Obviously there is going to be a lot of comments about the JAMA report, and this debate will go on for some time.

It is important that you get enough antioxidants in your diet:
1. Beta-carotene: carrots, pumpkin, cantaloupe, squash, sweet potatoes, broccoli, tomatoes, kale, collards, peaches and apricots.
2. Vitamin C: citrus fruits, oranges, strawberries, bell peppers, broccoli, kale, cauliflower and tomatoes.
3. Vitamin E: fortified cereals, sunflower seeds, almonds, sunflower oil, hazel nuts, tomato sauce, peanut butter, wheat germ, avocado.
4. Selenium: seafood, lean meat, poultry, whole grains, garlic, eggs, and low-fat dairy.

Antioxidants are believed to be scavengers of free radicals- natural byproducts of the body's use of oxygen. About 160 million people in North America and Europe are using supplements.

Beta-carotene, vitamins C and E, zinc and copper may help in prevention of macular degeneration.

Of note is that ginkgo biloba (an herbal supplement) has failed in trials and has no major effect on older people with dementia.

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