Refresher Course: Nutritional Imbalance in Cancer Patients

On Monday and Tuesday was held at the State Cancer Institute, the first refresher course 'Nutritional Imbalance in Cancer Patients', which was full of very interesting lectures.

The course consisted of various topics, such as:

• Feeding tubes.
• Care and handling of the feeding tubes.
• Chemotherapy toxicity.
• Nutrition in children with stress.
• Toxicity of drugs in the pediatric area.
• Radiation toxicity.
• Immunonutrition in cancer patients.
• Oncological surgery and nutritional risk.
• Assessment of nutritional status in cancer patients.

For me the course was incredible, I liked all the topics, but the one that caught my attention was Immunonutrition.

This conference speaks of the use of various nutrients that can improve the health of patients with cancer and was also motivational for the area of nutrition. These nutrients include:

• Glutamine: It's the preferred energy substrate for cells with high proliferative capacity, such as intestinal epithelial cells, the immune system, the renal tubule and erythrocytes. Which they're damaged by chemotherapy and radiotherapy.
• Arginine: It has cytotoxic effects (expels various pathogenic microorganisms), and cytostatic (inhibit the growth of microorganisms). And generates nitric oxide also has tumoricidal function may eliminate tumor cells.
• Omega 3: It has an anti-inflammatory effect and stimulates the immune system function.
• Probiotics: They favor the formation of intestinal microbiota and is a trophic stimulation of gastrointestinal mucosa.

The immunonutrients are added to a complete diet, and depending on the patient can be supplied enteral, parenteral or oral.

A complicated patient

Today at the State Cancer Institute became a a young patient (28 years old) diagnosed with testicular cancer and metastases in the central nervous system. 

The patient is undergoing chemotherapy and being evaluated by a doctor for radiotherapy, also he presented cachexia and weakness on the right side of the body, so it couldn't move or walk.

Therefore, we applied a medical history and nutritional value to determine his energy needs. We consider a nutritional support for the patient, because in this stage of the disease, he need a comfort diet more than a strict food plan.

We put on the patient diet plan foods that he likes and care that food consistencies were soft to avoid fatigue, in addition we recommended a protein module to prevent loss of strength and muscle mass.

I think it was a good decision because we're applying the principles of palliative care (palliative care is care given to improve the quality of life of patients who have a serious disease), which should start from the moment that the patient gets into the health unit (at any age and stage of disease) and not when he or she is in the final stage of the disease.

Also remember that palliative care should be provided by a specialized team of doctors, nurses, nutritionists, psychologists, social workers and other specialists.

"Palliative care is given throughout a patient’s experience with cancer. It should begin at diagnosis and continue through treatment, follow-up care, and the end of life."

Hypothyroidism diet

Last Wednesday a patient went to the State Cancer Institute, she had a diagnosis of Birads IV and hypothyroidism. So I had to review the recommendations for patients with hypothyroidism again.

It is important to say that there is no same diet for each patient, even though they have the same condition characteristics are different.

The general recommendations are:

• Eating foods rich in fiber: They help control weight and reduce insulin levels, which are altered in patients.
• Eating foods rich in selenium: They help in hormonal control.
• Eating foods rich in iodine: They help in hormonal control and the proper functioning of the thyroid.

You should avoid certain foods known as goitrogens. These foods interfere with the absorption of iodine and thyroid function.

 Nutritional deficiencies

These weeks I have been studying for my exam, which I consider important to emphasize the role of vitamins and minerals in nutrition.

Nutritional deficiencies are the result of your body not getting enough of the nutrients it needs, mainly those from fruits and vegetables (they're rich in vitamins, minerals, fiber and water that are important for development and preventing disease).

The lack of these nutrients our body manifests different signs and symptoms like problems of digestion, skin problems, damage to major organs and even neurological problems, that make our body doesn't look good. Children are more at risk for complications than adults.

The picture shows the damage that can cause deficiencies of vitamins and minerals in our body:

You can prevent nutritional deficiencies by making sure you get enough nutrients from your diet. Always remember that your plate of food should look like the image:

Enteral Nutrition

I had the opportunity to attend the 2nd. Congress of Clinical Gastronomy and Nutrition, there was a conference about some features that have been updated within nutrition, especially enteral nutrition.

First of all, it's important to define what is enteral nutrition?. Enteral nutrition or tube feeding refers to the delivery of a nutritionally complete feed (with food that contains protein, carbohydrate, fat, water, minerals and vitamins according to patient needs) directly into your stomach or small intestine.

Enteral nutrition can be given through different types of tubes. You can use different connections, devices and other materials. The main problem is that these tubes and materials could be mistaken for medical use, causing infections and health problems in the patient. So in the congress it mentioned that the new material for enteral nutrition will be in accordance with an international color code. The violet color should be used to avoid confusion in the hospital. I think this is a great initiative that gives nutrition the attention it truly deserves in the treatment of patients.

Probiotic yoghurt vs. Common yoghurt

These days I read some articles that talk about the benefits of yoghurt. The probiotic yoghurt is any yoghurt with live active bacteria (they're of various types like Lactobacillus or Bifidobacterium, which are considered beneficial to the body), which means that the more natural yoghurt is a probiotic food. All yoghurts contain a certain amount of bacteria, yoghurts sold as "probiotic yogurt" contain higher amounts of beneficial bacteria (It's because some companies select some bacteria that are more likely to survive digestion).

These bacteria have been shown to reduce the effects of some gastrointestinal problems, prevent colon cancer and can reduce lactose intolerance. In addition,  it's a natural immune system booster, so it's very common drink them to improve overall health and prevent certain diseases.

However, the yoghurt in some people can cause side effects such as gas, bloating and over-stimulation of the immune system.

The medical and scientific community mentions that products labeled as probiotic yogurt aren't necessarily better. So, you can select the yoghurt that you have on hand, but taking care that it doesn't have high levels of sweeteners such as high fructose corn syrup or sugar.

Milk consumption and cancer

During this week I searched articles related to milk consumption in patients with cancer. I think that "milk" is a very controversial topic because there are articles that mention that milk is a food that prevents cancer and a rich source of energy, protein, calcium and vitamin D, which are essential nutrients for patients who already have cancer, other articles say that milk shouldn't be consumed because it generates metastasis, increases symptoms and can cause disease recurrence.

The main problem is that we now live in a highly industrialized world where cows are injected with hormones to increase milk production. Companies are using recombinant growth hormones in cows. This hormone can increase milk production by 20%. According to WHO, the injection of this hormone increases the concentration of IGF-1 (insulin-like growth factor-1) in milk.

IGF-1 causes the cells divide and reproduce, but doesn't distinguish cancer cells from healthy cells. 

According to information, I would recommend consumption of organic milk to get all the nutrients that milk provides, but this type of milk isn't processed hygienically and the body of the patient with cancer is susceptible to disease, so it's better to wait during the treatment (surgery, chemotherapy or radiotherapy) of the disease without milk and choose coconut, soy, almond or rice milk and long after you can consume organic milk.

Several options to replace cow's milk.

Workshop: "El plato del bien comer"

This month my colleagues and I are organizing a workshop for hospitalized children and their parents to learn should be your dish as breakfast, lunch and dinner, in addition they can classify foods and so they see which are the healthiest options for them.

We got some food replicas that are sold in the supermarket for children and collect the boxes of some products such as biscuits, jelly, cereal and milk to make the dish didactically and so patients and their parents understand better.

In addition to the plate, we will make other material in which patients can classify fats and sugars and they realize that certain products aren't suitable to consume them.

The workshop starts this week, we hope to be successful and that people take something home to put it into practice.

Gastric cancer

This week I attended a patient with gastric cancer for the first time, so I had to research the topic to learn more.

Stomach (gastric) cancer is a cancer that starts in the stomach. Therefore, they are patients who need  nutritional care since your digestive system is compromised. The main causes or risk factors of this cancer are:

The condition that usually is associated with gastric cancer is the Dumping Syndrome, which is generated because food come faster and fill the intestine, causing inflammation and abdominal pain, diarrhea, sweating and palpitations in the patient.

The nutritional therapy consists of:

• Consume only small amounts of simple carbohydrates (2 teaspoons) at each meal.
• Increase consumption of protein and fats to prevent weight loss and gastric emptying.
• Don't drink liquids with meals, consume only 30 - 60 minutes before or after.
• Eat every 2 - 3 hours, eat slowly!
• Keep regular mealtimes.
• Avoid extreme temperatures of food.

Making a healthy cookbook...

This week I had to search at different websites and writing a kind of cookbook about healthy drinks for the children and adults of the State Institute of Oncology (here is where I am doing my social service for one year), because we always give them industrialized juices for breakfast and dinner. In addition, these kind of juices are unhealthy for the patients.

When I was doing my cookbook I learned how to make some drinks (such as flavored waters) and juices that provide a lot of vitamins and minerals. 

I think that I can make and drink these beverages everyday by its content and the cost. For example, one recipe is a kind of apple soda (kids love apple sodas, at least my nephew says YES!), so you have to liquefy 1 big apple, 6 guavas, 1 teaspoon of honey and 1/2 cup of mineral water. It has the effervescent effect of soda, also it provides fiber, iron, calcium, carotene and vitamins A, B and C, useful in children with cancer that mostly have malnutrition.

P.S. Today is my best friend's birthday (: