NET Nutrition, Luz Chavez, RD, University of Chicago


so just start I want to touch on why
nutrition is important for any kind of oncology patient not just for patients
with neuro endocrine tumors some benefits of healthy eating is that it
actually helps improve your tolerance to the treatments that you are receiving
and what I mean by this is that for many cancer types if you are a patient who is
losing weight you are also losing lean body mass and studies have shown that if
you are losing lean body mass this can actually increase your risk of toxicity
from the treatments and studies have shown that this could potentially lead
to receiving less treatments compared to those patients who aren’t losing weight
healthy eating can also help support your immune system if you are not eating
adequately and you’re losing the lean body mass and I mentioned before this
can lead to long term consequences typically what this means
it means that you are more likely to have poor wound healing you are also to
increased risk of acquiring an infection now unfortunately many patients when
they are going through treatments they do report more than one side effect and
this could include a variety of things from nausea it could be vomiting
diarrhea decreased appetite and unfortunately the list goes on
medications are implemented but sometimes you could feel a little bit
better if you couple those medications with nutrition therapy now with that
being said you know where do you start there’s so much information on the
Internet especially I feel over the last few
years there’s a lot of different diets on the internet it’s hard to know where
to start I would definitely encourage you seeking the advice of a registered
dietician especially one who is certified and oncology nutrition but
this is a good place to start I’d like to refer to the American Institute of
cancer research they have 10 recommendations for cancer
prevention that can be very helpful I know what you’re thinking you know
these are for cancer prevention this doesn’t apply to you however it does
they recommend that even after you have been diagnosed that you actually
continue to follow these recommendations during your treatments and after
treatments and as many suggestions as possible now some of these
recommendations are to try to maintain a healthy body weight stay physically
active they also recommend to consume a more plant-based diet also try to reduce
your intake of red meat red meat does include pork beef and lamb and I
typically recommend for patients to try to consume less than 18 ounces in a one
week period now in terms of things that you should try to limit and avoid as
much as possible that includes processed meats sugar sweetened beverages and you
know kind of like sweets and then also junk food and the reason for this is
because these are tied to empty calories the empty calories are going to lead to
weight gain and over being overweight and obese has been found to increase
your risk of certain cancer types so this is a great place to start
especially if you aren’t symptomatic if you aren’t having any kind of symptoms
from carcinoid syndrome for example or if you’re going through treatments and
your symptoms may be minimal minimal this is where I would recommend for you
to start and that sounds great in theory but how do you actually implement that
so the AIC are actually came out with this infographic that I think visualizes
it pretty nicely they take a standard dinner plate 2/3 of that dinner plate is
going to be all of your plant-based items so that’s gonna be your fruit your
veggies your whole grains or beans and then the remainder third of your dinner
plate is going to be your animal protein and I would go step further and actually
suggest that if you do like seafood that at least once a week that actually be a
fatty fish source like salmon so as I’ve mentioned before the previous
recommendations can be applied to you know several different cancer types if
you seek the advice of a dietitian she’s gonna be taking several different things
into considerations especially if you do have in your under current tumor some of
those things would be the primary site the treatments would also be taken into
consideration as well as the side effects that you would be having from
those treatments and the reason for this is just you know even if you have the
same tumor type you may not necessarily respond the same way to some of the
nutrition therapy so because of time constraints I cannot get into all of the
treatment related side effects however I will touch on diarrhea because it is a
side effect that demonstrates well the difference in the tree interventions for
just general diarrhea and for those who have carcinoid syndrome easy place to
start if you have just general diarrhea is to start with pectin containing foods
the reason for this is that it’s actually a soluble fiber and will
actually help bulk your poop some of these foods include bananas and apple
sauce basically the BRAT diet is kind of what you want to think about the bananas
the rice the applesauce can be pretty effective next your dietitian may
recommend to include pectin supplements especially if the pectin containing
foods aren’t enough or you just can’t eat enough some examples include
benefiber or mannitol which is basically just banana flakes and you can find
these over the counter at Moore store most stores or even Amazon and typically
for these we would recommend about one to three times a day and we would start
you off once a day and slowly titrate up now the reason for most dieticians kind
of pushing bananas is because it contains potassium when you have
diarrhea you lose quite a bit of sodium and potassium in your stool so bananas
is an easy way to get your soluble fiber and replenish some potassium
but it’s also easy on the stomach so some other suggestions that you could
implement especially if you’re having steatorrhea in particular where your
mouths are in fat you would actually want to avoid greasy ER fried foods some
other tips that you could implement would be avoiding spicy foods or even
very sweet foods or beverages and if you do feel like consuming something that’s
a little bit on the sweet side a solution that you could trial is to
dilute it with water and typically 1 to 1 is the ratio so if you want 1/2 a cup
of juice you would dilute it with half a cup of water another suggestion would be
to try to eliminate lactose sources particularly milk especially if you’ve
been having diarrhea for a few days many patients can become sensitive to lactose
even if they haven’t been in the past so this is another easy suggestion to
implement you would also want to avoid high-fiber foods and I know I previously
said you want soluble fiber but in terms of insoluble fiber this would actually
increase transit time which you don’t need at this time you’re already having
diarrhea so some of these insoluble food sources would include things like
popcorn things like cabbage or broccoli and even nuts and seeds for example and
then of course medications can be trialed and this would these
recommendations would come from your physician primarily so diarrhea with
carcinoid syndrome is a little bit different it can occur several times a
day similar to regular diarrhea however with carcinoid syndrome and today wheels
may not necessarily be effective so the modem and the lomotil may not work it
may not necessarily slow at night when you’re sleeping either and if you fast
it may not slow either and unfortunately this will result in dehydration and
electrolyte abnormalities which could increase your risk of malnutrition which
is why it’s important to definitely work with your physician and your dietician
to try to help alleviate your symptoms as much as possible but
what are some things that you could implement if you’re having diarrhea due
to the carcinoid syndrome you could consume a small small frequent meals of
aloe a mine high-protein diet and I’ll get into that a little bit more in the
next couple slides dry flushing dry flushing is another symptom of carcinoid
syndrome that could benefit from nutrition therapy now the reason for
Drive lunch that it’s called dry flushing is because there’s no
perspiration involved and dietitians like to use the five e’s as a way to
remember the things that can worsen your symptoms with dry flushing and that is
basically eating epinephrine your emotions ethanol and exercise now the
nutrition interventions for dry flushing you’ll notice that they’re similar to
the ones for diarrhea due to carcinoid syndrome and that’s to avoid large meals
avoid alcohol which is the ethanol that I previously mentioned you would want to
avoid spicy foods and you would also want to include a high protein diet but
also low and a mines now the reason for this is the amides are actually you want
to think of them as almost like the building blocks to the catecholamines
and what that does is it stimulates the production of serotonin which will
increase your carcinoid syndrome symptoms now the low a mind diet these
are the foods that you would either want to eliminate or minimize as much as
possible and this is why it’s important to see a dietitian because she can help
you kind of balance this and make sure that you aren’t low in vitamins and
minerals some of the things that you would want to definitely avoid would be
aged or hard cheeses alcohol salted smoked animal proteins any kind of
spoiled animal protein yeast extracts brewers east hydrolyzed proteins fava
and soybeans and fermented foods there is quite a bit of things on this list
which is why I will kind of continue to endorse that you meet with it
patience oh she can help you manage this now why is the high-protein diet so
important even if you’re not going through a if you’re not having symptoms
from carcinoid syndrome at the moment your tryptophan level can be low this is
an essential amino acid that can only be found in complete proteins and it’s a
precursor for serotonin we need tryptophan because it is necessary for
the synthesis of proteins but also niacin which I’ll touch on why that’s
important some symptoms of niacin deficiency is more diarrhea and that is
not something that you need more of at this time you will also have dermatitis
so scaly brown patches on your arms and legs and more serious cases dementia
nervousness and even depression weight loss poor appetite will just further
contribute to this nice and deficiency because you aren’t getting enough and
now how do you treat a niacin deficiency so your dietitian or physician will
typically recommend a high-protein diet and they will start you on a
multivitamin and also supplement with nice and as well and they will determine
if this is truly needed by looking at your weight loss history if you’re
having flushing symptoms poor appetite or if you have an elevated serotonin
level now some food sources of nice and there’s animal protein such as chicken
and beef it can be found in fruits as well like avocado dates and passion
fruit vegetables like mushrooms broccoli asparagus and then tryptophan you can
also find in food sources as well and that would be food animal proteins such
as chicken turkey also eggs sunflower pumpkin seeds peanuts and soybeans so
kind of eating a variety of different things and if you’ll notice a lot of
plant-based items as well now should you avoid foods with serotonin especially
since we’re talking about so tonin being the cause of a lot of your
symptoms short answer is no you don’t want to avoid foods with serotonin the
only time you would want to avoid foods with serotonin if you are doing a
24-hour urine collection for the five HIAA test and this basically measures
the breakdown product of serotonin serotonin will from food sources will
not affect the tumor growth or your symptoms
now just to summarize all this if you’re symptomatic you would want a
high-protein diet low in fat you would want to make sure you’re staying very
well hydrated especially if you’re having diarrhea you want to decrease
added sugar limit or avoid spicy foods and then of course have a more low a
mind diet thank you

Daniel Yohans

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