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Nutrition & GIST The Life Raft Group. Christy Tangney, PhD, FACN, CNS Cheryl Sullivan, MS,RD,CSND,LDN February 27 th , 2008. Benefits of Adequate Nutrition. Feel better Decrease your risk for infection Improve wound healing Improve strength and energy Tolerate side effects of

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Nutrition gist the life raft group l.jpg

Nutrition & GISTThe Life Raft Group

Christy Tangney, PhD, FACN, CNS

Cheryl Sullivan, MS,RD,CSND,LDN

February 27th, 2008

©2003 RUSH University Medical Center


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Benefits of Adequate Nutrition

  • Feel better

  • Decrease your risk for infection

  • Improve wound healing

  • Improve strength and energy

  • Tolerate side effects of

    treatment better

©2003 RUSH University Medical Center


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Nutrition Related Side Effects During Treatment

Such as…

Poor Appetite

Nausea and/or Vomiting

Diarrhea

Constipation

Ingestion & Heart Burn

Bloating

©2003 RUSH University Medical Center

Eldrige B, Hamilton K, 2004


Poor appetite l.jpg

Anorexia

Cancer Cachexia-

more complicated metabolic scenario which contributes to changes in muscle function, fluids and energy metabolism as well as immunosuppression..

WHAT can I DO?

Smaller, frequent meals

Nutrient dense foods

Pleasant dining atmosphere

Assistance with meal preparation

Nutrition is part of treatment

Liquid nutrition supplements

Possible use of appetite stimulants: Marinol, Megace

Poor Appetite

©2003 RUSH University Medical Center

Eldrige B, Hamilton K, 2004


Nausea and vomiting l.jpg

Why?

Chemotherapy, radiation, immunotherapy, pain, fatigue, mucous drainage, constipation, certain medications

Acute, Delayed or Anticipatory

WHAT can I DO?

Eat small, frequent meals to prevent empty stomach

Eat foods at cool or room temperature

Avoid strong aromas

Use peppermints, lemon drops, root beer barrels

Take medications as prescribed

Nausea and Vomiting

©2003 RUSH University Medical Center

Eldrige B, Hamilton K, 2004


Diarrhea l.jpg

Why?

Diet, stress, inflammation of intestinal mucosa, medications, lactose intolerance

Uncontrolled diarrhea can lead to dehydration and malnutrition

WHAT can I DO?

Limit insoluble fiber, increase soluble fiber

Possible lactose restriction

Restrict high-fat foods, caffeine, very sweet foods, gas-forming vegetables

Encourage multivitamin use

Diarrhea

©2003 RUSH University Medical Center

Eldrige B, Hamilton K, 2004


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Increase soluble fiber

Legumes (1/2 cup cooked)

– Black Beans, Kidney Beans

– Lima Beans, Navy Beans

– Northern & Pinto Beans

Citrus fruit (grapefruit, orange)

Prunes (1/4 c)

Pears

Brussel Sprouts

Restrict gas-forming vegetables

Cabbage; radishes; onions; broccoli; Brussels sprouts; cauliflower;

How to treat diarrhea

©2003 RUSH University Medical Center

Eldrige B, Hamilton K, 2004


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Why?

Dehydration, medications, lack of physical activity

Why Important?

poor appetite

Bowel protocol to prevent constipation

Medications to promote bowel movements

High fiber diet, with gradual increase

25-35g fiber/day

64fl-oz daily

Constipation

©2003 RUSH University Medical Center

Eldrige B, Hamilton K, 2004


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Ingestion & Heart Burn

WHAT can I DO?

  • Avoid overeating

  • Remain sitting up for 30 mins – 60mins after consuming meals

  • Limit caffeine

  • Limit high fat foods

  • Avoid tight fitting clothes

  • Limit food that incorporates air (little carbonated products)

  • Elevate the head of your bed

©2003 RUSH University Medical Center


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Bloating

  • Limit carbonation

  • Choose less high fat foods (fried, greasy foods)

  • Simethicone, Bean-o, Gas-ex

  • Limit dairy or milk products if you have a lactose intolerance

©2003 RUSH University Medical Center


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Why?

Certain chemotherapies and/or radiation therapy

Why Important?

Speed of recovery depends on nutritional status

WHAT can I DO?

Avoid tart, acidic, salty or spicy foods

Soft foods to liquid diets

Chilled foods and beverages

Use straw or head tilt

Baking soda, water, saline rinse

Medications

Sore Mouth or Throat

©2003 RUSH University Medical Center

Eldrige B, Hamilton K, 2004


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Why?

Radiation to Head & Neck, some chemotherapy agents, medications, dehydration, oral infections, surgery

Dental and gum disease, difficulty eating, talking, taste alterations

WHAT can I DO?

Add broth, soup, sauces, gravy

Drink plenty of fluids

Soft/bland foods, cold or at room temperature

Chew sugarless gum/candy

Limit caffeine

Artificial saliva

Avoid very sweet or sticky foods

Dry Mouth (Xerostomia)

©2003 RUSH University Medical Center

Eldrige B, Hamilton K, 2004


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Etiology not well understood

Ageusia- very little or no sense of taste

Dysgeusia- metallic, bitter, salty or sweet taste

May return either partially or completely;

May take up to a year after therapy ends

WHAT can I DO?

Plastic or glass eating utensils if c/o metallic taste

Sugar-free gums or candies (or sweeteners) can eliminate bitter taste

Choose foods that don’t require cooking

Experiment with new foods, marinades, spices

Red meat not usually well tolerated

Taste and Smell Alterations

©2003 RUSH University Medical Center

Eldrige B, Hamilton K, 2004


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Gastric Surgery

  • Smaller, more frequent meals

  • Avoid foods with a lot of sugar

    • Avoid added sugars

  • Drink liquids in between meals

    • Wait at least 30mins – 60mins after eating

  • Consume protein containing foods with each meal

  • High fiber may be difficult to digest following surgery

  • Avoid milk products if you have a lactose intolerance

©2003 RUSH University Medical Center


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Nutrient Digestion

  • Stomach

    • Intrinsic Factor  needed for Vitamin B-12 absorption

  • Duodenum

    • Iron, Calcium, Magnesium, Zinc, Glucose, Vitamin C

  • Jejunum

    • Thiamin, Riboflavin, Pyridoxine, Folic Acid, Amino Acids, Vitamins A,D,E,K

  • Ileum

    • Fat, Cholesterol, Bile Salt, Vitamin B-12

  • Colon

    • Water, sodium, potassium, Vitamin K

©2003 RUSH University Medical Center


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Fluid Retention & Edema

  • Limit Sodium Intake

    • Less than 2000mg/day

    • Less than 700mg/meal

  • Increase physical activity

  • Fluid restriction if advised by your doctor

©2003 RUSH University Medical Center


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Nutrition and Recovery

  • Recover from side effects of treatment

  • Attain and/or maintain ideal body weight

  • Choose a Plant-based Diet

    • Vegetables, fruit, legumes, and whole grains

    • AICR recommends these foods cover 2/3 of your plate: at least 50%!

    • Choose 100% whole wheat products (bread, pasta, chips); brown rice, oats, barley, bulgur

    • Legumes: the beans: black, fava, lima, navy, pinto and kidney; black-eyed pea, chickpeas

©2003 RUSH University Medical Center


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The “Perfect Plate”

Size of your palm

Choose fish, poultry, and other lean proteins for ¼ of your plate

Size of

your fist

Eat at least 3 servings of whole grain breads, cereals, pastas, rice, legumes, and sweet potatoes everyday

Starch

Protein

Choose another

Eat five or more servings every day of a variety of colorful veggies and fruits & 3 or more servings of low fat dairy per day

Vegetable

Fruit/Veg/Milk

At least size of your fist

Plant based foods like veggies & fruits should cover at least half of your plate

©2003 RUSH University Medical Center

Created By: Jennifer Ventrelle MS, RD, LDN


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Nutrition and Recovery

  • Decrease fat intake

    • 20-30% of total caloric intake

    • Choose plant-based fats

  • Regular physical activity

    • At least 30 minutes of moderate to vigorous physical activity, above usual activities, on 5 or more days of the week; 45 to 60 minutes of intentional physical activity are preferable

  • Drink alcohol in moderation

  • Limit consumption of red meat and processed foods

  • Limit salt intake

©2003 RUSH University Medical Center


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Lifestyle Behaviors?

Healthy Weight & A Stronger Body

©2003 RUSH University Medical Center


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6-9 Fruit/Vegetable Servings/Day

  • Snack on fresh or dried fruit between meals

  • Choose 100% fruit juices

  • Add extra vegetables to soups or pasta sauce

  • Mix fruit with yogurt

  • Add vegetables on sandwiches

  • Salsa

  • Stirred-fried vegetables

  • Try a new fruit or vegetable each week

Dyer D. A Dietitian’s Cancer Story. Information &

Inspiration for Recovery & Healing. Swan Press. 2002

©2003 RUSH University Medical Center


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What Counts as a Serving?

  • Fruits·1 medium apple, banana, orange ·½ cup of chopped, cooked, frozen or canned fruit (in 100% juice)·¾ cup of 100% fruit juice

    • ¼ cup dried fruit

  • Vegetables·1 cup of raw, leafy vegetables ·½ cup of other cooked, raw or frozen vegetables

    ·¾ cup of 100% vegetable juice

©2003 RUSH University Medical Center

www.5aday.org


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What Counts as a Serving?

  • Beans and nuts·½ cup of cooked for frozen legumes (beans/peas) ·2 tablespoons of peanut butter ·1/3 cup nuts

  • Dairy foods and eggs·1 cup of milk or yogurt ·1 ½ ounces of natural cheese ·2 ounces of processed cheese ·1 egg

  • Meats·2-3 ounces of cooked, lean meat, poultry, or fish

©2003 RUSH University Medical Center


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Whole Grains- What are they?

  • All 3 parts of the kernel

    • When refined, removes bran and germ  25% of a grain’s protein is lost, along with at least seventeen key nutrients

  • Protein, fiber, vitamins and minerals

©2003 RUSH University Medical Center


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Whole Grains – what are they?

  • Wheat, corn, rice, oats, barley, quinoa, sorghum, spelt, rye

  • Whole grains have some valuable antioxidants not found in fruits and vegetables, as well as B vitamins, vitamin E, magnesium, iron and fiber.

www.wholegraincouncil.org

©2003 RUSH University Medical Center


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Whole Grains- What Counts as a Serving?

  • 1/2 cup cooked brown rice or other cooked grain

  • 1/2 cup cooked 100% whole-grain pasta

  • 1/2 cup cooked hot cereal, such as oatmeal

  • 1 ounce uncooked whole grain pasta, brown rice or other grain

  • 1 slice 100% whole grain bread

  • 1 very small (1 oz.) 100% whole grain muffin

  • 1 cup 100% whole grain ready-to-eat cereal

©2003 RUSH University Medical Center


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Prebiotics

  • Non-digestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacterial speices already resident I the colon, and thus attempts to improve host health.

  • Stimulate colonic motility

  • Fructans

    • Chicory root, wheat, artichoke, garlic, tomato, banana, onion

  • Powder packets, chewables, yogurt…

©2003 RUSH University Medical Center

Gibson, GR. J Nutr 1995


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Probiotics

  • Live microbial feed supplement which beneficially affects the host animal by improving microbial balance

    • Bifidobacteria

    • Lactobacilli

  • http://nccam.nih.gov/health/probiotics/

©2003 RUSH University Medical Center


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Use a gradual plan

Start with a high fiber cereal or mix them

Add cooked grains to breads muffins, coffee cakes

©2003 RUSH University Medical Center


Eat breakfast as a king lunch as a citizen and dinner as the beggar on the corner l.jpg

Eat breakfast as a king, lunch as a citizen, and dinner as the beggar on the corner

Hungarian proverb

©2003 RUSH University Medical Center


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Store and Prepare Foods Safely the beggar on the corner

  • Wash hands before/after handling raw meat and poultry.

  • Sanitize cutting boards in a solution of 1 tsp chlorine bleach in 1 qt of water

  • Wash kitchen towels/cloths often in hot water in washing machine. The sponge

  • Keep raw meat, poultry, fish, and their juices away from other food. After cutting raw meats, wash hands, cutting board, knife, and counter tops with hot, soapy water.

  • Marinate meat and poultry in a covered dish in the refrigerator.

©2003 RUSH University Medical Center


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Serving & Storing Foods Safely the beggar on the corner

  • Never leave food out over 2 hours. (1 hour in temperature above 90 °F)

    • Bacteria that cause food borne illness grow rapidly at room temperature.

  • Meat and poultry defrosted in the refrigerator may be re-frozen before OR after cooking. If thawed by other methods, cook before re-freezing.

©2003 RUSH University Medical Center


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Meal Planning the beggar on the corner

  • Think of the Perfect Plate

  • Think of your own health and your family’s: Modelling behaviors

  • Great resources on the Web

    • Log in to plan your meals today. Example of the Meal Planner

      • http://www.mealsmatter.org/MealPlanning/MealPlanner/index.aspx

  • Cooking Light

  • Shop smartly: Jewel, Trader Joe’s

©2003 RUSH University Medical Center


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Oatmeal Cereals the beggar on the corner

Many forms of oatmeal are whole grain….

Old fashioned, quick and Instant Oats from Quaker® all would qualify

Steel Cut Irish Oatmeal as shown here is an excellent whole grain source…

“Steel cut” means the groats have been steamed and roasted and then cut into thirds, not rolled… they take longer to cook and are chewier

Size box: 16 oz

Cost: $2.50-4.50

©2003 RUSH University Medical Center


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Size box: 28 oz the beggar on the corner

Cost: $5.99 -$7.99

©2003 RUSH University Medical Center


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Cereals the beggar on the corner

High in Fiber, low in Sugar and Fat

Size box: 10 oz

Cost:$1.99

©2003 RUSH University Medical Center


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Dietary Supplements the beggar on the corner

  • Discuss all dietary supplements (vitamins, herbs, minerals) with your healthcare providers

  • Dietary supplements are not regulated by the FDA

  • Should never replace whole foods

  • Lack of regulatory oversight of dietary supplements has led to misleading health claims

©2003 RUSH University Medical Center


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Antioxidants the beggar on the corner

  • Concern regarding use of antioxidants during treatment due to production of free radicals

    • If undergoing radiation and chemotherapy not to exceed upper intake limits for the dietary reference intakes for vitamin supplements that contain antioxidants

      Upper Tolerable Limits

  • Vitamin C (mg): 2,000

  • Vitamin E (IU): 1,000

  • Vitamin A (µg): 3,000

  • Selenium (µg): 400

  • Zinc (mg): 40

©2003 RUSH University Medical Center

fnic.nal.usda.gov


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Nutrition and Cancer Related Websites the beggar on the corner

  • www.cancer.org

  • www.cancer.gov

  • www.oncologynutrition.org

  • www.quackwatch.org

  • www.cancerRD.com www.cancernutritioninfo.com

  • http://nccam.nih.gov

©2003 RUSH University Medical Center


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Thank you! the beggar on the cornerQuestions?

©2003 RUSH University Medical Center


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