If “food is medicine”, why not prescribe it?

Slide1

Published in e-hospice online on the 13th of December (click here)

People with a terminal illness often look for ways to help themselves. Dr Philip Lee, a consultant physician, who passed away in 2011 was treating people with metabolic diseases, many of who needed to make significant changes in their diets in order to survive. Following his diagnosis of metastatic lung cancer and knowing the therapeutic power of food, he changed his diet. See his video on the Help the Hospices website.

Dr Lee was an advocate of the consensus statement on nutritional care for palliative patients, now endorsed by many healthcare professional bodies to improve the training of staff in nutritional care.

Palliative care patients may also suffer from nutritional problems due to late consequences of cancer treatment, such as: anorexia-cachexia, diarrhoea, constipation, nausea, abdominal pain and other digestive problems.  A recent conference at the Royal Marsden Hospital considered dietary changes to help these problems, along with other interventions, e.g. antibiotic treatment of small bowel bacterial overgrowth, a major cause of diarrhoea or sometimes constipation. The wife of a patient related how after admission to a hospice her husband’s low fat diet for fat malabsorption was ignored. The sausages and other fatty food he ate worsened his symptoms of diarrhoea and abdominal pain. She could not forget his experience.

Recently, a hospice patient disclosed that she drank her own rice milk because of her allergy to dairy products. When told this ‘special milk’ could be provided by the hospice, she was astonished. She hadn’t thought her dietary needs would be considered part of her care. Other patients in the hospice told us how wonderful they find desserts in small shot cups. With their reduced appetite, they could now manage these portions and no longer felt guilty leaving food uneaten.

Over 2,500 years ago, Hippocrates said: ‘Food is medicine’. Even now research into illness rarely considers food as a factor in our health or recovery. However, there is a greater awareness and evidence:

  • The ‘China Study’ by Dr Colin Campbell showed that diet plays a major role in our health.
  • Michal Pollen in his book In Defense of Food says “don’t eat something your grandmother would not recognise”.
  • Even President Clinton has become a vegan after 2 major heart operations (watch video).

Food is overlooked, taken for granted and people say, without checking, that there is no evidence for food as medicine.  As scientists, our duty is to resist any prejudgement, to delve deeper and ask the question: can nutritious food be prescribed as medicine? After all, this is what patients want.

Dr Eleni Tsiompanou, MSc Nutritional Medicine

 

Nutrition in Palliative Care – More than just ‘Tea and Sympathy’

Food, exercise, lifestyle and the external environment

We’ve known since Ancient times that food, exercise and lifestyle plus the external environment in which we live, have a definite influence on our health. This has now been verified beyond any doubt through epidemiological research and experiments. Good nutrition helps us to have a feeling of well-being, preserve and increase our strength and energy, maintain a healthy weight and retain adequate stores of useful nutrients, tolerate treatment related side effects, decrease the risk of infection and heal and recover quickly.

Nutrition in palliative care

In palliative care, good nutrition can enhance recovery, when healing is possible. Poor nutrition on the contrary results in poor resistance to infections, impaired wound healing, increased susceptibility to pressure ulcers and fatigue. Good, nutritious food can also contribute to the patient’s overall sense of wellbeing. A drop in essential amino acids or glucose can adversely affect the nervous system and behaviour. Last but not least, food has a major psychological and social significance.

Personalised nutritional advice

Each one of our patients is an individual and so they need to have personalised advice. If they live alone they will need practical advice on how to prepare nutritious food when, at the same time, they can experience overwhelming fatigue. Practical advice on where to get good ‘meals on wheels’ can be extremely important for them. Their individual preferences need to be taken into account: if they like eating meat and two vegetables, they may ignore dietary advice to eat, for example, fish. On the other hand, a serious illness often leads people to make radical changes to their lifestyle in an attempt to become stronger.

A patient’s story

When Phil who was only 45 found out he had metastatic lung cancer, he turned overnight from a successful consultant physician to a patient with a life-limiting condition. During an admission to hospital for a severe infection, he lost 2 stones of his body weight. He was started on chemotherapy, which resulted in severe nausea and vomiting. These symptoms were made worse by anxiety and fear, which also affected his appetite. More than a year later, he was strong and receiving treatment for disease recurrence to the mediastinal lymph nodes.

He talks openly in this video about the physical and emotional impact the disease had on his life. One of the most significant pieces of advice he said he received during the period that chemotherapy had changed his sense of taste and smell and wiped out his appetite was, to eat porridge with honey and bananas. For a while, this was what he had for breakfast, lunch and dinner.

Furthermore, exercise played a significant role in his rehabilitation. Armed with his scientific background and inquisitive mind, he sought additional ways to support himself, increase his chances of survival and improve his quality of life.

He believed that ‘good food’, regular exercise, meditation, Qigong, hypnotherapy, laughter and love, combined together will help him. And I had no reason to doubt that. I supported him through his decision to change his habits and to follow ‘an anti-cancer diet and lifestyle’.

Hippocrates and our responsibilities

We approach each person with an understanding that they are not just body, but also mind, emotions and soul; they bring their personal history, belief system, hopes and cultural background. As healthcare practitioners we seek to help the individual patient, showing compassion and care. 

To use Hippocrates’ words:

Life (ours and our patients’) is short, the Art of Healing is long, the Opportunity to help our patients is fleeting, Experiment is sometimes treacherous and Judgement can be difficult

Michelangelos_hand



 

PATIENTS AS EXPERTS

I was at the Macmillan Primary Care Conference 2011 in London today, to facilitate a workshop on Cancer Anorexia Cachexia Syndrome.

One of the big themes that came out of this meeting was the importance of listening to our patients.

Patients are experts in their illness and doctors can learn a lot from them.

A video interview of a patient/doctor who talks candidly about his experience of food after being diagnosed with metastatic lung cancer is available online on the Food and Nutrition Group’s (FNG) at Help the Hospices webpage. 

Many of the problems that patients face when they have a diagnosis of cancer come up during this interview, as well as some suggestions to solve them. 

Going back to basics, eating a well-cooked nutritious food, appropriate for each person’s individual needs and circumstances, can make a difference.

Eating it together with a loved one, in a normal, pleasant environment is even better.

Not much more is needed sometimes!

Img_0466