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

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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

 

Green soup on prescription: “Watercress & Broccoli Soup”

A wonderful, tasty soup that is full of healthy ingredients. It won’t take you more than 20 minutes to prepare it. Just make sure you don’t overcook the greens. Add some parsley also if you have it. Eat it with some white fish and you have everything you need for a whole meal, full of nutrients that your body and mind need to function well.

Watercress & Broccoli Soup

Broccoli cut into small pieces
A handful of watercress leaves
A handful of spinach leaves
1 small sliced onion
2 garlic cloves, crushed
1cm piece of fresh root ginger, peeled and cut into small pieces
Olive oil
Thai fish sauce
Lime juice
Salt and pepper

Method
Gently sweat the onions, garlic, ginger, fish sauce and tamari sauce in a little water.
Add the broccoli and enough water to cover and bring to the boil. Simmer until the broccoli is just tender.
Add the watercress and spinach and leave to boil for another minute.
Blend the soup in a food processor until smooth and thick.
Add oil, some lime juice, season with salt and pepper and serve.

Bon appétit (enjoy your meal, in French)

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Cooking on prescription

Doctors teaching cooking? Why not. More and more physicians turn to this simple measure to inspire people to get back to their kitchen. This is a place where a treatment for any illness can start, a cure can be found and a sense of community and connection can begin to heal the mind and soul of every person.

Cooking can change lives, can even save lives. This is why in my hospice we have started giving cooking demonstrations for patients and bereaved relatives. And they are such fun, both for staff and for patients and relatives! To paraphrase Andrew Boorde from his 1547 medical book ‘Breviary of Health’: ‘A Good Physician Is Half A Cook’.

As a doctor with specialisation in nutritional medicine I am delighted to be putting on my apron at work and taking part in the new revolution in medicine and healthcare which starts from real food in our kitchens!

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Recipes to improve your health, boost your energy and lift your spirits

Once again, I am returning to the mental health charity Stuart Low Trust with a selection of recipes and information on how cooking can save your life.

I believe that a good physician is half a cook. Of course, science and experience are important. I will bring all these elements into my presentation trying to persuade you that your efforts to improve your health start in your kitchen.

I hope to see you there:

Friday 27 Sept 2013 6:30 – 9.00 pm. Refreshments provided at 6:30, presentation begins at 7:30

St Mary’s Community Centre, Upper Str, Islington N1 2TX. FREE EVENT

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THE TREASURE OF HIPPOCRATES

Delphi
An Invitation to Book Club at PENNY BROHN CANCER CARE
in BRISTOL

 

 THURSDAY 21 MARCH 2013, 4.30 p.m. – 6.00 p.m.

 

“THE TREASURE OF HIPPOCRATES:
Ancient knowledge on health and medicine
applied in the 21st Century”

 

Speaker: Dr ELENI TSIOMPANOU

 

 

 

2,500 years ago Hippocrates said ‘Health is the greatest gift given to man’. Starting as an itinerant physician, he travelled from his home on the Greek island of Cos, through Greece and Asia Minor practising the gentle art of physical observation, using his medical knowledge to show that disease was the product of environment and lifestyle. He believed that the body contained within itself the benign power of nature to rebalance and heal. His medical ethics included the instruction to treat the whole, not just the afflicted part in order to help, and to do no harm.

 

Here in the 21 century, Dr Eleni Tsiompanou also bases her medical practice on such ethics: ‘my job is to inspire, empower, support, rebalance and help patients to rediscover a quality of life’ she says. The writer of many books and articles, with a special interest in nutrition for the health-compromised, she has worked in palliative medicine, integrative oncology and general medicine. Living in London, she regularly makes her way to Bristol to work as one of Penny Brohn Cancer Care’s doctors. Her interest in the history and philosophy of medicine originates from her native Greece. ‘ I believe that food, exercise, lifestyle and the environment all contribute to health’ she says ‘and I have seen how spiritual practice, music, the arts, singing and harmonious living can restore balance. Health is much more than the absence of disease: it can be vibrant, dynamic and long lasting when we live in harmony with our true nature’.

 

I am sure that this Book Club will be fascinating and informative. In bringing the date forward to 21st of March to avoid clashing with Easter, I hope that as many of you as possible will come and bring your friends.

 

Pat Pilkington
Co-Founder, Penny Brohn Cancer Care
Bristol BS20 0HH

 

 

“From Hippocrates to 21st Century Nutritional Medicine”

You are invited to an event organised by the Hellenic Medical Society UK, on Friday 19th of October at the Hellenic Centre in London:  

The 2012 Hippocratic Oration:  

“From Hippocrates to 21st Century Nutritional Medicine” 

The President of the Hellenic Medical Society UK Dr Dimitris Paschos & the HMS Committee will honour:

  Prof Joe Millward PhD, DSc RPHNutr, Emeritus Professor of Human Nutrition,  Institute of Biosciences and Medicine, University of Surrey, Guildford, UK 

 who will deliver his lecture with 

 Dr Eleni Tsiompanou MD, MSc Nutritional Medicine, Researcher in History of Medicine, Physician 

 7pm: Friday 19th October 2012

At the Great Hall of The Hellenic Centre,  16-18 Paddington Street, London W1U 5AS

 The event is open to the general public  

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Professor Spyros Marketos (1931-2012): my inspiration

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Professor Spyros Marketos (1931-2012). Past President of the International Hippocratic Foundation of Kos (1991 to 2000)

‘Galen’ – first pointed me to Hippocrates‘Galen’, not the great physician philosopher of ancient times but a ‘modern’ version who, for me, was no less inspiring, was the pseudonym used in Kathimerini, a daily newspaper in Greece, by a Professor of the History of Medicine in Athens, Dr Spyros Marketos. Every Sunday, absorbed by his words, I found inspiration particularly about his accounts of the lives and work of great medical scientists that had shaped modern medicine; the pathologist, George Papanikolaou, DNA pioneers James Watson and Francis Crick.

In 1987, while still a medical student in Northern Greece, I wrote to ‘Galen’ asking to meet him. ‘Galen’, Professor Marketos, replied inviting me to visit him. Travelling overnight in the sleeper of a slow train from Thessaloniki to Athens, I arrived as the sun appeared on the horizon. I stayed in a small hotel near the Acropolis and walked to his office in Kolonaki, in Athens. This was to be the first of countless trips over the next few years. 

Professor Marketos had invited me to join his circle of young medical students studying the history and philosophy of medicine. And so my journey began. 

Studying the books in the Hippocratic Corpus, I discovered that Hippocrates and his followers knew how to use diet to restore health in people. Despite the fact that they did not have our anatomical, biochemical and physiological understanding, they used methods from an understanding of the needs of the human body. 

From ‘Galen’ and my own interest in Hippocrates, I went on to study for an MSc in Nutritional Medicine at the University of Surrey, the first university-level, evidence-based Masters degree course in this subject in the UK.

Recently, on a visit to Kos, continuing my research into the life of Hippocrates, my journey has, in a sense also brought me back to ‘Galen’.

I feel truly indebted to Professor Spyros Marketos who inspired me at the beginning of my medical career. 

 

Kos – the Island of Hippocrates, the Father of Medicine

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I just returned from a trip to Kos, the birthplace of Hippocrates, the father of Medicine.

This is an exceptional island which is blessed with the most extraordinary flora.

Some of the plants and trees are unique and rare.

Kos has a mild climate, rich soil and amazing sea and surroundings, which not only feed the people with nutritious food but also provide beautiful sights to nurture their soul. 

It is not perhaps by coincidence that Hippocrates developed his medical theories and practice on this place. 

Walking in the centre of the town of Kos, near the plane tree under which Hippocrates allegedly taught his students, I discovered and photographed many edible plants that also have great nutritional power and healing properties. A few of them are seen in the slide above.

 

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

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Healthy Diet – Key for Cancer Survivors

Last week at the Late Effects of Cancer Treatment Conference’ in Sheffield some of the discussion was around the importance of diet for cancer survivors. 

Dan Porter, a cancer survivor who spoke on the last day, said that the first thing he did after his cancer diagnosis was to find out how he could improve his diet. He said how difficult/impossible it was to find information through mainstream and how much research he had to do on his own to discover what foods and dietary changes would help him. He also commented that “scientists can become cynical and dismiss things that can be helpful to patients”.

 This is a common theme amongst people who are diagnosed with cancer and their carers. If we ask patients or read their cancer online blogs they say how they have no access to decent information about nutrition, diet and exercise. This is one of them: http://www.theride.org.uk/why/

And yet, recent findings confirm that specialised aspects of nutrition play a major and hitherto unsuspected role in both the causation of disease and the regeneration on a cellular level, which of course is absolutely fundamental in dealing with cancer.

The relevance of nutrition to cancer survivors is very considerable because of its tangible influence on the lengthening of life and improvement in quality of life, even in terminally ill patients. The emerging significance of nutrition means that even undergraduate students need to be made aware of these important developments in the treatment of cancer, which must not be neglected in shaping the treatment of cancer survivors.

Through my work as doctor at the Penny Brohn Cancer Care (PBCC) charity in Bristol and as a palliative care doctor in a hospice and the community, I have witnessed the importance of nutrition throughout the cancer patient’s journey. 

PBCC have produced evidence-based Healthy Eating Guidelines and have been offering nutritional advice for many years to hundreds of patients who come to benefit from their experience.

In my role as Chair of the Food and Nutrition Group at ‘Help the Hospices’, we have produced a Consensus Statement on Nutritional Care of Palliative Care Patients which has been widely endorsed by several organisations, including the Royal College of Physicians, The Royal College of Nursing, the British Dietetic Association, the National Council for Palliative Care and others. This shows the realisation by healthcare professionals of the importance of good nutritional care for people with palliative care needs. This importance can be easily translated and indeed extended to initiatives for cancer survivors who have a great opportunity to benefit from a good diet.

Patients, survivors and users ask first and foremost this question: ‘what should I eat’.

They want to help themselves.

They want information and support to understand how they can improve their diet and lifestyle in general.

Learning what foods are going to help them live better and longer, what foods will support their immune system and give them pleasure, could transform their experience and make their cancer journey less difficult.

During their treatment, they may experience a plethora of problems (nausea, vomiting, constipation, diarrhoea, loss of appetite, dry mouth, mucositis, pain, shortness of breath, reduced saliva, unexplained weight loss) that can be helped by good nutritional advice.

These can be dealt with an individualised plan, as no one person is the same and everyone’s needs are different.

When they finish their treatment they may continue with a healthy diet for secondary cancer prevention.

An effort to highlight the importance of a good diet and offer cancer survivors support and advice would benefit both those that need it and those who care for them. 

The author is making a plea for the recognition that research and evidence on the relevance of diet on cancer prevention and treatment has evolved quite fundamentally and needs to be included in the future agenda for cancer survivorship.

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“Eating More Than Words”

“In the course of my life, I have often had to eat my words, and I must confess that I have always found it a wholesome diet is a famous quote attributed to Sir Winston Churchill who died in 1965 aged 91 at his home. Although this is a plea for verbal caution, for patients and carers who want the most nutritious diet to help them feel better it is about as much use as the mixed metaphor ‘don’t eat with your mouth full.’

However, those who have been dismissive of Nutritional Science, once the Cinderella of scientific studies, are now literally ‘having to eat their words’.  There is increasing and compelling evidence of how nutrition can benefit people.

Research has gone into such detail that it has demonstrated how carrots and tomatoes provide more nutrients the longer they are cooked; while onions, leeks and garlic need to be chopped at least ten minutes prior to cooking in order to stimulate their active ingredients. Use them in cooking before 10 minutes after they are chopped and they give their characteristic taste and smell but not their active ingredients.

Spices and herbs have also been shown to provide health benefits; for example turmeric has anti-inflammatory properties. In fact, research has now shown that turmeric is better absorbed and its’ effects in the body are multiplied, when it is eaten together with pepper and fat as in a curry.

The Nutrition Now’ campaign of The Royal College of Nursing acknowledges the importance of good Nutritional Care with the principle that food and drink are as important as drugs in patient care. When researchers have asked patients and carers what else they want besides expert medical treatment the answer is clear: they want information and advice on how to help themselves; just having things done to them is not enough. It rings true; we all want to be empowered to do something for ourselves. This really underlines why nutrition is so important.

Finding a recipe for someone’s condition that they will also enjoy can provide great pleasure, nutritional benefit and be the simple expression of love by the carer.

(a version of this article first appeared in the Hospice Information Bulletin)


 

A Good Physician Is Half a Cook (and vice versa)

A Good Physician Is Half A Cook. This is a paraphrase from Andrew Boorde’s 1547 medical book ‘Breviary of Health’ in which he writes: “a good cook is halfe a physycyon”.

 2000 years earlier, Hippocrates wrote in The Art (of Medicine) that highly skilled physicians treat their patients, using not only drugs, but also the right diet and lifestyle, to assist the human body in the healing process: ‘The physicians of greatest repute obviously cure by regimen and other substances…’  

 

In my thesis for an MSc in Nutritional Medicine I wrote about ‘Food asMedicine: Exploring Nutritional Knowledge in the Hippocratic Corpus’. I examined a number of books in the Corpus, in which Hippocrates emphasises the importance of physicians’  knowledge of nutrition and dietetics.

In Ancient Medicine, he talks about the required fields of study for physicians. A good physician, he says, should have knowledge of the properties of each food, of their differences according to variety, conditions of growth and processing and of their uses for restoration of health and healing of the sick. He, however, should learn much more than a list of foods and their effect on the body. He must also have an understanding of the particular characteristics of individuals and, of the mechanisms by which each food affects different people:

 

Required Fields of Study for a Physician,  according to Hippocrates

·      Anatomy and Physiology of the Human Body

·      Properties of foods and drinks, in their natural form and after processing and cooking

·      Natural and artificial exercises

·      Laws of the Universe – Astronomy

 

As more and more evidence emerges on the importance of food and lifestyle for our health, many modern doctors choose to get more knowledge and education on Nutrition. At the same time, the best medical journals around the world, increasingly publish studies that research dietary influences on health and disease.

A shift in the focus of healthcare is apparent. Food is becoming again an essential therapeutic tool, a medicine!

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