Let food be medicine and medicine be food Hippocrates (460–370 BC)
Many diseases, apart from suffering and anxiety, are accompanied by the insidious enemy as he is malnutrition. If left untreated, it can lead to many complications and extend the recovery period. What is it and why is nutritional support in disease so important?
Malnutrition is a factor that has a huge impact on the condition of the body, and thus on the effectiveness of therapy. It worsens the patient’s condition, weakens him, reduces his quality of life and prolongs or even prevents his recovery. Malnutrition very often causes serious complications of treatment, such as pressure ulcers or difficult-to-heal wounds. It often contributes to the discontinuation of further treatment, e.g. in the case of the need to discontinue chemotherapy due to the patient’s cachexia. Sometimes it even makes it impossible to start therapy, such as undergoing a major surgery or the aforementioned chemotherapy. Malnutrition is an enemy that causes additional suffering for patients and deprives them of the motivation to fight the disease.
What are the causes of malnutrition? Why is it so often accompanied by the disease? There can be many reasons for this, and unfortunately, a nutritious natural diet is not always enough to provide all the necessary nutrients in this particular period of fighting the disease. Often the patient’s condition prevents the natural intake of food or its adequate amount. Sometimes food preparation difficulties or problems with chewing and swallowing arise. It also happens that the body’s need for nutrients, especially protein (in oncological diseases, bedsores, postoperative conditions) increases many times in relation to the course of the disease.
Oncological patients are particularly exposed to malnutrition. Symptoms of nutritional disorders are found in 30-85% of patients. Although they most often accompany the disease in the stage of generalization, they can very often be diagnosed at the time of diagnosis. Often, neoplastic disease accompanies cachexia, also called cancer cachexia. It is a complex metabolic process combined with chronic inflammation, increased energy and protein requirements and concomitant anorexia (anorexia), which quickly leads to malnutrition and even cachexia of the patient. Subsequently, it affects the atrophy of muscles and even internal organs. There is chronic nausea, weakness, and aggravation of anorexia. Untreated cachexia worsens the patient’s condition so much that it makes it difficult or even impossible to continue anticancer treatment or adversely affects its effectiveness. Over 5% weight loss significantly worsens the prognosis of cancer patients, and when weight loss reaches over 30%, it is inevitably fatal. In the terminal stage of the disease, cachexia is the direct cause of death in 5-20% of patients, not the underlying disease.
The most common causes of disease-related malnutrition, especially cancer-related malnutrition, are:
– oral eating disorders (anorexia developing secondary to chronic inflammation, mechanical obstruction of the passage of food in the gastrointestinal tract);
– increased loss of nutrients (malabsorption or digestion disorders, exudative enteropathy or the presence of a gastrointestinal fistula),
– disorders of metabolic processes,
– intensification of inflammatory reactions due to the action of pro-inflammatory cytokines,
– intensification of catabolic processes,
– increased demand due to cancer or comorbid diseases (e.g. infection, inflammation, intensification of metabolic processes – as already mentioned above for lung cancer);
– side effects of anti-cancer treatment (loss of appetite, disturbed taste and smell, nausea and vomiting, diarrhea).
Often the cause of malnutrition in neoplastic disease may be improperly conducted therapy that does not take into account nutritional support, and the still lingering superstitions of “cancer must be starved”. It has been known for a long time that fasting not only does not inhibit the development of cancer, but also significantly worsens the patient’s condition and, as a result, death from malnutrition may occur faster than from the disease itself.
That is why it is so important to remember to support the patient’s nutritional status through the use of an appropriate diet during the disease. The diet should not only be wholesome and high-calorie, but also enriched with wholesome and easily digestible protein, antioxidants and omega 3 and 6 fatty acids that reduce the inflammatory processes of the body, thus slowing the development of the disease.
To prevent malnutrition, it is recommended to use specialized industrial diets for oral or tube administration, which in a small volume contain a large amount of calories, protein, essential nutrients and minerals, as well as the desired omega-3 fatty acids and antioxidants. Professionally, nutritional support in the disease is called nutritional treatment and is defined as providing the patient with the enteral or intravenous route of the necessary building and energy nutrients (proteins, sugars, fats, minerals and vitamins), which he is unable to take in a natural way, according to his needs. Nutritional treatment should not be taken lightly and should always be an integral part of the overall treatment process.
Oral nutrition diets in the form of delicious cocktails (EnergyZip 200 ml Fig. 1) are usually used to supplement the patient’s diet, providing them with the right amount of protein and other nutrients to support their faster recovery. Due to the small portion and delicious taste, they are easy to take even for patients with reduced appetite.
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The recommended solution for patients who, due to treatment complications, such as taste disturbances, anorexia, sore mouth, do not want to or cannot take oral liquid diets, is a novelty – the unflavoured Immax 350 g powder diet (Fig. 2). The composition of the diet has been designed to fight malnutrition, and you can do it unnoticed by adding it to natural food without affecting its taste.
Another group of diets commercially available for nutritional treatment are nutritionally complete high-protein gavage (or PEGa) diets that completely replace food for those patients who cannot eat orally. The National Health Fund reimburses home enteral nutrition. For this purpose, it is necessary to undergo the qualification process in the nutritional clinic, to which you receive a referral at the exit from the hospital. However, if the patient is forced to wait for reimbursement, it is also recommended to use specialized diets instead of serving mixed meals during the waiting period. Such diets (Trophic 1000 ml, Fig. 3) contain the daily recommended nutrients, are wholesome, high-protein, and thanks to the homogeneous consistency they do not clog the tube, which is a common complication of mixed cuisine. The use of industrial diets allows patients to expect to be included in the reimbursement by the National Health Fund in the best possible form.
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There are also diseases in which proper dietary management significantly reduces the symptoms of the disease. As in the case of patients with Alzheimer’s disease, where the use of a specialized diet containing an exclusive mixture of nutrients (capric acid, caprylic acid, phosphatidylserine, DHA, vitamins D and B12) improves brain function.
To meet the needs of patients, enteral nutrition products for oral and gavage therapy can be ordered online or by phone. Order safely, without leaving home, queuing and lifting at nutripharma.pl or by calling 720 877 720. They are delivered to any place in Poland within 1 business day.
Ida Hoffmann
Clinical Nutrition Specialist
Nutripharma
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