A. Indications for nutritional therapy
A large multi center meta analysis describes the benefits of your own stem cells for peripheral vascular disease. Bone marrow stem cells were used and injected into muscles and intravenously.
This is an excellent article outlining how stem cells from your own bone marrow can help with neurorestoration of various cells in the brain. My technique involves using intravenous and nasal nebulizer therapy. Kidney disease is a common and difficult to treat series of conditions.
They typically stem from age related degeneration of the tissues. A variety of medications are used to try to halt or slow damage , but are often ineffective. Stem Cell therapy , as has been shown. Diabetes is a devastating degeneration of virtually all tissues of the body. Here in this article the research shows stem cell benefits to a vast number of tissues and organs damaged by Diabetes.
I have seen this on my patient population. So the stem cells work not. This is a great commentary on the viability and reliability of adipose or fat derived stem cells for regenerative purposes.
They are very easy to extract from patients in just a matter of minutes , and as the article says they have the ability to become various types o. Here's a great study on the use of stem cells for Rheumatoid Arthritis. It essentially describes that stem cells suppress a complicated inflammation mechanism. In RA there are cells that attack our own tissues , these are called T cells. Stem cells derived form fat can. This is an 80 year old patient with severe shoulder pain and osteoarthritis in a variety of her joints.
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Patients may rely on religion and spirituality as important means to interpret and cope with illness. The wide range of practices related to neutropenic diets reflects the lack of evidence regarding the efficacy of dietary restrictions in preventing infectious complications in cancer patients. Studies evaluating various approaches to diet restrictions have not shown clear benefit.
A meta-analysis and a systematic review of articles evaluating the effect of a neutropenic diet on infection and mortality rates in cancer patients found no superiority or advantage in using a neutropenic diet over a regular diet in neutropenic cancer patients. Even after the observational study was omitted from the analysis, the results persisted. The review concluded that these individual studies provided no evidence showing that the use of a low-bacterial diet prevents infections.
Other studies have demonstrated potential adverse effects of neutropenic diets. One group of investigators [ 6 ] conducted a retrospective review of patients who had undergone hematopoietic cell transplantation HCT. The patients who received the neutropenic diet experienced significantly more documented infections than did the patients receiving the general hospital diet that permitted black pepper and well-washed fruits and vegetables and excluded raw tomatoes, seeds, and nuts.
The neutropenic diet group had a significantly higher rate of infections that could be attributed to a gastrointestinal source, as well as a trend toward a higher rate of vancomycin-resistant enterococci infections. Without clinical evidence to define the dietary restrictions required to prevent foodborne infection in immunocompromised cancer patients, recommendations for food safety are based on general food safety guidelines and the avoidance of foods most likely to contain pathogenic organisms.
The effectiveness of these guidelines is dependent on patient and caregiver knowledge about, and adherence to, safe food handling practices and avoidance of higher-risk foods.
Leading cancer centers provide guidelines for HCT patients and information about food safety practices related to food purchase, storage, and preparation e. Comprehensive food safety information designed by the U. Food and Drug Administration for people with cancer and for transplant recipients is also available online.
Recommendations support the use of safe food handling procedures and avoiding consumption of foods that pose a high risk of infection, as noted in Table 7. Maintaining adequate nutrition while undergoing treatment for cancer is imperative because it can reduce treatment-related side effects, prevent delays in treatment, and help maintain quality of life.
Patients are likely to search the Internet and other lay sources of information for dietary approaches to manage cancer risk and to improve prognosis. Unfortunately, much of this information is not supported by a sufficient evidence base.
The sections below summarize the state of the science on some of the most popular diets and dietary supplements. A vegetarian diet is popular, is easy to implement and, if followed carefully, does not result in nutrition deficiencies. There is strong evidence that a vegetarian diet reduces the incidence of many types of cancer, especially cancers of the gastrointestinal GI tract. There are no published clinical trials, pilot studies, or case reports on the effectiveness of a vegetarian diet for the management of cancer therapy and symptoms.
There is no evidence suggesting a benefit of adopting a vegetarian or vegan diet upon diagnosis or while undergoing cancer therapy. On the other hand, there is no evidence that an individual who follows a vegetarian or vegan diet before cancer therapy should abandon it upon starting treatment.
One pilot study has suggested that following a plant-based diet can prevent tumor progression in men with localized prostate cancer. It is a high-carbohydrate, low-fat, plant-based diet stemming from philosophical principles promoting a healthy way of living.
Although there are anecdotal reports on the effectiveness of a macrobiotic diet as an alternative cancer therapy, none have been published in peer-reviewed, scientific journals. No clinical trials, observational studies, or pilot studies have examined the diet as a complementary or alternative therapy for cancer.
In fact, two reviews of the diet and its evidence for effectiveness in cancer treatment concluded that there is no scientific evidence for the use of a macrobiotic diet in cancer treatment.
No current clinical trials are studying the role of the macrobiotic diet in cancer therapy. A ketogenic diet has been well established as an effective alternative treatment for some cases of epilepsy and has gained popularity for use in conjunction with standard treatments for glioblastoma. The ketogenic diet can be difficult to follow and relies more on exact proportions of macronutrients typically a 4 to 1 ratio of fat to carbohydrates and protein than do other complementary and alternative medicine CAM diets.
Because safety and feasibility have been proven, several trials are recruiting patients to study the effectiveness of the ketogenic diet on glioblastoma.
Therefore, if a patient diagnosed with glioblastoma wishes to start a ketogenic diet, it would be safe if implemented properly and under the guidance of a registered dietitian,[ 10 ] but effectiveness for symptom and disease management remains unknown. The use of probiotics has become prevalent within and outside of cancer therapy. Strong research has shown that probiotic supplementation during radiation therapy, chemotherapy, or both is well tolerated and can help prevent radiation- and chemotherapy-induced diarrhea, especially in those receiving radiation to the abdomen.
Melatonin is a hormone produced endogenously that has been used as a CAM supplement along with chemotherapy or radiation therapy for targeting tumor activity and for reducing treatment-related symptoms, primarily for solid tumors.
Several studies have shown tumor response to, or disease control with, chemotherapy alongside oral melatonin, as opposed to chemotherapy alone; one study has shown tumor response with melatonin in conjunction with radiation therapy. However, another study did not demonstrate increased survival with melatonin, but did demonstrate improved quality of life. Melatonin taken in conjunction with chemotherapy may help reduce or prevent some treatment-related side effects and toxicities that can delay treatment, reduce doses, and negatively affect quality of life.
Melatonin supplementation has been associated with significant reductions in neuropathy and neurotoxicity, myelosuppression, thrombocytopenia, cardiotoxicity, stomatitis, asthenia, and malaise. Overall, several small studies show some evidence supporting melatonin supplementation alongside chemotherapy, radiation therapy, or both for solid tumor treatment, for aiding tumor response and reducing toxicities, while negative side effects for melatonin supplementation have not been found.
Therefore, it may be appropriate to provide oral melatonin in conjunction with chemotherapy or radiation therapy to a patient with an advanced solid tumor. Glutamine is an amino acid that is especially important for GI mucosal cells and their replication. These cells are often damaged by chemotherapy and radiation therapy, causing mucositis and diarrhea, which can lead to treatment delays and dose reductions and severely affect quality of life.
Some evidence suggests that oral glutamine can reduce both of those toxicities by aiding in faster healing of the mucosal cells and entire GI tract.
For patients receiving chemotherapy who are at high risk of developing mucositis, either because of previous mucositis or having received known mucositis-causing chemotherapy, oral glutamine may reduce the severity and incidence of mucositis. For patients receiving radiation therapy to the abdomen, oral glutamine may reduce the severity of diarrhea and can lead to fewer treatment delays. In addition to reducing GI toxicities, oral glutamine may also reduce peripheral neuropathy in patients receiving the chemotherapy agent paclitaxel.
Oral glutamine is a safe, simple, and relatively low-cost supplement that may reduce severe chemotherapy- and radiation-induced toxicities. The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above. Added Carneiro et al. Nutrition Screening and Assessment.
Added Daniel et al. Added text to state that the prevalence of obesity is higher in adult cancer survivors than in those without a cancer history; and that cancer survivors with the highest rates of increasing obesity are colorectal and breast cancer survivors and non-Hispanic blacks cited Greenlee et al.
Added text about the benefits of using immune-enhancing formulas for preoperative and postoperative nutrition support for individuals undergoing gastrointestinal surgery cited Song et al.
Added Pharmaceutical management of cancer-associated cachexia and weight loss as a new subsection. This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about nutrition before, during, and after cancer treatment. It is intended as a resource to inform and assist clinicians who care for cancer patients.
It does not provide formal guidelines or recommendations for making health care decisions. Board members review recently published articles each month to determine whether an article should:. Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
Any comments or questions about the summary content should be submitted to Cancer. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries. Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches.
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Drugs Approved for Different Types of Cancer. Drugs Approved for Conditions Related to Cancer. Access to Experimental Drugs. Chronic disease—related malnutrition e.
Acute disease—related or injury-related malnutrition e. Loss of muscle mass. Loss of subcutaneous fat. Localized or generalized fluid accumulation that may sometimes mask weight loss. Diminished functional status as measured by hand grip strength. Screening Early recognition of nutrition-related issues is necessary for appropriate nutrition management of cancer patients. Education by registered dietitian or other clinician. Intervention by registered dietitian. Critical need for improved symptom management.
Food- and nutrition-related history. Biochemical data, medical tests, and procedures. Localized or generalized fluid accumulation. Diminished functional status e. Subcutaneous fat loss Orbit. Thoracic and lumbar regions. Subcutaneous muscle loss Temple. Tumor location current or anticipated mechanical function impairment.
Anticipated duration of symptoms. Eat foods that are high in protein and calories. Eat high-protein foods first in your meal while your appetite is strongest—foods such as beans, chicken, fish, meat, yogurt, and eggs. Add extra protein and calories to food.
Cook with protein-fortified milk. Drink milkshakes, smoothies, juices, or soups if you do not feel like eating solid foods. Prepare and store small portions of favorite foods. Seek foods that appeal to the sense of smell. Experiment with different foods. Eat larger meals when you feel well and are rested. Sip only small amounts of liquids during meals. Eat your largest meal when you feel hungriest, whether at breakfast, lunch, or dinner. Be as active as possible to help develop a bigger appetite.
Consider asking your health practitioner about blenderized drinks with a high nutrient density. Tell your doctor if you are having eating problems such as nausea, vomiting, or changes in how foods taste and smell. Perform frequent mouth care to relieve symptoms and decrease aftertastes. Consider tube feedings if you are unable to sustain a certain amount of caloric intake to maintain strength.
Drink plenty of fluids each day, including water, warm juices, and prune juice. Be active each day; take walks regularly. Eat more fiber-containing foods. Drink hot liquids to help relieve constipation, including coffee, tea, and warm milk.
Talk with your doctor before taking laxatives, stool softeners, or any medicine to relieve constipation. Limit certain foods if you develop gas, including broccoli, cabbage, cauliflower, beans, and cucumbers.
Eat a large breakfast, including a hot drink and high-fiber foods. Consider a fiber supplement. Drink plenty of fluids to replace those lost from diarrhea, including water, ginger ale, and sports drinks. Let carbonated drinks lose their fizz before you drink them. Eat foods and liquids that are high in sodium and potassium. Very hot or cold drinks. Greasy, fatty, and fried foods. Foods that can cause gas, such as carbonated beverages, cruciferous vegetables, legumes and lentils, and chewing gum.
Milk products unless low lactose or lactose free. Sugar-free products sweetened with xylitol or sorbitol. Sip water throughout the day. Have very sweet or tart foods and drinks — such as lemonade, to help make more saliva. Chew gum or suck on hard candy, ice pops, or ice chips; sugar free is best, but consult your doctor if you also have diarrhea.
Eat foods that are easy to swallow. Moisten food with sauce, gravy, or salad dressing. Do not drink any type of alcohol, beer, or wine. Avoid foods that can hurt your mouth, i. Keep your lips moist with lip balm.
Rinse your mouth every 1 to 2 hours. Do not use mouthwash that contains alcohol. Do not use tobacco products, and avoid second-hand smoke. Talk with your doctor or dentist about artificial saliva or other products to coat, protect, and moisten your throat and mouth.
Prepare your own low-lactose or lactose-free foods. Choose lactose-free or low-lactose milk products. These products do not contain any lactose. Choose milk products that are low in lactose.
Hard cheeses such as cheddar and yogurt are less likely to cause problems. Try using lactase tablets when consuming dairy products. Lactase is an enzyme that breaks down lactose. Avoid only the milk products that give you problems. Try small portions of milk, yogurt, or cheese to see if you can tolerate them.
Try calcium-fortified nondairy drinks and foods, which you can identify by food labels. Eat more calcium-rich vegetables, including broccoli and greens. Eat bland, soft, easy-to-digest foods rather than heavy meals. Eat dry foods such as crackers, breadsticks, or toast throughout the day.
Eat foods that are easy on your stomach: Avoid strong food and drink smells. Avoid eating in a room that has cooking odors or is overly warm; keep the living space comfortable but well ventilated. Sit up or recline with your head raised for 1 hour after eating. Rinse your mouth before and after eating.
Suck on hard candies such as peppermints or lemon drops if your mouth has a bad taste. Eat five or six small meals each day instead of three large meals. Do not skip meals and snacks; for many people, having an empty stomach makes nausea worse. Choose foods that appeal to you. Do not force yourself to eat any food that makes you feel sick. Do not eat your favorite foods, to avoid linking them to being sick.
Have liquids throughout the day and drink slowly. Sip only small amounts of liquids during meals because many people feel full or bloated if they eat and drink at the same time. Have foods that are neither too hot nor too cold. Eat dry toast or crackers before getting out of bed if you have nausea in the morning. Plan the best times for you to eat and drink. Relax before each cancer treatment.
Wear clothes that are loose and comfortable. Keep a record of when you feel nausea and why. Talk with your doctor about the use of antinausea medications. Choose foods that are easy to chew, i.
Cook foods until they are soft and tender. Cut food into small pieces and use a blender or food processor to puree foods. Drink with a straw to help push the drinks beyond the painful parts of your mouth. Use a very small spoon to help you take smaller bites, which may be easier to chew. Eat cold or room-temperature foods to avoid hurting your mouth with food that is too hot. Suck on ice chips to help numb and soothe your mouth. Avoid certain foods and drinks when your mouth is sore, such as: Drinks that contain alcohol.
Toothpicks or other sharp objects. Choose foods that are easy to swallow, e. Choose foods and drinks that are high in protein and calories. Moisten and soften foods with gravy, sauces, broth, or yogurt. Sip drinks through a straw to make them easier to swallow.
Do not eat or drink things that can burn or scrape your throat, such as: Hot foods and drinks. Foods and juices that are high in acid. Sharp or crunchy foods. Use plastic utensils, and do not drink directly from metal containers if foods taste metallic.
Substitute poultry, fish, eggs, and cheese for red meat. Consult a vegetarian or Chinese cookbook for useful nonmeat, high-protein recipes. Add spices and sauces to foods; marinate foods. Eat meat with something sweet, such as cranberry sauce, jelly, or applesauce. Try tart foods and drinks. Try to eat your favorite foods, if you are not nauseated. Try new foods when feeling your best.
If tastes are dull but not unpleasant, chew food longer to allow more contact with taste receptors. If smells are an issue, keep foods covered, use cups with lids, drink through a straw, and use a kitchen fan when cooking, or cook outdoors. Use sugar-free lemon drops, gum, or mints when experiencing a metallic or bitter taste in the mouth.
Visit your dentist and maintain good oral hygiene. Do not eat or drink until vomiting stops. Drink small amounts of clear liquids after vomiting stops. Once you can drink clear liquids without vomiting, try full-liquid foods and drinks or those that are easy on your stomach. Ask your doctor to prescribe medicine to prevent or control vomiting antiemetic or antinausea medicines. Sit upright and bend forward after vomiting. Eat lots of fruits and vegetables, which are high in fiber and low in calories.
Eat foods that are high in fiber, such as whole-grain breads, cereals, and pasta. Choose lean meats such as lean beef, pork trimmed of fat, or poultry without skin. Choose low-fat milk products. Eat less fat; limit amounts of butter, mayonnaise, desserts, fried foods, and other high-calorie foods. Cook with low-fat methods such as broiling, steaming, grilling, or roasting. Eat small portion sizes. Limiting salt will help you not retain water if your weight gain results from water retention.
Talk with your doctor before going on a diet to lose weight. Pay attention to portion sizes; check food labels and the serving sizes listed. Include and savor foods that you enjoy most so you feel satisfied. Eat only when hungry. Consider psychological counseling or medications if you find yourself eating to address feelings of stress, fear, or depression, and try to find alternatives to eating out of boredom.
Patient is moderately to severely malnourished, will undergo major surgery, and is anticipated to not achieve adequate oral nutrition for at least 7 to 14 days postsurgery. Patient is malnourished and anticipated to have inadequate ingestion or absorption for 7 to 14 days or longer. Patient has a mechanical obstruction preventing food from reaching the small bowel for proper digestion and absorption. Short estimated life expectancy fewer than 2—3 months.
Bolus feedings can be offered several times 3—6 times each day; as much as to cc can be given over 10 to 15 minutes. Bolus feeding should be used only when the endpoint of the tube is in the stomach; it should never be used when feedings are delivered into the duodenum or jejunum. This precaution protects against gastric distention and dumping. A gravity drip from a bag or syringe with a slow push can be used to administer the formula. Diarrhea is a common side effect of this infusion method but can be controlled with a change in formula, additions to the formula, and a change in the amount of formula given over a finite period of time.
Enteral feeding pumps provide reliable, constant infusion rates and decrease the risk of gastric retention. Continuous feeds can be cycled to run at night to allow greater flexibility and comfort.
If it is physically possible, these nocturnal feeds can allow daytime oral or bolus feedings to meet nutrition goals and provide a more normal lifestyle. Sepsis a risk of parenteral nutrition. Aspiration and diarrhea a risk of tube feeding. Pressure sores and skin breakdown. Complications caused by fluid overload. Store boiled water in the refrigerator; discard unused water after 48 hours.
Hematopoietic cell transplantation patients are advised not to use well water from private wells or from public wells in communities with limited populations because tests for bacterial contamination are performed too infrequently.
Contact the bottler directly to confirm which process is used. Contact information for water bottlers is available on the International Bottled Water Association website. Nutr Cancer 67 8: Low bacterial diet versus control diet to prevent infection in cancer patients treated with chemotherapy causing episodes of neutropenia.
Cochrane Database Syst Rev 9: Normal hospital and low-bacterial diet in patients with cytopenia after intensive chemotherapy for hematological malignancy: Ann Oncol 18 6: Feasibility and safety of a pilot randomized trial of infection rate: J Pediatr Hematol Oncol 28 3: Randomized comparison of cooked and noncooked diets in patients undergoing remission induction therapy for acute myeloid leukemia.
J Clin Oncol 26 Questioning the role of a neutropenic diet following hematopoetic stem cell transplantation. Biol Blood Marrow Transplant 18 9: Food Safety for People with Cancer. Last accessed January 5, Food Safety for Transplant Recipients. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: Biol Blood Marrow Transplant 15 Microbiological food safety and a low-microbial diet to protect vulnerable people.
Foodborne Pathog Dis 11 6: Special Diets Maintaining adequate nutrition while undergoing treatment for cancer is imperative because it can reduce treatment-related side effects, prevent delays in treatment, and help maintain quality of life. Vegetarian or vegan diet A vegetarian diet is popular, is easy to implement and, if followed carefully, does not result in nutrition deficiencies.
Ketogenic diet A ketogenic diet has been well established as an effective alternative treatment for some cases of epilepsy and has gained popularity for use in conjunction with standard treatments for glioblastoma.
Probiotics The use of probiotics has become prevalent within and outside of cancer therapy. Melatonin Melatonin is a hormone produced endogenously that has been used as a CAM supplement along with chemotherapy or radiation therapy for targeting tumor activity and for reducing treatment-related symptoms, primarily for solid tumors.
Oral glutamine Glutamine is an amino acid that is especially important for GI mucosal cells and their replication. Role of nutritional status in predicting quality of life outcomes in cancer--a systematic review of the epidemiological literature. Vegetarian diets and the incidence of cancer in a low-risk population. Cancer Epidemiol Biomarkers Prev 22 2: Potential attenuation of disease progression in recurrent prostate cancer with plant-based diet and stress reduction.
Integr Cancer Ther 5 3: A randomized trial of diet in men with early stage prostate cancer on active surveillance: Contemp Clin Trials 38 2: