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8/29/2013
1
Jennifer Wolfshohl RD, CSO, LDRegional Patient & Family Conference
7 September 2013Boston, MA
Nutrition &
Bone Marrow Failure
Objectives
� Optimize blood production & maintain health
� Identify the building blocks of a healthy diet
� Nutrition during treatment
� Supplements
� Reliable resources
Where to begin?
American Institute for Cancer Research
� Be as lean as possible without becoming underweight.
� Be physically active for at least 30 minutes every day.
� Avoid sugary drinks. Limit consumption of energy-dense foods.
� Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
� Limit consumption of red meats (beef, pork and lamb) and avoid processed meats.
� If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
� Limit consumption of salty foods and foods processed with salt (sodium).
� Don't use supplements to protect against cancer.
� And always remember . . . Do not use tobacco in any form
Maintain a Healthy Weight
� Waist circumference� Men < 40 inches
� Women < 35 inches
� Smaller, more frequent meals and snacks
� Focus on fiber & protein� Mindful eating
� Increase satiety
� Stabilize blood sugar � 25-30 grams fiber per day
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Nutrient Dense Food First� Minimally processed plant based
� 8-10 servings of fruits and vegetables every day� Green leafy vegetables
� kale, chard, mustard/collard greens� blueberries , blackberries
� Make your grains “whole”� 100% whole wheat/grain, barley, amaranth, rye, quinoa
� Beans & Legumes
� Excellent source of iron, protein, fiber and folate� Hummus – try adding avocado, lima beans, or edamame
� Healthy Fats � Nuts, seeds, avocado, olives/olive oil, canola oil, flax seed, fish
� Calcium rich foods� Lean protein
Nutrition Through Treatment
Nutrients for Bone & Bone Marrow� Protein
� Building blocks of red & white blood cells� Maintains strength, rebuilds tissue� Key nutrient for maintaining immune function
� Vitamins and minerals� Iron, Vitamins C and B for making blood cells� Antioxidants to help maintain integrity of cells� Calcium + Vitamin D for bone health
� Calories� Provide energy for all bodily functions� Keeps body from breaking down protein� Increased need when body is stressed
� Fluids � Required for blood volume� Electrolyte balance
Proper Nutrition Proper Nutrition Proper Nutrition Proper Nutrition Poor Nutrition Poor Nutrition Poor Nutrition Poor Nutrition
� Help the body to maintain healthy cells and support repair
� Maintain a sense of well-being
� Reduce risk of illness
� Help to maximize the impact of treatment
� Does not cause bone marrow failure
� Can reduce quality of life and functional status
� Increase risk for other illness
� Reduce our body’s natural defenses
� Limit body’s ability to repair itself
Maintain Your Weight� Weight loss during treatment can increase fatigue
� Adequate nutrition are essential for:� Rebuilding and maintaining blood cells
� Immune function
� Preserving lean muscle mass
� Optimizing energy
� Hydration
Poor Appetite� 6-8 small meals instead of 3 large meals
� Eat when you feel the hungriest
� Use smaller plates
� Keep favorite foods in the home
� Set a timer to go off every 1 – 1 ½ hrs
� Create an eating routine
� Eat protein first
� Keep meal times relaxing
� Carry snacks with you� Fill zip lock bags with high calorie, high snack ideas.
� Prepare in bulk when you feel the best
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Nutrition Supplements� Ensure/Boost
� Ensure Clear
� Boost Very High Calorie
� Scandi Shake
� Carnation Instant Breakfast
� Orgain
� Mix1
� Benecalorie
� Unjury
Taste Change (Xerostomia)� ¾ tsp baking soda, 1 tsp salt and 1 quart water swish and spit� Biotene tooth paste or mouth wash� Cold or moist may be best� Liquids, gravies, marinades, sauces, condiments� Citrus vs cooling fruit� Zinc lozenges, gum, mints� Try plastic-ware� Have a caregiver prepare food in a
separate room
� +fat, salt, sour, sweet
Nausea/Vomiting� Simple carbohydrates
� breads, rice, pasta, pretzels, crackers, cooked sushi
� Try eggs� Complete protein= contain all essential amino acids which are
the building blocks for protein
� Moist and bland, easy to tolerate
� Try adding to casseroles, pasta, or making a breakfast wrap or omelet
� Hard boiled or deviled egg
� Ginger ale, ginger tea, ginger candies/chews/gums
Constipation� Do not exceed 72 hrs with out a bowel movement
� Increase insoluble fiber� Bran, prunes, plum juice, potato with skin, popcorn
� Fluids� Eat a high fiber breakfast with a hot drink
� Bran muffin made with prune juice in place of water
� Regular activity
� If gas is a problem� Omit carbonated drinks, gums, straws, cruciferous vegetables,
cucumbers, dried beans, peas, and onions
� Bowel regimen� Senokot, Colace, Milk of Magnesia, Miralax
Diarrhea� Limit fat, sugar, artificial sweeteners, caffeine
� > 4 loose BM/day� Drink 8 oz of clear liquid, isotonic solution following each BM
� Jell-o, G2, Popsicles, watermelon
� Soluble fiber to add bulk to stool� Banana, potato, rice, apple sauce, smooth peanut butter� Benefiber, Metamucil
� Greek yogurt� Double protein, contains probiotics� Cool/easy to swallow
� Base for fruit smoothies or topping for a whole grain waffle� Dip a banana in yogurt, roll in nuts, freeze to make a Popsicle
� Glutamine?
Hydration
� Drink 8 -12 cups caffeine-free non alcoholic liquids/day
� Take a water bottle when leaving home.
� Drink even if not thirsty
� Stagger liquids with meals to increase overall consumption of both liquids and solids
� If urine is darker than a pale straw color or has a strong odor, you likely need to drink more water
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Fight Fatigue� Exercise each day� Prepare meals ahead of time and freeze them� Use convenience foods that are ready to eat� Let friends and relatives help � Fluids– dehydration can worsen fatigue� Protein� Increase rest
� Getting more sleep at night� Naps � Minimize caffeine
� Avoid skipping meals. � Try to eat even when you are tired. � Food is fuel --- eat or drink something every 2-3 hours.� Make eating a priority!
Food Safety� Goal = Use the common sense approach to lower risk of
infection, and encourage diet flexibility to eat as well as possible.
� Wash hands
� Autologous- 3 months
� Allogenic- follow diet until off all immunosuppressive therapy � (cyclosporine, prednisone, FK-506 (Tacrolimus) or MMF
(CellCept)
Food Safety� Keep hot foods hot, & cold foods cold
� Danger zone 40 – 140 degrees F
� Avoid raw meat and fish� Avoid aged cheese� Avoid raw or unpasteurized drinks, honey, unroasted raw
nuts� Avoid homemade fermented drinks, homemade wine, cider,
root beer, miso, and vinegar� Avoid buffets, salad bars, and crowded restaurants� Wash fruits and vegetables well� Recalls and Alerts
Supplements
Reasons for Caution� Not FDA regulated� Blood thinning or thickening properties
� Vitamin K (K2)
� Altered metabolism� Grapefruit, Green tea & Velcade
� Antioxidants and chemo/radiation� Hormonal properties
� Soy Isoflavone & Estrogen
� High dose of herb/vitamin toxicity� Fact check:
� Memorial Sloan Kettering Herbal Database� Quack Watch
Color Phytochemical Fruit/Vegetables
Red Lycopene Tomatoes and tomato products, pink grapefruit, watermelon
Red/purple Anthocyanins, polyphenols
Berries, grapes, red wine, prunes
Orange α-, β-carotene Carrots, mangoes, pumpkin
Orange/yellow β-cryptoxanthin, flavonoids
Cantaloupe, peaches, oranges, papaya, nectarines
Yellow/green Lutein, zeaxanthin Spinach, avocado, honeydew, collard and turnip greens
Green Sulforaphanes, indoles Cabbage, broccoli, Brussels sprouts, cauliflower
White/green Allyl sulphides Leeks, onion, garlic, chives
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www.eatright.org
Resources� American Institute for Cancer Research
� www.aicr.org
� Academy of Nutrition and Dietetics� www.eatright.org
� www.foodsafety.gov
� Memorial Sloan Kettering Herbal Database� www.mskcc.org/mskcc/html/11570.cfm
� Quack Watch� www.quackwatch.com
Questions?