"We do different diets for different patients. When sick, people need more nutrition to fight the disease they are suffering from" - Dr Anita Jatana, chief nutritionist, Indraprastha Apollo Hospitals, Delhi
"Many people don’t need any medicine for their blood pressure or diabetes. In metabolic disease, quantity [of food] matters along with quality" -Dr Chin Kun Wang Nutritionist and metabolism expert
My chemotherapy was one of the best phases of my life. I rediscovered myself,” says Nirmala Gupta, 58, who fought third-stage breast cancer three years ago. Quite unusual for someone to say such a thing.
Cancer was not a stranger to Nirmala. She had seen her mother and sister suffer from it. So when she felt a lump in her breast, she knew it was not normal. She consulted a doctor without telling anyone and even underwent a few initial tests. When her doctor confirmed cancer, she broke the news to her husband.
Within a week, she underwent surgery to remove the lump. Dr Siddharth Sahni, senior consultant, oncology, Indraprastha Apollo Hospitals, told her that to be able to bear the side effects of the strong medicines, she needed to prepare her body. “My sister grew weak after chemotherapy,” says Nirmala. “She couldn’t eat anything because of ulcers in the mouth and food pipe, a side effect of chemotherapy. I didn’t want that to happen to me.”
Nirmala’s elder daughter, Ritika, studied how to prepare one’s body for chemotherapy and found that food played a major role in it. Chemotherapy, she says, kills the rapidly dividing cells in the body. “These are generally cancer cells, but other cells such as those in bone marrow, mouth and gut also get affected. Chemotherapy drugs bring down the body’s immunity so that the body doesn’t resist them,” says Nirmala.
Chemotherapy primarily affects bone marrow, hair, gut and mouth. Patients suffer from sore mouth, ulcers, nausea and fatigue. Food that does not irritate one’s system is helpful, and doctors advise alkaline food. The food should also be easy to digest and rich in antioxidants, vitamins and minerals. “I made different types of vegetable and fruit juices for my mother, and replaced dairy products with soya and tofu, as they are easy to digest,” says Ritika. “Different juices were given at different stages of chemotherapy. All that helped her tremendously.”
Says Nirmala: “Thanks to those juices, I didn’t suffer from mouth ulcers or loss of appetite during chemotherapy. Though I felt a little tired during the first cycle of chemotherapy, it vanished by the time I started the second cycle. It was like taking vitamin supplements.”
The juices helped Nirmala after chemotherapy, too. “My hair became denser and I now have lovely curls at the fringes, the kind I always wanted,” she says. “Sometimes my friends feel that I wear a wig.”
Scientists across the world have been trying to decode cell function. They say food plays an important role in the prevention, treatment and management of a disease, from cold and cough to bacterial infection, diabetes and cancer.
The body is under a lot of stress when unwell. Medicines, though essential for recovery, add to it. That is when the body needs nutrients to tackle not only the stress but also the side effects of the medicines. Dr Brijesh Arora, senior consultant, paediatric oncology, at Tata Memorial Cancer Hospital and Research Institute, Mumbai, says mortality in malnourished children who have cancer is higher. “Their body fails to take the aggressive treatment required to kill the disease. In many a case, we have to stop medication midway. We then started giving ready-to-use therapeutic food (RUTF), a calorie-dense meal, to these kids and realised that, as they gained weight, their body’s response to the treatment improved,” he says.
RUTF is a WHO- and UNICEF-certified medical nutrition therapy for treatment of severe malnutrition. It is an energy-dense food with a balanced composition of both type I and II micronutrients essential for growth, development and normal functioning of the body. It not only helps in weight gain, but also results in improvement in organ function and immunity.
Arora says one of his patients, a 15-year-old who weighed only 35kg, was suffering from acute lymphoblastic leukaemia (a common type of blood cancer) and was severely malnourished. “Every time we tried giving him the chemo medicine, he developed complications and had to be hospitalised. We gave RUTF and, within six weeks, he gained 13kg. He could complete the remaining chemotherapy in time without any major complication.”
Every disease claims something specific from the body, and there are diseases which occur because of faulty eating habits. What you eat plays a major role in causing and controlling diabetes, coronary artery disease, high cholesterol and high blood pressure. “I tell my patients, ‘you are what you eat’. In severe cases of diabetes, if a patient loses 5-7 kilograms, his drugs and their dosage go down dramatically. With every 7kg weight loss, you eat one drug less,” says noted Delhi-based diabetologist Dr Anoop Misra. Misra closely works with a nutritionist who ensures that every patient’s diet is modified according to their nutritional needs.
But does the diet change have to be drastic during sickness? “Not really,” says Rekha Sharma, former chief nutritionist, All India Institute of Medical Sciences. “A balanced diet is what you always need. In most health conditions, you need to tweak it a bit.”
For example, one should, in normal course, consume a lot of fibre and proteins, less but complex carbohydrates and little fat. But in diabetes, one must regulate complex carbohydrate intake to avoid hypo- or hyper-glycaemia. When the kidneys are affected by the disease, protein intake is generally restricted.
Dr Chin Kun Wang, a Thailand-based nutritionist and metabolism expert, says that at ideal body weight a lot of health problems disappear. “Many people don’t need any medicine for their blood pressure or diabetes,” he says. “In metabolic disease, quantity [of food] matters along with quality. For example, by eating a large bowl of soup with less salt, you may actually be consuming the same quantity of salt as is there in a small bowl of soup with regular salt. It is important to measure a day’s quantity.”
Similarly, the body needs extra calories and energy to combat a viral or bacterial infection. Plenty of fluids and soft food such as porridge and khichdi are helpful. They provide instant energy to the body without putting stress on the digestive system.
However, in some medical conditions, it is important to understand the specific food requirement. A burns patient, for example, needs more calories—as high as 3,000 a day—because there is rapid breakdown of protein, leading to a negative nitrogen level in the body. “These patients may lose weight rapidly, if not supplemented with high-calorie diet. Ideally, there should not be more than 10 per cent loss in body weight,” says Dr Kuldeep Singh, a burns specialist at Indraprastha Apollo Hospitals.
Neural problems, pre- and post-bariatric surgery and kidney disorders require drastic diet changes. A patient who has undergone bariatric surgery is advised intake of easy-to-digest food in limited quantity. The meal size should remain small as the surgery reduces the size of the stomach. So the challenge is to provide the required nutrition in a small meal. Patients are advised not to eat high-calorie food. Even the regular food should be supplemented with essential vitamins and minerals.
Similarly, people suffering from epilepsy need food that are high on fat. Nutritionists devise a special ketogenic diet, which helps control seizures. The body derives energy from fat instead of carbohydrates.
Researchers say that in most neurological diseases, the body faces a deficit energy production. During metabolic stress, ketones serve as an alternative energy source and maintain normal brain cell metabolism. Some believe that BHB, a major ketone, is a better fuel than glucose and provides more energy per unit oxygen used.
Similarly, there are conditions such as celiac disease, where one cannot digest gluten, which is present in most carbohydrates. Then there are people who are lactose intolerant. They cannot digest lactose protein, present mainly in milk. “All these conditions,” says Dr Anita Jatana, chief nutritionist, Indraprastha Apollo Hospitals, Delhi, “can be tackled with a tweak in diet.”