ANH Feature: More dietetic crimes against humanity

If you were diagnosed with bowel cancer and were scheduled for tumour removal and a gut resection would you instinctively choose food like this for your healing and recovery?  Actually – would you ever choose food like this?

Meal suggestions

• Tinned macaroni cheese, spaghetti or spaghetti bolognese
• Instant potato mixes
• Frozen or ready meals that can be baked or microwaved
• Baked beans on toast with grated cheese or a poached egg
• Tinned or packet soups made with fortified milk (see below for ingredients) or add grated cheese – eat with bread and butter
• Longlife double cream
• Tinned milk puddings, sponge puddings, crème caramels, instant whip (made with fortified milk)
• Milk – dried, evaporated or longlife
• Tinned fruit in syrup
• Cheese and cheese spreads for toast

Snacks for between meals

• Breakfast cereals (if softened with milk)
• Sweet biscuits (dip in tea to soften)
• Piece of cake (add cream/custard to soften)
• Rice pudding
• Scones
• Muffins
• Cheese and biscuits
• Cubes of cheese

A close relative of one of the ANH-Intl team is being faced with such a nutritional dilemma in a major UK NHS hospital.  But luckily is one of the few informed consumers that knows better than to follow these frankly terrifying nutritional guidelines from the dieticians at the hospital. 

Nutritional crimes against the sick

Some of you may have taken a sharp intake of breath reading the abbreviated list above, but it's only when you read the full booklet (unfortunately unavailable online) given to patients with bowel cancer that you realise what a truly heinous crime against humanity is being waged by UK dieticians.  Their recommendations defy most logic, common sense and the call of our DNA — let alone the science.  Patients are encouraged to eat foods high in sugar, fat and dairy in an attempt to increase calories and told to "avoid filling yourself up with large servings of vegetables, salads, water and fizzy drinks as they give bulk but are low in calories and protein"!  Fizzy drinks, at least we can agree on something. 

Other tips include eating little and often, what you want and when you want it, treating yourself to your favourite foods and having a glass of sherry, brandy or any alcohol before a meal to stimulate your appetite.  If that's not bad enough, words really begin to fail us at the imperative to "add glucose powder, sugar or honey to drinks, fruit juice, puddings, porridge etc.  And to use syrup and honey on bread or puddings".  Ahem, weren't these recommendations for patients with bowel cancer recovering from surgery?  And aren't there well established links between sugar, processed food, lack of fibre and phytonutrients and colorectal cancer?

In case you think we're making this up you can take a look at similar guidelines from another two UK NHS sources we've found online: 

NHS Derby City and NHS Derbyshire County: Big Nutrition for Small Appetites: getting a lot out of a little
Barnet and Chase Farm Hospitals: Making the Most of Every Mouthful

This seems to be standard dietetic fodder recommended to many different groups of patients.  You may like to remind yourself of our earlier feature this year on the differences between dieticians and nutritional therapists and revisit the horrifying nutritional guidelines for cancer patients from London's Royal Marsden hospital.

Fortified milk and dairy intolerance

Apart from loading the sick and vulnerable with saturated fat, simple carbohydrates, gluten and sugar, the other common recommendation is to make your own 'fortified or enriched milk' and use it ubiquitously.  It's a simple innocuous looking recipe to the uninformed, consisting of 1 pint of full cream milk with 4 tablespoons of dried milk powder added to it.  For a little extra 'enrichment' — it's all about getting those calories in — you can also use evaporated milk or double cream for further 'enrichment' of cereals and puddings.  Apparently fortified milk is one of the best ways to increase your caloric and protein intake.  What happened to simple chicken and fish?  Two of the most easily digested proteins that carry very little risk for an inappropriate gut response or creating further inflammation in an already wounded intestine.

Is this really an innocuous healthy food?  What about our ability to digest milk and dairy products?  Milk is one of the most well known foods allergens through either an allergy to the cow's milk protein or a deficiency of lactase to digest the predominant sugar, lactose.  Reactions can be swift (30 mins to 2 hours after eating) and include a range of symptoms from nausea, cramps, bloating and gas to diarrhoea.  Whilst these are unpleasant, they are not considered life threatening, but what people fail to realise is that they are still a source of intense inflammation.  And inflammation is one of the key foundation stones of chronic disease. 

Many people don't realise that they have a problem with a food allergen such as lactose.  And also don't realise that it's hidden in so many foods, such as bread, baked goods, processed breakfast cereals, instant potato mash, margarine, lunch meats, sweets and sugary snacks, mixes for pancakes, biscuits and cookies and powdered meal-replacements — actually pretty much most of the recommendations from the dieticians!

Root of the problem: reductionism

In the world that has spawned modern medicine, everyone has a specific job and within that job, specific tasks. In the case of the oncologist, the task is to treat or remove the cancer to the best of the oncologist’s ability. The oncologist knows that people who have important tissues, organs or parts of organs removed from their bodies are very sick people. These sick people have little appetite or may find it difficult to eat. They are therefore at great risk of losing weight. The dietician is called in to address this problem — and this problem alone.  The dietician is not asked to provide food that helps healing — food that is low in simple carbohydrates and sugars, yet is rich in anti-inflammatory botanical nutrients and proteins, amino acids, fibres, vitamins and minerals to enhance healing in the body and even help address possible underlying causes that might have given rise to the cancer in the first place. 

As a result, the kind of advice being dished out by dieticians in many hospitals is simply a stopgap, weight-gain-at-any-cost dietary regime.  It’s all about maximising calorie intake, even if the foods containing those calories might be proven to give rise to increased risk of cancer if consumed long-term.  And of course the ties between Big Food and the dietetic associations round the world is well known.  Sadly, unprocessed wholefoods, vegetables and fruits don't put much money into the coffers of Big Food, whose very large and unmistakable footprint is visible through most dietetic advice.

It’s a sad fact that many people will have to look elsewhere for good advice that is informed by a more complete understanding of how foods, eating habits and lifestyles interact with a damaged and stressed body.  Preventing weight loss is rather more about balancing physical activity with the right amounts of nutrients, consumed at the right times, to help bring the complex interacting metabolic, endocrine, immune and nervous systems back into balance.

Your gut as your health barometer

The gut is already the most challenged set of tissues in the body given that we ingest 30 – 50 tonnes of antigenic ('non-us') material in a lifetime.  Each time we eat, we create inflammation and our immune cells in the gut have to work overtime.  The immune system in our gut is challenged more in one day than the rest of our immune system in a lifetime.  As such, our gut health is determined on the ability to come back to a normal non-inflamed set-point after each challenge.  Hence, consistently challenging the gut with pro-inflammatory or allergenic foods is just setting one up for a future health crisis.  If your gut is happy and healthy, so will you be.  And that is why it makes no sense to advise patients in their vulnerable recovery state to consume the very foods that have likely contributed to their colorectal cancer in the first place. 
 

Steps towards healing the gut:

• Listen to your gut.  Is it happy and healthy?  How does it react when you eat certain foods?  Do you experience any symptoms after eating?  No matter how small or insignificant you may feel a symptom is, take note, as it's usually the tip of the iceberg – the early warning if you like.  Respond soon enough and the iceberg has a chance to melt!
• Reduce exposure to inflammatory foods e.g. gluten-containing grains; processed and ready-made foods; high sugar-laden foods and drinks; refined carbohydrates (cakes, pastries, biscuits etc); dairy products (which also have a morphine-like effect on the gut!); peanuts which are a source of dangerous aflatoxins; foods that you know you react to or are intolerant to.
• Increase the level of protective phytonutrients in your diet through eating a rainbow of brightly coloured fruits and vegetables daily.  Aim for a profusion of different colours so you know you're getting those important antioxidants, plant nutrients and essential fibre.
• Make sure you're getting sufficient good quality, unprocessed protein into your daily diet.  Chicken and fish are more easily digested than red meat for an impaired gut.  As a rule you need about 1 g per kg/body weight, but when you're ill or recovering from surgery your requirement increases to as much as 3 g per kg/body weight.  High quality protein shakes such as the ones from companies that supply practitioner products can be very useful here.
• Work on getting more fibre into your diet and make sure you have more soluble (e.g. oatmeal, oat cereal, lentils, apples, oranges, pears, oat bran, strawberries, nuts, flaxseeds, beans, dried peas, blueberries, psyllium, cucumbers, celery, and carrots) than insoluble (whole wheat, whole grains, wheat bran, corn bran, seeds, nuts, barley, couscous, brown rice, bulgur, zucchini, celery, broccoli, cabbage, onions, tomatoes, carrots, cucumbers, green beans, dark leafy vegetables, raisins, grapes, fruit, and root vegetable skins) fibre.  The sources of your fibre affect the type of colonies of bacteria living in your gut, so it's not just about supporting good bowel movements.
• Try to reduce your meal frequency to 3 meals a day with no snacks to reduce your inflammatory response after eating.  However, this is not likely to be possible after gut surgery when you'll need to eat little bits more often until your gut is healed.
• Make sure you're drinking at least 1.5 L per day of clean water, more if you're very active.
• Ensure you hit the magic 7-8 hours sleep a night and try to hit the hay before 10 pm if you can.
• Practice the Inner Smile every day.  No kidding!  This is a very ancient, tried and tested method of health promotion from the Taoists in China and it's really simple.  You literally 'smile' through yourself on the inside — imagine an inner smile of huge appreciation moving through your body and organs.  It's a great way to start the day and you don't have to look goofy on the outside when you're doing it.  You can keep your grin on the inside only, but you'll tap into some of the health, happiness and longevity benefits the Taoists have been practicing for thousands of years.

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Updated: 13 Jun 2012