DIET
(see Anorexia, Nutrition)

Many patients and carers worry about “correct diet”. Dietary advice should be available to patients in the same way as physiotherapy, occupational therapy or psychotherapy.

The carer’s interest in a patient’s food intake carries a message. Even when a patient is unable to enjoy eating, attention to an adequate dietary intake can provide psychological support to both patient and family. There are social and emotional aspects to eating.

Advice from a dietitian is usually welcomed. The dietitian can give advice on:

• Overcoming eating problems

• A balanced diet

• Dietary supplements

• Special diets

When discussing diet it is important to consider any eating problem which includes:

• Poor appetite (see Anorexia)

• Taste changes (see Taste)

• Sore mouth (see Mouth Care)

• Difficult or painful swallowing (see Dysphagia)

• Early fullness (see Small Stomach Syndrome)

• Nausea (see Nausea & Vomiting)

• Weakness or embarrassment

• Boring food

Dietary advice generally includes:

• Encourage fluids

• Encourage fiber (fruit and vegetables)

• Eat little and often

• Eat whatever you enjoy (no foods are harmful)

Fluid and a moderate amount of fiber will help to prevent constipation. Taste changes are common and new food preferences often develop, much to the person’s surprise. Long-standing dietary restrictions (for example, low salt or low fat diets) can usually be relaxed if the patient is finding them irksome.

It can be helpful to ask the patient to outline his normal daily food intake. Fortifying a normal diet with increased protein (meat, fish, nuts, beans, eggs, cheese, milk) and increased calories (pasta, bread, jam, cakes, butter) is one way of boosting dietary intake. High dose Vitamin C (500mg 4 times a day) for 6 weeks may improve appetite and well-being.

Dietary supplements are helpful for patients with a reduced appetite. Energy supplements in the form of tasteless glucose polymers (Polycose) are useful. These can be added to drinks, soups, casseroles, custards, tapioca and milk puddings. The aim is to add as much as possible without altering the flavor or texture of food.

Nutritionally complete foods (Ensure Plus, Sustacal, etc.) can replace eating for patients unable to manage normal meals due to weakness, small appetite, nausea or dysphagia. These have disadvantages (they are sometimes seen as “invalid foods”, or reduce the appetite for normal meals, or simply become boring), but they can be very helpful for weak patients who want to maintain a normal food intake. Small, frequent sip feedings (50ml per hour) are encouraged. A dietitian should advise on selecting suitable supplements that the patient likes.

Special dietary regimes are often promoted to cancer patients. These diets are usually only one part of a holistic approach to health (complementary to orthodox medicine) which encourages patients to be active in maintaining their own health. There is no evidence that they improve prognosis. The diets are sometimes accompanied by megavitamin therapy and other oral supplements (including selenium, zinc, herbal mixtures, carrot juice, evening primrose oil, glanolin, etc.) some of which are very expensive.

These diets are usually low calorie, vegetarian diets. The high fiber element can make them unmanageable for patients with a colostomy or an esophageal tube. Provided they are not physically harming the patient or causing undue expense, such special diets can on occasion improve patient morale.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.