NUTRITION IN CANCER, AIDS, AND OTHER SPECIAL PROBLEMS
Role in wellness
Consequently, the nutritional status of patients with cancer, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and pulmonary disease is challenged by manifestations not only of the disease but also by the ramifications of treatment.
Most medical nutrition therapy prescribed focuses on reducing these effects and supporting the nutritional status of patients through the potentially debilitating side effects of treatment. Because these disorders are chronic, nursing care often continues after the patient leaves the hospital setting and returns home. The role of home care and hospice nurses is crucial for providing continued medical care, but also important are the nutritional support and food consumption strategies as patients recover and become acclimated to their conditions. The goal of maintaining good nutritional status is to improve survival rates, reduce treatment side effects, and increase the quality of life.
Consider the effects of these disorders through the health dimensions. The physical health dimension challenge is to halt or minimize malnutrition often associated with symptoms or treatments. Intellectual dimension is a factor as these disorders are marked by either their chronic or potentially life-threatening outcomes. Maintaining optimal nutrient intake while dealing with serious illness also requires intellectual abilities to comprehend the different aspects of treatment and rehabilitation.
Facing death from AIDS or cancer or dealing with the chronic pulmonary diseases stresses our emotional health ability to cope; nurses need to be sensitive to the emotional burden patients and families are experiencing. Social health may be compromised as prejudice against (and fear of) clients with HIV/AIDS and cancer affects the ability of individuals to continue their social and work relations as they did in the past. Dealing with societal and emotional issues may warrant counseling support for clients and their families. Spirituality and faith can provide personal insight for gathering strength to heal.
Nutrition is an important part of cancer treatment. Eating the right kinds of foods before, during, and after treatment can help you feel better and stay stronger. The American Cancer Society has prepared this guide to help you and your loved ones learn about your nutritioeeds and cope with treatment side effects that may affect how well you can eat.
The information in this guide is not meant to replace the advice of a medical professional. If you have any questions or concerns you should talk to a doctor, nurse, or dietitian about your nutritional needs.
A registered dietitian can be one of your best sources of information about your diet. If you are going to meet with a dietitian, be sure to write down any questions before your meeting so you don’t forget anything, and ask the dietitian to repeat or explain anything that is not clear. If you have a question about something in this guide, your dietitian can give you a more detailed explanation. For more information or for a referral to a registered dietitian, contact the American Dietetic Association.
Special effects experts make up an actress to look like she has mouth cancer.
Because your nutritioeeds will probably change as you go through the cancer experience, we have organized this guide by the stage of your cancer treatment.
You can reduce your risk of cancer by as much as 30% to 40% by making healthier food choices. In fact, some foods can actually help protect against certain cancers. Eating a plant based diet (fruits, vegetables, whole grains and beans) and being physically active is your best insurance to reduce your risk of cancer, as well as heart disease and diabetes.
Cancer
Cancer cells differ from normal cells in several ways. These characteristics may involve any or all of the following:
(1) uncontrolled cellular reproduction where cells become independent of normal growth signals;
(2) cells contain abnormal nucleus and cytoplasm; and
(3) the mitosis rate generally increases.
The nucleus of the cells may be an abnormal shape and have clearly abnormal chromosomes. This process that results in abnormal cell production is called carcinogenesis.
The abnormalities in cell replication occur in several stages: initiation, promotion, and progression.
Initiation of the process results in a mutation of deoxyribonucleic acid (DNA). Though exact causes are not clear for all malignancies, some factors such as physical and chemical agents or exposure to microorganisms may initially cause the mutation.
The second phase is where the replication of the mutated cell is promoted and abnormal cell growth results. Factors that have been identified in some malignancies include estrogen, testosterone, nitrates, cigarette smoke, and alcohol.
The third stage is the progression of the abnormal cells outside the original location of the cell.
The rate of tumor growth is dependent on characteristics of both the host and tumor. Host factors may include age, sex, nutritional status, the presence of other diseases, hormone production, and immune function. Tumor factors could include where the tumor is located and its access to adequate blood supply In the United States there are an estimated 1.2 millioew cases of cancer each year. Cancer is the second leading cause of death, with more than 500,000 deaths each year. Scientists estimate that 50% to 75% of all cancer deaths can be linked to human behaviors and lifestyle factors.
Nutrition factors are considered one of the important environmental and lifestyle factors in the etiology and prevention of cancer.
Nutrition and dietary factors may interact within the process of carcinogenesis in all three stages: initiation, promotion, and progression. Furthermore, nutritional factors may assist in blocking those three stages. For example, antioxidants in the diet may protect the cell from DNA mutation.
It is important to remember that no one food causes cancer and no one food can prevent it.
The National Cancer Institute encourages cancer prevention by encouraging the following guidelines:
• Not smoking cigarettes or using other tobacco products
• Not drinking too much alcohol
• Eating five or more daily servings of fruits and vegetables
• Eating a low-fat diet
• Maintaining or reaching a healthy weight
• Being physically active
• Protecting skin from sunlight
Understanding Gene Testing
What is the relationship between genes and cancer?
Cancer is a disease of genes gone awry. Genes that control the orderly replication of cells become damaged, allowing the cell to reproduce without restraint and eventually to spread into neighboring tissues and set up growths throughout the body.
All cancer is genetic, in that it is triggered by altered genes. However, just a small portion of cancer is inherited: a mutation carried in reproductive cells, passed on from one generation to the next, and present in cells throughout the body. Most cancers come from random mutations that develop in body cells during one’s lifetime – either as a mistake when cells are going through cell division or in response to injuries from environmental agents such as radiation or chemicals.
Cancer usually arises in a single cell. The cell’s progress from normal to malignant to metastatic appears to follow a series of distinct steps, each one controlled by a different gene or set of genes. Several types of genes have been implicated. Oncogenes normally encourage cell growth; when mutated or overexpressed, they can flood cells with signals to keep on dividing. Tumor-suppressor genes normally restrain cell growth; when missing or inactivated by a mutation, they allow cells to grow and divide uncontrollably. (The inherited genes that predispose for breast and ovarian cancer, Li-Fraumeni syndrome, retinoblastoma, Wilms’ tumor, and familial adenomatous polyposis are malfunctioning tumor-suppressor genes.) DNA repair genes appear to trigger cancer – and perhaps other inherited disorders – not by spurring cell growth but by failing to correct mistakes that occur as DNA copies itself, letting mutations accumulate at thousands of sites. (Genes that have been linked to hereditary colon cancer are such “proofreader” genes.)
Cancer usually arises in a single cell. The cell’s progress from normal to malignant to metastatic appears to follow a series of distinct steps, each controlled by a different gene or set of genes. Persons with hereditary cancer already have the first mutation.
Benefits of Good Nutrition
Good nutrition is especially important if you have cancer because the illness itself, as well as its treatments, can affect your appetite. Cancer and cancer treatments can also affect your body’s ability to tolerate certain foods and to use nutrients.
The nutrient needs of people with cancer vary from person to person. Your doctor, nurses, and a registered dietitian can help you identify your nutrition goals and plan ways to help you meet them. Eating well while you are being treated for cancer can help you:
- feel better
- keep up your strength and energy
- keep up your weight and your body’s store of nutrients
- tolerate treatment-related side effects
- lower your risk of infection
- heal and recover quickly
Eating well means eating a variety of foods that will give you the nutrients you need to protect your health while fighting cancer. These nutrients include protein, carbohydrates, fat, water, vitamins, and minerals.
Nutrition and cancer
Is the cure for oral cancer sitting in your refrigerator? Probably not. However, the odds are that some of the most effective weapons to help prevent cancer (or its recurrence, if you’re a cancer survivor) are as close as your kitchen.
Nobody has all the answers of course. It is very easy to become frustrated after hearing yet another news report about a particular food or substance that causes or prevents cancer; then months later, hearing about the same substance doing exactly the opposite from a different researcher. At times, it’s hard to know what to believe. In spite of this, there are many promising possibilities that merit closer attention. In the battle against cancer, anything that we can do to optimize the strength and effectiveness of our immune system, and provide our own defenses with the tools they need to protect us, is important. Perhaps important enough to stack the odds in our favor.
A rapidly growing number of published studies show that certain groups of food components seem to help prevent cancer and sometimes even assist the body in fighting the disease if you already have cancer. These components are what researchers call chemo-protective agents, including a group commonly known as anti-oxidants; they appear to protect the body from the effects of carcinogenic (cancer-causing) elements. Two examples are vitamins C and E, each known to have anti-oxidant properties. It’s believed that they work by preventing damage at the DNA level. If the DNA is already damaged, they may even help in its repair. Remember that damage to the structure of DNA is the precursor to cells transforming from normal to malignant.
It is not difficult to find good sources of anti-oxidants, in fact they probably are sitting in your refrigerator right now. A diet that incorporates a high level of many common fruits and vegetables can be rich in preventative agents including anti-oxidants, according to the American Cancer Society (ACS). The ACS has recently published a set of nutritional guidelines for cancer patients, including what we know about foods that help prevent cancer. Most all fruits and vegetables are important sources of vitamins and other chemo-preventative elements, and almost all are naturally low in fat and high in fiber. Fruits and vegetables are also rich in a newly explored class of compounds known as phytochemicals (phyto is Latin for plant) thought to have important, healthful properties.
Other anti-oxidants, which are not vitamins, are also found in fruits and vegetables and appear to have powerful cancer-fighting properties. Beta Carotene, a substance which gives some vegetables their color like carrots and peppers, and which the body converts into vitamin A, is one of these.When ingested in a natural state (in a beta-carotene rich food, such as leafy green vegetables, carrots, or bell peppers), it may improve immune responses in the body by stimulating a molecule that helps the immune system target and destroy cancer cells.
In any discussion of the cancer-fighting potential of a healthy diet, it is important to remember that many different foods contain beneficial elements. The new ACS guidelines emphasize the need to eat a varied diet, rather than any one particular food or group of foods. The new guidelines also emphasize the need to limit or control obesity, not only through a decrease in calories consumed, but also through exercise, which strengthens the body and promotes better utilization of any digested nutrients. Animal studies have shown that both fat itself and excess calories likely play a role as cancer promoters. When people consume more calories thaecessary to maintain optimum health, it stimulates their metabolic overdrive into making cells divide faster, which increases the risk that something can go awry, resulting in cells with damaged or incorrect DNA.
This is about the point where most people start thinking about taking vitamin supplements as an alternative to planning out a specific, healthy diet. Unfortunately, that may not help as much as you might think. For instance, a study might identify a particular active ingredient in a food which produces the beneficial results. However, it is now believed that that ingredient needs to be consumed in concert with the other vitamins, phytochemicals, and often other components of the food, not normally classified as a nutrient, such as fiber, to be effective. The exact mechanism by which this synergistic benefit takes place is still under study. For example, one study has shown that although pre-menopausal women who ate foods rich in vitamin A and Carotenes appeared to have a reduced risk of breast cancer, women who took only supplements of these same elements did not. Other factors may influence a studies outcome other than what is included in the guidelines for the study. Is it perhaps possible, that those individuals who eat a balanced diet in lieu of the “quick fix” of popping a few vitamin capsules, in general have a higher awareness of living a healthy lifestyle, and that other factors included in that healthier lifestyle, also contributed to the positive outcome.
There are potentially beneficial chemicals in foods that are not exactly nutrients as science understands them. For instance, not only does the compound beta-glycyrrhetinic acid give licorice its distinctive taste, but it has also been shown to be a potent chemo-preventive agent in laboratory animals, even though it’s not a nutrient in the standard sense. We are discovering many more of these types of agents as research progresses. What this all means, is that we are still identifying the numerous variables that provide the benefits which we seek.
The concept of nutrient synergy has led researchers to investigate other types of compounds found in foods. Less traditional elements that have shown promise in the laboratory include the mineral selenium, bioflavenoids (taste compounds), and the cell compound ubiquinone. Selenium appears to work in conjunction with vitamin E to shield host cells from damage. In fact, the body’s natural immune response has been found to be heavily depressed in selenium-deficient animals. A depressed or incompetent immune system is incapable of identifying and destroying the constant assaults that we are exposed to including the precursors to developing cancer.
Bioflavonoids, including those found in apples, onions, tea, and red wine, are now being studied for possible cancer-fighting properties. In one 24-year study, people who ate bioflavonoid-rich foods had a 20% lower risk for cancer. Laboratory and animal studies have even indicated that some of the compounds in green tea might have the capacity to selectively destroy cancer cells (black tea does not appear to do the same). Ubiquinone, a fat-soluble vitamin-like compound that assists in generating energy within our cells, is potentially a highly effective anti-oxidant, according to some early tests. Although it exists naturally in the body, it can also be supplemented by eating beef, pork, mackerel, salmon, sardines, anchovies, and nuts. Much research remains to ultimately determine its true benefits.
Researchers have also found that high levels of soybean consumption are associated with lowered rates of many types of cancers. A chemical derived from soybeans has been found to shrink abnormal growths that lead to oral cancer, according to a UC Irvine College of Medicine clinical study. The Bowman-Birk component is a protease inhibitor, based on a chemical found in soybeans that prevents the enzyme chymotrypsin from breaking down proteins in the body. The mechanism by which it does this is not completely clear, and is currently under investigation. But this process appears to have definite chemo-preventative properties.
Given all this, the safe and logical approach is to eat whole foods that are rich in chemo-protective nutrients and not try to high-dose yourself with an individual component that a current study reports to have beneficial properties. There are real dangers in this approach. Vitamin A and its retinoids are known to have chemo-protective effects.
But if you high dose yourself with vitamin A in an isolated form such as a supplement capsule, you run the risk of developing a dangerously toxic level of it in your body. You can overdose on Vitamin A, but you can’t overdose on spinach – and the spinach is more likely to provide the benefit you’re looking for.
Even though many of these individual substances may help prevent occurrence or reccurrence of cancer, a good diet is even more important for those undergoing treatment for cancer. Radiation and chemotherapy take a severe toll, and a proper diet rich iutrients is needed to rebuild cells and fortify the body during treatments. Radiation and chemotherapy cause significant collateral damage to the body overall while they are attacking the cancer itself. There is an enormous amount of cellular repair necessary. To accomplish this, the body must have the nutritional building blocks to handle the task. Even here, researchers are presenting some encouraging news. For example, Vitamin E’s powerful anti-oxident properties may help to decrease the toxicity of certain chemotherapy drugs such as Adriamycin, which while an important anti-cancer drug, carries with its use a potential toxicity to the heart. Vitamin E has shown some capacity to decrease the harmful effects of this treatment, without interfering with the treatment itself.
More about diet during cancer treatments
In the end, given all these variables, and the seemingly infinite number of possible combinations of synergistic effects, the benefits of any specific type of diet are very difficult to prove. A published study might focus on a segment of the population given a particular nutrient, but may not consider other lifestyle or genetic factors, which contribute to the studies positive or negative outcome. Participants in studies often “police” and keep track of their own dietary habits and as a result, such surveys may be flawed, or only reflect short-term eating habits. These points are not the norm, but they occur often enough to consider weighing what you hear on the news carefully, and checking with a medical professional before you engage in any particular dietary plan. Other studies are done in the laboratory with animals. While these yield new information, the results may not correctly reflect the effects of the same nutrients on humans. Having considered all of this, one thing is for certain, it is never wrong to eat plenty of fresh fruits, vegetables, and whole grains. These are the primary sources of the nutritious elements your body needs to maintain a healthy and competent immune system, your primary defense against cancer and other illnesses.
Nutrients
Protein
We need protein for growth, to repair body tissue, and to keep our immune systems healthy. When your body doesn’t get enough protein, it takes you longer to recover from illness and you have lower resistance to infection. People with cancer ofteeed more protein than usual. After surgery, chemotherapy, or radiation therapy, extra protein is usually needed to heal tissues and to help prevent infection. Good sources of protein include lean meat, fish, poultry, dairy products, nuts, dried beans, peas and lentils, and soy foods.
Fats
Fats play an important role iutrition. Fats and oils provide a rich source of energy for the body. They are used to store energy, insulate body tissues, and transport some types of vitamins through the blood. They also play an important role in food preparation by enhancing food flavor, making baked products tender, and conducting heat during cooking. You may have heard that some fats are better for you than others. When considering the effects of fats on your heart and cholesterol level, choose unsaturated fats (monounsaturated and polyunsaturated).
Monounsaturated fats are found mainly in vegetable oils such as canola, olive, and peanut oils. They are liquid at room temperature.
Polyunsaturated fats are found mainly in vegetable oils such as safflower, sunflower, corn, flaxseed, and canola oils. Polyunsaturated fats are also the main fats found in seafood. They are liquid or soft at room temperature. Certain polyunsaturated fatty acids, such as linoleic acid and alpha-linolenic acid, are called essential fatty acids, because the body cannot make them. They are needed to build cells and make hormones. Essential fatty acids must come from foods we choose.
Saturated fats (or saturated fatty acids) are mainly found in animal sources such as meat and poultry, whole or reduced-fat milk, and butter. Some vegetable oils like coconut, palm kernel oil, and palm oil are saturated. Saturated fats are usually solid at room temperature.
Trans fatty acids are formed when vegetable oils are processed into margarine or shortening. Sources of trans fats in the diet include snack foods and baked goods made with partially hydrogenated vegetable oil or vegetable shortening. Trans fats also are found naturally in some animal products, such as dairy products.
Carbohydrates
Carbohydrates give the body the fuel it needs for physical activity and for proper organ function. There are also good and bad sources of carbohydrates. The best sources of carbohydrates — fruits, vegetables, and whole grains — supply needed vitamins and minerals, fiber, and phytonutrients to the body’s cells. Other sources of carbohydrates include bread, potatoes, rice, spaghetti, pasta, cereals, dried beans, corn, peas, and beans. Sweets (desserts, candy, and drinks with sugar) can supply carbohydrates, but provide very few nutrients.
Water
Water and fluids are vital to our health. All body cells need water to function. If you do not take in enough fluids or if you are vomiting or have diarrhea, you may become dehydrated. In general, a person should drink about eight 8-oz. glasses of water or clear liquid each day to be sure that all the body cells get the fluid they need.
Vitamins and minerals
Vitamins and minerals are needed for proper growth and development. They also allow the body to use the energy (calories) supplied in foods. A person who eats a balanced diet with enough calories and protein usually gets plenty of vitamins and minerals. But it can be hard to eat a balanced diet when you are being treated for cancer and have treatment side effects that last for long periods of time. When that is the case, your doctor or dietitian may suggest a daily multivitamin and mineral supplement. If you are thinking of taking a vitamin or supplement, be sure to discuss this with your doctor first. Some people with cancer take large amounts of vitamins, minerals, and other dietary supplements to try and boost their immune system or even destroy cancer cells. Some of these substances can be harmful, especially when taken in large doses. In fact, large doses of some vitamins and minerals may reduce the effectiveness of chemotherapy and radiation therapy. During treatment, it may be best to choose one with no more than the Daily Value (DV) for all nutrients and one without iron, unless your doctor thinks that you need iron. Again, discuss this with your doctor first.
Antioxidants
Antioxidants are substances that protect the body’s cells from damage caused by free radicals (by-products of the body’s normal processes). Examples of antioxidants include vitamin C, vitamin E, vitamin A (beta carotene), and selenium. If you want to take in more antioxidants, health experts recommend eating a variety of fruits and vegetables, which are good sources of antioxidants. Taking large doses of antioxidant supplements is usually not recommended while having chemotherapy and radiation therapy. Talk with your doctor to determine the best time to take antioxidant supplements.
Herbs
Herbs have been used to treat disease for hundreds of years. Today, herbs are found in many products, such as pills, liquid extracts, teas, and ointments. While many of these products are harmless and safe to use, others can cause severe and harmful side effects. Some may even interfere with proven cancer therapies, including chemotherapy, radiation therapy, and recovery from surgery. If you are interested in using products containing herbs, talk about it with your doctor or nurse first.
Safety considerations
Many people believe that if they find a pill or supplement in stores , it is safe and effective. The Food and Drug Administration (FDA) put out new rules in 2007 to help ensure that supplements contain what their labels claim they do. However, some of these rules will not be fully in effect until 2010. Even then, the supplement’s safety and its effect on the body are not addressed by the new FDA rules. The FDA does not require manufacturers of these products to print possible side effects on their labels. The FDA cannot pull a dietary supplement or herbal product from the market unless it can prove that the product is unsafe.
Tell your health care team about any herbal products and supplements that you are using or are thinking about using. Bring the bottle(s) of the supplement to your doctor to talk about the dose and to be sure that the ingredients do not interfere with your health or cancer treatments. Some other safety tips:
- Ask your doctor or nurses for reliable information on dietary supplements.
- Check the product labels for both the quantity and concentration of active ingredients contained in each product.
- Stop taking the product immediately and call your doctor if you have side effects such as wheezing, itching, numbness, or tingling in your limbs.
Some people with cancer take large amounts of vitamins, minerals, and other dietary supplements in an effort to enhance their immune systems or even destroy cancer cells. Some of these substances can be harmful. In fact, large doses of some vitamins and minerals may reduce the cancer-fighting effects of chemotherapy and radiation therapy.
Before Treatment Begins
When you are healthy, eating enough food to get the nutrients you need is usually not a problem. In fact, most nutrition guidelines stress eating lots of vegetables, fruits, and whole grain products such as whole wheat breads or pasta; limiting the amount of red meat that you eat, especially those that are processed or high in fat; cutting back on fat, sugar, alcohol, and salt; and staying at a healthy weight.
When you are being treated for cancer, however, this may be hard to do, especially if you have side effects or just don’t feel well. As a result, you may need to change your diet to help build up your strength and withstand the effects of your cancer and its treatment.
When your cancer was first diagnosed, your doctor talked with you about a treatment plan. This may have involved surgery, radiation therapy, chemotherapy, hormone therapy, biologic therapy (immunotherapy), or some combination of treatments. All of these treatments kill cancer cells. But in the process some healthy cells also become damaged.
That is what causes the cancer treatment side effects. The following side effects can affect your ability to eat:
- Loss of appetite (anorexia)
- Weight loss or gain
- Sore mouth or throat
- Dry mouth
- Dental and gum problems
- Changes in taste or smell
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Fatigue (tiredness)
- Depression
You may or may not have any of these side effects. Many factors determine if you will have any side effects and how severe they will be. These factors include the type of cancer you have, the part of the body affected, the type and length of your treatment, and the dose of treatment.
Many side effects can be controlled and most go away after treatment ends. Talk with your doctor or nurse about your chances of having side effects and what can be done to help control them. After your treatment starts, tell your cancer care team about any side effects that are not controlled. Let them know if the medicines they have given you to control the side effects do not work, so that others can be used.
Ways to get the nutrients you need
If you have cancer, you need to take in enough nutrients to meet the following goals:
§ Prevent or reverse nutritional deficiencies
§ Decrease side effects of cancer and its treatment
§ Maximize your quality of life
Your health care team has several methods to help you get the nutrients you need. The most common ways are:
By mouth
If you can, try to meet your nutritional needs by eating and drinking nutritious foods and drinks. You may be able to get enough nutrients by eating high-calorie, high-protein meals supplemented with snacks, canned liquid nutrition products, and homemade drinks and shakes. If that proves to be too hard, or if your calorie and nutrient needs have greatly increased, you may need to use a feeding tube.
By feeding tube
Tube feedings are used most often to maintain good nutrition or to boost weight in people who have a poor appetite. Tube feedings can be given at home, if needed, with the help of family, friends, or caregivers. Once tube feedings begin, you will usually feel better because your nutritional needs are being met.
For tube feeding, a thin, flexible tube is placed through the nose and into the stomach. Once the tube is in place, liquid formulas can be given. If needed, such formulas can provide all of your needs for calories, protein, vitamins, and minerals. People who have feeding tubes can usually continue to eat by mouth since the tube is small and does not keep you from swallowing.
If you need a feeding tube, every effort will be made to help you eat by mouth, too. For example, you may be tube fed at night while you sleep toallow you to eat during the day. Most people get used to tube feedings within a few days. Some people may need longer to adjust. It often helps to talk with someone who has also had a feeding tube.
A more permanent type of tube can be placed directly into the stomach(gastrostomy) or the intestines (jejunostomy). These surgical procedures can usually be done in an outpatient setting.
By vein (total parenteral nutrition)
Tube feedings may not always provide all the needed fluids and nutrients in people with serious digestive problems. In these cases, nutrient solutions can be given directly through a vein. This type of therapy is called intravenous hyperalimentation or total parenteral nutrition (TPN). TPN is most often used when someone has had surgery of the digestive system; when there is a complete blockage of the bowel; when the person has severe vomiting or diarrhea; or when complications from cancer or treatment prevent eating or using a feeding tube. Like tube feedings, TPN can be given at home.
Nutritional Effects of Cancer Treatments
Surgery
Treatment for many malignancies (particularly, solid tumors) includes surgical resection of the tumor.This route of treatment can allow for diagnosis, resect a solid tumor, prevent metastasis of the malignancy, or reduce the size of the tumor to alleviate pain. The nutritional consequences related to surgery are dependent on the type and extent of the surgical resection. Resections of any portion of the gastrointestinal(GI) tract can cause alterations iutrition intake and nutrient absorption.Secondly, energy and protein requirements may need to be increased to promote optimal wound healing postoperatively. Malabsorption does tend to be the primary nutritional problem with surgeries involving the GI tract; yet unless small bowel resection is extensive, the adaptability of the small intestine may prevent the occurrence of major clinical problems.
Many cancer patients enter surgery already experiencing protein-calorie malnutrition that places them at higher risk for complications.
Additionally, any problems associated with surgery (Table 22-1) will be further complicated if the patient receives subsequent radiation therapy and chemotherapy.
Chemotherapy
Most chemotherapy protocols include a combination of chemotherapy agents.
Chemotherapy agents include alkylating drugs, antibiotics, antimetabolites, hormones, enzymes, plant alkaloids, and biologic response modifiers. These agents act by inhibiting one or more steps of DNA synthesis in rapidly proliferating cells that are characteristic of the malignant cell. Unfortunately, bone marrow and cells lining the GI tract tend to be susceptible to damage from chemotherapy because of their rapid turnover rate.79 The effect on these cells account for many of the side effects that are associated with chemotherapy including nausea, vomiting, diarrhea, mucositis, hair loss, and immunosuppression.
The severity and manifestation of the side effects depend on the particular chemotherapy agent, dosage, duration of treatment, rates of metabolism, accompanying drugs, and individual susceptibility. These symptoms can lead to malnutrition through a variety of mechanisms: anorexia; nausea; vomiting; mucositis; stomatitis; cardiac, renal, and liver injury (toxicity); and learned food aversions.
Nutritional implications of chemotherapeutic agents are summarized in Table 22-2.
Radiation Therapy
Radiation therapy uses ionizing radiation to kill cells by altering the DNA of the malignant cell. This alteration interferes with the factors controlling replication. Radiation is used to treat tumors sensitive to radiation exposure or tumors that cannot be surgically resected. Radiation can also be used to reduce tumor size so that a successful surgical resection can occur. Unfortunately, as with chemotherapy, normal cells within the treatment range who are also in that stage of cell replication may also be damaged. This may contribute to the physical side effects, which may include hair loss, mucositis, and vomiting and diarrhea. Nutritional problems vary according to the region or area of the body radiated, dose, fractionation, and whether radiation is used as combination therapy with surgery or chemotherapy.
Complications may develop only during radiation treatment or become chronic and progress even after treatment is completed.
Primary radiation sites that result iutrition problems include the head and neck, the abdomen and pelvis (GI tract), and the central nervous system.
Radiation at all three sites may cause anorexia, nausea, and vomiting. In the head and neck, these common effects create problems of food ingestion as stomatitis, esophageal mucositis, loss of taste sensation, and dry mouth. Side effects to the abdomen and pelvis alter the GI tract, reducing digestion and absorption of nutrients in part because of the development of diarrhea and steatorrhea, and possibly, malabsorption, ulceration, and bowel damage or obstruction.
Preparing Yourself for Cancer Treatment
Until you begin treatment, you won’t know exactly what, if any, side effects you may have or how they feel. One way to prepare for them is to think of your treatment as a time to focus on yourself and on getting well. Some other ways to get ready include the following:
The power of positive thinking
You can reduce your anxiety about treatment side effects by having a positive attitude, talking about your feelings, and learning as much as you can about your cancer and treatment. Planning how you will cope with possible side effects can make you feel more in control and help you keep your appetite.
Many people have few or no side effects that keep them from eating. Even if you have side effects, they may be mild, and you may be able to control side effects with drugs that are available. Most of these effects go away after cancer treatment ends.
Eating well
Your body needs a healthy diet to function at its best. It is even more important if you have cancer. With a healthy diet, you’ll go into treatment with reserves to help keep up your strength, prevent body tissue from breaking down, rebuild tissue, and maintain your defenses against infection. People who eat well are better able to cope with side effects of treatment. And you may even be able to handle higher doses of certain drugs. In fact, some cancer treatments are more effective in people who are well-nourished and are getting enough calories and protein.
- Don’t be afraid to try new foods. Some things you may never have liked before may taste good to you during treatment.
- Choose a diet with many types of plant-based food. Try substituting dried beans and peas for meat at a few meals each week.
- Try to eat at least 5 colorful servings a day of fruits and vegetables, including citrus fruits and dark-green and deep-yellow vegetables. Colorful vegetables and fruits and plant-based foods contaiatural health-promoting substances called phytochemicals.
- Limit high-fat foods, especially those from animal sources. Choose lower-fat milk and dairy products. Reduce the amount of fat in your meals by choosing a lower-fat cooking method such as baking or broiling.
- Limit the amount of salt-cured, smoked, and pickled foods that you eat.
- Drink alcohol in moderation, if at all.
- Try to maintain a healthy weight and be physically active.
- If you are not able to do any of the above during this time, do not worry about it.
Plan ahead
- Stock your pantry and freezer with your favorite foods so you won’t need to shop as often. Include foods you know you can eat even when you are sick.
- Cook in advance and freeze foods in meal-sized portions.
- Talk to your friends or family members about ways they can help with shopping and cooking, or ask a friend or family member to take over those jobs for you.
- You can also talk to your doctor, nurse, or a registered dietitian about any concerns you have about eating well. She or he can help you plan meals and develop a grocery list in case you have side effects such as constipation or nausea.
Include nutritious snacks
During cancer treatment your body ofteeeds extra calories and protein to help you maintain your weight and recover and heal as quickly as possible. Nutritious snacks can help you meet those needs, keep up your strength and energy level, and enhance your feeling of well-being. To make it easier to add snacks to your daily routine, try the following:
- Eat small, nutritious snacks throughout the day.
- Keep a variety of protein-rich snacks on hand that are easy to prepare and eat. These include yogurt, cereal and milk, half a sandwich, a bowl of hearty soup, and cheese and crackers.
- Avoid snacks that may make any treatment-related side effects worse. If you suffer from diarrhea, for example, avoid popcorn and raw fruits and vegetables. If you have a sore throat, avoid dry, coarse snacks and acidic foods.
- If you are able to eat normally and maintain your weight without snacks, then do not include them.
Examples of Nutritious Snacks
Angel food cake
Gelatin
Popcorn, pretzels
Bread
Granola
Puddings, custards
Cereal — hot or cold
Homemade milkshakes and drinks
Sandwiches
Cheese
Ice cream
Sherbet
Cookies
Juices
Soups — broth-based or hearty
Crackers
Milk
Sports drinks
Dips made with cheese, beans, and yogurt
Muffins
Vegetables — raw, cooked
Eggnog (pasteurized)
Nuts
Yogurt — carton, frozen
Fruit — fresh, canned, dried
Peanut butter
Suggestions for increasing calories and protein
Eat several small, frequent meals and snacks a day rather than 3 large ones.
Eat favorite foods at any time of the day. For example, eat breakfast foods for dinner if they appeal to you.
Eat every few hours. Don’t wait until you feel hungry.
Eat your biggest meal when you feel hungriest. For example, if you are hungriest in the morning, make breakfast your biggest meal.
Try to eat high-calorie, high-protein foods at each meal and snack.
Exercise lightly or take a walk before meals to increase your appetite.
Drink high-calorie, high-protein beverages such as milkshakes and canned liquid supplements. Cold drinks are usually tolerated well.
Drink most of your fluids between meals instead of with meals. Drinking fluid with meals can make you feel too full.
Try homemade or commercially prepared nutrition bars and puddings.
High-protein foods*
Milk products: Eat cheese on toast or with crackers. Add grated cheddar cheese to baked potatoes, vegetables, soups, noodles, meat, and fruit. Use milk in place of water for cereal and soups. Include cream sauces on vegetables and pasta. Add powdered milk to cream soups, mashed potatoes, and puddings and casseroles. Add yogurt or cottage cheese to favorite fruits or blended smoothies.
Eggs: Keep hard-cooked eggs in the refrigerator. Chop and add to salads, casseroles, soups, and vegetables. Make a quick egg salad. All eggs should be well cooked to avoid the risk of harmful bacteria.
Meats, poultry, and fish: Add leftover cooked meats to soups, casseroles, salads, and omelets. Mix diced and flaked meat with sour cream and spices to make dip.
Beans, legumes, nuts, and seeds: Sprinkle seeds on desserts such as fruit, ice cream, pudding, and custard. Also serve on vegetables, salads, and pasta. Spread peanut butter on toast and fruit or blend in a milkshake.
High-calorie foods*
Butter and margarine: Melt over potatoes, rice, pasta, and cooked vegetables. Stir melted butter or margarine into soups and casseroles and spread on bread before adding other ingredients to your sandwich.
Milk products: Add whipping cream to desserts, pancakes, waffles, fruit, and hot chocolate, and fold into soups and casseroles. Add sour cream to baked potatoes and vegetables.
Salad dressings: Use regular (not low-fat or diet) mayonnaise and salad dressing on sandwiches and dips with vegetables and fruit.
Sweets: Add jelly and honey to bread and crackers. Add jam to fruit, and use ice cream as a topping on cake.
*Adapted from Eldridge B, and Hamilton KK, Editors, Management ofNutrition Impact Symptoms in Cancer and Educational Handouts.
High-Calorie, High-Protein Shake and Drink Recipes
If you need more calories or have trouble swallowing, you might try the following recipes. They might not be right for everyone. If you want to increase calories but not fat, try using reduced-fat dairy products.
For the recipes below, follow these basic instructions:
Place all ingredients in a blender container or prepare in a large container with a hand-held blender. Cover and blend on high speed until well mixed. Chill drinks before serving. Store unused drinks in the refrigerator or freezer. Add 1 to 2 tablespoons of powdered milk to each recipe to increase protein.
Note: If you cannot tolerate milk or milk products or if you have diabetes, ask your nurse or dietitian for other recipe ideas.
Fortified milk
Drink or use in cooking to add protein
Blend and chill at least 6 hours. Can also be made with buttermilk or dry buttermilk.
(211 calories and
Sherbet shake
A refreshing shake
1 cup sherbet
1/2 cup whole milk or low-fat milk
1/2 teaspoon vanilla extract
(422 calories and
Cottage cheese smoothie
A thick, protein-packed drink
1/3 cup cottage cheese
1/2 cup vanilla ice cream
1/4 cup prepared fruit flavored gelatin
(310 calories and
Classic instant breakfast milkshake
A protein-packed favorite
1/2 cup whole milk
1 envelope instant breakfast mix
1 cup vanilla ice cream (add flavorings or different flavor ice creams forvariety)
(474 calories and
Peach yogurt frost
A frosty, tangy drink
1 envelope vanilla instant breakfast mix
1 cup whole milk
1/2 cup peach yogurt
6 to 10 crushed ice cubes
(400 calories and
Chocolate cocoa drink
A cool, creamy chocolate drink
1 ¼ cup vanilla ice cream
1/2 cup whole milk
1 package of hot chocolate mix
2 teaspoons sugar
(600 calories and
Homemade soup recipes
Winter soup
2 tablespoons canola oil
1 medium onion, chopped
2 (14 ½-oz) cans fat-free chicken broth, or same amount of homemade broth
3/4 cup tomato sauce
1/2 cup macaroni, uncooked
1 (15-oz) can white beans (cannelloni or Great Northern beans), drained
Pepper to taste
Heat oil in a large soup pot over medium low heat. Add onion and cook for3 minutes. Add broth and tomato sauce, bring to a boil, then stir in macaroni. Reduce heat, cover and simmer for 10 minutes. Add pepper to taste, then stir in white beans. Heat mixture thoroughly. Serve in soup bowls with croutons, cornbread, crackers, or a sprinkle of Parmesan cheese. Makes 4 to 6 servings.
Approximate nutrients per serving: 295 calories,
1 teaspoon canola oil
1 cup onion, diced
1 large clove garlic, minced
2 cups water
1 ½ cups potato, peeled and diced
1/2 cup carrots, peeled and chopped
2 (15-oz) cans tomatoes (no salt added)
1 (10-oz) package frozen mixed vegetables
1 teaspoon chili powder
1/2 teaspoon each oregano and marjoram
In a large pot over low heat, sauté the turkey, onion, and garlic in oil. Drain fat. Add water and potatoes and bring to a boil. Cook 10 minutes.Add carrots and tomatoes and cook 10 minutes more. Add mixed vegetables and spices, cover, and simmer for 15 minutes. Makes 8 servings, 1½ cups each.
Approximate nutrients per serving: 190 calories,
Gazpacho
2 cans tomato soup
2 cans water
1 tablespoon olive oil
1 teaspoon salt
Dash hot sauce
Dash garlic powder
1 small onion, chopped
1 cucumber, peeled, seeded, and chopped
1 green pepper, seeded and chopped
1 large can or 2 fresh tomatoes, peeled, seeded, and chopped
Mix together the first 6 ingredients, then add remaining 4. Chill and serve with chips or crackers. Puree in blender or food processor if desired. Makes 8 one-cup servings.
Approximate nutrients per serving: 90 calories,
Cream of broccoli soup
3 cups broccoli florets and peeled stems, finely chopped
1 ½ cups water
1 tablespoon canola or olive oil
1/2 cup onion, chopped
1 tablespoon all-purpose flour
3 cups 1%-fat milk
1/2 teaspoon salt (optional)
1/2 teaspoon pepper
1/4 teaspoon paprika
1/4 teaspoon celery seed
1/8 teaspoon cayenne pepper
Combine broccoli and water in a 3-quart saucepan and bring to a boil. Lower heat; cover and simmer for 10 minutes. Drain, saving liquid. Put oil in a larger saucepan over low heat and add onion and sauté until soft. Add flour and continue to cook for several seconds, stirring constantly. Stir in reserved liquid and cook until thickened. Add milk, broccoli, salt, black pepper, paprika, celery seed, and cayenne pepper, mixing well. Heat to serving temperature over low heat. Makes 6 servings.
Approximate nutrients per serving: 101 calories,
Potato soup
3 medium potatoes, peeled and cubed
2 cups reduced-sodium chicken broth
2 stalks chopped celery
1/2 small onion, peeled
1 tablespoon olive oil
1 tablespoon flour
2 cups milk
2 eggs, hard cooked, peeled, and chopped
Salt and pepper to taste
Cook the potatoes in chicken broth with celery and onion until the potatoes are tender. Blend the mixture in a blender or processor. In a heavy saucepan over low heat, stir flour into the oil to make a paste. Slowly add the milk, stirring or whisking continuously until the mixture is thoroughly blended and heated through. Add the pureed potato mixture. Add chopped eggs that have been pushed through a sieve. Mix well and season with salt and pepper as desired. Serve hot or cold. (This soup thickens when chilled and may need to be thinned with more chicken broth or milk.) Makes 4 servings.
Approximate nutrients per serving: 240 calories,
Don’t forget about physical activity!
Physical activity provides many benefits such as helping to maintain muscle mass, strength, and stamina, and bone strength. It can help reduce depression, stress, and constipation. So, if you don’t already exercise, talk to your doctor about including at least 30 minutes or more of moderate activity, like walking, on 5 or more days of the week as you are able. If your doctor approves, start where you are (perhaps 5 to 10 minutes each day) and work up to the goal of 30 minutes — as you are able.
Eat five to nine servings of fruits and vegetables every day.
It’s easier than you may think – just aim for one or two servings at every meal and snack. For example, a glass of orange juice along with fruit on cereal for breakfast, a salad that includes fresh, raw vegetables with dressing on the side for lunch, fruit for an afternoon snack and whole grain pasta with tomato and mushroom sauce for dinner. A serving equals one medium-size fruit, one-half cup cooked, or one-cup leafy vegetables.
Look for foods that list whole grains as the first ingredient – such as whole-wheat flour, rolled oats or whole meal rye. Limit consumption of refined carbohydrates, including cakes, pastries and other sugars.
Eat small portions of only low-fat meats. A three-ounce cooked portion is recommended – remember that three ounces is the size of a deck of playing cards. Choose fish, poultry or beans as an alternative. Prepare meat, fish and poultry by baking, broiling or poaching rather than frying or charbroiling.
Eat a low-fat diet.
High-fat diets are associated colorectal, prostate and endometrial cancers.
Exercise your options to reduce cancer risk.
Exercise also can reduce cancer risk by helping people maintain a healthy weight. Regular physical activity, along with a nutritious diet is key to maintaining a healthy weight and reducing your risk of developing cancer. Physical activities may account for as much as 15% to 40% of the calories burned each day.
Maintain a healthy weight throughout life.
Overweight adults are at greater risk for colon, endometrial, breast (postmenopausal), esophageal, pancreatic and kidney cancer. As body mass index increases, risk for other major health problems also increases, such as heart disease, stroke, diabetes, gallbladder disease, sleep apnea and osteoarthritis. M. D. Anderson experts recommend that people lose weight if currently overweight or obese.
Making healthy choices is the key to maintaining a healthy weight. When you go out to eat, choose meals low in fat and calories. Nowadays, many restaurants serve large portions, so share with a friend or save half of the meal for lunch the next day. It’s also important to keep in mind that low-fat or fat-free doesn’t always mean low calorie!
Eat two to three servings of low-fat or nonfat dairy products for calcium every day.
Calcium may protect against colorectal cancer. Skim or one percent milk, yogurt and calcium-fortified orange juice are good sources of calcium.
If you drink alcoholic beverages, do so in moderation.
Drinking has been linked to colon, breast and liver cancers and when combined with smoking, greatly increases the risk of head and neck cancer. People who drink alcohol should limit their intake to no more than two drinks per day for men and one drink a day for women. A drink is defined as
Children’s Nutrient Needs
Nutrients that are essential to children with cancer include protein, carbohydrates, fat, water, vitamins, and minerals.
Proteins
The body uses protein to promote growth, repair tissue, and maintain the lining of the gastrointestinal tract, skin, blood cells, and immune system. Children with cancer who do not get enough protein may be slow to recover from illness and especially vulnerable to infection. After a child undergoes surgery, chemotherapy, or radiation treatments, he or she will need extra protein to heal tissues and to help prevent infection.
Protein is essential for a child’s proper growth and development. During illness, a child’s proteieeds typically increase. In fact, a child undergoing cancer therapy may require as much as 50% more protein than a child of the same age who is not receiving cancer treatment.
Carbohydrates and Fats
Carbohydrates and fats provide the body with the calories it needs to fuel activities. A child’s calorie needs depend on his or her age, size, and level of physical activity. Infants, children, and adolescents need extra calories to promote proper growth and development. Children being treated for cancer need even more calories for tissue healing and energy. In fact, a child undergoing treatment for cancer may need 20% more calories than his or her counterpart who is not receiving cancer treatment.
Vitamins and Minerals
Vitamins and minerals play many key roles in the body. For example, many of these nutrients help ensure proper growth and development and enable the body to use the calories it gets from food. Children who eat a balanced diet usually get enough vitamins and minerals, however it may be hard for a child undergoing cancer treatment to eat a balanced diet. Common treatment side effects, like nausea and vomiting, can interfere with eating well. If your child has persistent eating problems, ask your doctor, nurse, or dietitian for help. Sometimes your doctor will recommend taking a daily multivitamin while your child undergoes treatment.
Water
Water and fluids are vital to a child’s health. If your child does not take in enough fluids or loses fluids from vomiting or diarrhea, he or she may become dehydrated. Test your child for dehydration by lightly pinching the skin over the breast bone. If the skin does not return to normal and remains raised, your child may be dehydrated. Other symptoms include dryness in the lining of the mouth, darker color of the urine, listlessness, and dizziness. If you suspect your child is dehydrated, promptly notify your doctor. Ask your doctor, nurse, or dietitian how much fluid your child needs each day to keep from becoming dehydrated.
Cancer Nutrition: Malnutrition Factor
According to the National Cancer Institute, about one-third of all cancer deaths are related to malnutrition. Cancer can deplete your body’s nutrients and cause weight loss. Cancer and cancer treatment can also have a negative effect on your appetite and your body’s ability to digest foods. For cancer patients, optimal cancer nutrition is important.
Cancer Nutrition: Assessing Patient Needs
Cancer patients at Cancer Treatment Centers of
Cancer Nutrition: Patient Support
At Cancer Treatment Centers of
Cancer Treatment Centers of
At Cancer Treatment Centers of
Cancer Nutrition: More Information
You will find more information on cancer nutrition and nutritional cancer prevention on this site. Please explore our site or call us toll-free at the number provided on this page.
AQUIRED IMMUNODEFICIENCY SYNDROME (AIDS/HIV infection)
In 1983 the retrovirus human immunodeficiency virus (HIV) was isolated as the cause for acquired immunodeficiency syndrome (AIDS). A retrovirus injects its ribonucleic acid (RNA) into the target cell and then transcribes the RNA into DNA using a reverse transcriptase enzyme. Target cells for HIV include the T4 or CD4 lymphocytes, B-lymphocytes, monocytes, macrophages, and other cells of the immune system.
As many as 1 billion copies of HIV can be made in one day and several generations can exist in just hours. The initial infection with HIV may include symptoms such as fever and malaise. Antibodies are produced against the virus and are detectable within 2 to 4 months after exposure. It is at this stage that an individual can be seropositive. This presence of HIV antibodies is confirmed using two major tests: the ELISA (enzyme-linked immunosorbent assay) and the Western Blot, polymerase chain reaction (PCR).
The replication of the infected cell results in a steady depletion of the CD4+ cell count causing a severe depression of immune function and increasing the risk for opportunistic infections and malignancies (Table 22-4).
The diagnosis of AIDS includes the positive antibody test for HIV; a CD4 cell count of less than 200 mm3 or below 14% of the total white blood cell count; and the clinical diagnosis of one of 25 AIDS-defining diseases.
20 The progression from HIV to AIDS varies for each individual and may not be evident for several years. The two major prognostic factors for HIV are the CD4 T cell count and the measurement of plasma HIV RNA (viral load for HIV).
HIV is a bloodborne and sexually transmitted infection. It is transmitted through contact with contaminated blood, semen, vaginal secretions, and breast milk. HIV also crosses the placenta from the mother to the baby. At the end of 2001, 40 million people worldwide were infected with HIV. Since the epidemic began, it is estimated that more than 60 million people have been infected. Infection in women and children has increased significantly. This is especially true in sub-Saharan Africa where AIDS is the leading cause of death.
There has been significant progress for treatment of HIV and AIDS over the past decade with the use of highly active antiretroviral therapy (HAART). Up until the 1990s, treatment for HIV and AIDS focused on treatment with one or two drugs.
Today, HAART uses combinations of nonnucleoside reverse transcriptase inhibitors and nucleoside analogue reverse transcriptase inhibitors with the newest class of drugs, protease inhibitors. Although there has been remarkable success in decreasing viral load with these new regimens, they have not been without complications.
Adherence to these regimens is often difficult because of the number and the complexity of medications to be taken daily. Drug resistance develops easily if adherence is not maintained.
A secondary immunodeficiency syndrom caused by a virus and characterized by severe immune deficiency resulting in opportunistic infections, malignancies, and neurologic lesion in individuals without prior history of immulogic abnormality.
AIDS (acquired immune deficiency syndrome) is caused by HIV (human immunodeficiency virus), and is a syndrome that leaves the body vulnerable to a host of life-threatening illnesses. There is no cure for AIDS, but treatment with antiviral medication can suppress symptoms. AIDS is universally fatal, in large part due to the proliferation of opportunistic infections.
Humans may alter their usual eating habits for many reasons, including weight loss, disease prevention or treatment, removing toxins from the body, or to achieve a general improvement in physical and mental health. Others adopt special diets for religious reasons. In the case of some vegetarians and vegans, dietary changes are made out of ethical concerns for the rights of animals.
Purpose
People who are moderately to severely overweight can derive substantial health benefits from a weight-loss diet. A weight reduction of just 10–20 (4.5–9.1 kg) can result in reduced cholesterol levels and lower blood pressure. Weight-related health problems include heart disease, diabetes, high blood pressure, and high levels of blood sugar and cholesterol.
In individuals who are not overweight, dietary changes may also be useful in the prevention or treatment of a range of ailments including acquired immunodeficiency syndrome (AIDS), cancer, osteoporosis, inflammatory bowel disease, chronic pulmonary disease, renal disease, Parkinson’s disease, seizure disorders, and food allergies and intolerances.
Description
Origins
The practice of altering diet for special reasons has existed since antiquity. For example, Judaism has included numerous dietary restrictions for thousands of years. One ancient Jewish sect, the Essenes, is said to have developed a primitive detoxification diet aimed at preparing the bodies, minds, and spirits of its members for the coming of a “messiah” who would deliver them from their Roman captors. Preventative and therapeutic diets became quite popular during the late twentieth century. Books promoting the latest dietary plan continue to make the bestseller lists, although not all of the information given is considered authoritative.
The idea of a healthful diet is to provide all of the calories and nutrients needed by the body for optimal performance, at the same time ensuring that neither nutritional deficiencies nor excesses occur. Diet plans that claim to accomplish those objectives are so numerous they are virtually uncountable. These diets employ a variety of approaches, including the following:
· Fixed-menu: Offers little choice to the dieter. Specifies exactly which foods will be consumed. Easy to follow, but may be considered “boring” to some dieters.
· Formula: Replaces some or all meals with a nutritionally balanced liquid formula or powder.
· Exchange-type: Allows the dieter to choose between selected foods from each food group.
· Flexible: Doesn’t concern itself with the overall diet, simply with one aspect such as fat or energy.
Suggested daily food servings. (Illustration by Electronic Illustrators Group.)
Diets may also be classified according to the types of foods they allow. For example, an omnivorous diet consists of both animal and plant foods, whereas a lactoovo-vegetarian diet permits no animal flesh, but does include eggs, milk, and dairy products. A vegan diet is a stricter form of vegetarianism in which eggs, cheese, and other milk products are prohibited.
A third way of classifying diets is according to their purpose: religious, weight-loss, detoxification, lifestyle-related, or aimed at prevention or treatment of a specific disease.
Precautions
Dieters should be cautious about plans that severely restrict the size of food portions, or that eliminate entire food groups from the diet. It is highly probable that they will become discouraged and drop out of such programs. The best diet is one that can be maintained indefinitely without ill effects, that offers sufficient variety and balance to provide everything needed for good health, and that is considerate of personal food preferences.
Low-fat diets are not recommended for children under the age of two. Young childreeed extra fat to maintain their active, growing bodies. Fat intake may be gradually reduced between the ages of two and five, after which it should be limited to a maximum of 30% of total calories through adulthood. Saturated fat should be restricted to no more than 10% of total calories.
Weight-loss dieters should be wary of the “yo-yo” effect that occurs wheumerous attempts are made to reduce weight using high-risk, quick-fix diets. This continued “cycling” between weight loss and weight gain can slow the basal metabolic rate and can sometimes lead to eating disorders. The dieter may become discouraged and frustrated by this success/failure cycle. The end result of “yo-yo” dieting is that it becomes more difficult to maintain a healthy weight.
Caution should also be exercised about weight-loss diets that require continued purchases of special prepackaged foods. Not only do these tend to be costly and over-processed, they may also prevent dieters from learning the food-selection and preparation skills essential to maintenance of weight loss. Further, dieters should consider whether they want to carry these special foods to work, restaurants, or homes of friends.
Concern has been expressed about weight-loss diet plans that do not include exercise, considered essential to long-term weight management. Some diets and supplements may be inadvisable for patients with special conditions or situations.
Certain fad diets purporting to be official diets of groups such as the American Heart Association and the Mayo Clinic are io way endorsed by those institutions. Patients thinking of starting such a diet should check with the institution to ensure its name has not been misappropriated by an unscrupulous practitioner.
Side effects
A wide range of side effects (some quite serious) can result from special diets, especially those that are nutritionally unbalanced. Further problems can arise if the dieter is taking high doses of dietary supplements. Food is essential to life, and improper nutrition can result in serious illness or death.
Research and general acceptance
It is agreed among traditional and complementary practitioners that many patients could substantially benefit from improved eating habits. Specialized diets have proved effective against a wide variety of conditions and diseases. However, dozens of unproved but widely publicized “fad diets” emerge each year, prompting widespread concerns about their usefulness, cost to the consumer, and their safety.
Editor’s note: In honor of World AIDS Day, the following article takes stock in the overall health of the individual, and proposes a hopeful solution. Nutrition is key to anyone’s good health.
AIDS Ayurvedic Remedies
According to the modern concept AIDS stands for Acquired Immune Deficiency Syndrome. It is caused the virus, Human Immune Deficiency Virus, HIV. It is a set of disease that destroys an individual immune system.
However according to the Ayurvedic perspective, AIDS is related to loss of energy. This disease results in weakening of:
· Plasma
· Blood cells
· Muscular tissue
· Adipose tissue
· Bony tissue
· Bone marrow
· Reproductive tissue.
According to ayurvedic studies, the person suffering from AIDS is likely to have the following symptoms:
· Prolonged fever
· Fatigue
· Skin irritations
· Sleeplessness
· Contagious disease
· Loss of appetite
· Loss of weight
· Prone to allergies
Ayurvedic Treatment
Ayurvedic treatment has proved to be quite beneficial without any side effects.Following are the various ayurvedic treatments against AIDS:
· To improve the patient’s immunity strength they are given toxins and rejuvenator. The toxins develop the patient’s immune systems and motivate the appetite.
· Blood is also purified in various ways, with the help of different medicines.
· Corrective measures are adopted towards improving the conditions of liver.
· Ayurveda recommends diet with ghee. It asks you to avoid food with spice and oily.
· Ghee is recommended in the diet of the AIDS patients by ayurveda because it helps to eject or drive out the toxins from the body through enemas, purgation and emesis.
· Moderate intake of alcohol is recommended since alcohol has positive effects in removing blockages and helping smooth flow of blood.
· Ayurvedic treatment asks the AIDS patients to do vigorous exercise. Heavy exercise heats up the blood and this helps in fighting against the viruses, sometimes viruses even get destroyed by the heated blood.
· Preparing herbo-minerals compounds following certain formulae can improve the conditions of AIDS patients.
Some ayurvedic medicines that help against fighting AIDS
The following are some of the ayurvedic medicines that improve and help in making progress for the AIDS patients:
o Chyavanprash.
o Raktavardhak.
o Sookshma triphala tablets.
Raktavardhak helps in building the immunity of the patient and making it strong and resistant.
The functions of the sookshma triphala tablets are fight against the infections present in the body of the AIDS patient.
The most important, effective and popular ayurvedic remedy for AIDS is chyavanprash.
It acts as a toxin and thus makes the patients immune system strong and rejuvenate it. Chyavanprash is made of amalaki or goose berry which supplies a lot of vitamin c to the body. It also supplies anti oxidants like bioflavonoid, vitamin B complex and vitamin A.
A spoon of Chyawanprash
A special characteristic of this fruit, amalaki, is that it is antifungal and anti bacterial, therefore it helps in digestion and also lowers the blood pressure and high cholesterol. The other useful effects of amalaki, present in chyavanprash is that it helps in repairing the muscles and improves the skin also. Apart from amalaki chyavanprash has other essential ingredients like 35 herbs. Therefore all the ingredients of chyavanprash make it a powerful remedy towards fighting a dreadful disease like Aids. It is not very difficult find chyavanprash as it is available in most local medical stores.
Therefore if we sum up the qualities of chyavanprash, we see that it helps in the various systems of our body like digestive, respiratory and sexual systems.
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Definition
Acquired immune deficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). It was first recognized in the
Description
AIDS is considered one of the most devastating public health problems in recent history. In June 2000, the Centers for Disease Control and Prevention (CDC) reported that 120,223 (includes only those cases in areas that have confidential HIV reporting) in the United States are HIV-positive, and 311,701 are living with AIDS (includes only those cases where vital status is known). Of these patients, 44% are gay or bisexual men, 20% are heterosexual intravenous drug users, and 17% are women. In addition, approximately 1,000-2,000 children are born each year with HIV infection. The World Health Organization (WHO) estimates that 33 million adults and 1.3 million children worldwide were living with HIV/AIDS as of 1999 with 5.4 million being newly infected that year. Most of these cases are in the developing countries of Asia and
Risk factors
AIDS can be transmitted in several ways. The risk factors for HIV transmission vary according to category:
· Sexual contact. Persons at greatest risk are those who do not practice safe sex, those who are not monogamous, those who participate in anal intercourse, and those who have sex with a partner with symptoms of advanced HIV infection and/or other sexually transmitted diseases (STDs). In the
· Transmission in pregnancy. High-risk mothers include women married to bisexual men or men who have an abnormal blood condition called hemophilia and require blood transfusions, intravenous drug users, and women living ieighborhoods with a high rate of HIV infection among heterosexuals. The chances of transmitting the disease to the child are higher in women in advanced stages of the disease. Breast feeding increases the risk of transmission by 10-20%. The use of zidovudine (AZT) during pregnancy, however, can decrease the risk of transmission to the baby.
· Exposure to contaminated blood or blood products. With the introduction of blood product screening in the mid-1980s, the incidence of HIV transmission in blood transfusions has dropped to one in every 100,000 transfused. With respect to HIV transmission among drug abusers, risk increases with the duration of using injections, the frequency of needle sharing, the number of persons who share a needle, and the number of AIDS cases in the local population.
· Needle sticks among health care professionals. Present studies indicate that the risk of HIV transmission by a needle stick is about one in 250. This rate can be decreased if the injured worker is given AZT, an anti-retroviral medication, in combination with other medication.
HIV is not transmitted by handshakes or other casual non-sexual contact, coughing or sneezing, or by bloodsucking insects such as mosquitoes.
AIDS in women
AIDS in women is a serious public health concern. Women exposed to HIV infection through heterosexual contact are the most rapidly growing risk group in the
AIDS in children
Since AIDS can be transmitted from an infected mother to the child during pregnancy, during the birth process, or through breast milk, all infants born to HIV-positive mothers are a high-risk group. As of 2000, it was estimated that 87% of HIV-positive women are of childbearing age; 41% of them are drug abusers. Between 15-30% of children born to HIV-positive women will be infected with the virus.
AIDS is one of the 10 leading causes of death in children between one and four years of age. The interval between exposure to HIV and the development of AIDS is shorter in children than in adults. Infants infected with HIV have a 20-30% chance of developing AIDS within a year and dying before age three. In the remainder, AIDS progresses more slowly; the average child patient survives to seven years of age. Some survive into early adolescence.
Causes and symptoms
Because HIV destroys immune system cells, AIDS is a disease that can affect any of the body’s major organ systems. HIV attacks the body through three disease processes: immunodeficiency, autoimmunity, and nervous system dysfunction.
Immunodeficiency describes the condition in which the body’s immune response is damaged, weakened, or is not functioning properly. In AIDS, immunodeficiency results from the way that the virus binds to a protein called CD4, which is primarily found on the surface of certain subtypes of white blood cells called helper T cells or CD4 cells. After the virus has attached to the CD4 receptor, the virus-CD4 complex refolds to uncover another receptor called a chemokine receptor that helps to mediate entry of the virus into the cell. One chemokine receptor in particular, CCR5, has gotten recent attention after studies showed that defects in its structure (caused by genetic mutations) cause the progression of AIDS to be prevented or slowed. Scientists hope that this discovery will lead to the development of drugs that trigger an artificial mutation of the CCR5 gene or target the CCR5 receptor.
Once HIV has entered the cell, it can replicate intracellularly and kill the cell in ways that are still not completely understood. In addition to killing some lymphocytes directly, the AIDS virus disrupts the functioning of the remaining CD4 cells. Because the immune system cells are destroyed, many different types of infections and cancers that take advantage of a person’s weakened immune system (opportunistic) can develop.
Autoimmunity is a condition in which the body’s immune system produces antibodies that work against its own cells. Antibodies are specific proteins produced in response to exposure to a specific, usually foreign, protein or particle called an antigen. In this case, the body produces antibodies that bind to blood platelets that are necessary for proper blood clotting and tissue repair. Once bound, the antibodies mark the platelets for removal from the body, and they are filtered out by the spleen. Some AIDS patients develop a disorder, called immune-related thrombocytopenia purpura (ITP), in which the number of blood platelets drops to abnormally low levels.
Researchers do not know precisely how HIV attacks the nervous system since the virus can cause damage without infecting nerve cells directly. One theory is that, once infected with HIV, one type of immune system cell, called a macrophage, begins to release a toxin that harms the nervous system.
The course of AIDS generally progresses through three stages, although not all patients will follow this progression precisely:
Acute retroviral syndrome
Acute retroviral syndrome is a term used to describe a group of symptoms that can resemble mononucleosis and that may be the first sign of HIV infection in 50-70% of all patients and 45-90% of women. Most patients are not recognized as infected during this phase and may not seek medical attention. The symptoms may include fever, fatigue, muscle aches, loss of appetite, digestive disturbances, weight loss, skin rashes, headache, and chronically swollen lymph nodes (lymphadenopathy). Approximately 25-33% of patients will experience a form of meningitis during this phase in which the membranes that cover the brain and spinal cord become inflamed. Acute retroviral syndrome develops between one and six weeks after infection and lasts for two to three weeks. Blood tests during this period will indicate the presence of virus (viremia) and the appearance of the viral p24 antigen in the blood.
Latency period
After the HIV virus enters a patient’s lymph nodes during the acute retroviral syndrome stage, the disease becomes latent for as many as 10 years or more before symptoms of advanced disease develop. During latency, the virus continues to replicate in the lymph nodes, where it may cause one or more of the following conditions:
Persistent generalized lymphadenopathy (pgl)
Persistent generalized lymphadenopathy, or PGL, is a condition in which HIV continues to produce chronic painless swellings in the lymph nodes during the latency period. The lymph nodes that are most frequently affected by PGL are those in the areas of the neck, jaw, groin, and armpits. PGL affects between 50-70% of patients during latency.
Constitutional symptoms
Many patients will develop low-grade fevers, chronic fatigue, and general weakness. HIV may also cause a combination of food malabsorption, loss of appetite, and increased metabolism that contribute to the so-called AIDS wasting or wasting syndrome.
Other organ systems
At any time during the course of HIV infection, patients may suffer from a yeast infection in the mouth called thrush, open sores or ulcers, or other infections of the mouth; diarrhea and other gastrointestinal symptoms that cause malnutrition and weight loss; diseases of the lungs and kidneys; and degeneration of the nerve fibers in the arms and legs. HIV infection of the nervous system leads to general loss of strength, loss of reflexes, and feelings of numbness or burning sensations in the feet or lower legs.
Late-stage disease (AIDS)
AIDS is usually marked by a very low number of CD4+ lymphocytes, followed by a rise in the frequency of opportunistic infections and cancers. Doctors monitor the number and proportion of CD4+ lymphocytes in the patient’s blood in order to assess the progression of the disease and the effectiveness of different medications. About 10% of infected individuals never progress to this overt stage of the disease and are referred to as nonprogressors.
Opportunistic infections
Once the patient’s CD4+ lymphocyte count falls below 200 cells/mm 3, he or she is at risk for a variety of opportunistic infections. The infectious organisms may include the following:
· Fungi. The most common fungal disease associated with AIDS is Pneumocystis cariniipneumonia (PCP). PCP is the immediate cause of death in 15-20% of AIDS patients. It is an important measure of a patient’s prognosis. Other fungal infections include a yeast infection of the mouth (candidiasis or thrush) and cryptococcal meningitis.
· Protozoa. Toxoplasmosis is a common opportunistic infection in AIDS patients that is caused by a protozoan. Other diseases in this category include isoporiasis and cryptosporidiosis.
· Mycobacteria. AIDS patients may develop tuberculosis or MAC infections. MAC infections are caused by Mycobacterium avium-intracellulare, and occur in about 40% of AIDS patients. It is rare until CD4+ counts falls below 50 cells/mm3.
· Bacteria. AIDS patients are likely to develop bacterial infections of the skin and digestive tract.
· Viruses. AIDS patients are highly vulnerable to cytomegalovirus (CMV), herpes simplex virus (HSV), varicella zoster virus (VZV), and Epstein–Barr virus (EBV) infections. Another virus, JC virus, causes progressive destruction of brain tissue in the brain stem, cerebrum, and cerebellum (multifocal leukoencephalopathy or PML), which is regarded as an AIDS-defining illness by the Centers for Disease Control and Prevention.
Aids dementia complex and neurologic complications
AIDS dementia complex is usually a late complication of the disease. It is unclear whether it is caused by the direct effects of the virus on the brain or by intermediate causes. AIDS dementia complex is marked by loss of reasoning ability, loss of memory, inability to concentrate, apathy and loss of initiative, and unsteadiness or weakness in walking. Some patients also develop seizures. There are no specific treatments for AIDS dementia complex.
Musculoskeletal complications
Patients in late-stage AIDS may develop inflammations of the muscles, particularly in the hip area, and may have arthritis-like pains in the joints.
Oral symptoms
In addition to thrush and painful ulcers in the mouth, patients may develop a condition called hairy leukoplakia of the tongue. This condition is also regarded by the CDC as an indicator of AIDS. Hairy leukoplakia is a white area of diseased tissue on the tongue that may be flat or slightly raised. It is caused by the Epstein-Barr virus.
Aids-related cancers
Patients with late-stage AIDS may develop Kaposi’s sarcoma (KS), a skin tumor that primarily affects homosexual men. KS is the most common AIDS-related malignancy. It is characterized by reddish-purple blotches or patches (brownish in African-Americans) on the skin or in the mouth. About 40% of patients with KS develop symptoms in the digestive tract or lungs. KS may be caused by a herpes virus-like sexually transmitted disease agent rather than HIV.
The second most common form of cancer in AIDS patients is a tumor of the lymphatic system (lymphoma). AIDS-related lymphomas often affect the central nervous system and develop very aggressively.
Invasive cancer of the cervix (related to certain types of human papilloma virus [HPV]) is an important diagnostic marker of AIDS in women.
While incidence of AIDS-defining cancers such as Kaposi’s sarcoma and cervical cancer have decreased since increase use of antiretroviral therapy, other cancers has increased in AIDS patients. People with HIV has shown higher incidence of lung cancer, head and neck cancers, Hodgkin’s lymphoma, melanoma, and anorectal cancer from 1992 to 2002.
Diagnosis
Because HIV infection produces such a wide range of symptoms, the CDC has drawn up a list of 34 conditions regarded as defining AIDS. The physician will use the CDC list to decide whether the patient falls into one of these three groups:
· definitive diagnoses with or without laboratory evidence of HIV infection
· definitive diagnoses with laboratory evidence of HIV infection
· presumptive diagnoses with laboratory evidence of HIV infection.
Physical findings
Almost all the symptoms of AIDS can occur with other diseases. The general physical examination may range from normal findings to symptoms that are closely associated with AIDS. These symptoms are hairy leukoplakia of the tongue and Kaposi’s sarcoma. When the doctor examines the patient, he or she will look for the overall pattern of symptoms rather than any one finding.
Laboratory tests for HIV infection
Blood tests (serology)
The first blood test for AIDS was developed in 1985. At present, patients who are being tested for HIV infection are usually given an enzyme-linked immunosorbent assay (ELISA) test for the presence of HIV antibody in their blood. Positive ELISA results are then tested with a Western blot or immunofluorescence (IFA) assay for confirmation. The combination of the ELISA and Western blot tests is more than 99.9% accurate in detecting HIV infection within four to eight weeks following exposure. The polymerase chain reaction (PCR) test can be used to detect the presence of viral nucleic acids in the very small number of HIV patients who have false-negative results on the ELISA and Western blot tests. These tests are also used to detect viruses and bacterium other than HIV and AIDS.
Other laboratory tests
In addition to diagnostic blood tests, there are other blood tests that are used to track the course of AIDS in patients that have already been diagnosed. These include blood counts, viral load tests, p24 antigen assays, and measurements of α2-microglobulin.
Doctors will use a wide variety of tests to diagnose the presence of opportunistic infections, cancers, or other disease conditions in AIDS patients. Tissue biopsies, samples of cerebrospinal fluid, and sophisticated imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography scans (CT) are used to diagnose AIDS-related cancers, some opportunistic infections, damage to the central nervous system, and wasting of the muscles. Urine and stool samples are used to diagnose infections caused by parasites. AIDS patients are also given blood tests for syphilis and other sexually transmitted diseases.
Diagnosis in children
Diagnostic blood testing in children older than 18 months is similar to adult testing, with ELISA screening confirmed by Western blot. Younger infants can be diagnosed by direct culture of the HIV virus, PCR testing, and p24 antigen testing.
In terms of symptoms, children are less likely than adults to have an early acute syndrome. They are, however, likely to have delayed growth, a history of frequent illness, recurrent ear infections, a low blood cell count, failure to gain weight, and unexplained fevers. Children with AIDS are more likely to develop bacterial infections, inflammation of the lungs, and AIDS-related brain disorders than are HIV-positive adults.
Treatment
Treatment for AIDS covers four considerations:
Treatment of opportunistic infections and malignancies
Most AIDS patients require complex long-term treatment with medications for infectious diseases. This treatment is often complicated by the development of resistance in the disease organisms. AIDS-related malignancies in the central nervous system are usually treated with radiation therapy. Cancers elsewhere in the body are treated with chemotherapy.
Prophylactic treatment for opportunistic infections
Prophylactic treatment is treatment that is given to prevent disease. AIDS patients with a history of Pneumocystis pneumonia; with CD4+ counts below 200 cells/mm3 or 14% of lymphocytes; weight loss; or thrush should be given prophylactic medications. The three drugs given are trimethoprim-sulfamethoxazole, dapsone, or pentamidine in aerosol form.
Anti-retroviral treatment
In recent years researchers have developed drugs that suppress HIV replication, as distinct from treating its effects on the body. These drugs fall into four classes:
· Nucleotide analogues. These drugs work by interfering with the action of HIV reverse transcriptase inside infected cells, thus ending the virus’ replication process. These drugs include zidovudine (sometimes called azidothymidine or AZT), didanosine (ddI), zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), and abacavir (ABC).
· Protease inhibitors. Protease inhibitors can be effective against HIV strains that have developed resistance to nucleoside analogues, and are often used in combination with them. These compounds include saquinavir, ritonavir, indinavir, nelfinavir, amprenavir, and lopinavir..
· Non-nucleoside reverse transcriptase inhibitors. This is a new class of antiretroviral agents. Three are available, nevirapine, which was approved first, delavirdine and efavirin.
· Fusion inhibitors, the newest class of antiretrovirals. They block specific proteins on the surface of the virus or the CD4 cell. These proteins help the virus gain entry into the cell.The only FDA approved fusion inhibitor as of spring 2004 was enfuvirtide.
Treatment guidelines for these agents are in constant change as new medications are developed and introduced. Two principles currently guide doctors in working out drug regimens for AIDS patients: using combinations of drugs rather than one medication alone; and basing treatment decisions on the results of the patient’s viral load tests.
Stimulation of blood cell production
Because many patients with AIDS suffer from abnormally low levels of both red and white blood cells, they may be given medications to stimulate blood cell production. Epoetin alfa (erythropoietin) may be given to anemic patients. Patients with low white blood cell counts may be given filgrastim or sargramostim.
Treatment in women
Treatment of pregnant women with HIV is particularly important in that anti-retroviral therapy has been shown to reduce transmission to the infant by 65%.
Alternative treatment
Alternative treatments for AIDS can be grouped into two categories: those intended to help the immune system and those aimed at pain control. Treatments that may enhance the function of the immune system include Chinese herbal medicine and western herbal medicine, macrobiotic and other special diets, guided imagery and creative visualization, homeopathy, and vitamin therapy. Pain control therapies include hydrotherapy, reiki, acupuncture, meditation, chiropractic treatments, and therapeutic massage. Alternative therapies can also be used to help with side effects of the medications used in the treatment of AIDS.
Prognosis
At the present time, there is no cure for AIDS.
Treatment stresses aggressive combination drug therapy for those patients with access to the expensive medications and who tolerate them adequately. The use of these multi-drug therapies has significantly reduced the numbers of deaths, in this country, resulting from AIDS. The data is still inconclusive, but the potential exists to possibly prolong life indefinitely using these and other drug therapies to boost the immune system, keep the virus from replicating, and ward off opportunistic infections and malignancies.
Prognosis after the latency period depends on the patient’s specific symptoms and the organ systems affected by the disease. Patients with AIDS-related lymphomas of the central nervous system die within two to three months of diagnosis; those with systemic lymphomas may survive for eight to ten months.
Prevention
As of 2005, there was no vaccine effective against AIDS. Several vaccines are currently being investigated, however, both to prevent initial HIV infection and as a therapeutic treatment to prevent HIV from progressing to full-blown AIDS.
In the meantime, there are many things that can be done to prevent the spread of AIDS:
· Being monogamous and practice safe sex. Individuals must be instructed in the proper use of condoms and urged to practice safe sex. Besides avoiding the risk of HIV infection, condoms are successful in preventing other sexually transmitted diseases and unwanted pregnancies. Before engaging in a sexual relationship with someone, getting tested for HIV infection is recommended.
· Avoiding needle sharing among intravenous drug users.
· Although blood and blood products are carefully monitored, those individuals who are planning to undergo major surgery may wish to donate blood ahead of time to prevent a risk of infection from a blood transfusion.
· Healthcare professionals must take all necessary precautions by wearing gloves and masks when handling body fluids and preventing needle-stick injuries.
· If someone suspects HIV infection, he or she should be tested for HIV. If treated aggressively and early, the development of AIDS may be postponed indefinitely. If HIV infection is confirmed, it is also vital to let sexual partners know so that they can be tested and, if necessary, receive medical attention.
Key Terms
Acute retroviral syndrome
A group of symptoms resembling mononucleosis that often are the first sign of HIV infection in 50-70% of all patients and 45-90% of women.
AIDS dementia complex
A type of brain dysfunction caused by HIV infection that causes difficulty thinking, confusion, and loss of muscular coordination.
Antibody
A specific protein produced by the immune system in response to a specific foreign protein or particle called an antigen.
Antigen
Any substance that stimulates the body to produce antibody.
Autoimmunity
A condition in which the body’s immune system produces antibodies in response to its own tissues or blood components instead of foreign particles or microorganisms.
CCR5
A chemokine receptor; defects in its structure caused by genetic mutation cause the progression of AIDS to be prevented or slowed.
CD4
A type of protein molecule in human blood, sometimes called the T4 antigen, that is present on the surface of 65% of immune cells. The HIV virus infects cells with CD4 surface proteins, and as a result, depletes the number of T cells, B cells, natural killer cells, and monocytes in the patient’s blood. Most of the damage to an AIDS patient’s immune system is done by the virus’ destruction of CD4+ lymphocytes.
Chemokine receptor
A receptor on the surface of some types of immune cells that helps to mediate entry of HIV into the cell.
Hairy leukoplakia of the tongue
A white area of diseased tissue on the tongue that may be flat or slightly raised. It is caused by the Epstein-Barr virus and is an important diagnostic sign of AIDS.
Hemophilia
Any of several hereditary blood coagulation disorders occurring almost exclusively in males. Because blood does not clot properly, even minor injuries can cause significant blood loss that may require a blood transfusion, with its associated minor risk of infection.
Human immunodeficiency virus (HIV)
A transmissible retrovirus that causes AIDS in humans. Two forms of HIV are now recognized: HIV-1, which causes most cases of AIDS in Europe, North and South America, and most parts of
Immunodeficient
A condition in which the body’s immune response is damaged, weakened, or is not functioning properly.
Kaposi’s sarcoma
A cancer of the connective tissue that produces painless purplish red (in people with light skin) or brown (in people with dark skin) blotches on the skin. It is a major diagnostic marker of AIDS.
Latent period
Also called incubation period, the time between infection with a disease-causing agent and the development of disease.
Lymphocyte
A type of white blood cell that is important in the formation of antibodies and that can be used to monitor the health of AIDS patients.
Lymphoma
A cancerous tumor in the lymphatic system that is associated with a poor prognosis in AIDS patients.
Macrophage
A large white blood cell, found primarily in the bloodstream and connective tissue, that helps the body fight off infections by ingesting the disease-causing organism. HIV can infect and kill macrophages.
Monocyte
A large white blood cell that is formed in the bone marrow and spleen. About 4% of the white blood cells iormal adults are monocytes.
(MAC) infection
A type of opportunistic infection that occurs in about 40% of AIDS patients and is regarded as an AIDS-defining disease.
Non-nucleoside reverse transcriptase inhibitors
The newest class of antiretroviral drugs that work by inhibiting the reverse transcriptase enzyme necessary for HIV replication.
Nucleoside analogues
The first group of effective anti-retroviral medications. They work by interfering with the AIDS virus’ synthesis of DNA.
Opportunistic infection
An infection by organisms that usually don’t cause infection in people whose immune systems are working normally.
Persistent generalized lymphadenopathy (PGL)
A condition in which HIV continues to produce chronic painless swellings in the lymph nodes during the latency period.
pneumonia (PCP)
An opportunistic infection caused by a fungus that is a major cause of death in patients with late-stage AIDS.
Progressive multifocal leukoencephalopathy (PML)
A disease caused by a virus that destroys white matter in localized areas of the brain. It is regarded as an AIDS-defining illness.
Protease inhibitors
The second major category of drug used to treat AIDS that works by suppressing the replication of the HIV virus.
Protozoan
A single-celled, usually microscopic organism that is eukaryotic and, therefore, different from bacteria (prokaryotic).
Retrovirus
A virus that contains a unique enzyme called reverse transcriptase that allows it to replicate withiew host cells.
T cells
Lymphocytes that originate in the thymus gland. T cells regulate the immune system’s response to infections, including HIV. CD4 lymphocytes are a subset of T lymphocytes.
Thrush
A yeast infection of the mouth characterized by white patches on the inside of the mouth and cheeks.
Viremia
The measurable presence of virus in the bloodstream that is a characteristic of acute retroviral syndrome.
Wasting syndrome
A progressive loss of weight and muscle tissue caused by the AIDS virus.
The disorders of cancer, acquired immunodeficiency syndrome (AIDS), and pulmonary disease are characterized by wasting and malnutrition, largely caused by the effect of the disorders or the secondary consequences of treatment on the GI tract. Medical nutrition therapy focuses on reducing these effects.
Local or systemic effects of the cancer combined with antineoplastic therapy place the patient with cancer at increased risk of developing malnutrition or cancer cachexia through a variety of mechanisms: anorexia, nausea, vomiting, mucositis, organ injury (toxicity), and learned food aversions. Nutrition support must be individualized and is an essential component of the total management of cancer.
With the provision of adequate nutrition support, cancer patients may have a decreased risk of surgical complications. They will also have the nutrients needed to rebuild normal tissues that have been affected by antineoplastic therapy and have an increased tolerance to therapies. Overall, quality of life is enhanced. AIDS, caused by the retrovirus human immunodeficiency virus (HIV), leads to the breakdown of the immune system, opportunistic infections, or enteropathy.
Malnutrition, a common complication of HIV/AIDS, is multifactorial and includes decreased nutrient (food) intake, malabsorption, and altered metabolism. Goals of medical nutrition therapy are individualized, and interventions are based on nutritional status, causes of malnutrition, complications that affect nutritional status, and the ability to maintain health as long as possible. Early recognition and intervention for nutritional risk factors and indicators are keys to effective nutrition support and related medical therapies.
The two categories of pulmonary disorders cause either chronic changes in respiratory function, such as chronic obstructive pulmonary disease (COPD), or acute changes in respiratory function, such as respiratory distress syndrome (RDS) and acute respiratory failure (ARF). ARF and RDS may develop in patients who are critically ill, in shock, severely injured, or who have sepsis. The goal of medical nutrition therapy for COPD is to maintain respiratory muscle strength and function while preventing or treating existing malnutrition.
As pulmonary disorders progress, nutritional status tends to decline and malnutrition exacerbates declining respiratory muscle function and ventilatory drive. For ARF and RDS, the function of medical nutrition therapy is to inhibit tissue destruction by providing the extra nutrients required for hypermetabolic conditions. Malnutrition and the method of refeeding influence the outcome in respiratory disease or respiratory failure.
