Berna Harmse explains malnutrition in the context of cancer care and how to avoid it.
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What is malnutrition?
Malnutrition occurs when there is either a lack of proper nutrition or an excess of certain foods in diets; it includes under and over nutrition. However, it’s common for most people to think about malnutrition more in terms of undernutrition, in reference to chronic disease.
Symptoms are fatigue, dizziness, low blood glucose, low blood pressure and weight loss. This in turn has vast implications with regards to wound healing, immunity and the proper functioning of the body.
Cancer and malnutrition
Cancer itself influences physiology around nutrition in various ways. Some patients have increased nutrient requirements and often need more energy and protein. Other patients develop insulin resistance during treatment, which changes the body’s availability of energy fuels to be cells.
Side effects of cancer treatment can also contribute to weight loss and eventually malnutrition due to lack of appetite, taste perception changes, swallowing difficulty and fatigue (not being able to prepare a meal). Surgery might change the way the body absorbs certain nutrients. The nature of malnutrition, weight loss and the causes are complex; a dietitian can help with individualised advice around food challenges you’re facing. Here are some ideas that might be helpful to get you started.
Tips for gaining weight while eating well
To gain weight, you need to consume an extra 2100 – 4200 kJ a day. This means you need to eat high-energy foods such as those rich in fat, proteins and carbohydrates. Increase the amount you eat gradually.
Make food work for you
If you have a small appetite or if you suffer from a loss of appetite:
- Eat small frequent meals and snacks rather than relying on three meals a day.
- Eat slowly and relax during meals. Nervous tension may contribute to underweight in some people.
- Prepare and cook meals when you have the time and energy. Store them in the fridge or deep freeze for later use.
- If you can’t manage a cooked meal, have lighter snack-type foods.
Make ordinary food more nourishing
Improve the nutritional value of everyday foods by preparing them differently. For instance:
Milk: Add 50g (about three tablespoons) full cream milk powder to 500ml liquid milk and mix well. Use these in drinks and in prepared dishes such as mashed potato, soup, white or cheese sauce, and milkshakes. You can also use it with cereal.
Soups: Add one or more of the following: cream, enriched milk, grated cheese, milk powder, beaten eggs or fried croutons.
Fruit: Stew dried fruit with sugar, glucose or honey and enjoy it with custard, full cream yoghurt or cream. Stewed fruit is quicker and easier to eat than fresh fruit so it’s worth trying.
Healthy snack-type foods
Snack foods are easy to prepare, and they are just as nourishing as cooked meals.
- Breakfast cereals with enriched milk (see above).
- Crackers with peanut butter, cream cheese, butter or jam.
- Baked potatoes with any of the following fillings: baked beans, cheese, mince, leftovers, avocado or sweet corn.
- Omelettes with fillings such as cheese, tomato, mushrooms, bacon, ham or mixed vegetables.
- Sandwiches with the following fillings:
- Cream or cottage cheese with sliced banana and a drizzle of honey.
- Avocado and bacon.
- Egg mayonnaise.
- Cream cheese and pineapple.
- Peanut butter and jam/syrup/honey.
- Dates and cottage cheese.
- Peanut butter and grated carrot.
- Mashed banana, raisins and sunflower seeds.
- Make dips with sour cream, avocado pear or full cream yoghurt or cream cheese. Add herbs, mustard, tinned tomato and serve with fresh vegetables and crackers.
Keep a supply of the following foods in case you can’t get to the shops or if there is no time to cook:
- Cartons of long-life milk and fruit juice.
- Frozen foods: meat, ready-prepared meals for heating in the microwave or oven, fish, vegetables and ice cream.
- Dried fruits, biltong, crackers, skim milk powder and nuts.
- Additional supplement drinks: Ensure, Nutren Fibre, Lifegain, and Replace.
- Tinned foods: soups, baked beans, pasta, fish, custard, fruit and milk puddings.
Avoid low kilojoule foods
Avoid foods that fill you up without adding many kilojoules to your diet. These include foods such as low-fat products, popcorn, and crackers without fillings.
MEET THE EXPERT – Berna Harmse
Berna Harmse is a private practicing dietitian. She holds a MSc in Dietetics, and has a special interest in oncology nutrition. She is also an external lecturer at Stellenbosch University Division of Human Nutrition.
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