The nose doesn't lie. The sight of her is easily deceived, but the sense of smell is not. This is why you have to eat with your nose first than with your eyes. The nose immediately tells us if a food is good, if it is really what it seems, and if it is right for us at that moment or not. Word of Charles Cracco. The advice of the starred chef is valid for everyone, even for those who are undergoing treatment for cancer. Treatments that often alter or destroy taste (dysgeusia), which cause nausea and inappetence, which can cause stomatitis, mucositis, gastritis, constipation or diarrhea, and weight loss. Or which, on the contrary, can lead to weight gain, the risk of diabetes and metabolic syndrome, sarcopenia (loss of muscle mass). The culinary art can be an important ally if you know how to use it. And it is precisely for this reason that Carlo Cracco has been called to give his contribution in this second year of the Oncowellness project, which aims to help cancer patients recover well-being during and after therapies, through nutritional advice (and real and own recipes, including videos), on physical activity and on integrative therapies, such as mindfulness.
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The online platform
Let's say right away what it is: Oncowellness is an online site, free, constantly accessible without the need to register (therefore no data is requested). Launched last year, the project was implemented by Pfizer, supported by a board of oncologists, nutritionists, physiatrists, rehabilitators, trainers, and sees the collaboration of seven patient associations (AIL - Italian Association against Leukemia-lymphoma and myeloma, Europa Donna Italy, IncontraDonna Foundation, Susan G. Komen Italy, APS PaLiNUro Association - Patients Free from Urothelial Neoplasms and WALCE - Women Against Lung Cancer in Europe). There are general indications on the potential benefits for all cancers and a specific focus on four types of cancer: breast, lung, genitourinary and blood.
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In addition to the three areas - "physical activity", "nutrition" and "complementary non-pharmacological therapies" - there is also a fourth, "Flavors and Health", where you can find the recipe book signed by Cracco (here are some examples: asparagus risotto and vanilla; prawns, chickpeas, citrus fruits and saffron salad; pumpkin cream, amaretti and pomegranate) and video recipes with the aim of combining appetite and nutritional advantages. This is accompanied by a sort of guide to discover the ingredients used by the chef, with health and gastronomic curiosities, created with the help of Maurizio Muscaritoli, Director of Internal Medicine and Clinical Nutrition at the Policlinico Umberto I in Rome, and other Oncowellness experts. "Today we are all much more aware of the role of nutrition in oncology, which is important not only within hospitals but also in the area, when the patient returns home. In the case of breast cancer, for example, continue to follow up in the long run period for patients is very important, because weight gain increases the risk of relapses. Nutritional follow-up must be done in the sense of preventing malnutrition both by default and by excess, therefore, in a parallel path to the oncological one".
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Very often chemotherapy induces nausea, vomiting and loss of appetite, for this - the expert still explains - the patient must be encouraged to eat the foods he prefers. It may be useful to avoid consuming food in the same room in which it was prepared and to ventilate the rooms so as not to let cooking smells stagnate before the meal. Processed foods, too spicy, and which can increase regurgitation or heartburn should be avoided.
Beware of interactions of foods, supplements, and herbs with medications
No food - continues Muscaritoli - is in itself indicated or forbidden to the cancer patient, but it is necessary to know that some can interact with the drugs: "Any type of product, even herbal, must be taken during the period of cancer treatment only and only where there is the need has been proven and always having communicated it to the attending physician or nutritionist.When taking vitamin preparations or preparations with an antioxidant action, for example, it is always necessary to inform the doctor, because even harmless nutrients can somehow interfere with the effects of the therapy In particular, antioxidant vitamins should only be taken if there is a proven deficiency and always under medical advice".
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An example? "The so-called St. John's wort (hypericum, ed.)," he replies Sarah Galimberti, Professor of Hematology at the University of Pisa and Director of Hematology at the Pisan University Hospital: "Many herbs, like this one, act on the liver and can modify the plasma level of a drug, interfering with its efficacy or toxicity ". Grapefruit and Seville oranges can also help reduce the absorption of some medications.
Patient nutrition should be personalized
The diet must be designed starting from the deficiencies of macro- or micro-nutrients while maintaining the objective of mitigating the symptoms that the patient presents in that phase of the disease or therapy, continues Galimberti. People with nausea and vomiting should adequately hydrate in small sips and eat dry, dry foods, avoiding anything that is sour or toasted, such as coffee and barley. Patients with constipation must drink plenty of liquids and add fibers - they can help themselves with kiwis, prunes or grapes - while those with diarrhea must reduce the ingested fibers. "Asthenia and fatigue can be counteracted with protein and micronutrient deficiencies, taking into account the daily intake of complex carbohydrates that offer energy without weighing heavily on glycemic control".
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But the message is clear: there isn't a diet that fits everyone and the word is, even in this case, personalisation. "It is useless to impose a rigid diet that the patient is unable to follow," he stresses Valentina GuarneriDirector of Oncology 2 at the Veneto IRCCS Oncological Institute in Padua: "Gluttony must absolutely be allowed and you need to have common sense: understand what is good for you and what is not good for you, and slowly adapt what was done before to what that would be correct. It should also be understood that there is no diet that works if it is not accompanied by correct physical activity".
On Oncowellness it is also possible to find information on complementary non-pharmacological therapies, i.e. that series of resources whose purpose is not to cure tumors but to alleviate, prevent or reduce side effects, in particular sleep disorders, stress, mood disorders, pain, fatigue, nausea. "The correct wording now in the literature is that of integrated therapies", he points out Stephen the GreatHead of the Komen Italia Center for Integrated Treatments in Oncology, Gemelli IRCCS University Hospital Foundation in Rome: "Based on scientific evidence, which obviously remains the guiding criterion in this matter, as in all medicine, the most used integrated therapies are mindfulness, which arises from the integration of yoga with psychotherapy techniques, acupuncture, phytotherapy, music therapy and all that is gathered under the definition of massage therapy, or a set of practices that involve the use of the hands to alleviate specific ailments and symptoms due to side effects".
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In recent years, the interest of the scientific community in these practices has grown a lot, because with the improvement in life expectancy has increased the need to also improve the quality of the time gained, without interfering with the oncological treatments which often continue for long periods. "At the same time - concludes Magno - the scientific literature on these practices has increased".