Monday, September 11, 2006

An Unwanted Journey: Day 0293 - Food for the Journey

Side effects from chemotherapy are arriving earlier and lasting longer than ever. But thanks to the good advice from a nutritionist at the Grand River Regional Cancer Centre, the bowel troubles were less intense this time. She recommended the BRAT diet - bananas, rice, apple sauce and toast.

Part of the rationale was that chemotherapy accelerates transit time in cancer patients. Normally that's not a problem, but if you've been eating acidic or spicy foods, then you can expect troubles. A bland diet means that no matter how quick the transit time, at least you won't have to deal with acid burns during bowel movements.

Sorry, but when we're dealing with colorectal cancer, there's no getting around some of the distasteful aspects of side effects. This is one little lesson that is well worth remembering though.

This time, after the 6th treatment, the side effects lasted far longer, from Friday afternoon to Monday afternoon. But the dietary recommendations meant relatively less pain.


Dietary recommendations are probably the most frustrating aspect of gathering useful information for cancer patients. Part of the problem is the implied judgement, especially with colorectal cancer, that linkages are often made when discussing diet.

I have come to reject those linkages in my own case, partially to protect myself emotionally, partially because I am not convinced anyone is saying anything very useful about diet and the cause of my own tumour growth. After all, I was vegetarian for years and a vegan for quite a while before being diagnosed. I ate well and kept good dietary habits, even though I was certainly overweight.

Speculation about what I ate as a teenager having a causative relationship with my eventual cancer is about as useless to me now as wondering about how I dealt with stress as a 40-something man when the tumour started growing.

But if you leave causation aside, dietary recommendations are also fraught with contradictions for the patient trying to deal with cancer and treatment-related side effects. Fiber or no fiber? Veggies and fruit or bread and rice? Lots of little meals or one or two bigger meals? Ask one nutritionist and then another and you'll be sure to get different recommendations, each of which sounds reasonable at the time.

Ultimately, my recommendation would be to find a nutritionist at your treatment centre who knows how to listen, who isn't ideologically tied to a particular approach, and who is willing to take the time to understand exactly what is happening in your life at a specific time. The nutritionist I speak with every two weeks is precisely that kind of person. Her's is not an exact science, but she listens and she adapts to what I tell her about my experiences.

I see the nutritionists inthe chemo suite regularly giving lengthy consultations with patients. In my view, a well-designed and adaptive nutritional strategy can help tremendously, but only if the patient gives accurate information and the nutritionist listens carefully.

Bon appetit!

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