Unwanted weight loss and lack of interest in food drives many cancer patients to conventional canned nutrition formulas like Ensure, but these may actually foster the oncogenic process. This article outlines the underlying physiology of cachexia and compares various feeding formulas including holistic nutrition options.
Harnessing the Power of Nutrition to Complement Brain Tumor CareJeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at the 1st Annual Brains Matter conference (Sept 2012 in Seattle), sponsored by the Chris Elliott Foundation. Learn how nutrition can play a powerful role to influence the terrain (environment) surrounding cancer cells. Discover foods that can "talk" to your genes, suppressing oncogenes and turning on tumor suppressor genes. Explore simple diet and lifestyle changes you can make to nourish your wellness when facing a brain tumor diagnosis.
Modulating Oncometabolic Syndrome: Integrative Diet & Nutrition to Complement...Jeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at CMBM's Food as Medicine conference, Indianapolis 2013. Oncometabolic Syndrome is a cluster of metabolic factors that influence the growth and progression of cancer. Standard lab testing can be used to assess nutritional factors that may influence cancer outcomes, tailor a protocol to an individual's unique needs, and evaluate the efficacy of the nutrition intervention in modulating these factors.
Radiation Therapy: Nutritional Strategies to Improve OutcomesJeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at "Integrative Cancer Medicine: Clinical Applications of Cancer Strategies" conference April 26-29, 2013, Scottsdale AZ. Explore the mechanisms of tumor resistance to radiation therapy. Review diet, lifestyle, nutritional and botanical strategies for bolstering therapeutic efficacy. Employ selective radioprotectors to lessen injury to healthy tissues. Take into consideration the unfavorable consequences of radiotherapy, which can potentially increase the oncogenic potential of surviving tumor cells, and develop a plan for blocking these pathways. Cases will be presented from 15 yrs experience of the Nutritional Solutions team in counseling clients undergoing radiation therapy for Glioblastoma multiforme brain tumors, colorectal, head-and-neck, breast and gynecologic cancers.
This presentation compares the effects of different animal proteins on cancer, diabetes, heart disease and stroke. Presentation covers fish, dairy, poultry, red meat, processed meat and eggs.
Targeting abdominal obesity in diabetology: What can we do about it?My Healthy Waist
By Luc Van Gaal, MD, PhD, Professor of Medicine, Antwerp University Hospital, Faculty of Medicine, Department of Diabetology, Metabolism & Clinical Nutrition, Antwerp, Belgium
Predimed study is one of the few truly long term randomized trials with disease and mortality outcomes. It is unique in many ways and will have a strong and lasting impact
Abdominal obesity, intra-abdominal adiposity and related cardiometabolic risk...My Healthy Waist
By Jean-Pierre Després, PhD, FAHA, Scientific Director, International Chair on Cardiometabolic Risk, Professor, Division of Kinesiology, Université Laval, Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada.
Harnessing the Power of Nutrition to Complement Brain Tumor CareJeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at the 1st Annual Brains Matter conference (Sept 2012 in Seattle), sponsored by the Chris Elliott Foundation. Learn how nutrition can play a powerful role to influence the terrain (environment) surrounding cancer cells. Discover foods that can "talk" to your genes, suppressing oncogenes and turning on tumor suppressor genes. Explore simple diet and lifestyle changes you can make to nourish your wellness when facing a brain tumor diagnosis.
Modulating Oncometabolic Syndrome: Integrative Diet & Nutrition to Complement...Jeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at CMBM's Food as Medicine conference, Indianapolis 2013. Oncometabolic Syndrome is a cluster of metabolic factors that influence the growth and progression of cancer. Standard lab testing can be used to assess nutritional factors that may influence cancer outcomes, tailor a protocol to an individual's unique needs, and evaluate the efficacy of the nutrition intervention in modulating these factors.
Radiation Therapy: Nutritional Strategies to Improve OutcomesJeanne M Wallace PhD
Presentation by Jeanne M. Wallace, PhD, CNC, at "Integrative Cancer Medicine: Clinical Applications of Cancer Strategies" conference April 26-29, 2013, Scottsdale AZ. Explore the mechanisms of tumor resistance to radiation therapy. Review diet, lifestyle, nutritional and botanical strategies for bolstering therapeutic efficacy. Employ selective radioprotectors to lessen injury to healthy tissues. Take into consideration the unfavorable consequences of radiotherapy, which can potentially increase the oncogenic potential of surviving tumor cells, and develop a plan for blocking these pathways. Cases will be presented from 15 yrs experience of the Nutritional Solutions team in counseling clients undergoing radiation therapy for Glioblastoma multiforme brain tumors, colorectal, head-and-neck, breast and gynecologic cancers.
This presentation compares the effects of different animal proteins on cancer, diabetes, heart disease and stroke. Presentation covers fish, dairy, poultry, red meat, processed meat and eggs.
Targeting abdominal obesity in diabetology: What can we do about it?My Healthy Waist
By Luc Van Gaal, MD, PhD, Professor of Medicine, Antwerp University Hospital, Faculty of Medicine, Department of Diabetology, Metabolism & Clinical Nutrition, Antwerp, Belgium
Predimed study is one of the few truly long term randomized trials with disease and mortality outcomes. It is unique in many ways and will have a strong and lasting impact
Abdominal obesity, intra-abdominal adiposity and related cardiometabolic risk...My Healthy Waist
By Jean-Pierre Després, PhD, FAHA, Scientific Director, International Chair on Cardiometabolic Risk, Professor, Division of Kinesiology, Université Laval, Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada.
'Lo último en obesidad'. Este es el título del Simposio Internacional que organizamos en la Fundación Ramón Areces los días 1 y 2 de diciembre de 2015. En colaboración con la Fundación General CSIC, reunió a algunos de los mayores expertos en la materia para analizar cómo reducir este grave problema de salud pública.
The root cause of chronic diseases, cancer and aging was recently understood. It includes 1- A state of chronic low grade inflammation secondary to hyperglycemia and obesity leading to insulin - leptin resistance. 2- Mitochondrial dysfunction. Diet, Intermittent fasting or its alternative the Metabolic Bariatric Surgery and Exercise play a significant rule in the salvage of these problems. Exercise is any bodily activity that enhances or maintain physical fitness and overall health, Exercise with its Countless Benefits is the logical salvage for a group of diseases related to inactivity . In view of the prevalence, global reach and health effect of these physical inactivity related diseases, the issue should be appropriately described as pandemic, with far-reaching health, economic, social and Environmental consequences.These diseases include, Obesity, Coronary artery disease, Diabetes, Hypertension, Cancer, Depression and anxiety, Arthritis, Osteoporosis, Etc, etc, etc… I think we have no option except doing regular exercises if we seriously search for a salvage to escape the bad and serious consequences of these new life style diseases.
The root cause of chronic diseases, cancer and aging is recently understood. It includes 1- A state of chronic low grade inflammation secondary to hyperglycemia and obesity leading to insulin resistance. 2- Mitochondrial dysfunction. Exercise play a significant rule in the salvage of these problems. Exercise is any bodily activity that enhances or maintain physical fitness and overall health, Exercise with its Countless Benefits is the logical salvage for a group of diseases related to inactivity . In view of the prevalence, global reach and health effect of these physical inactivity related diseases, the issue should be appropriately described as pandemic, with far-reaching health, economic, social and Environmental consequences.These diseases include, Obesity, Coronary artery disease, Diabetes, Hypertension, Cancer, Depression and anxiety, Arthritis, Osteoporosis, Etc, etc, etc… I think we have no option except doing regular exercises if we seriously searching for a salvage to escape the bad and serious consequences of these new life style diseases.
Hypertrophic obesity is associated with type 2 diabetes and impaired adipogen...My Healthy Waist
By Ulf Smith, MD, PhD, Professor of Internal Medicine, The Lundberg Laboratory for Diabetes Research, Center of Excellence for Cardiovascular and Metabolic Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden
Menopause role of isoflavones by dr alka mukherjee nagpur m.s.indiaalka mukherjee
Soy-based isoflavones are modestly effective in relieving menopausal symptoms; supplements providing higher proportions of genistein or increased in S(-)-equol may provide more benefits. Soy food consumption is associated with lower risk of breast and endometrial cancer in observational studies. The efficacy of isoflavones on bone has not been proven, and the clinical picture of whether soy has cardiovascular benefits is still evolving. Preliminary findings on cognitive benefit from isoflavone therapy support a "critical window" hypothesis wherein younger postmenopausal women derive more than older women
Several areas for further research have been identified on soy and midlife women. More clinical studies are needed that compare outcomes among women whose intestinal bacteria have the ability to convert daidzein to equol (equol producers) with those that lack that ability (equol nonproducers) in order to determine if equol producers derive greater benefits from soy supplementation. Larger studies are needed in younger postmenopausal women, and more research is needed to understand the modes of use of soy isoflavone supplements in women. The interrelations of other dietary components on soy isoflavones consumed as a part of diet or by supplement on equol production also require further study, as do potential interactions with prescription and over-the-counter medications. And finally, greater standardization and documentation of clinical trial data of soy are needed.
Soy products can take several weeks or more to reach their maximal benefit. For example, a 2015 review found that soy isoflavones take more than 13 weeks to reach just half of their maximum effect. Traditional hormone therapy, on the other hand, takes about three weeks to show the same benefit.
It’s packed with nutrition
Soy is low in saturated fat and calories. It’s also high in these beneficial nutrients:
• fiber
• protein
• omega-3 fatty acids
• antioxidants
It may help to reduce your risk of heart disease
Eating tofu and other soy-based foods a few times a week can help you cut back on some animal-based protein sources, such as steak or hamburger, that are high in saturated fat and cholesterol.
Yogurt consumption for a healthier diet and lifestyle: overview from cohorts ...Yogurt in Nutrition #YINI
Yogurt is generally considered as a healthy food because of its nutrient composition, its profile of fermented food, and its link with an improved metabolic fitness. Population studies show that yogurt consumers report a greater intake of some nutrients,
e.g. calcium and protein, and fruits and vegetables compared to non-consumers. This is concordant with recent data demonstrating that diet quality is improved in yogurt consumers. Other cohort studies have shown that yogurt consumption is
associated with a reduced body weight over time. Our research experience with the Quebec Family Study reveals that yogurt consumption might be the “signature of a healthy lifestyle”. Indeed, female yogurt consumers report a better macronutrient
composition of the diet than non-consumers; they are also more physically active and display feeding behaviors which are more compatible with body weight stability. This agrees with results of the Infogene Study demonstrating that yogurt consumers
are more prone to adhere to a Prudent dietary pattern whereas non-consumers tend to exhibit a Western pattern. In summary, currently available cohort studies tend to show that yogurt consumption is associated with a healthy eating pattern
and lifestyle.
'Lo último en obesidad'. Este es el título del Simposio Internacional que organizamos en la Fundación Ramón Areces los días 1 y 2 de diciembre de 2015. En colaboración con la Fundación General CSIC, reunió a algunos de los mayores expertos en la materia para analizar cómo reducir este grave problema de salud pública.
The root cause of chronic diseases, cancer and aging was recently understood. It includes 1- A state of chronic low grade inflammation secondary to hyperglycemia and obesity leading to insulin - leptin resistance. 2- Mitochondrial dysfunction. Diet, Intermittent fasting or its alternative the Metabolic Bariatric Surgery and Exercise play a significant rule in the salvage of these problems. Exercise is any bodily activity that enhances or maintain physical fitness and overall health, Exercise with its Countless Benefits is the logical salvage for a group of diseases related to inactivity . In view of the prevalence, global reach and health effect of these physical inactivity related diseases, the issue should be appropriately described as pandemic, with far-reaching health, economic, social and Environmental consequences.These diseases include, Obesity, Coronary artery disease, Diabetes, Hypertension, Cancer, Depression and anxiety, Arthritis, Osteoporosis, Etc, etc, etc… I think we have no option except doing regular exercises if we seriously search for a salvage to escape the bad and serious consequences of these new life style diseases.
The root cause of chronic diseases, cancer and aging is recently understood. It includes 1- A state of chronic low grade inflammation secondary to hyperglycemia and obesity leading to insulin resistance. 2- Mitochondrial dysfunction. Exercise play a significant rule in the salvage of these problems. Exercise is any bodily activity that enhances or maintain physical fitness and overall health, Exercise with its Countless Benefits is the logical salvage for a group of diseases related to inactivity . In view of the prevalence, global reach and health effect of these physical inactivity related diseases, the issue should be appropriately described as pandemic, with far-reaching health, economic, social and Environmental consequences.These diseases include, Obesity, Coronary artery disease, Diabetes, Hypertension, Cancer, Depression and anxiety, Arthritis, Osteoporosis, Etc, etc, etc… I think we have no option except doing regular exercises if we seriously searching for a salvage to escape the bad and serious consequences of these new life style diseases.
Hypertrophic obesity is associated with type 2 diabetes and impaired adipogen...My Healthy Waist
By Ulf Smith, MD, PhD, Professor of Internal Medicine, The Lundberg Laboratory for Diabetes Research, Center of Excellence for Cardiovascular and Metabolic Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden
Menopause role of isoflavones by dr alka mukherjee nagpur m.s.indiaalka mukherjee
Soy-based isoflavones are modestly effective in relieving menopausal symptoms; supplements providing higher proportions of genistein or increased in S(-)-equol may provide more benefits. Soy food consumption is associated with lower risk of breast and endometrial cancer in observational studies. The efficacy of isoflavones on bone has not been proven, and the clinical picture of whether soy has cardiovascular benefits is still evolving. Preliminary findings on cognitive benefit from isoflavone therapy support a "critical window" hypothesis wherein younger postmenopausal women derive more than older women
Several areas for further research have been identified on soy and midlife women. More clinical studies are needed that compare outcomes among women whose intestinal bacteria have the ability to convert daidzein to equol (equol producers) with those that lack that ability (equol nonproducers) in order to determine if equol producers derive greater benefits from soy supplementation. Larger studies are needed in younger postmenopausal women, and more research is needed to understand the modes of use of soy isoflavone supplements in women. The interrelations of other dietary components on soy isoflavones consumed as a part of diet or by supplement on equol production also require further study, as do potential interactions with prescription and over-the-counter medications. And finally, greater standardization and documentation of clinical trial data of soy are needed.
Soy products can take several weeks or more to reach their maximal benefit. For example, a 2015 review found that soy isoflavones take more than 13 weeks to reach just half of their maximum effect. Traditional hormone therapy, on the other hand, takes about three weeks to show the same benefit.
It’s packed with nutrition
Soy is low in saturated fat and calories. It’s also high in these beneficial nutrients:
• fiber
• protein
• omega-3 fatty acids
• antioxidants
It may help to reduce your risk of heart disease
Eating tofu and other soy-based foods a few times a week can help you cut back on some animal-based protein sources, such as steak or hamburger, that are high in saturated fat and cholesterol.
Yogurt consumption for a healthier diet and lifestyle: overview from cohorts ...Yogurt in Nutrition #YINI
Yogurt is generally considered as a healthy food because of its nutrient composition, its profile of fermented food, and its link with an improved metabolic fitness. Population studies show that yogurt consumers report a greater intake of some nutrients,
e.g. calcium and protein, and fruits and vegetables compared to non-consumers. This is concordant with recent data demonstrating that diet quality is improved in yogurt consumers. Other cohort studies have shown that yogurt consumption is
associated with a reduced body weight over time. Our research experience with the Quebec Family Study reveals that yogurt consumption might be the “signature of a healthy lifestyle”. Indeed, female yogurt consumers report a better macronutrient
composition of the diet than non-consumers; they are also more physically active and display feeding behaviors which are more compatible with body weight stability. This agrees with results of the Infogene Study demonstrating that yogurt consumers
are more prone to adhere to a Prudent dietary pattern whereas non-consumers tend to exhibit a Western pattern. In summary, currently available cohort studies tend to show that yogurt consumption is associated with a healthy eating pattern
and lifestyle.
A ketogenic diet to lose weight and fight metabolic diseasehananenina5
Obesity and metabolic diseases are major health problems worldwide.
In 2016, obesity affected 13% of adults globally.
Obesity is a risk factor of metabolic syndrome, a cluster of metabolic abnormalities, including type 2 diabetes, high blood pressure, high waist-to- hip ratio, and low HDL (good) cholesterol.
To combat this, many diets have emerged, including the ketogenic diet, in which a person consumes a very limited amount of carbohydrates. Some research suggests this diet may have benefits for people with obesity.
However, some experts have questioned the health benefits of the keto diet and called for more research. While it may help you lose weight, there may also be complications.
This article explains how the keto diet may help people lose weight and manage metabolic disease. It also discusses some of the possible drawbacks.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
The WDF mission:
Similar to Considering the mechanisms behind cancer cachexia-anorexia can inform wiser nutritional interventions (20)
Selecting high-quality dietary supplements: Finding the products and companie...Jeanne M Wallace PhD
The primary objective of this article is to elucidate the variables relating to supplement quality, such as purity and potency. The reader will learn about excipients, ingredient selection and verification, standardization, natural vs synthetic forms, GMPs, certificate of analysis (3rd-party assays), industry standards, packaging for potency preservation.
A model for drug nutrient synergies: Focus on cortisone drugsJeanne M Wallace PhD
The growing use of natural agents in integrative medicine has increased the need for reliable information on drug-nutrient and drug-herb interactions. The author presents 6 parameters for consideration when screening for interactions, and provides detailed information using dexamethasone as an example.
Adjunctive nutrition and phytotherapy in primary malignant brain tumors.Jeanne M Wallace PhD
Case reports of 23 clients (including 48-yr woman Dx GBM IV in Oct 1997 and alive & well in Oct 2017 20 yrs later) and description of the author's approach to integrative care for clients with glioma-type brain tumors, focusing on natural agents that may enhance the efficacy and reduce undesirable side effects of allopathic treatments.
For 30yrs, the medical field has regarded gadolinium (MRI contrast agent) is safe and biologically inert. New studies suggest call this into question. Learn the risks and how you can protect yourself.
Harnessing the Power of Food: Epigenetics in the Anti-Cancer KitchenJeanne M Wallace PhD
What if the only tools in your dispensary against cancer were foods? Would you know which foods to select—and how to prepare them—for the most potent anti-cancer effects? What would you eat for dinner to downregulate your body’s oncogenic potential? Learn how to assemble an anti-cancer food pharmacy incorporating emerging research in oncology epigenetics. Merge culinary arts and nutritional oncology on an eye-opening journey from shopping basket to kitchen countertop to culinary delight. These are the slides from a workshop with Jeanne M. Wallace, PhD, CNC, at the 2013 Integrative Cancer Medicine: Clinical Applications of Cancer Strategies" conference, April 26-29, 2013
Scottsdale, AZ.
Peruse the list of edibles—fruits, nuts, berries, and perennial vegetables—here on Cache Soil-To-Table's 1-acre permaculture site in Northern Utah, USDA hardiness zone 6a, elevation 4,600'.
Where do you find foods with Super Powers? Do you know how to identify the most nutritious foods? For access to the most nutrient-dense foods—seasonal, local, colorful, heirloom, organic, sustainably grown—an increasing number of people are choosing to grow their own. Whether you have an acre, an urban plot, or merely a windowsill, why not plants foods in your landscape? Discover easy-to-grow rare fruits with excellent nutritional value. Includes great growing tips and resources for sourcing seeds, plants, trees.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Considering the mechanisms behind cancer cachexia-anorexia can inform wiser nutritional interventions
1. www.gahmj.com • November 2014 • Volume 3, Number 6 59
WHAT TO EAT WHEN YOU CAN'T EAT
Forum
FORUM: WHAT TO EAT WHEN YOU CAN’T EAT
About the Author
Marcia Meredith has been a registered nurse for 35 years and a nurse practitioner since 2002. She is a
2006 graduate of the 2-year program at the Ayurvedic Institute in Albuquerque, New Mexico (www.
ayurveda.com), and a grateful student of Dr Vasant Lad. She studied with Maya Tiwari of the Wise
Earth School of Ayurveda from 1998 to 2004. She acknowledges Alakananda of the Alandi Ashram in
Boulder, Colorado, for her wisdom and teachings. She offers Ayurveda health consultations and
Ayurvedic treatments at her private healthcare practice, Health Through Ayurveda, in Minneapolis,
Minnesota. Marcia has a deep passion for Ayurveda with its gentle, natural medicine approach.
Considering the Mechanisms Behind Cancer
Cachexia-Anorexia Can Inform Wiser Nutritional
Interventions
Jeanne M. Wallace, PhD, CNC, United States; Michelle Gerencser, MS, United States; Patrice Surley,
MH, NC, United States
W
eight loss and anorexia are symptoms of aggressive tumor
metabolism. There has been a determined effort to prevent
weight loss in cancer patients ever since it was first reported to
be associated with poor survival in lung cancer.1 Ascribing wasting to
increased resting energy expenditure and malnutrition, the goal histori-
cally has been to maximize caloric intake, and in the fat-phobic era, this
has meant carbohydrate loading. However, high-carbohydrate, calorie-
dense interventions provide limited patient benefit in terms of quality of
life and survival.2-4
Emerging evidence reveals that shortened survival is more a function
of aggressive tumor metabolism than of weight loss per se.5 Metabolic
adaptations driven by tumor metabolism are directly responsible for the
muscle loss and adipose depletion in cachexia.5,6 With this, we must
reconsider the usefulness of increasing calories by unskillful means.
We can address weight loss more proficiently by first assessing con-
tributing factors to determine why the patient cannot eat. For an esti-
mated 50% to 80% of cancer patients, the primary culprit is cancer-
induced anorexia-cachexia (CIAC). Other treatable factors, summarized in
Table 1, can significantly contribute to weight loss as well. While a deeper
exploration of these is beyond the scope of this summary, Table 1 provides
an assessment tool.
CIAC syndrome involves severe wasting of skeletal and cardiac mus-
cle, with or without depletion of adipose stores, that—unlike starvation—
cannot be fully reversed by increased calorie intake.7 The underlying
mechanisms of this complex metabolic disorder include8,9
• Sustained inflammation—increased inflammatory cytokines TNF-!, IL-1, IL-6 and IFN-";
high c-reactive protein (CRP) parallels progressive weight loss in cachectic patients10
• Insulin resistance11,12
• Altered carbohydrate, lipid, and protein metabolism—increased anaerobic glycolysis (ie,
Warburg effect) and reduced beta-oxidation of fats
• Diminished redox resilience—reactive nitrogen species induce myocyte apoptosis
• Anabolic resistance—postulated to be due to decreased anabolic hormones (eg, testoster-
one) and increased catabolic factors (eg, cortisol and myostatin).
With the underlying pathophysiology of CIAC elucidated, let’s consider potential disad-
vantages of commercial enteral feeding formulas (CEFF).
Jeanne M. Wallace
Michelle Gerencser
Patrice Surley
2. 60 November 2014 • Volume 3, Number 6 • www.gahmj.com
GLOBAL ADVANCES IN HEALTH AND MEDICINE
Forum
FORUM: WHAT TO EAT WHEN YOU CAN’T EAT
INSULIN RESISTANCE
The glycemic load (GL) of CEFFs is particularly worrisome (Table 2). For reference, a GL#10
per serving is considered high, and CEFFs range from 20 to 26 per 8-oz (240 mL) serving. These
formulas, known contributors to hyperglycemia, can worsen insulin resistance, and metabolic
syndrome is a negative prognostic factor across several cancer types.13-15
High-carbohydrate calorie loading in an effort to address weight loss may directly fuel a
metabolically active tumor.5 Forging an environment permissive of tumor progression via mul-
tiple pathologic mechanisms,16 insulin resistance
• stimulates mitosis;
• increases IL-6 and fosters inflammation;
• increases IGF-1 signaling, which is implicated in tumor cell evasion of apoptosis;
• suppresses immune function;
• promotes angiogenesis;
• boosts leptin, which stimulates cell migration and metastasis;
• increases circulating free estrogen levels; and
• contributes to treatment resistance by stimulating tumor cell glutathione synthesis.17,18
PRO-INFLAMMATORY FATS
Highly imbalanced omega-6 to omega-3 ratios—particularly with elevated insulin—can fuel
Table 1 Contributing Factors That May Exacerbate Cachexia
Factor Explanation
Dehydration May reduce appetite
Nausea (and subclinical nausea) Nausea, vomiting, queasiness, reduced appetite; food avoidance may occur with-
out overt awareness of nausea
Zinc deficiency Poor appetite, reduced sense of smell and taste,
impaired anabolic signaling
Dysgeusia Treatment-induced damage to taste buds; foods taste metallic, overly salty, or like
“cardboard”
Xerostomia Reduced saliva flow leads to difficulty swallowing, impaired digestion (which
begins in the mouth)
Mucositis Food avoidance due to oral pain, may benefit from bland/soft or liquid diet
Swallowing difficulties May require adaptations to food consistency (liquid diet, blenderized food,
increased food viscosity)
Impaired digestive competence
(hypochlorhydria or
pancreatic insufficiency)
Early satiety, dyspepsia, gas/bloating shortly after meals, prolonged sense of
fullness after meals, impaired digestion and absorption of proteins and fats
Intestinal wall injury/
Malabsorption
Bowel resection, abdominal radiotherapy, chemotherapy, gluten sensitivity, treat-
ment-induced villous atrophy, intestinal permeability defects; weight loss, difficul-
ty gaining or maintaining weight, cramping, bloating, diarrhea, abdominal pain,
constipation, steatorrhea
Dysbiosis/small intestine
bacterial overgrowth
Gastrointestinal flora participate in digestion and enterocyte health; emerging
awareness of the role of the microbiome in weight management
Diarrhea Rapid transit time diminishes absorptive capacity
Constipation May result in reduced appetite, nausea
Conditioned food avoidance Previous treatment-induced dyspepsia leads to learned food avoidance, often
without conscious awareness
Fatigue, depression/anxiety,
adrenal insufficiency
Patient is too exhausted to plan meals, shop, cook, and eat
Misguided food beliefs Adherence to diet with inadequate fat or protein intake due to beliefs about
what constitutes an ideal “anti-cancer” diet; fear of eating the “wrong” foods
leads to reduced intake
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chronic systemic inflammation.19 Smoldering inflammation fosters multiple hallmarks of can-
cer, including proliferation and survival, angiogenesis, metastasis, and treatment resistance.20,21
GASTROINTESTINAL IMBALANCES
Liquid formulations fail to prompt digestion. The high osmolality of formulas containing
hydrolyzed proteins and simple sugars can increase transit time and diarrhea. Inadequate sol-
uble fiber hinders healthy gut flora and, together with high glycemic intake, can produce
dysbiosis. Artificial sweeteners induce glucose intolerance by altering gut microbiota.22 There
is a growing awareness of the diverse roles of the gut microbiome in nutrient and energy acqui-
sition from the diet, regulating mood, immunity, and inflammation. Emerging studies high-
light gut barrier dysfunction and the microbiome as potential targets in muscle wasting.23,24
UNDESIRABLE INGREDIENTS
CEFFs provide excess amounts of certain micronutrients that are potentially contraindi-
cated in cancer patients: iron,25-27 copper,28,29 and synthetic folic acid.30-32 Growing numbers
of nutritionally aware consumers and healthcare providers decline to use formulas with arti-
ficial ingredients, high-fructose corn syrup, or genetically modified organisms (GMOs) and are
seeking a more healthful, whole foods–based approach.
Moreholisticfeedingoptionsareavailable(Table2).LiquidHope(FunctionalFormularies,
Dayton, Ohio), a whole foods meal replacement, has an excellent omega-6:3 ratio and high
fiber. The GL=13, 50% less than most CEFFs. The omega-6:3 ratio of Orgain (Irvine, California)
shakes is 19:1, but the total fat content is low and could be remedied with supplemental fish
oil. Orgain High Protein Shake has a low GL of 5. Vega One (Burnaby, British Columbia,
Canada) powder can be added to any liquid, such as unsweetened nut milk or green tea. Rich
in fiber, it provides 1500 mg omega-3 and its GL=1. However, it contains more iron than is
advisable except in cases of iron-deficiency anemia. CEFFs should be selected on a case-by-case
basis, matching formula strengths and weaknesses to the client’s needs.
To craft a patient-centered feeding strategy, define goals that address the underlying
metabolic abnormalities in CIAC. Ideal feeding approaches reduce inflammation and
improve insulin sensitivity, muscle mass, redox resilience, gut barrier function, and micro-
biome health.
Low-fat, high-carb strategies are inadequate to reverse CIAC. An intriguing solution is to
emphasize carefully selected dietary fats instead of carbohydrates. This approach reduces the
key source of energy for malignant cells while providing a substrate (ketones) to which
healthy cells can adapt.5,33 Ketone bodies decrease glucose and glutamine uptake, diminish
lactate release, and directly reduce muscle protein degradation, further reducing the supply of
gluconeogenic precursors.6,34
A high-fat medium chain triglycerides (MCT)–supplemented diet (80% calories from fat)
mitigated weight loss by 50% compared to a standard diet (12% fat, 50% carbohydrate) in an
animal model of colorectal cancer cachexia.35 In a model of pancreatic cancer cachexia, mice
fed a ketogenic diet showed a 45% increase in muscle weight and a 20% increase in body
weight compared to controls.6 Metabolic reprogramming by ketones reduced expression of
signature genes associated with cachexia.
Low-carbohydrate diets have proven superior to isocaloric low-fat diets at reducing serum
glucose, insulin resistance, and inflammatory markers like CRP.5 These are the very metabolic
factors associated with cancer recurrence and cachexia. High-fat diets, even those supplying
up to 85% of calories as fat, are well tolerated by healthy volunteers, with no impairments in
hepatic, renal, cardiac, or hemopoietic function.35
Our office has been providing clients with a high-fat, low-carbohydrate smoothie recipe
since 2001 (Table 3). While this approach is well tolerated, it is important to observe contraindi-
cations such as biliary obstruction, intense nausea, or diarrhea. Home preparation allows for
quality ingredients and recipe adjustment for digestive concerns, taste, and allergies. The key
ingredients—MCTs, carnitine, fish oil—have specific purposes. MCTs, unlike longer chain fatty
acids, readily absorb across the small intestine without needing bile salts or enzymatic digestion.
L-carnitine supports intestinal transport of lipids and fatty acid oxidation by type I and type IIa
muscle fibers. Adequate levels are rate limiting for ketoadaptation.36 Carnitine is commonly
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deficient in cancer patients, and supplementation supports lean body mass and improves appe-
tite.37 High-dose fish oil improves omega 6:3 ratio in high-fat feeding regimes, improves protein
metabolism, and counteracts anabolic resistance.38 Fish oil (2.2 g/d) permitted 69% of lung can-
cer patients to gain or maintain muscle compared with 29% of patients receiving standard
care.39 Fish oil eicosapentaenoic acid (EPA) stabilized weight in pancreatic cancer patients.40
Combination protocols (Megace plus EPA, L-carnitine, and/or antioxidants) have proven more
effective than single-agent therapy.41,42
We have let a misdirected fear about the
culprit in cachectic wasting drive a whole
industry of high-glycemic feeding formulas,
and we need not continue. We can educate
patients about CIAC mechanisms as a cause of
weight loss and anorexia. We can empower
patients to target inflammation and reverse
insulin resistance rather than just pushing
them to eat the very foods that intensify
cachexia. Rather than relying on body weight
alone,appropriatemonitoringneedstoinclude
Glasgow Prognostic score (CRP and serum
albumin), insulin resistance markers (serum
glucose,insulin,high-densitylipoprotein,triglycerides,uricacid),mid-armcircumference(orother
lean body mass indicators), hand-grip strength, performance status, fatigue, and quality of life.
About the Authors
Nutritional Solutions provides cutting edge translational research in nutrition oncology and innova-
tive cancer nutrition guidance to people with cancer and their families. Owner and founder Jeanne M.
Wallace, PhD, CNC, pioneered the oncometabolic approach to cancer nutrition in 1996. She was joined
later by Michelle Gerencser, MS, and Patrice Surley, MH, NC, and the group has more than 50 years
of clinical experience and continues to evolve the approach in response to emerging research. Nutritional
Solutions has served thousands of clients all over the world, consulting by phone and Skype. Easily digest-
ible and comprehensive written materials, drawing on almost 9000 published studies, along with the
one-on-one consulting relationship, allow each client to increase his or her cancer nutrition knowledge base
and a deep personal understanding of cancer nutrition as a manner of living.
Table 3 Low-glycemic Load Smoothie Recipe
Basic Recipe
1/2 cup full-fat coconut milk
2 heaping tablespoons protein powder—can be whey from organic, grass-fed cows or other non-antigenic protein
such as rice, pea, hemp protein
1 tablespoon liquid sunflower lecithin (helps emulsify the fats for easier digestion)
2 tablespoons medium chain triglycerides oil
1 teaspoon liquid fish oil, supplying 1626 mg EPA, 1126 mg DHA (reduce dose if platelets <100, taking blood thinners,
or in cases of diarrhea)
1 tablespoon L-carnitine liquid, supplying 3 g (essential for metabolism of fats, boosts energy)
1-2 tablespoons freshly ground flaxseed meal, 2 tsp ground chia seed meal or pectin (optional: use as needed for soluble fiber)
Probiotic supplying 50-100 billion cfu acidophilus/bifidus (for constipation or diarrhea; use caution if ANC$1.0)
Flavor Variations
Lemon Ginger—2 tablespoons lemon juice, ¼ tsp zest of organic lemon or tangerine, ½ tsp grated fresh ginger root
(good for nausea and appetite)
Tropical Paradise—Add ½ cup pineapple or papaya and 1 tablespoon lime juice (supports digestion)
Nutty Butter—1 tablespoon peanut butter, sunflower seed butter, or almond butter
Chocolate Mint—1 teaspoon unsweetened cocoa powder, ½ teaspoon peppermint extract, and 3-4 drops liquid stevia
Apple Spice—½ cup unsweetened applesauce, ½ teaspoon cinnamon, ¼ teaspoon ginger and ! teaspoon nutmeg
Pumpkin Spice—Add ¼ cup canned pumpkin, ¼ teaspoon pumpkin pie spice
Abbreviations
CEFF Commercial enteral feeding formulas
CIAC Cancer-induced anorexia-cachexia syndrome
CRP C-reactive protein
EPA Eicosapentaenoic acid
GL Glycemic load
IFN-" Interferon-gamma
IGF-1 insulin-like growth factor-1
IL-1 Interleukin-1
IL-6 Interleukin-6
MCT Medium chain triglycerides
TNF-! Tumor necrosis factor-alpha
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