FOOD & LIFESTYLE IN PALLIATIVE CARE

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1 FOOD & LIFESTYLE IN PALLIATIVE CARE Tea and Sympathy and much more Dr Eleni Tsiompanou Associate Specialist in Palliative Medicine Princess Alice Hospice & Kingston Hospital Specialist in Nutritional Medicine

2 Four Health Pillars FOOD - Eat just the right amount, mainly greens and wholesome foods ACTIVITY exercise every day RELAXATION relax and sleep well CONNECTION - with your environment, people & something bigger than you

3 Why talk about nutrition & lifestyle? Because it matters to patients and carers Research has confirmed that appetite and the ability to eat are very important physical aspects of a patient s quality of life Good nutrition can enhance recovery, when healing is possible Simply and solely the subject of our inquiry is how to ease the suffering and alleviate the pain of our patients Hippocrates

4 Users view: I want to do something for myself

5 Nutritional care is essential Nutritional needs identified for all people Needs to be individualised & stage appropriate Nutritional needs may change It is a matter for all palliative care professionals All need training & regular updates Food & Nutrition Group Consensus Statement Healthcare organisations are responsible for delivery of nutritional care

6 Nutrition & Lifestyle in Palliative Care Living Life to the Full right until the end Members of the MDT contributed to the day Social worker and care worker from NH attending Patient s perspective Steve s session on Mindful Eating Feedback: the course was amazing, my colleague and I really enjoyed it and learned so much. We are planning to feedback to our eating and drinking group and get moving on the action points we thought of after the course

7 Healing with food Blessing of food gratitude and consciousness Awareness and intention Mindful eating Compassion

8 Ladies Lunch Group Cooking on Prescription Menu Brief meditation Talk about mindful eating Cookery demonstration: Sardine Pâté Date & Coconut Truffles

9 Bereaved Relatives Support Group 148 studies on effects of social isolation on health, found that social isolation is: As bad as smoking 15 cigarettes a day As dangerous as being an alcoholic Twice as dangerous as obesity

10 Glycemic index and load Low-glycemic index foods are known to improve glucose tolerance and reduce insulin resistance The glycemic index and glycemic load of a meal are important for mood regulation

11 Dark chocolate Food of the Gods Editorial: The essence of chocolate: A rich, dark, and well-kept secret. Nutrition Nov-Dec 09;25: Improves insulin sensitivity May improve DNA resistance to oxidative stress Catechins & procyanids beneficial effect against chronic inflammation Significant calorific value Remarkable effect on energy levels

12 Personal support

13 Connection

14 Review: Nutritional support for malnourished people with cancer Oral nutritional interventions are widely recommended for malnourished cancer patients, but the evidence for their benefits to clinical, nutritional and patient-centred outcomes is limited Recent research has largely focused on treatments aiming to modulate the inflammatory processes associated with cachexia, but to date has not identified a single treatment with clear efficacy C Baldwin. Curr Opin Support Palliat Care 2011;5(1):29-36

15 SO WHAT HAPPENS IN CANCER? Malnutrition-deficiency of energy, protein and other nutrients Abnormalities in hormones insulin:glucagon ratio, insulin resistance Inability to use nutrients effectively

16 TIPS ON THE MANAGEMENT OF ANOREXIA CACHEXIA SYNDROME

17 Natural Exercises: Sight, Hearing, Voice and Thoughts Sight - The soul is moved and warmed. As it warms it dries, the moisture having been emptied out. Hearing sounds vibrate the soul, which is moved and exercised and so it is warmed and dried. Thoughts - the soul is warmed and dried; can help with weight loss Voice exercises (speech, reading or singing) - move the soul, warm it and dry it, consuming the moisture Walking is a natural exercise, much more so than the other exercises. The properties of the several kinds of walking are as follow. A walk after dinner Early morning Walks after gymnastics

18 1st Hippocratic Aphorism Life is short, the Art long, opportunity fleeting, experiment treacherous, judgment difficult