By Real World Health Care Editorial Staff  |  Mar 8, 2023

Cancer Patients Can Benefit from Improved Nutrition Options

In 2018, Dr. Dhagash Joshi, MD, came to a career-changing realization in his role as a hospitalist physician at Marian Regional Medical Center in Santa Maria, California. His hospital, located near several large and growing cancer centers, was seeing an influx of oncology patients with complex needs. In caring for these patients, he discovered that as much as they needed medical care to thrive, they also needed proper nutrition.

His interest in nutrition was further piqued after attending a 2018 Academy of Nutrition and Dietetics Conference, where at one session, he was the lone physician in a room full of dieticians and nutritionists. He was especially intrigued by a conference presenter whose study showed that a weight loss of only 2.5 percent in body mass index (BMI) after a cancer diagnosis cuts the median length of survival nearly in half. Losing more weight reduces the median length of survival even more.

Dr. Dhagash Joshi

Dr. Dhagash Joshi

“As physicians, we do everything we can to care for patients, improve their quality of life, and extend their life through treatments such as surgery, chemotherapy and radiation,” he said. “But we’re missing a big piece of the puzzle—nutrition—which we often delegate to nutritionists and dieticians.”

The real “aha” moment for Dr. Joshi came when he was caring for a patient with aggressive biliary cancer. The patient had lost a tremendous amount of weight, and Dr. Joshi encouraged him to increase his calorie consumption, suggesting he regularly drink one of the nutritional supplement shakes available in grocery stores. The problem? The patient couldn’t bear the taste.

“After trying a couple of these supplement shakes, I had to agree with him,” Dr. Joshi said.

Why Can’t Cancer Patients Get Proper Nutrition?

According to Dr. Joshi, cancer patients face several challenges maintaining adequate caloric intake. Often, cancer treatments such as chemotherapy and radiation cause nausea, vomiting, indigestion, and trouble swallowing, leading patients to avoid foods that can trigger these gastrointestinal distresses. In addition, cancer treatments place the entire body under constant stress, which serves to dampen appetite and reduce the desire or craving for food.

“Over half of Americans with cancer are malnourished,” Dr. Joshi said. “That number is even higher in certain cancers like pancreatic cancer.”

Dr. Joshi noted that patients who are malnourished will have a more difficult time tolerating aggressive treatment and will be weaker, more dehydrated and less able to fight off the infections that are possible with the lower blood cell counts common with chemotherapy.

“Over time, even a 200-calorie daily deficit can add up,” he said. “The goal should be 2,000 calories a day. If you have an off day, try to make up for it the next day.”

Dr. Joshi encourages patients with cancer to weigh themselves immediately upon diagnosis and every day thereafter, and to keep a log of their weight. His philosophy is that cancer patients should get their calories wherever and however they can – within reason. For example, he doesn’t recommend 2,000 calories a day in nutrition-empty food like soda and chips. He does recommend starting meals with the most calorie-dense foods possible. That may mean starting the meal with a steak instead of a salad, for example.

“Nutritional supplements are a good way to remind yourself to catch up on extra, nutrition-dense calories,” he said.

Nutritional Supplements and the Bliss Point

After discovering – through interviews with patients and multiple rounds of taste-testing — that many of the nutritional shakes and supplements on the market were unpalatable to cancer patients, Dr. Joshi decided to take on the challenge of improving the options. His initial goal was to create a supplement that was not only wholesome, but also provided a taste experience like one would get with a box of luxury chocolates.

At the same time, he wanted to avoid the overly sweet taste that can cause a burning sensation or dryness in the mouth of cancer patients, whose taste receptors are compromised by chemotherapy or radiation.

“Taste and mouthfeel are extremely important to cancer patients,” he said. “If it doesn’t taste good and feel good, patients won’t drink it.”

Dr. Joshi and his team of nutritionists, physicians and food scientists spent three years tweaking his supplement formula to achieve the “bliss point” – the perfect combination of saltiness, sweetness and richness (fat) that rewards the brain and makes one want to consume the product again. The final formula in his line of Reason supplements contains a combination of European milk protein, coconut-derived MCT oil and natural flavors in a high-calorie (1.4/mL, or up to 450 calories per serving), low-glycemic-index supplement that is easy to swallow and digest and works for tube feeding.

Dr. Joshi concludes, “Whether patients get their nutrition from these new supplements, any other calorie-dense supplement, or any healthy, whole food diet they can tolerate, the important thing is to get the proper amount of carbohydrates, proteins, fats, vitamins, and minerals your body needs to maintain weight and energy and function at its best.”

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