Nutrition Management for Patients Living with Neuroendocrine Tumors

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Nutrition Management for Patients Living with Neuroendocrine Tumors Leigh Anne Burns, MS, RD, LDN Oncology Nutritionist LSUHSC School of Medicine New Orleans Ochsner - Kenner Neuroendocrine Tumor Clinic
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Nutrition Management for Patients Living with Neuroendocrine Tumors Leigh Anne Burns, MS, RD, LDN Oncology Nutritionist LSUHSC School of Medicine New Orleans Ochsner - Kenner Neuroendocrine Tumor Clinic Objectives Provide a Brief overview of Neuroendocrine tumors. Discuss Symptoms and complications related to nutrition among NET survivors. Discuss Nutrition management and meal planning to reduce symptoms of NET Neuroendocrine tumors Overview Solid tumors which appear in Neuroendocrine cells Most common types are Carcinoid and Pancreatic Net have the ability to secrete active hormones Slow Growing Pancreatic (PNET) Tumor Types Hormone secreted Symptoms Gastrinoma Gastrin Zoliinger Ellison syn. Peptic Ulcers diarrhea, GERD Insulinoma Insulin Hypoglycemia Glucagonoma Glucagon Hyperglycemia, diabetes, diarrhea Somatostatinoma somatostatin steatorrhea/diarrhea, Hyperglycemia, weight loss, gallstones VIPoma Vasoactive intestional Peptide Profound watery diarrhea, low K+, flushing, weight loss, nausea Effects of NET and GI Consideration Over expression of hormones including serotonin and other peptides Altered GI structure, function and motility Organ involvement and surgical procedures Mediation and treatment Determining Causes of Diarrhea Medical team will review records, lab results, and symptoms described by patients, to evaluate problems related to diarrhea and malabsorption. This provides a plan for the medical team for use in decreasing the number and / or consistency of bowel movements. Basic Mechanisms Responsible for Clinically Significant Diarrhea Osmotic diarrhea Secretory diarrhea Decreased contact time / surface area Probable combination of the above Contributing Factors of Osmotic Diarrhea Malabsorption such as lactose intolerance Ingestion of poorly absorbed substrates such as: sorbitol, mannitol, Epson salt or antacids Diarrhea will stop Contibuting factors to Secretory Diarrhea Intestinal water secretion water exceeds absorption Bacterial toxins Drugs (laxatives,some types of asthma medications, antidepressants, cardiac) Miscellaneous: heavy metals, organic toxins, and plant products (e.g. arsenic, insecticides, mushroom toxins, caffeine) Tumor-Associated Secretory Diarrhea Vipomas: VIP (vasoactive intestinal peptide) Gastrinomas: gastrin Carcinoid: histamine, serotonin, polypeptides Other Causes of Diarrhea Short bowel syndrome Inflammatory bowel disease Celiac sprue Pancreatic insuffiency Intestinal surgery Gallbladder removal Bacterial overgrowth Bile acid colitis Drug-induced (sms analogs) Changing Food Into Energy Intake calories as: Carbohydrates Proteins Fats Results in: Formed stools Runny stools Fatty stools Normal GI Tract Assesment of Diarrhea Related Problems Rapid transit times (30-60 min postprandial stool) Watery explosive stools Floating foul stools Dietary Factors that May Worsen Diarrhea Dietary Factor Source Caffeine Fructose (in quantities surpassing the gut's absorptive capacity) Lactose Coffee, tea, cola, OTC headache remedies Apple juice, pear juice, grapes, honey, dates, nuts, figs, soft drinks (especially fruit flavored), prunes Sugar-free gum, mints, sweet cherries, prunes milk, yogurt, soft cheeses Use of medications to Control Diarrhea and Steatorrhea Anti Diarrhea drugs - Imodium, Kaopectate Tincture of opiate or codeine Cholestyramine Pancreatic Enzymes Probiotics Factors Resulting in Increased Activity Motility Stress Foods Concentrated sweets Mix solids and liquids Extreme hot or colds Fiber types Anti-diarrhea Medications They treat only the symptoms They work by slowing down the movement of the gut This allows more time for water to be absorbed which makes the stool less watery Probiotics Useful in treating diarrhea related to antibiotic use from bacteria overgrowth Helps replace normal flora to the GI tract High dosage may increase gas or diarrhea Cholestyramine Used when bile salts are thought to play a role in the diarrhea Action is to binds bile acids, keeping them from reaching the colon and thereby stopping bile-acid-induced diarrhea Common after gallbladder removal or presence of short bowel syndrome Cholestyramine It is Not absorbed by the body Adverse effects Interaction with medications by reduced effect Constipation, bloating, abdominal pain, irritation of anal area Characteristics of Steatorrhea Excessive excretion of fecal fat Large, greasy Foul smelling Stool floats May see oil droplets Pale stools Contributing Factors to Steatorrhea Insufficient release of lipase Short bowel syndrome Gallbladder removal Side effect of medications (SMS analogs) Pancreatic enzymes Provide lipase and enzymes to aid in digestion of fats, carbohydrates and protein Take with feedings Adjust dosage with amount of fat in the diet Probiotics Useful in treating diarrhea related to antibiotic use from bacteria overgrowth Helps replace normal flora to the GI tract High dosage may increase gas or diarrhea Problems associated with Chronic Diarrhea and Malabsorption Involuntary Weight loss Inadequate absorption of calories Vitamin and mineral losses Fat soluble vitamins, Mg, K Uncontrolled stools Gas / bloating Adjustments in Diet Improves Proteins Stool Output Carbohydrates Fats Fluids 10 8 Treatment Plan Take medication as prescribed Modify diet Keep records Report problems Summary Individuals can achieve improvements in health and symptoms during the treatment of NETs with the right combination of diet, medication and lifestyle
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