CACS meeting of 7/19/03:  Meeting summary

Topic:  Update on Nutritional Concerns for the Carcinoid Patient

Speaker:  Ms. Monica Warner, M.S., R.D., C.D.N., research coordinator, Carcinoid Cancer Foundation, Inc., New York, NY

 

Availability of an online report.  In May 2000 in Sarasota, Florida, Monica Warner presented a similar talk to the one she gave at CACS in July 2003.  A transcript of that May 2000 talk is available at http://www.carcinoid.org/MwarnerlectureSept2.htm .  We recommend that the reader first look at that reference.  The summary herein will concentrate only on the question-and-answer part of the July 2003 CACS meeting.

 

Questions and answers: 

 

Q.    How do meat and beans compare for the recommended high protein diet? 

A.     The amount of protein would be equivalent, but the protein in beans is not as complete because it doesn’t contain as many types of amino acids (the building blocks of proteins).  Vegetarians have to combine such foods as beans, rice, and tofu to have complete protein. 

 

Q.    If your primary tumor is in the pancreas, do you need to take the recommended pancreatic enzymes?

A.     This is a question to ask your doctor.  (The enzymes help with gas/bloating/fatty stools (steatorrhea/ “floaties”.) 

 

Q.  What can help with carcinoid diarrhea if you cannot tolerate sandostatin?

A.  Some suggestions:  Imodium, Lomotril (anti-intestinal motility medications), anticholinergic drugs, low fat diets, tincture of opium, fresh ground nutmeg (3 tsp/day) (this can be put in an empty pill capsule obtainable from a drugstore for ease of swallowing)

 

Q.  Are strawberries something that carcinoid patients should avoid?  (The questioner gets pain and a flush).

A.  This could be a food allergy rather than a noid reaction. 

 

Q.  How can you tell if a change in one of your laboratory tests (such as 5-HIAAA) is significant?

A.  Each test has its own spread/range and significance.  [Additional comment by CACS:  One carcinoid specialist, Dr. Eugene Woltering, has said that a change in a biochemical factor needs to be by at least 15% to 20% to be significant.]

 

Q.  If carcinoid tumors produce excess serotonin, what does this do in the body?

A.  This can cause flushing, diarrhea, and heart disease.  [Additional comment by CACS:  Serotonin can affect fibers, which also can lead to adhesions in the digestive tract.]  Blood levels of serotonin should be measured as well as levels in urine.  These effects are why it is crucial to treat with Sandostatin to bring down the hormone levels and not just “wait and see”. 

 

Q.  Are there any chemicals in food that “activate” tumor markers?

A.  No, there is no relationship to what’s in food vis-à-vis increases in markers. 

 

Q.  What else can reduce serotonin levels?

A.  Tumor debulking can do this if it is possible to do so for a particular patient. 

 

Q.  Is it all right to use a calcium supplement?

A.  There is a suggestion that calcium may have an antitumor effect.  It is generally good to get enough—especially for women. 

 

Q.  Can a local nutritionist contact you?

A.  Yes, of course.  The best way to reach me is on Tuesdays through Thursdays at this toll-free number:  888-722-3132. 

 

Q.  I was a vegetarian but now I crave meat and eggs.  Should I worry about cholesterol?

A.  You do not need to be concerned about cholesterol now. 

 

Q.  Does the alkaline vs. acidic balance in the body have any effect on tumor cells?

A.  I do not know, but healthy diets tend to be high in fruits, vegetables, and grains. 

 

The speaker ended with the news that while survival in the 1970s after carcinoid diagnosis with liver metastases was 3 years, Dr. Richard Warner reported recently at a scientific meeting in Salt Lake City that his group’s database shows 10 to 15-year survivals now.