1. Gut Reaction: Dealing with Gastrointestinal Complications Real Life Real Food for Cancer Survivors presented by: Jennifer Koorenny MS, RD

2. Topics of Discussion: ► The Gastrointestinal (GI) Tract ► When Digestion Goes Wrong ► Remove and Repair ► Recipes

3. Our Digestive Systems Role ► Transports food through the GI tract ► Secretes digestive juices to breakdown foods into smaller, usable forms of nutrients (glucose, amino acids, fatty acids, etc) ► Absorb digested foods, micronutrients (vitamins, minerals), water and electrolytes

4. The GI Tract Tubular structure extending from mouth to anus, approximately 30 feet in length, divided into sections with highly specialized functions. ► Mouth (chewing) ► Esophagus (swallowing) ► Stomach (storage, digestion, rate food moves into SI) ► Small intestine: duodenum, jejunum, ileum (digestion, absorption) ► Large intestine: colon, sigmoid, rectum (water absorption, fiber fermentation, waste excretion) The GI tract is the second largest surface area of the body

5. GI Function ► Big role in our body’s detoxification system ► Regulates much of our infection-fighting immune system ► All of the digestive functions of the body ► Nearly all of the absorptive function of the body (skin, respiratory membranes excluded)

6. When Digestion Goes Wrong ► Leaky Gut Syndrome  Prolonged medication and antibiotic use  Diet choices  Chronic stress  Environmental Contaminants  Gastrointestinal disease  Overconsumption of alcoholic beverages  Dysbiosis: imbalance of GI flora

7. What is Leaky Gut? ► Increased intestinal permeability ► Allows passage of foreign materials to pass into the bloodstream  Undigested food particles  toxic molecules  disease producing bacteria

8. Common Dietary Factors Related to Leaky Gut ► Low plant food intake ► Poor quality food  Highly processed, refined diet ► High animal protein diet ► Acidic beverages (sodas, alcohol) ► Eating on the run ► Exposure to dietary antigens (food sensitivities), microorganisms, bacterial toxins, chemotherapy ► Low gastric acid production ► Antibiotic or medication use

9. Other Factors: Stress and Digestion ► Stress  Decreases gastric and pancreatic secretions  Decreases muscle contractions in GI tract  Increases constriction of sphincters  Liver, releases glucose  Increases cortisol levels (chronic stress):  Hyperglycemia  Decreased immune function  Water and vitamin losses

10. Other Factors: Relaxation and Digestion ► Relaxation  Increases gastric and pancreatic secretions  Increases GI motility  Relaxes sphincters  Liver, glycogen synthesis  Gall bladder, contracts to release bile when signaled

11. Remove to Repair ► Requires identification of possible offenders  Keep a detailed diet diary  Track GI function, noting gas, bowel movements, moods, any changes in skin integrity, etc.  Note changes in stress level or physical signs of chronic stress

12. Stress: Mind-Body Connection ► Avoid or reduce exposure to stressors, or ► Learn to manage them  Yoga  Meditation  Hobby  Physical Activity  Deep Breathing  Exit a situation when possible  Consult a professional counselor

13. Identify Potential Food Sensitivities Notice whether certain types of food are related to pain, rashes, GI discomfort: ► Night shades (tomatoes, potatoes, eggplant, peppers) ► Wheat ► Gluten ► Dairy ► Soy (This is not a comprehensive list) (This is not a comprehensive list)

14. Eliminate Potential Offenders ► Elimination Diet*  Remove potential offenders from diet for a specified time period – usually 3-4 weeks ► May require eliminating all foods from a family  “Challenge” all foods individually for 3-5 days to assess for return of symptoms  Re-eliminate foods that cause a reaction  Process takes one-four months to complete *Guidance from a dietitian is recommended

15. Repair: Treating Inflammation ► Reduce spicy and acid forming foods, alcohol, coffee, tea ► Eat foods containing pre- and probiotics ► Include whey protein with glutamine ► Get adequate amounts of calcium, magnesium, iron, zinc, selenium ► Modify textures of foods (soups, smoothies, pureed or soft foods)

16. Repair: Restoring Bacteria There are more bacteria in our intestinal tract than cells in our body. There are more bacteria in our intestinal tract than cells in our body.

17. Pre-biotics (FOS): Pre-biotics (FOS): Support the Growth of “Good Bacteria” Foods naturally containing FOS: ► Bananas ► Garlic ► Onions ► Leeks ► Soybeans ► whole grains ► Honey ► Most fruits ► Blueberries ► Asparagus ► Peas ► Legumes ► Eggplant ► Jerusalem artichokes

18. Pro-biotics: the “Good Bacteria” Natural food sources: ► Cultured yogurt ► Tempeh ► Miso ► Sourdough bread ► Naturally fermented vegetables (sauerkraut, kimchi) Foods fortified: ► Soy yogurt ► Some juices: ie Good Belly® ► others?

19. Repair: Improving Absorption ► Partial digestion (digestive enzymes – papaya, pineapple, acidophilus – yogurt, buttermilk. Consult physician if this continues; Rx may be required) ► Liver detoxification (brassica family of vegetables, Vitamin C, E, beta carotene, B vitamins) ► Improve Colon Health (vitamins D, K, C, organic coconut oil) ► Reduce Constipation (fiber and fluids, flaxseed meal, probiotics, FOS, aloe vera juice) ► Reduce Diarrhea (increase soluble fiber intake, temporarily remove insoluble fiber, probiotics)

20. Maintenance: Dietary Changes ► Eat whole foods and less processed foods  Read ingredient lists and look for foods containing <5 items  Include 2 ½ – 3 cups of vegetables daily  Increase plant proteins  Increase whole grains  Learn to cook from scratch ► Reduce meat intake ► These may require some initial lifestyle changes, but they do get easier!

21. Online Food Planner www.myfoodmyhealth.com ► Online weekly meal planner for multiple health conditions & food allergies  20+ health conditions including: celiac, autism, candidiasis, diabetes, etc.  Food allergies including: wheat, dairy, gluten, soy etc.  Delicious & nutritious chef-created recipes  Easy to prepare in less than 30 minutes  International flavors  Whole, natural ingredients

22. Only the Tip of the Ice-Berg Gastrointestinal problems are serious and these recommendations are not comprehensive and are made to help you troubleshoot potential problems. Gastrointestinal problems are serious and these recommendations are not comprehensive and are made to help you troubleshoot potential problems. This presentation is not intended as treatment and if problems are a concern, it is recommended you discuss them with your doctor or request an appointment with a registered dietitian. This presentation is not intended as treatment and if problems are a concern, it is recommended you discuss them with your doctor or request an appointment with a registered dietitian.

23. Recipes: Mango Lassi ► 1 cup frozen mango chunks (probably about 1/2 fresh mango) ► 3/4 cup low-fat kefir or yogurt ► 2 tsp ginger syrup (see recipe) or 1 tsp honey (optional) ► Ice, if desired ► Whirl all ingredients in a blender or mini food processor. Pour into a large glass and eat with a spoon. Serves one generously.

24. Recipe: Raita ► 1/2 large English or seedless cucumber, or 1 standard cucumber ► 1/2 cup low-fat or nonfat plain yogurt (I like European Style, which is thicker than normal yogurt but not as thick as Greek-style) ► 1/4 teaspoon fine sea salt ► 1 clove of fresh garlic (optional) ► Peel the cucumber and seed if necessary. Using a box grater, grate the cucumber. Take cucumber pulp in your hand and squeeze with both hands over the sink to drain (a ton of water will come out). In a small bowl, combine cucumber, yogurt, salt, and garlic powder. Stir and taste for salt.

25. Thank you! Any Questions?