“Niacin deficiency, general protein energy deficiency, nutrition problems due to surgery, malnutrition and chronic diarrhea, and the excess metabolism of tryptophan,” are the key nutritional issues for carcinoid patients says endocrinologist Jeffrey I. Mechanick, M.D. Dr. Mechanick has been working with carcinoid patients at Mt. Sinai School of Medicine in New York City, where he is Clinical Professor of Medicine and an attending physician, for over twenty years, beginning when he was a Fellow in Endocrinology at the hospital in 1981. He became interested in carcinoid patients as he worked at Mt. Sinai alongside Richard R.P. Warner, M.D., a nationally and internationally recognized carcinoid specialist and Medical Director of The Carcinoid Cancer Foundation.
The challenges of working with carcinoid patients, explains Dr. Mechanick, are both in the very early diagnostic stage as well as in the advanced stage, when very sick patients are undergoing surgical intervention.
When carcinoid patients inquire about the best diet for them, Dr. Mechanick’s advice is based upon whether or not the patients have symptoms. For those without symptoms, he recommends a traditional healthy diet, including fresh fruits and vegetables, protein, and healthy fat. A multivitamin is suggested if one’s diet does not include the daily recommended levels of vitamins as outlined by the Food and Drug Administration. In the absence of pellagra, a disease that affects carcinoid patients who have niacin deficiency, Dr. Mechanick says there is no reason to take dietary supplements.
For carcinoid patients who have symptoms, Dr. Mechanick recommends dietary modifications based upon the symptoms. For example, a diet for patients with diarrhea should include starchy, easily digestible carbohydrates and low saturated fats. When carcinoid patients have surgery to remove a large portion of the small intestine, they may experience short bowel syndrome, a condition in which nutrients are not properly absorbed (malabsorption). Dr. Mechanick suggests those patients replace Vitamins A, D, E, and K if there is a deficiency. Pancreatic enzymes, including Viokase, Ultrase, Creon, or Pancrease, can also be used to treat malabsorption. A possible side effect of taking Sandostatin is biliary stasis, a problem with the flow of bile that may lead to gallstones. Dr. Mechanick says those patients should take Ursodiol, a bile acid.
To Read the Complete Interview with Dr. Mechanick go the Carcinoid Cancer Foundation website by clicking here: http://carcinoid.org/pcf/docs/Mechanick0210.shtml
Additional Resources about Nutrition and Diet:
- U.S. Food and Drug Administration, http://www.fda.gov/
- United States Department of Agriculture, National Agricultural Library, Food and Nutrition Information Center, https://www.nal.usda.gov/fnic
- American Institute for Cancer Research, The New American Plate, http://www.aicr.org/new-american-plate/
- Carcinoid Cancer Foundation, http://www.carcinoid.org (see sections on Nutrition and Frequently Asked Questions)
- The New American Plate Cookbook: Recipes for a Healthy Weight and a Healthy Life, published by The American Institute for Cancer Research, www.amazon.com
- Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating, by Walter C. Willett, M.D., www.amazon.com