Editor’s note: In addition to diabetes and heart disease, some 40 million Americans are recovering from, or living with, serious physical conditions such as cancer, autoimmune disorders, degenerative diseases and other conditions where nutrition is critical and the right ingredients can help improve outcomes and quality of life. Author Mark Anthony, in addition to being a biochemist, professor of health science and nutrition, and champion athlete, is also a cancer survivor. Here, he highlights untapped opportunities processors have for meeting the needs of this huge consumer demographic.

A run-in with a serious disease is a powerful stimulus for change, and reducing symptoms and risk factors through diet is generally a focal point of that change. Recovery has many stages, and good nutrition is critical along all of them.

Four of the 10 leading causes of death in the US— heart disease, cancer, stroke, and type 2 diabetes—are inexorably linked to dietary risk factors and obesity. Then, there are the survivors: those who have struggled with these and other diseases—and overcome them—but must pay special attention to nutrition to stay healthy.

Of course, much research focuses on dietary patterns and specific nutrients that can help prevent diseases.The results also happen to be critical to recovery from, and management of, serious illnesses.

According to the CDC, cardiovascular diseases account for nearly 600,000 deaths per year, a figure matched by cancer deaths from all forms.

For example, cancer survivors are becoming more of the rule than the exception: Estimates are that about 5% of the US population is currently undergoing or has undergone chemotherapy for cancer.

National Cancer Institute statistics show that, on average and considering all categories and age groups, nearly 70% of those diagnosed with cancer survive at least five years past diagnosis.

A similar picture is true of heart disease sufferers, in that most people survive their first heart attack. That means a significant portion of cancer and heart disease patients are struggling to re-establish health. They are joined by a large population coping with other conditions common to modern industrialized nations, such as arthritis and autoimmune diseases.

Hydration Boost

For patients recovering from cancer, the benefits of sound nutrition begin early. In preparation for treatment, patients are encouraged to bolster nutritional status to cope with the rigors of therapy, which can be severe. Many of the potential treatment side effects negatively impact nutrition by causing appetite suppression. For example, patients suffering from head and neck cancer have significant nutrition challenges. Both the cancer itself and the therapy can result in difficult and painful swallowing.

The sense of taste often can be distorted during cancer recovery. Nausea and severe dehydration commonly accompany chemotherapy, making specific foods or even the very thought of eating seem unpleasant. Sometimes, drinking can be a challenge. Severe dehydration is, of course, potentially life-threatening. Rehydration is so critical that it can require intravenous fluids. But when treatment is completed, hydration continues to be an important factor in recovery.

The American Cancer Society (ACS) recommends a comprehensive range of dietary liquids to maintain fluid and electrolyte balance. They include everything from dairy products, to fresh fruit and vegetable juices, to sports drinks—all in addition to water. The ACS goal is to reach at least 64oz/day.

The choice of fluids for hydration is ever-expanding, while consumers are more mindful of calories, especially from sugar. This is especially true of persons in recovery. And, like all consumers, they are looking for more natural and creative ways of hydration.

Many sports drinks, a fast-growing rehydration choice for today’s consumers, are well-suited to the recovery consumer, too. These are notably lower in sugar content and calories than sodas and other sugar-sweetened beverages—generally in the range of 50 kcals per 8oz serving, compared to 120-140 kcals or more. Some sports beverages, such as PepsiCo.’s Gatorade G2 series, weigh in at a mere 10 kcals per 8oz serving.

Another example of the best of these, especially when it comes to contributing to the renewal of health, is R.W. Knudsen & Sons Inc.’s Recharge line of sports beverages. These consist of fruit juice and purified water, spiked with a small amount of mineral-rich sea salt for sodium. The fruit juice supplies potassium and minor amounts of trace minerals, all combining for an electrolyte-rich beverage.

The recent trend of coconut waters also has influenced the ranks of sports drinks. This is due to a naturally high potassium content. Coconut water contains small amounts of natural sugar, with almost no fat, and is naturally rich in magnesium (although not as rich in sodium) as most sports drinks. Sodium is the electrolyte most rapidly lost during heavy exercise; however, that is not the primary concern when simply maintaining hydration. Coconut waters represent an excellent source of natural hydration.

Complexity of Cancer

Andrew Abraham, MD, found his own cancer diagnosis to be the motivation to create a line of organic products to help support a healthy recovery—especially hydration—a key part of any recovery. Abraham’s Orgain Inc.’s line of products includes a selection of organic protein shakes and hydration powers. The hydration formula is a powder mix that derives small amounts of sweetener from dehydrated coconut water, a small amount of pure cane sugar, tapioca dextrins, sea salt, and naturally-sourced B vitamins.

At just 20 kcals per serving, the mix also is a rich source of natural potassium from coconut. The company’s protein shakes specifically are designed to help provide supplemental nutrition or even be used as full meal replacements, when eating is a challenge.

Colorectal cancer is the third-most diagnosed cancer among both men and women. This type of cancer carries unique problems when it comes to formulating a healthy diet for recovery. The primary job of the colon is to extract water from food. If some or all of the colon is lost, hydration is threatened.

Recovering patients are at greater risk for dehydration for life. Increased risk of dehydration, also increases the risk of kidney stones and kidney disease in general, again increasing the need for potassium, a vital mineral that tends to reduce the formation of kidney stones. After recovery, patients generally are encouraged to resume an active lifestyle, including exercise—which also is highly demanding of fluids and electrolytes.

The potential complications of colon cancer do not end with hydration. Eating itself can present multiple challenges. Depending upon the loss of all or portions of the colon, the patient can be at increased risk for occasional to periodic bowel obstructions. This is particularly true of survivors who have lost the entire colon.

While general dietary recommendations encourage the consumption of fiber as part of a healthy diet, for some colorectal cancer recoverers, this advice must be weighed against the potential for developing an obstruction. Also, if a portion of the terminal ileum is lost, vitamin B12—absorbed in this portion of the small intestine—might have to be provided through dietary or sublingual, supplemental form.

Hunger Management

If the healing person is undergoing or has had radiation therapy, there likely will be side effects. Severity or impact on diet and appetite depend on the area of the body treated; the dose of radiation; the number of treatments; and whether or not it is combined with chemotherapy.

For many, anemia and subsequent fatigue can be intense and distressing, making both nutrient-dense foods (those that are rich in nutrients per calorie) and energy-dense foods (those that are rich in calories per unit volume), along with fluids, even more important to maintain strength and encourage healing.

However, because nausea can be persistent and the thought of eating might be unpleasant, the ACS recommends frequent snacking on foods that are rich in both protein and calories, even when the patient is not hungry. Dietitians typically encourage such clients to lean more heavily on “cues” from other organoleptic qualities, such as temperature and texture, plus visual and socio-historic (for example, comfort and familiarity of a dish) for tolerating and even enjoying foods and beverages.

Also encouraged is stocking up on foods from which quick meals can be made. This can mean increased adoption of certain packaged foods or ingredients that have a longer shelflife or that can be readily frozen or otherwise stored. Meal replacements, too, can help overcome the inherent difficulties in consuming enough food to maintain energy and hydration.

Following surgery, the need for protein increases along with the need for added calories in order to aid wound healing and recovery.

Energy needs under normal circumstances are about 25-35kcals/kg body weight, while protein requirements weigh in at 0.8-1g/kg of body weight. The need for fluids is about 30ml/kg of body weight or roughly nine and a half, 8oz glasses liquid/day for a 165lb person.

After surgery, these quantities rise to 30-40kcals and 1.0-1.8g of protein—similar to that of athletes. Fluid needs depend on the circumstances. In general, it is recommended that the distribution of calories be among food products that are based on and include plenty of fruits and vegetables, whole grains, and healthy fats and dairy, with less emphasis on red meat, particularly processed meats.

Cooling the Flames

Nearly all disease states are marked by inflammation of some sort, and many of the most serious diseases are accompanied by cachexia, the illness-related loss of appetite and severe fatigue also known as “wasting syndrome.” It leads not only to weight loss through atrophy of muscle and the body’s scavenging itself for fuel; in its worst stages, cachexia cannot be reversed through diet. But in those recovering or living with a chronic syndrome that affects appetite, a rounded and varied diet can help.

For more than 30 years, the Mediterranean Diet has been considered a proven, effective, overall healthful approach to eating.

In general, the Mediterranean Diet is centered on foods from fruits, vegetables, whole grains, potatoes, beans, nuts, and seeds. This dietary pattern also is low in saturated fats and cholesterol, with olive oil as the dominant source of fat. Dairy products, fish, and poultry are consumed in low to moderate amounts, while red meat is eaten in small quantities. Wine intake is moderate. Many of the herbs and spices contribute positively to the dietary pattern.

The fatty acids inherent in the Mediterranean Diet contributes to its anti-inflammatory nature. Arachidonic acid (an omega-6 fatty acid found in meats) tends to favor the production of metabolites that are both pro-inflammatory and pro-thrombotic when consumed in excess. Both oleic acid (dominant in olive oil) and omega-3 fatty acids (found in fish and walnuts) induce the production of metabolites that counter this effect, leaning the balance toward more anti-inflammatory conditions.

Phenolic compounds from olives, virgin olive oil, and red wine have important anti-inflammatory, antiangiogenic, and anticancer potential. Resveratrol, the antioxidant component in red wine, has received the greatest attention, no doubt due to the wine connection. This compound, however, is present in many dark red and blue fruits. Oleuropein, the phenolic compound in the olive leaf, would be most abundant in the first press of olive oil—the virgin oils. Carnosol, found in herbs such as rosemary and sage, is another potential anti-cancer and anti-inflammatory phenolic compound.

Plant Particulars

Plant-derived foods are critical sources of nourishment, antioxidants, fiber, vitamins, minerals, and energy for a healthy body. However, certain compounds from an important group of phytochemicals (plant-derived protective compounds) known as polyphenols are believed, in some cases, to be negatively associated with cancer.

The presence of isoflavones has increased the popularity of soybeans and other legumes as preferred sources of plant-derived protein. Higher intake of soybean products has been suggested as a reason for the lower incidence of breast cancer and prostate cancer in Asian populations. Many isoflavones (including genistein, abundant in soybeans), are considered phytoestrogens, because they have a structural similarity to estrogen. In the body, these compounds compete with estradiol, the body’s natural estrogen, for the estrogen receptor.

This is believed to be of help in the treatment of estrogen-related cancers; in fact, there is now evidence to support the potential role of genistein in the treatment of different types of cancer. This is the subject of a recent review in the journal, Advances in Nutrition. It follows earlier controversies that initially suggest an opposite effect of phytoestrogens.

Blueberries and other dark fruits with a dark-reddish hue generally contain anthocyanins, a group of water-soluble pigments that belong to a class of compounds called flavonoids. These are powerful antioxidants. In animal studies, anthocyanins derived from blueberries demonstrated protection from oxidative stress, and the associated mitochondrial damage and dysfunction that hinders energy production and leads to cell death.

A Good Offense

One of the main concerns of those recovering from or in remission from serious diseases, especially cancer, is the later recurrence of the disease. And it is a legitimate concern: Depending on the type of cancer and how early it was discovered and treated, recurrence rates after the five-year mark range from a few percent to 20% or more. Recurrence after the 10-year point is sometimes double that of the five-year. For this reason, lifelong nutrition intervention and maintenance is key to reducing those percentage points.

Vitamin E, a powerful fat-soluble antioxidant, recently has received much attention as a protective micronutrient, but not the form of vitamin E that most think about. What most call vitamin E is tocopherol. (See “Generation E,” PF January 2016.)

The tocotrienol forms are found in annatto seed and red palm oil, as well as a variety of nuts, seeds and grains, and the oils extracted from them. Some studies have determined tocotrienols might be up to several hundred times as potent antioxidants that scavenge dangerous free radicals as the tocopherol form of E. Only a comparatively small percentage of research into protection from cancer has been done on tocotrienols, but it has proven incredibly promising. Tocotrienols, unlike tocopherols, are unsaturated— making them more efficient at penetrating membranes. In studies, they have exhibited significant anticancer potential.

A recent study in Biochemistry and Cell Biology demonstrated the anti-cancer properties of gamma-tocotrienols against human breast cancer cells. In this study, tocotrienols drove the cancer into a stress-mediated cell death. In other words, in this model, this particular form of this essential dietary element proved toxic to human breast cancer cells. It was speculated that normal healthy cells might carry a natural protection against stress-induced cell death, a survival mechanism that could be missing in some malignant cells.

Micronutrients (vitamins and minerals) and phytochemicals play an important role in preventing the regrowth of cancer cells, or the expansion of cells that may have escaped treatment. The immune system normally acts as a kind of surveillance system that kills cancer cells before they can do damage. The health of the immune system depends upon numerous micronutrients, in addition to sufficient energy (calories) and protein.

Vitamin C, D, iron, zinc, copper, omega oils, beta-glucans, and a host of other and various micronutrients aid in maintaining immune health. (See “2016 Ingredients for Health Guide: Immunity,” http://bit.ly/1mp8zEf.)

A diet rich in foods from fruits and vegetables is associated with lowered risk for cancer and must be part of any healthy diet for recovery from cancer, heart disease, and other conditions. For example, a recent review of vitamin C (given in supplemental form) suggests it plays a powerful role in preventing or minimizing organ failure, from overwhelming amounts of dangerous free radicals generated as a result of the disease process in critically ill patients.

Gut Power

A healthy digestive tract is closely linked to a healthy immune system via the populating bacteria. Probiotic bacteria are the beneficial microorganisms that populate the intestinal tract.

Probiotics are widely available in naturally fermented foods, like yogurt, kefir, various juices, and naturally fermented vegetable products. But new strains of hardy probiotics that can withstand the rigors of food processing—even high-temperature baking—are included in many new, non-traditional formulations, such as baked goods, cereals, confections, and hot beverages.

Numerous studies using animal models and human epidemiological studies have demonstrated that the consumption of probiotics can positively impact conditions, such as lactose intolerance, antibiotic-induced diarrhea, gastroenteritis, constipation, and genitourinary tract infections.

Evidence suggests foods rich in probiotics can play a preventive role in the onset of colorectal cancer.

Prebiotics include a variety of soluble fibers and resistant starch. The precise mechanisms by which both prebiotics and probiotics can help prevent colorectal cancer are under study. Some research suggests it’s possible that prebiotic/probiotic synergy inactivates carcinogens; improves the immune response; forces cell differentiation; or affects the signaling pathways of the cancer cells.

That is, they cause the normally immortal cancer cells to undergo normal cell death. Prebiotics also have a known role in reducing the risk factors of cardiovascular disease, aiding the recovery of cardiovascular patients.

Chronic Fatigue and Sleep

“Persons suffering from painful fibromyalgia, and the energy depletion that defines Chronic Fatigue Syndrome and fibromyalgia, are unable to condition [exercise] beyond a certain point,” says Jacob Teitelbaum, MD, director of the Practitioners Alliance Network and author of “From Fatigued to Fantastic!”

“If they exercise beyond that point, they can experience a post-exertion fatigue that can leave them bed-bound for a day or two,” adds Teitelbaum. “This, along with pain, often makes people afraid to exercise at all, something that leads to severe deconditioning—and that can be more devastating than the exercise.”

Adds Teitelbaum, “For chronic fatigue, nutrients that increase energy production can be very helpful. The most powerful single nutrient for increasing energy production is the ATP precursor, ribose. Two recent studies showed an average 60% increase in energy—a 10% increase is considered dramatic—after only three weeks of use.”

Teitelbaum points out that ribose, a pentose monosaccharide sugar, is both heat- and cold-stable, making it easy to add to food. “It also looks, tastes, and functions in most formulations like table sugar and is almost as sweet,” he adds.

Metabolic studies suggest ribose provides 1.5-2.5kcals/g, vs. sucrose’s 4kcals, as it is not metabolized in a way that adds calories. However, currently FDA laws require that, since “-ose” is a chemical designation for sugar molecules, all “-ose” ingredients list the calories as 4kcal/g. Studies by Teitelbaum suggest ribose could improve sleep and cognitive function, while decreasing pain.

Other key ingredients Teitelbaum recommends include magnesium and B vitamins for energy; theanine (in its L-theanine isomeric form) “for sleep and calming;” and iodine at 200µg/day as “helpful for energy, since toxins in the environment interfere with its uptake, decreasing thyroid function and increasing breast cancer risk.”

The importance of sleep in many chronic conditions or during recovery from long or major illness also can be addressed with other ingredients. One popular sleep-enhancing ingredient is melatonin. Although well-known in its supplement form, tart cherry juice, a source of natural melatonin, is becoming increasingly popular among beverage manufacturers creating drinks for enhanced calmness and sleep.

An aging population means a rapid rise in the number of people who will have a moderate-to-severe chronic condition or disease. Advances in medical technology also equate to more survivors living in a state of long-term, if not permanent, recovery. This means an already significant and underserved demographic will likely increase by double-digit percentage rates. This represents a highly significant market opportunity for product developers invested in improving the health and lifestyle of consumers.

Originally appeared in the February, 2016 issue of Prepared Foods as Recovery Health.

Joint Operation

Arthritis is a heterogeneous group of diseases that share common features. The most notable is inflammation, which leads to joint damage, loss of bone, severe pain, and disability. However, damage due to the chronic inflammation of arthritis is not restricted to joints. Many other organs and systems can be damaged. Inflammation and scarring can affect lungs, kidneys, cardiac membranes, and blood vessels. It also contributes to the buildup of atherosclerotic plaque.

The incidence of arthritis increases along with body mass index (BMI), jumping from about 16% of normal weight individuals to nearly 29% among individuals who are obese. It has been estimated using data from the Boston University Framingham Heart Study that, given the aging US population, the prevalence of arthritis could affect 67 million by the year 2030.

Although the mechanisms underlying the inflammation of arthritis remain unclear, the inflammatory process itself benefits from a number of micronutrients and phytochemicals. A number of these are part of the Mediterranean Diet.

In addition to antioxidants, omega-3 fatty acids have shown promise in helping mitigate the inflammation in rheumatoid arthritis, an autoimmune form of the disease in which an unknown trigger causes the body’s immune system to misrecognize cartilaginous tissue of the joints as foreign, and so attacks and destroys it. Vitamin C is critical for the laying down of cartilage. Gelatin and collagen peptides provide the building blocks of these tissues. All these nutrients are easily incorporated into food and beverage products.