Nutrition

A Guide

to

Nutrition and a Holistic way of

Living With GIST

Specially put together for

Friends of Max

“I can’t change the direction of the wind,

but I can adjust the sails to reach my destination”

Jimmy Dean

You have all embarked on a new journey following your diagnosis with GIST. This booklet intends to empower you to lead a more positive and holistic way of life.
A healthy life is all about maintaining a balanced energy flow through both the mind and the body.
This balance is maintained by drinking and eating the same amount of calories the body needs to function and carry out its physical activities throughout the day.

A body with a well-balanced energy flow is healthy and capable of rejuvenating and regenerating.
The three important cornerstones of this energy balance in the body are:
1. Food
2. Exercise and Yoga
3. Meditation
A proper alignment of the above three will create an alkaline environment in the body.
The body thrives in an alkaline pH, thereby creating a healthy favourable environment for its
Cancer cells are not known to survive in this alkaline environment.

The GIST patient goes through three phases of treatment:
1. Neo-Adjuvant therapy to shrink the tumour:
Making changes in your lifestyle and diet should begin from now. This will not only bring about changes in the energy balance in the body but will also give you the strength and attitude to overcome the disease.
2. Surgery:
There will be some modifications in your diet and lifestyle post-surgery after removal of the tumour. Follow your doctor’s advice for the same.
3. Adjuvant or Maintenance phase:
You will continue your drug therapy to prevent recurrence of the tumour. This period may involve some changes to suit the type of surgery done. It is important to continue and maintain your lifestyle changes to allow you to have a positive and fulfilling life.

Nutrition

Nutrition is about having the correct balance between our fluid and solid intake and the essential components of our food like Carbohydrates, Fats, Proteins, Vitamins and Minerals.

Guidelines for Nutrition
1. Eat Natural and if possible have Organic (chemical free) food.
2. Have a Diet which is
HIGH in fibre, fruits and vegetables
and
LOW in red and processed meat, saturated fat (fatty meats, biscuits, cheese and butter) and salt.
Fibre comes from the outer layer of grains, fruits, vegetables, legumes and nuts. Fibre helps in adding bulk to our stools and moves food quickly through the digestive system. This eliminates accumulated toxins, fats and waste from the body.

3. Have at least five portions of fruits and vegetables everyday.
A portion of fruit is equal to a middle size apple or banana.
A portion of vegetable is three heaped tablespoons of cooked vegetables or a bowl of salad.
Have local, fresh and seasonal fruits and vegetables instead of those which have travelled thousands of kilometres to reach your table.
4. Avoid packaged/ processed foods on daily basis like chips/noodles/aerated cola drinks/bakery products. All processed /packaged foods have preservatives/chemicals/excess of salt to enhance their shelf life. These are harmful to our system.

5. Avoid processed meats like sausages/hotdogs/salami/ham/bacon and other meats which are factory processed .These are known to have a lot of chemicals and hormones which when consumed on regular basis do cause harm to the system.
WHO has classified ‘processed red meat’ as Carcinogenic, i.e., it has ability to cause cancer.
6. Go easy on Oil.

“Change your thoughts and you change your world”.

Norman Vincent Peale

We need to align the functioning of our body in a better way to lead a positive and healthy life. These changes can be done by correcting a few of our food habits.
How to cause Alkalinity in the body through the food we eat:
1. Drink enough water
2. Eat fresh fruits and green leafy vegetables.
Fruits and Vegetables are a good source of Vitamins A, C, E and folate, minerals and fibres.
3. Use fresh Indian spices in your cooking. Indian spices are known to have healing properties.
Here are a few of them:
Turmeric (curcumin), fennel, saffron, cumin, cinnamon, ginger and cloves
4. Have vegetable juices like carrot, white pumpkin, curry leaves juice, lime water.
5. Substitute sugar in your diet with jaggery (organic) or honey.
6. Eat multiple small meals throughout the day.

List of Alkaline Foods:
Alkalizing Grains: Millet, bajra, nachani, amaranth (rajgira).
Alkalizing Vegetables: Beet, broccoli, cauliflower, celery, lettuce, onions, peas, spinach, carrots, garlic, capsicum, cucumber, pumpkin, sprouts.
Alkalizing Fruits: Apple, banana, berries, grapes, melon, lemon, orange, peach, pear, watermelon and pomegranate.
Alkalizing Protein: almonds, tofu, flax seeds, and nuts.
Alkalizing Spices: cinnamon, curry leaves, ginger, mustard, sea salt.
Coconut water: Hydrates the body, is rich in nutrients, is rich in potassium and it helps digestion. It also reduces muscle cramps.

How to avoid Acidic environment in your body
Stay away from the following:
• Excess use of processed / packaged foods.
• Processed and red meats.
• Excess of oily/fried and spicy foods/drinks.
• Alcohol.
• Tobacco, pan masala and similar products.
• Excess of tea/coffee.
• Sugar and related items which have white refined sugar as its major component like cakes, sweetmeats (mithai). White sugar is a known culprit as it has chemicals which are known to cause acidity and create an unhealthy environment in the body.
• Heavy meals.
• Lethargy and long periods of inactivity.

A few tips about Daily Habits to create Alkalinity in the body
• Have water on an empty stomach when you first wake up in the morning. The quantity of water may vary from person to person depending on his ability to tolerate it. You can have 2 glasses of water or even 4 to 5; some people like to drink warm water.
• Water helps in removal of toxins from the system.
• Some people prefer honey or a lemon squeezed in the water. It is a matter of individual preference.
• 30 minutes after having water, have a glass of freshly made alkaline juice like carrot juice. There are other juices including fruit juices which can also be consumed. Consult your nutritionist for the same.
• This will set your body up for a more alkaline state. Have a diet of 70 to 80 % of alkaline foods.
• Have fresh home-made breakfast if possible with less of oil and spice.
• Steam or lightly grill food instead of frying.
• Have plenty of fresh salads in your Lunch/Dinner which gives good roughage and nutrients.
• Have balanced meals with the required components like carbohydrates (roti / bread/ bhakri), fats (oil) and proteins (dal, meat).
• Neem and turmeric paste, made into balls and consumed daily is known to have anticancer properties.
• Avoid sleeping / lying down until 2 hours have passed after a meal; this will prevent acid reflux.
• Have fruits if possible on an empty stomach.
• Avoid grapefruit; it interacts negatively with Imatinib.

Physical Well Being
Believe you can and you are halfway there.
T.Roosevelt

These are some useful tips:
• Exercise at least for 30 minutes a day.
• Pranayama and Yoga are known to improve oxygenation of the body.
• GIST patients experience some amount of muscle wasting and loss of muscle tone. Exercise can help build up the muscle mass and tone again.

Exercise
Exercise helps in building a good immunity. It has been proved that regular exercise of at least 30 minutes a day goes a long way in keeping the body fit.
When you exercise, the body releases Endorphins which trigger a positive feeling of well being. Sustained physical activity through its role in Energy balance, Hormone metabolism and Insulin regulation, alters inflammatory and immune factors, reduces belly fat, and helps peristalsis motion better, thus removing toxins and waste from the colon.
Simple exercise such as brisk walking is also recommended.
Regular exercise sets in a positive pattern of living and promote spsychological wellbeing and purpose in life.
Daily exposure to sunlight is important. It is an important source of Vitamin D which is known to build your bones and known to have anti cancer properties.
For the best kind of sunlight exposure, go for walks at sunrise or before sunset.
Exercise should be done depending upon your physical state and health.
Consult your physician before starting any vigorous exercise.

Note of Caution: A gap of six months is recommended after undergoing abdominal surgery and restarting your exercise regimen. Always consult your doctor before restarting your exercise regime.
Types of Physical activities:
Walking, Jogging, Swimming, Pilates, Aerobics, Cycling, Climbing stairs, Dancing; Floor exercises like push ups, sit ups ,leg lifts; Gym exercises; Sports like Cricket , Football, Table tennis, Badminton, Squash and Yoga.
Exercise is the most underutilized Anti-Depressant!!
Practising Yoga and Meditation for good health

1. Yoga and Meditation strengthens the Immune system:
Regular practice of meditation and gentle Yoga has a rapid effect at the genetic level in circulating cancer-fighting immune cells
2. Yoga detoxifies the body:
Yoga activates the Lymphatic system and helps reduce toxins from the body and internal organs.
The practise of Yoga improves blood flow in the body.
Yoga helps in activating the following organs which help in reducing toxins from the body. These organs are the Lungs, Kidneys, Liver, Intestines and Skin.
3. Yoga builds bones:
Yoga helps building bone mass by subjecting the bony structure to varied manipulated and sustained alignments of body weight to bones.
4. Yogaand Meditation reduces stress:
Yoga gives a sense of calmness and a sense of purpose, reduces anxiety and builds up confidence. It improves quality of sleep, the most natural source of rest and rejuvenation.
5. Yoga helps reduces acidity in the body:
Yoga activates the Lungs and Kidneys to eliminate/reduce acids from the body. Sweat from our skin also helps remove acids and makes the body more alkaline.
6. Yoga Re-oxygenates the body:
Yoga helps in increasing Oxygenation of the body through breathing techniques(Pranayama).
Oxygenation helps in creating an alkaline state.
7. Yoga and Meditation helps reconnect Mind and Body:
Improves Mind and Body communication and connects the focused mind with the body.

Please train to do Yoga with a certified Yoga trainer, who is qualified to understand your medical issue and can decide which Asanas/Yoga postures are okay for you and which ones you should avoid.

Nothing is impossible, the word itself says, “I’m possible!”
Audrey Hepburn
Surgery for GIST and its impact on Nutrition:

Impact of GIST surgery on nutrition depends on the specific organ removed or involved in the surgery.
In general GIST Surgery is less radical as it is done after “Neo adjuvant therapy” which shrinks the tumour resulting in lesser organ loss.
In Duodenal GIST depending on its location, surgery may either be Pancreas – saving or radical. In such case you might require pancreatic exocrine and endocrine supplement.
In the small intestine, large intestine and rectum there is not much of nutritional deficiency problem post-surgery, but there may be a functional problem. By functional problem we mean loose motions, increased frequency of passing stools because of less absorption of water by the remaining large intestines.
The Stomach is a reservoir which helps in the digestive process and gradually releases its contents into the duodenum so that the digestion in the small intestine is performed.
The removal of the stomach causes various functional and absorptive changes leading to various nutritional deficiencies.
Symptoms due to various deficiencies can be late and not immediate, hence regular follow up is important in such cases.
This is characterized by intolerance to large meals; hence one should have small frequent meals. It leads to low haemoglobin due to malabsorption of Iron and Vitamin B 12, hence supplementation of Iron and vitamin B12 should be given.
Thinning of the bones due to poor absorption of calcium, calls for calcium supplements.
Other Vitamins and mineral deficiencies include Vitamin A, Vitamin B1, Vitamin E, Vitamin K, and Zinc which need to be replaced by supplements in your daily life.

Nutritional and Holistic Tips from Patients
Mrs N
Age 46 years
• Imatinib may cause hypocalcaemia and hence calcium rich food should be consumed along with vitamin D supplements. I take greens and broccoli, twice a week.
• I also take a cupful of nuts everyday like cashew, almonds, pine nuts, walnut and a cup of dal/lentils for protein.
• I am on Sunitinib and this drug causes severe acid reflux. So, i have stopped drinking coffee or tea in the morning and I supplement it with ABC juice i.e. apple, beetroot and carrot juice.
• I eat bland food with less salt and spice to avoid mouth sores. I drink tender coconut water every day which is rich in nutrients.

Mr P
Age 48 years
• I strongly believe that Yoga and Meditation should be practiced daily. Yoga helps in fine tuning the body and shaping and strengthening the muscles tissues and meditation helps in shaping and strengthening our brain and mind, and would refer this as mental therapeutic approach and this has healed me.
Mr V
Age 29 years
• I lay emphasis on the importance of a good night’s sleep to heal the body. I advise avoiding tea/coffee after 5 pm, stop digital devices one hour before sleeping and avoid heavy meals and alcohol at night.

Mr P
Age 42 years
• After waking up, generally I start with vegetable juice like carrot, beet root.
• I then prefer to go on fruits – cut fruits or juice (watermelon or papaya).
• I have occasionally also had either of the following when possible: amla juice or wheat grass (powder with warm or normal temperature water)
• Overall, I have increased my fruits intake and when possible I like drinking fresh coconut water
• I have reduced my non-vegetarian diet to 2-3 days a week, maximum
• Apart from diet, I had started with light yoga and pranayama.
• I love music and I play the guitar and sing and this keeps me happy and refreshes me.

5. Mrs S
Age 63 years
• She has been on Imatinib for 14 years and says she has 2 glasses of water (from a copper jug) first thing in the morning followed by 1 hour of brisk walk and 20 minutes of exercise.
• She emphasises on having a positive attitude and says, a strong desire to live negates any side-effects of Imatinib.
• She talks of the sandwich technique to avoid nausea due to Imatinib, i.e., having Imatinib halfway through your meal and then completing her meal after taking Imatinib.
• She emphasises on the importance of taking Imatinib regularly without breaks as a key to disease free survival.

6. Mr N
Age 43 years
• Biting on a Clove pod helps in reducing my nausea.
• Coconut water helps in reducing cramps and rehydrates my body.
• Regular use of carrot and white pumpkin juice first thing in the morning helps in reducing my acidity. I use ginger garlic paste in my food.
• I drink curry leaves juice plain or with buttermilk before lunch.
• Yoga and meditation gives me a sense of calm and purpose.
• I regularly walk in sunlight for 30 minutes to keep fit.
• I have given up on alcohol and avoid packaged foods.
Light will always shine on you! Live life to the fullest and Lead a life positively to make a difference to yourself and people around you!

Thank You
We are grateful to the following people for their valuable inputs.
Chief contributor: Nikhil Guhagarkar (FOM City Chapter leader, Mumbai)
Editing: Viji Venkatesh (The Max Foundation, Region Head, South Asia)
Surgery for GIST: Dr Rajiv Shah (G.I. Oncosurgeon, Lilavati Hospital, Mumbai)
Tips from patients by
Nandini Dabbir, P.S.Parameswaran, Vikram Jain, Pranay Ranjan, Vasamvada Shukla, Nikhil Guhagarkar
Max and FOM team in India.

Disclaimer:
The above information has been put together by patients and caregivers. It is based on their personal experiences. This booklet is in no way intended to replace professional medical advice. If you are facing an active cancer, please consult with your healthcare professional. None of the information in this document should be taken as a substitute for professional advice or treatment by a qualified Doctor. Please consult your Doctor/Dietician/Yoga Trainer/Health professional before using the information.
Please contact:friendsofmax@gmail.com in case of any comments/suggestions.