Introduction: What to Eat When You Can't Eat

Food is perhaps the most common and most tangible expression of love, care, and concern. The shared sensual delight of cooking and of eating is a remarkably large dimension of the human experience. The prominence of food in life means that both patients and their families can undergo profound emotional and social shifts when illness is accompanied by neither the desire nor the capacity to eat. This can include significant disruption of established patterns, important relationships, and even one’s self-image. Common human emotions experienced by patients and their loved ones can include helplessness, exclusion, rejection, anxiety, and other forms of distress. There are many medical terms to describe the symptoms behind the inability to eat such as loss of appetite (anorexia), loss of taste (dysgeusia), and/or food aversion (due to xerostomia, mucositis, nausea, vomiting, constipation, diarrhea, or dysphagia). No matter the name applied, what counts most from a patient’s perspective is that the inability to eat results in a remarkably diminished quality of life. In fact, quality of life scores are largely determined by patients’ perception of their nutrient intake and their experience of unintentional weight loss. The Western standard of care is to provide small, frequent meals of energy-dense food, avoiding extremes of taste or aroma, presented with style in a pleasant environment. Numerous commercial high-calorie and high-protein nutritional formulas are both promoted and prescribed as beneficial supplements. And drug therapies commonly recommended include either progestagens (megesterol acetate or medroxyprogesterone acetate) or corticosteroids such as dexamethasone. The former are associated with deep venous thromboses, water retention, vaginal spotting, and sexual dysfunction. The latter can result in profoundly low vitamin D states. However, this standard of care is not universal. I can attest that when I practiced at Keio University Medical School in Tokyo, Japan, I and my oncology colleagues prescribed with good results Kampo (traditional Japanese herbal medicine) formulas such as Rikkunshito for relief of cancer-related anorexia and cachexia. And I learned while travelling in Cambodia of the importance of soups made with Cannabis sativa for the care and comfort of patients with advanced cachexia and related barriers to eating. These observations reinforce this journal’s commitment to advancing meaningful knowledge for all health practitioners from a global perspective. We collectively—both East and West—have much to learn from the world’s many healing traditions and much to learn from those who practice holistic and integrative care grounded in Western science. In this spirit, Global Advances in Health and Medicine invited renowned practitioners from multiple perspectives to share their insights on the vexing problem of “what to eat when one can’t eat.” What follows are five important statements from practitioners of Ayurveda, anthroposophic medicine, holistic nutrition, integrative oncology, and traditional Chinese medicine (TCM). Our hope is that all readers will gain insights and perspective that will enhance the quality of life for all persons who suffer from the inability to eat.