Monday, 5 October 2015

Food, chemo and body image.

My relationship with food has changed dramatically since my Leukaemia diagnosis. 

Before cancer, I had been a vegetarian for six years, enjoyed food, felt guilty about enjoying certain foods, and had been told throughout my teenage and adult life to “diet” or “cut down” or “watch” what I was eating. These influences came from unrealistic media ideals equating attractiveness with being slim, the fashion and beauty industry, celebrities, airbrushing, and my large family who have always been vocal proponents of “dieting”, where weight gain was often commented upon, and weight loss was celebrated.

In the two weeks before my diagnosis, after suffering with tonsillitis and barely even managing to tolerate water, I lost over 6kgs (1 stone) in weight and I continued to lose weight after I was admitted and diagnosed. My weight has fluctuated throughout my adult life from around 65kgs at my lightest to around 77kgs at my heaviest (approx 10st 2lb - 12st 1lb). My lowest post-diagnosis weight was around 62kgs. 

Once diagnosed, I was told to “eat eat eat!” and it took a lot of willpower to get on board with the notion and to not see my dramatic, unhealthy weight loss as a good thing. It’s crazy, in fact it’s absolutely batshit insane, that part of me was happy about losing the weight. What does that say about me and my ideals? While my body was literally fighting to keep me alive, and I was unwittingly starving it of the nutrients it needed, I was happy because of the aesthetic “benefits”. 

I think although I always ate a fairly healthy diet, it is fair to say that I had a very unhealthy relationship with food and my body image. Weight gain was largely attributable to the alcohol I consumed while at university in Norwich, where I enjoyed a fair amount of good Chardonnay on a regular basis but did not factor the calories into my diet. Weight loss happened when I ate a severely calorie-restricted yet entirely unsustainable diet.

Since as long as I can remember I had never felt good or confident about the way I looked. As a teenager I was physically very fit due to my hobby as an Irish dancer, and had very little body fat, but I was muscular and never naturally slim or slender; I always considered myself to be fat. And no one ever contradicted that assumption, rather I would be encouraged to eat less and “cut out” certain foods. 

So when lots of health professionals are telling you to eat, and eat whatever you fancy (crisps, pizza, chocolate, milkshakes, whatever you can tolerate), it’s a very confusing situation to find yourself in. At one point I had a dietician forcing high-calorie Fortisip drinks on me which, to someone like me, was baffling. I was a fatty, remember? 

Soon after diagnosis I was advised by my consultant to follow a neutropenic diet. Neutropenia is a condition caused by leukaemia and its treatments. It is characterised by an abnormally low number of neutrophils in the blood, which are a type of white blood cell responsible for fighting infection. Neutropenic patients are therefore very susceptible to potentially life-threatening bacterial infections. Some hospitals and healthcare professionals wholeheartedly embrace the idea, which was the case at University Hospitals Coventry and Warwickshire where I received my chemotherapy, whereas some hospitals and healthcare professionals do not, which was the case at the Queen Elizabeth Hospital in Birmingham where I had my stem cell transplant and subsequent admissions. Some health professionals believe that following a neutropenic diet is a way of preventing some infections but the evidence suggests that there is no real proven correlation between following a neutropenic diet and the amount of infections a neutropenic patient might incur. I followed the diet anyway as I thought I'd rather be safe than sorry.

The main principle of a neutropenic diet is to avoid foods and ways of preparing food which would necessarily lead to an increased likelihood of bacterial presence. Fresh fruit and veg should only be consumed if it can be peeled and/or thoroughly cooked. All dairy products should be pasteurized, soft or mould-ripened cheese should be avoided completely. All raw or undercooked meat, eggs, honey, uncooked herbs and spices (including pepper), or anything purchased from deli-style counters should be avoided altogether. “Use by” dates on food packaging should be adhered to, reheated food should be avoided as well as takeaways and fast food restaurants. Hand-washing prior to food preparation should be thorough. It's a bit like a pregnancy diet only stricter.

The first few weeks of hospital food was fine. Even though I was restricted by both a vegetarian and a neutropenic diet, I survived quite happily on baked potatoes with beans or cheese, macaroni cheese, vegetable curry, cauliflower cheese, cheese sandwiches, egg mayonnaise sandwiches, cheese and potato pie. Then all that cheese just gets too much. These days I can’t look at a cauliflower cheese or a baked potato without gagging. 

My family were great at bringing food in to the hospital for me and luckily I had a fridge in my room where I could store things, but as they were unable to reheat the food it mainly consisted of cold pizza, cold noodle dishes, cold tomato pasta, hoummus and crackers, and better sandwiches. I always had a supply of crisps, my favourite flavour changing more often than the hospital bed sheets, and I learned that I loved sugary kids cereals. Morrison's do a honey-cheerio dupe called "loopy bees" which I was addicted to. 

I think I have mentioned in a previous blog post that whenever I am admitted to hospital I become obsessed with food. Of course, there have been times when I have been in hospital and felt so nauseated that I have survived on water and a few packets of salt and vinegar crisps for a week. This was usually when I was suffering with an infection, or feeling nauseated from the chemo. A lot of people find that the chemo really affects their sense of taste and often prefer more bland foods. Having always had a very high tolerance for spicy food, I found that I could barely handle pepper and a for the longest time anything remotely sweet tasted absolutely disgusting to me, instead tasting tangy and bitter. What I craved was fresh and crunchy food which was really difficult on the neutropenic diet. All I wanted was a massive plate of salad! 

Around December, for the first time since becoming a vegetarian, I began to crave chicken. KFC in particular. All I could think of was deep fried chicken. I have no idea why as I had always found the thought of eating meat a bit disgusting and never felt like I had been denying myself. Of course I couldn't actually have KFC because of my neutropenic diet so I first tried Quorn replacement products, mainly the chicken-style nuggets, and liked them (actually I still prefer them to "real" chicken nuggets). And then one day there was some leftover chicken in the fridge which my mum had made, and I couldn't resist it. I devoured the lot like a cavewoman, tearing it from the bone with my teeth. I think I ate chicken for every meal for the rest of that week. I now eat fish, seafood and chicken fairly regularly, turkey at Christmas, and I have also tried shredded duck and pulled pork but I don't intend to add these to my gastronomic repertoire. The thought of beef or lamb or anything else really hasn't tempted me.

After my stem cell transplant all I could think about was food. I spent hours perusing takeaway menus of local curry houses and googling everything I was unfamiliar with, fantasizing about visiting a variety of restaurants and choosing my imaginary three courses. All I would watch on the TV were cooking programmes and I would write down recipes to try when I got home. On Pinterest I created recipe boards for Chinese food, vegetarian dishes, chicken, healthy meals, Indian food, sweet treats, sandwiches and snacks, dips, sides and condiments. I couldn’t wait to get home and start pickling things. During my most recent admission with GvHD, my obsession was anything remotely east Asian; Chinese, Japanese, Vietnamese and Malaysian cuisines in particular. On discharge from hospital I ordered a food shop from Ocado and when it arrived I realised that I had bought very little actual food and the order consisted mostly of condiments such as mirin, hoisin sauce, soy sauce, rice wine vingar, miso paste, fish sauce, shaoxing wine and oyster sauce. 

Now I see food as nutrition, and I am consciously attempting to redefine my relationship with food as something which for so long was a predominantly emotional connection to one which is more practical. Of course I love food and eating tasty meals, and that is something I want to focus on rather than any irrational feelings of guilt or attaching any sort of moral judgement to the process of fuelling my body. 2500 years ago Hippocrates said “leave your drugs in the chemist’s pot if you can heal the patient with food” and while I am not on board with whatever the latest faddy superfood is, and the this-pomegranate-will-cure-your-cancer mumbo jumbo of alternative therapies, I do believe the good nutrition is the foundation for good health. Eating good, wholesome, balanced meals, with some foods eaten more moderately and some foods in abundance, is the way to utilise food as a medicine.

Some tasty meals I have made and/or enjoyed recently:


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