GenInv – Health and Wellness

The Cooking with Cancer Concept:

Taste and Smell in Cancer

Luis F. Pineda, M.D., M.S.H.A

Taste and Smell in Cancer

Introduction

With the aging process and prolongation of life, cancer is, and will continue to be, a major health issue. One of many, not the least important, yet critical problems, is the ability of patients with cancer to support normal nutrition.

Basic assumptions are that cancer, a state of abnormal cellular behavior, imposes a catabolic state on the individua

taste and smell in cancer cancer

Documented further by recent technological development of the PET scan, we are able to obtain images of cancer cell locations on the basis of the incorporation of radioactively labeled glucose as the result of their hyperactive metabolism. If the individual is unable to keep up to the demand on the basis of incorporation or intake of nutrients, then malnutrition and weight loss ensues. There is a possible participation of endogenously released cytokines such as Interleukins or a tumor necro

sis factor.

Additionally, the cancer treatment modalities of today are causes of substantial changes to taste, smell, and appetite by either psychological trauma, neurochemical changes or inflammatory cytolytic damage to the mouth, nose, or gastrointestinal tract. Things are further worsened by cancer therapy complications, including infection, nausea, and vomiting.

Palliative modalities of pain control, use of narcotic pain medications such as codeine, morphine and analogs, which directly a

ffect the central nervous system (limbic system), affect the function of the gastrointestinal tract causing severe constipation, nausea and vomiting. Most culinary literature available addresses these issues by attempting to minimize the smell of preparation, the temperature, and color. By this, I mean, historically it was recommended to consume white, cold, and non smelly foods versus hot, red, and smelly foods. By garnishing and coloring the food we can now impact the taste and intake and create appeal.

Most nutritional literature available addresses these issues by the drastic use of involuntary nutrition such as total parenteral nutrition or TPN, tube feeding via gastrointestinal infusion through nasogastric or percutaneous endoscopicly placed gastric tube (PEG). All of these are unappealing and excessively expensive interventions. The use of high calorie oral supplements such as puddings, bars, and boosters have failed despite their easy availability. This failure is due to patient intolerance, mostly because of the high carbohydrate content, which makes the products excessively sweet.

Appetite stimulants such as Marinol® (tetrahydrocannabinol) or Megace® (megastrol) have the disadvantage of causing mental status changes and sedation. They are exceedingly expensive, or in the case of Megace, there is an inability to use it in cases of hormone dependent cancers (ex. prostate cancer – a very common cancer in adult males). There is also the potential for abnormal blood clotting which is already heightened in cancer.

The management of cancer induced taste alteration should be aimed at maintaining optimal nutrition (Brodie 1998), but above all, quality of life.

Taste

Flavor is a complex mixture of sensory inputs (Smith 2001). Its components are gustation (taste), olfaction (smell, perhaps more important than credited), and tactile (mechanics of chewing). Traditionally described qualities of taste are sourness, sweetness, bitterness, and saltiness. Some others may exist, notably Umami, (Japanese translation “delicious”). This is most elicited by glutamate, an enhancer of taste commercially available as monosodium glutamate or MSG. In 1908, Ikeda from Japan, recognized it as the tasting chemical component of the brown algae soup Kombu. This Umami concept was developed by Chaudhari and Roper from the University of Miami in 1998. Loosely implying a “meaty” taste, this concept is still not widely accepted.

Most recent research has documented Umami receptors mediated via mGluR4 glutamate receptor, as well as mT2R8 denatonium receptors located in the mouth, glutamate related and cyclic AMP conducted via calcium channels. Sodium glutamate is a food enhancer that is very similar in taste to common cooking salt and definitely enhances the pleasantness of food by at least 50% or better at appropriate culinary levels (Yamaguchi, 1984). The main concern has been the flatulence and abdominal discomfort sometimes associated with it. It is blam