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<b>An Example of an Adjunctive Nutritional Approach to Cancer Treatment</b>
A program developed over the past ten years by Keith I. Block, MD, illustrates one approach to nutritional treatment that can be used in conjunction with mainstream cancer care. The program, as described by its developer, is intended to be used adjunctively and not as a substitute for medical treatment. At present, it is used in Block's private medical practice in Evanston, Illinois, and at an independent medical center in Chicago.

According to Block's protocol, individualized dietary guidelines and nutritional treatment are used in combination with mainstream cancer treatment, exercise, and psycho- social support strategies for stress reduction. Overall dietary guidelines are made on the basis of nutritional assessments, including the use of body composition analysis, blood and laboratory studies, determinations of nitrogen balance, and other biochemical and clinical evaluations. Patients are given a range of food choices within an overall framework that covers five food groups (cereal grains, vegetables, fruits, fats, and proteins). Foods are divided into exchange lists so patients can select foods according to their tastes while still satisfying the overall nutritional requirements of the program.

The semivegetarian diet Block recommends consists of high-fiber, low-fat, protein-restricted foods along with specific items such as soybean products, shiitake mushrooms, and sea vegetables. In general, Block recommends that 50 to 60 percent of calories be derived from complex carbohydrates, 12 to 25 percent of calories from fat, and the remainder from protein sources. The diet, which is modified on an individual basis, emphasizes foods high in vitamins, trace minerals, and substances thought to reduce cancer risks. Developed in part from macrobiotic principles, the diet has been modified to incorporate information from other sources, primarily experimental data from the scientific literature on substances that may be active in inhibiting tumor growth or stimulating immune responses. Nutritional analysis has reportedly shown Block's nutritional program to be nutritionally adequate; the Recommended Daily Allowances (RDAs) were met or exceeded for almost all nutritents for which RDAs have been established and for which nutrient analyses are available, and the diet reportedly exceeds requirements for vitamins A, C, and B12, calcium, iron, magnesium, and several other elements.

Block's use of an adjunctive dietary program for cancer patients has several goals, some of which he believes have been met in many cases, based on observations of patients treated with this regimen. One goal is to maintain adequate nutritional support through oral feeding as much as possible, in order to improve patients' quality of life and help them retain "a sense of self-empowerment and clinical autonomy." He notes that few of the cancer patients on his program experience weight loss, except those with anorexia in late stages of disease, or experience hair loss during chemotherapy. Another goal is to enhance patients' resistance to the disease by focusing on improving immune function and inhibiting tumor growth through the provision of a low-fat diet, which may decrease the intake of tumor- promoting substances. The high intake of vitamin A- containing vegetables in the diet is believed to enhance patients' responses to conventional cancer treatment. Overall, Block believes his program to be of benefit in diminshing the side effects of conventional treatment and in improving patients' quality of life. <b>The treatment protocol has been described in some detail in unpublished manuscripts, but thus far, it has not been studied systematically so that its effects on patients can be judged adequately.</b>
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