Yum, Yum - Part 2

During the time that I was struggling with food on the Sutent trial, I kept a barebones food diary. I recorded everything that I ate, in what quantity, at what time, and whether or not I had any reaction. By reviewing the food diary, I learned that I was better off to eat small "meals" during the day, and I could easily identify foods that triggered nausea and vomiting. "Meals" could be a pretty broad term, and depended in part on what foods I reacted to. I set up a pattern that made sense to me and have stuck to it pretty well since - small helpings at "normal" mealtimes plus a couple of snacks during the day. I'm not always good about sticking to healthy snacks but for the most part I'm pretty conscious of what I'm putting in my mouth (except for anything from Andrew's!)

I have one kink in my requirements: two medications must be taken on an empty stomach (Nexavar and Levothyroxine). "Empty stomach" means no food for two hours before, and one hour after, taking the medication. I've gotten around that by scheduling those medications in mid-afternoon, between 2:00 and 4:00 p.m. Those taking Nexavar on the normal schedule (that is, 4 times more than I'm taking) have the additional burden of scheduling that medication twice. My buddy Bruce sets an alarm for 4:00 a.m., takes his Nexavar, and goes back to bed.

Lest you think that the "empty stomach" requirement isn't a big deal, ignoring it can alter how the drug is taken up by the body. If Nexavar is taken with food, for example, its effectiveness is reduced by 60-75%. Why go through all those side effects for nothing? Yet the "empty stomach" recommendation, the standard for clinical trials and oncologists' advice, may not be universal. A recent study suggests that, in some cases, drug efficacy may in fact be improved by taking it with food.

It's become a controversial subject in oncological circles, and more research will be required. Ohio State University is seeking grants to study the relationship between nutrition and cancer therapies; I suspect others will be delving into this too. The more they find out, the better off we are.