Wasting is one of the most distressing and common complications of living with cancer. In plain and simple terms, cancer can lead to starvation. Far too often, medical teams treat wasting as an unavoidable complication of the later stages of the disease. What physicians are beginning to realize, however, is that treating wasting complications earlier in the course of treatment can lead to longer life and even remission.
Wasting can be part of paraneoplastic syndrome, a combination of fever, loss of appetite, appearance of white hard bumps on the skin, and an accelerated metabolism throughout the body. This form of wasting, called cachexia, is due to the body’s immune response to the cancer itself.
And the immune system itself can be the cause of cachexia. Tumor-necrosis factors (TNFs) from the immune system attack and kill cancer cells. These substances kill cancer, but increase metabolism throughout the body. At the same time, they stimulate the release of serotonin.
Serotonin is a well-known regulator of mood. A boost of serotonin in the brain can make you feel happier. The brain, however, is not the only site in the body where serotonin is made.
Serotonin produced in the gastrointestinal tract induces nausea with alternating constipation, bloating, and diarrhea. When this happens to someone who has cancer, appetite and ability to digest food are reduced at very time nutritional needs begin to skyrocket.
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In simple starvation, fat is consumed before the body begins to break down muscle and vital organs. In cachexia caused by cancer, the body gets its energy needs equally from fat and the destruction of healthy tissues.
Cachexia occurs with about 15 to 20 per cent of all cancers. It is not unusual for the symptoms of cachexia to occur before the cancer itself is detectable. Any cancer may cause any symptom of cachexia, but the most common indications are:
These symptoms can, of course, be caused by any of a multitude of health conditions that are not cancer. Sometimes, however, they are a signal that cancer care by a physician and the patient’s own careful attention to diet are needed right now.
The single most important way to prevent wasting and to counteract cachexia to eat a combination of protein, carbohydrate, and healthy fats whenever you can. Cancer is never a signal you need to go on a diet.
It is especially important to avoid eating just carbohydrate, for instance, crackers and sweetened beverages if you possibly can. On the other hand, it is also best to avoid eating your favorite foods on those days you get chemotherapy. You do not want to associate bad memories with your favorite foods.
High-protein drinks are an excellent way to get needed macronutrients, and since they are usually not a favorite food, there is no risk to appetite in the future if they are consumed during chemotherapy. Their nutrients are readily available, so the body does not have to expend the 5 to 10 per cent of total calories normally needed to digest food.
Some high-protein drinks, such as Boost and Ensure, also provide a large part of the magnesium cells need synthesize new DNA. Magnesium deficiency is also implicated as a cause of the overproduction of the TNF that causes tissue destruction.
Take supplemental magnesium chloride (up to 600 milligrams a day), but only an extended-release supplement, and only if you do not suffer diarrhea. It is also important to avoid any formula that contains ornithine alpha-ketoglutarate, since this amino acid requires extra glucose in the bloodstream to be absorbed into the muscles that need it.
Essential fatty acids plus vitamin E also reduce wasting in cancer patients, especially when cancer has metastisized to the pancreas. A study at the Tumor Biology Center in Freiburg, Germany found that just a single 1.5 fish oil capsule a day for six weeks was enough to stop weight loss (and support an average 0.6 per cent weight gain) in 17 cancer patients.
Laboratory studies with animals suggest that an even better combination is high protein, omega-3 fatty acids from fish oil, and supplementing with the amino acid leucine. This amino acid is most highly concentrated in tofu, spirulina, egg white, and cod, as well as an number of foods (pork rinds, beluga caviar, dried seal meat, Gruyere cheese, bacon) that are not advisable in most cancer diet
Still better is a combination of high protein, leucine, omega-3 fatty acids from fish oil, and “dense” energy foods. In this case, as hard as it may be to accept, the dense energy of choice is sugar. In a clinical trial involving 200 patients and investigators from Australia, Canada, Europe, and the USA, scientists found that pancreatic cancer patients, who usually suffer severe weight loss, were able to stop weight loss and even gain weight if they were given not just the omega-3 fatty acids or the amino acids or the calories they needed, but all three. In this clinical trial, only the combination of all the macronutrients the body needs had a lasting effect.
Getting at least 2,000 milligrams (two capsules) of EPA from fish oil was associated with stabilizing weight, and higher levels of EPA were associated with gaining weight, provided the patient was able to consume 1,500 or more calories per day.
Contact Dr. Tarugu at GastroinFlorida.com to schedule your next exam.