The word “Cancer” is almost synonymous with a terminal illness, especially to most people who have lost their loved ones through the disease. Diagnosis of cancer is both scary and intimidating and remains a leading cause of death worldwide claiming over 10 million lives annually. This translates to one cancer death for every six deaths. The greatest challenge associated with cancer is not just the almost definite death, but the long-term disability as a result of gross weight and lean muscle loss.
Cancer occurs due to the overgrowth of abnormal cells beyond the normal limits. Cancer affects both men and women in almost equal measures. The lifetime prevalence of cancer in men and women is one in two men compared to one in every three women. Lung, prostate, colorectal, stomach, and liver cancers are the most common cancers in men while breast, colorectal, lung, cervix, and thyroid are most common in women.
Cancer and cancer treatment affect the nutrition status of the patient leading to excessive weight loss and muscle wasting. Cancer tumors along the digestive tract can cause complete or partial blockage to the food passage. In addition, cancer treatment can cause side effects limiting dietary intake.
A healthy diet plays a critical role in cancer treatment. A basic understanding of factors that increase under-nutrition can go a long way to aid cancer patients to prevent nutrition-related challenges.
Factors that drive weight loss and muscle wasting in cancer patients
- Reduced Oral Intake
The greatest challenge associated with cancer care is malnutrition. Cancer patients experience under-nutrition, a type of malnutrition due to inadequate dietary intake of essential nutrients
(protein, fats, and vitamins). Cancer increases energy requirement consumption. To meet this demand, the body breaks up stored fats and lean muscles to generate energy a situation that leads to weight loss and muscle wasting. This phenomenon commonly is seen at the end stage of life. The body part affected by cancer also influences nutrient intake. Cancer that affects the gastrointestinal system, head, neck, and abdomen is associated with profound weight loss and muscle wasting. Tumors can put pressure on the digestive system making it impossible to swallow, digest, or even absorb nutrients.
The type of cancer treatment; chemotherapy, radiotherapy, or surgery increases the body’s energy demands and increases the risk of weight loss and muscle wasting. In addition, cancer treatment has multiple side effects. Nausea and vomiting, sore mouth and throat, loss of taste or smell, dry mouth, and loss of appetite all lead to the poor appetite that results in inadequate dietary intake. Changes in food taste can render it unappealing. This is complicated further by nausea and vomiting, diarrhea, bloating, or excessive gas making feeding undesirable. The result is a poor food intake and loss of energy. If depression sets in, it causes energy drainage and loss of willpower to eat or drink.
2. Increased glycolysis in tumor cells
Tumor cells are known to alter their metabolism to support their expansive growth. This pathological disturbance causes cellar mutations and proliferation that increase energy demand.
3. Protein Catabolism
Unlike normal cells, cancerous cells develop uncanny methods to acquire nutrients to aid in their rapid growth. One such example is the breakdown of protein to support the aerobic process. This type of breakdown involves the destruction of lean body muscles leading to loss of body muscle mass a precursor to the debilitating end-stage cancer care. This process is nutrient demanding and hence the rapid muscle wasting, weight loss, and disability.
4. Tumor Burden
Ample evidence indicates that tumor burden is a driver of weight loss in cancer patients.
Muscle loss contributes to significant disability and poor quality of life. It reduces the patient’s capacity to withstand long-term chemotherapy and increases susceptibility to infections and treatment resistance compromising the already fragile health status.
5. Systemic Inflammation
Chronic systemic inflammation is recognized as a cardinal sign of lean mass decline and weight loss in cancer patients. The progressive loss of skeletal muscle mass increases the risk for malfunction and poor response to treatment with impaired quality of life and increased mortality.
Considerations to optimize dietary intake in cancer care
While many factors increase the risk of weight loss and lean muscle wasting in cancer patients, there exist several factors that can be adopted to help restore nutritional status and aid in weight management;
- Invest in Essential Nutrients
Cancer and cancer treatment affect your dietary intake and how your body utilizes nutrients. During illness, nutrient requirements increase to fight the infection and for maintenance. Cancer is one such disease that increases nutrients demand to cater to rapid cell multiplication. Knowledge of basic dietary requirements can help counter such challenges and enhance treatment outcomes.
The nutrition requirement of a cancer patient is not that different from that of the general population. The emphasis is on a balanced diet that contains quality carbohydrates, proteins, fats, fiber, and fruits and vegetables. Limit the amount of sugar-sweetened beverages, high sodium foods, saturated fats, and over-processed food as they are poor in nutrients. In a cancer patient, abundant sugar is food for the cancerous cells.
However, cancer treatment may call for deviation from what is normally eaten. Include foods that help build the immune system to withstand the cancer invasion, increase your strength and energy, ability to function, and tolerate some of the treatment side effects. Stick to a balanced diet that includes;
Quality sources of carbohydrates
The primary role of carbohydrates is to provide the body with energy in form of glucose. Compared to healthy cells, cancer cells consume a lot of energy because they use a less efficient process to break down glucose for their metabolism. To meet the high energy requirement, cancer cells metabolize glucose in absence of adequate oxygen anaerobically increasing their glucose consumption by as much as 40%. As a result, the liver breaks down protein and fats and converts them into sugar. When carbohydrates supply is less to meet the demand, the body results in breaking down muscles and fats leading to excessive weight loss.
To effectively control the blood sugar and prevent sugar spikes that fuels cancer cells, blood sugar control is important. Investing in a diet that draws most of its food from whole grains, vegetables, fruits, legumes, nuts, and seeds is desirable.
Diet rich in protein
Protein is the body building block. For a cancer patient, protein is required for repair, healing, building muscle mass, and preventing weight loss. Protein is also key to a healthy immune system that helps fight infections.
A diet high in plant protein is ideal in cancer care. Choose plant protein from beans, lentils, and soy products. Plant protein is also a rich source of fiber which is good for digestion, antioxidants that scavenge for free radicals, and phytonutrients including vitamins and minerals that support a healthy immune system.
Change in taste may not be very favorable to plant protein leaving you with the option to eat animal protein. Choosing a quality animal protein is important. Choose lean meat sources like poultry, fish, and turkey and minimal red meat.
Include dairy products as they are rich sources of protein. Milk especially Greek Yogurt which has a high protein content, and eggs.
Dietary fats and oils
Fats and oils are good sources of energy. The body breaks down fat and oils and stores energy, insulates body parts, and transports vitamins A, D, E, and K. Choosing healthy fats that are rich in monounsaturated and polyunsaturated fats and limit or avoid unhealthy fats that cause inflammation in the body is important.
Maintain adequate hydration
Every body cell and organ depend on adequate hydration to perform their tasks. Fluid is essential in the body as it aids the transport of nutrients to every cell, carries toxins away from the body, balances the body temperatures, controls heart rate, and generates saliva. A normal body loses fluids through breathing, perspiration, and sweating. People with cancer require additional fluids to cater for water loss through, high fever, vomiting, and diarrhea, which are common treatment side effects.
Cancer patients should increase their water intake throughout the day. Consuming nourishing fluids like soup, tea, milk, and fresh fruit juices with no added sugar is advisable. Eat food that is high in water content like vegetables and fruits. Appropriately manage treatment side effects to limit fluids lost through vomiting, diarrhea, and high fevers. Drink water and not wait to get thirsty. As people age, their urge to drink water diminishes and can end up dehydrated. It is important to desist from foods and beverages that can increase dehydration. Sugar-sweetened beverages are a case in point.
Always be on the lookout for symptoms of dehydration; excessive thirst, diminished urinary output, and sunken eyelids, and seek medical intervention promptly.
2. Practice safe food preparation
Cancer and cancer treatment weaken the immune system leaving the body prone to infections. Safe food handling is one way to reduce the risk of food-borne infections. Hand washing when preparing food is one important practice. Wash hands after every critical time. Wash hands with soap for 20 seconds, before and after preparing food, and use clean towels to wipe all food surface areas, utensils, and cutting boards. Use a separate board for cutting meat, and poultry from other food products like fruits and vegetables.
Ensure proper cooking of food, serve when still hot, and store leftovers within 3 hours of cooking.
As a general rule, avoid salads, buffets, and potlucks to prevent food-borne diseases. Avoid unpasteurized milk products and raw eggs. Eat more homemade foods and avoid takeaway.
3. Be cautious of dietary supplementation
Dietary supplements are products that are used to support health status. The supplements are usually in the form of pills, capsules, liquids, powder, or teas. Supplements are rarely prescription drugs and can be accessed from most drug outlets as over-the-counter orders. Most supplements are purported to be effective against numerous ailments but adequate scientific evidence and clinical trials to support the claims may be inefficient.
For instance, the American Cancer Association cautions that dietary supplements lack the strict safety and effectiveness required of medicine and are only considered special food. Instead, companies that produce supplements are expected to advise on the safety of the product, give dosage instructions, clearly indicates the content of the product, and avoid false claim about their efficacy.
Cancer patients are advised to be cautious when it comes to supplementation. Supplements may interfere with the effectiveness of either chemotherapy or are likely to increase treatment side effects. As many problems are likely to occur during cancer treatment it is advisable to inform your doctor before surgery or other forms of cancer treatment about any form of supplement you are taking so that you can be advised appropriately.
4. Manage cancer treatment side effects
In most cancer patients, the effect of cancer treatment reduces their ability to eat or absorb food. Making a small adjustment to your diet can help. Eat small portions of food more frequently. Having some food in the stomach can help relieve some symptoms like nausea. Try and avoid fried and greasy food as they can aggravate nausea and vomiting. It is important to remain hydrated and remember to drink liquids in between meals and possibly throughout the day. If you are offended by smells, let someone else prepare the food for you. Hot food has a pungent smell, let it cool before serving to reduce the effect of smells. Keep track of the food that causes nausea and try to avoid it.
Avoid highly processed foods, and sugar-sweetened drinks, dwell on whole grains like oatmeal, legumes, plenty of vegetables and fruits, and quality sources of protein like skinless chicken, lean beef, and hard-boiled eggs. Teas like peppermint and ginger are known to control the nauseous feeling.
5. Incorporate physical activity regimen when possible
Cancer-related weight loss and skeletal muscle wasting is harmful to cancer patients. It is associated with an increased risk of death, intolerance to cancer treatment, treatment toxicity, and decreased quality and quantity of life. Thus, preserving skeletal mass becomes a critical component of cancer care.
Physical activity and programmed exercises are now recognized as key elements to strengthening skeletal muscle mass and preventing muscle loss. Engaging in low-grade physical activity and reducing periods of prolonged inactivity are some examples.
Though cancer is associated with profound weight loss and muscle wasting, being careful of the diet you eat, observing hygienic practices to prevent infection, and being active within your capability are some key considerations.
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