In the previous entry, the need for proper weight and nutritional management was addressed for cancer prevention as well as during treatment. We understand that weight loss in cancer is more than “just not wanting to eat” but the body’s reaction to a very high demand for calories and energy. Preserving lean body weight in muscles is the best way we can protect our energy and stamina during and after treatment.
How Much is the Right Amount to Lose or Gain?
There are a number of ways to estimate our lean body mass, and they can be applied during cancer treatment, guided by your oncologist, oncology nurse and nutritionist. Graphs and tables are the most rudimentary way to estimate it, based on height and weight for many body types (“small”, “medium” or “large” frames). A Body Mass Index (BMI) can be calculated as a ratio of weight to height, and standards exist for men and women. Bioimpedance analysis, a more exacting measure, is not routinely available, so we use BMI.
In general, more of deviation than 10% of ideal body weight is problematic, but such is a general rule, and a gap must be individualized based on a variety of other medical factors. For example, if some weight is from fluid retention, the formula changes.
Gaining Weight is Not So Easy
Although it may seem an easy task, gaining weight in the midst or after treatment is not as easy as it sounds. The process from start to finish: menu planning, shopping, transporting, putting away, preparation, clean-up as well as the inevitable bathrooming all take precious energy. The number of calories needed also varies based upon medical circumstances, and can range from 3000-8000 calories/day. Set aside your thoughts about wonderful ice cream and deserts being in charge here. Those calories must be good calories from sources rich in certain nutrients: specific proteins and their amino acid building blocks, antioxidants, whole grains, fiber, vitamins and minerals. The creative part here is getting these building blocks into foods that are tasty, exciting and nutritious. It is not only possible but do-able, especially with help from family and friends. Oncology nutritionists and many published books contain recipes and guidance (see pages 272-277 in Learn to Live Through Cancer: What You Need to Know and Do for a sampler. Cook for Your LIFE is a nonprofit organization whose mission is to improve the health of people touched by cancer by giving them the practical knowledge, tools, and inspiration to cook their way through treatment and into a healthy survivorship. Look online at www.cookforyourlife.org.) Work with the nutritionist at your treatment center to join these principles with your food preferences or religious restrictions. Some patients may need to use a feeding tube during treatment or after. Techniques to do so are also part of the skillset of your treatment team. Be sure to benefit from their experience.
Because we often see food as part of our basic existence, its absence opens up an emotional bundle for us all. Such fears and entitlements are fast prey for hucksters who offer supplements that have not been tested for safety or usefulness. Be especially aware of claims that purport to cure illnesses through nutrition, but even more way of claims to eradicate illnesses as diverse as cancer, Parkinson’s disease and multiple sclerosis. No known chemical can do all of the above that is tested and proven.
Certain supplements have been tested to standards as high as chemotherapy or radiation therapy, and those are worth considering with your treatment team. Omega-3 fatty acid fish oils rich in EPA (eicosapentanoic acid) have been shown in small but careful clinical trials to discourage the body from using huge amounts of calories that divert them from lean body muscle mass. A selection of amino acids: arginine, glycine and beta-hydroxymethyl butyrate (HMB) likewise have been shown effective in good quality tests. Run them by your treatment team. Good nutrition sources may also be combined with appetite stimulants like dronabinol (Marinol ®) or nabilone (Cesamet®) which are as FDA approved, clean versions of marijuana sold in capsules with a prescriptions at local pharmacies. Oxandrolone (Oxandrin®) is an example of a type of hormone that builds muscle, is FDA approved and may be of benefit. Our awareness of its misuse in the weight lifting community often diverts its usefulness in cancer-induced weight loss. Work with your treatment team to sort out these possibilities. The supplements themselves do not cause the weight gain, good calories do, so they are in addition to those good calories.
Weight Gain Problematic as Well
Logic would tell us that if weight loss is bad, then weight gain is good. Too simple. Too much weight gain is bad for certain patients with certain types of cancers, particularly breast or prostate cancers. As the hormones that nurture cancer growth are oil-soluble (estrogen in breast cancer and testosterone in prostate cancer), they are stored in fat cells, so too much weight gain can retain substances that can make cancer grow or grow back. Eating and snacking in such situations needs to focus on the healthy spectrum of foods despite our first thought to be a bit indulgent at a time of high distress. Such weight gain however, seems extremely hard to take off after the fact. Indulgent foods can be made in a healthy way can satisfy both needs. Refer to Learn to Live Through Cancer: What You Need to Know and Do and Cook for Your LIFE for healthy snacking tips that also satisfy our needs for comfort foods.
Ideal body weight is an essential part of general health as well as health maintenance during cancer treatment and survivorship. An individualized approach available at or by referral at your accredited cancer center is vital to help you stay as close to an ideal body weight. Learning how many calories you need from specific sources can then be individualized based upon food preferences and other medical factors. The art of translating such guidelines into tasty and attractive meals moves science into art. Resources are available to do so. Take advantage of them during treatment; don’t wait until you’ve gained or lost a lot to work on a plan. Good nutrition, some activity and restorative rest are key components to emerging from treatment as healthy as possible.