“If he would only
eat more, I know he’d gain the weight and strength he
needs to get better,” says a concerned wife speaking
with her husband’s doctor. The husband tells his doctor,
“I force myself to eat at times, just to make my wife
less worried. But I have no appetite and after only a
bite or two, I’m so full that I can’t continue.” This
scenario is typical of a condition known as
“cancer-related weight loss.”
Many factors can
influence the outcome of a person’s chances of surviving
cancer, but in recent years, the role of maintaining
optimal nutritional health has become increasingly
important in successfully managing this disease.
Nutrition is one area of cancer care where caregivers
can play an important role. It’s crucial for both the
caregiver and the one being cared for to know what to
expect about every aspect of the disease, especially the
impact of cancer-related weight loss and the
nutritional challenges and needs that may arise.
A caregiver may try to tempt a person living with
cancer into eating by preparing favorite foods and
desserts. On the other hand, this well intentioned
effort may cause a loved one to feel nagged by demands
“Forcing a person with cancer to eat can
have a negative impact. It places additional stress on
the situation and eating becomes less enjoyable.
Ultimately, the caregiver’s attempt to help can
backfire,” suggests Denae Garrett, M.S., R.D., Chao
Family Comprehensive Cancer Center, Irvine, California.
“However, most people with cancer can identify times of
the day or night when they feel best and may have a
better appetite. It’s a good idea to use those times to
prioritize eating. Remember to keep meal times flexible
— it’s ok to eat breakfast foods at 4pm or have a
It’s true that people with
cancer may feel better after eating something, so it
helps to focus on what they were able to eat, rather
than what was left uneaten.
understanding cancer-related weight loss, a caregiver
can help improve the quality of life of someone with
cancer through increased strength and activity resulting
from a good, solid nutritional program designed by the
When Weight Loss Isn’t Desirable
Caregivers have an opportunity to influence the diet
of people with cancer, and recognizing cancer-related
weight loss is often the first step. Many times the
initial symptom of cancer is weight loss, so it’s
important to have a person with cancer assessed by a
medical professional in order to specifically identify
the causes for the unexplained weight loss.
Weight loss when living with cancer is different than
weight loss from dieting. Many people go through life
trying to lose weight and stay fit, but with cancer,
weight loss isn’t desirable. People with cancer need to
maintain weight and muscle to prevent complications that
can impact the effectiveness of therapy and ultimately
survival. In fact, losing as little as five percent of
body weight can adversely affect a person’s response to
cancer therapy. Slowing or stopping weight loss and
rebuilding muscle allows for more energy, strength and
independence to perform everyday functions and favorite
Simply eating more food or using conventional
nutritional beverages may not be enough to prevent or
reverse the weight and muscle loss, but there are
nutritional options available. In fact, certain fatty
acids have been found to play a role in cancer-related
weight loss. One such fatty acid is EPA (or
eicosapentaenoic acid), an omega-3 fatty acid that has
been effective in stabilizing weight loss in people with
cancer. A therapeutic nutritional beverage with 2 grams
of EPA has been shown to help restore normal metabolism
and build muscle so that people with cancer have
increased strength to respond to cancer therapies.
It is important to address the metabolic problems
associated with cancer-related weight loss early on,
because excessive weight and muscle loss can adversely
affect a person’s response to cancer therapy. The
earlier a person with cancer begins taking a therapeutic
nutritional beverage specifically designed to help
normalize metabolism and promote weight gain, the easier
it may be to manage or even hold off cancer-related
As with any illness or injury, a
person produces and releases different substances into
the bloodstream that promote healing. This type of
reaction from the immune system tends to speed-up the
regular metabolic rate, causing more calories than usual
to be burned. Once well, a person’s metabolism then
returns to normal, but during the time it ran at a
higher rate, some inches and pounds most likely were
When a person with cancer fights a tumor,
however, this response can continue indefinitely. The
tumor produces substances that alter the metabolism of
macronutrients — protein, carbohydrates and fat — and
causes the body to burn calories faster than they
ordinarily can be replaced. The result is catabolism,
the breakdown of muscle and other tissue.
addition to cancer-related weight loss, there are many
other reasons people with cancer lose weight. Causes
include depression, fatigue, pain, altered taste
perception, side effects of treatment, or obstruction of
the gastrointestinal tract. In these cases as well,
consumption of a high calorie, high protein,
EPA-containing beverage may help reverse weight loss.
Psychological distress also can play a major role in
weight loss. The anxiety that comes with receiving a
diagnosis of cancer, the intensified feelings of anxiety
and depression, and the possibility of pain, all can
cause weight loss. Once a particular psychological issue
is addressed, some of the weight loss may be reversed.
The Search for Treatment
Promising new science shows that it may be possible to
prevent or reverse cancer-related weight loss by
providing a specific combination of nutrients that can
help restore the body’s metabolism. One key nutrient is
the omega-3 fatty acid EPA, which helps to counteract
the metabolic changes that lead to weight loss. Research
shows consuming 2 grams of EPA daily may help stabilize
weight loss by reducing production of tumor factors that
cause weight loss. Researchers who examined the effect
of EPA in clinical studies found two important results.
According to a study published in Nutrition and Cancer,
EPA supplementation stabilized weight in patients with
cancer-related weight loss, and increasing the dose of
EPA from 2 to 6 grams per day did not lead to weight
In a study published in the British
Journal of Cancer, researchers hypothesized that
providing EPA in combination with calories, protein,
vitamins and minerals may result in weight gain rather
than just weight stabilization. Study participants drank
a high protein, high calorie, therapeutic nutritional
beverage with EPA. After only three weeks of drinking
two cans of the therapeutic nutritional beverage per
day, in addition to a usual diet, patients increased
muscle and were able to eat more food. In addition, a
sub-group of the patients also participated in a smaller
study to test their physical activity level. Published
in Clinical Nutrition, the study found that some
patients, who once had been too weak to be active, were
able to get out of bed and resume normal activity after
By including a high-protein,
high-calorie therapeutic nutritional beverage with EPA,
along with a nutritional assessment and management by
medical professionals, the nutritional status and
quality of life for people with cancer experiencing
cancer-related weight loss can improve.
Tips to Promote Good Nutrition
In addition to utilizing an existing
therapeutic nutritional beverage with EPA, caregivers
must still try to help the ones being cared for eat a
variety of foods, since lots of nutrients from many
different sources are required to meet physical and
nutritional needs. Caregivers can help people with
cancer create a flexible, personalized nutritional plan
that will be easy to adapt to their ever-changing needs.
Following are guidelines to help create the basis for a
sound, nutritional program.
There are many ways to add calories, and eating high
calorie foods is a good place to start. Caregivers and
people with cancer can enjoy adding the following to
increase calorie intake:
onto hot foods such as toast, soups, vegetables,
cooked cereals, rice and soft-boiled eggs.
mayonnaise instead of salad dressing for use in meat
salads, in deviled eggs and on lettuce.
butter - also high in protein - with an apple,
banana, or pear, or spread it on a sandwich with
pies, hot chocolate, fruit, gelatin and other
desserts with whipped cream. Cook with heavy cream
instead of milk.
Sprinkle nuts or
seeds on vegetables, salads, and pasta, or sprinkle
on desserts such as fruits, ice cream, pudding and
It can be extremely beneficial for a person with cancer
to receive extra protein, especially if they are healing
after surgery. The following suggestions will
help provide more healing proteins and extra calories to
Add nonfat dry
milk or powdered protein supplements, like Soy
Protein Shakes, to regular milk. Also, they can be
added to sauces and gravies or used for
breading meat, fish or poultry.
with milk instead of water.
half-and-half and evaporated milk when making
instant cocoa, canned soups, mashed potatoes, and
Add extra ice
cream to milkshakes.
Add small pieces
of meat, fish or poultry to soups and to vegetable,
noodle and rice casseroles.
cheese to cream sauces, casseroles, or vegetables.
cheese over hot apple pie.
cheese and cream cheese with fruit.
Use cream cheese
and margarine on hot bread or rolls.
chopped hard-boiled eggs into sauces, gravies,
chopped meats, or salad dressings or sprinkle over
Loss of Appetite
Sometimes medical treatments and therapies can cause a
decrease in appetite. Here are some ways that caregivers
can help make favorite dishes appealing again:
such as lemon juice, mint, basil and other herbs and
spices to perk up the taste and smell of food.
Add sugar and
salt to foods, if intake is not restricted.
attractively and in a pleasing atmosphere.
Vary the colors
of foods on the plate and use garnishes such as
lemon or lime wedges.
settings and soft background music can help make
mealtimes more enjoyable, too.
therapeutic nutritional beverage such as ProSure to
help reverse the metabolic changes that can affect
Walk the dog or
take an early-evening stroll before eating.
may help stimulate the appetite.
Plan the biggest
meal of the day when a person with cancer is most
hungry, even if that’s early in the day.
Serve foods a
loved one enjoys whenever they feel like eating,
even if it’s not a usual meal time:
Overcoming Vomiting and Nausea
If a person with cancer is suffering from vomiting,
nausea, or feels too full to eat, try these tips:
Drink liquids an
hour before or after eating to keep from filling up
quickly during meals.
high-carbohydrate foods such as crackers and toast
if troubled by nausea. They move through the stomach
quickly and may be particularly helpful if eaten
first thing in the morning.
Eat slowly and
chew food thoroughly.
eating. Activity can slow digestion and may cause
If food smells
cause nausea, keep a person with cancer out of the
kitchen while meals are prepared - even have them
leave the house, if possible. Cold foods tend to
have fewer odors, so try serving more dairy
products, chicken or tuna salad sandwiches, cold
soups and cool desserts with fruit.
Change of Taste and Smell
Some therapies and treatments can change the way food
tastes and smells. Here are some tips that may help
alleviate these symptoms:
Serve food cold
or at room temperature to decrease its smell and
that provide texture and crunch to help give a real
sense of eating that is not provided by soft, bland
and condiments such as salt, lemon juice, catsup,
pickles and olives that don’t rely on smell to
Avoid the area
where food is being prepared, as odors may increase
the chance for nausea.
small meals during the day rather than three large
Soothing Mouths and Throats
Some treatments can make mouths and throats
uncomfortable, dry and sore. Here are some tips that may
help to eliminate some of these problems:
Try moist and
liquid foods such as soups and stews. They may be
easier to chew and swallow.
Try soft, cold
foods such as ice cream, frozen fruit-juice bars,
watermelon and grapes. They may feel and taste
better than other foods.
Drink through a
straw to make swallowing easier.
beverages and highly acidic foods, like citrus
juices and tomatoes.
Try fruit juices
such as apple and nectar instead.
If diarrhea is a problem, these suggestions may help to
prevent, or at the very least, lessen the severity:
Try eating small
meals frequently rather than two or three large
meals each day and don’t skip meals.
fatty and fried foods.
products cause problems, try decreasing the amount
that a person with cancer eats or drinks at one
eliminate items from the diet temporarily if they
are causing too many problems.
Drink plenty of
liquids to counter fluid loss.
It is a good
idea to keep an oral electrolyte solution on hand at
home to help replace water and minerals lost during
Talk with a
doctor if diarrhea occurs more than twice daily.
If blood is
noticed in the stool, be sure to tell the doctor
Gas may cause cramping, bloating and pain. To help
prevent it, try these tips:
beverages, chewing gum, highly spiced foods and too
Don’t talk and
chew at the same time. This can cause air to be
swallowed, which then causes gas.
Eat only peeled,
cooked fruits and vegetables that don’t have seeds.
Strain the seeds out of tomatoes.
corn (including popcorn) and nuts.
the cabbage and onion families - including broccoli
and garlic - also may cause problems.
Keeping regular can be a problem for anyone, but in
particular for people who have been receiving different
medicines, treatments, therapies, as well as
experiencing extreme metabolic changes. Here are some
ideas that caregivers can use in helping to keep
foods such as raw fruits and vegetables, or
whole-grain, high-fiber cereals.
If a person with
cancer has trouble swallowing, try grating or
cooking the fruits and vegetables.
Don’t forget to
add prune juice to their diet.
Drink plenty of
liquids and exercise as much as possible.
If a person with
cancer still suffers from irregularity and continued
discomfort, be sure to speak to a doctor.
an opportunity to play an active role in helping people
with cancer. By understanding the importance of
nutrition in the treatment of cancer, and applying
useful strategies and tips, caregivers can help people
with cancer regain weight and reclaim quality of life.
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