Advice for those who are wasting away


Studies have shown that a weight loss greater than 6% of normal weight at the time of cancer diagnosis significantly affects survival for the worse. For many common cancers it has been established that this adverse effect of weight loss outweighs the possible good impact of conventional treatment such as chemotherapy. So it would make sense not to panic and rush into treatment. Instead, sort out your nutritional status and weight problems first and then proceed. You will not only weather the treatment better: your odds for survival will go up.

Have a look at this interesting and useful article from the National Cancer Institute about strategies for controlling weight loss in cancer:

www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/HealthProfessio...

Here is a battle plan: -

  1. Take Immunopower and High Dose Vitamin C.
  2. Use Dr Quillin's "Dragon-Slayer" shake recipe daily, (see recipes), with medium chain triglycerides added, to counter wasting. Coconut butter is a good source of MCTs. (P. Quillin, Beating Cancer with Nutrition, Nutrition Times Press, Tulsa, O.K., p93).
  3. Take 5000mg daily of fish oil: Higher Nature Omega-3 Fish Oil 1000, or 4/5 tablespoons of Omega Nutrition Flax Seed Oil in shakes. Keep in fridge, to prevent rancidity. (Omega-3 fatty acids have been shown to significantly counter wasting, in part because their anti-inflammatory actions block Tumour Necrosis Factor, and Interleukin 6, hormones of the immune system over-expressed in cancer, which promote metabolic breakdown.)
  4. Eat as often as you can. A small, regular intake is preferable to nothing. If you have zero appetite, distract yourself while you eat: listen to music, read, watch a video. You may have to consider eating as an exercise in willpower for a time. Purée rather than juice. If at all possible, try and eat slightly more than you are normally used to. This is to compensate for the fact that in advanced cancer your resting metabolic rate (i.e. rate at which you burn calories and consume energy), is actually elevated significantly above average. Hence the rapid wasting. If eating alone is not enough to maintain your weight stable, then you may need pharmacological help (see below: 8 and 9).
  5. Use Slippery Elm - glucose free - as a drink to settle your stomach and Silymarin to improve liver function.
  6. Avoid Glucose Rich Total Parenteral Nutrition (intravenous feeding). This feeds the cancer more than it feeds you. Moreover, overfeeding of glucose/dextrose combination in TPN formulae can lead to liver and respiratory problems. A Harvard doctor, George Blackburn, who has studied nutrition in cancer for several decades, offers the following conclusions, after an extensive review of clinical trials with TPN in cancer. TPN in cancer is used to improve fitness, metabolic status and body composition, (and therefore quality of life). Most symptoms of malnutrition in cancer can be prevented by properly administered TPN, using a tailored prescription of macronutrients and micronutrients. If the need for TPN arises, show your oncologist the table in Dr Blackburn's article.

    "The high dextrose content of conventional TPN formulae should be minimized, and instead a portion of the calories should be supplied by approximately 30% lipids, including a minimum of no less than 4-6% Omega-6 fatty acids and some Omega-3 fatty acids, now known to counter wasting in cancer."

    This is appropriate as, whereas tumours depend largely on glucose for energy, the cancer patient’s metabolism is adapted to fat as a primary fuel.

    In the absence of fluid restriction, the average semi-stressed cancer patient requires approximately 30 - 35 ml of fluid per kilogram per day. Electrolyte (sodium, potassium, calcium, magnesium, phosphate), mineral and vitamin requirements for patients with cancer are essentially the same as patients with non-malignant disease."

    "The provision of TPN during chemotherapy should be reserved for those patients with hypoalbuminemia, (low blood albumin score, a good index of malnutrition), or weight loss greater than 10% who are responsive to prescribed dose and schedule of chemotherapy."

    On the other hand, "among patients receiving bone marrow transplants, those who cannot eat for a prolonged period, particularly if they are severely malnourished, may benefit from TPN."

    It has also been demonstrated that TPN "administered with insulin (1 mU per kilogram of body weight per minute) results in improved skeletal muscle protein synthesis and whole-body protein net balance compared to TPN alone."

    However, you should note that as a general rule TPN used indiscriminately in cancer does not confer significant survival benefits, probably because, being invasive, it offers a route for blood-borne infections. It can nevertheless be a useful adjuvant therapy to salvage patients out of bad, malnourished states, in the absence of alternative feeding routes.

    Ideally, if it is simply physically impossible for you to eat, or if your doctors and/or attendants judge this to be the case, then it is a matter of the utmost urgency to start Enteral Nutrition, naso-gastric tube feeding, which is far safer than Total Parenteral Nutrition. If necessary, your surgeons may also institute Parenteral Nutrition through percutaneous gastrostomy – a feeding tube placed directly into the stomach through the stomach wall, when the oral route is blocked, - or feeding jejunostomy – a surgical permanent opening directly into the small intestine. Enteral Nutrition can also be done at home. In skilled hands, a naso-gastric tube can be inserted in minutes, and will enable a regular effortless supply of good nutritional support. The ideal formula should again be low in glucose, specifically Dr Blackburn’s. However, if this is unobtainable, Novartis’ Impact in Enteral Nutrition format, is a good second best, that has been extensively tested on cancer patients with improved outcome. The critical thing to remember is that if you can stave off cachexia or wasting, your cancer will find it much harder to get the upper hand. So it is important to take early preventative action in this respect, and be on guard.

  7. Snack on high protein things, such as nuts, spirulina bars, oat cakes, brown rice crackers.
  8. Advanced cancer causes a profound systemic derangement in all aspects of the body's metabolism. This means that even intensive nutritional therapy may not be enough to halt wasting and promote healing at this stage. Prospects are best when such therapies are combined with approaches that put a major spoke in the metabolic derangement wheel the cancer spins. If possible, lower tumour burden by surgery, or other means that do not destroy the immune system. (See IV Vitamin C Therapy/Phototherapy etc). Then add one of the two following strategies:

    If your cachexia, or wasting, is aggressively active, consider a course of Hydrazine Sulphate. This drug, which has been the subject of a number of studies since the 1970s, including trials by the US National Cancer Institute, has been demonstrated to improve appetite, and weight gain, and both halt wasting, and sometimes tumour growth, by interfering with the availability of "new glucose" in the liver, which tumours ferment as their source of energy. The dose used in most studies is 3 x 60 milligram tablets daily for a month. Thereafter after a break of 2 to 6 weeks further courses can be taken. Side effects are minimal and hydrazine sulphate does not appear to cause bone marrow depression, unlike most chemotherapeutic agents. However, please note, hydrazine sulphate should not be administered to patients taking alcohol, barbiturates, anti-depressants and antipsychotics. The combination can cause dangerous falls in blood pressure. If you need any of the above drugs and hydrazine sulphate, discuss appropriate substitutes with your doctor.

  9. If you cannot take Hydrazine Sulphate because you genuinely need the above listed drugs, an orthomolecular alternative to consider is Insulin. Cancer patients, particularly in the late, wasting stages, are usually insulin resistant. Thus giving extra insulin makes sense because it has been shown to reduce production of new sugar in the liver, just like Hydrazine Sulphate, and reduce protein breakdown, which results in muscle wasting. Monitoring blood glucose levels may be a good way of determining cachexic activity. They are usually abnormally high if cachexia is present.
  10. Another agent which may be of use is Megestrol Acetate, a progestational steroid (a synthetic hormone that mimics the action of progesterone in pregnancy, to store fat). A number of trials with this hormone have demonstrated appetite improvement and weight gain not only in advanced breast cancer but in AIDS patients as well. It is thought Megestrol Acetate may work by influencing metabolism of fat stores in the body, so that more fat is stored or conserved, instead of being broken down and oxidised to fuel the excess energy production in cancer. Male patients whose cachexia or wasting results in part from low hormone status, may also benefit from testosterone supplements. (Obviously, prostate cancer would be a contra-indication to this).
  11. If you are depressed and receiving pharmacological treatment for this, you should be aware that the following drugs reduce appetite and weight and may thus be working against you: Amphetamines, and their analogues including phentermine, phenylpropanolamine; norepinephrine uptake inhibitors; fenfluramine and dexfenfluramine; several seratonin uptake inhibitors, including fluoxetine (Prozac) and sertraline (Zoloft); sibutramine (Meridia). On the other hand, there are drugs for depression, known as monoamine oxidase inhibitors, e.g. amytryptiline (Elavil) and lithium, which can make some individuals increase in appetite and weight. These may be an option, if you are truly dependent. But, in general, we do not recommend any of these drugs.
  12. As malnutrition sets in with advanced cancer, levels of albumin in the blood fall steeply. (Normal levels are in the range of 3.1 – 4.3 g/dl, but ideally you should be above 3.7 g/dl at least). Albumin is produced by the liver and is the chief protein found in blood, acting as a key antioxidant, detoxifier and transporter of important nutrients. Intravenous infusions of albumin can be dangerous, due to the dramatic alterations in blood volume they cause, so they are not a good option for boosting albumin. Japanese research however suggests that the algae, chlorella, which is rich in albumin, and a power-house of other nutrients, may be a good supplement to use at such times. (A study has shown a 30% rise in albumin in 68% of malnourished elderly people who took 6 grams a day of chlorella for 6 months). Monitoring the rise and fall of blood albumin has prognostic implications for survival and recovery and vice versa.
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