Nutritional care for cancer patients: These nutrients can help prevent or treat low muscle mass
10/01/2020 / By Skye Anderson / Comments
Nutritional care for cancer patients: These nutrients can help prevent or treat low muscle mass

Nutrition is an important part of health and development. According to the World Health Organization, good nutrition is key to having a strong immune system, safer pregnancies and childbirth for women, a lower risk of non-communicable diseases (e.g., heart disease, cancer) and a longer life span.

Good nutrition means getting the right amounts of vitamins, minerals and other important nutrients that your body needs to work its best. While this isn’t hard to achieve for people without any health problems, ensuring proper nutrition when you’re sick can be a huge challenge.

In an article published early this year, researchers from Canada and Italy discussed the importance of nutrition for cancer patients, especially those suffering from low muscle mass. They noted that many cancer patients have poor nutritional status, and this negatively impacts their clinical outcomes.

Poor nutrition manifests itself in a severe loss of muscle mass in people with cancer, regardless of cancer stage. It also often co-exists with obesity. The researchers said only a few studies have looked into nutritional interventions for preventing or treating low muscle mass in cancer patients, so they decided to explore this topic. Their report includes a list of important nutrients cancer patients need to include in their diet to avoid or address the problem of severe muscle mass depletion.

Nutritional care is what cancer patients need

Food is the body’s primary source of energy. We need to get enough energy from our diet to avoid weight loss and maintain muscle mass. According to experts, eating the right foods can not only help stimulate the production of muscle protein, but it can also stop its breakdown. This breakdown is part of the natural process of muscle remodeling, which takes place as we build muscle mass throughout our lives.

Earlier studies have found that age doesn’t affect the rates of muscle protein synthesis and degradation, but it does affect our response to nutrients, insulin and resistance exercise. As we age, we become less responsive to these, which results in the loss of skeletal muscle mass. This is why, among other things, experts urge older adults to exercise regularly and to take amino acid supplements to restore their anabolic response and combat the loss of muscle that occurs with age.

But unlike in older adults, the loss of muscle observed in cancer patients is not caused by anabolic resistance but by cancer-related weight loss. This observation gave rise to the obesity paradox, and for a while, researchers believed that being obese actually contributed to favorable clinical outcomes for cancer patients.

But later investigations showed that this is a false assumption and that having excessive amounts of fat does not help reverse low muscle mass. Researchers have now shifted their focus on understanding the impact of good nutrition and the importance of nutritional care for cancer patients. As a fundamental step in the nutrition care process, researchers say that the energy requirements of individual patients should be accurately determined so that they can receive effective diet recommendations.

Important nutrients that can help fight low muscle mass in cancer patients

Several studies have found that the total energy expenditure of cancer patients is different from that of healthy people. This is due to factors like systemic inflammation, cancer stage and lack of physical activity.

British researchers also reported that although the resting energy expenditure (REE) of pancreatic cancer patients is high, their total energy expenditure is still lower than most healthy adults. Meanwhile, another study found that in patients with early-stage colorectal cancer, body mass and body composition also affects total energy expenditure.

But because not much research has been done on the subject, dietary recommendations for cancer patients are primarily based on their body weight. As per the guidelines set by the European Society for Clinical Nutrition and Metabolism (ESPEN), cancer patients should limit their calorie intake to no more than 25 to 30 kcal/kilogram body weight per day.

Determining the energy requirements of cancer patients is a crucial part of dietary interventions that could increase their survival and improve their quality of life. Inaccurate estimations of their energy requirements can impact diet recommendations and the ability of healthcare providers to optimize the nutritional status of their patients. Without a thorough understanding of a total energy expenditure, researchers fear that nutritional interventions can aggravate the loss of muscle mass or increase fat mass.

Based on existing literature, cancer patients who wish to prevent the loss of muscle mass and bodyweight that accompanies their condition should endeavor to include more of the following nutrients in their diet:

Protein

Having an adequate supply of protein is key to gaining and maintaining healthy muscles. Without ample amounts of protein, treatments for low muscle mass are doomed to fail. However, researchers have yet to determine the right amount of protein that cancer patients need to prevent or treat low muscle mass.

At present, guidelines on protein intake for cancer patients are not directed at addressing the loss of muscle. But some studies have made the connection between low protein consumption and the loss of muscle mass in cancer patients. Researchers have also discovered that eating good dietary sources of essential amino acids can help stimulate the production of muscle protein.

Foods that contain essential amino acids include: eggs, nuts, meat, fish, poultry, whole grains, nuts and seeds.

B-hydroxy B-methylbutyrate (HMB)

HMB is found naturally in foods, albeit in small amounts. HMB helps regulate protein turnover and minimize protein degradation. Produced during the breakdown of leucine — one of the amino acids that make up one-third of muscle protein — HMB is commonly used today as a supplement to promote muscle-building and increase physical activity.

In some human studies, HMB combined with amino acids like arginine and glutamine has helped patients with advanced cancer gain lean mass. When taken alone, HMB is also said to improve body composition. HMB supplements have provided significant benefits not only to cancer patients but also to older adults and patients with HIV/AIDS, chronic obstructive pulmonary disease and rheumatoid arthritis.

Glutamine

A non-essential amino acid, glutamine plays many roles in human metabolism. It serves as a fuel source for intestinal cells, a substrate for glucose production and a nutrient in muscle protein metabolism, especially during infection, inflammation and trauma. Because of its involvement in protein synthesis, researchers believe that increasing the intake of glutamine can help prevent low muscle mass in cancer patients.

Foods that are rich in glutamine include: meat, seafood, milk, nuts, eggs, cabbages and beans.

Carnitine

Carnitine can be obtained from food or through the conversion of lysine inside the body. Cancer patients, however, have low carnitine levels because of reduced food intake, decreased carnitine absorption and increased urinary excretion — a side effect of chemotherapy. But research has found that supplementing with carnitine or eating more carnitine-rich foods can help cancer patients gain lean mass.

The best dietary sources of carnitine are: meat, fish, poultry and milk.

Creatine

Creatine is a compound naturally found in the muscles. It is composed of the three amino acids, namely, arginine, methionine and glycine. Creatine is a popular supplement used by athletes to improve their performance, especially during short high-intensity bouts of activity. Older adults also take creatine supplements to improve their lean mass and muscle function.

Creatine can be obtained from red meat and fish.

Fish oil and eicosapentaenoic acid (EPA)

Fish oil is one of the best sources of omega-3 fatty acids, particularly docosahexaenoic acid (DHA) and EPA. Besides its anti-inflammatory benefits, EPA (and fish oil) also helps increase weight gain and appetite, as well as improve physical performance in cancer patients. One study even reported that during chemotherapy, about 69 percent of patients who were taking fish oil supplements maintained or gained skeletal muscle.

Cancer patients suffer from a lot of problems due to poor nutrition. One of the negative effects of poor nutrition is the severe loss of muscle mass. But recent studies have shown that improving the nutritional intake of cancer patients can help prevent or treat low muscle mass.

In particular, researchers propose that diet recommendations be personalized and based not on body weight, but energy expenditure. They also suggest including more of certain nutrients that promote the production of muscle protein.

For patients looking to increase their muscle mass or prevent the loss thereof, increasing your intake of foods rich in protein, essential amino acids, glutamine, carnitine and creatine is advised. You can also take HMB and fish oil supplements upon the advice of your healthcare provider.

Sources:

WHO.int

TuftsMedicarePreferred.org

OnlineLibrary.Wiley.com

Link.Springer.com

NCBI.NLM.NIH.gov

Nature.com

Academic.OUP.com

MedicalNewsToday.com

News-Medical.net

Food.NDTV.com

ODS.OD.NIH.gov

ACSJournals.OnlineLibrary.Wiley.com

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