Ask the expert
cancer of the gullet
Question
Why is it that even though my husband is eating quite well, he is still losing weight?
Answer
It would be helpful to work out your husband's nutritional requirements (e.g. daily calorie and protein requirements) and compare them to what he is currently consuming.A Registered Dietitian will be able to perform this calculation for you, and your Husbands Hospital Doctor or GP can make a referral to a Dietitian.
When somebody is having treatment for cancer it is reasonable to expect that their nutritional requirements may be raised due to the stress or demands on the body to heal, repair and to grow new cells. Additionally, we know that for patients that have experienced weight loss, they may require an extra 400-1000kcals per day to promote an increase in weight/stores.
You mention that your husband is eating quite well which is good to hear. Keep a list of what he is managing each day. Whilst eating well could mean the inclusion of fruit, vegetables and salad for example, these are not foods high in calories and protein. This could mean that your husband is filling up without getting enough of certain macro nutrients and this could be contributing to weight loss. Again, the Dietitian will be able to make an assessment of your husband's dietary intake and advise on ways to ensure that his requirement for energy and protein are met.
Cancer cachexia could explain progressive weight loss despite adequate nutritional intake. Cachexia is a complex problem involving a change in the way the body normally uses protein, carbohydrate and fat. It is characterized by loss of weight, an accelerated loss of muscle mass and poor appetite. Whilst we don't know exactly what happens in cachexia, current thinking is that the cancer releases chemicals into the blood that can speed up metabolic rate and cause other metabolic derangements that make the body break down protein and fat faster than normal. Scientists are understanding more about cachexia and how it affects the body in the advanced stages of cancer. They are developing and investigating new drugs and supplements that may help to block the chemical causes of cachexia, and the results are awaited.
In recent years, there has been a great deal of interest in the role of fish oils (e.g. eicosopentanoic acid) in reducing or preventing cancer cachexia. Oral nutritional supplement drinks have been designed which contain fish oils and early stage clinical trials have found them to be beneficial in maintaining or increasing the weight of patients with pancreatic cancer who have cachexia. It may be that such supplements benefit people with other types of cancer but these benefits need to be clearly established.
I would recommend that your husband is assessed by a Registered Dietitian who will be able to carry out an individual nutritional assessment and help you to understand the reasons for your husband's weight loss. The Dietitian will advise on dietary modification and also discuss whether oral nutritional supplement drinks would be beneficial for your husband to try.
