Symptoms: Controlling Weight Loss

Weight loss is a common problem in individuals with cancer of the pancreas and/or after a Whipple procedure, the most common surgery for pancreatic cancer.  The weight loss can be associated with treatment or the cancer itself.  Tumor-induced weight loss, also known as cancer cachexia, is a complex problem that affects the way calories and protein are used in the body.  Cancer cachexia can cause the body to burn more calories than usual, break down muscle protein and at the same time decrease appetite.

Tumor-Induced Weight Loss
Most pancreatic tumors release compounds called cytokines into the blood, which alter the body’s use of nutrients (proteins, carbohydrates and fats).  In addition to altering nutrient metabolism, cytokines cause the body to burn calories faster than they are replaced.  The body’s appetite is then suppressed causing decreased food intake.  This process leads to thinner bodies, smaller muscles and fatigue.  Weight loss and malnutrition can have a significant impact on quality of life, daily functioning, response to treatment, longer or unexpected hospital stays and complications such as infections.

Strategies for helping individuals with tumor-induced weight loss are nutrition counseling, oral nutrition supplements and appetite-stimulating medications.  Controlling tumor growth through treatment (e.g., chemotherapy, chemoradiation therapy) can also assist in controlling weight loss.

Some evidence suggests that fish oil may decrease tumor-induced weight loss.  Specifically, EPA (eicosapentaenoic acid), a building block of fish oil, has been shown in studies to be beneficial in weight gain and rebuilding lean body mass.  EPA is one of the omega-3 polyunsaturated fatty acids found in fish oil that may help ease cancer cachexia by decreasing the metabolic changes associated with the production of cytokines discussed above.  While the average American diet includes only about 0.1 gram of EPA per day from EPA food sources found naturally in deep sea oily fish (e.g., salmon, mackerel, herring, sardines and tuna), studies show the optimal dose is 2 grams per day.  Nutritional supplements, such as Boost®, Ensure® and Scandical®, may be used in combination with the EPA-containing supplements to aid in weight gain.  Ask your doctor or registered dietitian about the options that may be best for your individual needs.

Deodorized fish oil is available in capsules, liquid or a pudding-like mixture.  Common complaints reported with fish oil and EPA capsules include fishy taste, odor and burping.  However, there are now products available that are deodorized and flavored to reduce or eliminate these negative side effects.  Because the FDA does not regulate supplements, the quality and dosage of the EPA found in capsules and liquids varies between manufacturers.  For information on the safety and potency of fish oil supplements, go to ConsumerLab.com.

If oral supplement drinks are already being consumed by the patient, the combination of EPA, protein and calories in special medical nutritional products may be the optimal way of taking EPA.  A doctor or registered dietitian should advise the patient about taking EPA, the source and the amount.

MCT (Medium Chain Triglyceride) oil and FOS (fructooligosaccharide) fiber are other nutrients which may help control weight loss.  MCT oil is a calorie-rich type of fat that is rapidly absorbed by the body.  It is found naturally in coconut oil, palm kernel oil and butter.  It is also added to some medical nutritional supplements and can be purchased alone as a nutritional supplement.  FOS fiber stimulates the growth of healthy intestinal bacteria and improves nutrient absorption, providing additional calories for energy and reducing incidence of diarrhea.  FOS fiber is naturally occurring in vegetables such as leeks, onions and asparagus and can also be purchased as a nutritional supplement.  Studies have shown that FOS does not influence glucose or lipid metabolism in diabetics.  Use of oral nutritional supplements may promote weight gain, help increase strength and physical activity and improve quality of life.

The following tips may assist in controlling weight loss:

• Consult with a registered dietitian for nutrition counseling.
• Get plenty of rest.
• Schedule meals five to six times per day including snacks in between meals throughout the day.
• Eat calorie-rich, nutrient-dense foods and try not to consume foods or liquids with little nutritional value, like soft drinks.
• Restrict or avoid any foods that may cause or worsen diarrhea.
• Use medical nutritional products, such as Boost®, Ensure® and Carnation® Instant Breakfast®, as snacks or drink with medications that can be taken with food.
• If tumor-induced weight loss is suspected, consider using protein and energy dense oral supplements containing MCT oil, EPA and FOS fiber.
• Consider use of pancreatic enzymes and consult with a doctor on proper directions for their use.
• Check with the doctor to see if medications would be helpful in controlling weight loss.
• Maintain adequate hydration.
• Be active:
• Aim for a total of 30 minutes per day of activity, such as walking.
• Break activity into small increments (five to ten minutes at a time, totaling 30 minutes per day).

Products on the Market for Weight Gain

SCANDISHAKE®

Carnation® Instant Breakfast®

Boost®

Ensure®

Additional Resources

American Dietetic Association

American Dietetic Association: Oncology Nutrition Dietetic Practice Group

ConsumerLab.com

The information and services provided by the Pancreatic Cancer Action Network, Inc. are for informational purposes only.  The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment.  If you are ill, or suspect that you are ill, see a doctor immediately!  The Pancreatic Cancer Action Network does not recommend nor endorse any specific physicians, products or treatments even though they may be mentioned on this site.  080922