Guidelines for Effective Weight Loss and Weight Gain during Cancer Treatment

Thursday, May 17, 2007 - 4:34pm

The following excerpt is adapted from; What to Eat If You Have Cancer: Healing Foods That Boost Your Immune System by Maureen Keane, MS, and Daniella Chace, MS (McGraw-Hill, 2006).

Maintaining a healthy body weight and making good food choices that give your body the right nutrients can sometimes be a challenge. But if you are preparing for cancer treatment, now more than ever is the time to focus on your body's nutritional needs. The fact is that maintaining a healthy body weight may contribute to your recovery and the success of your treatment plan.

Keep in mind that a thin, underweight body may not be able to tolerate the stress of cancer treatment. At the other end of the spectrum, there is evidence that being overweight may increase the chance of cancer recurrence. So whether your goal is weight loss or weight gain during treatment, you'll want to be sure that you are getting the nutrients your body needs to heal while carefully eliminating foods that no longer serve you.

Weight-gain guidelines

If you have a low body weight, it is likely that you also have low levels of lean muscle tissue, low stores of fat, and low stores of essential vitamins and minerals such as vitamin A, iron, and calcium. Some patients with a low body weight have difficulty tolerating cancer treatment. This is because those necessary stores that a healthy body builds up are depleted; and problems occur when, for example, a person with a low body weight does not have the necessary energy reserves for that needed boost on days when it may be difficult to eat.

A low body weight may be the result of a naturally high metabolism or of careful management of food intake and energy expenditures. Other times it is a sign of malabsorption or malnutrition. If you have trouble gaining or maintaining weight, it is important to inform your doctor to be sure that there are no medical factors that need to be addressed. For example, if you have a thyroid problem or a disease that causes malabsorption-such as celiac disease-you will want to address these issues before cancer treatment begins.

Preparation for cancer treatment is not the right time to be on a calorie-restricted diet (fewer than 1,200 calories per day) with the intention of losing weight. It is impossible to get all of the nutrients you need to prepare your body for treatment when you are consuming this limited amount of calories. At this point you need to be storing nutrients to help fuel your immune system as you undergo treatment.

On the other hand, do not eat indiscriminately in a quest for calories. Fried foods and sweets will indeed result in weight gain-but not the type you need. Junk food will do nothing to build nutrient stores or lean muscle tissue. Be mindful of the nutritional value of the foods you choose.

Weight-gain tips and food choices

When your goal is to build a healthy body for treatment, certain foods pack an especially powerful nutritional punch. Choose those that provide you with more than just empty calories.

Nuts and seeds are an excellent choice when you are looking for a nutrient-rich snack that will help you build a healthy body. They are rich in cancer-fighting and heart-healthy oils and are high in protein. But again, be mindful: Don't just grab any snack that includes nuts or seeds. Avoid nuts and seeds that are flavored, oiled, fried, or salted. Eat yogurt- or chocolate-coated nuts only in small quantities.

Tips for adding nuts and seeds to your diet

1.   Whole nuts and seeds

One serving equals one medium handful. Sprinkle seeds and crushed nuts on cereals, vegetables, and salads. Mix them with a small amount of dried fruit and eat as a snack or small meal. Use them as a crunchy topping on casseroles.

2.   Nut and seed butters

One serving equals 3 tablespoons. Examples of nut butters include sesame seed butter (tahini), hazelnut butter, and peanut butter. To make your own nut butter, add fresh unsalted nuts to a blender, food processor, or food grinder. Add sweeteners such as molasses or honey and seasonings such as cinnamon or nutmeg. Process until smooth.

3.   Savory nut butters

One serving equals 3 tablespoons. These can be made by adding garlic, onions, peppers, or other seasonings to the unsweetened nuts. Dilute nut butters with canola, flaxseed, or olive oil and use as a salad dressing; or mix them with a little soymilk and use as a sauce or a vegetable dip.

4.   Nut milks

Commercially available nut milks, which can be purchased at health-food stores and some grocery stores, include coconut milk, almond milk, and hazelnut milk. Nut milks can easily be made at home. Just add a handful of nuts to a blender with 1 cup of filtered water. Process until the water is milky in color. Strain to remove the fiber and store in the refrigerator. Nut milks can be sweetened with honey or molasses and then blended with fruit juice, dried fruit, soft whole fruit, yogurt, or soymilk to produce a calorie-rich shake. Store in the refrigerator, where it will keep for four or five days.

Incorporating smoothies into your diet is another option for promoting healthy weight gain. There are a multitude of ingredients that can enhance the nutritional value of a simple fruit smoothie, including flaxseed oil, protein powder (soy, rice, or whey), ground flaxseed for increased fiber, and nut butters.

In addition to choosing foods like nuts, seeds, and smoothies that pack a nutritious punch, you might try changing some of your mealtime habits to ensure that eating continues to be an enjoyable part of your day. For instance, try eating five or six small meals per day instead of two or three large ones. If you cannot manage to eat all of the recommended vegetable servings, try juicing some of them. Choose foods that are as appealing to the eye as they are to the palate. And try to make mealtimes a pleasant experience by relaxing beforehand, eating with friends or family, and creating a positive atmosphere at the table. All of these small changes to your routine may help you enjoy the food you eat and will make your mealtime experience more pleasurable, enabling you to get the nutrition you need.

A few more tips

  • Foods that taste sweet should be eaten only on a full stomach.
  • Drink eight to 10 glasses of (preferably filtered) water per day.
  • Drink half a glass of water with a teaspoon of lemon juice to stimulate digestive juices a half hour before mealtime.
  • Exercise for about a half hour before meals to stimulate your appetite.
  • Don't drink fluids or soups with meals; they will fill you up and leave no room for foods that are dense in nutrients.
  • If you do not gain weight, increase serving sizes.

For more information on gaining weight during your cancer treatment see the following article from TheDietChannel: Increase Your Calories & Protein during Cancer Treatment.

When you have lost weight before or during treatment

A 5 percent weight loss from your normal weight is considered significant. Losing 10 percent of your normal weight is a red flag. A 15 percent weight loss may lead to fatigue, depression, and loss of appetite and can reduce your body's ability to heal.

If you have lost a lot of weight as a result of your cancer treatment, your physician may want you to increase the amount of fats in your diet. This is because fats and other lipids are a concentrated source of energy. Carbohydrates and proteins each contribute 4 calories for every gram consumed. Fats contribute 9 calories per gram, more than double the other energy sources. Fats are also easily stored in the body, providing you with a backup energy source for times when you cannot eat.

If your doctor recommends that you increase the fat in your diet, look for foods that are high in omega-3 or monounsaturated fatty acids, such as canola or olive oil. The fatty acids in coconut milk are also a good choice because they are high in medium-chain triglycerides, which are easily absorbed with minimal digestion. The foods rich in monounsaturated fats will not only increase your caloric intake but also aid in preventing metastasis and enhance your immune system.1,2

Sometimes radiation and chemotherapy can cause temporary intestinal damage, which decreases your ability to digest fats. If this happens, your stools will be frequent, bulky, and light in color. Treatment may also affect the liver's ability to produce bile, which also results in fat malabsorption. Pancreatic enzymes may be reduced by treatment, as well. If you suffer from malabsorption, you may want to speak with your doctor about adding a digestive enzyme supplement to your diet.

Weight loss and cancer treatment

Weight loss can be beneficial for cancer patients both as a preventive measure and to aid recovery. There is evidence that being overweight may increase the chances of cancer recurrence, especially with hormone-related cancers.3 In breast cancer patients who are overweight, weight loss can aid the healing process.4,5

Set reasonable weight-loss goals

Needless to say, losing weight is easier said than done. To help the process along, set realistic goals. Start with a moderate goal of 10 percent. This means if you weigh 200 pounds, your first 10 percent will be 20 pounds; your second 10 percent will be 18 pounds. After that first 10 percent, your risk of developing many diseases decreases substantially. You do not have to aim for an "ideal" weight, which is often unrealistically low. Moderate reductions are easier to sustain and are accompanied by many of the same benefits you would gain with more ambitious-and more difficult-weight-loss goals.

What to eat for weight loss

If you do not already eat a whole-foods diet, this is a good time to start. The term whole foods refers to foods that are minimally processed and do not contain additives or preservatives. For example, if you were making a food choice based on a whole-foods diet, you would choose grains and beans over refined white bread and pasta.

When people first begin a whole-foods diet, they often lose weight because the higher fiber content of the food causes satiety and increases metabolism. In addition to eating whole foods, practice portion control and concentrate on the quality of the foods you choose. If you set your sights on becoming healthier, rather than thinner, you might be surprised at how quickly you start seeing results.

Portion control for weight control

Portion size is the key to weight control. Supersized portions are a major cause of obesity in the United States, and monitoring portion sizes can help you regain control of your weight. Here are some tips to help you with portion control:

  • Buy yourself a set of measuring cups and spoons. For one month measure everything you eat. This will teach you how to estimate portion sizes.
  • Most restaurants serve at least double serving sizes. Eat half your entrée and take the rest home for lunch or dinner the next day.
  • Stop serving meals family-style. Rather than bring all the food to the table and have everyone fill their own plates, measure food out in the kitchen for the adults and allow no seconds.
  • Let young children determine how much they want to eat. Adults often overestimate a child's energy needs and offer too much food. Insisting that your children finish all the food on their plates is the same as encouraging them to overeat.
  • Divide your plate into quarters. One quarter should be filled with a protein food, one with a whole-grain starch or starchy vegetable, and two quarters with vegetables. In at least one meal each day, half of the vegetables should be raw, such as a salad or raw vegetable appetizer.
  • Choose a serving of fruit for dessert.
  • You should be able to see your plate under the food. If you like the sight of your plate piled high, switch to a small salad plate.
  • Start dinner with a low-calorie soup course. This can curb your hunger, so you eat less for the rest of the meal.

Managing your weight during cancer treatment does not need to be a daunting task. Learn to listen to your body's needs. Making methodical lifestyle changes will help you achieve your goal-whether it's maintenance, weight loss, or weight gain-and will support your overall health as well as assist you in your recovery.


Weight-gain Smoothies

The following recipes are from More Smoothies for Life by Daniella Chace (Random House, 2007). For best results, combine all ingredients in a blender or food processor and purée until smooth. Served chilled.

Peanut Butter Cup

1 cup organic milk
1 cup ice
¼ cup nonfat dry milk or protein powder
1 tablespoon organic flaxseed oil
2 tablespoons cocoa powder
2 tablespoons peanut butter or almond butter
1 tablespoon toasted wheat germ

Use organic milk or a milk substitute such as rice milk, almond milk, oat milk, or soymilk; whey also works well in smoothies because it dissolves easily, making creamy drinks. It also contains detoxifying agents such as glutathione that help remove metals and environmental chemicals from our bodies. If you are allergic or sensitive to dairy products, however, try one of the alternatives such as soy, rice, or pea protein.

Chai Crème Frappe

1 cup chai tea
1 cup milk
½ cup ice
¼ cup nonfat dried milk
1 tablespoon honey

Nonfat dry milk adds creaminess to recipes and a substantial dose of protein. Each tablespoon adds more than a gram of easily metabolized protein.

Weight-loss Recipes

Quinoa Tabouli Salad

Fresh parsley, mint, and lemon juice are the bright flavors that make this Lebanese dish so popular. Quinoa cooks quickly; it is easy to digest, high in fiber, and fairly high in protein. It's also delicious!

1 cup cooked quinoa
1 green onion, minced
1¼ cup minced parsley
½ cup fresh mint, minced
1 tablespoon lemon juice
1 tablespoon extravirgin olive oil
1 teaspoon cumin
white pepper to taste

Precook quinoa, following the instructions on the package. It's very simple and takes only minutes to prepare. Combine all ingredients and chill. Serves 4.

White Bean Salad

1 can white beans, drained and rinsed
1 cup chopped fresh Italian parsley
2 fresh tomatoes, chopped
½ red onion, minced
juice of ½ a lemon
2 tablespoons balsamic vinegar
¼ teaspoon sea salt
1 tablespoon extravirgin olive oil

Mix all ingredients and serve or chill. Serves 4.

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[2]. Tisdale MJ, Brennan RA. A comparison of long-chain triglycerides and medium-chain triglycerides on weight loss and tumour size in cachexia model. British Journal of Cancer. 1988;58(5):580-583.

[3]. Samanic C, Chow WH, Gridley G, Jarvholm B, Fraumeni JF Jr. Relation of body mass index to cancer risk in 362,552 Swedish men. Cancer Causes and Control. 2006;17(7):901-909.

[4]. Eliassen AH, Colditz GA, Rosner B, Willett WC, Hankinson SE. Adult weight change and risk of postmenopausal breast cancer. Journal of the American Medical Association. 2006;296(2):193-201.

[5]. Kuhl H, Stevenson J. The effect of medroxyprogesterone acetate on estrogen-dependent risks and benefits-an attempt to interpret the Women's Health Initiative results. Gynecological endocrinology. 2006;22(6):303-317.