Malnutrition Among Cancer Patients

Howard Hughes, the multi-billionaire, died of malnutrition. It is hard
to believe that there can be malnutrition in this agriculturally abundant
nation of ours–but there is. At the time of the Revolutionary War, 96%
of Americans farmed while only 4% worked at other trades. Tractors and harvesting
combines became part of an agricultural revolution that allowed the 2% of
Americans who now farm to feed the rest of us. We grow enough food in this
country to feed ourselves, to make half of us overweight, to throw away
enough food to feed 50 million people daily, to ship food overseas as a
major export, and to store enough food in government surplus bins to feed
Americans for a year if all farmers quit today. With so much food available,
how can Americans be malnourished?

The answer is: poor food choices. Americans choose their food based upon
taste, cost, convenience and psychological gratification–thus ignoring
the main reason that we eat, which is to provide our body cells with the
raw materials to grow, repair and fuel our bodies. The most commonly eaten
foods in America are white bread, coffee and hot dogs. Based upon our food
abundance, Americans could be the best nourished nation on record. But we
are far from it.

Overwhelming evidence from both government and independent scientific surveys
shows that many Americans are low in their intake of:¹

Meanwhile, we also eat alarmingly high amounts of: fat, salt, sugar, cholesterol,
alcohol, caffeine, food additives and toxins.

This combination of too much of the wrong things along with not enough of
the right things has created epidemic proportions of degenerative diseases
in this country. The Surgeon General, Department of Health and Human Services,
Center for Disease Control, National Academy of Sciences, American Medical
Association, American Dietetic Assocation, and most other major public health
agencies agree that diet is a major contributor to our most common health
problems, including cancer.

The typical diet of the cancer patient is high in fat while being low in
fiber and vegetables–“meat, potatoes, and gravy” is what many
of my patients lived on. Data collected by the United States Department
of Agriculture from over 11,000 Americans showed that on any given day:

41 percent did not eat any fruit
82 percent did not eat cruciferous vegetables
72 percent did not eat vitamin C-rich fruits or vegetables
80 percent did not eat vitamin A-rich fruits or vegetables
84 percent did not eat high fiber grain food, like bread or cereal³

The human body is incredibly resilient, which sometimes works to our disadvantage.
No one dies on the first cigarette inhaled, or the first drunken evening,
or the first decade of unhealthy eating. We misconstrue the fact that we
survived this ordeal to mean we can do it forever. Not so. Malnutrition
can be blatant, as we see in the starving babies in third world countries.
Malnutrition can also be much more subtle.

It was the Framingham study done at Harvard University that proclaimed:
“Our way of life is related to our way of death.” Typical hospital
food continues or even worsens malnutrition. While many Americans are overfed,
the majority are also poorly nourished. If proper nutrition could prevent
from 30 to 90% of all cancer, then doesn’t it seem foolish to continue feeding
the cancer patient the same diet that helped to induce cancer in the first
place?

Malnutrition Among Cancer Patients

From 25-50% of hospital patients suffer from protein calorie malnutrition.
Protein calorie malnutrition leads to increases in mortality and surgical
failure, with a reduction in immunity, wound healing, cardiac output, response
to chemo and radiation therapy, plasma protein synthesis and generally induces
weakness and apathy. Many patients are malnourished before entering the
hospital and another 10% become malnourished once in the hospital. Nutrition
support, as peripheral parenteral nutrition, has been shown to reduce the
length of hospital stay by 30%. Weight loss leads to a decrease in patient
survival. Common nutrient deficiencies, as determined by experts at M.D.
Anderson Hospital in Houston, include protein, calorie, thiamin, riboflavin,
niacin, folate and K.

So nutrition therapy has two distinct phases:

1. Take the clinically malnourished patient and bring them up to
“normal” status.

2. Take the “normal” sub-clinically malnourished person
and bring them up to “optimal” functioning. For at least the few
nutrients tested thus far, there appears to be a “dose-dependent”
response– more than RDA levels of intake provide for more than “normal”
immune functions.

Not only is malnutrition common in the “normal” American, but
malnutrition is extremely common in the cancer patient. A theory has persisted
for decades that one could starve the tumor out of the host. That just ain’t
so. The tumor is quite resistant to starvation and most studies find more
harm to the host than the tumor in either selective or blanket nutrient
deficiencies.⁴ Pure malnutrition (cachexia) is responsible for
at least 22% and up to 67% of all cancer deaths. Up to 80% of all cancer
patients have reduced levels of serum albumin, which is a leading indicator
of protein and calorie malnutrition.⁵ Dietary protein restriction
in the cancer patient does not affect the composition or growth rate of
the tumor, but does restrict the patient’s well being.⁶

A commonly used anti-cancer drug is methotrexate, which interferes with
folate (a B vitamin) metabolism. Many scientists guessed that folate in
the diet might accelerate cancer growth. Not so. Depriving animals of folate
in the diet allowed theirs tumor to grow anyway.⁷ Actually, in
starved animals, the tumors grew more rapidly than in fed animals, indicating
the parasitic tenacity of cancer in the host.⁸ Other studies
have found that a low folate environment can trigger “brittle”
DNA to fuel cancer metastasis.

There is some evidence that tumors are not as flexible as healthy host tissue
in using fuel. A low carbohydrate parenteral formula may have the ability
to slow down tumor growth by selectively starving the cancer cells.⁹
Overall, the research shows that starvation provokes host wasting while
tumor growth continues unabated.¹⁰

A position paper from the American College of Physicians published in 1989
basically stated that TPN had no benefit on the outcome of cancer patients.¹¹
Unfortunately, this article excluded malnourished patients, which is bizarre,
since TPN treats malnutrition, not cancer.¹² Most of the scientific
literature shows that weight loss drastically increases the mortality rate
for most types of cancer, while also lowering the response to chemotherapy.¹³

Parenteral feeding improves tolerance to chemotherapeutic agents and immune
responses.¹⁴ Of 28 children with advanced malignant disease,
18 received parenteral feeding for 28 days with resultant improvements in
weight gain, increased serum albumin, and transferrin and major benefits
in immune functions. In comparing cancer patients on TPN versus those trying
to nourish themselves by oral intake of food, TPN provided major improvements
in calorie, protein, and nutrient intake but did not encourage tumor growth.
Malnourished cancer patients who were provided TPN had a mortality rate
of 11% while the group without TPN feeding had a 100% mortality rate.¹⁵
Pre-operative TPN in patients undergoing surgery for GI cancer provided
general reduction in the incidence of wound infection, pneumonia, major
complications and mortality.¹⁶ Patients who were the most malnourished
experienced a 33% mortality and 46% morbidity (problems and illness) rate,
while those patients who were properly nourished had a 3% mortality rate
with an 8% morbidity rate. In 49 patients with lung cancer receiving chemotherapy
with or without TPN, complete remission was achieved in 85% of the TPN group
versus 59% of the non-TPN group.¹⁷ A TPN formula that was higher
in protein, especially branched chain amino acids, was able to provide better
nitrogen balance in the 21 adults tested than the conventional 8.5% amino
acid TPN formula.¹⁸

A finely tuned nutrition formula can also nourish the patient while starving
tumor cells. Enteral (oral) formulas fortified with arginine, fish oil and
RNA have been shown to stimulate the immune system, accelerate wound repair
and reduce tumor burden in both animals and humans. Diets with modified
amino acid content, low tyrosine (2.4 mg/kg body weight) and low phenylalanine
(3.5 mg/kg body weight), were able to elevate natural killer cell activity
in 6 of 9 subjects tested.¹⁹

In 20 adult hospitalized patients on TPN, the mean daily vitamin C needs
were 975 mg, which is over 16 times the RDA, with the range being 350-2250
mg.²⁰ Of the 139 lung cancer patients studied, most tested deficient
or scorbutic (clinical vitamin C deficiency).²¹ Another study
of cancer patients found that 46% tested scorbutic while 76% were below
acceptable levels for serum ascorbate.²² Experts now recommend
the value of nutritional supplements, especially in patients who require
prolonged TPN support.²³ The Recommended Daily Allowance (RDA)
is inadequate for many healthy people and nearly all sick people.

The take-home lesson here is that:

1. At least 20% of Americans are clinically malnourished, with 70%
being sub-clinically malnourished (less obvious), and the remaining “chosen
few” 10% in good to optimal health.

2. Once these malnourished people get sick, the malnutrition oftentimes
gets worse through higher nutrient needs and lower intake

3. Once at the hospital, malnutrition escalates another notch

4. Cancer is one of the more serious wasting diseases known

5. A malnourished cancer patient suffers a reduction in quality and
quantity of life, with higher incidences of complications and death

6. The only solution for malnutrition is optimal nutrition

References

1. Quillin, P., HEALING NUTRIENTS, p.43, Vintage Books, NY, 1989

2. Kune, GA, and Kune, S., Nutrition and Cancer, vol.9, p.1, 1987

3. Patterson, BH, and Block, G., American Journal of Public Health, vol.78,
p.282, Mar.1988

4. Axelrod, AE, and Traketelis, AC, Vitamins and Hormones, vol.22, p.591,
1964

5. Dreizen, S., et al., Postgraduate Medicine, vol.87, no.1, p.163, Jan.1990

6. Lowry, SF, et al., Surgical Forum, vol.28, p.143, 1977

7. Nichol, CA, Cancer Research, vol.29, p.2422, 1969

8. Norton, JA, et al., Cancer, vol.45, p.2934, 1980

9. Dematrakopoulos, GE, and Brennan, MF, Cancer Research, (sup.),vol.42,
p.756, Feb.1982

10. Goodgame, JT, et al., American Journal of Clinical Nutrition, vol.32,
p.2277, 1979

11. Annals of Internal Medicine, vol.110, no.9, p.735, May 1989

12. Kaminsky, M. (ed.), HYPERALIMENTATION: A GUIDE FOR CLINICIANS, Marcel
Dekker, NY, Oct.1985

13. Dewys, WD, et al., American Journal of Medicine, vol.69, p.491, Oct.1980

14. Eys, JV, Cancer, vol.43, p.2030, 1979

15. Harvey, KB, et al., Cancer, vol.43, p.2065, 1979

16. Muller, JM, et al., Lancet, p.68, Jan.9, 1982

17. Valdivieso, M., et al., Cancer Treatment Reports, vol.65, sup.5, p.145,
1981

18. Gazzaniga, AB, et al., Archives of Surgery, vol. 123, p.1275, 1988

19. Norris, JR, et al., American Journal of Clinical Nutrition, vol.51,
p.188, 1990

20. Abrahamian, V., et al., Journal of Parenteral and Enteral Nutrition,
vol.7, no.5, p.465, 1983

21. Anthony, HM, et al., British Journal of Cancer, vol.46, p.354, 1982

22. Cheraskin, E., Journal of Alternative Medicine, p.18, Feb.1986

23. Hoffman, FA, Cancer, vol.55, 1 sup.1, p.295, Jan.1, 1985