Chemotherapy can lead to weight gain

Just don't lose weight: what to eat if you have cancer?

Diagnosis cancer. This is bad for those affected and their families. The therapy is often stressful and exhausting. Some patients may find it good when they shed a few pounds. "Cancer is often associated with a reduced appetite and unwanted weight loss," says Andrea Jaworek, head of the nutrition team at Klinikum rechts der Isar. Stop! Don't lose weight! Cancer patients need their strength in the fight against cancer. A stable weight alleviates the side effects of chemotherapy or radiation therapy and maintains quality of life and productivity. With an optimally adapted diet, the immune system can work better, cancer patients have more energy and spend less time in hospital. "The main goal of nutrition in cancer is to provide the body with sufficient energy and nutrients, to alleviate symptoms and largely to maintain the quality of life", summarizes Andrea Jaworek. Under the medical direction of Prof. Marc Martignoni and Dr. Alexander von Werder, Andrea Jaworek and her nutrition team look after around 1000 cancer patients every year at the Klinikum rechts der Isar.

Andrea Jaworek, head of the nutrition team at Klinikum rechts der Isar.

Avoid malnutrition in cancer

Some types of cancer, therapies, and medications, such as breast cancer, can lead to weight gain. But the majority of cancers are associated with unwanted weight loss if left unchecked. The tumor changes the metabolism and weakens the body. The risk of malnutrition is high. This often occurs before the actual diagnosis. Malnutrition is when a person accidentally loses at least five percent of their body weight within three to six months. With a weight of 80 kilos, that's only four kilos. Many patients are happy when they lose weight on the side. But it is also a warning sign if you are overweight.

“Working at a university hospital means that we see a lot of serious cases and also rare diagnoses,” says Andrea Jaworek. Proper nutrition is particularly tricky for patients with tumors in the gastrointestinal tract. For these patients, the physical and psychological stress is particularly high, especially after a serious operation in which, for example, large parts of the intestine, the stomach or the esophagus had to be removed. In order to give them quality of life and enjoyment of food again, nutritional therapy is a very important pillar of treatment. “Everyone has different needs and needs,” emphasizes Jaworek. The diet must be adjusted individually, depending on diagnosis, age, energy requirements and personal food preferences.

The interdisciplinary nutrition team

The interdisciplinary nutrition team advises inpatients, semi-inpatients and outpatients at the Klinikum rechts der Isar on diet-related illnesses and diseases that result in nutritional problems, e.g. gastrointestinal diseases, pancreatic diseases or various types of cancer. Nutrition is an important pillar of therapy for patients. The aim is to improve or maintain the nutritional status, reduce symptoms such as nausea or indigestion, and ensure quality of life.

Special case: stomach cancer, esophageal cancer and colon cancer

"If, for example, the stomach has to be removed when diagnosing gastric cancer, which is called gastrectomy in technical terms, the small intestine is connected directly to the esophagus," explains the head of the nutritional advice service. With far-reaching consequences: the stomach normally passes on the pre-digested food pulp in small amounts to the small intestine. Now this natural reservoir function is missing. The denaturation of proteins by gastric acid no longer takes place either. If the diagnosis is esophageal cancer, the esophagus must be removed in whole or in part, depending on the tumor. The stomach is then reshaped into a narrow replacement esophagus and pulled upward. Removing parts of the intestine also has serious consequences for food intake and digestion. “The intestine is responsible for absorbing nutrients with different functions depending on the section. Some sufferers have to inject certain nutrients from now on because they lack the special section of the intestine for natural absorption, ”explains Andrea Jaworek.

Patients with gastroenterological cancer have to struggle particularly hard with nausea, loss of appetite, diarrhea, vomiting, changes in taste or difficulties in chewing and swallowing. Food that is difficult to digest, such as legumes, whole grain products, but also breaded and deep-fried foods, can often no longer be tolerated. “It is very difficult for these patients to even meet their daily energy needs. Especially since the need for calories in cancer can be increased. Depending on the activity, you calculate with around 30-35 kcal per kilo of body weight, that's 2100-2450 kcal at 70 kilos, ”says Andrea Jaworek. Psychologically it is also hard to accept that suddenly it is over after half a pretzel if you were hungry enough for a three-course meal before the illness.

· Lots of small servings, around five to six meals a day

· Enrich healthy foods with high calories with cream, butter or oil

· Eat high-calorie and protein-rich foods, add drinking food if necessary

· Eat in a nice atmosphere / in company

· Arrange food nicely on large plates

· Quickly available, tasty dishes at hand

· Immediately indulge in the desire to eat

· Try different consistencies and temperatures

Enrich healthy foods with high calories

“We advise our patients to eat at least five to six small meals a day. It is ideal if you enrich healthy foods with cream, butter or oil, ”explains the nutritionist. The extra shot of cream in the soup is wanted from now on, as is the creamy yoghurt or the plentifully cheese-baked casserole. If you can't eat a whole slice of bread, you should brush half of the bread with more butter to get the calories you need.

That sounds enviable, but it's not. “The pressure to have to eat and maintain your weight is extremely high,” says Jaworek. Then it can help, for example, to arrange the food nicely on a large plate - the eye can eat and it looks less than it is. Consistency and temperature also play a role: patients with taste disorders often find cold dishes with a soft consistency to be more pleasant. Energy-rich sip foods can also be an option - at home too. "We advise our patients to eat something immediately when they feel like it." A cancer patient often fails to cook for long. A well-stocked pantry and favorite foods that are readily available are then important. Andrea Jaworek: “Eating is not just about taking in calories, it is about quality of life and the joy of life. If we can give this back to our patients, we have done a good job. "