Weight loss (unwanted)

Cachexia is a form of extreme leanness, which occurs in the terminal phase of chronic conditions such as cancer, serious infectious diseases (TB, AIDS), great old age, ... Cachexia mainly occurs in malignant tumors of the lungs, esophagus, stomach, stomach intestines and pancreas.

Symptoms 

The most important symptom of cachexia is weight loss, both from fat and muscle tissue and even from bone mass. Loss of appetite (anorexia), general weakness (asthenia) and a decrease in hemoglobin (anemia) are also important symptoms. Treating cachexia is not simply a matter of eating more. Even if you eat or try to eat more, or if you receive tube feeding directly into the stomach or bloodstream, the condition is not reversible.

Causes

Recent research gradually offers more insight into the causes of cachexia. It is the result of a very complex pseudo-inflammatory reaction of the body to the existing tumor, a reaction that completely removes the metabolism (metabolism) from its normal. Substances such as cytokines play an important role in this. Sometimes the tumor itself produces substances that cause cachexia. In cachexia, in addition to the pseudo-inflammatory response, there is also an increase in metabolism and a change in the way the body uses proteins, fats, and carbohydrates.

Therapy

New drugs and nutritional supplements to block those reactions are in full development. Substances such as omega-3 fatty acids, antibody-based components and also thalidomide (softening, which became discredited in the 1960s because it appeared to cause birth defects) are eligible. As cachexia occurs not only in cancer but also in AIDS, advanced kidney disease, serious infections, etc., the new developments can hopefully provide a solution for a whole range of patients. 

Inexplicable weight loss

Weight loss that at first glance seems inexplicable is a common consequence of a cancer process and in some cases even the first sign of a tumor that has not yet been diagnosed. Weight loss in cancer patients can have all kinds of causes. In many cases, it will be reversible and have nothing to do with the metabolic imbalance of 'real' cachexia. For example, a tumor may obstruct the passage of the throat, mouth or esophagus in such a way that swallowing or eating is painful or difficult so that eventually weight loss will occur. Removing the tumor can offer a solution in those cases.

Reversible weight loss

In addition to a tumor, treatment can also make it more difficult to ingest sufficient energy. For example, irradiation of the esophagus can make it more difficult to swallow and irradiation of the intestine can lead to diarrhea. Chemotherapy can cause nausea and vomiting, and other symptoms that disrupt food intake. These side effects cause a temporary weight loss. In the case of such complaints, which do not fall under the term cachexia because the weight loss is reversible, the advice of a nutritionist or dietitian can help to reduce or resolve the complaints and thus stop weight loss. 

Cachexia, patient and environment

Cachexia is not only difficult for the patient himself. It is also extremely hard for the environment to see the patient 'deteriorate'. A normal reaction is, therefore: with all means the patient tries to get the food to eat, which does not always succeed or which regression, even if it succeeds, unfortunately, does not stop. 

It is not a good idea to force the patient to eat. A well-known American professor and hematologist-oncologist put it this way: "A lack of appetite is not painful, but forced eating can be." make the most of the moments when you do want to eat. 

Nutrition tips

• Try to drink at least 1.5 liters per day, between meals.
• Distribute the diet throughout the day, with many small meals.
• Do not skip meals.
• Take enough time for the meal; eat as much as you want and can.
• Eat what you feel like, taking in enough energy is the message right now, even if you do not always get this energy from equally healthy things such as cookies, candy, chips, ...
• Choose energy-rich foods and add them to preparations and meals: fatter types of fish, vegetable 
  oils to stew vegetables and fry meat and fish, add some vegetable cream to soups, sauces, coffee, ...
• Fat is an energy source. Therefore, do not use lean or light products. Generously spread butter or margarine on bread and cake and melt a knob of butter through the vegetables or porridge.
• Feel free to drink chocolate milk or eat (cream) ice cream, cake, candy or cake.
• Try to limit raw vegetables, fruit and fiber-rich products with meals; they quickly give a feeling of satiety. Take them in between, with dip sauce made from peanut butter (or other nut paste) with fruit and dip sauce such as guacamole (avocado dip) with vegetables. Or make 'energy balls' by mixing finely chopped dried fruit, nuts, honey, and some muesli and rolling them into balls. Store in a refrigerator or freezer.
• Add honey or sugar to drinks and dishes.
• Take something extra as a snack, such as milk, pudding, cookies, pieces of cheese, nuts, dried fruit, and savory snacks.
• If the weight loss continues despite the application of these tips, adding powdered preparations (extra calories, proteins, etc.) to the diet or switching on drinking nutrition (usually extra calories, and possibly also proteins, as a supplement to the regular diet) are useful. This is available at the pharmacy. However, never switch this on your own, first consult the treating physician or a specialized oncological dietitian .