How Important Is Calorie Intake During Cancer Treatment?
Registered dietitian and oncology nutritionist Julie Lanford discusses the impact of calorie intake during cancer treatment, a simple calculation to use for caloric intake, and nutrition advice for common dietary needs for boosting during treatment.
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Transcript:
Lisa Hatfield:
Nutrition plays a crucial role in supporting the body during cancer treatment. Proper nutrition can help manage side effects and maintain strength and energy. What should my caloric intake look like? I’m diving deep into this topic as part of the Patient Empowerment Network RESTORE program to uncover how best patients can best support our bodies through nutrition during treatment.
Julie, how can patients accurately determine their specific caloric needs during cancer treatment considering the increased energy demands and perhaps the patient’s existing treatment plan?
Julie Lanford:
Well, calculating caloric needs is not an exact science. So as a dietitian, we were trained in this, but even being trained, each person is very different. Treatment regimens are different, and the foods they like are different. So, we often don’t actually calculate someone’s needs, unless there is some kind of problem going on.
So typically the sign to that would be unintentional weight loss either before a diagnosis or after diagnosis and because of treatment. So if people start with losing weight and feeling like they can’t quite keep it stable, that’s when we will go through these calculations.
And someone’s medical team can do this for them, but it’s also a pretty simple sort of range that you can come up with for yourself just to see how you’re doing. So we always calculate things for whatever reason in kilograms, per calorie per kilogram. So if anybody in the audience is wanting to try to figure out some kind of range for what would help them maintain their current weight, they can take their pounds, their body weight in pounds divided by 2.2, and that will give them kilograms. And then what we use for calculations, it can be pretty broad.
So, but let’s just say in general, I might calculate for somebody a range between 25 and 35 calories per kilogram. And that is, it might seem like a lot for some people. Some people might not be familiar with how many calories are in different things. It’s really mostly meaningful if you’re somebody who’s not eating well, and you’re taking a lot of supplement drinks or things like that, that have the calories listed on them. Of course, it’s easier to figure it out that way.
I often use a calorie range to help people like that figure out, well, how many, supplement drinks like Ensure or BOOST or Carnation Instant Breakfast might you need to drink in a day if you’re not able to eat in order to help maintain your weight. So it can be helpful to have that range, but it’s not always easy for patients to figure out how many calories they’re taking in. And that’s just a general guide.
Some people’s treatment regimens or types of cancer will actually put them in more of a hypermetabolic state. And we may even estimate up to 40 calories per kilogram. And then if somebody is a small individual, not very active, and they’re not in a hypermetabolic state, even down to 20 might be something we work with. So it is quite a range, but I do think for some people it’s helpful to really compare those numbers.
Lisa Hatfield:
Julie, what are some practical tips for incorporating high-calorie, nutrient-dense foods into my diet, especially when I’m experiencing a lack of appetite or nausea?
Julie Lanford:
I’m always encouraging people to just make sure if they are nauseated to the point where it’s affecting their intake of food, then they need to be sure they’re taking nausea medicine. Whatever it is, if it’s a once a day, or the sort of quick-acting nausea medicine, or both, and making sure to take those 30 minutes before they plan to eat. And that way, once they approach the table, the nausea’s sort of settled down, and it’s easier to take those foods in.
The last thing we want is for somebody to not take their nausea medicine, then get to the table, then the smells or the looks of the foods make, they feel nauseated, they can’t eat it, then they take their nausea medicine, but then it’s like another 30 to 45 minutes before it’s kicked in, and now you’ve missed a window of opportunity to put those calories in.
So that’s your first, and I think most important when it comes to nausea. And then the second thing actually ties in very well with the poor appetite challenges, is that you just want to maximize the volume of the food you’re eating. So you may not be able to eat as much as you normally do, but if you can make those meals or snacks as calorie-dense as possible, then that way even if you eat less foods, you’re getting as many calories. And the most dense version of calories is actually fat. So as long as you’ve got your nausea under control, and your digestive system is basically kind of working okay, you can get more calories per volume by having higher fat foods. So that’s why we’re always telling people choose whole milk, choose the highest fat cheeses, peanut butter, which is a good source of healthy types of fats, heart-healthy fats, avocados.
Anytime you can include those types of things into the foods that you know you like, you’re going to be able to boost their calorie content. Other people find that actually drinking foods or calories is easier than eating them. If you don’t have much appetite, it somehow just feels like you’re eating less if you’re drinking it through a straw. So making things like smoothies, or cream soups or anything that you can think that you’ll be able to swallow.So even if it’s that you’re drinking chocolate milkshakes all day long, that is going to be better for you than not having enough to eat. Because if your body does not have the calories and the protein to sort of recover from the treatments and the challenges that you’re facing, there’s really not much no tools your body has to help with that. So I always say eating something is better than eating nothing. So don’t take any foods off the table. If you have a wide variety of choices, given your appetite challenges, of course, we want people to consume lots of nutritious, healthy, or traditionally healthy foods.
But if you can’t do that, any food is better than no food. And that’s kind of the bottom line. And remembering that the higher fat versions of things are likely to have higher calories. If you’re choosing a supplement drink, I would look at the calories and the protein to make sure and, it’s going to be higher calorie if it’s using things like real sugar rather than artificial sweeteners. So some of those drinks are kind of tailoring to the people who want to do more keto-type diet for people who are in cancer treatment and just need more calories. You need the drinks with the highest calorie content. So I would not be using those. We want the sugar that will help to add more calories into it.
Lisa Hatfield:
Okay, thank you. Julie, how often should patients reassess their caloric and protein intake with their healthcare team? And what signs should prompt them to seek adjustments to their nutritional plan? And are there any tools that patients might be able to use for screening and monitoring nutritional intake during cancer treatment?
Julie Lanford:
So there are some screening tools that treatment centers will often be using. There’s like a three question malnutrition screening tool that a lot of cancer centers have integrated, and they would be using that pretty regularly, maybe not every week, but a few times throughout treatment. But generally, the things that they’re asking on that are things that any patient should, I think, be monitoring for self-monitoring or caregivers monitoring for them, which is just what is your weight status compared to what your usual weight is. And I like to compare to someone’s usual weight, as an adult and before any inkling of cancer came around. So if somebody lost weight, significant amounts of weight before diagnosis, I’m not looking at their usual weight as at diagnosis, I’m looking at their usual weight going back. And so that’s one thing is just change in weight.
If your weight is changing, that is a sign that your nutrition strategy might need a little tweaking. If your intake is not very good, that’s another sign. So those are kind of the key things is just are you able to eat? And are you maintaining your weight? Usually people are getting weighed once a week if they’re coming in for treatments regularly. Now, if somebody is not coming in very often, you probably will need to monitor your weight at home. And yes, you need to advocate for yourself in the doctor’s office, because sometimes they just don’t pick up on those changes or they don’t see them as particularly important.
So I would say that you are somebody as a patient or a caregiver that needs to kind of bring up that conversation. If you have noted a drop, and then it some drops some more, if you’re going down and up and down and up and generally staying the same, that’s okay. But if we’re seeing drops and drops and drops, even if it’s just two pounds here, two pounds there, but you’re not rebounding, then that to me is a sign you need to make a change with your nutrition strategy.
Lisa Hatfield:
Okay, thank you. And are there any tools that patients can use to monitor that? Or do you recommend just basically using the scale and identifying if there’s weight loss and notifying their health care team? Is that the best way to monitor?
Julie Lanford:
Mainly yes, the scale is the easiest. You can do fancy things like body composition analysis, which honestly, some of those that they’ll sell to you at home probably aren’t very accurate. Perhaps they might be accurate, if you’re always comparing to yourself or if you do any workouts in the gym, and you notice that you’re just not able to do as much, but there’s so many things that impact your strength, given that you’re under cancer treatment, it’s really hard to tell. So weight is kind of the key thing. If your clothes fit differently, sometimes that can also be a sign of body composition changes, or you may notice that your body composition is changing. I would say if your body composition is changing, that also may tip you to think that your sort of exercise approach may need to be adjusted as well.
That’s the pairing of nutrition and exercise is that if your weight staying stable, but your body composition is changing, or you’ve noticed muscle loss, either through strength, or just by looking at how your body looks, you can eat enough protein, but that’s not going to build muscle, what builds muscle is using your muscles. So it needs that combination of both being physically active and perhaps using a trainer or somebody who can help you focus on different areas where you’ve noticed muscle loss, and also making sure to provide your body with those nutrients that need to build the muscles.
Lisa Hatfield:
Okay, thank you. You heard it here directly from the experts. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.
