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Diet problems research

Researchers are looking at ways to prevent and treat cancer cachexia.

Researching diet problems

Why we need research

Scientists have to fully research all treatments. Only then can they become standard treatment for everyone. This is so that we can be sure they are safe and work better than the treatments we already use.

Research into diet problems

There is ongoing research into new ways of treating diet problems and cancer.

Scientists have developed better drugs to help control sickness in the last 20 years. A lot of research in nutrition and cancer has been into preventing cancer through diet. More research is now looking into cancer cachexia.

Cachexia

People with cachexia lose muscle and often fat as well. It often happens with people in advanced cancer.

Cachexia is also called wasting syndrome or anorexia cachexia syndrome. Anorexia means loss of appetite.

Cachexia is more than only loss of appetite. It is a complex problem. It involves changes in the way your body uses proteins, carbohydrates, and fat. You may also burn up calories faster than usual.

Drug therapy: drugs that block cytokines

Scientists think that cancer causes the immune system to release certain chemicals into the blood. This causes inflammation. These chemicals are called cytokines. They contribute to the loss of fat and muscle in people with cachexia. Knowing this, they are trying to find drugs to help block cytokines.

Thalidomide

Thalidomide got a bad name for causing birth defects in the late 1950s and early 1960s. But it is only dangerous if taken in pregnancy.

Previous trials looked at the use of thalidomide in people with cachexia. Thalidomide seems to interfere with certain cytokines in cachexia. Some of the results showed that thalidomide:

  • improved appetite
  • increased lean body mass

But a 2012 Cochrane systematic review Open a glossary item looked at thalidomide and cachexia. It was in people with advanced cancer. The researchers found that there was not enough scientific evidence to say that thalidomide can or cannot help with cachexia.

Non steroidal anti inflammatory drugs

Inflammation due to cancer may cause cachexia. So, scientists are looking at ways to reduce it. One way of doing so is the use of non steroidal anti inflammatory drugs (NSAIDs).

The MENAC trial looks at a combination of treatments for cachexia. It is for people with advanced cancer. One of the treatments is NSAIDs. This trial has not closed yet, so no results are available.

Anti inflammatory drugs can be harmful. Do not take them regularly without checking with your doctor. Especially if you:

  • have a stomach ulcer
  • have a bleeding disorder
  • are taking drugs to thin your blood (warfarin or heparin)

Drug therapy: drugs that improve appetite

These drugs are called appetite stimulants. They help some people with cachexia.

Megestrol

Previous trials showed that megestrol acetate might help people with cachexia. It increased their appetite and weight. It also seemed better than the steroid drug dexamethasone with fewer side effects.

But researchers did a systematic review Open a glossary item of studies in 2013. The review showed that there was a higher risk of death using megestrol acetate. Megestrol acetate can also cause blood clots.

A systematic review in 2018 found that the evidence to support the benefit and harm of megestrol acetate was low to very low.

Another systematic review of studies in 2018 looked at megestrol acetate with placebo. It showed moderate evidence for weight gain.

The review also found that megestrol acetate had very low evidence for an improvement in quality of life. The evidence for side effects of megestrol acetate was also moderate.

The researchers could not conclude on the best dose of megestrol acetate for weight gain, a better quality of life or minimal side effects. We need more research.

Cannabinoids

The cannabis plant produces substances or chemicals called cannabinoids. Cannabinoids can have medicinal effects on the body.

The main cannabinoids are:

  • delta-9-tetrahydrocannabinol (THC)
  • cannabidiol (CBD)

THC is a psychoactive substance that can create a ‘high’ feeling. It can affect how your brain works, changing your mood and how you feel.

CBD may relieve pain, lower inflammation and decrease anxiety without the psychoactive ‘high’ effect of THC.

The manmade (synthetic) form of THC is available in the drugs nabilone and dronabinol. Nabilone is licensed for use in the UK. Doctors can use it to help with sickness from chemotherapy.

People often link natural cannabis use with an increased appetite. Small studies suggested the same result. So, researchers used the manmade drugs in trials for people with cachexia. They found that the manmade drugs did not improve appetite in people with advanced cancer.

Researchers did a systematic review Open a glossary item of cannabis and cannabinoids in 2018. It was on people having palliative care for cancer. They found that cannabis and cannabinoids had no effect on weight, calorie intake or appetite. And that the quality of the evidence in the studies varied from low to very low.

The researchers said that we need more research. Only then can doctors use cannabis and cannabinoids in palliative care.

Anamorelin

Ghrelin is an appetite regulating hormone found in the stomach lining. Anamorelin is a drug that mimics this hormone and improves appetite.

Two large trials (ROMANA 1 and 2) showed that anamorelin increased both body mass and body weight. It was in people with advanced non small cell lung cancer and cachexia. The researchers suggested that anamorelin is safe. Also, that it is effective as a treatment for anorexia and cachexia.

In 2017 researchers did the ROMANA 3 trial. It was an extension of the first two trials with the same people taking part. The ROMANA 3 trial showed that anamorelin:

  • was well tolerated
  • increased body weight
  • improved other symptoms

Researchers also used anamorelin in a trial for people with advanced digestive (gastrointestinal) cancers. They had cachexia. They found that appetite, lean body mass and weight improved.

The results from research on anamorelin are promising so far. More research is continuing.

Supplements and antioxidants

Researchers are looking at supplements that might help people with cachexia.

Omega 3 food supplements

One nutrient researchers are looking at is fish oil, which contains omega 3 fatty acids.

There are 3 fatty acids that make up omega 3:

  • alpha linolenic acid (ALA)
  • eicosapentaenoic acid (EPA)
  • docosahexaenoic acid (DHA)

The body needs omega 3 fatty acids to function in a normal way. It is also called essential fatty acids.

But they are not made in the body. We have to get them from our diet. ALA is in seeds, nuts and plant oils. EPA and DHA are in the flesh of cold water fish.

Scientists think that omega 3 fatty acids reduce inflammation in people with cancer cachexia. Early studies in animals showed positive results.

A systematic review Open a glossary item in 2007 and another in 2008 were less positive about the benefit in people with cancer.

But a review study of 31 clinical trials in 2019 found that people with cancer benefit from EPA particularly. The exact reason is still unclear. EPA seems to increase body weight and lean body mass. The authors of the review suggested more research to understand exactly how omega 3 can help in cancer cachexia.

Increasing omega 3 in your diet

Foods rich in omega 3 fatty acids include oily fish like:

  • mackerel
  • salmon
  • tuna
  • sardines

They are also in several oils, including:

  • rapeseed
  • linseed
  • walnut
  • soya
  • flax

Dark green vegetables also contain a little omega 3.

Taking fish oil supplements

Some of the common side effects of omega 3 supplements are:

  • bloating
  • tummy (abdominal) pain
  • constipation
  • diarrhoea
  • wind (flatulence)
  • nausea or vomiting

Antioxidants and cancer prevention

Scientists think that people with cachexia have chronic inflammation. This causes the release of cytokines and particles called reactive oxygen species (ROS) form. ROS can cause damage to cells and may play a role in cancer and cachexia.

In theory antioxidants should protect against the effect of ROS. But previous studies had mixed results.

Antioxidant research

Researchers did a systematic review Open a glossary item of studies in 2016. They looked at the role of vitamins, minerals, proteins, and other supplements for the treatment of cachexia in cancer.

The researchers found that they could not suggest the use of minerals, vitamins, proteins, or other supplements in cancer patients. The researchers also said that they did not find any serious side effects with supplements. But they suggested more research to have clear evidence for the use of vitamins, minerals and supplements.

Doctors don't recommend antioxidants, vitamin and mineral supplements for people with cancer. There is no proof that they help. Especially not a higher dose than the Recommended Daily Allowance (RDA).

Talk to your doctor before taking any vitamins, minerals or supplements.

Exercise and cachexia

Some studies showed that exercise might help with cachexia.

But a Cochrane systematic review Open a glossary item in 2014 found that there was not enough evidence to say if exercise for people with cancer cachexia is safe and effective. The researchers said that there was a strong rationale for the use of exercise. But that we need more good quality research.

Cancer drugs for muscle wasting

Bermekimab is a type of immunotherapy called a monoclonal antibody. Bermekimab works by blocking a molecule of the immune system called IL-1alpha. This molecule causes inflammation and pain.  

Researchers are already looking at bermekimab as a treatment for patients with colorectal cancer. A new trial will look at how the treatment can help people with:

  • advanced lung cancer
  • pancreatic cancer
  • ovarian cancer

The researchers think it could help with symptoms such as weight loss and problems with mobility.

Speak to your doctor if you want to know more about this trial.

Last reviewed: 
01 May 2020
Next review due: 
01 May 2023
  • Pharmacologic management of cancer anorexia/cachexia

    C Loprinzi and others

    UpToDate website

    Accessed April 2020

  • Megestrol acetate for cachexia–anorexia syndrome. A systematic review

    V  Ruiz‐García and others

    Journal of Cachexia, Sarcopenia and Muscle. 2018 June; 9(3): 444–452

  • Systematic review and meta‐analysis of cannabinoids in palliative medicine

    M Mücke and others

    Journal of Cachexia, Sarcopenia and Muscle, 2018 April; 9(2): 220-234

  • Protective Effects of Omega-3 Fatty Acids in Cancer-Related Complications

    R Freitas and M Campos. 

    Nutrients, 2019, 11(5), 945

  • A systematic review on the role of vitamins, minerals, proteins, and other supplements for the treatment of cachexia in cancer: a European Palliative Care Research Centre cachexia project

    M Cuhls and others

    Journal of Cachexia, Sarcopenia and Muscle, 2017 February; 8(1), 25-39

  • Exercise for cancer cachexia in adults: Executive summary of a Cochrane Collaboration systematic review

    A Grande and others

    Journal of Cachexia, Sarcopenia and Muscle, 2015, 6(3), 208–211. 

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. If you need additional references for this information please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in.

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