Is a High Protein Diet Good for Cancer Patients

Why are high-protein diets important to cancer patients?

If a lack in protein is seen in patients during treatment, it will be difficult for their body cells to have sufficient energy to fight the cancerous cells. It could cause weakened
- Hematopoietic ability: weakened ability for immature cell to develop into the different types of blood cells i.e. white blood cell, red blood cells.
- Repair ability: For cuts to heal, our bodies rely on the skin cells ability to regenerate. This usually occurs within a specific "repair time" and is referred to as the cell's repair ability.
With these damaged abilities, it could largely affect the treatment progress, increase the severity of side-effects from treatment, and increase chances of malnutrition. Patients could also risk having muscle loss, a weakened immunity, and weight loss.
Cancer patients usually need more protein than usual. Extra protein is used for healing damaged tissue, and to keep our immune system healthy. Surgery, chemotherapy, or radiation therapy could damage the immune system as they also attack white blood cells which are responsible for immune response. Protein is needed to make new components, like antibodies and white blood cells, for recovering the immune system.

Diving into a more complex concept, cancer patients with a lack of protein in their daily diets could experience muscle protein depletion which could lead to cancer cachexia.

Cancer cachexia is a wasting syndrome that is often developed by many cancer patients due to their negative protein and energy balance, as well as uncontrolled loss of lean body mass by tumour-derived factor. Potential aspects that cachexia causes are:
- Involuntary loss of muscle mass, or decreased muscle synthesis
- Progressive loss of adipose tissue
- Anorexia
These aspects are often what causes cancer-associated malnutrition, which can be used to predict,
- Risk of physical impairment
- Post-operative difficulties
- Chemotherapy toxicity
- Mortality
However, investigations were able to show that an increased amount of protein intake in meals would help promote muscle protein anabolism (protein formed from amino acids in the body) for cancer patients. Maintenance of skeletal muscle would require available amino acid as protein synthesis is promoted only with the presence of available precursors. A high protein diet can ensure a constant supply of amino acid precursor that support muscle synthesis, which could slow down the process of cachexia. therefore, a high protein diet is greatly encouraged.

How much is the right amount?

The National Academy of Medicine in the United States recommends that adults consume at least:
- 0.8 grams of protein per kilogram of body weight per day (7 grams of protein per 20 pounds of body weight) to provide energy for the body to maintain normal operations and activities.
However, due to the growth of cancer cells, the body is in a high metabolic state. This accelerates the process of nutrition and energy consumption, so cancer patients generally consume more calories and protein than ordinary people and would need to consume:
- 1.5-2 grams of protein per kilogram of body weight per day (for cancer patients)
Despite these well calculated values determining optimum protein intake, it is important for the patient to refer to a medical professional for an accurately calculated and tailored daily protein intake.

i.e. Older patients would often experience inactivity and systemic inflammation which leads to an anabolic resistance (protein synthesis becomes less responsive). The recommended intake for the elderly would be around:
- 1.2-1.5g/kg/d
On the other hand, patient with normal kidney function can consume up to and above 2g/kg/d.

While those with acute or chronic renal failure should not consume protein amount exceeding 1.0 or 1.2 g/kg/d to prevent risks of kidney failure.

Patients experiencing cancers that cause gastric obstructions (i.e. ovarian, bowel, stomach, small intestine, etc. cancers) may want to consume hydrolysed proteins.

Due to:
- Active muscles during digestion become useless
- Unable to absorb proteins into the body
Hydrolysed proteins are proteins taken from foods such as soy, corn, or wheat which has been partially broken down with chemicals allowing absorption into the body much easier. The chemical reactions mimic the procedures in natural digestion therefore recognized and accepted by the human body.

Overall, there are many issues and external factors that come into play when determining the amount of protein to be consumed by cancer patients, so it is vital patients confirm with their doctors and health professionals to ensure they are following a safe and correct diet plan personalized for themselves.

What is the best source of protein for cancer patients?

It is often recommended that cancer patients should consume high-quality protein through natural and fresh foods or nutritional supplements.

Sources of high-quality protein may include:
- Eggs
- Milk (if not lactose intolerant)
- Fish
- Meat*
- Beans, soy beans products…etc
  *These foods are not only protein abundant; they are also rich in nutrients. Take red meat as an example, it is both rich in protein as well as other nutrients such as vitamin B12, iron, etc. These can enhance the cell's hematopoietic capacity; however, foods must be eaten in moderation for beneficial effect. For example, overeating red meat for long periods of time would increase the risk of colorectal cancer.
3 quick, fun and easy recipes for you to try at home!

It is important that cancer patients are more cautious, than the average person, when creating their own diet menus. One must not blindly follow unproven high-protein diet methods, and "quality protein" should be the only kind of proteins readily available in your pantry. With the help of our clinic's dietitian, we have provided the following 3 quick and easy high-protein meals for chemo patients!

Appetizer: Penta-colour beans with fragrant sesame sauce

Main ingredients:
- Black beans (cooked) 1 can
- Chickpeas (cooked) 1 can
- Edamame 1 cup
- Corn (cooked) 1 can
- Red kidney beans (cooked) 1 can
Ingredients for sauce:

Black/White sesame 50 grams
Low-sodium soy sauce 1 tablespoon
Mirin 1/2 tablespoon
Sesame oil 1 teaspoon
Sugar ½ table spoon
Shallots 2 pieces
Garlic 2-3 cloves

Method:
1. Sauté sesame seeds until golden brown, grind and set aside.
2. Add soy sauce, mirin, sesame oil, sugar, scallions, crushed garlic into sesame seeds, and mix until a sauce is formed.
3. Rinse black beans, chickpeas, corn and red kidney beans in water to wash away excess salt.
4. Boil edamame until cooked and drain water, and remove the skin of the edamame.
5. Mix the sauce with the prepared beans together and enjoy!
Main course: Mexican Tuna and Cheese quesadillas

Ingredients:

Tuna 1 can
Low-fat Greek yogurt 1 tablespoon
Mustard ½ tablespoon
Juiced lemon ½
Red onion (chopped) 1 tablespoon
Pickled cucumber (chopped) 1 tablespoon
Whole wheat tortillas 2 pieces
Low-fat grated cheese ½ cup

Method:
1. Drain out water from canned tuna.
2. Mix lemon juice, cheese, mustard sauce, minced onions and minced pickled cucumber into tuna well.
3. Spread 1-2 teaspoons of cooking oil onto a flat non-stick pan, and place a piece of tortilla in the pan.
4. Spread prepared tuna mix and chopped cheese onto the tortilla (already in the pan), and put another piece of tortilla on top.
5. Fry for 1-2 minutes until cheese has melted, then flip the tortilla and lightly fry for another 1-2 minutes until the bottom is nice and golden brown.
6. Cut into 4-6 servings and enjoy!
Drink: Mixed berry high protein smoothie

Ingredients:

Oatmeal ¼ cup
Bananas 1
Strawberry (frozen) 6-8 berries
Blueberries (frozen) ¼ cup
Flax seed powder One pinch
Whey protein powder 2 tablespoons
Low-fat Greek yoghurt 1 cup
Nut Butter 1-2 tablespoons
milk or other milk alternatives 1 cup

Method:
1. Place all ingredients into a blender.
2. Blend for around 1 minute or until smooth and enjoy!
In a rush? Don't fret, have some high protein snacks!
- Cheese with crackers
- Granola bars
- Greek yogurt
- Hard-boiled eggs
- Nuts (i.e. cashews, peanuts, almonds, walnuts, etc.)
- Beans (i.e. edamame, red kidney beans, etc.)
- Drinks rich in nutrients (made for cancer patients)
Tip:
There is no evidence to show that a "sugar free" diet can give lower risks of being diagnosed with cancer, nor does it boost chances of survival after diagnosis! So, don't stress too much about consuming sugar but of course, eat everything in moderation and contact your personal doctor for a tailored nutritional plan for you!

Extra protein power?
- Melted Cheese – sprinkle cheese over salads, soups, cauliflower, etc.
- Greek yoghurt – Add your favourite fruits and make a beautiful yoghurt parfait!
- Beans – Blend to make soups, add to salads, sprinkle some sea salt over steamed edamame beans, etc.
- Egg – Hard boiled chopped and added to any dish!
- Nuts – Add to yoghurt parfaits, salads, sprinkle over Thai noodles, fruits salads, etc.
Alternatives (lactose intolerant, supplements, etc.)

For those who do not prefer putting as much effort or energy into preparing high-protein meals, or those who are lactose intolerant, there are lots of different alternatives that can be just as effective. To replace meals, whey protein powder, soy protein, or hemp proteins are perfectly good alternatives. These are both lactose intolerant friendly and efficient ways for the body to absorb the nutrients it needs.

An example of an excellent protein powders are:
- Fresubin Protein Powder by Fresenius Kabi
- Beneprotein by Nestle
Whey protein powder are hydrolysed, which included protein digestive enzyme to help break down protein to smaller-chained amino acids. Smaller-chained amino acids are more rapidly absorbed in gastrointestinal tract and readily available for use by the body. Therefore, whey protein would be better in terms of absorption.

It is advertised as a high-quality unflavoured whey protein powder that helps supply protein needed by the body to help maintain muscle.

It comes in individual packages or in large cans; the powder can be added to foods such as,
- egg salad
- yoghurt
- cheese
- oatmeal
- drinks i.e. hot chocolate, tea
This protein abundant source can help every cancer patient to efficiently and conveniently achieve their optimum daily protein intake. If the patient does not have an appetite, these protein powders can also be easily made into shakes that can be used to replace daily meals. There are many ways you can use to create your own concoctions so, let your creativity and imagination run free!

References:
1. http://www.espen.info/wp/wordpress/wp-content/uploads/2016/11/ESPEN-cancer-guidelines-2016-final-published.pdf
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398892/#:~:text=It%20is%20estimated%20that%20half,loss%20of%20lean%20body%20mass.
3. https://gasparinutrition.com/the-advantages-of-hydrolyzed-whey-protein/
4. https://www.cancerresearchuk.org/about-cancer/coping/physically/bowel-problems/types/blocked-bowel-obstruction#:~:text=Bowel%20obstruction%20can%20happen%20when,can%20stop%20the%20muscles%20working
5. https://www.oncolink.org/support/nutrition-and-cancer/during-and-after-treatment/protein-needs-during-cancer-treatment
6. https://www.nestlehealthscience.us/brands/beneprotein/beneprotein?lightboxid=497
7. https://www.fresubin.com/sites/default/files/2020-02/Productsheet_Fresubin_Protein_Powder_2019.pdf
8. https://www.oncolink.org/support/nutrition-and-cancer/during-and-after-treatment/protein-needs-during-cancer-treatment#:~:text=Products%20such%20as%20double%20strength,may%20best%20meet%20your%20needs.
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