Catabolic Wasting

Whey Protein

Scientists have examined the impact of whey protein concentrate on preventing or treating catabolic wasting, immune dysfunction, and cancer. A study involving HIV-positive men fed whey protein concentrate found dramatic increases in glutathione levels, with most men reaching their ideal body weight (Bounous et al. 1993). In another study, when different groups of rats were given a powerful carcinogen, those fed whey protein concentrate showed fewer tumors and reduced tumor masses (McIntosh et al. 1995). Whey appears to inhibit the growth of breast cancer cells at low concentrations. In one clinical study, when cancer patients were fed whey protein concentrate at 30 grams a day, some patients' tumors showed a regression (Kennedy et al. 1995).

The research using whey protein concentrate has led researchers to a discovery regarding the relationships between cancerous cells, whey protein concentrate, and glutathione. Glutathione is an antioxidant that protects the body against harmful compounds. It was found that whey protein concentrate selectively depletes cancer cells of their glutathione, thus making them more susceptible to cancer treatments, such as radiation and chemotherapy (Kennedy et al. 1995; Baruchel et al. 1996). It has been found that cancer cells and normal cells will respond differently to nutrients and drugs that affect glutathione status.

The concentration of glutathione in tumor cells is higher than that in the normal cells that surround the tumor. This difference in glutathione status between normal cells and cancer cells is believed to be an important factor in the resistance of cancer cells to chemotherapy. Research has shown that cancer cells subjected to whey proteins were depleted of their glutathione and their growth was inhibited, although normal cells had an increase in glutathione and increased cellular growth. These effects were not seen with other proteins.

Not surprisingly, these researchers concluded, "Selective depletion of tumor glutathione may, in fact, render cancer cells more vulnerable to the action of chemotherapy and eventually protect normal tissue against the deleterious effects of chemotherapy."

Whey protein also appears to play a direct role in bone growth. Researchers found that rats fed whey protein concentrate showed increases in bone strength, as well as bone protein, such as collagen. Whey protein was found to stimulate total protein synthesis, DNA content, and increased hydroxyproline content of bone cells in a dose-dependent manner.

It should be noted that not all whey protein concentrates are created equal. Processing whey protein to remove the lactose and fats, but without losing its biological activity, takes special care by the manufacturer. The protein must be processed under low-temperature and low-acid conditions so as not to denature it. Maintaining the natural state of the protein is essential to its biological activity.

Whey protein has the highest biological value rating of any protein. When the biological value is high, that means protein is absorbed, used, and retained better in the body. High biological values also are associated with tissue sparing. Thus, whey protein concentrate can be beneficial for people with wasting catabolic diseases.

Other Nutritional Supplementation

Conjugated linoleic acid (CLA), a fatty acid, has anticatabolic properties. This has been demonstrated in laboratory mice injected with endotoxin to produce catabolic response. By 72 hours after feeding with linoleic acid, the mice presented body weights similar to controls. The researchers concluded that conjugated linoleic acid prevented anorexia in endotoxin-injected test subjects (Miller et al. 1994). The suggested dose of CLA for a person in a catabolic state is 2 1000-mg capsules taken 2 times a day.

The amino acid arginine can help to generate anabolic cell replacement throughout the body and can suppress excess levels of ammonia in the body, a common problem associated with catabolic breakdown (Vanaja et al. 2001; Kosenko et al. 1995; Kennedy et al. 1994; De Bandt et al. 1998). The suggested dose for arginine to counteract catabolism is 5-20 grams a day. Additional amino acid supplementation should include 2400 mg of L-carnitine and 4 capsules a day of a branched-chain amino acid complex which includes at least 1200 mg of leucine, isoleucine, and valine.

Warning: Some nutritionists are concerned about the use of high doses of glutamine or arginine in cancer patients. Glutamine and arginine promote cellular growth, and the concern is that these amino acids could cause cancer cells to grow faster. Scientific studies, however, show that glutamine and arginine provide beneficial effects to cancer patients. Only one study on breast cancer patients hinted at a risk for arginine supplementation.

Resistance Training

Resistance or strength training is defined by resisting, lifting, and lowering weights. Resistance exercise training for a period of 8-12 weeks results in significant increases in muscle mass, muscle strength, and muscle function. Even in cases where dietary intake of protein falls below recommended daily allowances, the anabolic effect of resistance training appears to improve energy intake and protein use, allowing nitrogen retention (Castaneda et al. 1998). The benefits of resistance training have been shown to improve muscle strength and functioning in people with disease-causing muscle wasting and in healthy but frail elderly people (Fielding 1995). Resistance exercise training should be considered as an adjunct treatment modality that is cost-effective, noninvasive, and a means to improve the quality of life.

Appetite Stimulants

Appetite stimulants have been used in both HIV and cancer patients who have wasting syndrome.

Marinol (dronabinol) is a synthetic version of the active ingredient in marijuana, 9-tetrahydro-cannibol (THC). Marinol can be prescribed by a physician and taken orally. Results have been mixed as a treatment for nausea and vomiting due to chemotherapy. However as an appetite stimulant, results are more encouraging. In a study of 139 people with HIV, Marinol significantly improved appetite, body weight, and mood and decreased nausea and vomiting compared to those on placebo (Beal et al. 1995). Side effects from Marinol may include heightened awareness, a sense of well-being, and elation. Dizziness, drowsiness, muddled thinking, and anxiety are also possible side effects.

Megace is a synthetic progesterone used to stimulate appetite in people with wasting syndrome caused by HIV or advanced stages of cancer. It is also used as a therapy in women with breast cancer by interfering with the action of estrogen on cancer cell receptor sites. Although an increase or stabilization of weight may be seen after 6 weeks at the therapeutic dose of 800 mg a day, most of the gain will be in fat. A lower therapeutic dose along with resistance training will help to promote more muscle mass. Megace has a low incidence of adverse side effects when taken as directed.

Testosterone

Testosterone is a natural anabolic steroid and can help place patients in a positive nitrogen balance. Dosages of 100-200 mg a week can be given to most men and women. Consideration can be given to DHEA (see the DHEA Replacement Therapy protocol) and pregnenolone as well. The intravenous administration of vitamins--in particular, vitamin C, 25-50 grams, 2-3 times a week--may be helpful.

Testosterone supplementation in male HIV patients with wasting syndrome has been shown to increase lean body mass at doses of 200 mg daily administered intramuscularly. The most significant results were seen in combination with resistance weight training. In a study conducted at Massachusetts General Hospital, 54 men were given testosterone or placebo and placed on a 12-week exercise training program or no training at all. Lean body mass and muscle increased in those undergoing training and testosterone therapy. Levels of beneficial HDL cholesterol increased in those training, but fell in those supplementing with testosterone. Viral load fell in those taking the hormone (Fairfield et al. 2001).

Consideration should be given to "adrenal support." Patients with catabolic wasting should be assumed to have some degree of adrenal fatigue from the stress of chronic disease (see the Adrenal Disease protocol).

Warning: The possibilities discussed above have not been thoroughly studied with respect to potentially worsening cancer (if cancer is the source of the cachectic state). It is suggested that you discuss any potential treatment with a physician practicing complementary medicine prior to initiating therapy.

Summary

Catabolic wasting can be counteracted by proper nutrient supplementation. A daily dose of 2000 mg of glutamine is suggested to prevent glutamine depletion in the tissues and the ensuing catabolic effect. Fish and borage oil supplementation, in the dose of 1300 mg of DHA, 500 mg of EPA, and 1200 mg of GLA a day, should be considered to suppress inflammatory cytokines and prostaglandins that can destroy tissue. Two 1000-mg CLA capsules should be taken 2 times a day to facilitate the transport of glucose into muscle cells. The intake of 30 grams a day of biologically active whey protein concentrate, 10-20 grams of arginine, 2400 mg of L-carnitine, and a branched-chain amino acid complex may produce a dramatic anticatabolic tissue-sparing effect and regulate immune system cytokines that are thought to cause cachexia.

The multinutrient Vitamin Depot Online.com Mix formula should be given to all people with catabolic breakdown to provide the basic building blocks the body needs to start rebuilding.

A person at risk for developing catabolic wasting syndrome or who is already suffering from cachexia (tissue wasting) should consider the following supplements:

1. Glutamine, 2000 mg a day, available in capsule or powder form.
2. Super GLA/DHA oil, 8 capsules a day (provides optimal potencies of GLA from borage oil and DHA/EPA from fish oil concentrate).
3. Conjugated linoleic acid (CLA), (76%) 2000 mg 2 times a day.
4. Biologically active whey protein concentrate, 30-60 grams a day.
5. Arginine, 10-20 grams a day in divided doses.
6. L-carnitine, 2400 mg a day in divided doses.
7. Vitamin Depot Online.com Mix, 9 tablets, 14 capsules, or 3 scoops of powder daily in divided doses.
8. Consider growth hormone, DHEA, and/or testosterone replacement therapy.
9. Branched Chain Amino Acid Formula, 1200-2400 mg a day.

Product availability

Glutamine, enhanced whey protein, arginine, Vitamin Depot Online.com , Super GLA/DHA, CLA, Mega EPA, L-carnitine,DHEA, and the Branched Chain Amino Acid Formula can be ordered by calling (800) 544-4440 or by ordering online. Growth hormone and testosterone are prescription drugs.