Podcasts about Cachexia

“There's actually quite a bit of debate about what the clinical definition of cancer cachexia is, but in its simplest definition of cachexia in this case is cancer-induced body weight loss. You can have cachexia in other diseases, for heart failure or renal failure, but it's basically tumor-induced metabolic derangement that leads to inflammation and often anorexia, which produces body weight loss,” ONS member Teresa Zimmers, PhD, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about cancer cachexia. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by December 27, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome:  Episode Notes  Complete this evaluation for free NCPD.  Oncology Nursing Podcast™ episodes:  Episode 251: Palliative Care Programs for Patients With Cancer Episode 116: Screen and Manage Malnutrition in Patients With Cancer Episode 93: How to Manage Nutrition for Patients With Cancer ONS Voice articles:  An Oncology Nurse's Guide to Cachexia in Patients With Cancer  Manage Malnutrition's Monstrous Consequences in Patients With Cancer  Managing Weight Loss in Patients With Cancer  Nutritional Support Reduces Weight Loss for Patients With Head and Neck Cancer  ONS course: Introduction to Nutrition in Cancer Care  ONS Nutrition Learning Library  ONS Symptom Intervention Resource: Anorexia  American Society of Clinical Oncology (ASCO) Cancer Cachexia Guidelines  Cachexia Score screening tool  Cancer Cachexia Network  Cancer Cachexia Society  Malnutrition Screening Tool   Patient Generated Subjective Global Assessment  Society on Sarcopenia, Cachexia, and Wasting Disorders   To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an Oncology Nursing Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode  “Anorexia is often a component of cancer cachexia. In fact, some people call it cancer-induced anorexia, cachexia syndrome, because the tumors produce factors that act on the hypothalamus and hindbrain to produce, among other things, anorexia, but not just anorexia, you know, feelings of misery, anhedonia, wanting to withdraw from social interactions, but definitely altered desire to eat and altered taste of food.” TS 5:32  “Cachexia is most common, you know, where it's been examined, in patients with upper GI cancers. You could think of those as risk factors for cachexia. So that includes, of course, head and neck cancer, esophageal, gastric, pancreatic, liver and biliary cancers. It's also found to be very prevalent among patients with any kind of metastatic cancer and very frequent in patients who are hospitalized for their cancer. But beyond that, about half of patients with non-small cell lung cancer also experience cachexia.” TS 8:21  “I've been told by oncologists that cachexia is frequent in patients with certain rare cancers like ocular melanoma, small cell lung cancers, but generally speaking, cachexia is underrecognized.  Most people have in their minds this picture of someone who's sort of end-stage cachexia, that's emaciated. And in fact, most patients, or many patients in the U.S. at least, arrive with a cachexia diagnosis and may be overweight or even indeed obese, but that does not mean that they don't have cachexia.” TS 8:54  “I have tremendous respect for our nurses who take care of patients, and all of them have their preferred screening tools. There is no single accepted or mandated approach to diagnosing or treating someone with cancer cachexia. And I should say that I didn't mention a widely accepted definition for cancer cachexia in the field, a diagnostic criterion, is weight loss of greater than 5% in the prior six months—and this is unintentional weight loss. TS 11:05  “I hear from family members all the time about how this was actually the most distressing part of their loved one's cancer journey because it's something so visible. And also, so much of our relationships happen over meals. And what I've heard time and time again is that telling someone that there is a word for this, cachexia, and explaining that it is the tumor—right, it's the cancer that's causing this appetite loss—would have helped because there tends to be a lot of conflict over meals, you know, a lot of guilt on sides when it comes to eating and trying to prepare meals that are appetizing for the person with cancer.” TS 22:24    “I think that we don't often think about how much the cachexia itself affects the cancer treatment outcomes. The presence of weight loss correlates with treatment toxicity. Chemotherapy is often dosed on body surface area. Patients who have very low muscle, for example, experience greater toxicities, and maybe we should be dosing based on lean muscle mass. Patients with cachexia have poor outcomes after surgery. And actually, patients with cachexia don't respond to immunotherapy, which of course has been transformative for cancer care. So, treating cachexia may actually enable patients to respond better to all of their cancer interventions.” TS 28:45 

This podcast explores the syndromes of frailty, sarcopenia and cachexia and how they relate to and intersect with malnutrition. Dr. Jensen offers key aspects of each of these syndromes and the importance of including them as part of the malnutrition assessment process. Business Corporate by Alex Menco | alexmenco.net Music promoted by www.free-stock-music.com Creative Commons Attribution 3.0 Unported License creativecommons.org/licenses/by/3.0/deed.en_US December 2024

Weight loss drugs are in the spotlight. Obesity is a huge and potentially profitable problem, attracting lots of scientific and medical resources.But there are circumstances where avoiding weight loss is crucial and where it is beneficial to put weight on. Cachexia is a serious condition affecting cancer patients, which is characterised by significant weight loss and muscle wasting. Appetite is often suppressed, but just eating more doesn't work anyway.The resulting frailty and weakening of the body has debilitating effects on the daily lives of cancer patients. Cachexia can even affect the outcome of the cancer itself, both by weakening immune systems and by making it harder for patients to tolerate harsh cancer treatments. Long thought to be just an inevitable side effect of cancer, the condition is now being studied separately with a view to fidnbing new treatments as adjuncts to cancer therapy.One company at the clinical trial stage for treating cachexia is Actimed Therapeutics, and I am thrilled to be joined by their CEO, Robin Bhattacherjee.We discuss the challenges of developing treatments to halt and reverse weight-loss when the mainstream drug industry is going the other way, the innovative approach of Actimed Therapeutics in working with the molecule S-pindolol, and the huge impacts this work can have for the survival rate of cancer patients.Robin also shares insights from his extensive career in the biopharma industry, and gives excellent advice to people starting their career in this field.“This could be transformational for cancer patients.” – RobinYou'll hear about:00:25 - An introduction to Robin01:59 - Robin on his journey into science06:41 - Advice for starting a career in pharmaceuticals11:15 - What is cachexia?17:01 - Treating cachexia to fight cancer18:40 - S-pindolol the lead molecule explained22:50 - Balancing catabolic and anabolic actions25:31 - Other mechanisms that need targeting26:32 - The progress of clinical trials33:16 - The challenges raising money for anti-weight loss productsConnect with Robin:LinkedIn - https://www.linkedin.com/in/robin-bhattacherjee-4b436613/ Actimed Therapeutics - https://actimedtherapeutics.com/home/ Connect with me:LinkedIn: https://www.linkedin.com/in/markdavison100/ If you need any lab equipment:Grant Instruments: https://www.grantinstruments.com/ Grant Instruments on LinkedIn: https://www.linkedin.com/company/grant-instruments-cambridge-ltd/ 

In this eye-opening episode, I'm sharing my top strategies to build unbreakable bones and age powerfully. From surprising supplements to simple exercise tweaks, I'm breaking down the science-backed ways to keep your skeleton strong well into your golden years. Whether you're approaching menopause or already there, you'll learn how to take control of your bone health and avoid becoming a scary statistic. Don't wait for a fracture to wake you up—tune in now to discover how to build a body that's truly built to last! What you'll learn: The shocking link between hip fractures and mortality rates in older adults Key nutrients beyond calcium that are crucial for bone strength How protein intake affects your bone health (it's not just for muscles!) The unexpected supplement that could supercharge your bone-building efforts Simple, low-impact exercises to stress your bones in all the right ways Why menopause is a critical time for bone health and what to do about it How to work with your doctor to optimize hormones for stronger bones Full show notes: https://www.jjvirgin.com/healthybones 7-Day Eat Protein First Challenge: http://jjvirgin.com/proteinfirst Use my Eat Protein First Calculator: http://jjvirgin.com/proteinfirst Flavorchef bone broth: https://affiliates.theflavorchef.com/121.html Reignite Wellness™ Collagen Peptides Powder: https://reignitewellness.com/products/all-systems-glow-collagen Reignite Wellness™ SHEatine: https://reignitewellness.com/products/sheatine-capsules Vital Choice wild-caught seafood: https://vitalchoice.sjv.io/daKYGy Check out Power Plate: https://powerplate.com/jjvirgin use code JJVIRGIN for 20% off your order Reignite Wellness™ Plant-Based & Paleo-Inspired All-In-One Shakes: https://reignitewellness.com/collections/shakes Download my free Resistance Training Cheat Sheet: https://jjvirgin.com/resistance Get 60 FREE delicious, protein-packed shake recipes in my Eat Protein First Smoothie Guide: https://jjvirgin.com/smoothie TRX Resistance Training Equipment: Free Shipping on all orders $99+: https://trxtraining.sjv.io/EKrvrP Weighted Vest: https://amzn.to/4aSOVIM Study: Intake of Milk or Fermented Milk Combined With Fruit and Vegetable Consumption in Relation to Hip Fracture Rates: A Cohort Study of Swedish Women: https://academic.oup.com/jbmr/article-abstract/33/3/449/7605545?redirectedFrom=fulltext Study: Vitamin D and Bone Health; Potential Mechanisms: https://docs.google.com/document/d/18ppTkh7GN9vnsn9jxVePAHhqVO9SumqW6nBMeuEGsYk/edit?tab=t.0 Study: Habitual use of fish oil supplements, genetic predisposition, and risk of fractures: a large population-based study: https://www.sciencedirect.com/science/article/pii/S0002916522004191 Study: Creatine supplementation for older adults: Focus on sarcopenia, osteoporosis, frailty and Cachexia: https://www.sciencedirect.com/science/article/abs/pii/S8756328222001442#:~:text=Creatine%20has%20also%20been%20shown,in%20older%20adults%20%5B14%5D. Study: Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women—A Randomized Controlled Study: https://pmc.ncbi.nlm.nih.gov/articles/PMC5793325/ Study: The benefits of exercise in postmenopausal women: https://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.1993.tb00099.x Study: Effects of Weight-Bearing Exercise Training on Bone Mineral Density and Neuromuscular Function of Osteopenic Women: https://journals.sagepub.com/doi/10.1177/1721727X1201000318 Study: Whole-body vibration exercise in postmenopausal osteoporosis: https://pmc.ncbi.nlm.nih.gov/articles/PMC4440196/#:~:text=Researchers%20used%20a%20vibration%20frequency,at%20the%20femoral%20neck%20region. Study: Estrogen and bone health in men and women: https://www.sciencedirect.com/science/article/abs/pii/S0039128X14003031#:~:text=Menopause%20and%20the%20accompanying%20loss,and%2010.6%25%2C%20lumbar%20spine. Study: Menopause and Bone Loss: https://www.endocrine.org/patient-engagement/endocrine-library/menopause-and-bone-loss#:~:text=Menopause%20significantly%20speeds%20bone%20loss,are%20affected%20by%20osteoporosis%20worldwide. Episode Sponsors:  Try Timeline: https://www.timelinenutrition.com/shop?rfsn=7082975.4b75243 Use code JJ10 for 10% off all products Go to qualialife.com/VIRGINWELLNESS to try Qualia risk-free for up to 100 days and code VIRGINWELLNESS for an additional 15% off

Palliative Care nurse practitioner Meg Harrison speaks about the amazing work of the Cachexia Clinic, its positive impact on patients and their families, and how Barwon Health is a leader and innovator in this space. Please take the opportunity to listen and share through your networks to keep the conversations happening.

Did you miss the ESMO Congress 2024? Listen here: NEJM Editor-in-Chief Eric Rubin and NEJM Evidence Associate Editor Oladapo Yeku discuss research that was presented at the 2024 European Society of Medical Oncology annual meeting. Visit NEJM.org to read the latest research.

Today we dive deep into the world of veterinary nutrition with Dr. Lindsey Bullen, one of the few board-certified veterinary nutritionists in private practice. The right diet can make a significant difference in managing your dog's cancer and overall health. Dr. Bullen shares her insights on home-cooked diets, the importance of diagnostics, cancer-specific dietary needs, and much more. Quotes: "Every single pet presents a puzzle, even if they have the same disease state." - Dr. Lindsey Bullen "Maintaining appetite and ensuring proper nutrition is critical for dogs with cancer." - Dr. Lindsey Bullen Related Resources: Find a board-certified veterinary nutritionist on the Vet Specialists website: https://www.vetspecialists.com/find-a-specialist Join our Facebook support group at https://www.dogcancer.com/support Your Voice Matters! If you have a question for our team, or if you want to share your own hopeful dog cancer story, we want to hear from you! Go to https://www.dogcancer.com/ask to submit your question or story, or call our Listener Line at +1 808-868-3200 to leave a question. Related Videos:            A keto diet: https://www.youtube.com/watch?v=KfHTQEn8hC8 The best and worst foods for dogs with cancer: https://www.youtube.com/watch?v=iAgObIOhEMg Can I prevent dog cancer with diet? https://www.youtube.com/watch?v=lSYvdvyG6Vk Foods that help fight and prevent cancer: https://www.youtube.com/watch?v=7gLCvvwSwjg What to feed a dog with cancer: https://www.youtube.com/watch?v=aitN0v9Uu4A Fight cancer through the gut: https://www.youtube.com/watch?v=nbZFyCvriN8 Related Links: What does a veterinary nutritionist actually DO? https://www.dogcancer.com/articles/diet-and-lifestyle/veterinary-nutritionists/ Reduce Cancer Risk Using Food: https://www.dogcancer.com/articles/causes-and-prevention/how-to-reduce-cancer-risk-using-food/ Guidelines for a Dog Cancer Diet: https://www.dogcancer.com/articles/diet-and-lifestyle/dog-cancer-diet/  Chapters: 00:00 – Introduction from Molly Jacobson 02:30 - Welcome Dr. Lindsay Bullen 04:30 - Cooking for Dogs: Perspectives and Considerations 06:00 - The Origins of Veterinary Nutrition as a Specialty 08:00 - Research in Performance Animals and Nutrition 09:00 - The Importance of Individualized Pet Nutrition 10:30 - Why Veterinary Nutrition Training is Lacking 11:30 - Encouraging More Nutrition Training in Veterinary Schools 12:30 - The Nutritionist's Role: When and How to Consult One 13:30 - The Challenges of Accessing Veterinary Nutritionists 15:00 - The Intake Process 16:30 - Blood Work and Urinalysis 18:00 - Reviewing Medical Records for Nutritional Planning 20:00 - Dietary History and Food Allergies 23:00 - Identifying and Managing Pet Allergies 24:30 - Dog Cancer Diets: Factors and Recommendations 26:00 - Examples: Managing Hemangiosarcoma and Lymphoma 28:00 - Importance of Protein, Fat, and Carbohydrates in Cancer Diets 30:00 - Cachexia and Its Impact on Appetite 32:00 - Using Drugs and Appetite Stimulants 33:30 - Enhancing the Deliciousness Factor in Dog Food 35:00 - Flexibility and Preferences 37:00 - Balancing Quality of Life and Nutrition 38:00 - Considerations for Home-Cooked Diets 40:00 - Challenges of Preparing Home-Cooked Diets 41:00 - Carbohydrates in Dog Diets: Myths and Facts 43:00 - The Role of Carbohydrates in Cancer Diets 44:00 - Future Discussions: Preventing Cancer with Diet 45:00 - Final Tips Get to know Dr. Lindsey Bullen, veterinary nutritionist: https://www.dogcancer.com/people/lindsey-bullen-dvm-dacvim-nutrition/ For more details, articles, podcast episodes, and quality education, go to the episode page: https://www.dogcancer.com/podcast/ Learn more about your ad choices. Visit megaphone.fm/adchoices

I always find cachexia in serious illness puzzling. I feel like I recognize it when I see it, but I struggle to give a clear definition or provide effective ways to address it. In today's podcast, we had the opportunity to learn from a renowned expert in palliative care, Eduardo Bruera, about cachexia and anorexia in serious illness. Eduardo established one of the first palliative care programs in 1984, created the Edmonton Symptom Assessment Scale (ESAS), and significantly contributed to the evidence base for palliative care symptoms that many of us rely on daily. During our discussion with Eduardo, we delved into how we can define cachexia and anorexia, why they occur in conditions like cancer, how to assess for them, and explored the interventions that are helpful and those that are not in the treatment of these conditions.

Expert: Joana Liz Pimenta, ICBAS- Abel Salazar Institute of Biomedical Sciences, Porto, Portugal

Dr. John Sweetenham shares highlights from Day 3 of the 2024 ASCO Annual Meeting, including selected studies on the treatment of cancer cachexia, surgical approaches in advanced ovarian cancer, and advanced colorectal cancer with liver metastases. TRANSCRIPT Dr. John Sweetenham: I'm Dr. John Sweetenham, the host of the ASCO Daily News Podcast, with my top takeaways on selected abstracts from Day 3 of the 2024 ASCO Annual Meeting.  Today's selection features studies addressing the treatment of cancer cachexia and 2 studies of surgical approaches to the treatment of advanced ovarian cancer and of advanced colorectal cancer with liver metastases.  My full disclosures are available in the transcript of this episode.   Cachexia affects up to 80% of patients with advanced cancer and is thought to be directly responsible for 30% of cancer deaths, according to the National Cancer Institute. Despite these statistics, the condition remains understudied and there is no standard treatment. Current guidelines recommend dietary counseling and low-dose olanzapine or short courses of corticosteroids or progesterone analogues can be used to promote weight gain. However, the guidelines mainly point to evidence gaps. No drug therapy could be strongly endorsed to improve patient outcomes and no recommendations could be made regarding exercise.  Dr. Tora Solheim from the Cancer Clinic at St. Olavs Hospital in Trondheim, Norway, today reported results from the MENAC trial in LBA12007, which tested an intervention that combined treatment with nonsteroidal anti-inflammatory medication ibuprofen, home-based exercise to improve endurance and muscle strength, nutritional counseling, and supplements containing omega-3 fatty acids, which, based on previous research, may enhance muscle mass in patients with cancer cachexia. This trial enrolled 212 patients with stage III or IV lung or pancreatic cancer from 17 sites in 5 countries. All patients were receiving palliative chemotherapy and either had cachexia or were at high risk of developing it. Half were randomly assigned to the intervention and half to standard care. For the exercise components of the intervention, patients were encouraged to engage in aerobic activity such as walking, swimming, or even household chores at least twice a week. They were also encouraged to perform strengthening exercises such as half squats, bicep curls, and knee lifts 3 times per week.  Over 6 weeks, the trial found average body weight stabilized in the intervention group compared with a loss of 1 kg in the standard care group, but there were no differences between the two groups and the secondary endpoints of muscle mass and daily step count as measured by ActiGraph. Dr. Solheim pointed out that 6 to 8 weeks may be too early to observe any anabolic effects on muscle mass or function, but that this timeframe was chosen, she said, because previous studies, including her team's own feasibility study had encountered high dropout rates among similar patient groups after 6 to 8 weeks.  Although these are interesting data, I think they also pose many questions: Is maintaining 1 kg of body weight a meaningful endpoint? Did the patients report any improvement in other symptoms? How was at-home exercise monitored for compliance? Did we know whether the patients were fulfilling adequate amounts of exercise? And there are many more questions. I think the investigators should be congratulated for demonstrating the feasibility of conducting a randomized trial in this challenging patient group, and this will hopefully provide a basis for future studies exploring new interventions. In LBA5505, Dr. Jean-Marc Classe presented data from the CARACO study, a randomized trial evaluating the use of retroperitoneal lymph node dissection in patients undergoing primary surgery or interval cytoreductive surgery after neoadjuvant chemotherapy for advanced epithelial ovarian cancer.   To provide some context, an earlier study, the phase 3 LION trial, assessed the role of RPLD in patients with advanced ovarian cancer with complete resection and normal lymph nodes after primary surgery. In this trial, RPLD provided no significant improvement in overall or progression-free survival and was associated with a significant increase in serious postoperative complications and 60-day mortality. In recent years, the use of neoadjuvant chemotherapy and interval surgery has increased significantly in the U.S. and Europe, and it was unknown whether RPLD could have a benefit among these patients. The CARACO trial was undertaken to answer this question, enrolling patients treated with either primary surgery or neoadjuvant chemotherapy and interval surgery to reflect a real-world population. The multicenter trial enrolled 379 patients with FIGO stage III-IVA epithelial ovarian cancer with no suspicious retroperitoneal lymph nodes in whom optimal surgery was achievable with primary surgery or with interval cytoreductive surgery after neoadjuvant chemotherapy with residual tumor at less than 1 cm. Patients were randomly assigned to surgery with or without retroperitoneal lymph node dissection. Patients receiving primary surgery accounted for about 26% of the no RPL arm and 21% of the RPL arm. The primary endpoint was progression free survival, and secondary endpoints included overall survival, safety, surgical outcomes, and quality of life.  Although the trial initially planned to enroll 450 patients, enrollment slowed after the presentation of the results of the Lyon trial, leading to a premature closing of this trial to enrollment with 379 patients. The median age of enrolled patients was 64 - 65 years and 87% had serous or endometrioid carcinoma. Surgery was performed with no residual tumor in around 86% of the patients in the no RPL arm and 88% of patients in the RPL arm. Importantly, the median duration of surgery was 240 minutes in those with no RPL versus 300 minutes in the RPL arm, representing an additional hour for those who underwent retroperitoneal lymph node dissection. Severe morbidity within 30 days of surgery was significantly improved in the no RPL arm compared with the RPL arm as assessed by rates of transfusion or blood loss, re-intervention, and urinary injury. In an intent to treat analysis, there was no significant difference in progression-free survival in patients who did or did not receive retroperitoneal lymph node dissection. The respective median progression-free survivals were 14.8 and 18.6 months. Median overall survival was 48.9 months and 58.8 months, respectively, and on subgroup analysis, no benefit for retroperitoneal lymph node dissection was observed.   Although the results of this study are slightly confounded by the failure to reach their target accrual, the data shows strong evidence that these patients can be spared the additional surgery and subsequent surgical complications without compromising progression free or overall survival. Dr. Classe and his colleagues hope to determine whether retroperitoneal lymph node dissection is useful in patients with suspicious nodes.  The third selected abstract today is 3500, which describes a remarkable prospective study of chemotherapy plus liver transplantation versus chemotherapy alone in patients with unresectable colorectal cancer liver metastases. The results of the so-called TRANSMET study were presented by Dr. Adam from Villejuif, France, on behalf of a study group including centers from France, Belgium, and Italy. In the introduction to the study, the presenter pointed out that liver resection is currently the optimal treatment for liver metastases from colorectal cancer and offers the potential for long-term survival and even cure. But resection is only possible in 10% to 20% of patients. And although cytoreductive chemotherapy may convert some patients to a resectable status, this is relatively rare. The current standard of care is the use of chemotherapy, which may prolong survival but is not curative. Liver transplantation has been used in this context since the 2000s with apparent improvements in outcome, but TRANSMET is the first randomized trial to assess the benefit of adding liver transplantation to chemotherapy in this patient group.  The TRANSMET study evenly randomized 94 patients to either undergo chemotherapy and liver transplantation or only chemotherapy. The patients were highly selective in terms of age, performance status, resection of primary tumor, months of tumor control, previous line of therapy, and tumor markers. It's noteworthy that of the 157 patients eventually considered, 63 failed to meet the demanding eligibility criteria on the review of the trial committee. The 5-year overall survival rate in the intent to treat analysis was 57% in the chemotherapy plus liver transplant cohort and 13% in the chemotherapy-alone arm. Progression-free survival was 17.4 versus 6.4 months, respectively. 28 of the 38 transplanted patients suffered relapses, 15 of which were in the lungs. Surgical resection and/or radio ablation were used in many of these patients. The authors concluded that liver transplantation is an option which should be considered in this highly selective patient group and that the outcomes reported here are comparable to outcomes for liver transplantation and other conditions. Understandably, this is a small study in a highly selective group, and it's difficult to know where this will gain traction. With a shortage of organs for donation, prioritization of this small patient group may be challenging.   That concludes today's report. Join me again tomorrow to hear more top takeaways from ASCO24. If you value the insights that you hear on the ASCO Daily News Podcast, please remember to rate, review, and subscribe wherever you get your podcasts.   Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Follow ASCO on social media:  @ASCO on Twitter  ASCO on Facebook  ASCO on LinkedIn    Disclosures: Dr. John Sweetenham: Consulting or Advisory Role: EMA Wellness

Anabolic resistance, a phenomenon marked by reduced muscle protein synthesis and impaired muscle maintenance, is a significant concern in aging populations. In this episode, Dr. Armstrong and Corbin Bruton discuss anabolic resistance and its impact on healthy aging.They explore the factors contributing to anabolic resistance, ranging from age-related declines in muscle protein synthesis to alterations in cellular signaling pathways. Despite its prevalence, the hosts challenge the notion that anabolic resistance is an inevitable consequence of aging, emphasizing the role of lifestyle interventions in mitigating its effects. Through discussions on resistance training, protein intake optimization, and other strategies, they highlight actionable steps individuals can take to combat anabolic resistance, maintain muscle health, and… age well.Articles:Aragon, A. A., Tipton, K. D., & Schoenfeld, B. J. (2023). Age-related muscle anabolic resistance: inevitable or preventable? Nutrition reviews, 81(4), 441-454. https://doi.org/10.1093/nutrit/nuac062Breen, L., & Phillips, S. M. (2011) Skeletal muscle protein metabolism in the elderly: Interventions to counteract the 'anabolic resistance' of ageing. Nutrition & Metabolism, 8: 68. https://doi.org/10.1186/1743-7075-8-68Burd, N. A., Gorissen, S. H., & van Loon, L. J. C. (2013). Anabolic Resistance of Muscle Protein Synthesis with Aging. Exercise and Sport Sciences Reviews, 41(3): 169-173.  https://doi.org/10.1097/JES.0b013e318292f3d5Burd, N. A., Wall, B. T., & van Loon, L. J. C. (2012). The curious case of anabolic resistance: old wives' tales or new fables? Journal of Applied Physiology., 112(7), 1233–1235. https://doi.org/10.1152/japplphysiol.01343.2011Haran, P. H., Rivas, D. A., & Fielding, R. A. (2012). Role and potential mechanisms of anabolic resistance in sarcopenia. Journal of Cachexia, Sarcopenia and Muscle, 3(3), 157-162. https://doi.org/10.1007/s13539-012-0068-4Morton, R. W., Traylor, D. A., Weijs, P. J. M., & Phillips, S. M. (2018). Defining anabolic resistance: implications for delivery of clinical care nutrition. Current Opinion in Critical Care, 24(2): 124-130. https://doi.org/10.1097/MCC.0000000000000488Paulussen, K. J., McKenna, C. F., Beals, J. W., Wilund, K. R., Salvador, A. F., & Burd, N. A. (2021). Anabolic resistance of muscle protein turnover comes in various shapes and sizes. Frontiers in nutrition, 8, 615849.  https://doi.org/10.3389/fnut.2021.615849Rennie M. J. (2009). Anabolic resistance: the effects of aging, sexual dimorphism, and immobilization on human muscle protein turnover. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme, 34(3), 377–381. https://doi.org/10.1139/H09-012Support the Show.Have questions you want answered and topics you want discussed on the Aging Well Podcast? Send us an email at agingwell.podcast@gmail.com or record your question for us to use in an upcoming episode:https://www.speakpipe.com/AgingWellPodcast

In this episode we will be covering Facebook Live Questions 3/4-3/10/24  free Facebook Group Registered Dietitian Exam Study Group with Dana RD! Don't forget to check out my recorded courses here.Looking for additional tutoring service? Visit my website! Interested in monthly group tutoring? Click here to learn more and apply.Free Downloads: danajfryernutritiontutoring.teachable.com/p/my-downloadable-462494Interested in learning more about the Spring Group Tutoring? Click here to learn more and apply for the group! Access to the program starts 3/1 (ends 4/28) and our first class is Monday 3/11 at 8p est.

In this episode of "Dietitians Only," we delve deep into the critical role of nutrition in managing and healing pressure injuries. Sara Glanz, MS, RD, LD, CNSC reviews who's at high risk for developing pressure injuries, staging, and how nutrition can help in prevention and healing. In addition to discussing recommendations for calories and protein, we review the latest research and guidelines surrounding vitamin, arginine, and HMB supplementation. This episode is packed with valuable information and actionable tips that can help you prevent and treat pressure injuries through proper nutrition.  Show notes:     An Update on MNT for Pressure Injuries | 1 CPEU webinar Nutrition Recommendations for Pressure Injury Healing infographic National Pressure Injury Advisory Panel website: https://npiap.com  Munoz N, Posthauer ME, Cereda E, et al. The role of nutrition for pressure injury prevention and healing: the 2019 international clinical practice guideline recommendations. Advances in Skin & Wound Care. 2020;33:123-36.   Holeček M. Beta‐hydroxy‐beta‐methylbutyrate supplementation and skeletal muscle in healthy and muscle‐wasting conditions. Journal of Cachexia, Sarcopenia and Muscle. 2017;8(4):529-541. doi:10.1002/jcsm.12208.  Ogura Y, Yuki N, Sukegane A, Nishi T, Miyake Y, Sato H, Miyamoto C, Mihara C.J Treatment of pressure ulcers in patients with declining renal function using arginine, glutamine, and β-hydroxy-β-methylbutyrate. Wound Care. 2015 Oct;24(10):478-82. doi: 10.12968/jowc.2015.24.10.478.  Schneider KL, Yahia N. Effectiveness of arginine supplementation on wound healing in older adults in acute and chronic settings: A systematic review. Advances in Skin & Wound Care. 2019;32(10):457-62.  Wong A, Chew A, Wang CM, Ong L, Zhang SH, Young S.J The use of a specialized amino acid mixture for pressure ulcers: a placebo-controlled trial. Wound Care. 2014 May;23(5):259-60, 262-4, 266-9. 

Creatine is a supplement that every single person out there can benefit from. No matter your age, size, health status, or activity level.  Let's address every common concern and question that most people have about creatine. I'm going to give you all of the information to ease your mind and hopefully, you'll become a lifelong fan of this beneficial supplement. I'm not even selling it. So don't worry there's no sales pitch at the end. I truly just want you to do whatever you can to optimize your health for overall strength and longevity.  In this episode:  • Creatine monohydrate vs. creatine HCL • Does creatine cause bloating or weight gain? • Does creatine cause hair loss? • Does creatine cause muscle cramps? • Creatine and bipolar disorder • Creatine and non-athletic lifestyle benefits  • Creatine and athletic benefits • Dosing recommendations  • Is creatine loading necessary? PubMed Links: Creatine supplementation and cognitive performance in elderly individuals  https://pubmed.ncbi.nlm.nih.gov/17828627/ Creatine supplementation for older adults: Focus on sarcopenia, osteoporosis, frailty, and Cachexia: https://pubmed.ncbi.nlm.nih.gov/35688360/ Creatine in T Cell Antitumor Immunity and Cancer Immunotherapy: https://pubmed.ncbi.nlm.nih.gov/34067957/    Creatine electrolyte supplement improves anaerobic power and strength: a randomized double-blind control study: https://www.tandfonline.com/doi/full/10.1186/s12970-019-0291-x Creatine Supplementation in Women's Health: A Lifespan Perspective: https://www.mdpi.com/2072-6643/13/3/877  To sum it all up, creatine is safe, effective, and everyone should strongly consider using it throughout any stage of life. It aids in brain health, athletic performance, muscle health, bone health, sleep quality, and mood. And these are facts that have been proven over and over by legitimate scientific studies.  Don't get hung up on the brand. Just look for a label that says creatine monohydrate. I highly recommend this product not just for performance but also for longevity, optimizing aging, and protecting health through the lifecycle.  If you enjoyed this, share it on social media, tag FitFizz and let me know your favorite part. Send it your loved ones and get them on some creatine!  Thank you so much for listening! I'm Kelly Wilson, your health concierge, and until next time, breathe, stay strong, and always celebrate victory! Website: fitfizzstudio.com Social: @fitfizz

Dr. Charles Loprinzi shares the latest update to the management of cancer cachexia guideline. Dr. Loprinzi discusses the evidence that prompted the rapid update to the guideline and reviews the new evidence-based recommendations, including the addition of low-dose olanzapine as a treatment option for patients with advanced cancer to improve weight gain and appetite. Dr. Loprinzi reviews the limitations of the update, and outstanding research questions in the domain of cancer-associated cachexia. Read the latest update, "Cancer Cachexia: ASCO Guideline Rapid Recommendation Update" at www.asco.org/supportive-care-guidelines TRANSCRIPTThis guideline, clinical tools, and resources are available at http://www.asco.org/supportive-care-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest disclosures in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO.23.01280  Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. Charles Loprinzi from Mayo Clinic, Co-Chair on “Cancer Cachexia: ASCO Guideline Rapid Recommendation Update.” Thank you for being here today, Dr. Loprinzi.  Dr. Charles Loprinzi: It's a pleasure to participate. Brittany Harvey: Then, just before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Loprinzi who has joined us here today, are available in line with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes.   Then, to get into the content of this rapid recommendation update, first, Dr. Loprinzi, what prompted this rapid update to the ASCO management of cancer cachexia guideline, which was previously published in 2020? Dr. Charles Loprinzi: The impetus for the updated guideline was a recent JCO publication regarding the results of a randomized controlled trial looking at olanzapine. This prompted the expert panel to revisit this topic. The trial, conducted in India, involved 124 patients with stomach, hepatopancreatobiliary, or lung cancers as they initiated chemotherapy. Weight gain greater than 5% occurred in 60% of patients in the olanzapine arm versus 9% of the patients in the placebo arm with a p-value of 0.001 or less. Substantially improved appetite was seen in 43% versus 13%, with placebo also a p-value of less than 0.001. Grade 3 or greater chemotherapy toxicity was less common with olanzapine 12% versus 37%, with placebo with a p-value of 0.002. No substantial olanzapine-associated toxicity was apparent. There was one evidence of this with olanzapine versus two for placebo. So that was the reason for going ahead with this update. Brittany Harvey: I appreciate that background information. So then, based on this updated study on olanzapine, what are the updated recommendations from the expert panel for treating cancer cachexia? Dr. Charles Loprinzi: So, let me start to address this question by reviewing what the 2020 ASCO guidelines published said regarding the management of cancer cachexia in adults with advanced cancer. It concluded that evidence was insufficient to strongly endorse any pharmacologic agent for established anorexia/cachexia. Nonetheless, the guideline recommendation supported that clinicians could offer a short-term trial of a progesterone analog such as megestrol acetate or a corticosteroid such as dexamethasone to patients experiencing weight loss and/or appetite stimulation. These drugs stimulated appetite and caused weight gain, but they did not improve quality of life, they did not improve survival, and there was toxicity associated with these agents and therefore it was not strongly recommended.  The expert panel thoroughly discussed a potential role for olanzapine because of a couple of trials suggesting it was beneficial but concluded that the evidence was insufficient for a recommendation. Now, there was evidence from two randomized trials that supported olanzapine was an effective alternative for treating cancer-associated anorexia/cachexia. Thus, olanzapine was considered promising, but the data were not conclusive enough to support a guideline treatment recommendation. The new JCO publication was the impetus for making this guideline change. Brittany Harvey: Understood. So then, based off this new change to the recommendations, what is the breadth of these recommendations and what do these options mean for patients with advanced cancer?  Dr. Charles Loprinzi: The updated guidelines recommended that for adults with advanced cancer, clinicians could offer low-dose olanzapine once daily to improve appetite and cause weight gain. It was noted that the majority of the evidence for this recommendation came from patients with lung or GI cancers, and the largest study enrolled patients who were receiving cytotoxic chemotherapy concurrently. Having said this, there's evidence from the other two randomized trials noted above that olanzapine is helpful in patients with a wide variety of cancers and regardless of whether patients were receiving concomitant chemotherapy.   Of note, extensive data support that olanzapine leads to significant appetite stimulation and weight gain in patients without cancer who were taking olanzapine for psychiatric reasons. This was known from a long time ago in patients in that situation, who don't necessarily want to gain weight, would gain 10-20-30-40 pounds, get prediabetes, and get diabetic sort of troubles. The guideline update continues to support that clinicians may offer a short-term trial of a progesterone analog or a corticosteroid to those experiencing weight loss and/or appetite when there's a good reason for not using olanzapine.  Brittany Harvey: Understood. I appreciate you reviewing those two updated recommendations from the guideline panel.  So then you've talked about this a little bit already in describing the study details, but what is exciting about olanzapine in this setting and what should clinicians know as they implement these updated recommendations?  Dr. Charles Loprinzi: It's exciting that olanzapine is now the best-studied established treatment available for patients suffering from cancer-associated anorexia/cachexia in different oncologic situations, for prevention and/or for treatment of cancer-associated or cancer treatment-associated nausea and/or vomiting, and for treatment of cancer-associated anorexia/cachexia. Varying daily doses of olanzapine have been used, ranging from 2.5 to 10 milligrams per day. Data support that it is quite appropriate to use the 2.5-milligram per day dose for the initial treatment of cancer-associated appetite and/or weight loss. For patients who do not appear to benefit and have no apparent olanzapine toxicity, it seems reasonable to me to try a higher dose. Another thing to note is that olanzapine is a generic drug which is relatively inexpensive. While this drug has been noted to cause sedation, such sedation is usually short-lived despite drug continuation. Brittany Harvey: So then, it's great to hear that recent data have caused an update to these guidelines. But in your perspective, Dr. Loprinzi, what are the most pressing outstanding questions regarding the management of cancer cachexia? Dr. Charles Loprinzi: My goodness, you're putting pressure on me. I've been involved with a large number of cancer anorexia/cachexia trials for the better part of four decades, which did not support as strong an ASCO guideline recommendation as we now have with olanzapine. Noting that I was involved with one of the trials that supported that olanzapine was helpful for treating cancer-associated anorexia/cachexia. This is one of the trials. It was a short trial. We were mainly looking at nausea and vomiting treatment for advanced cancer, but we saw a marked increase in appetite in over just a day or two of using olanzapine. Having said this, there's always room for improvement, and a number of drugs are under development for treatment of cancer-associated anorexia/cachexia.   Recent discussions regarding the topic of olanzapine for treating cancer-associated anorexia/cachexia noted that the primary endpoint of the current trial was weight gain and that this was felt to be a more objective endpoint than appetite would be. As noted in the earlier part of the discussion, substantial improvement was seen both in weight gain and appetite, both with p-values of less than 0.001. My own opinion is that appetite improvement is as important, if not more important than is weight gain in the study population. Given that the trial was double-blinded and placebo-controlled, appropriate questionnaires regarding appetite should be able to be considered as an objective evaluation of a subjective symptom in the same way that appropriate questionnaires regarding a patient's pain can be considered an objective evaluation of a subjective symptom. For some of these subjective symptoms, you just don't have other good ways we can figure these things out by a blood test or something like this. So it's what the patient says which is most important.  Brittany Harvey: Absolutely. Incorporating how the patient feels is key to achieving better outcomes for patients.  So I want to thank you so much for your work to rapidly update this guideline and thank you for your time today, Dr. Loprinzi. Dr. Charles Loprinzi: You're welcome. Pleasure to participate. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/supportive-care-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experiences, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

Adriana Alveraz, MD, regional oncologist and palliative medicine physician, joins the Cancer Advances Podcast to talk about cancer-related anorexia and cachexia syndrome. Listen as Dr. Alveraz explains the challenges in diagnosing this syndrome, what physicians should pay attention to, as well as the importance of palliative care with cancer treatment.

William J. Evans, PhD is an Adjunct Professor of Medicine at the Duke University Medical Center and Human Nutrition in the Department of Nutritional Sciences at the University of California, Berkeley. Dr. Evans is the author or co-author of more than 300 publications in scientific journals, has more than 75,000 citations and was the first to describe sarcopenia. He is the co-inventor of a non-invasive and accurate measurement of muscle mass which is strongly related to health outcomes in older people. He is a founding member of the Society for Sarcopenia, Cachexia, and Wasting Disorders.In this episode we discuss:What's more important, muscle size or strength?The difference between lean body mass and skeletal muscle.What you should focus on to maintain health as you age.Why much of the research about muscles up until now has been wrong. This episode is brought to you by Apollo Neuro, Ned, Inside Tracker, 1stPhormMentioned in this episode:$40 off the Apollo Wearablehttp://apolloneuro.com/drlyonGet 15% off with code DRLYONhttp://helloned.com/DRLYONInside Tracker 20% Off the Entire Storehttps://info.insidetracker.com/drlyonVisit 1st Phorm Website for Free Shippinghttp://www.1stphorm.com/drlyon

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.05.02.539076v1?rss=1 Authors: Kwon, Y.-Y., Hui, S. Abstract: Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

It can be easy to write off doing high intensity exercises with our older adults…especially the ones with comorbidities, but if we compare the risks vs the rewards, you'll see that there's definitely some pros to doing HIIT training. Keep listening to find out more! Dun, Y., Smith, J. R., Liu, S., & Olson, T. P. (2019). High-intensity interval training in cardiac rehabilitation. Clinics in Geriatric Medicine, 35(4), 469–487. https://doi.org/10.1016/j.cger.2019.07.011 Blackwell, J. E. M., Gharahdaghi, N., Brook, M. S., Watanabe, S., Boereboom, C. L., Doleman, B., Lund, J. N., Wilkinson, D. J., Smith, K., Atherton, P. J., Williams, J. P., & Phillips, B. E. (2021). The physiological impact of high‐intensity interval training in octogenarians with comorbidities. Journal of Cachexia, Sarcopenia and Muscle, 12(4), 866–879. https://doi.org/10.1002/jcsm.12724   Want to make sure you stay on top of all things geriatrics? Go to https://MMOA.online to check out our Free eBooks, Lectures, & the MMOA Digest!

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.01.12.523716v1?rss=1 Authors: Li, B., Sun, Q., van de Lisdonk, D., Ferrer, M., Gegenhuber, B., Wu, M., Tollkuhn, J., Janowitz, T. Abstract: Interleukin-6 (IL-6) has been long considered a key player in cancer-associated cachexia. It is believed that sustained elevation of IL-6 production during cancer progression causes brain dysfunctions, which ultimately result in cachexia. However, how peripheral IL-6 influences the brain remains poorly understood. Here we show that neurons in the area postrema (AP), a circumventricular structure in the hindbrain, mediate the function of IL-6 in cancer-associated cachexia in mice. We found that circulating IL-6 can rapidly enter the AP and activate AP neurons. Peripheral tumor, known to increase circulating IL-6, leads to elevated IL-6 and neuronal hyperactivity in the AP, and causes potentiated excitatory synaptic transmission onto AP neurons. Remarkably, neutralization of IL-6 in the brain of tumor-bearing mice with an IL-6 antibody prevents cachexia, reduces the hyperactivity in an AP network, and markedly prolongs lifespan. Furthermore, suppression of Il6ra, the gene encoding IL-6 receptor, specifically in AP neurons with CRISPR/dCas9 interference achieves similar effects. Silencing of Gfral-expressing AP neurons also ameliorates the cancer-associated cachectic phenotypes and AP network hyperactivity. Our study identifies a central mechanism underlying the function of peripheral IL-6, which may serve as a target for treating cancer-associated cachexia. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Grip strength might predict older adults at risk for chronic disease or early death. In a new study published in the Journal of Cachexia, Sarcopenia and Muscle, researchers at the University of Michigan demonstrated that grip strength can demonstrate existing muscle weakness, and that this muscle weakness is associated with accelerated biological age. Just as […] The post 354. Grip strength might predict risk of chronic disease or early death appeared first on Dr. David Geier - Feel and Perform Better Than Ever.

We all know that protein is a vital nutrient for muscle-building, but how much do you really need to take to build muscle effectively? According to research, it appears to be between 1.2 and 1.6 grams of protein per kilogram of body weight.References:Ryoichi Tagawa, Daiki Watanabe, Kyoko Ito, Keisuke Ueda, Kyosuke Nakayama, Chiaki Sanbongi, Motohiko Miyachi, Dose–response relationship between protein intake and muscle mass increase: a systematic review and meta-analysis of randomized controlled trials, Nutrition Reviews, Volume 79, Issue 1, January 2021, Pages 66–75, https://doi.org/10.1093/nutrit/nuaa104Tagawa, R., Watanabe, D., Ito, K. et al. Synergistic Effect of Increased Total Protein Intake and Strength Training on Muscle Strength: A Dose-Response Meta-analysis of Randomized Controlled Trials. Sports Med - Open 8, 110 (2022). https://doi.org/10.1186/s40798-022-00508-wNunes et al. Journal of Cachexia, Sarcopenia and Muscle. 2022. https://doi.org/10.1002/jcsm.12922VISIT OUR STOREStore: https://www.selfelements.comFOLLOW USwww.selfprinciple.orgwww. youtube.com/selfprinciplewww.youtube.com/plantbasedkidneyhealthwww.instagram.com/seanhashmimd

Videos: DR. SCOT YOUNGBLOOD AT SAN DIEGO CITY COUNCIL MEETING (12:36) Edward Dowd Interviews (47:25) Quercetin helps to reduce the risk of pancreatic cancer Univ. of Hawaii and Univ. of Southern California, November 1, 2022 Quercetin, which is found naturally in apples and onions, has been identified as one of the most beneficial flavonols in preventing and reducing the risk of pancreatic cancer. Although the overall risk was reduced among the study participants, smokers who consumed foods rich in flavonols had a significantly greater risk reduction. This study, published in the American Journal of Epidemiology, is the first of its kind to evaluate the effect of flavonols – compounds found specifically in plants – on developing pancreatic cancer. Researchers from the Univ. of Hawaii and Univ. of Southern California tracked food intake and health outcomes of 183,518 participants in the Multiethnic Cohort Study for eight years. The study evaluated the participants' food consumption and calculated the intake of the three flavonols quercetin, kaempferol, and myricetin. The analyses determined that flavonol intake does have an impact on the risk for developing pancreatic cancer. The most significant finding was among smokers. Smokers with the lowest intake of flavonols presented with the most pancreatic cancer. Smoking is an established risk factor for the often fatal pancreatic cancer, notes the research. Among the other findings were that women had the highest intake of total flavonols and seventy percent of the flavonol intake came from quercetin, linked to apple and onion consumption. It is believed that these compounds may have anticancer effects due to their ability to reduce oxidative stress and alter other cellular functions related to cancer development. Previously, the most consistent inverse association was found between flavonols, especially quercetin in apples and lung cancer, as pointed out in this study. No other epidemiological flavonol studies have included evaluation of pancreatic cancer. While found in many plants, flavonols are found in high concentrations in apples, onions, tea, berries, kale, and broccoli. Quercetin is most plentiful in apples and onions. Hops may help lower Alzheimer disease risk University of Milano-Bicocca (Italy), November 9 2022. Hops, the plant whose flowers are used to make beer, could have a future in the prevention of Alzheimer disease according to research reported in the journal ACS Chemical Neuroscience. “The search for natural compounds, whose intake through diet can help prevent the main biochemical mechanisms responsible for Alzheimer disease onset, led us to screen hops,” Alessandro Palmioli of the University of Milano-Bicocca and colleagues wrote. Acting on other positive findings for hops, the team identified feruloyl and p-coumaroylquinic acids, flavan-3-ol glycosides and procyanidins as compounds responsible for the plant's neuroprotective action. These molecules interacted with amyloid-beta (a substance that forms sticky plaques in the brains of Alzheimer disease patients), to prevent it from forming fibrils and becoming toxic. Hops extracts were also found to prevent cell death by inhibiting oxidative stress and inducing autophagy, a process by which cells break down and destroy old or damaged proteins or other substances. The Tettnang variety of hops proved to be the most successful of the four varieties tested. “The identification of natural compounds or natural mixtures, such as nutraceuticals, exploitable for the development of preventive strategies against Alzheimer disease (and other neurodegenerative diseases) appears as a better alternative to the treatment of symptoms, as the neuronal damage associated with the disease is irreversible,” the authors remarked. “Our results show that hop is a source of bioactive molecules with synergistic and multitarget activity against the early events underlying Alzheimer disease development. We can therefore think of its use for the preparation of nutraceuticals useful for the prevention of this pathology.” Healthy plant-based diets better for the environment than less healthy plant-based diets Harvard School of Public Health, November 10. 2022 Healthier plant-based dietary patterns are associated with better environmental health, while less healthy plant-based dietary patterns, which are higher in foods like refined grains and sugar-sweetened beverages, require more cropland and fertilizer, according to a new study led by researchers at Harvard T.H. Chan School of Health and Brigham and Women's Hospital. The findings also showed that red and processed meat had the highest environmental impact out of all food groups in participants' diets, producing the greatest share of greenhouse gas emissions and requiring the most irrigation water, cropland, and fertilizer. “The differences between plant-based diets was surprising because they're often portrayed as universally healthy and good for the environment, but it's more nuanced than that,” said Aviva Musicus, postdoctoral research fellow in the Department of Nutrition at Harvard Chan School and corresponding author of the study. Previous research has documented that different types of plant-based diets have various health effects. For example, plant-based diets higher in whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea/coffee are associated with reduced chronic disease risk, while plant-based diets high in fruit juices, sugar-sweetened beverages, refined grains, potatoes, and sweets/desserts are associated with an increased risk of chronic disease. Yet little research has been conducted to determine the environmental impacts, such as greenhouse gas emissions, use of high-quality cropland, nitrogen from fertilizer, and irrigation water, of these dietary approaches. The researchers analyzed the food intakes of more than 65,000 qualifying participants, and examined their diets' associations with health outcomes, including relative risks of cardiovascular disease, and with environmental impacts. Higher scores on the unhealthy plant-based diet index indicated higher consumption of refined grains, sugary drinks, fruit juice, potatoes, and sweets/desserts; while higher scores on the healthy plant-based diet index indicated higher consumption of vegetables, fruits, whole grains, nuts, legumes, vegetable oils, and tea/coffee. Participants who consumed healthy plant-based diets had lower cardiovascular disease risk, and those diets had lower greenhouse gas emissions and use of cropland, irrigation water, and nitrogenous fertilizer than diets that were higher in unhealthy plant-based and animal-based foods. Participants who ate unhealthy plant-based diets experienced a higher risk of cardiovascular disease, and their diets required more cropland and fertilizer than diets that were higher in healthy plant-based and animal foods. The findings also reinforced earlier studies showing that diets higher in animal-based foods, especially red and processed meat, have greater adverse environmental impacts than plant-based diets. Removing digital devices from the bedroom can improve sleep for children, teens Penn State University, November 4, 2022 Removing electronic media from the bedroom and encouraging a calming bedtime routine are among recommendations Penn State researchers outline in a recent manuscript on digital media and sleep in childhood and adolescence. The recommendations, for clinicians and parents, are: Make sleep a priority by talking with family members about the importance of sleep and healthy sleep expectations; Encourage a bedtime routine that includes calming activities and avoids electronic media use; Encourage families to remove all electronic devices from their child or teen's bedroom, including TVs, video games, computers, tablets and cell phones; Talk with family members about the negative consequences of bright light in the evening on sleep; and If a child or adolescent is exhibiting mood or behavioral problems, consider insufficient sleep as a contributing factor. “Recent reviews of scientific literature reveal that the vast majority of studies find evidence for an adverse association between screen-based media consumption and sleep health, primarily delayed bedtimes and reduced total sleep duration,” said Orfeu Buxton, associate professor of biobehavioral health at Penn State. The reasons behind this adverse association likely include time spent on screens replacing time spent sleeping; mental stimulation from media content; and the effects of light interrupting sleep cycles, according to the researchers. Black Sesame Seed Reduces High Blood Pressure Mahidol University (Thailand), November 10, 2022 Research from Thailand's Mahidol University has found that black sesame seeds can significantly reduce blood pressure among men and women. The research tested 30 men and women with an average age of 50 years old. They were considered ‘pre-hypertensive' as their blood pressure levels were high but not yet high enough to be prescribed medication. During the four week study, the patients did not take any medications or dietary supplements. The volunteers were divided into two groups. One group was given six placebo capsules per day, and the other group was given six capsules of 420 milligrams of black sesame seed meal. Each person in the sesame seed group was given a total of 2,520 milligrams (2.5 grams) per day. According to the USDA, a tablespoon of sesame seeds weighs about nine grams. This would mean that the subjects were given a little less than a quarter tablespoon per day. The research found the sesame seed meal significantly decreased the blood pressure among the treated group. Their average systolic blood pressure after the four weeks was 121 mmHg, while the average blood pressure of the placebo group was 129 mmHg. The sesame seed group also showed decreased levels of malondialdehyde and increases in their blood vitamin E levels. Malondialdehyde is an indicator of the amount of lipid peroxidation taking place within the bloodstream. As other research has shown, lipid peroxidation is linked to the blood vessel damage seen in atherosclerosis. This is a relationship of free radical oxidation. When low-density lipoproteins are oxidized, they can damage blood vessels because they effectively steal electrons from blood vessel wall cells. Conversely, higher vitamin E levels are typically linked with lower lipid peroxidation because vitamin E is an antioxidant. The researchers analyzed the black sesame seed meal, and it was found to contain 105 micrograms per gram of tocopherols – primarily gamma tocopherol. By the way, this is a different configuration of synthetic vitamin E found in most supplements – rac-α-tocopheryl acetate – referred also as alpha-tocopherol. The main medicinal constituents of black sesame seed include sesamol, sesamin and sesamolin, which are known to be antioxidants. They also contain catechins, known for their anticancer properties. Is muscle weakness the new smoking? Grip strength tied to accelerated biological age, study shows University of Michigan, November 10, 2022 Everyone ages at a different pace. That's why two 50-year-olds, despite living the same number of years, may have different biological ages—meaning that a host of intrinsic and extrinsic factors have caused them to age at varying paces with different levels of risk for disease and early death. Lifestyle choices, such as diet, and smoking, and illness all contribute to accelerating biological age beyond one's chronological age. For the first time, researchers have found that muscle weakness marked by grip strength, a proxy for overall strength capacity, is associated with accelerated biological age. Specifically, the weaker your grip strength, the older your biological age, according to results published in the Journal of Cachexia, Sarcopenia and Muscle. Researchers at Michigan Medicine modeled the relationship between biological age and grip strength of 1,274 middle aged and older adults using three “age acceleration clocks” based on DNA methylation, a process that provides a molecular biomarker and estimator of the pace of aging. The clocks were originally modeled from various studies examining diabetes, cardiovascular disease, cancer, physical disability, Alzheimer's disease, inflammation and early mortality. Results reveal that both older men and women showed an association between lower grip strength and biological age acceleration across the DNA methylation clocks. “We've known that muscular strength is a predictor of longevity, and that weakness is a powerful indicator of disease and mortality, but for the first time, we have found strong evidence of a biological link between muscle weakness and actual acceleration in biological age,” said Mark Peterson, Ph.D., M.S. at University of Michigan. “This suggests that if you maintain your muscle strength across the lifespan, you may be able to protect against many common age-related diseases. We know that smoking, for example, can be a powerful predictor of disease and mortality, but now we know that muscle weakness could be the new smoking.” The real strength of this study was in the 8 to 10 years of observation, in which lower grip strength predicted faster biological aging measured up to a decade later, said Jessica Faul, Ph.D., M.P.H., a co-author of the study and research associate professor at the U-M Institute for Social Research. Past studies have shown that low grip strength is an extremely strong predictor of adverse health events. One study even found that it is a better predictor of cardiovascular events, such as myocardial infarction, than systolic blood pressure—the clinical hallmark for detecting heart disorders. Peterson and his team have previously shown a robust association between weakness and chronic disease and mortality across populations.

In the latest installment of the pharmaphorum podcast, Editor in Chief Jonah Comstock sits down with Russell Potterfield, CEO at Endevica Pharma. A biotech CEO who comes from the business and investment worlds, Russell now runs Endevica, which is working on a novel therapy for cachexia, a wasting syndrome that accompanies many cancers.

What did randomized controlled trials find as the effects of supplemental feeding on clinical outcomes?

Back in the host's chair this week, Bob Hughes welcomes Dr. Bill Evans, one of the world's foremost experts on muscle aging, to the podcast. Bill is adjunct professor of Human Nutrition at University of California Berkeley and an adjunct professor of medicine in the Geriatrics Program at Duke. Previously, he was vice president and head of Muscle Metabolism Discovery Performance Unit at GlaxoSmithKline and he was also president of the Muscle and Health Division at KineMed. He was also president of the Muscle and Health Division at KineMed. Earlier this year, he was recognized with a Lifetime Achievement Award at the 2022 International Conference on Frailty, and Sarcopenia Research. Today, Bill brings his vast amount of experience and expertise to the podcast to discuss how muscle aging affects longevity in older people and the relationship between muscle aging and age-related diseases. He begins by sharing his experience in the longevity industry, particularly with muscle aging, and goes on to discuss the term ‘sarcopenia', including what it means and how it relates to muscle degeneration. He then explains the differences between sarcopenia and cachexia, and referring to several studies, shares the meaning of frailty, the relation of walking speed with age, and the importance of the brain–muscle connection. At the conclusion of the episode, Bill discusses the future of muscle aging and how the longevity industry hopes to find solutions that will improve the lives of people on a global scale. Episode Highlights: Bill's journey in the muscle aging industry Why muscle degeneration? The origin of the term ‘sarcopenia' The differences between sarcopenia and cachexia Is sarcopenia due to dysregulation of neuronal inputs? The contribution of fast-twitch and slow-twitch muscle fibers in aging Sarcopenia and age-related diseases What is frailty? Why our walking speed slows down as we age The relation between exercise and psychological state The brain-muscle connection The future of the longevity industry from Bill's viewpoint Quotes: “What are some of the causes of late life disability? How does muscle change as we grow older? Why do we lose muscle?” “A large percentage of women in particular over the age of 60 reported that they couldn't even lift 10 pounds. And the muscle weakness progressed as they grew older.” “The primary deficit and functional deficit as we grow older is loss of strength. And that is directly related to how much muscle we have.” “Cachexia is associated with a rapid increase in the breakdown of muscle, while sarcopenia is associated with a more gradual decrease in the rate of synthesis of muscle.” “People generally over the age of 75, have circulating markers of inflammation.” “People with type two diabetes and insulin resistance lose muscle at almost double the rate of people with normal glucose tolerance.” “If we improve strength in an older person, their spontaneous activity goes up. And their habitual walking speed goes up as well.” Links: Email questions, comments, and feedback to podcast@bioagelabs.com Translating Aging on Twitter:https://twitter.com/BioAgePodcast ( @bioagepodcast) BIOAGE Labs Websitehttps://bioagelabs.com/ ( BIOAGELabs.com) BIOAGE Labs Twitterhttps://twitter.com/bioagelabs?lang=en ( @bioagelabs) BIOAGE Labshttps://www.linkedin.com/company/bioage-labs/ ( LinkedIn) https://www.linkedin.com/in/william-evans-phd-94a58415/ (Dr. Bill Evans on LinkedIn)

Dr. Jeanine Cook-Garard learns about Cachexia - a condition that causes body muscles to waste away. It comes with extreme weight loss and can include loss of body fat. It's usually one of the symptoms that appear when you have a chronic condition. Her guest is Dr. Ken Gruber, the founder, former CEO, and current Chief Scientific Officer of Endevica Bio, a biotech company developing drugs for conditions which lack any true therapy.

I'm sure immunity is a topic that is on all of our minds. Our immune system is valuable, it protects us, but when it doesn't have the right tools or knowledge, or it may be faced with something that confuses it, it may not do the right things for our body. So joining us today at Maximal Being Fitness, Nutrition, and Gut Health, is Gian-Carlo Torres, a mission-driven entrepreneur. He has spent the past four years working closely alongside doctors, scientists, and world-renowned health publications to study the powerful effects of glutathione. Topics - The science behind the immune system- How does glutathione work and interact with your body and help your immune system?- Glutathione intake- What glutathione is and the role that it has in the human body- Other ways that we can help boost our immune systemDoc Mok an advanced GI doctor specializing in nutrition, gut health, and cancer. Joining him is the podcast's layman, Jacky P, smashing the broscience on this week's podcast. Their guest Gian-Carlo Torres is a mission-driven entrepreneur whose personal health, career, and life have all been shaped by the love he has for his family.If you enjoy the podcast, would you please consider leaving a short review on Apple Podcasts/iTunes? It takes less than 60 seconds, and it really makes a differenceReach Out to use team@maximalbeing.comOr Speak pipe https://www.maximalbeing.com/contact/Support the Show at https://www.patreon.com/maximalbeingOur sponsorsiHerb supplement – https://www.maximalbeing.com/iherbBDB5528 and receive 10% off your ordersInstacart – https://www.maximalbeing.com/instacartResourceshttps://www.maximalbeing.comSocialFacebook: https://www.facebook.com/maximalbeing/Twitter:  https://twitter.com/maximalbeingInstagram:  https://www.instagram.com/maximal_being/Pinterest: https://www.pinterest.com/maximalbeing/Linked'in: https://www.linkedin.com/in/maximal-being-13a5051a1/YouTube:  https://www.youtube.com/channel/UCi7KVUF8U-gfhOE1KSNAqIgJOIN OVER 3,418 MAXIMAL BEINGS AND GET OUR FREE 9 STEP GUIDE TO REMODELING YOUR GUT, FREE MACRO CALCULATOR, & 10% OFF COUPONhttps://maximalbeing.us4.list-manage.com/subscribe?u=ce1e2f527d19296e66d8a99be&id=2d68acf4e0Sign-up for our Kombucha Coursehttps://www.maximalbeing.com/product-category/courses/Need a FREE consult book it nowhttps://www.maximalbeing.com/contact/#start-booking-servicesNeed a Custom Nutrition, Fitness or Guthealth planhttps://www.maximalbeing.com/product-category/personalized-plans/Our Gearhttps://www.maximalbeing.com/product-category/clothing/Support the show (https://www.patreon.com/maximalbeing)

The Oncology Journal Club - Delivering Oncology News DifferentlyThe Oncology Podcast, brought to you by Oncology News Australia, is proud to present Episode 33 in our series The Oncology Journal Club.Was Beethoven's death the result of medical malpractice? This week the OJC team tackle this crucial question plus the microbiome, trial design bias, five year outcomes for metastatic non-small-cell lung cancer and much more...Hans Prenen gets us started by talking us through the connection between the gut microbiome and immune checkpoint inhibitors and Eva Segelov has a mega paper this week…  She tackles our friend Bishal Gyawali's paper addressing biases in study design that distort the appraisal of clinical benefit and ESMO-Magnitude of Clinical Benefit Scale. Fascinating stuff!Then Craig Underhill gives us his thoughts on Five-Year Outcomes With Pembrolizumab Versus Chemotherapy for Metastatic Non-Small-Cell Lung Cancer.Today's quick bites are as diverse as ever covering highlights from the AACR ASM, Fecal transplants for patients with cachexia, the TAPUR trial, Controversies in Thoracic Oncology, the costs of fear of cancer recurrence and much more.With the usual top quality banter, papers you won't hear of anywhere else and expert analysis from our Hosts, you are in for another great episode of The Oncology Journal Club!Full bios and the list of all papers discussed are available on our website.For the latest oncology news visit www.oncologynews.com.au and for regular oncology updates for healthcare professionals, subscribe for free to get the weekly The Oncology Newsletter.The Oncology Podcast - An Australian Oncology Perspective

In this 21-minute episode, Martin Chasen, MBChB FCP, MPhil, talks about multimodal intervention and why it's beneficial for patients with cancer; summarizes existing clinical practice guidelines that promote and use multimodal intervention; and describes the role patients can play in their multimodal therapy during cancer care. 

In this VETgirl online veterinary CE podcast, we review cardiac cachexia in cats with congestive heart failure (CHF) - does it affect their prognosis and outcome? Cachexia, or bodily wasting in the form of muscle and weight loss, is a common systemic effect of numerous chronic diseases, including CHF.

In this episode you will learn what Cachexia is and how it is linked to lupus and other chronic illness such as Cancer. You will hear about the signs, symptoms and it there exists treatment. You'll find out the origin of the word Cachexia. Cachexia Common in Lupus — More than half of patients in a large cohort developed involuntary weight loss. Did you know that Thunderstorms can cause individuals with Asthma be hospitalized? Resource Source Reference: Stojan G, et al "Cachexia in systemic lupus erythematosus: risk factors and relation to disease activity and damage" Arthritis Care Res 2020; DOI: 10.1002/acr.24395. Sponsors Goli Gummy - https://go.goli.com/suelynne1 ; Use Promo Code: suelynne1 Vitalizehair.com - Promo Link available on My Story Living with Lupus IG Page #lupus #cachexia #lupusawareness #goli #acv #goligummies #tastetheapplenotthevinegar --- Send in a voice message: https://anchor.fm/susan-hendrix/message

Today we have Cathleen S. Graham RN, CHPN, the regional manager for one of the nation's largest hospice organizations and the CEO of CannabisNurse.com. Cathleen is also a partner with Leaf Medic, Michigan's first online vocational school to offer cannabis industry training. Cathleen suggests you look for unbiased scientific locations to learn more. Her suggestions include:Cannabis Nurse.com: https://cannabisnurse.com/American Cannabis Nurses Association: https://cannabisnurses.org/Cannabis Nurses Network: https://www.cannabisnursesnetwork.com/The Society of Cannabis Clinicians: https://www.cannabisclinicians.org/Dr. Sulak at https://healer.com/The debilitating medical conditions that qualify an individual for the medical use of marijuana include one or more of the following: CancerGlaucomaHIV PositiveAIDSHepatitis CAmyotrophic Lateral Sclerosis (ALS)Crohn’s DiseaseAgitation of Alzheimer’s DiseaseNail PatellaPost - Traumatic Stress Disorder (PTSD)Obsessive Compulsive Disorder (OCD)ArthritisRheumatoid ArthritisSpinal Cord InjuryColitisInflammatory Bowel DiseaseUlcerative ColitisParkinson’s DiseaseTourette’s DiseaseAutismChronic PainCerebral PalsyA chronic or debilitating disease or medical condition or its treatment that produces 1 or more of the following:Cachexia or Wasting SyndromeSevere and Chronic PainSevere NauseaSeizures (Including but not limited to those characteristic of epilepsy)Severe and Persistent Muscle Spasms (Including but not limited to those characteristic of multiple sclerosis)For every pro there is a possible con. For example, cannabis is said to help manage anxiety or symptoms of PTSD. However, if one takes too much cannabis it can cause anxiety and panic. Also, if one with PTSD obtains a cannabis chemovar that is high in pinene it can cause the symptoms of PTSD to become worse. Cannabis is also known to increase heart rate up to 50%.A recent study published in Forensic Science International this month declared “After exclusion of other causes of death we assume that the young men experienced fatal cardiovascular complications evoked by smoking cannabis.”These reports indicate that the need for education is paramount for the safety of the consumer. CBD is a great vasorelaxant and can decrease blood pressure as well as stabilize blood sugar levels. CBD does not activate CB1 receptors in the brain, and is devoid of the psychotropic actions of THC (meaning it will not get you high). Indeed, CBD may antagonize the psychoses associated with THC (meaning CBD decreases the effects of THC). The difference between cannabis oil and hemp CBD oil is the amount of THC that is allowed. Hemp CBD oil is allowed to have 0.3% THC along with all the other cannabinoids found in that particular plant. Cannabis oil has a lot more THC and very little CBD. A research study suggests that 96% of cannabis has no CBD in it at all. CBD is found mostly in the Hemp plant. CBD isolate is just that- only the CBD. This isolate does not have any other cannabinoids. CBD is the cannabinoid that has the most medicinal benefit- CBD alone is great at decreasing pain, inflammation, nausea, insomnia, and muscle spasms as well as many other symptoms too.  Also, CBD does not show on a drug screen test as they usually only test for THC. When you use full spectrum cannabis or hemp products you are getting the most medicinal benefit as they all work well to balance each other and create an entourage effect. It is important to remember that if you use a full spectrum hemp oil that you can fail a drug test as these products do have 0.3% THC. There are both pros and cons to the different methods of administration. Smoking the byproducts can cause serious diseases in a person. Vaping or dabbing can reduce those harmful byproducts by not combusting the product. Inhaling is the fastest way to get cannabis into your body-- it is also the shortest lasting-- meaning you have to use this method a lot more often to feel the medicinal benefits. Note: We caution you that vaping has been determined to be dangerous. Edibles or Medibles take a lot longer to feel the effects although the effects may last up to 8 hours using this method. When you eat cannabis it is important to remember that the Delta 9 THC converts to 11 Hydroxy THC which is 3-4 times more potent and psycho active than Delta 9 THC. 11 Hydroxy THC passes through the blood brain barrier easier and that is good news for Parkinson’s patients. Sublingual is the easiest to micodose and is often used by the pediatric patients the most. Topical products are not psycho active and work at the site where it is applied.Medical marijuana may affect the effectiveness of medications taken to control GVHD (tacrolimus, cyclosporine, steroids) as well as anti-depressants and potentially antibiotics and antifungals: What we do know from our knowledge is that it does have some effect on post-transplant medications so there is some effect on mycophenolate, tacrolimus, cyclosporine or steroids so many of the medications a patient might receive post-transplant, these agents may inhibit them and cause increased levels of the drug which may result in toxicity. Also, it can inhibit our antidepressants which would again increase our level of toxicity with those drugs. We can see some potential drug-drug interactions with our antibiotics, as well as our antifungals which many transplant patients will receive. We do worry about these because things like Voriconazole, Posaconazole, any of our azoles. Many of our mycins, erythromycin, clarithromycin, antibiotics may be affected by these.There are concerns about infection in transplant patients who use marijuana: From an infection standpoint, we do have concerns. Especially with smoking marijuana in our patient population. We have concerns with fungal infections. There are some case reports looking at patients who are smoking marijuana or who have smoked marijuana or who are immunosuppressed post-transplant who have developed severe fungal infections and have died from those fungal infections. That could be a result of mold spores that may be contained in the buds that are smoked, as well it could be a result of increase in inflammation and causing infection risk in the lungs. Again, when we have patients who are immunosuppressed, who have too few white blood cells, we really do advise them NOT to use smoked products. We really advise them to use edibles or tinctures of some other nature.Microbe contamination of marijuana products is a concern: There's no standard manufacturing, so we worry about microbe contamination just like we would worry about smoking those natural products with mold spores.Micro contamination, we worry about pesticide contamination from how the crops were raised. With that, in our immunosuppressed patient population this is a real concern because patients can be more susceptible to these types of toxicities. Then there is just an unmonitored chain supply. Again, with FDA approved drugs as they go through quality control - we do monitor where the drugs are and what temperatures they are and when they have been where. In this situation, there really is an unmonitored chain supply so we do not know where there might be potential places for contamination to occur as the product is being prepared for patient use.Small studies suggest that marijuana may help in control of Graft Versus Host DiseasePlease remember: this is an overall, general education. Again, we want to stress that with laws differing so much state to state regarding the use of cannabis or CBD, it is very important you learn the laws for YOUR state. We also are working with what is legal at the time of this recording, in June 2020. Please consult your doctor should you have personal questions or concerns, applicable to your care plan.For more from the National Bone Marrow Transplant Link, visit us online at nbmtlink.org or call us at 800-546-5268.This season of Marrow Masters is sponsored by the nbmtLINK, Jazz Pharmaceuticals and The Leukemia & Lymphoma Society.nbmtLINK website: https://www.nbmtlink.org/The Leukemia & Lymphoma Society: https://www.lls.org/

Prof Laviano is an Associate Professor at Sapienza University of Rome in Italy. His background is internal medicine and Nephrology, as well as clinical nutrition Prof Laviano has served on various committees within ESPEN over the years He has also served as Editor for various publications such as, British Journal of Nutrition, Nutrition, Journal of Cachexia, Sarcopenia, and Muscle; Current Opinion in Clinical Nutrition and Metabolism Prof Laviano has more than 180 publications in international peer reviewed journals In this episode we chat about hospital malnutrition

The Oncology Journal Club - Delivering Oncology News DifferentlyThe Oncology Podcast, brought to you by www.oncologynews.com.au, is proud to present the next episode of The Oncology Journal Club.This week we have our final post ASCO 2020 Review episode, hosted by Professor Eva Segelov from Monash University. Eva is joined by Dr Craig Underhill from Albury-Wodonga and Professor Hans Prenen from Belgium.This week Eva presents an important update on cachexia and a surprise paper... if you don't know what 'manels' are, this one's for you! Craig chats with Dr Christopher Steer, a Geriatric Oncology specialist, about papers presented at the recent ASCO meeting, including Kheng Soo's paper on “Integrating Geriatric Assessment and Management Into Cancer Care” which Christopher hails as ‘The Rolls Royce Model of Cancer Care in Older Adults'.Hans presents some fascinating translational studies from Nature and we also have not 1 not 2 but 3 new segments this week… you may have noticed a little competitiveness between the team so of course they had to have one each!We hope you enjoy another entertaining episode of The Oncology Journal Club. As ever, the links to all the papers discussed today are available below.As ever, the links to all the papers discussed today are available in the notes on our website.About The Oncology Journal ClubWe have taken an old concept and updated it with a new format. In each episode a team of expert contributors will review topical journal papers and studies presented at key meetings to help keep you informed of the latest developments on the go.For the latest oncology news visit www.oncologynews.com.au and for regular oncology updates for healthcare professionals, please subscribe to The Oncology Newsletter.The Oncology Podcast - An Australian Oncology Perspective

In this podcast, Associate Editor Mary Marian, DCN, RDN, CSO, FAND, interviews author Todd W. Mattox, PharmD, BCNSP, on his article "Cancer Cachexia: Cause, Diagnosis, and Treatment" published in the October 2017 issue of NCP. https://doi.org/10.1177/0884533617722986

An interview with Dr. Eric Roeland from Massachusetts General Hospital Cancer Center on “Management of Cancer Cachexia: ASCO Guideline.” This guideline provides evidence-based recommendations on the clinical management of cancer cachexia in adult patients with advanced cancer. Recommendations are made on both pharmacologic and nutritional interventions. Read the full guideline at www.asco.org/supportive-care-guidelines   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Hello and welcome to the ASCO Guidelines Podcast Series brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows including this one, at podcast.asco.org. My name is Brittany Harvey, and today I'm speaking with Dr. Eric Roland from Massachusetts General Hospital Cancer Center. Lead author on Management of Cancer Cachexia, ASCO Guideline. Thank you for being here, Dr. Roland. Well thank you very much. Before we get into the content of this guideline, I want to note that all conflict of interest disclosure information for the expert panel is available online with the publication of the guideline in the Journal of Clinical Oncology. Dr. Roland, do you have any conflicts of interest to disclose? Yes, within the last two years, I've served as a consultant for Asahi Kasei Pharmaceuticals, DIG Consulting, Napo Pharmaceuticals, American Imaging Management, Immuneering Corporation, and Prime Oncology. I've also served on advisory boards for Herron Pharmaceuticals and Vector Oncology. And I serve as a member on the Data Safety Monitoring Boards for Oragenics, Kalyra Pharmaceuticals, and [INAUDIBLE] Life Sciences Pharmaceutical Company. Thank you. Then first, can you give us a general overview of what this guideline covers? Sure. We performed a systematic review of the literature regarding available evidence for nutritional and pharmacologic interventions for cancer cachexia. Specifically, we searched PubMed and the Cochrane Library for randomized controlled trials and systematic reviews published between 1966 in 2019. We focused our review on adult patients with advanced or incurable cancer. And given the highly variable nature of cancer cachexia, we specifically evaluated the endpoints of loss of appetite or anorexia, body weight, and lean body mass, or skeletal muscle. Our targeted audience included clinicians as well as patients and caregivers. Can you provide us with a little background on cancer cachexia? Yes, first I think it's incredibly important for us to define cancer cachexia, especially given its prevalence in cancer care. Traditionally, cancer cachexia has been defined as a certain amount of weight loss over a defined time period. However, cachexia is much more complicated than weight loss alone. It is a multifactorial syndrome characterized by loss of appetite, weight, and skeletal muscle, which leads to fatigue, functional impairment, increased treatment related toxicity, poor quality of life, and even reduced survival. And as clinicians, we need to try to identify any reversible causes contributing to cachexia and treat them. This of course, includes treating the underlying cancer when possible. Additionally, it's essential for patients to receive optimal palliation of all symptoms that may be interfering with the intake of calories, such as pain, nausea, vomiting, constipation, diarrhea, and depression. Therefore, as clinicians, we need to work in teams of experts that might include expertise in pain, palliative care, nutrition, physical occupational therapy, and mental health where available. We also need to introduce and discuss the term, cachexia, with our patients and their caregivers, who often have never heard of it before. They may not understand that this term is unique and very different from weight loss alone. I personally have found that describing the unique nature of cachexia and providing the information to patients and caregivers can be very helpful. Additionally, we need to recognize that food is a very complicated issue. And when we engage patients and caregivers around issues of food, we need to recognize that there are informational needs, but there are also emotional needs. And as clinicians, we help patients and caregivers gain access to evidence based information and interventions, but we equally need to ensure that they receive emotional support. Food represents hope and control in an uncontrollable situation. And not being able to eat or feed a loved one can cause severe distress. Therefore, we need to engage patients and caregivers regarding these emotional issues and make sure they feel heard. We can also reach out to our mental health colleagues, such as social workers and psychologists, who may help us support patients and caregivers in this difficult issue. Then, what are the key recommendations covered in this guideline? With regard to our systematic review, we identified 20 systematic reviews and 13 additional randomized controlled trials. And from this data, we made the following recommendations. First, we found limited data supporting the integration of dietary counseling with or without oral nutritional supplements. However, given the lack of harm and the critical role of educating patients and caregivers, we felt it was important to support referring patients with incurable cancer and loss of appetite and/or body weight to registered dietitian for assessment and counseling. It's critical for patients and caregivers to learn about practical and safe approaches to feeding. Specifically, registered dietitians may help develop strategies, such as shifting away from three larger meals per day towards frequent high protein, high calorie, nutrient dense snacks. Dietitians can also address questions regarding specific diets, including fad diets and unproven or extreme diets. Moreover, clinicians should not routinely offer enteral tube feeding or parenteral nutrition to manage cachexia in patients with incurable cancer. A short term trial of parenteral nutrition may be offered to a very select group of patients, such as patients with a reversible bowel obstruction, or short gut, or issues with malabsorption, but otherwise reasonably fit. We also can consider discontinuing previously initiated enteral parenteral nutrition near the end of life, as it is associated with net harm at that time. With regard to pharmacologic interventions, there are no FDA approved drugs to treat cancer cachexia. Yet there is sufficient data to support two pharmacologic interventions associated with improvements in appetite and/or body weight. And these include progesterone analogs, such as megestrol acetate and corticosteroids. The optimal dose and timing of each drug remains unknown. Regarding megestrol acetate, data support its role in improving appetite, modest weight gain, and improvement in quality of life. However, the weight gain associated with megestrol acetate is primarily fat and not skeletal muscle. We also need to be aware of side effects of megestrol acetate, including an increased risk of thromboembolic events, edema, adrenal insufficiency, and even an increased risk of death. As for corticosteroids, the first published double-blind randomized study dates back all the way to 1974, which showed an improvement in appetite and sense of well-being. However, clinicians are aware of the multiple side effects associated with corticosteroid use, that often limit initiation and timing of their use. Additionally, the weight gain associated with corticosteroids is not skeletal muscle. As important as it is to know what drugs are evidence based, it is also important to note what pharmacologic approaches are not supported by evidence. There are many agents that have been evaluated in clinical trials without any evidence to support an improvement in cancer cachexia outcomes. One such drug that frequently is asked about is dronabinol or the general class of cannabinoids. Insufficient data was available to recommend dronabinol or medical cannabis, and they have notable side effects, including altered mental status and a higher risk of falls. Especially in the elderly. Why is this guideline important? And how will it impact practice? Cachexia is a very common clinical entity and causes lots of distress for patients and caregivers. Oftentimes, the issues regarding nutrition and weight loss can be the central focus of clinical appointments and conversations with oncologists. We need to ensure that patients and caregivers have access to evidence based information and recognize that some interventions may be associated with more harm than benefit. And finally, you've just spoken to this a bit, but how will these guideline recommendations affect patients? Primarily, I think these cancer cachexia guidelines will serve as a great educational resource. They will also allow patients to better understand the risks associated with some of the pharmacologic interventions. I also think it's critical to define the current state of evidence in cancer cachexia, as we have many new exciting clinical trials evaluating novel agents in the setting. Furthermore, as a cancer community, we need to ensure that interventional trials are focused on clinically meaningful endpoints, such as improvements in appetite, muscle mass, and quality of life. We also need to encourage a rigorous but expedited approval of these agents, given the lack of any FDA approved drugs in this setting. Lastly, we need to recognize this is a multi-modal syndrome that requires the help and expertise of our interdisciplinary colleagues. Supporting our patients and their caregivers with this very difficult syndrome requires as much help as possible. Great. Thank you for your work on these guidelines and for taking the time to speak with me today, Dr. Roland. Thank you so much, Brittany. I would also like to recognize and thank ASCO for its support of these guidelines, the talented ASCO staff, and the experts who contributed. Most of all, I'd like to recognize our patients and their caregivers. And thank you to all of our listeners for tuning into the ASCO Guidelines Podcast Series. To read the full guideline, go to www.asco.org/supportive-care-cancer-guidelines. This guideline also has a companion, cancer.net podcast episode. Cancer.net is the patient information website of ASCO. And we encourage you to learn more by tuning into their episode. You can find their podcast and all ASCO podcasts at podcast.asco.org. You can also find many of our guidelines and interactive resources in the free ASCO guidelines app, available in iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast. And be sure to subscribe, so you never miss an episode.

[music] ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so the data described here may change as research progresses. Greg Guthrie: Hi, everyone. I'm Greg Guthrie, a member of the cancer.net content team. And I'll be your host for today's Cancer.Net podcast. Cancer.Net is the patient information website of ASCO, the American Society of Clinical Oncology. Today, we're going to be talking about cachexia. And our guests are Dr. Charles Loprinzi and Hester Hill Schnipper. Dr. Loprinzi is the Regis Professor of Breast Cancer Research at the Mayo Clinic in Rochester Minnesota where he is an emeritus chair of the Division of Medical Oncology and an emeritus vice-chair of the Department of Oncology. He is also the Cancer.Net Associate Editor for Psychosocial Oncology. Thanks for joining us, Dr. Loprinzi. Dr. Charles Loprinzi: It's good to be here, Greg. Greg Guthrie: And Hester is the emeritus manager of oncology social work at Beth Israel Deaconess Medical Center in Boston. And she now works in private practice. A 2-time breast cancer survivor, she's a nationally known speaker, is active in numerous oncology organizations, and has written 2 books about breast cancer. Her daily clinical responsibilities include working with individuals, couples, and families living with cancer, and facilitating support groups. She is also a member of the Cancer.Net Editorial Board. Thanks for joining us today, Hester. Hester Hill Schnipper: Thanks for inviting me. Greg Guthrie: Great. Now, today, ASCO is publishing a new guideline on the management of cancer cachexia. Dr. Loprinzi and Hester both served on the panel for this guideline. Before we begin, we should mention that they do not have any relationships to disclose related to this guideline. But you can find their full disclosure statements on Cancer.Net. Now, let's talk a little bit about what this guideline means for people with cancer and those who care for them. So Dr. Loprinzi, what is cancer cachexia, and how common is it? Dr. Charles Loprinzi: So cancer cachexia, the definition. We oftentimes call it cancer anorexia/cachexia, and so I'll try to define both anorexia and cachexia. A lot of people have heard of anorexia nervosa where people do not eat very well, so it's a loss of appetite is what anorexia is. For the cachexia part, you think of the people in the World War II camps when they came out at the end, where they had not eaten for a long time, and they were very, very, very thin. So cancer anorexia and cachexia is a phenomenon that comes on in patients with cancer, very frequently when they have advanced cancer, but oftentimes when they're just diagnosed, where patients are much thinner, and they're not eating very well. Greg Guthrie:  Hester, did you have something to add on that? Hester Hill Schnipper: I think many patients, when they are newly diagnosed, experience appetite loss even if their weight has been normal up until then. But one of the ways to divide the world, are people who can't stop eating when they're under stress, and people who shut down and don't eat when they're under stress. So plenty of brand-new cancer patients fall into the second category, and, at least for some period of time during the particularly crisis anxiety-filled weeks around diagnosis, are not eating very much or very well. But that, generally, improves then as things settle down and their treatment begins and is not usually a cause for real worry. Greg Guthrie: So is the cause of cancer cachexia often caused by the cancer itself, or is it a reaction to the cancer? Hester Hill Schnipper: I suspect that Dr. Loprinzi can answer that better than I can. But my impression is that it usually is caused by the cancer itself and just the multiple medical problems that may accompany an advanced cancer. Dr. Charles Loprinzi: So I agree with Hester on this point here. And it's not the treatment; it's the cancer itself. People used to think that patients who were receiving chemotherapy for early breast cancer, they were going to lose a lot of weight because patients who were getting chemotherapy for advanced disease lost a lot of weight. But in fact, patients with early breast cancer, when they get chemotherapy to try to help cure them, they gain weight. So it's not the chemotherapy that's causing the problem. It's the cancer itself. It changes the metabolic phenomenon of the body. People don't eat very well. And even if they get calories in, they don't metabolize them well, and so they still lose weight. Greg Guthrie: So, Hester, what are some of the problems that can come from cachexia? Hester Hill Schnipper: Well, certainly there are many medical related problems that Dr. Loprinzi can speak to better than I can. But the psychosocial or psychological issues also can be very troublesome for both the patient and those who love the person who is ill. If you are feeling terrible and not eating, that is obviously worrisome both to the patient and to their family members. And family members, generally, react by trying to encourage or even really pressure somebody to eat: making favorite foods, bringing in much more food than somebody wants, and then feeling very disappointed and perhaps even rejected if the patient just can't eat it. I mean, certainly, much of our advice—and maybe we're going to be talking a little bit more about this later—is to sort of back off and to a large extent let the patient direct what he or she is willing and able to eat. Dr. Charles Loprinzi: And I would add to that, when you've lost a lot of weight and you're not eating well, it can impair your ability to function well. Patients who have lost weight, related to cancer, do worse in terms of prognosis, with shorter survival and more side effects from chemotherapy. And their quality of life is not as good. So it is a big problem with those situations. Greg Guthrie: So who's generally bothered more by a patient's loss of appetite. Is it the patient or the patient's family and loved ones? Hester Hill Schnipper: My experience is that it's generally more the family and loved ones. I mean, if the patient doesn't feel like eating, he or she just doesn't feel like eating. I mean, we've all had viral syndromes where, for a few days, we don't have any appetite. And you just don't have any appetite or are not interested in it. And I think some exaggerated version of that is probably what most patients feel. But family members feel very worried about it. There's all the sort of mythology around food and around nurturing and around love, and most of us take pleasure out of cooking for and feeding people whom we love. And when someone you love is sick, those feelings are even larger than they might otherwise be, and we kind of panic if everything we're trying to do to take care of somebody isn't working. Dr. Charles Loprinzi: So I agree with Hester. In many patients, they just don't have an appetite. It's not a problem. It's not like they have pain, or it's not like they have nausea or vomiting. Now there are some patients whom that bothers them that they don't have an appetite, but many patients it really doesn't bother them. But as Hester said nicely, the family is oftentimes bothered tremendously by this particular situation. Greg Guthrie: Okay. So, Hester, I'm going to follow up a little more. Is it important for family and loved ones to encourage patients to eat more then? Hester Hill Schnipper: I think not. I think it is very important to try in a loving non-pressured way to communicate about it like, "Dad, is there anything you can think of that might taste good? Would you like a little bit of ice cream?" I mean, that kind of comment. And if dad says, "No. I don't want anything," then try again a few hours later. I mean, certainly more frequent offerings of small amounts of food are much more likely to be accepted than bringing in a full dinner plate. But I think it's important to take cues from the patient because too much pressure is going to result in somebody eating even less than she might have otherwise. Dr. Charles Loprinzi:  I agree with that, 100%. There is actually an interesting story, true story, of a patient who mentioned this to somebody who was interviewing the patient afterwards. And the patient had advanced cancer and noted that when some of her relatives came in to visit her—and these are in her dying days and weeks—when her family came in to visit her, she would pretend she was asleep so she wouldn't have to interact with them because she knew they were just going to pressure to eat. And that's just a disaster in my mind. So it's a crazy sort of story to hear and all that. But I've mentioned that sometimes to patients' families so that they know don't over-bother the patients. Hester Hill Schnipper: We can all relate to that. Even though you've always loved my lasagna, you may not want it tonight. Dr. Charles Loprinzi: Yes. Especially if I have a viral syndrome and I just feel bad, I want to kick the food across the room because if I eat it, I'm going to throw up. Hester Hill Schnipper: Right. Greg Guthrie: So for patients who need nutrition, how often should tubes be inserted into the stomach to provide nutritional feedings? Dr. Charles Loprinzi: So that's a great question, Greg. And there are ways you can get nutrition into a person who's not eating well, assuming their bowels are still working, and it's not a bowel obstruction sort of thing. And you can put food into the stomach. How can you do that? You can put a tube down their nose and put food in through that way—liquid nutrition that way. Or you can get a procedure done where you put a tube sticking out from the abdominal wall and the tube right into the stomach that way or to the small intestine. So you can give food in that manner. It's not infrequently done. Some countries more than others. And it's not frequently done. It can be helpful on a patient who might have an obstruction of the esophagus so they can't otherwise swallow food, but, otherwise, the rest of the bowel is working and all that sort of thing. But oftentimes, if the bowel is working, if you put the food in that way, it does not improve quality of life or quantity of life for patients. And it can be a lot of hassle for doing it, and it's uncomfortable. So it's not recommended for most patients in this situation. If they just can't eat, then trying to force the food into them through their bowel does not seem to help things overall in terms of their quality or quantity of life. [crosstalk] Hester Hill Schnipper: Yeah. My experience has been supporting everything you have just said, that this is a particularly difficult part of an ongoing difficult conversation between a doctor and a dying or very ill patient because most people think that if you don't eat, you're going to die more quickly. And families, particularly, often pressure the physician to go ahead in this way. And once you have put in a feeding tube or some other way to artificially feed someone, it's harder to take it out than it would have been to make the decision not to do it in the first place. Greg Guthrie: So this is really an important quality of life decision? Dr. Charles Loprinzi: Yes. You're right. Hester Hill Schnipper: And the quality of life, obviously, being part of the bigger decision about quantity of life, and what are somebody’s values and goals. Greg Guthrie: So that's really interesting. We've talked about introducing nutrition directly to the bowel, but how often should intravenous nutrition be given to people with advanced cancer cachexia? Dr. Charles Loprinzi: That's a great follow up question, Greg. So given intravenous or IV nutrition, that can be done. You can put an intravenous line oftentimes in the neck or sometimes in the thick part of the arm. And you can run nutrition in that way for days or weeks. So it can be done. It is done in patients who do not have functioning bowels, in general. And it could be helpful in that situation and could keep people alive for months and years in that situation. In patients with advanced cancer where they're just not eating and they're losing weight, is it beneficial to do that in those patients where there's this metabolic problem, and even if you give nutrition to them, they don't use it very well, and they may not gain weight otherwise? So that's been the subject of a lot of randomized trials where half the people get the intravenous nutrition and half the people do not. And the data that are available are that those who get the intravenous nutrition do worse than the patients who do not. Part of that is because they can get infections from this process. Or part of it is that you can get the glucose too high. And it's a lot of a hassle that sort of way. There's even some situations where cancers might grow faster by giving them more nutrition there. So it's not recommended to be done in most patients. Sometimes, it is started. And if it is started, there should be clear goals, "Okay. We're going to do this for a month, and our goal is this so that mom gets strong enough to walk to the mailbox," and if at one month, she's doing worse and not doing that then it's oftentimes time to say, "Okay. Let's stop that. It didn't work very well." Greg Guthrie: So Dr. Loprinzi, we've talked about nutrition, but how is cancer cachexia treated? Dr. Charles Loprinzi: That's a good question. We've actually started off with a lot of the things you can't do. But what can you do? And those are somewhat limited, unfortunately. But there are some things. One is nutritional consultation, dietitian, that sort of thing. Part of the benefit they can provide is to recommend patients don't take crazy diets. And there are a lot of crazy diets out there recommended for patients with cancer. And they might be able to help them so that they can get more nutrition in. There's not a lot of randomized data to demonstrate that does a lot of good, but it's a recommendation that makes some sense. On the other hand, what about giving drugs? There are many drugs that have been studied, randomized controlled trials with placebo where half the people get the drug and half the people get a placebo. And there are 10 or 15 things that have been tried. There are a couple of them that do show that you can use the drugs to stimulate appetite and improve weight. And there are 2 different classes of drugs. One is a steroid medication like dexamethasone. And the other is a progesterone hormone-like medication like megestrol acetate. So those can be given. The guidelines that ASCO came out with recently that looked at this, and looked at all the randomized trials, suggested that physicians should not feel pressured to give these medications. And the reason for that is that these medications do not improve quality of life or survival, and they can have some side effects. Steroid medications can increase the chance of infection. They can cause peptic ulcer disease or stomach ulcer disease. The megestrol acetate can cause blood clots. And in some of the randomized trials, the patients who got the megestrol acetate for treating cachexia, on average, died sooner than the patients who did not. So not recommended for everybody. But if a patient really says, "My loss of appetite is really bothering me, not the family, but bothering me," then they might choose to try these medications. It's reasonable to try them for a limited period of time and then see if they work, right? For 2 weeks or 3 weeks, and then stop if it doesn't work. There are studies going on trying to find newer better agents for this situation, but results from those are not available yet. Greg Guthrie: Great. So, Hester, how does this ASCO guideline, management of cancer cachexia, help improve the lives of patients? Hester Hill Schnipper: Well, we're hoping that this ASCO guideline, like all the others, will be useful to physicians, nurses, dieticians, patients, and families themselves, anybody working with cancer patients or thinking about how to improve the quality of life of cancer patients. I am particularly hoping that these guidelines will decrease the use of very difficult treatments that don't generally help or improve somebody's quality of life or the length of time that someone has to live in very difficult and stressful circumstances. We're hoping that it will help families understand why medical recommendations are made and why, often, in this situation, the recommendation is to not do something, because that's not usually what families expect to hear. So understanding better that the focus needs to be on someone's quality of life and how best to make the best of whatever days there are, that's one of our major goals. I also would like to add that I regularly write a blog called Living With Cancer which is published through the BIDMC Cancer Center, and there is a blog available talking more about this issue and primarily from the psychosocial or family side of it. Greg Guthrie: Thanks for sharing that, Hester. We'll definitely put a link to that in our blog post on this podcast and in the transcript. But this has been a really helpful discussion. It's really important to talk about cachexia in terms of quality of life. And, obviously, this is an important facet for this ASCO guideline to cover. So Dr. Loprinzi, Hester, thank you for sharing your expertise and insight today. It was great having you. Hester Hill Schnipper: Thank you so very much for asking me. Dr. Charles Loprinzi: Thank you very much. ASCO: Learn more about cancer cachexia at www.cancer.net/appetiteloss and www.cancer.net/weightloss. And if this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play. This Cancer.Net podcast is part of the ASCO Podcast Network. This collection of 9 programs offers insight into the world of cancer care, covering a range of educational, inspirational, and scientific content. You can find all 9 shows, including this one, at podcast.asco.org. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/donate. [music]

The author of the New York Times bestselling , previous podcast guest on the episodes:  and also is back! His name is Max Lugavere and his new book features a lifestyle program for resetting your brain and body to its “factory settings,” to help fight fatigue, anxiety, and depression and to optimize cognitive health for a longer and healthier life. In , Max expands the plan, which focused on nutrition and how it affects brain health, and expands it to encompass a full lifestyle protocol. We know now that the health of our brains—including our cognitive function and emotional wellness—depend on the health of our gut, endocrine, cardiac and nervous systems as there is a constant feedback loop between all systems. Drawing on globe-spanning research into circadian biology, psychology, dementia prevention, cognitive optimization, and exercise physiology, The Genius Life shows how to integrate healthy choices in all aspects of our daily routines: eating, exercising, sleeping, detoxing, and more to create a healthy foundation for optimal cognitive health and performance. Among Max’s groundbreaking findings, you will discover: · A trick that gives you the equivalent of a “marathon” workout, in 10 minutes · How to get the benefits of an extra 1-2 servings of veggies daily without eating them · The hidden chemicals in your home that could be making you fat and sick · How to boost melatonin levels by up to 58% for deeper sleep without supplements Max is a filmmaker, health and science journalist and author. He is also the host of the #1 iTunes health podcast . Lugavere appears regularly on the Dr. Oz Show, the Rachael Ray Show, and The Doctors. He has contributed to Medscape, Vice, Fast Company, CNN, and the Daily Beast, has been featured on NBC Nightly News, The Today Show, and in The New York Times and People Magazine. He is an internationally sought-after speaker and has given talks at South by Southwest, TEDx, the New York Academy of Sciences, the Biohacker Summit in Stockholm, Sweden, and many others... During our discussion, you'll discover: -Just how bad is bread?...8:08 It's one of humanity's oldest and most revered processed foods Max's views have softened slightly over the years Grains can serve a functional purpose Glycogen storage Help to power through resistance training Not as toxic as made out to be, but not the most ideal option available Changed views on brown rice Preparation methods are important Avoid GMO forms of GMO foods No such thing as a one size fits all diet, nor an exercise regimen Increased carbs in the diet may lead to increased strength (performance enhancing tool) -How Max's views on MDMA have evolved over the years...19:45 Being used to treat PTSD; given "breakthrough drug" status by the FDA Being used to treat alcoholism, autism Chronically dangerous to the brain; imbalance in neurotransmitters Serotonin is modulated w/ MDMA Acute doses are limited in potential harm; benefits outweigh the risks Psilocybin can reduce activity in default mode network in the brain Can damage mitochondria when consumed in large amounts Increase levels Supplement w/ (code: BENGREENFIELD10) Dr. John Lieurance's / (code: BEN) -Max's overall goal in writing ...29:00 The goal was to help people identify diseases such as dementia or cancer years or decades before they manifest physically was to identify which foods affect the brain We're essentially in "The Hunger Games" books Sedentary, addicted to devices, rampant stress, circadian rhythms are out of sync The default state of any organism is health; our society is anything but healthy Max's mom developed dementia at a young age; was eventually diagnosed w/ pancreatic cancer Conditions don't develop overnight Prevention is not discussed by and large in mainstream medicine Cachexia: extreme muscle wasting Certain cancers are hormonally related Book: by William Li -Fish consumption and optimizing brain health...46:00 Fear of consuming mercury w/ fish is overblown; the benefits outweigh the risks Selenium: mercury ratio in fish is key People who eat more fish have better health; protection against Alzheimers Women who eat more fish have smarter kids Oily fish (wild salmon, mackerel, sardines) are preferable Lifestyle considerations: (code: BEN) w/ dry brush or enema Frequent movement -Healthy detoxification...51:26 The 3 P's of health detoxification: peeing, pooping, perspiring can upregulate autophagy Article: -Why Max advocates increasing protein intake...55:45 Confusing mechanism w/ outcomes The benefits outweigh the risks Reasons to increase protein: In old age, double the allowance helps maintain muscle mass Inverse relationship between increased protein and amyloid plaque More protein = less carbs and fat Protein leverage hypothesis: hunger mechanisms are leveraged by need for essential amino acids Protein is the most satiating of the macronutrients; metabolic advantage Very nutrient-dense foods Ensure protein you consume is buffered w/ collagen or the amino acids contained therein Book: by James Clement Supplement w/ -Max's big wins regarding biohacking, food prep, etc...1:05:08 Drink clean water (code: GREENFIELD) Add minerals into the reverse-osmosis water (code: GREENFIELD10) Time spent in nature 30 minutes of sunlight in the morning Suprachiasmatic nucleus controls circadian rhythms 20 minutes in nature can reduce cortisol levels Staying active 2 minutes of activity for every 30 minutes sedentary can reset the blood flow to the brain Fascia is a piezoelectric tissue , deep tissue work can be mildly addicting -Max's favorite workout regimens...1:13:45 Resistance and strength training Cut back on carbs, lost efficacy in strength training Not a fan of steady-state cardio; lots of throughout the day Staying active boosts lymph fluids Keep protein intake up: 1.6 g/kg of lean mass High intensity repeat training You can have a great body w/out obsessing over fitness Be more present with your food; distractions while eating can increase calorie consumption -And much more! Resources from this episode: - BGF podcasts w/ Max Lugavere: - - - - Dr. John Lieurance's / (use code BEN at checkout for a 5% discount) - - Book: by William Li - - - Book: by James Clement - - (use code GREENFIELD10) Episode sponsors: - You can grab your own Kion Creatine now at and save 20% off your first order with discount code: BGF20 -: After using the Joovv for close to 2 years, it's the only light therapy device I'd ever recommend. Give it a try: you won't be disappointed. Order using and receive my brand new book, Boundless absolutely free! -: A wellness company specializing in innovative nutraceuticals made from healing hive compounds and plant-based ingredients. Get 15% off your order when you use discount code: BEN -: A plant-based beverage that helps support the body’s natural ability to produce collagen, smooth fine lines and wrinkles, and protect the skin from sun exposure and toxins. Receive a 20% discount on your entire order when you use discount code: "BENG20" Do you have questions, thoughts or feedback for Max or me? Leave your comments below and one of us will reply!

¡Gracias por escuchar!Para empezar el año, este episodio lo dedicaré a hablar de como la composición corporal influye sobre la eficacia y eventos adversos asociados al uso de glucocorticoides.Agradezco su continuada atención a este podcast y les recuerdo que se pueden suscribir a el en iTunes, Spotify o usando su gestor de podcasts favorito. Como siempre su retroalimentación es bienvenida y les pido amablemente dejen su calificación a este y otros episodios en iTunes.Estas son algunas de las referencias consultadas para este episodio:van der Goes, M. C. et al. Patient and rheumatologist perspectives on glucocorticoids: an exercise to improve the implementation of the European League Against Rheumatism (EULAR) recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann. Rheum. Dis. 69, 1015–1021 (2010).Konijn, N. P. et al. The short-term effects of two high-dose, step-down prednisolone regimens on body composition in early rheumatoid arthritis. Rheumatology (Oxford) http://dx.doi.org/10.1093/ rheumatology/kew221 (2016).Buttgereit, F., Smolen, J. S., Coogan, A. N. & Cajochen, C. Clocking in: chronobiology in rheumatoid arthritis. Nat. Rev. Rheumatol. 11, 349–356 (2015).Arvidson, N. G., Gudbjornsson, B., Larsson, A. Hallgren, R. The timing of glucocorticoid administration in rheumatoid arthritis. Ann. Rheum. Dis. 56, 27–31 (1997).Cutolo, M. Glucocorticoids and chronotherapy in rheumatoid arthritis. RMD Open 2, e000203 (2016).Smith-Ryan, A. E. et al. Validity and reliability of a 4-compartment body composition model using dual energy X-ray absorptiometry-derived body volume. Clin. Nutr. http://dx.doi.org/10.1016/j. clnu.2016.05.006 (2016).Summers, G. D., Metsios, G. S., Stavropoulos- Kalinoglou, A. & Kitas, G. D. Rheumatoid cachexia and cardiovascular disease. Nat. Rev. Rheumatol. 6, 445–451 (2010).Walsmith, J. & Roubenoff, R. Cachexia in rheumatoid arthritis. Int. J. Cardiol. 85, 89–99 (2002).Arshad, A., Rashid, R. & Benjamin, K. The effect of disease activity on fat-free mass and resting energy expenditure in patients with rheumatoid arthritis versus noninflammatory arthropathies/soft tissue rheumatism. Mod. Rheumatol. 17, 470–475 (2007).Elkan, A. C., Hakansson, N., Frostegard, J., Cederholm, T. & Hafstrom, I. Rheumatoid cachexia is associated with dyslipidemia and low levels of atheroprotective natural antibodies against phosphorylcholine but not with dietary fat in patients with rheumatoid arthritis: a cross-sectional study. Arthritis Res. Ther. 11, R37 (2009).

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CW: Our middle subject today involves some discussion of serious illness including cancer, HIV, and eating disorders from 20:35 to 35:40.Today's subjects: Holy War (football rivalry), Society on Sarcopenia, Cachexia, and Wasting Disorders and Defiance, Ohio.Next Week's Subjects: Stephen Sewall (colonial judge), Here's the man! (1962 album by Bobby Bland) and The Llama(animal)Theme and Interstitial Music by Apache TomcatIf you like the show, rate us on Itunes, if you dont, keep it between you and the lord.

You know you're not in the best of health. After all, you've had your share of heart-related issues. However, you're still getting around and able to do most of the activities you did in the past. You're just moving a little slower. But, you have noticed your shoulders are starting to look a little smaller and your legs a bit skinny. You shrug it off, telling yourself that it must be just due to your age. Then, your balance and stability start to falter. You dismiss it. “It’s just one of those things,” you think. The muscle loss continues. Your scale weight drops. On one hand, you feel good because your doctor’s been telling you to drop some weight for a while, but you don’t really look leaner in the mirror. You just look skinnier. In jeans and a long-sleeved shirt, you look normal. In fact, some of your friends remark about how much weight you’ve lost, so you fool yourself into thinking it’s actually a good thing. You get a blood test and your blood sugar is at pre-diabetic or diabetic levels. You wonder how that’s possible since you don’t have much of an appetite anymore, and barely eat anything. “It must be genetic,” you think. Your doctor wants you to get on a diabetes drug just to be safe. You rarely feel energetic or enthusiastic. You don’t like the feeling. It’s not like you have a reason to feel depressed, but you do. Life is actually pretty good, so you don’t want to burden anyone by sharing how you feel. Maybe the feeling will pass. If this sounds at all familiar, stop! As bad as the above scenario sounds, it can get a lot worse. This is what sarcopenia and cachexia sound and feel like. Sarcopenia is age-related muscle loss. Cachexia is accelerated, disease-related tissue loss. Neither is a good situation, but cachexia causes much more dramatic deterioration in your health. In this article, I hope to open your eyes to the effects of age and disease-related tissue loss, and implore you to take action and extend your quality of life.  Unfortunately, most doctors give little direction to their older adult patients, seeing their physical decline (and cognitive decline) as just a part of getting old. In my opinion, this mindset would be like a football team giving up when they’re behind by two touchdowns after the first half of the game. Although there are many different diseases connected to cachexia, and the strategies to slow it have similarities, I'm writing this article with the focus on cardiac cachexia because I believe a close family with heart disease is dealing with cardiac cachexia right now. Perhaps you, or one of your family members is as well.  Muscle And Quality Of Life To think of muscle as something useful only for vanity or athletics is like thinking your brain is only good for math problems and trivia. Here’s a handful ways muscle impacts your health, none of which relate to vanity or being the fittest man or woman in your age range. Muscle provides strength, stamina, and balance for everyday movement. Muscle and its connection to your nervous system (the neuromuscular system) creates smooth, fluid movement so you can continue knocking golf balls down the fairway, write your name with the same handwriting you’ve used your whole adult life, or lift a soup spoon to your mouth without spilling on your chin. Muscle protects and stabilizes your joints.Would you knowingly drive down the road with loose lug nuts on each of your tires? Of course that would be stupid. Yet, that’s what happens when you ignore the loss of muscle supporting your joints, and hope that you make it through the day without hurting something. Like the giant cables that support a bridge, your muscles add support to your joints. Muscle is the main storage area for glucose. Your liver and muscle tissue are the only places you can store glucose. When the tanks shrivel up, you either have to avoid carbs completely, which isn’t fun or realistic,

This week, Dr. Nasha Winters ND, FABNO, L.Ac, Dipl.OM and CEO of Optimal Terrain Consulting joins me to share her incredible, real-life journey of healing through lifestyle and emphasis on whole health. After beating a diagnosis of terminal cancer at the age of 19, she transformed her life into an ongoing resource for thousands of people who are navigating their way through cancer and standard of care treatments. Her refreshing multi-view approach focuses on the whole person, focusing less on the cancer and more on making the host stronger. She combines conventional therapy with whole-body, nutritional lifestyle therapy to optimize her patients' terrain. Her book, TheMetabolic Approach to Cancer: Integrating Deep Nutrition, the Ketogenic Diet, and Nontoxic Bio-Individualized Therapies is available now.   Key Takeaways:   [3:36] How a cancer diagnosis at 19 led Dr. Nasha to Naturopathic medicine. [14:15] The process of Test, Assess and Address for cancer patients. [17:02] Can cancer be cured through a single therapy or a ketogenic diet? [24:05] Cancer, Cardiovascular disease, Diabetes, Alzheimer's are in the same metabolic hiccup. [29:51] Analyzing the results of genetic testing and industry created fear. [35:34] Can the ketogenic diet or intermittent fasting assist patients during Cachexia? [51:30] The health benefits of mistletoe. [59:07] Other beneficial ‘fringe' interventions for cancer treatment.   Mentioned in This Episode: Low Carb Cardiologist Website Dr. Scher on Twitter Dr. Scher on Facebook Terrain 10 Optimal Terrain Consulting Optimal Terrain on Facebook The Metabolic Approach to Cancer: Integrating Deep Nutrition, the Ketogenic Diet, and Nontoxic Bio-Individualized Therapies, by Dr. Nasha Winters and Jess Higgins Kelley

In this podcast, Associate Editor Mary Marian, DCN, RDN, CSO, FAND, interviews author Todd W. Mattox, PharmD, BCNSP, on his article "Cancer Cachexia: Cause, Diagnosis, and Treatment" published in the October 2017 issue of NCP.

Nicole is a Professor at the University of Calgary who focuses on physical activity for cancer survivors. In this episode, we chat about head and neck cancer, and some of the challenging side effects of the cancer and its treatment. Due to its location, cancer-related cachexia is common concern, along with some of the real difficulties and pain with just eating a meal, and how these affect exercise decisions.   Interestingly, HPV is such a common risk factor for Head and Neck cancer, that there are two separate types of HN cancer – HPV related on non-HPV related. We chat about the implications of this and how to reduce your overall risk.   Finally, we chat about our shared frustration in the translation of research into practice and how our research lines differ from the advice we give in a clinic.   If you’re in the Calgary area and are interested in getting involved in a research study, check out Nicole’s Lab at: https://www.ucalgary.ca/healthandwellnesslab/people/dr-culos-reed   Learn more about Nicole’s Thrive Health Services here: http://thrivehealthservices.com/about-us/ and check out Nicole on twitter @NCulosReed.     Check out www.reachbeyondcancer.com for our services or find me on twitter @CiaranFairman.     Show Notes. 0:30 – What is Head and Neck cancer and who is defined and a Head and Neck cancer patient/survivor.   2:15 – How is HPV puts you at a heightened risk of Head and Neck Cancer. There’s no screening for Head and Neck Cancer.   7.30 – Screening for HPV is part of the treatment for H/N cancer.   9.00 - Other risk factors for Head and Neck cancer.   9.30 – Side effects of treatment that’s unique to H/N cancer – Cancer-related cachexia, eating, hearing etc.   14.00 – How treatment needs to change for H/N cancer – more than just nutrition.   16.15 – The role of physicians vs. exercise physiologist in cancer care.   19.00 – How long and painful meals can be for H/N cancer patients/survivors and how that affects their exercise.   24.00 – Timing of exercise in H/N cancer – it may be better to wait until after treatment and what this means.   26.00 – How just moving can be helpful – worrying about structured exercise later.   28.00 – What we research vs. how we translate that to actionable advice.   33.00 – The importance of having trained professionals in this area that have a background in cancer.   36.00 – How weight training is an important, low-calorie tool to help H/N cancer.   38.00 – Common modifications with H/N cancer – balance issues, functional impairment.   40.00 – The importance of strategies aimed at long term adherence to exercise as opposed to short term improvements. Stoplight program to modify exercise.   44.00 – The importance as exercise oncologists establishing a line of communication with medical professionals.

This year in the United States, over 22,000 people will be diagnosed with a primary brain or spinal tumor. Of these, more than 13,000, many of them younger than 21 years old, will die of their disease. New treatment modalities are critical in the battle against cancer. Adrienne Scheck, PhD, is an associate professor of neurobiology at Barrow Neurological Institute. Dr. Scheck’s expertise includes neuro-oncology. She is a member of the American Association for Cancer Research, Society for Neuro-Oncology, American Association for Cancer Research, American Society for Biochemistry and Molecular Biology, Women in Cancer Research, and the American Association for the Advancement of Science. Dr. Scheck’s work consists mainly of translational research to develop novel adjuvant therapies for the treatment of brain tumors. She also use various molecular and molecular genetic techniques to investigate why current therapies sometimes fail.   See Scheck AC[Author] on PubMed. Here’s the outline of this interview with Dr. Adrienne Scheck: [00:00:37] Dr. Jong M Rho. [00:01:18] Glioblastoma. [00:03:53] Hanahan, Douglas, and Robert A. Weinberg. "Hallmarks of cancer: the next generation." cell 144.5 (2011): 646-674. [00:05:01] Cancer metabolism: see Tripping Over the Truth: The Return of the Metabolic Theory of Cancer Illuminates a New and Hopeful Path to a Cure. [00:05:37] Positron emission tomography (PET). [00:06:20] Thomas Seyfried: Cancer: A Metabolic Disease With Metabolic Solutions. [00:07:21] Adding ketones to a in vitro model. [00:09:14] Poff, Angela M., et al. "The ketogenic diet and hyperbaric oxygen therapy prolong survival in mice with systemic metastatic cancer." PloS one 8.6 (2013): e65522. [00:11:38] 4:1 KetoCal. [00:13:14] Dr. Cate Shanahan at the Keto Summit. [00:15:05] Ketogenic Diet With Radiation and Chemotherapy for Newly Diagnosed Glioblastoma. [00:17:08] Charlie Foundation and Matthew's Friends. [00:21:42] Clinical trial diet is as close to 4:1 as possible. [00:22:09] Ketogenic Mealplanner – Electronic Ketogenic Manager (EKM). [00:23:01] Cachexia. [00:24:09] Ketones of 3mM, glucose of 4mM. [00:25:59] Adrienne gave a talk in Banff but I couldn’t find it online. [00:26:23] Trial eligibility. [00:30:29] Confounding lifestyle factors. [00:32:58] MRI for tumor metabolism . [00:34:25] Is there something special about brain tumors that makes them particularly susceptible? [00:35:25] Dominic D'Agostino on my podcast and the Keto Summit. [00:35:48] Edema, angiogenesis, and inflammation. [00:37:36] Lussier, Danielle M., et al. "Enhanced immunity in a mouse model of malignant glioma is mediated by a therapeutic ketogenic diet." BMC cancer16.1 (2016): 1. [00:40:14] Gut microbiome. [00:41:50] Ketone supplementation. [00:47:54] Effects in cancer patients may be different from in a healthy person. [00:48:45] Students Supporting Brain Tumor Research. [00:50:35] MaxLove Project. [00:50:47] Donations. [00:52:28] Finding a physician and a dietician. [00:55:13] Education for dietitians and practitioners. [00:57:51] Pluripotency. [00:58:55] Adam Sorenson and father Brad.

Amelia Johnston from Latrobe University talks to us about Cachexia, a wasting disease commonly associated with cancer which often puts an end to treatment, and how their new research has shown it may be possible to reverse it. We learn about the discover of thousands of bones of a previously unknown human ancestor, Homo naledi, in a cave in South Africa, and how it they cast doubts about existing theories of human origins.We hear from Andy Greentree, a quantum physicist and researcher at RMIT who is investigating ways to look at living organisms on a sub-microscopic level to better understand the processes of life.

Prof David Currow of Flinders University Adelaide, Australia discusses research from a phase III trial at ESMO 2014 surrounding a new drug called Anamorelin for patients with advanced lung cancer. The new drug has been seen to improve appetite and body mass by mimicking the effects of the so-called “hunger hormone” ghrelin, which is secreted by the stomach.

Dr Michael Sawyer explains that chemotherapy toxicities are related to patient lean body mass and suggests that this may explain the discrepancies that have traditionally been observed in the adverse effects experienced by male and female patients undergoing chemotherapy. Dr Sawyer’s study also concluded that gastrointestinal and lung cancer patients with a low lean body mass had a lower survival rate, and experienced higher levels of toxicities.

Palliative Medicine

Palliative Medicine

Regulated protein synthesis and degradation mediate skeletal muscle homeostasis.

Animal Medical Intuitive Brent Atwater shares information about Feline Cancer Cachexia and Cat Wasting Disorders, plus Brent answers listeners’ questions about their pet’s health concerns. Send your question to Brent@PetLifeRadio.com More details on this episode MP3 Podcast - My Cat is Too Thin and Wasting Away! : Feline Cachexia on Pet Life Radio