Never, Ever Drink This "Nutritious" Beverage
Never, Ever Drink This "Nutritious" Beverage
In a classic Simpsons episode, Homer decides to climb the “Murderhorn,” the tallest mountain in Springfield. This occurs after homer joins a 24-hour gym (that he pronounces “gyme”) and meets Rainier Wolfcastle, the show's equivalent of Arnold Schwarzenegger.
After hitting the weights, building some muscle, and losing his famous belly, Homer is approached by “Powersauce,” a supplement company that wants to promote the climb by “fueling” Homer with its energy bars. Homer eventually makes it to the peak of the mountain, after he nearly dies. It also became known to Homer during the trek that his Powersauce bars were actually made of apple cores and shredded Chinese newspaper.
This episode comes to my mind every time I hear a patient tell me they were recommended Boost, Ensure, Glucerna, or one of the many popular meal replacement shakes and supplements.
Unfortunately, this episode pops into my head quite often...
Cancer Patients, Cachexia, and Nutrition
Significant muscle loss remains a concern for cancer patients during treatment. The treatment itself can cause eating difficulties due to nausea, bowel issues, or even damage to the mouth or esophagus resulting in pain with swallowing and difficulty eating adequate amounts of food. Chemoradiation also disrupts normal taste and salivary gland function. It is surprising to see how little people will eat when they cannot taste the food. Oftentimes, this leaves liquid meal replacement products as the go-to source for nutrition.
However, weight loss in cancer patients is not always bad. In many cases, weight loss may even be helpful, as fat tissue gives off inflammatory factors and hormones that can fuel cancer growth.1,2 Weight gain in breast cancer patients, for instance, can lead to increased chances that the treated cancer will recur.3
Cachexia, on the other hand, is the unwanted, significant, and progressive loss of appetite, weight, and body mass (especially muscle).4 It is also accompanied by a state of systemic inflammation throughout the body. Cachexia is the fear that has led many dietitians and oncologists to tell patients to eat whatever they can, just do not lose weight. The loss of muscle mass from cachexia in cancer patients is usually considered irreversible.
However, decades of research have started to tell us what works and what doesn’t when it comes to stopping the loss of muscle mass in cancer patients. Earlier studies in mice showed that medium chain triglycerides (MCT) appear to halt muscle loss without feeding cancer cells.5 In fact, weight loss was reduced in proportion to the amount of fat in the diet. Further data showed that MCT increased ketones in the blood, which may also help to combat cancer cachexia.6 More recent studies have shown that omega-3 fatty acids and fish oil may help fight cachexia.7
The key here is that healthy fat sources appear to combat cachexia, while recommending mega doses of sugar and other poor sources of nutrition provide little benefit. Simply telling patients to eat more, whether that is ice cream or popsicles, does not work as it does not address the underlying inflammatory and metabolic issues.8
What about telling patients to turn to the standard — Boost, Ensure, Glucerna, and Carnation Instant Breakfast?
I have compiled what I believe (in my humble opinion) are the worst possible ingredients to feed anyone, let alone cancer patients:
High-fructose corn syrup
Vegetable oils: Full of inflammatory omega-6 fatty acids and known to increase inflammation. As cachexia is inflammation gone amok, inflammatory food is likely the last thing we want to feed cancer patients.
Poor protein sources
What’s on the Label?
Perusing the nutrition facts label from Ensure Complete gives a clear picture as to what kind of supplement it is:
As you can see, this “supplement” has a whopping 51 grams of carbohydrates with 13g of protein and 11g of fat. Twenty grams of sugar further sweeten (or worsen) the deal for its consumers.
But it gets worse. Here is the ingredient label:
The ingredients listed on nutrition labels are in order of quantity. In other words, the first four ingredients often make up the bulk of the product. In the case of Ensure Complete, the first four ingredients are water, corn maltodextrin, sugar, and canola oil.
Two of the first three ingredients are carbohydrates, with the second being pure sugar. Pile this on top of all the issues with cancer and sugar and radiation and chemotherapy that we have discussed about a million times (see here, here, here, and here). The fourth ingredient is Canola Oil, the vegetable oil created from the seed of the rape plant. It was first made in Canada in the 1970s, thus giving it the name Canola — Can stands for Canada and ola for oil. In 2011, 25% of canola was manufactured from genetically modified sources (GMOs). Nowadays that number is apparently 90%.
Canola oil is one of the many vegetable oils that go through extreme processing. This includes using the solvent hexane to extract the oil from seeds. This gunk is then pressed and washed with sodium hydroxide. The oil is also heated and steamed to remove the foul odor and eventually bleached to lighten the color.
As if this process did not sound bad enough, it damages the oil creating oxidation and trans fatty acids.9 Trans fatty acids have been found to cause many health issues like heart disease, inflammation, and cancer.10–13 Canola oil also has double the amount of inflammatory omega-6 fatty acids versus omega-3 fatty acids. While omega-3 fatty acids have many health benefits, the plant form found in canola oil (alpha linoleic acid) does not have the health benefits of the forms found in fish and animals, like DHA and EPA.
Furthermore, ALA has to be converted to EPA or DHA, a process that the human body is not very good at.14 The body also gets worse at this with higher amounts of omega-6s, further limiting any health benefit from this processed vegetable oil. As cachexia is a state of inflammation, it stands to reason that this may not be the best step forward for those cancer patients struggling to keep on weight.
At Least There is Protein
Way back when I was in high school, perusing the aisles of my local GNC in an effort to find a good protein shake to build some muscle for the girls at school, I would always find the best deal on soy protein isolate. While whey was always around $30 per bottle, soy protein was usually under $10. I remember asking the meathead that worked behind the counter why that was the case. “Because soy protein isolate is garbage,” was his response. I went home and did some research, and he was right.
Somewhere along the line, people began considering soy products healthy. Their prices gradually shot up as a result. The cheap garbage on the bottom shelf at GNC was said to have a plethora of health benefits and was worthy of a higher price tag.
Yet, while some soy products were originally thought to have health benefits, and while this is a controversial topic,15 most people consider soy protein isolate to contain very little health benefit and to be potentially dangerous. Data has revealed that soy protein isolate stimulates breast tissue in premenopausal women, causing excessive growth of breast tissue (hyperplastic epithelial cells), secretion of breast fluid, and elevated levels of estrogen throughout the body.16 Even in the vegetarian community, it seems that enthusiasm for soy protein isolate has simmered down.
To add insult to injury, you will notice that the number two protein ingredient of Ensure Complete is soy protein isolate. This continues and rounds out the usage of utterly second-rate ingredients in these supplements.
Hate the Players, not the Game
While I keyed in on Ensure with this article, the other supplement drinks are similar, or unfortunately, even worse. Glucerna is for diabetics, yet the label reveals a handful of similar ingredients. Boost High Protein contains sugar as the largest non-water ingredient with a mind-blowing 27g per serving. Carnation Instant Breakfast is an absolute abomination, with its number one ingredient (besides water) as corn syrup. Yes, its number one ingredient is a combination of the number one and two worst ingredients listed above.
The Unfortunate Conclusions
I would not feed these “supplements” to my worst enemy, let alone a cancer patient. Seeing them permeate cancer centers throughout the country is extremely frustrating for those of us who want our patients to get adequate and actual nutrition during their cancer treatment. These products are even promoted to children, with the Carnation Instant Breakfast website telling parents to “add a twist” to their child’s breakfast. Is it any wonder that we have an obesity crisis on our hands when kids are told to drink 27g of sugar for breakfast?
From kids to cancer patients, the craziest part of the “standard” of meal replacement is that we could actually have the argument of whether Powersauce bars (i.e. Chinese newspaper and apple cores) are perhaps healthier than these typical “nutritious” meal replacement drinks like Ensure, Boost, Glucerna, and Carnation Instant Breakfast.
To Your Health,
Dr. Colin Champ
Dr. Colin Champ is a practicing radiation oncologist and nutritional expert. He is the author of Misguided Medicine: The truth behind ill-advised medical recommendations and how to take health back into your hands” You can hear more from him as the host of the incredibly popular Caveman Doctor podcast.
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2. Simone BA, Champ CE, Rosenberg AL, et al. Selectively starving cancer cells through dietary manipulation: methods and clinical implications. Futur Oncol. 2013;9(7):959-976. doi:10.2217/fon.13.31.
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14. Gerster H. Can adults adequately convert alpha-linolenic acid (18:3n-3) to eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3)? Int J Vitam Nutr Res. 1998;68(3):159-173. http://www.ncbi.nlm.nih.gov/pubmed/9637947. Accessed February 14, 2015.
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