Chronic inflammation and oxidative stress due to a pathological condition, external chemical or physical factors results in a change in the metabolism of substances in the body.
Prolonged inflammatory processes may lead to malnutrition – a decrease in appetite and subsequent reduction in nutrition, development of nutritional deficiencies and electrolyte disorders.
As a consequence of malnutrition, compensatory catabolic processes are activated in the body (molecule, substance and tissue breakdown processes), leading to loss of muscle and body mass. At its advanced phases malnutrition may lead to anorexia and cachexia (overall exhaustion of the body).
Prima Sanitas Protein and Glutamine + electrolytes in combination with physical activity and an appropriate diet contributes to reaching the adequate protein, amino acid and macronutrient daily intake required for restoration and maintenance of normal muscle function, preservation of lean muscle mass and effective activation of anabolic processes in skeletal muscles.
Whey protein
After consumption proteins are broken down by gastric acid into their constituent units, amino acids. Amino acids are divided into nonessential and essential amino acids, all of which play important roles in cell metabolism, gene expression and cell signaling. A positive nutritional protein balance is necessary to ensure high plasma levels of amino acids, which together with physical activity result in an effective stimulus for skeletal muscle growth and preservation.
Protein is the macronutrient whose adequate intake in our daily lives is most difficult to reach without taking too much of other food groups. The reason is the widespread consumption of combined nutritional sources of protein enriched with additional fats and carbohydrates, often with proinflammatory qualities – cold meats, red meat, fried and breaded foods, etc.
Supplementation with protein powder is a quick and easy way to reach the body’s required protein demands without intake of other nutrients in daily excess.
In the presence of chronic inflammation, pathological condition, physical or chemical stress the body has increased demands of protein required for the recovery processes. To reduce muscle wasting and fight malnutrition and cachexia ESPEN recommendations for cancer patients are for increased protein intake between 1 to 1.5 g/kg/day.(1)
Gastrointestinal cancer patients are at particularly high risk of developing malnutrition. Initial dietary counseling prior to initiation of chemotherapy in combination with a daily intake of 20 to 30 g of whey protein has contributed to improvement of patients’ general condition, treatment tolerance and nutritional status.(2)
Glutamine
Glutamine is the most common nonessential amino acid in the human body. It is synthesized and stored in the largest amounts in skeletal muscles. Muscles release a constant amount of glutamine circulating in the blood, which is required to cover the demands and normal function of the cells of the immune system, liver, kidneys, intestines, nervous system, etc.
Glutamine is an important amino acid, a source of carbon and nitrogen needed in the biosynthesis of proteins, purines, pyrimidines and various cell structures and organelles, has antioxidant and anti-inflammatory properties. During catabolic states induced by sepsis, injury, surgery, severe physical exertion, toxic therapies and various chronic diseases, glutamine concentration in blood plasma and tissues (especially in skeletal muscles) is highly reduced.(3) Thus, glutamine becomes a conditionally essential amino acid, whose deficiency is also commonly manifested in cancer patients due to the stress induced by the toxicity of treatments, malnutrition and disease progression.
Progression of a cancer, which requires large amounts of glucose and amino acids, may cause additional glutamine deficiency, which may lead to difficulty recovering of the body from toxic treatments, weight loss and cachexia.(4)
Glutamine supplementation was avoided in the past due to suspicions that by increasing amino acid levels cancer cell biosynthesis can be stimulated in vitro. However, recent publications have demonstrated that due to the increased demands of malignant cells and poor blood supply low glutamine levels are commonly found in vivo in the tumor microenvironment.
Chronic glutamine deficiency and hypoxia cause acceleration in the mechanisms of cancer cell adaptation and may lead to development of more resistant disease and progression.(5) Additional newly published data show that glutamine in the tumor microenvironment is demanded by both cancer cells and tumor-infiltrating T lymphocytes. The cancer takes away the glutamine needed for T cell activation in the tumor microenvironment and thus suppresses the immune response.(6)
Various meta-analyses and studies reveal that intake of glutamine with a regular diet protects against mucositis induced by radiation therapy and chemotherapy (7), reduces chemotherapy-induced anthracycline cardiotoxicity, myalgias and arthralgias. Multiple animal studies demonstrate that glutamine intake may prevent Paclitaxel-, Cisplatin- and Oxaplatin-induced neurotoxicity, reduce gastrointestinal toxicities of Irinotecan and reduce 5-FU-induced mucositis and stomatitis.(8) Glutamine supplementation is likely to aid immune system recovery in immunocompromised cancer patients.(9) Retrospective analyses also show a correlation between increased serum glutamine levels prior to initiation of antitumor therapy in colorectal cancer patients and improved overall and progression-free survival compared to patients with low initial levels. This demonstrates the potential of using initial serum glutamine levels as a predictive marker. Good glutamine stores in skeletal muscles appear to be an indication of good general condition and a good prognostic marker.(10)
Pure glutamine intake is safe in doses of up to 30 grams a day for up to 1 year. Side effects are usually mild and include bloating, nausea, dizziness, heartburn and epigastric pain. Glutamine intake may reduce the effectiveness of anticonvulsants that are used to treat seizures.(11)
Electrolytes – magnesium, sodium, potassium
There is a correlation between electrolyte disorders and the general condition (ECOG) of cancer patients. Electrolyte changes may lead to impaired quality of life, changes in organ function, reduction in the ability to receive antitumor treatments and may affect the outcome of therapy. Some of the most common electrolyte deficiencies in cancer patients are those of potassium, sodium and magnesium. Their deficiency is clinically manifested by headache, nausea, muscle weakness and cramps, fatigue, dizziness, edema, changes in blood pressure and heart function, etc.
Potassium and sodium are essential electrolytes required for the proper function of all cells and tissues in the body.
The main role of these elements in the body is related to maintaining normal fluid levels inside and outside the cells. Potassium and sodium are also required for conduction of nerve impulses, contraction of muscles (including the heart), maintenance of normal blood pressure and proper water and mineral balance.
Magnesium
Magnesium is a macronutrient that is found in large amounts in the body. It is naturally obtained from a lot of foods such as spinach, legumes, nuts, seeds, whole grains, etc., which are good sources of this element. Magnesium is a cofactor in more than 300 enzyme systems that regulate different biochemical processes in the body, including protein synthesis, muscle and nerve function, blood sugar control, blood pressure regulation, etc.(12)
An adult body contains approximately 25 g of magnesium, 99% of which is found in bones and soft tissues. Less than 1% of the total magnesium is found in blood plasma and the constancy of its level is subject to strict control by the body. Normal serum magnesium concentrations range between 0.75 and 0.95 millimoles (mmol)/L – this homeostasis is largely regulated by the kidneys, which normally excrete about 120 mg of magnesium through urine every day under normal conditions.
Continued consumption of low-magnesium foods, malnutrition, alcohol abuse and the use of certain drugs such as diuretics, PPIs and antibiotics may cause a deficiency of this element in the body. Antitumor treatments, especially platinum-containing regimens, have also been shown to commonly induce magnesium deficiency.(13) Lower plasma levels of this element are associated with increased sense of weakness and fatigue, lack of appetite, nausea and vomiting, muscle cramps, seizures, etc.(14)
Data from various double-blind placebo-controlled studies demonstrate the benefit of magnesium supplementation in reducing inflammation and oxidative stress (15), improving the analgesic effects of opioid analgesics, reducing the required analgesic dose and the side effect of constipation (16), and the renoprotective effects during chemotherapy (17).
The recommended daily intake of magnesium, depending on age, is between 250 and 350 mg/d obtained through diet and/or supplementation. Continued daily supplementation with doses higher than 350 mg/d carries risks of side effects such as upset stomach, nausea, vomiting, diarrhea, etc.
Possible drug cross-reactions of magnesium
Supplementation with high doses of magnesium may reduce the effect of some antibiotics (tetracyclines, fluoroquinolones, aminoglycosides). Magnesium may reduce the absorption rate of oral bisphosphonates (Alendronate, Risedronate, etc.).(18)
