Many people with advanced cancer lose weight and muscle without trying. This condition, called cachexia, affects up to 80 percent of people with advanced cancer, especially those with pancreatic, stomach, lung and head and neck cancers, and it weakens the body, makes treatment harder to tolerate and shortens survival. Cachexia is not simply caused by eating less. Inflammation and signals released by the tumor cause the body to break down its own muscle and fat, which is why eating more alone often does not reverse it.1 This article explains how cachexia is recognized and what helps.
Recognizing Cachexia Early
An international consensus defines cachexia as losing more than 5 percent of body weight over six months, or less when muscle is already low.1 Muscle can be measured on the CT scans many patients already have, and grip strength is a simple test. Two blood tests, C-reactive protein, a marker of inflammation, and albumin, form the Glasgow Prognostic Score, developed in Scotland, which predicts which patients are at greatest risk. Acting early, before major weight loss, works best.
Nutrition: European Guidance
The European Society for Clinical Nutrition and Metabolism recommends enough calories and protein, generally 1 to 1.5 grams of protein per kilogram of body weight each day, and support from a dietitian for anyone losing weight.2 Small, frequent, protein-rich meals and nutritional drinks help. Fasting and strict ketogenic diets may not be appropriate for people who are already losing weight. See our articles on fasting during chemotherapy and the ketogenic diet.
Exercise
Resistance exercise, such as light weights or resistance bands, is the most direct way to signal the body to keep its muscle, and walking supports appetite and energy. Even short, regular sessions help.
Medicines
Anamorelin, approved in Japan. Anamorelin mimics ghrelin, the body’s hunger hormone. In the ROMANA trials in lung cancer, it increased body weight and lean body mass compared with placebo,3 and Japan approved it for cancer cachexia in 2021, the first country to do so.
Low-dose olanzapine, from India. In a randomized, placebo-controlled trial in India of people receiving chemotherapy for advanced stomach, liver, pancreatic, bile duct and lung cancers, a low daily dose of olanzapine led to weight gain of more than 5 percent in 60 percent of patients, compared with 9 percent with placebo, and improved appetite.4
Ponsegromab. This new antibody blocks GDF-15, a signal that drives appetite loss and wasting. In a randomized trial published in the New England Journal of Medicine in 2024, it increased weight compared with placebo over 12 weeks and improved appetite and activity, and larger trials are under way.5
Megestrol increases appetite, but the weight gained is mostly fat rather than muscle, and it raises the risk of blood clots. Steroids can help appetite for a short time.
Integrative Research in Cachexia
Omega-3 fatty acids, from the Netherlands. Omega-3 fatty acids from fish oil calm the inflammation that drives muscle breakdown. In a Dutch randomized trial at VU University Medical Center in Amsterdam of people with lung cancer receiving chemotherapy and radiation, those who took a nutritional drink enriched with omega-3 fatty acids had better quality of life and better physical and mental function than those who did not (van der Meij and colleagues, European Journal of Clinical Nutrition, 2012).
Rikkunshito, from Japan. Rikkunshito is a traditional Japanese herbal formula, approved and widely used in Japan, that raises levels of ghrelin, the hunger hormone. In a Japanese study of people with stomach cancer receiving cisplatin chemotherapy, it reduced loss of appetite and improved food intake (Ohno and colleagues, Clinical and Experimental Gastroenterology, 2011). The studies were small.
These are some of the natural and integrative options studied in cancer cachexia, and others have promising research as well. Which may fit your situation depends on your type of cancer, your current treatment and possible drug interactions. In a consultation, Dr. Silver, MD, educates you on these options and the research behind them. Request a consultation.
How Cancer Expert MD Helps
Cancer Expert MD provides education and consultation for people with every type and stage of cancer, and specializes in Stage IV and metastatic cancer. Our book, The New Reality of Cancer, covers nutrition, side effects and the natural compounds studied in cancer. See also our article on combating chemotherapy side effects.
Frequently Asked Questions
What is cancer cachexia?
Unintended loss of weight and muscle caused by inflammation and signals from the tumor. It affects up to 80 percent of people with advanced cancer.
Why doesn’t eating more fix it?
Because the body is actively breaking down its own muscle and fat. Good nutrition is essential, but it works best combined with exercise and treatment of the underlying inflammation.
Are there medicines for cancer cachexia?
Yes. Anamorelin is approved in Japan, low-dose olanzapine improved weight and appetite in a trial in India, and the new antibody ponsegromab is in larger trials.
Should someone losing weight fast or follow a ketogenic diet?
Fasting and strict ketogenic diets may not be appropriate for people who are already losing weight, so these approaches need careful individual review.
About the author. Dr. Silver, MD, graduated from Temple University School of Medicine, trained as an interventional cardiologist, and has practiced medicine for nearly fifty years. A lymphoma survivor of about twenty-five years, he is co-author, with Dr. Lindmeier, DHSc, of The New Reality of Cancer: The Science of Recovery. Read more about Dr. Silver, MD.
Research by Dr. Lindmeier, DHSc, cancer educator and co-author of The New Reality of Cancer.
This article is for general education only and is not individual medical advice. Always consult your own doctor before making any changes to your care.
© 2026 Lovely LYF LLC. All rights reserved. This article draws on the research in The New Reality of Cancer and may not be copied, republished or distributed without written permission.
For more in-depth information on this topic and many others, get our book, The New Reality of Cancer: The Science of Recovery.
More articles on integrative cancer treatments and all articles.
References
- Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. The Lancet Oncology. 2011;12(5):489–495.
- Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition. 2017;36(1):11–48.
- Temel JS, Abernethy AP, Currow DC, et al. Anamorelin in patients with non-small-cell lung cancer and cachexia (ROMANA 1 and ROMANA 2). The Lancet Oncology. 2016;17(4):519–531.
- Sandhya L, Devi Sreenivasan N, Goenka L, et al. Randomized double-blind placebo-controlled study of olanzapine for chemotherapy-related anorexia in patients with locally advanced or metastatic gastric, hepatopancreaticobiliary, and lung cancer. Journal of Clinical Oncology. 2023;41(14):2617–2627.
- Groarke JD, Crawford J, Collins SM, et al. Ponsegromab for the treatment of cancer cachexia. New England Journal of Medicine. 2024;391(24):2291–2303.
This article is for education only. It is not medical advice and does not diagnose or treat any condition. Cancer Expert MD has no financial relationship with any laboratory, drug maker, supplement company, clinic or hospital.
Leave a Reply