When someone gets a diagnosis of cancer, or in the case of this article, pancreatic cancer, they are usually given a set of nutritional guidelines to follow during their treatment and post-treatment stages. However, when it comes to cancer, dietary choices can be very confusing. Therefore, researchers are suggesting that an extensive examination of the individual patient’s situation is needed before any dietary recommendations can be made to find the recommendations that would create the most beneficial impact on the patient’s situation. This seems like a common sense approach and obvious one we utilize at the Magaziner Center for Wellness, but for some patients, at oncology offices, the nutritional and dietary guidelines they are getting are confusing, conflicting, and for some difficult to follow. That is why some of these people are coming to us, for a better understanding of how they may be able to fight their cancer diagnosis.
Let’s look at the challenges a pancreatic cancer patient faces in their dietary choices.
In a June 2020 study in the journal Nutrients,(1) specialists found that people with pancreatic cancer do not have a proper diet, despite the fact that they changed the way they eat. The reason? No official nutritional standards which, the study suggests seems to be a necessary element in the therapy pancreatic cancer patients.
What this study observed was:
Patients were not getting enough calories
The calories they were getting were high fat in nature.
Essential fatty acid consumption, Omega-3 for example, were very low
Too much sugar consumption
Vitamin D deficiency was observed in 100% of men and women in the study.
Patients also experienced the deficiency of vitamin E, folates and niacin.
The consumption of sodium and phosphorus was twice as high as recommended, and an insufficient supply of calcium was observed in 80% of women and 90% of men.
The insufficient consumption of magnesium, iodine and potassium in a significant part of the studied group was observed.
All participants consumed too much cholesterol and insufficient amounts of fiber.
It is clearly very difficult to battle cancer when your nutritional intake looks like that above.
Pancreatic cancer patients do not get enough protein
A June 2021 study (2) investigated the nutritional status and longitudinal dietary intake during the course of chemotherapy, and their relationships with the survival in patients with 38 patients with unresectable pancreatic cancer.
Moderate or severe malnutrition was found in 34.2% of the participants.
Daily protein intake was significantly higher in the survivor group than in the deceased group at one month after the initiation of chemotherapy. Conclusion: “Improving the dietary protein intake could be a useful therapeutic approach in patients with advanced pancreatic cancer receiving chemotherapy.”
Targeting adipose tissue to achieve weight loss
In a 2019 study in the journal Pancreatology (3), researchers made these observations on the critical nature of nutrition and lifestyle in battling pancreatic cancer.
“Despite advances in therapy and achievements in translational research, pancreatic cancer remains an invariably fatal malignancy. Risk factors that affect the incidence of pancreatic cancer include diabetes, smoking, obesity, chronic pancreatitis, and diet.”
“Chronic inflammation, hormonal effects, circulating adipokines (inflammatory cells), and adipocyte-mediated inflammatory (obesity related inflammation) and immunosuppressive microenvironment are involved in the association of obesity with pancreatic cancer.”
“(This research) leads us to conclude that targeting adipose tissue to achieve weight loss may represent a new therapeutic strategy for preventing and treating pancreatic cancer.”
Ketogenic diet and pancreatic cancer
The research above is certainly not the first research to make a connection between weight, fat, obesity and the prevention and treatment of pancreatic cancer.
In November 2018, researchers wrote in the journal Anticancer Research (4) about the ketogenic diet (a high-fat, adequate-protein, low-carbohydrate diet) and its potential use in pancreatobiliary cancer patients. Here is what the research team wrote:
“High-carbohydrate diets are generally provided to post-pancreatectomy cancer patients. (The) Low energy density of this diet may obstruct proper energy intake and recovery. This study aimed to assess the effects of high-fat, high-energy ketogenic diet in these patients.”
What the researchers were saying in the simplest of terms is that a high-carbohydrate diet may be exactly the WRONG diet for pancreatic cancer patients. It robs these patients of energy.
Here are the study results:
After pancreatectomy (surgery to remove all or part of the pancreas), 9 patients were provided with general diet while 10 were served a ketogenic diet. Meal compliance, energy intake rate, meal satisfaction and presence of complications were monitored throughout the patient’s hospital stay.
Findings:
Meal compliance, energy intake rate and meal satisfaction score were higher in ketogenic diet. The results: Post-pancreatectomy cancer patients who consumed a ketogenic diet had a higher energy intake and body cell mass (BCM), in other words they gained body mass.
These results suggest the potential use of a ketogenic diet as an adjuvant anti-cancer therapy.
This is just one suggestion to diet. At the Magaziner Center for Wellness we assess the individual patient’s body composition to help guide them to better nutritional choices. Our particular emphasis is on an anti-inflammatory diet and lifestyle, and biologic agents that quiet the inflammatory pathways since inflammation has been found to foster the growth of cancer cells.
In the journal Nutrients (5), researchers at North Dakota State University offered this:
Evidence is mounting which demonstrates that diet and nutrition are key factors in carcinogenesis (the formation of cancer). Diets low in folate and high in fruits, vegetables, red/processed meat, and saturated fat have been identified as pancreatic cancer risk factors.
Are fruits and vegetables bad?
Doctors in the Czech Republic have published findings (6) trying to solve the role of diet in the development of Pancreatic cancer.
Some foods they tested provided a very strong protective effect from pancreatic cancer. they included:
pickled cabbage
broccoli
cooked onion
tomatoes
raw carrot
cooked carrot
Cooked vegetables were beneficial: “statistically significant protective associations were found in consumption of more than three portions of cooked vegetables per week”and high consumption of citrus fruit.
Conflicting evidence and confusion
Another study published in the journal Anticancer Research (7) suggests this:
Fruits (particularly citrus) and vegetable consumption may be beneficial. The consumption of whole grains has been shown to reduce pancreatic cancer risk and fortification of whole grains with folate may confer further protection. Red meat, cooked at high temperatures, should be avoided, and replaced with poultry or fish. Total fat should be reduced. The use of curcumin and other flavonoids should be encouraged in the diet. There is no evidence for benefit from vitamin D supplementation. There may be benefit from dietary folate.
The role of inflammation
In a recent report, doctors confirm a strong association between pancreatic cancer and inflammatory stimuli or conditions such as cigarette smoking and diabetes, suggesting that inflammation may play a key role in pancreatic cancer.
Studies of dietary patterns and cancer outcomes also suggest that diet might influence an individual’s risk of pancreatic cancer by influencing the inflammation response. In this report strong suggestion is made that a proinflammatory diet may act as cofactor with cigarette smoking and diabetes to increase risk of pancreatic cancer beyond the risk of any of these factors alone. (8) Obviously a lifestyle change is needed for people at these elevated risk factors.
40 percent of pancreatic cancers could be avoided by maintaining a healthy weight and not smoking
In a recent study from England, doctors say almost 40 percent of pancreatic cancers could be avoided through maintaining a healthy weight and not smoking.
The English doctors noted that 8,800 people are diagnosed with the disease in the United Kingdom, but survival rates remain very low, with only three per cent of people diagnosed with pancreatic cancer surviving their disease for five years or more after their diagnosis.
While more research is needed to find better ways of diagnosing and treating the disease, there is evidence to suggest that some pancreatic cancers are linked to being overweight and to smoking – and almost four in 10 could be prevented by lifestyle changes to address this.(9)
What we see here in this article is conflicting evidence. Therefore the care of the cancer patients must rely on an individualized and monitored nutrition program. Our program emphasizes the concept of Thriving While Surviving. We strive to transform cancer from an acute disease into more of a chronic illness, one that can be lived with for many months or even years. Some of our patients have greatly outlived their life expectancy by even two or three-fold. Furthermore, most can continue with a productive and fulfilling life.
If you would like to explore more information, please contact our office so we can start a conversation with you.
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References
1 Kikut J, Jasińska A, Pobłocki J, Brodowski J, Małgorzata S. Assessment and State of Nutrition of Patients with Gastroenteropancreatic Neuroendocrine Neoplasms. Nutrients. 2020;12(7):E1961. Published 2020 Jun 30. doi:10.3390/nu12071961
2 Hasegawa Y, Ijichi H, Saito K, Ishigaki K, Takami M, Sekine R, Usami S, Nakai Y, Koike K, Kubota N. Protein intake after the initiation of chemotherapy is an independent prognostic factor for overall survival in patients with unresectable pancreatic cancer: A prospective cohort study. Clinical Nutrition. 2021 Jun 17.
3 Ok JH, Lee H, Chung HY, Lee SH, Choi EJ, Kang CM, Lee SM. The Potential Use of a Ketogenic Diet in Pancreatobiliary Cancer Patients After Pancreatectomy. Anticancer research. 2018 Nov 1;38(11):6519-27.
4 Weisbeck A, Jansen RJ. Nutrients and the Pancreas: An Epigenetic Perspective. Nutrients. 2017;9(3):283. Published 2017 Mar 15. doi:10.3390/nu9030283
5 Azeem K, Horakova D, Tomaskova H, Prochazka V, Shonova O, Martinek A, Kysely Z, Janout V, Kollarova H. Evaluation of dietary habits in the study of pancreatic cancer. Klin. Onkol. 2016;29(3):196-203.
6 Pericleous M, Rossi RE, Mandair D, Whyand T, Caplin ME. Nutrition and pancreatic cancer. Anticancer Res. 2014 Jan;34(1):9-21.
7 Antwi SO, Oberg AL, Shivappa N, Bamlet WR, Chaffee KG, Steck SE, Hébert JR, Petersen GM. Pancreatic cancer: associations of inflammatory potential of diet, cigarette smoking and long-standing diabetes.Carcinogenesis. 2016 Feb 12. pii: bgw022.
8 D M Parkin, L Boyd, L C Walker. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. British Journal of Cancer, 2011; 105: S77 DOI: 10.1038/bjc.2011.489
9 https://www.cancerresearchuk.org/about-us/cancer-news/press-release/2014-07-01-four-in-10-pancreatic-cancers-could-be-prevented-by-lifestyle-changes
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