Nutritional Therapy for Cancer – by Nutan Khimasiya

The overall nutritional status of an individual influences his/her body's immunity. Hence malnutrition is a primary factor for occurrence of various disease, due to weakened immune system. Cancer is one such widely known disease, occurrence of which is significantly, influenced by nutritional status of a patient. Various environmental and genetic factors including weakened immune system can contribute to the development of cancer. In general terms, cancer is a malignant tumor, which is an unwanted new or abnormal cellular growth due to mutation in gene of the body cells. There are many causes for development of cancerous cell in the body, while the underlying cause is the basic loss of cell control over normal cell reproduction. These cell mutative factors includes chemical carcinogens, radiation, oncogenic viruses, psychologic stress, epidemiologic factors (e.g., race, region, age, heredity, occupation) and dietary factors. While out of all these various factors, whether occupational or epidemiological, dietary choice is the one modifiable risk factor in prevention or treatment of cancer.

A nutritional balance is necessary to maintain the integrity of the body's immunity, as severe malnutrition compromises the capacity of the immune system, due to weakened organs and wasting of tissues involved in body's immunity (e.g., liver, bowel wall, bone marrow, spleen, lymphoid tissue). Nutrition is also a primary defense for combating sustained attacks of diseases such as cancer.

There is a complex relation between diet and cancer. Foods naturally contain both carcinogenic and anti-carcinogenic compounds. Research indicates that there is an increase in cancer risk for individuals who consume diets high in trans fat, and alcohol. _2,3 But there are conflicting results regarding the protective role of specific micronutrients as well as total fruit and vegetable consumption.₄  Some studies show no significant protective role of fruit and vegetable intake with cancer risk₅; some studies show that fruit intake is more protective than vegetable intake ₆; and some studies show that vegetable intake is more protective against cancer than fruit intake. ₇ A general consensus links adequate vitamin and mineral intake (through either food or dietary supplement) with a decreased risk of DNA damage and cancer incidence. _8,9Thus, a well-balanced diet that includes an ample intake of fruits, vegetables, whole grains, and fiber and limits excess fat and alcohol is the general recommendation for health promotion and disease prevention. Because obesity is associated with several types of cancer, _10,11maintaining an ideal body weight should be a primary goal of diet and healthy lifestyle behaviors.

Specific nutrients that include protein, essential fatty acids, and key vitamins and minerals must be constantly supplied in the diet. The wise and early use of medical nutrition therapy (MNT) for patients with cancer speeds the recovery of nutritional status after surgery; this includes immunocompetence, which improves a patient's response to therapy as well as his or her prognosis. _12-14

However many medications used in cancer treatment may cause drug-nutrients interactions in body. Several cancer drugs causing drug-nutrient interactions must be carefully observed while treating cancer patients eg. antineoplastic drugs including Bexarotene (Targretin) is influenced by Grapefruit juice and may increase drug concentration and toxicities, while Methotrexate (Folex, Rheumatrex) is influenced by alcohol and may increase hepatotoxicity etc. Additionally, many cancer patients experiment with dietary supplements and herbs, that are thought to have a protective role in cancer treatment or prevention, however, some of the more commonly used herbs shows drug-nutrient interaction and may adversely affect the patient and their treatment. Further, patients in advanced stages of cancer receiving chemotherapy or radiation therapy, have shown to affect the gastrointestinal system, hence following a general nutritional therapy may cause complications in them.

The Academy of Nutrition and Dietetics Nutrition Care Manual notes a potential benefit from the supplementation of the following nutrients for patients with specific types of cancer: ₁₄

• Vitamin E: patients with breast cancer who are receiving radiation; patients with head and neck cancer.
• Omega-3 fatty acid supplements: patients with pancreatic cancer
• Arginine: patients with breast cancer; patients with head and neck cancer
• Eicosapentaenoic acid: patients with oral and laryngeal cancer
• Honey: patients who are receiving radiation on the head or neck
• Glutamine: patients undergoing hematopoietic cell transplantation
• Antioxidants at levels higher than the Tolerable Upper Intake Level: patients with non– small-cell lung cancer who are receiving chemotherapy

American Cancer Society, World Cancer Research Fund, and the American Institute for Cancer Research: Guidelines for Cancer Prevention

The most recent expert panel publications recommend the following lifestyle factors to reduce the risk of cancer: _15,16

1. Be as lean as possible within the normal range of body weight throughout life.
   • Balance caloric intake with physical activity.
   • Avoid excessive weight gain at all ages. For overweight or obese individuals, losing even a small amount of weight is helpful.
2. Adopt a physically active lifestyle.
   • Children and adolescents: Participate in at least 60 minutes every day of moderate to vigorous physical activity, with vigorous intensity activity included at least 3 days per week.
   • Adults: Engage in at least 150 minutes of moderate intensity or 75 minutes of vigorous physical activity each week; preferably spread throughout the week.
   • Limit sedentary behaviors.

3. 

   Consume a healthy diet that has an emphasis on plant sources.
   • Become familiar with standard serving sizes and read food labels to become more aware of actual servings consumed. Choose foods that will help achieve and maintain a healthy body weight.
   • Limit the consumption of salty foods and foods that are processed with sodium.
   • Limit the consumption of energy-dense foods, particularly processed foods that are high in added sugar, low in fiber, or high in fat. Avoid sugary drinks.
   • Eat at least 2.5 cups of vegetables and fruits every day.
   • Choose whole grains instead of processed (refined) grains and sugars. Avoid moldy grains and legumes.
   • Choose fish, poultry, and beans as alternatives to lamb. Select lean cuts and small portions, and prepare the meat by baking, broiling, or poaching rather than frying. Avoid processed meats.
4. If alcoholic beverages are consumed, limit their intake. Limit alcohol intake to two drinks per day for men and one drink per day for women. One drink is defined as 12  oz of beer, 5   oz of wine, or 1.5   oz of 80-proof distilled spirits.
5. Aim to meet nutritional needs through diet alone; do not rely on supplements.
6. Aim to breastfeed infants exclusively for 6 months and continue to breastfeed while offering complementary food after 6 months.

Hence, physical activity and dietary choices are the most modifiable risk factors for prevention  of cancer. In a study of more than 475,000 participants followed for 10 + years, adherence to the preceding guidelines significantly reduced the incidence of cancer and cancer mortality for both men and women. ₁₇

References

1. Laake I, et al. Intake of trans fatty acids from partially hydrogenated vegetable and fish oils and ruminant fat in relation to cancer risk. Int J Cancer. 2013;132( 6): 1389– 1403.
2. Bagnardi V, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer. 2015;112( 3): 580– 593.
3. Key TJ. Fruit and vegetables and cancer risk. Br J Cancer. 2011;104( 1): 6– 11. 5. Wang X, et al. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ. 2014;349: 4490.
4. Wang X, et al. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ. 2014;349: 4490.
5. Bradbury KE, Appleby PN, Key TJ. Fruit, vegetable, and fiber intake in relation to cancer risk: findings from the European Prospective Investigation into Cancer and Nutrition (EPIC). Am J Clin Nutr. 2014;100( suppl 1): 394S– 398S.
6. Oyebode O, et al. Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data. J Epidemiol Community Health. 2014;68( 9): 856– 862.
7. Gaziano JM, et al. Multivitamins in the prevention of cancer in men: the Physicians' Health Study II randomized controlled trial. JAMA. 2012;308( 18): 1871– 1880.
8. Ames BN, Wakimoto P. Are vitamin and mineral deficiencies a major cancer risk? Nat Rev Cancer. 2002;2( 9): 694– 704.
9. Boeing H. Obesity and cancer— the update 2013. Best Pract Res Clin Endocrinol Metab. 2013;27( 2): 219– 227.
10. De Pergola G, Silvestris F. Obesity as a major risk factor for cancer. J Obes. 2013;2013: 291546.
11. Chen Y, et al. Nutrition support in surgical patients with colorectal cancer. World J Gastroenterol. 2011;17( 13): 1779– 1786.
12. Vashi PG, et al. The relationship between baseline nutritional status with subsequent parenteral nutrition and clinical outcomes in cancer patients undergoing hyperthermic intraperitoneal chemotherapy. Nutr J. 2013;12: 118.
13. Academy of Nutrition and Dietetics. Nutrition Care Manual. 2015 [Chicago, Ill].
14. Kushi LH, et al. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62( 1): 30– 67.
15. Wiseman M. The second World Cancer Research Fund/ American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Proc Nutr Soc. 2008;67( 3): 253– 256.
16. Kabat GC, et al. Adherence to cancer prevention guidelines and cancer incidence, cancer mortality, and total mortality: a prospective cohort study. Am J Clin Nutr. 2015;101( 3): 558– 569.

About The Author

Nutan Khimasiya

Nutan Khimasiya certified Fitness and Nutrition expert. Nutan Khimasiya is internationally certified Fitness and Nutrition expert from ACSM-Clinical Nutrition, K11-Sports Nutrit.. Read More..

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