Glioblastoma, an aggressive form of brain cancer, presents significant challenges in treatment and management. While medical interventions like surgery, chemotherapy, and radiation therapy are central to care, nutrition plays a vital supporting role in enhancing treatment outcomes and overall patient well-being. This article explores evidence-based nutrition guidelines for glioblastoma patients, drawing from research and expert recommendations.
The Crucial Role of Nutrition in Glioblastoma Care
Nutrition is not a one-size-fits-all approach, especially for cancer patients. Individualized dietary recommendations depend on the type of cancer, treatment plan, potential side effects, existing health conditions, and prognosis. Registered dietitians (RDs) can provide tailored strategies to manage treatment side effects and ensure adequate nutrient intake.
Why Nutrition Matters
- Supports Immune Function: A well-nourished body is better equipped to fight cancer and manage treatment side effects.
- Boosts Energy Levels: Cancer and its treatments can cause fatigue. Proper nutrition helps maintain energy and vitality.
- Promotes Healing and Recovery: Adequate nutrition is essential for tissue repair, wound healing, and recovery from treatment.
- Prevents Unintentional Weight Loss: Maintaining a healthy weight is crucial for strength and overall well-being during cancer treatment.
Dietary Strategies for Glioblastoma Patients
Before Treatment: Building Strength
The goal before starting treatment is to nourish the body and build strength in preparation for the challenges ahead.
During Treatment: Adapting to Changes
Surgery, radiation, and chemotherapy can make it difficult to eat normally, impacting appetite, digestion, and the ability to swallow. Adjustments to the diet may be necessary to minimize weight loss, promote healing, and build strength.
Protein Intake
Treatment often requires increased protein intake to maintain strength. When protein intake is insufficient, the body may break down muscle for fuel. Good sources of protein include:
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- Fish
- Chicken
- Eggs
- Yogurt
- Nut butters
- Legumes
Fiber Intake
A diet rich in high-fiber plant foods (fruits, vegetables, whole grains, nuts, seeds, and legumes) is generally recommended to provide essential nutrients and phytonutrients that promote health. However, depending on the cancer type or treatment, high-fiber foods may not be well-tolerated.
Carbohydrate Intake
Carbohydrates are the body’s primary energy source. Nutrient-dense carbohydrate sources include:
- Fruits
- Vegetables
- Whole grains
- Legumes
Antioxidants
While popular among cancer patients, antioxidant supplements may interfere with treatment. It's essential to discuss supplement use with a healthcare professional.
The Balanced Plate Method
A simple way to build healthy meals is by using the Balanced Plate Method, which emphasizes portion control and a variety of food groups.
Specific Dietary Patterns and Foods
Healthy Dietary Patterns
Research suggests that adherence to healthy dietary patterns may be associated with a reduced risk of glioma. These dietary patterns include:
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- Mediterranean diet
- Dietary Approaches to Stop Hypertension (DASH) diet
- Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet
- Paleolithic diet
- High-protein dietary patterns
- Vegetarian dietary patterns
These diets are rich in phytochemicals and antioxidants, which may offer protective effects against glioma.
Foods with Potential Protective Effects
Certain food groups have been highlighted for their potential protective effects against glioma:
- Fruits
- Vegetables
- Legumes
- Nuts
- Eggs
- Fresh fish
- Tea
- Coffee
Foods to Limit or Avoid
Adherence to unhealthy dietary patterns, such as the Western diet, or diets with high inflammatory potential, glycemic and insulinemic loads, and high consumption of grains (especially refined grains), processed meats, and processed fish, has been linked to an increased risk of glioma.
Managing Treatment Side Effects Through Nutrition
Surgery, radiation, and chemotherapy can lead to various side effects that impact nutrition. Here are some common side effects and dietary strategies to manage them:
Surgery
Surgery to the digestive tract may result in changes in food absorption, potentially necessitating a lower fiber diet. Surgery to the head or neck area may make chewing or swallowing difficult, requiring a diet of soft foods.
Read also: The Hoxsey Diet
Radiation
The part of the body being treated with radiation can influence what foods can be eaten. For example, radiation to the chest might cause inflammation of the esophagus, making swallowing difficult.
Chemotherapy
Chemotherapy can cause nausea, appetite loss, fatigue, and digestive issues. Dietary adjustments and strategies to manage these side effects are essential.
Common Nutrition Impact Symptoms
- Anorexia: Loss of appetite or desire to eat.
- Alterations in Taste and Smell: Changes in taste perception can make food unappealing.
- Mucositis: Inflammation of the mucous membranes, causing pain and difficulty eating.
- Dysphagia: Difficulty swallowing.
- Stomatitis: Inflammation of the mouth.
- Nausea and Vomiting: Common side effects of chemotherapy and radiation.
- Diarrhea and Constipation: Digestive issues that can impact nutrient absorption.
- Malabsorption: Impaired absorption of nutrients.
- Pain: Pain can make it difficult to eat.
- Depression and Anxiety: Emotional distress can affect appetite and food choices.
Malnutrition and Sarcopenia in Glioblastoma Patients
Malnutrition, characterized by insufficient energy intake, weight loss, loss of muscle mass, and diminished functional status, is a significant concern for cancer patients. Studies have reported malnutrition in a substantial percentage of cancer patients, leading to increased treatment toxicities, diminished quality of life, and higher mortality rates.
Sarcopenia, the condition of severe muscle depletion, is also prevalent in cancer patients. A low skeletal muscle index at cancer diagnosis has been associated with worse survival outcomes. Sarcopenic obesity, the presence of sarcopenia in individuals with a high BMI, is an independent risk factor for poor prognosis.
Early identification and management of malnutrition and nutrition impact symptoms are crucial. Nutrition intervention can improve outcomes by helping patients maintain weight, tolerate treatment, improve quality of life, and achieve better surgical outcomes.
The Role of a Registered Dietitian
Every patient at Fred Hutchinson Cancer Center has access to nutrition planning throughout their cancer care that matches their specific needs. A registered dietitian (RD) can provide personalized nutrition recommendations, addressing specific needs and side effects of treatment.
Benefits of Consulting an RD
- Individualized Nutrition Plans: RDs create tailored dietary plans based on the patient's cancer type, treatment, and individual needs.
- Side Effect Management: RDs provide strategies to manage common side effects of treatment, such as nausea, appetite loss, and digestive issues.
- Nutrient Optimization: RDs ensure that the diet is rich in essential nutrients, even when dietary restrictions are necessary.
- Weight Management: RDs help patients maintain a healthy weight throughout treatment.
- Education and Support: RDs provide education and ongoing support to help patients make informed food choices.
Research on Diet and Glioma Risk
A systematic review and meta-analysis of studies on diet and glioma risk found that higher intakes of healthy dietary patterns, vegetables, and fruits were significantly associated with a lower risk of glioma. The study included 24 articles involving over 2 million participants and 7,278 glioma cases.
Key Findings
- Healthy Dietary Patterns: A reduced risk of glioma was observed in individuals with the highest adherence to healthy dietary patterns.
- Vegetables and Fruits: Higher intakes of vegetables and fruits were associated with a significantly lower risk of glioma.
- Dietary Patterns: High protein, vegetarian, and western dietary patterns were significantly associated with glioma risk.
- High-Protein Diet: Adherence to a high-protein dietary pattern was inversely associated with the risk of glioma.
- Vegetarian Diet: Consumption of a vegetarian dietary pattern was also associated with a reduced risk of glioma.
- Western Diet: Greater adherence to the Western dietary pattern was associated with a greater chance of glioma.
The Ketogenic Diet and Glioblastoma
A randomized multi-site phase II clinical trial aims to assess whether a ketogenic diet improves overall survival in newly diagnosed glioblastoma patients who receive standard of care treatment when compared to the standard anti-cancer diet.
The ketogenic diet is proportionally higher in fat, significantly lower in carbs, and has adequate protein. This dietary combination decreases available glucose in the blood and increases the production of ketone bodies through the breakdown of fatty acids. These ketone bodies, which can cross the blood-brain barrier, become a critical energy source for the brain when glucose availability is low.
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