Liver cancer, particularly hepatocellular carcinoma (HCC), is a major global health concern and a leading cause of cancer-related deaths. Nutrition plays a vital role in supporting treatment outcomes and enhancing the overall well-being of patients undergoing treatment, which includes surgery, chemotherapy, and targeted therapies. A well-structured diet can effectively manage symptoms, maintain strength, and support recovery.
Understanding Liver Cancer and Its Impact on Nutrition
Liver cancer arises from the uncontrolled growth of liver cells, often linked to chronic liver diseases like hepatitis B and C or cirrhosis. Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer, often occurring alongside cirrhosis. In addition to common risk factors like hepatitis B virus/hepatitis C virus infection, age, and alcohol/tobacco consumption, nutritional risk factors also contribute to HCC development. These include high intake of saturated fats from red meat, cooking methods that generate heterocyclic amines, and food contamination with aflatoxins.
Chemotherapy, a common treatment, uses powerful drugs to kill or inhibit the growth of cancer cells. However, these treatments can significantly affect appetite, digestion, and nutrient absorption, leading to side effects such as nausea, fatigue, altered taste sensations, and difficulty swallowing.
The Importance of Nutritional Support
Given the complexity of liver cancer treatment and its impact on nutrition, consulting with healthcare providers for personalized dietary recommendations is crucial. A tailored diet during liver cancer treatment is essential for managing symptoms effectively and enhancing recovery outcomes. Patients are encouraged to seek guidance to navigate their nutritional journey successfully.
For patients being evaluated for HCC staging and treatment, special attention should be given to nutritional support, including proper assessment and therapy by a multidisciplinary team. These patients often develop HCC on top of long-lasting cirrhosis and may present with severe malnutrition. Cirrhosis-related complications should be properly addressed and considered in nutritional care.
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Nutritional therapy should focus on providing enough energy and protein to meet the increased requirements of both cirrhosis and cancer. Branched-chain amino acids are recommended in both cirrhosis and hepatocellular carcinoma as they can improve muscle mass, body protein, response to treatment, and quality of life.
Dietary Recommendations for Liver Cancer Patients
General Guidelines
- Eat Small, Frequent Meals: Eating five to six small meals throughout the day can help maintain energy levels and reduce nausea. Stacy Davis, a registered dietitian, suggests planning to consume six to eight smaller meals a day, instead of three large ones, to limit nausea. The American Cancer Society (ACS) recommends grazing and snacking throughout the day to maximize nutrient intake.
- Stay Hydrated: Maintaining adequate fluid intake is critical during treatment. Dehydration can exacerbate fatigue and other symptoms. Keep a water bottle filled and drink when thirsty. Avoid sugary drinks, as they offer little nutritional benefit.
- Prioritize Protein: Lean proteins are vital for supporting immune function and healing, providing essential amino acids for tissue repair and muscle maintenance. Dr. Schafer suggests low-fat dairy products such as milk, yogurt, and cheese or dairy substitutes. Nuts, nut butter, and beans can also provide hefty amounts of protein.
- Include Fruits and Vegetables: Fruits and vegetables should be a cornerstone of any diet for liver cancer patients, helping combat oxidative stress and supporting overall health by providing essential vitamins and minerals. Fruits and veggies are full of fiber, antioxidants, and nutrients needed to support the immune system during treatment.
- Choose Healthy Fats: Healthy fats aid in nutrient absorption and provide essential fatty acids that support overall health. Experts recommend avoiding fatty meats and instead eating more healthy fats. Try to avoid fried, greasy, and fatty foods; choose baked, broiled, or grilled foods instead.
Foods to Include
- Whole Grains: Whole grains are an excellent source of energy and dietary fiber, helping regulate blood sugar levels and promote digestive health.
- Legumes: Legumes such as beans and lentils are rich in fiber and protein. They may potentially protect against liver cancer and may have an inverse relationship with the condition. Research suggests that people may benefit from consuming 8-40 grams of legumes per day.
- Fish: The consumption of fish rich in n-3 polyunsaturated fatty acids or supplementation with n-3 polyunsaturated fatty acids seems to protect against the development of HCC, even among subjects with HBV and/or HCV infection. Fatty acids could exert anticancer effects through their ability to induce apoptosis of cells, regulate cell cycle and manipulate the production of eicosanoids.
- Specific Foods with Potential Benefits:
- Ginger: Ginger can help alleviate nausea by increasing the speed of gastric emptying and providing anti-inflammatory effects.
- Garlic: Garlic is known for its immune-boosting properties.
- Green Tea: Green tea is rich in catechins.
- Berries: Berries are high in vitamins C and E, providing antioxidant benefits.
Foods to Avoid
- Alcohol: Alcohol should be avoided completely, as it can exacerbate liver damage and interfere with treatment efficacy. Research says that alcohol gets processed mostly in your liver. Many [cancer] treatments require that the liver is working properly, and progression of liver disease due to alcohol use can lead to limited treatment options.
- Processed Foods: Processed foods are often high in sugar, salt, and unhealthy fats, which can worsen symptoms such as nausea or fatigue.
- Aflatoxins: The main dietary risk factor for the development of HCC is the contamination of food with aflatoxins. Aflatoxins can be found in products such as corn, wheat, peanuts, rice, sesame, sunflower seed, cottonseed and many spices.
- Red Meat: Excessive consumption of saturated fats, especially those derived from red meat, is associated with the development of HCC. Red meat intake was associated with an increased risk of mortality from liver disease and the incidence of HCC.
- Salt: When your liver struggles, it often causes a buildup of extra fluid around your organs called ascites, per the American Liver Foundation. Unfortunately, salt can add to this problem. When you eat salt, it eventually gets absorbed into your bloodstream. And where salt goes, water follows, according to Harvard Health Publishing.
- Unapproved Supplements: Patients should exercise caution with unapproved supplements that may interfere with treatment protocols or cause adverse effects.
Managing Treatment Side Effects Through Diet
Patients undergoing treatment for liver cancer often experience side effects that impact their ability to eat and maintain a healthy weight. Here are some strategies to manage these challenges:
- Nausea:
- Eat small, frequent meals.
- Try ginger in various forms (tea, added to recipes).
- Avoid strong odors and greasy foods.
- Loss of Appetite:
- Eat nutrient-dense foods, even if you can only manage small portions.
- Consider nutrition bars or supplemental drinks to meet calorie needs.
- Consult with a dietitian for personalized recommendations.
- Mouth Sores:
- Choose soft, non-irritating foods.
- Avoid acidic, spicy, and very hot foods.
- Rinse your mouth frequently with a salt water solution.
- Diarrhea:
- Stay hydrated by drinking plenty of fluids.
- Eat low-fiber foods and avoid dairy products.
- Consider the BRAT diet (bananas, rice, applesauce, toast).
The Role of Nutritional Assessment and Therapy
Nutritional assessment is of great importance in patients with cirrhosis and HCC, the goal is to establish a baseline body composition assessment and continue with frequent follow-ups to monitor the response to nutritional therapy. It is important to consider the fact that patients with previous liver disease have many complications that make nutritional assessment very complex.
Traditional markers, such as body weight, body mass index and even bioelectrical impedance, may be unreliable due to complications such as ascites/edema and hepatic encephalopathy. Functional testing, phase angle, and computed tomography scan-derived skeletal muscle index-L3 are among the most useful tools for nutritional assessment.
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