Neuroendocrine neoplasms (NENs) are a diverse group of tumors arising from the neuroendocrine system, with neuroendocrine tumors (NETs) being the most common type. These tumors, characterized by slow growth and high survival rates, often lead to liver metastases and endocrine syndromes. Both the tumor itself and systemic therapies can significantly impact a patient's nutrition. Conversely, malnutrition and obesity have been shown to negatively influence the development and prognosis of NETs. Therefore, nutritional plans are crucial in the multidisciplinary treatment of NET patients, improving their quality of life through tailored approaches based on individual nutritional needs and manageable symptoms related to pharmacological treatments.
Key Nutritional Issues in Carcinoid Patients
According to endocrinologist Jeffrey I. Mechanick, M.D., key nutritional issues for carcinoid patients include niacin deficiency, general protein energy deficiency, nutrition problems due to surgery, malnutrition and chronic diarrhea, and the excess metabolism of tryptophan. These challenges necessitate careful dietary management to support overall health and well-being.
General Dietary Recommendations for NET Patients
For NET patients without symptoms, Dr. Mechanick recommends a traditional healthy diet consisting of fresh fruits and vegetables, protein, and healthy fats. A multivitamin is suggested if the diet does not meet the daily recommended vitamin levels outlined by the Food and Drug Administration.
Dietary Modifications for Symptomatic Patients
For patients experiencing symptoms, dietary modifications should be tailored to address specific issues. For example, a diet for patients with diarrhea should include starchy, easily digestible carbohydrates and low saturated fats.
Managing Malabsorption and Short Bowel Syndrome
Patients who have undergone surgery to remove a large portion of the small intestine may experience short bowel syndrome, a condition in which nutrients are not properly absorbed. In such cases, Dr. Mechanick suggests replacing Vitamins A, D, E, and K if deficiencies are present. Pancreatic enzymes like Viokase, Ultrase, Creon, or Pancrease can also be used to treat malabsorption.
Read also: Overview of Metabolic Diets in Cancer Research
The Role of Supplements and Nutraceuticals
Dr. Mechanick emphasizes that supplements should only be used to address specific deficiencies. They can be beneficial when additional calories are needed, for chronic diarrhea, niacin deficiency, to supplement protein, and for additional fat-soluble vitamin needs.
Regarding nutraceuticals, which are food or food products that provide health and medical benefits, including the prevention and treatment of disease, Dr. Mechanick advises caution. He suggests consulting with a healthcare professional before incorporating these into the diet.
The Importance of a Registered Dietitian
To determine the best diet for each carcinoid patient, Dr. Mechanick recommends consulting a registered dietitian, preferably one specializing in cancer. He also stresses the importance of working closely with a carcinoid specialist.
Practical Tips for Managing Diet During Treatment
Greta Macaire, who presented at a NETRF Patient Education Conference at Stanford University, highlights the importance of paying attention to what you eat during cancer treatment. She advises discussing any dietary changes with the treatment team and accommodating dietary precautions due to allergies, co-occurring illnesses, and medications.
Meal Preparation and Shopping Strategies
Preparing nutritious meals can be challenging when feeling tired or experiencing changes in taste. Macaire suggests leveraging support from others by sharing specific recipes or preparing meals together. Taking advantage of freezer storage for individual portions of leftovers or entire meals is also recommended.
Read also: Managing Canine Lymphoma with Diet
Foods to Avoid and Consume for NET Patients
To reduce the frequency and severity of gastrointestinal symptoms, it's crucial to identify and avoid irritating foods. As a general rule, choose foods and drinks that are gentle on your digestive system.
Foods to Limit or Avoid
- High fiber (insoluble fiber)
- High amine
- High fat
- High sugar
- High salt
- High heat/hot spices (capsaicin)
- High alcohol content
- High in caffeine
- Highly carbonated beverages
- Highly processed foods
Foods to Include
Work with your doctor, dietitian, and treatment team on a personalized nutritional plan to support your health. Your medical history and any co-occurring conditions will drive your daily food choices.
The Role of Specific Dietary Patterns
Recent research has explored the role of specific dietary patterns, such as the Mediterranean diet, ketogenic diet, and intermittent fasting, in the context of NETs.
The Mediterranean Diet (MD)
The Mediterranean Diet (MD) is characterized by a high consumption of fruits, vegetables, nuts, seeds, cereals, and legumes, moderate intake of fish, olive oil, and alcohol, and low consumption of red meat and dairy products. Recognized by UNESCO as an intangible cultural heritage, the MD's benefits are attributed to the high content of polyphenols, vitamins, flavonoids, and antioxidants in Mediterranean foods. These components contribute to anti-proliferation effects, inhibition of degeneration, DNA damage prevention, and anti-inflammatory effects.
Studies have shown that patients with GEP-NETs consume Mediterranean food less frequently and Western foods (red/processed meats, butter, and sugar drinks) more frequently compared to healthy subjects. Furthermore, NETs patients with more aggressive disease (G2 status) showed lower adherence to MD than patients with less aggressive disease (G1 status).
Read also: Managing Pancreatic Cancer with Diet
The Ketogenic Diet (KD)
The ketogenic diet (KD), a high-fat, low-carbohydrate diet with an adequate amount of protein, is considered a promising approach for the treatment of various cancers. It may sensitize tumors to standard treatment by exploiting the reprogrammed metabolism of cancer cells, creating an unfavorable metabolic environment for cancer cells by inhibiting several signaling pathways involved in cancer cell survival.
Intermittent Fasting (IF)
Caloric restriction (CR) without malnutrition has shown promise in cancer prevention. Intermittent fasting (IF), a fasting-like diet, promotes regeneration and rejuvenation of multiple systems by promoting stem cell self-renewal and white blood cell formation.
Nutritional Therapy for Cancer Patients
Nutritional therapy aims to prevent malnutrition, maintain a healthy weight, assist in symptom management, and reduce the risk of treatment intolerance. International nutrition societies recommend dietary patterns that emphasize fresh fruits, vegetables, proteins, and wholegrain cereals while restricting fat, salt, sugar, and processed food intake.
The Importance of Fruits, Vegetables, and Nutrients
Dietary models based on a regular caloric intake of fruits, vegetables (especially cruciferous and garlic), and aliments rich in nutrients, such as vitamins (B-12 or D), folic acid, antioxidants, and selenium can play a protective role in cancer onset. Conversely, meat and animal products may increase the incidence of cancer.
Mediterranean Diet Scoring Systems
Different scoring systems and indexes have been developed to assess adherence to the Mediterranean diet. These include the Mediterranean Diet Score (MDS), the Italian Mediterranean Index, the modified Mediterranean diet (mMED), and the alternate Mediterranean diet (aMED).
Association Between MD and Cancer Risk
Studies have shown that adherence to the Mediterranean diet is associated with a reduced risk of breast cancer, colorectal cancer, gastric cancer, and prostate cancer.
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