Pancreatic Cancer: Why is Diet Important?

Pancreatic cancer and nutrition are closely intertwined. Research has shown that diet can help many patients manage the loss of appetite and weight loss that often accompany pancreatic cancer, and good nutrition is linked to better treatment outcomes. Intriguingly, mounting evidence also suggests that specific diets may directly affect the underlying biology of pancreatic tumors and improve the success of pancreatic cancer treatment. Read on to learn more about pancreatic cancer and diet.

Nutrition and pancreatic cancer symptoms

Fatigue, loss of appetite, and pain are the most prevalent and intense symptoms reported by patients with advanced pancreatic cancer, including pancreatic ductal adenocarcinoma (PDA). Even though loss of appetite is highly distressing for patients and their caregivers, this symptom is often overlooked by health care professionals. There are various reasons why pancreatic cancer patients experience loss of appetite and weight loss, and the role of diet is essential.

Experts suggest that pancreatic cancer-associated weight loss can be caused by:

Anorexia—a lack of desire to eat,
Malabsorption—an inability of the body to absorb nutrients from food, often due to a condition known as pancreatic exocrine insufficiency, and
Cachexia or sarcopenia—conditions that result in loss of muscle.

Evidence-based recommendations for a pancreatic cancer patient’s treatment plan should therefore include consultation with a dietitian, as well as evaluation and management of pancreatic exocrine insufficiency.

The role of diet in pancreatic cancer

Pancreatic cancer can affect how patients feel as well as their ability to eat, and time and effort should be invested into choosing a diet that is both tolerated and easily digestible. For patients with newly diagnosed PDA, nutritional health (often called “nutritional status”) is a good predictor of their prognosis, and good nutritional status is often associated with other factors such as positive psychological status, good social relationships, and longer survival. Therefore, efforts to support good nutrition can be important to help with malnutrition and improve a patient’s quality of life.

Diet is also an important component of specific treatment strategies that focus on cellular metabolism—the life-sustaining chemical processes that occur in cells—to improve pancreatic cancer outcomes. Scientifically engineered diets and foods can potentially manage weight loss, as well as challenge cancer cell growth and proliferation.

The therapeutic power of diet—what we know from other cancers

Scientific studies examining the therapeutic effects of specific diets or foods on cancer management and patient survival are scarce, especially for pancreatic cancer. However, there is growing interest in how diets can complement cancer treatments to induce metabolic shifts that inhibit cancer growth and proliferation.

Several studies support the use of the ketogenic diet (high fat and low carbohydrate) to complement standard cancer treatment, such as chemotherapy. In a recent scientific study, a specific ketogenic diet had promising effects on tumor growth and survival in patients with advanced cancer, including a few pancreatic cancer patients.

Ketogenic diets aim to address the reprogramming of normal metabolism known to be associated with pancreatic cancer (specifically, the way cells process glucose, or simple sugars). Thus, they aim to inhibit growth and proliferation of cancer cells by targeting metabolism within tumor cells, tumor gene expression, and the tumor microenvironment—the up-close environment of the tumor within the body. Also, considering the relationship between calorie intake, weight loss, and cancer survival, fats provide more calories per gram than proteins or carbohydrates.

Important results from pre-clinical experiments have shown that fasting, or diets that mimic fasting, can make different tumor types more sensitive to chemotherapy while protecting normal cells. Some of these results are associated with the mutations (changes) in specific genes that are often found in cancer cells, which may aid their growth and spread in the body. For example, mutated forms of the KRAS gene have been found in lung, colorectal, and pancreatic cancer cells.

A recent laboratory study using cells and mice showed that a fast-mimicking diet together with a high dose of vitamin C delayed tumor progression in the mice and sensitized a wide range of KRAS-mutated cancer tumors to chemotherapy, while protecting healthy cells. Although remarkably interesting, more work is needed to explore the roles of ketogenic and fasting diets on pancreatic cancer management in patients.

Recently, a review paper discussed findings from 29 studies that examined the effects of different diets or foods after cancer diagnosis (mainly breast, colorectal, and prostate cancers). These diets included the Western diet, the “prudent” diet, and the Mediterranean diet, and foods types included meat, dairy products, dietary fiber, certain fats, and nuts. The review highlighted interesting associations between these diets or foods and prognostic outcomes, such as cancer progression, cancer recurrence, and mortality.

For instance, diets rich in nuts, fruits, and vegetables lowered the risk of mortality in both breast and colorectal cancer patients, perhaps due to these foods being rich in certain nutrients, such as phytoestrogens, vitamins, antioxidants, and microelements. Additionally, dietary fiber from these foods could lower mortality by adjusting metabolism as well as the microbiome— the array of bacterial species found naturally in the human gut. Indeed, several other studies have established a strong association between cancer treatment and the gut microbiome.

Overall, results from the 29 reviewed studies indicated that detrimental dietary patterns, such as the Western diet, and/or the heavy consumption of some food categories, such as saturated or trans fats, could worsen prognostic outcomes in breast, colorectal, and prostate cancer patients. On the contrary, consumption of healthy protein food sources, fiber from nuts and cruciferous vegetables, as well as high-quality fats such as those found in fish, may protect against progression and mortality in patients diagnosed with these cancers.

Pancreatic cancer—diet-based therapeutics

The therapeutic power of different diets and foods remains mostly unexplored in people diagnosed with pancreatic cancer, although a few small studies are worth mentioning.

In a recent study with 28 patients undergoing chemotherapy for advanced pancreatic cancer, a diet known as “supplemented alkalization” positively influenced overall survival. The diet consisted of a daily intake of at least 400 grams of fruits and vegetables and no meat or dairy products. The authors suggested that the diet may have modified tumor metabolism by reducing inflammation, as well as affected the patient’s insulin levels and gut microbiome. Although the findings are interesting, the number of patients was low, and more studies are necessary.

Another interesting publication using pancreatic cancer cells and mice showed that, compared to a standard diet, a ketogenic diet resulted in reduced pancreatic tumor weight and increased muscle mass in the mice. The authors concluded that a ketogenic diet may inhibit cancer-induced weight loss, along with reducing uptake of glucose by cancer cells and diminishing cancer cell growth (glucose may be an important source of energy for cancer cells).

However, more patient data is needed to clarify the potential for a ketogenic diet to complement cancer treatment and improve patients’ survival. Also, the effects of a long-term ketogenic diet on health and the gut microbiome remain to be determined.

In addition, research into foods and diets that could aid treatment of pancreatic ductal adenocarcinoma (PDA) must consider the biological processes and metabolic reprogramming that influence tumor growth. The tumor microenvironment is also important; the dense stroma (non-cancerous cells found in a tumor) that surrounds pancreatic cancer cells may block cancer medications from reaching the tumor, so understanding the impact of diet on the stroma is key.

Some new research is focused on diets that involve molecules known as amino acids. Amino acids are the building blocks of proteins and are important components of the body’s metabolic processes. The human body can make some of its own amino acids (non-essential amino acids) but must obtain the rest from food.

A recent study showed that, in mice, depriving cancer cells of some amino acids can impact tumor growth and metastasis in some types of cancer cells. Similar preclinical studies using amino acid restriction have demonstrated that diets designed to deprive tumors of amino acids may hold promise for managing some kinds of metastatic pancreatic cancer, such as PDA.

Some non-essential amino acids are central components of a protein called collagen, which is found in the stroma surrounding pancreatic cancer cells. Also, certain non-essential amino acids and the biological processes involved in making them are known to play a role in tumor formation. Interestingly, preclinical studies have shown that pancreatic cancer cells need these amino acids for growth.

The dependence of pancreatic cancer on specific amino acids may be a vulnerability that could be exploited by therapeutics. In a recent press release, the company xCures Inc., a partner of Cancer Commons, announced their collaboration with an innovative biopharmaceutical company. They have launched a medical diet study that aims to test the potential of a highly engineered diet to manage advanced PDA.

Cancer Commons can help enroll patients with PDA to try the specialized diet alongside standard-of-care chemotherapies. Patients will not need to switch doctors and can continue their typical treatment plan, just with the addition of the scientifically formulated diet.

The diet contains all the daily nutrients specified in the Food and Nutrition Board’s Recommended Dietary Allowances and will be provided to each patient for three months. Relevant outcomes, such as blood serum measurements, satisfaction with the diet, as well as quality of life regarding pain, energy levels, mood, and digestion, will be evaluated.

In conclusion, although pancreatic cancer remains a challenging health concern, recent advances in science and the development of diet- and food-based therapies may show a promising future. To learn more about the role of diet and nutrition for your own advanced pancreatic cancer, or for a loved one, request free, personalized information from Cancer Commons.

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