Nutrition is of growing interest to patients as part of a holistic approach to their cancer care and is an important topic for patients and caregivers to consider following a cholangiocarcinoma (CCA) diagnosis. Certified specialist in oncology nutrition Stephanie Roit, MS, RD, CDN, CSO, and caregiver Anita Benson highlighted important considerations and personal experiences with proper nutrition in managing patients with CCA.
Ms Roit described the impact of nutrition on cancer and the benefits of plant-based foods in this population. Nutrition provides the body with its main source of energy and can supply antioxidants and phytochemicals. Optimal nutrition can improve quality of life and functional status but may be impacted by treatments. Malnutrition in cancer patients results in weight loss and decreased nutrient uptake, and cachexia, a syndrome of muscle loss with inflammation, can increase fatigue and cause treatment delays or toxicities. The ultimate goal for patients with CCA is to prevent malnutrition during treatment.1
Generally, patients with CCA should be consuming protein from various sources along with fruits and vegetables as tolerated and limiting the intake of ultra-processed foods. If possible, patients should meet with a registered dietician. Ms Roit emphasized the importance of consuming foods from plant sources. These can include whole grains, fruits, vegetables, nuts, seeds, and beans, which are high in fiber and antioxidants. Although this diet is plant based, it is flexible and allows for some animal-based foods. Plant-based foods have been shown to have an anti-inflammatory response and improve gut motility and may protect against infection, while phytochemicals and antioxidants may help remove or block carcinogens and prevent cell damage.1
Ms Roit also described current research around common diets in patients with CCA. The ketogenic diet, which is a high-fat diet, currently lacks clinical trial data in these patients. In addition, the high-fat content may be hard to tolerate, is low in antioxidants and fiber, and side effects can include constipation and weight loss. Diets that limit sugar are also not supported in human studies; however, choosing the right source of sugar and carbohydrates is important. It has been shown that there is an indirect link between excess sugar and increased inflammation, and sugary beverages and added sugars may increase cancer risk. However, glucose is the body’s main source of fuel and high-fiber carbohydrates may decrease cancer risk. Patients should consume natural sugars from whole foods such as fruits, whole grains, and starchy vegetables as opposed to added sugar from refined sources such as table sugar, maple syrup, and honey, which should be limited to less than 6% of daily total calories. Intermittent fasting is another diet trend where all food is consumed during an “eating window” of 8 to 12 hours. This diet has no clear benefit in patients with CCA and can have adverse effects such as weight loss, fatigue, and dizziness. Finally, the alkaline diet, which includes foods that have a high pH and restricts foods with a low pH, may provide unnecessary restrictions on some foods that are beneficial, such as protein-rich foods and whole grains. In general, there is no “one size fits all” approach to nutrition; however, plant-based, whole foods have cancer-fighting properties, whereas restrictive diets are likely not beneficial in these patients.1
Ms Benson shared her personal perspective as a caregiver regarding how proper nutrition affected her husband, who was diagnosed with stage 4 CCA in August of 2013. At the time of diagnosis, his prognosis was poor, with <1% chance of survival. He started treatment on 3 different chemotherapy drugs, and Ms Benson was determined to help her husband through his cancer battle. She researched the topic of nutrition and cancer and theorized that good nutrition may help to rebuild the “good cells” that were being killed by her husband’s chemotherapy. In her research, she found that a nutrient-rich, plant-based diet may reduce the risk of certain types of cancer, so she decided to try this high-quality nutrition regimen with her husband. She investigated making juices with high-quality ingredients, and she learned that juicing and its associated antioxidants may help fight tumor cells. For breakfast, they had a juice consisting of various fruits and high-quality greens, and she also served bulk food with fiber, such as whole oatmeal or whole-wheat toast with almond butter and homemade applesauce, with no sugar (Figure 1). For lunch, they consumed another juice 15 to 30 minutes before eating a meal, which consisted of steamed broccoli, brussels sprouts, collard greens, kale, baked sweet potato, or boiled lentils and beans (Figure 1). Ms Benson recognized this diet may not be the most exciting, so she made a conscious effort to make his meals look appetizing, including adding a variety of colorful foods (Figure 2). They did not consume any refined foods or sugar, including pasta or white rice, and avoided all alcohol and caffeine. Her husband’s tumor began to shrink, so they continued their journey with a high-quality diet. Eventually, his tumor shrank enough that he was able to undergo surgery to remove the tumor, and 5 years later, in 2019, he was declared cancer free and is still alive 10 years after his diagnosis.2
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