2 What are NETs? NET = Neuroendocrine tumours Slow growing tumours of the ‘diffuse’ endocrine systemMany different types of NETs -digestive & respiratory systems, ovaries, testes and pancreas‘Functioning’ (hormone secreting) or ‘Non-functioning’ (non-hormone secreting)Non-functioning tumours - symptoms relate to size, pressure on surrounding tissue
4 Why is nutrition important? High incidence of gastrointestinal involvement - small bowel, large bowel, rectum, stomachGeneral symptoms & treatments may affect nutritional health – diarrhoea, weight loss, lethargy, gas & bloating, nausea‘Carcinoid syndrome’ – increased intake of protein rich foods, role for limiting foods high in aminesAsymptomatic tumours – general healthy eating principles to maintain healthPrevention of reoccurrence of disease - general healthy eating principles for cancer prevention
5 Is there are ‘diet’ for people with NETs? Short answer – NOThere are:General healthy eating principles – Australian Guide to Healthy Eating (AGHE), Cancer Council of AustraliaSpecific nutritional strategies to cope with symptoms, effects of treatment.Nutritional adequacy must be individualised to be effective. No one diet fits allSome specific nutritional recommendations – carcinoid syndrome, increased intake of niacin
6 Australian Guide to Healthy Eating Include a variety of different foodsBreads & cereals: 4-12 serves/day (½ wholegrain varieties)Vegetables: 5 serves/dayFruit: 2 serves/dayMeat: 3-4 serves/weekFish: 2 serves/weekDairy: 3 serves/day‘Extras’ – limit to maintain a healthy weight
7 What is a serve? Breads & cereals 2 slices of bread or 1 medium bread roll1 cup cooked rice, pasta, noodles1 1/3 cup of breakfast cereal½ cup toasted muesli or 1 cup cooked porridgeVegetables½ cup cooked vegetables½ cup cooked dried beans, lentils1 cup salad1 small potato
8 What is a serve?Fruit:1 medium piece of fruit (150g) e.g. apple, pear, banana2 small pieces (150g) of fruit e.g. kiwi, manadarin1 cup diced fruit, fruit salad1 ½ tablespoons dried fruit½ cup fruit juiceMeat, meat alternatives:½ mince, 2 eggs2 slices roast meat, ½ chicken breast2 eggs1/3 cup lentils, chickpeas, split peas, kidney beans
9 What is a serve?Fish:150gm oily fish e.g. salmon, tuna, trout, mackerelCanola oils, margarine, walnuts, walnut oilSoy based foods e.g. edamame, tofu, soy & linseed breadGreen leafy vegetablesDairy:250ml ‘lite’ or skim milk200gm low fat yoghurt, custard2 scoops low fat ice cream2 slices (40gm) low fat cheese
10 Nutritional strategies for NETs Survey of NET patients in 1999, repeated 2005 showed similarresultsCarcinoid Nutrition Survey (Carcinoid Foundation 1999, 2005)n=97 62% female 38% male aged years of ageSigns and Symptoms with possible nutrition implicationsFatigue & weakness 60%Diarrhoea 51%Gas & bloating 51%Flushing 45%Abdominal pain 33%Weight loss 21%
11 "Nutritional Concerns for the Carcinoid Patient" Presented by Monica E. Warner, M.S., R.D., C.D.N. Research Coordinator, Carcinoid Cancer Foundation, Inc., New York, New York Year 2000 with Year 2008 update
12 Nutritional strategies for NETs Important to seek medical advice to find out underlying cause of symptoms in the first instanceDoctor may refer to a dietitian to help manage symptoms through individualised dietary adviceNutritional health, wellbeing is always the priority for nutrition therapy. Avoid unnecessary food restrictionsNutrition therapy is unlikely to resolve symptoms completely and is usually an adjunct to medical therapy e.g. diarrhoea, gas & bloating
13 Nutritional strategies for NETs Fatigue and weakness/weight lossCause? low body weight, poor appetite/nausea resulting in poor foodintake, poor dietary qualitySmall frequent mealsHigh calorie, high fat, high protein meals if toleratedHigh calorie, high protein liquids often tolerated better than solidsHigh calorie, high protein nutritional supplements (doctor, nurse, dietitian)No weight loss? Assess dietary quality against AGHE
14 Nutritional strategies for NETs DiarrhoeaCause? Increased secretion of serotonin from tumour, smallbowel resection, chemotherapy, response to some medicationsVery individualised - everyone has eats different food, reactsdifferently to food, severity of diarrhoea, cause of diarrhoeaSmall frequent mealsReduce foods very high in fibreReduce lactose intake (component of dairy foods)Lower fat mealsReduce intake of alcohol, spice, caffeinated drinks, other foods?Nutmeg – 3 teaspoons a day??
15 Nutritional strategies for NETs Gas and bloating/abdominal painVery individualisedSmall frequent mealsReduction in gas forming foods e.g. cabbage, cauliflower, broccoli, bok choy (Chinese broccoli), onion, leaks other foods?Reduce fibre, spice, alcohol, high fat meals, caffeineCarbonated drinks
16 Nutritional strategies for NETs FlushingSymptom of ‘carcinoid syndrome’, occurs in only 10% of people with NETsIncreased requirement for NiacinIncreased requirement for protein 1-1.5gm/kgMay be a role for limiting foods high in amines - (precursors for catecholamines e.g. adrenaline)Reduce large meals, alcohol, spices, other foods?
17 Eating more proteinRecommended increase of % of recommended intake of protein foodsMost people with good appetites eat this amount anyway100gm steak = 20-25gm, 2 eggs = 7gm, 1 glass milk – 10gmInclude protein foods at all meals and snacksEat more protein = increase niacin intake
18 MultivitaminsOnly recommended for patients with one or more symptoms of ‘carcinoid syndrome’ – flushing, diarrhoea, weight loss, poor intake of foodSupplements not needed if you are following a balanced and varied dietRecommended dose - multivitamin 2 x dose daily
19 NiacinIncreased serotonin production increases need for niacin – 60% of tryptophan is used in serotonin production, usual is 1%Symptoms – ‘pellagra’ skin lesions, scaly skin, dermatitis dementia, diarrhoea, depression, deathCriteria for Niacin supplementation: Elevated serotonin levels,flushing, weight loss, poor appetite/poor intake of foodIncrease protein intake (1-1.5g/kg) - meat, poultry, fish, wholegrain cereals, eggs, dairy25-50mg daily x 2 doses (more can worsen symptoms)
20 Niacin supplementation Complex B vitamin (100mg niacin) – ½ - 1 tablet twice dailyMultivitamin (18mg niacin) 1 tablet twice daily = 36mgComplex B vitamin (50mg niacin) ½ - 1 tablet twice daily
21 Foods high in amines Aged, fermented and spoiled protein foods Product of protein breakdownLevels increase with ‘age’ or matureReducing the ‘load’ of amines in the diet may help with symptomsNot necessary to avoid all foods that contain aminesAged cheeses, smoked, salted or pickled fish or meat, prawns,some nuts, vegemite, alcoholic beverages, miso soup,soy sauce, chocolate (in large amounts), coffee (in largeamounts), banana, avocado
22 Foods high in serotonin There is no need to avoid foods high in serotonin to controlsymptoms of carcinoid syndromeFoods high in serotonin DO NOT cause high levels of serotonin inthe bloodButternuts, black walnuts, English walnut, pecans,Pineapple, banana, kiwifruit, tomatoes, plums (also high in amines)Avocado, olives, eggplant (also high in amines)
23 Thank you More information: firstname.lastname@example.org Unicorn Foundation (Aus)The Carcinoid Cancer Foundation (USA)UK & Ireland Neuroendocrine Society (UK)
Your consent to our cookies if you continue to use this website.