Foods for Intrahepatic Cholangiocarcinoma!

Introduction

Foods for Intrahepatic Cholangiocarcinoma should be personalized for each individual and also must adapt when cancer treatment or tumor genetic change. The personalization and adaptation must consider all the active ingredients or bioactives contained in different foods with respect to cancer tissue biology, genetics, treatments, lifestyle conditions and diet preferences. Hence while nutrition is one of the very important decisions for a cancer patient and individual at risk of cancer to make – how to choose foods to eat is not an easy task.

Intrahepatic Cholangiocarcinoma, classified under a specific ICD-10 code due to its distinct nature, is a type of cancer that originates in the bile ducts within the liver. The definition and diagnosis of this condition rely heavily on detailed pathology outlines and radiological assessments, including MRI and other imaging techniques. Intrahepatic Cholangiocarcinoma staging, especially as per the AJCC 8th edition, is crucial for determining the extent of the disease and guiding treatment decisions.

Treatment for Intrahepatic Cholangiocarcinoma involves a multidisciplinary approach, adhering to established treatment guidelines. Options may include surgery, chemotherapy, and targeted therapies, depending on the stage and characteristics of the tumor. The survival rate and prognosis of patients with Intrahepatic Cholangiocarcinoma vary significantly, influenced by factors like tumor size, stage at diagnosis, and overall health of the patient.

Symptoms of Intrahepatic Cholangiocarcinoma are often non-specific and may include jaundice, abdominal pain, and weight loss. Early detection is challenging, but crucial for improving outcomes. Understanding the causes and risk factors associated with Intrahepatic Cholangiocarcinoma is essential for both prevention and early intervention strategies.

For Intrahepatic Cholangiocarcinoma does it matter what vegetables, fruits, nuts, seeds one eats?

A very common nutrition question asked by cancer patients and individuals at-genetic risk of cancer is – for cancers like Intrahepatic Cholangiocarcinoma does it matter what foods I eat and which I do not? Or if I follow a plant-based diet is that enough for cancer like Intrahepatic Cholangiocarcinoma?

For example does it matter if vegetable Globe Artichoke is consumed more compared to Garland Chrysanthemum? Does it make any difference if fruit Pummelo is preferred over French Plantain? Also if similar choices are made for nuts/seeds like Butternut over Chestnut and for pulses like Adzuki Bean over Catjang Pea. And if what I eat matters – then how does one identify foods which are recommended for Intrahepatic Cholangiocarcinoma and is it the same answer for everyone with the same diagnosis or genetic risk?

Yes! Foods you eat matters for Intrahepatic Cholangiocarcinoma!

Food recommendations may not be the same for everyone and can be different even for the same diagnosis and genetic risk.

All foods (vegetables, fruits, nuts, seeds, pulses, oils etc.) and nutritional supplements are made up of more than one active molecular ingredient or bio-actives in different proportions and quantities. Each active ingredient has a unique mechanism of action – which can be activation or inhibition of different biochemical pathways. Simply stated foods and supplements which are recommended are those which do not cause an increase of molecular drivers of cancer but reduce them. Else those foods should not be recommended. Foods contain multiple active ingredients – hence when evaluating foods and supplements you need to consider the impact of all active ingredients cumulatively rather than individually.

For example Pummelo contains active ingredients Quercetin, Curcumin, Daidzein, Phloretin, Formononetin. And French Plantain contains active ingredients Quercetin, Myricetin, Curcumin, Daidzein, Phloretin and possibly others.

A common mistake made when deciding and choosing foods to eat for Intrahepatic Cholangiocarcinoma – is to evaluate only selected active ingredients contained in foods and ignore the rest. Because different active ingredients contained in foods may have opposing effects on cancer drivers – you cannot cherry pick active ingredients in foods and supplements for making a nutrition decision for Intrahepatic Cholangiocarcinoma.

YES – FOOD CHOICES MATTER FOR CANCER. NUTRITION DECISIONS MUST CONSIDER ALL ACTIVE INGREDIENTS OF FOODS.

Skills Needed for Nutrition Personalization for Intrahepatic Cholangiocarcinoma?

Personalized nutrition for cancers like Intrahepatic Cholangiocarcinoma consists of recommended foods / supplements; not recommended foods / supplements with example recipes which prioritize use of recommended foods. An example of personalized nutrition can be seen at this link.

Deciding which foods are recommended or not is extremely complicated, requiring expertise in Intrahepatic Cholangiocarcinoma biology, food science, genetics, biochemistry along with good understanding of how cancer treatments work and associated vulnerabilities by which the treatments could stop being effective.

MINIMUM KNOWLEDGE EXPERTISE NEEDED FOR NUTRITION PERSONALIZATION FOR CANCER ARE: CANCER BIOLOGY, FOOD SCIENCE, CANCER TREATMENTS AND GENETICS.

Characteristics of cancers like Intrahepatic Cholangiocarcinoma

All cancers like Intrahepatic Cholangiocarcinoma can be characterized by a unique set of biochemical pathways – the signature pathways of Intrahepatic Cholangiocarcinoma. Biochemical pathways like Post Translation Modification, RAS-RAF Signaling, PI3K-AKT-MTOR Signaling, MAPK Signaling are part of the signature definition of Intrahepatic Cholangiocarcinoma. Each individual’s cancer genetics can be different and hence their specific cancer signature could be unique.

The treatments which are effective for Intrahepatic Cholangiocarcinoma need to be cognizant of the associated signature biochemical pathways for each cancer patient and individual at genetic risk. Therefore different treatments with different mechanisms of actions are effective for different patients. Similarly and for the same reasons foods and supplements need to be personalized for each individual. Hence some foods and supplements are recommended for Intrahepatic Cholangiocarcinoma when taking cancer treatment Radiation, and some foods and supplements are not recommended.

Sources like cBioPortal and many others provide population representative patient anonymized data from clinical trials for all cancer indications. This data consists of clinical trial study details like sample size / number of patients, age groups, gender, ethnicity, treatments, tumor site and any genetic mutations.

BAP1, IDH1, HLA-A, ACVR2A and MUC16 are the top ranked reported genes for Intrahepatic Cholangiocarcinoma. BAP1 is reported in 2.1 % of the representative patients across all clinical trials. And IDH1 is reported in 2.1 %. The combined population patient data cover ages from 29 to 86. 54.2 % of the patient data are identified as men. The Intrahepatic Cholangiocarcinoma biology along with reported genetics together define the population represented signature biochemical pathways for this cancer. If the individual cancer tumor genetics or genes contributing to the risk are also known then that should also be used for nutrition personalization.

NUTRITION CHOICES SHOULD MATCH WITH EACH INDIVIDUAL’S CANCER SIGNATURE.

Food and Supplements for Intrahepatic Cholangiocarcinoma

For Cancer Patients

Cancer patients on treatment or on palliative care need to make decisions on food and supplements – for the needed dietary calories, for managing any treatment side effects and also for improved cancer management. All plant-based foods are not equal and choosing and prioritizing foods which are personalized and customized to ongoing cancer treatment is important and complicated. Here are some examples providing guidelines for making nutrition decisions.

Choose Vegetable GLOBE ARTICHOKE or GARLAND CHRYSANTHEMUM?

Vegetable Globe Artichoke contains many active ingredients or bioactives such as Myricetin, Curcumin, Daidzein, Phloretin, Formononetin. These active ingredients manipulate various biochemical pathways like Microtubule Dynamics, NFKB Signaling, Inflammation and PI3K-AKT-MTOR Signaling and others. Globe Artichoke is recommended for Intrahepatic Cholangiocarcinoma when ongoing cancer treatment is Radiation. This is because Globe Artichoke modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Radiation.

Some of the active ingredients or bioactives in vegetable Garland Chrysanthemum are Myricetin, Curcumin, Daidzein, Phloretin, Formononetin. These active ingredients manipulate various biochemical pathways like Heat Stress Response, Extracellular Matrix Remodelling and Focal Adhesion and others. Garland Chrysanthemum is not recommended for Intrahepatic Cholangiocarcinoma when ongoing cancer treatment is Radiation because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

VEGETABLE GLOBE ARTICHOKE IS RECOMMENDED OVER GARLAND CHRYSANTHEMUM FOR Intrahepatic Cholangiocarcinoma AND TREATMENT Radiation.

Choose Fruit FRENCH PLANTAIN or PUMMELO?

Fruit French Plantain contains many active ingredients or bioactives such as Quercetin, Myricetin, Curcumin, Daidzein, Phloretin. These active ingredients manipulate various biochemical pathways like Microtubule Dynamics, Hypoxia, NFKB Signaling and PI3K-AKT-MTOR Signaling and others. French Plantain is recommended for Intrahepatic Cholangiocarcinoma when ongoing cancer treatment is Radiation. This is because French Plantain modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Radiation.

Some of the active ingredients or bioactives in fruit Pummelo are Quercetin, Curcumin, Daidzein, Phloretin, Formononetin. These active ingredients manipulate various biochemical pathways like DNA Repair, Heat Stress Response and Oxidative Stress and others. Pummelo is not recommended for Intrahepatic Cholangiocarcinoma when ongoing cancer treatment is Radiation because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

FRUIT FRENCH PLANTAIN IS RECOMMENDED OVER PUMMELO FOR Intrahepatic Cholangiocarcinoma AND TREATMENT Radiation.

Choose Nut BUTTERNUT or CHESTNUT?

Butternut contains many active ingredients or bioactives such as Myricetin, Curcumin, Daidzein, Phloretin, Formononetin. These active ingredients manipulate various biochemical pathways like Microtubule Dynamics, Oncogenic Cancer Epigenetics, NFKB Signaling and MAPK Signaling and others. Butternut is recommended for Intrahepatic Cholangiocarcinoma when ongoing cancer treatment is Radiation. This is because Butternut modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Radiation.

Some of the active ingredients or bioactives in Chestnut are Ellagic Acid, Myricetin, Curcumin, Daidzein, Phloretin. These active ingredients manipulate various biochemical pathways like Microtubule Dynamics, Heat Stress Response and Oxidative Stress and others. Chestnut is not recommended for Intrahepatic Cholangiocarcinoma when ongoing cancer treatment is Radiation because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

BUTTERNUT IS RECOMMENDED OVER CHESTNUT FOR Intrahepatic Cholangiocarcinoma AND TREATMENT Radiation.

For Individuals with Genetic Risk of Cancer

The question asked by individuals who have genetic risk of Intrahepatic Cholangiocarcinoma or familial history is “What Should I Eat Differently from Before?” and how they should choose foods and supplements to manage risks of the disease. Since for cancer risk there is nothing actionable in terms of treatment – decisions of foods and supplements become important and one of the very few actionable things which can be done. All plant-based foods are not equal and based on identified genetics and pathway signature – the choices of food and supplements should be personalized.

Choose Vegetable GIANT BUTTERBUR or ALASKA WILD RHUBARB?

Vegetable Giant Butterbur contains many active ingredients or bioactives such as Curcumin, Apigenin, Lupeol, Daidzein, Lycopene. These active ingredients manipulate various biochemical pathways like MAPK Signaling, Hypoxia, MYC Signaling and PI3K-AKT-MTOR Signaling and others. Giant Butterbur is recommended for risk of Intrahepatic Cholangiocarcinoma when associated genetic risk is ACVR2A. This is because Giant Butterbur increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in vegetable Alaska Wild Rhubarb are Curcumin, Apigenin, Lupeol, Daidzein, Lycopene. These active ingredients manipulate various biochemical pathways like TGFB Signaling and Extracellular Matrix Remodelling and others. Alaska Wild Rhubarb is not recommended when risk of Intrahepatic Cholangiocarcinoma when associated genetic risk is ACVR2A because it increases the signature pathways of it.

VEGETABLE GIANT BUTTERBUR IS RECOMMENDED OVER ALASKA WILD RHUBARB FOR ACVR2A GENETIC RISK OF CANCER.

Choose Fruit NANCE or STRAWBERRY?

Fruit Nance contains many active ingredients or bioactives such as Curcumin, Apigenin, Lupeol, Daidzein, Formononetin. These active ingredients manipulate various biochemical pathways like MAPK Signaling, Hypoxia and PI3K-AKT-MTOR Signaling and others. Nance is recommended for risk of Intrahepatic Cholangiocarcinoma when associated genetic risk is ACVR2A. This is because Nance increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in fruit Strawberry are Curcumin, Ellagic Acid, Resveratrol, Quercetin, Lupeol. These active ingredients manipulate various biochemical pathways like P53 Signaling and Stem Cell Signaling and others. Strawberry is not recommended when risk of Intrahepatic Cholangiocarcinoma when associated genetic risk is ACVR2A because it increases the signature pathways of it.

FRUIT NANCE IS RECOMMENDED OVER STRAWBERRY FOR ACVR2A GENETIC RISK OF CANCER.

Choose Nut COMMON WALNUT or PILI NUT?

Common Walnut contains many active ingredients or bioactives such as Curcumin, Ellagic Acid, Quercetin, Lupeol, Daidzein. These active ingredients manipulate various biochemical pathways like MAPK Signaling, Hypoxia, MYC Signaling and PI3K-AKT-MTOR Signaling and others. Common Walnut is recommended for risk of Intrahepatic Cholangiocarcinoma when associated genetic risk is ACVR2A. This is because Common Walnut increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in Pili Nut are Curcumin, Apigenin, Lupeol, Daidzein, Lycopene. These active ingredients manipulate various biochemical pathways like TGFB Signaling and Extracellular Matrix Remodelling and others. Pili Nut is not recommended when risk of Intrahepatic Cholangiocarcinoma when associated genetic risk is ACVR2A because it increases the signature pathways of it.

COMMON WALNUT IS RECOMMENDED OVER PILI NUT FOR ACVR2A GENETIC RISK OF CANCER.

In Conclusion

Foods and Supplements chosen are important decisions for cancers like Intrahepatic Cholangiocarcinoma. Intrahepatic Cholangiocarcinoma patients and individuals with genetic-risk always have this question: “What foods and nutritional supplements are recommended for me and which are not?” There is a common belief which is a misconception that all plant-based foods could be beneficial or not but would not be harmful. Certain foods and supplements can interfere with cancer treatments or promote molecular pathway drivers of cancer.

There are different types of cancer indications like Intrahepatic Cholangiocarcinoma, each with different tumor genetics with further genomic variations across each individual. Further every cancer treatment and chemotherapy has a unique mechanism of action. Each food like Globe Artichoke contains various bioactives in different quantities, which have an impact on different and distinct sets of biochemical pathways. The definition of personalized nutrition is individualized food recommendations for the cancer indication, treatments, genetics, lifestyle and other factors. Nutrition personalization decisions for cancer require knowledge of cancer biology, food science and an understanding of different chemotherapy treatments. Finally when there are treatment changes or new genomics is identified – the nutrition personalization needs re-evaluation.

The addon nutrition personalization solution makes the decision making easy and removes all the guesswork in answering the question, “What foods should I choose or not choose for Intrahepatic Cholangiocarcinoma?”. The addon multi-disciplinary team includes cancer physicians, clinical scientists, software engineers and data scientists.

References

• Msk Access 2021
• Massive parallel sequencing uncovers actionable FGFR2-PPHLN1 fusion and ARAF mutations in intrahepatic cholangiocarcinoma.
• DNA repair and redox activities and inhibitors of apurinic/apyrimidinic endonuclease 1/redox effector factor 1 (APE1/Ref-1): a comparative analysis and their scope and limitations toward anticancer drug development.
• The citrus flavonoid naringenin stimulates DNA repair in prostate cancer cells.
• Chlorogenic acid inhibits proliferation and induces apoptosis in A498 human kidney cancer cells via inactivating PI3K/Akt/mTOR signalling pathway.
• Research progress on the anticancer effects of vitamin K2.
• L-Ascorbic Acid Inhibits Breast Cancer Growth by Inducing IRE/JNK/CHOP-Related Endoplasmic Reticulum Stress-Mediated p62/SQSTM1 Accumulation in the Nucleus.
• Functional lipidomics: Palmitic acid impairs hepatocellular carcinoma development by modulating membrane fluidity and glucose metabolism.