Foods for Follicular Lymphoma!

Introduction

Foods for Follicular Lymphoma 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.

Follicular lymphoma is a slow-growing or indolent form of B-cell non-Hodgkin lymphoma, that occurs in the lymph nodes, bone marrow and other organs. It is a chronic disease with no cure but with a good prognosis. The 5-year survival rate for follicular lymphoma is 90%. Follicular lymphoma is more likely to occur in older individuals over 65 years of age and more likely to occur in males than females. People with follicular lymphoma may have no symptoms to mild or moderate symptoms of swollen lymph nodes, fever, and drenching night sweats. Follicular lymphoma can become a serious illness if it recurs or relapses after treatment or is transformed to diffuse large B-cell lymphoma, an aggressive form of non-Hodgkin B-cell lymphoma. A wait and watch active surveillance strategy is used for initial stages of follicular lymphoma. Treatment modalities for follicular lymphoma include radiation therapy, monoclonal antibody therapy, chemotherapy, targeted or immunotherapy and a bone marrow / stem cell transplantation. Right nutrition (foods and natural supplements) and exercise habits can help patients diagnosed with follicular lymphoma to improve their well-being.

For Follicular Lymphoma 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 Follicular Lymphoma 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 Follicular Lymphoma?

For example does it matter if vegetable Pepper (capsicum) is consumed more compared to Malabar Spinach? Does it make any difference if fruit Pummelo is preferred over Sweet Rowanberry? Also if similar choices are made for nuts/seeds like Chia over Brazil Nut and for pulses like Broad Bean over Catjang Pea. And if what I eat matters – then how does one identify foods which are recommended for Follicular Lymphoma and is it the same answer for everyone with the same diagnosis or genetic risk?

Yes! Foods you eat matters for Follicular Lymphoma!

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 Apigenin, Quercetin, Lycopene, Curcumin, Daidzein. And Sweet Rowanberry contains active ingredients Apigenin, Quercetin, Lycopene, Curcumin, Daidzein and possibly others.

A common mistake made when deciding and choosing foods to eat for Follicular Lymphoma – 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 Follicular Lymphoma.

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

Skills Needed for Nutrition Personalization for Follicular Lymphoma?

Personalized nutrition for cancers like Follicular Lymphoma 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 Follicular Lymphoma 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 Follicular Lymphoma

All cancers like Follicular Lymphoma can be characterized by a unique set of biochemical pathways – the signature pathways of Follicular Lymphoma. Biochemical pathways like Apoptosis, Cell Cycle, Oncogenic Histone Methylation, PI3K-AKT-MTOR Signaling are part of the signature definition of Follicular Lymphoma. Each individual’s cancer genetics can be different and hence their specific cancer signature could be unique.

The treatments which are effective for Follicular Lymphoma 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 Follicular Lymphoma when taking cancer treatment Prednisone, 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.

KMT2D, BCL2, TNFRSF14, ARID1A and EP300 are the top ranked reported genes for Follicular Lymphoma. KMT2D is reported in 57.2 % of the representative patients across all clinical trials. And BCL2 is reported in 43.2 %. The combined population patient data cover ages from 40 to 79. 50.0 % of the patient data are identified as men. The Follicular Lymphoma 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 Follicular Lymphoma

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 PEPPER (CAPSICUM) or MALABAR SPINACH?

Vegetable Pepper (capsicum) contains many active ingredients or bioactives such as Apigenin, Quercetin, Lycopene, Curcumin, Daidzein. These active ingredients manipulate various biochemical pathways like MAPK Signaling, Cytokine Signaling, Heat Stress Response and TGFB Signaling and others. Pepper (capsicum) is recommended for Follicular Lymphoma when ongoing cancer treatment is Prednisone. This is because Pepper (capsicum) modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Prednisone.

Some of the active ingredients or bioactives in vegetable Malabar Spinach are Apigenin, Quercetin, Lycopene, Curcumin, Daidzein. These active ingredients manipulate various biochemical pathways like Heat Stress Response, TGFB Signaling and TWEAK Signaling and others. Malabar Spinach is not recommended for Follicular Lymphoma when ongoing cancer treatment is Prednisone because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

VEGETABLE PEPPER (CAPSICUM) IS RECOMMENDED OVER MALABAR SPINACH FOR Follicular Lymphoma AND TREATMENT Prednisone.

Choose Fruit SWEET ROWANBERRY or PUMMELO?

Fruit Sweet Rowanberry contains many active ingredients or bioactives such as Apigenin, Quercetin, Lycopene, Curcumin, Daidzein. These active ingredients manipulate various biochemical pathways like MAPK Signaling, Cytokine Signaling, Heat Stress Response and TGFB Signaling and others. Sweet Rowanberry is recommended for Follicular Lymphoma when ongoing cancer treatment is Prednisone. This is because Sweet Rowanberry modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Prednisone.

Some of the active ingredients or bioactives in fruit Pummelo are Apigenin, Quercetin, Lycopene, Curcumin, Daidzein. These active ingredients manipulate various biochemical pathways like Cytokine Signaling, Heat Stress Response and TWEAK Signaling and others. Pummelo is not recommended for Follicular Lymphoma when ongoing cancer treatment is Prednisone because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

FRUIT SWEET ROWANBERRY IS RECOMMENDED OVER PUMMELO FOR Follicular Lymphoma AND TREATMENT Prednisone.

Choose Nut CHIA or BRAZIL NUT?

Chia contains many active ingredients or bioactives such as Apigenin, Lycopene, Curcumin, Daidzein, Lupeol. These active ingredients manipulate various biochemical pathways like MAPK Signaling, Cytokine Signaling, TGFB Signaling and NFKB Signaling and others. Chia is recommended for Follicular Lymphoma when ongoing cancer treatment is Prednisone. This is because Chia modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Prednisone.

Some of the active ingredients or bioactives in Brazil Nut are Ellagic Acid, Curcumin, Daidzein, Lupeol, Eugenol. These active ingredients manipulate various biochemical pathways like MAPK Signaling, Heat Stress Response, NFKB Signaling and Epithelial to Mesenchymal Transition and others. Brazil Nut is not recommended for Follicular Lymphoma when ongoing cancer treatment is Prednisone because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

CHIA IS RECOMMENDED OVER BRAZIL NUT FOR Follicular Lymphoma AND TREATMENT Prednisone.

For Individuals with Genetic Risk of Cancer

The question asked by individuals who have genetic risk of Follicular Lymphoma 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 NEW ZEALAND SPINACH or ALLIUM?

Vegetable New Zealand Spinach contains many active ingredients or bioactives such as Curcumin, Apigenin, Lupeol, Phloretin, Beta-sitosterol. These active ingredients manipulate various biochemical pathways like PI3K-AKT-MTOR Signaling, MYC Signaling, TGFB Signaling and Cell Survival and others. New Zealand Spinach is recommended for risk of Follicular Lymphoma when associated genetic risk is ARID1A. This is because New Zealand Spinach increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in vegetable Allium are Curcumin, Lupeol, Phloretin, Beta-sitosterol, Daidzein. These active ingredients manipulate various biochemical pathways like TGFB Signaling and others. Allium is not recommended when risk of Follicular Lymphoma when associated genetic risk is ARID1A because it increases the signature pathways of it.

VEGETABLE NEW ZEALAND SPINACH IS RECOMMENDED OVER ALLIUM FOR ARID1A GENETIC RISK OF CANCER.

Choose Fruit JAVA PLUM or ALASKA BLUEBERRY?

Fruit Java Plum contains many active ingredients or bioactives such as Curcumin, Apigenin, Lupeol, Phloretin, Beta-sitosterol. These active ingredients manipulate various biochemical pathways like Cell Cycle Checkpoints, Histone/Protein Acetylation, TGFB Signaling and Cell Survival and others. Java Plum is recommended for risk of Follicular Lymphoma when associated genetic risk is ARID1A. This is because Java Plum increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in fruit Alaska Blueberry are Curcumin, Apigenin, Lupeol, Phloretin, Beta-sitosterol. These active ingredients manipulate various biochemical pathways like TGFB Signaling and Epithelial to Mesenchymal Transition and others. Alaska Blueberry is not recommended when risk of Follicular Lymphoma when associated genetic risk is ARID1A because it increases the signature pathways of it.

FRUIT JAVA PLUM IS RECOMMENDED OVER ALASKA BLUEBERRY FOR ARID1A GENETIC RISK OF CANCER.

Choose Nut COMMON HAZELNUT or JAPANESE WALNUT?

Common Hazelnut contains many active ingredients or bioactives such as Curcumin, Lupeol, Phloretin, Beta-sitosterol, Lycopene. These active ingredients manipulate various biochemical pathways like PI3K-AKT-MTOR Signaling, MYC Signaling, TGFB Signaling and Cell Survival and others. Common Hazelnut is recommended for risk of Follicular Lymphoma when associated genetic risk is ARID1A. This is because Common Hazelnut increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in Japanese Walnut are Curcumin, Apigenin, Lupeol, Phloretin, Beta-sitosterol. These active ingredients manipulate various biochemical pathways like TGFB Signaling and Epithelial to Mesenchymal Transition and others. Japanese Walnut is not recommended when risk of Follicular Lymphoma when associated genetic risk is ARID1A because it increases the signature pathways of it.

COMMON HAZELNUT IS RECOMMENDED OVER JAPANESE WALNUT FOR ARID1A GENETIC RISK OF CANCER.

In Conclusion

Foods and Supplements chosen are important decisions for cancers like Follicular Lymphoma. Follicular Lymphoma 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 Follicular Lymphoma, 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 Pepper (capsicum) 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 Follicular Lymphoma?”. The addon multi-disciplinary team includes cancer physicians, clinical scientists, software engineers and data scientists.

References

• Pancan Pcawg 2020
• Pan-cancer analysis of whole genomes.
• Retinol decreases beta-catenin protein levels in retinoic acid-resistant colon cancer cell lines.
• Suppression of EGFR/STAT3 activity by lupeol contributes to the induction of the apoptosis of human non‑small cell lung cancer cells.
• Melatonin and vitamin D3 synergistically down-regulate Akt and MDM2 leading to TGFβ-1-dependent growth inhibition of breast cancer cells.
• https://www.ncbi.nlm.nih.gov/books/NBK538206
• https://my.clevelandclinic.org/health/diseases/22606-follicular-lymphoma
• https://lymphoma.org/understanding-lymphoma/aboutlymphoma/nhl/follicular-lymphoma