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What Foods are Recommended for Cancer?
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Foods for Polycythemia Vera!

Jul 28, 2023

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Introduction

Foods for Polycythemia Vera 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.

Polycythemia vera is a rare, chronic, blood cell disorder, classified as a myeloproliferative neoplasm or MPN. Polycythemia vera is caused by the dramatic overproduction of red blood cells (RBCs) in the bone marrow, along with excessive production of white blood cells and platelets too. It affects slightly more men than women and it occurs most often in individuals more than 60 years old. Individuals with polycythemia vera have an abnormally high number of circulating RBCs in their blood, causing the blood to thicken and increase in volume (a condition called hyperviscosity). Thickened blood may not flow through the smaller blood vessels (capillaries) properly. A range of symptoms can occur in individuals with polycythemia vera including nonspecific symptoms such as headaches, fatigue, weakness, dizziness, itchy skin; an enlarged spleen (splenomegaly); a variety of gastrointestinal problems; and a high risk of blood clot formation, which may prevent blood flow to vital organs. More than 90% of the individuals with polycythemia vera have a mutation in the JAK2 gene. The treatment of polycythemia vera is aimed at reducing the levels of red blood cells and preventing the complications especially of blood clot formation (thrombosis). Treatment options include phlebotomy (drawing out blood at regular intervals) to reduce the volume of circulating RBCs so that blood can flow properly. Patients are also treated with myelosuppressive drugs like hydroxyurea and busulfan, that suppress the formation of blood cells in the bone marrow. There are additional treatments such as low-dose aspirin and a newly approved drug targeted to the JAK2 enzyme that is found to be effective. Additionally, supportive care with the right nutrition (foods and natural supplements) that have inherent bioactives to modulate the disease causing pathways can help improve patient well-being.



For Polycythemia Vera 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 Polycythemia Vera 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 Polycythemia Vera?

For example does it matter if vegetable Parsnip is consumed more compared to Common Beet? Does it make any difference if fruit Black Elderberry is preferred over Black Mulberry? Also if similar choices are made for nuts/seeds like Black Walnut over European Chestnut and for pulses like Alfalfa over Yellow Wax Bean. And if what I eat matters – then how does one identify foods which are recommended for Polycythemia Vera and is it the same answer for everyone with the same diagnosis or genetic risk?

Yes! Foods you eat matters for Polycythemia Vera!

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

All cancers like Polycythemia Vera can be characterized by a unique set of biochemical pathways - the signature pathways of Polycythemia Vera. Biochemical pathways like RAS-RAF Signaling, Cytokine Signaling, JAK-STAT Signaling, Hematopoiesis are part of the signature definition of Polycythemia Vera.

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 Black Elderberry contains active ingredients Formononetin, Phloretin, Apigenin, Quercetin, Stigmasterol. And Black Mulberry contains active ingredients Formononetin, Phloretin, Apigenin, Quercetin, Stigmasterol and possibly others.

A common mistake made when deciding and choosing foods to eat for Polycythemia Vera – 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 Polycythemia Vera.

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

Skills Needed for Nutrition Personalization for Polycythemia Vera?

Personalized nutrition for cancers like Polycythemia Vera 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 Polycythemia Vera 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.

Foods to Eat After Cancer Diagnosis!

No two cancers are the same. Go beyond the common nutrition guidelines for everyone and make personalized decisions about food and supplements with confidence.

Characteristics of cancers like Polycythemia Vera

All cancers like Polycythemia Vera can be characterized by a unique set of biochemical pathways – the signature pathways of Polycythemia Vera. Biochemical pathways like RAS-RAF Signaling, Cytokine Signaling, JAK-STAT Signaling, Hematopoiesis are part of the signature definition of Polycythemia Vera. Each individual’s cancer genetics can be different and hence their specific cancer signature could be unique.

The treatments which are effective for Polycythemia Vera 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 Polycythemia Vera when taking cancer treatment Ruxolitinib, 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.

JAK2, TET2, DNMT3A, SH2B3 and ARID2 are the top ranked reported genes for Polycythemia Vera. JAK2 is reported in 76.5 % of the representative patients across all clinical trials. And TET2 is reported in 21.6 %. The combined population patient data cover ages from to . 0.0 % of the patient data are identified as men. The Polycythemia Vera 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.

Foods for Polycythemia Vera!

Food and Supplements for Polycythemia Vera

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 PARSNIP or COMMON BEET?

Vegetable Parsnip contains many active ingredients or bioactives such as Formononetin, Phloretin, Quercetin, Stigmasterol, Curcumin. These active ingredients manipulate various biochemical pathways like JAK-STAT Signaling, MAPK Signaling, Cytokine Signaling and MYC Signaling and others. Parsnip is recommended for Polycythemia Vera when ongoing cancer treatment is Ruxolitinib. This is because Parsnip modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Ruxolitinib.

Some of the active ingredients or bioactives in vegetable Common Beet are Formononetin, Phloretin, Apigenin, Stigmasterol, Curcumin. These active ingredients manipulate various biochemical pathways like DNA Repair and Oncogenic Cancer Epigenetics and others. Common Beet is not recommended for Polycythemia Vera when ongoing cancer treatment is Ruxolitinib because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

VEGETABLE PARSNIP IS RECOMMENDED OVER COMMON BEET FOR Polycythemia Vera AND TREATMENT Ruxolitinib.

Choose Fruit BLACK MULBERRY or BLACK ELDERBERRY?

Fruit Black Mulberry contains many active ingredients or bioactives such as Formononetin, Phloretin, Apigenin, Quercetin, Stigmasterol. These active ingredients manipulate various biochemical pathways like JAK-STAT Signaling, Hypoxia, MAPK Signaling and MYC Signaling and others. Black Mulberry is recommended for Polycythemia Vera when ongoing cancer treatment is Ruxolitinib. This is because Black Mulberry modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Ruxolitinib.

Some of the active ingredients or bioactives in fruit Black Elderberry are Formononetin, Phloretin, Apigenin, Quercetin, Stigmasterol. These active ingredients manipulate various biochemical pathways like DNA Repair and Oncogenic Cancer Epigenetics and others. Black Elderberry is not recommended for Polycythemia Vera when ongoing cancer treatment is Ruxolitinib because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

FRUIT BLACK MULBERRY IS RECOMMENDED OVER BLACK ELDERBERRY FOR Polycythemia Vera AND TREATMENT Ruxolitinib.

Choose Nut BLACK WALNUT or EUROPEAN CHESTNUT?

Black Walnut contains many active ingredients or bioactives such as Formononetin, Phloretin, Apigenin, Quercetin, Curcumin. These active ingredients manipulate various biochemical pathways like RAS-RAF Signaling, MAPK Signaling and MYC Signaling and others. Black Walnut is recommended for Polycythemia Vera when ongoing cancer treatment is Ruxolitinib. This is because Black Walnut modifies those biochemical pathways which have been scientifically reported to sensitize the effect of Ruxolitinib.

Some of the active ingredients or bioactives in European Chestnut are Formononetin, Phloretin, Apigenin, Quercetin, Stigmasterol. These active ingredients manipulate various biochemical pathways like DNA Repair and Oncogenic Cancer Epigenetics and others. European Chestnut is not recommended for Polycythemia Vera when ongoing cancer treatment is Ruxolitinib because it modifies those biochemical pathways which make the cancer treatment resistant or less responsive.

BLACK WALNUT IS RECOMMENDED OVER EUROPEAN CHESTNUT FOR Polycythemia Vera AND TREATMENT Ruxolitinib.

For Individuals with Genetic Risk of Cancer

The question asked by individuals who have genetic risk of Polycythemia Vera 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 CAULIFLOWER or KOHLRABI?

Vegetable Cauliflower contains many active ingredients or bioactives such as Curcumin, Formononetin, Bergapten, Isoliquiritigenin, Catechol. These active ingredients manipulate various biochemical pathways like Chemokine Signaling, RAS-RAF Signaling, PI3K-AKT-MTOR Signaling and MYC Signaling and others. Cauliflower is recommended for risk of Polycythemia Vera when associated genetic risk is ARID2. This is because Cauliflower increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in vegetable Kohlrabi are Quercetin, Curcumin, Formononetin, Bergapten, Isoliquiritigenin. These active ingredients manipulate various biochemical pathways like PI3K-AKT-MTOR Signaling and Hematopoiesis and others. Kohlrabi is not recommended when risk of Polycythemia Vera when associated genetic risk is ARID2 because it increases the signature pathways of it.

VEGETABLE CAULIFLOWER IS RECOMMENDED OVER KOHLRABI FOR ARID2 GENETIC RISK OF CANCER.

Choose Fruit RED RASPBERRY or PUMMELO?

Fruit Red Raspberry contains many active ingredients or bioactives such as Quercetin, Ellagic Acid, Curcumin, Formononetin, Bergapten. These active ingredients manipulate various biochemical pathways like MYC Signaling, RAS-RAF Signaling, PI3K-AKT-MTOR Signaling and Hematopoiesis and others. Red Raspberry is recommended for risk of Polycythemia Vera when associated genetic risk is ARID2. This is because Red Raspberry increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in fruit Pummelo are Quercetin, Curcumin, Apigenin, Formononetin, Bergapten. These active ingredients manipulate various biochemical pathways like PI3K-AKT-MTOR Signaling and Hematopoiesis and others. Pummelo is not recommended when risk of Polycythemia Vera when associated genetic risk is ARID2 because it increases the signature pathways of it.

FRUIT RED RASPBERRY IS RECOMMENDED OVER PUMMELO FOR ARID2 GENETIC RISK OF CANCER.

Choose Nut BUTTERNUT or CASHEW NUT?

Butternut contains many active ingredients or bioactives such as Curcumin, Myricetin, Apigenin, Formononetin, Bergapten. These active ingredients manipulate various biochemical pathways like JAK-STAT Signaling, MYC Signaling, PI3K-AKT-MTOR Signaling and Hematopoiesis and others. Butternut is recommended for risk of Polycythemia Vera when associated genetic risk is ARID2. This is because Butternut increases those biochemical pathways which counteract the signature drivers of it.

Some of the active ingredients or bioactives in Cashew Nut are Quercetin, Curcumin, Myricetin, Formononetin, Bergapten. These active ingredients manipulate various biochemical pathways like PI3K-AKT-MTOR Signaling, Oncogenic Cancer Epigenetics and MYC Signaling and others. Cashew Nut is not recommended when risk of Polycythemia Vera when associated genetic risk is ARID2 because it increases the signature pathways of it.

BUTTERNUT IS RECOMMENDED OVER CASHEW NUT FOR ARID2 GENETIC RISK OF CANCER.


In Conclusion

Foods and Supplements chosen are important decisions for cancers like Polycythemia Vera. Polycythemia Vera 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 Polycythemia Vera, 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 Parsnip 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 Polycythemia Vera?”. The addon multi-disciplinary team includes cancer physicians, clinical scientists, software engineers and data scientists.


Personalized Nutrition for Cancer!

Cancer changes with time. Customize and modify your nutrition based on cancer indication, treatments, lifestyle, food preferences, allergies and other factors.

References

Scientifically Reviewed by: Dr. Cogle

Christopher R. Cogle, M.D. is a tenured professor at the University of Florida, Chief Medical Officer of Florida Medicaid, and Director of the Florida Health Policy Leadership Academy at the Bob Graham Center for Public Service.

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