Q. The best diet for Neuroendocrine Cancer? A. The one that works for you.

Opinion Post

I’ve lost count of the number of diet related questions I receive online or are posted in my private Facebook support group.  The question is normally worded along these lines: “What should I be eating if I have Neuroendocrine Cancer”.  The answer is almost impossible.  Here are a few of the reasons why these things get muddled:

1. Not everyone has access to a NET specialist, let alone a Dietitian who specialises in NET. So they come to patient groups to ask a very ‘heterogeneous’ group of patient diagnoses and experiences. Consequently, the responses are usually multiple and widely different. The person who asked is often left confused with bewildering opinions and options. 

2. The heterogeneity of Neuroendocrine Neoplasms extends to dietary issues too.  No single diet suits everyone with a Neuroendocrine Neoplasm.  Moreover, many people won’t have any dietary issues at all and could be panicked by changing things that don’t need to be changed.

3. Quite a lot of diet and nutrition information seems to focus on “carcinoid syndrome” which only represents those with predominately serotonin secreting tumours which are functional i.e. around 10% of the total patient population. What about the other 90%? This is partly caused by the fact that many organisations and many people still call our disease by the antiquated and epidemiologically incorrect title of “carcinoid”.  The whole issue is exacerbated by the impression I see inside and outside of patient groups that every patient gets “carcinoid syndrome” – something which is totally incorrect.  The fact is, many types of Neuroendocrine Cancer and many different associated syndromes will have different diet and nutrition issues.  Add in pre-existing comorbidities and it becomes a real conundrum with conflicting requirements.  Something which can only be decoded by a diet and nutrition expert who is well versed in Neuroendocrine Cancer including the associated syndromes and treatment side effects.  

4. The internet contains a lot of food and cancer myths. Some of it is innocently shared in patient groups without realising all of the above. Also, there is information lacking context shared in patient groups, also due to the misunderstandings above. People mean well but they really don’t know anything about the person asking the very generic question in most cases. 

I can’t stop people asking questions and I can’t stop people trying to help as best they can (except where this breaches my site rules).  My advice to anyone asking the question to seek the knowledge from specialist dietitians with experience in Oncology issues and have knowledge of Neuroendocrine Cancer and the effects of two things:  the treatment side effects and the syndromic side effects. Sure, also ask questions in patient groups but learn enough to know that your particular type of NEN has known issues and the solution may not be the same as someone answering who has a totally different experience.

It’s also worth noting that many patients will have regular issues (perhaps pre-existing) which are unrelated to Neuroendocrine Cancer and so regular diet and nutrition issues are something available from most dietitians. Patients should not expect to be told precise details of what to eat.  Moreover, they should not expect to be told what will work for them – even an experienced dietitian might struggle to answer that.  General guidance is what to expect.  Tailored guidance from a professional is the optimum strategy. Trial and error are very often the best approaches. Don’t be afraid to accept and take some risks but manage them and continually re-assess.  

Don't Be Afraid To Take Whisks Kitchen Home Simple Wall image 1

Internet savvy patients will be able to find the best stuff online but it’s still always useful to run it past a NET-aware dietitian, failing that at least a NET specialist doctor or nurse, some of whom have become quite knowledgeable about these issues out of sheer demand and necessity. But be careful of the internet, there’s a lot of food and cancer myths out there.  And be careful about ‘celebrity’ or ‘fad’ diets out there, many are not designed for cancer patients and can cause harm.  My own research is attached below, some contain links to professional input, mainly from world-renowned NET Specialist Dietitian Tara Whyand.

Article 1 – Vitamin and Mineral Challenges. This was co-authored by Tara Whyand, UK’s most experienced NET Specialist Dietitian. This blog provides a list of vitamins and minerals which NET Cancer patients are at risk for deficiencies, together with some of the symptoms which might be displayed in a deficiency scenario.

Article 2 – Malabsorption. Overlapping slightly into Part 1, this covers the main side effects of certain NET surgical procedures and other mainstream treatments. Input from Tara Whyand.

Article 3 – ‘Gut Health’. This followed on from the first two blogs looking specifically at the issues caused by small intestine bacterial overgrowth (SIBO) as a consequence of cancer treatment. Also discusses probiotics. Input from Tara Whyand.

Article 4 – ‘Food for thought The issue of amines and syndromes

Article 5 – ‘Pancreatic Enzyme Replacement Therapy’. The role of PERT (Creon etc) in helping NET Patients. Input from Tara Whyand

Article 6 – Featuring the 2020 video series by Tara Whyand RD

Supplementary – The Diarrhea Jigsaw

Tara has operational dietitian experience plus has also been heavily involved in research in support of the nutritional needs of Neuroendocrine Cancer patients. She attends and speaks at many conferences and patient meetings. I am thankful to have her permission to publish her 2020 video webcasts containing the latest thinking on Diet and Nutrition for Neuroendocrine Cancer patients.  The first video is a general introduction to the series plus the following linked episodes

  • Episode 1 – Pancreatic Exocrine Insufficiency
  • Episode 2 – Protein and Cancer
  • Episode 3 – The Ileum and Ileum Surgery
  • Episode 4 – Sugar, Cancer and the Ketogenic Diet
  • Episode 5 – How to Gain Weight
  • Episode 6 – Hair Loss and Nutrition
  • Episode 7 – Zinc
  • Episode 8 – Chemotherapy and Supplements
  • Episode 9 – Surgery and the Pancreas
  • Episode 10 – Niacin

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3 thoughts on “Q. The best diet for Neuroendocrine Cancer? A. The one that works for you.

  • Hi, I have Net in the small intestine with metastasis in the liver since 2018, my first G 68 pet scan was in 2019 since this test until the last one last month august 6 I have something that my doctors don’t pay attention in my head and neck report said brain: physiologic radiotracer uptake in the pituitary gland. Otherwise , no abnormal radiotracer in the brain. Maybe you can help me with this interpretation. Last week my doctor check my THS was high and my T4 normal. So I don’t know if this results are because I have hypothyroidism or because is something wrong in my pituitary gland.
    Thank you

    • 1. Uptake in the pituitary is very common. It’s normally a false positive (physiologic uptake)..

      2. Hypothyroidism is high TSH low T4 and it’s one of the most common conditions in the title for females particularly. Thyroxine is one of the most prescribed drugs in the world backing up that claim. Plus also be aware that Lanreotide and Octreotide can mess with those levels.

      • Dolores Fernandez

        I Thank you for your time and response. I am in Lanreotide,for 3 years, my sugar is high but when I have a blood test my 1ac is 5.2 so probably is the same with my results for thyroid.
        I have a 2 different treatments, Lutathera don’t work after I finish my treatments the symptoms came back 3 months later more severe, then I had already 3 chemoembolization and Creon for my pancreas, I feel ok but I start to worry about the pituitary because I have headaches almost every day. I just to had migraines when I young so the pain is similar.
        Know I feel better after your comments, thank you very much for your help.

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