Diet for Lung Cancer

Lung cancer is the 3rd most commonly diagnosed type of cancer and responsible for the most cancer deaths. Early diagnosis is often key to increasing the chance of a favourable outcome (WCRF, 2018).  This post will explore the diet for lung cancer from prevention to treatment. You can read this post top to bottom or navigate using this Table of Contents

This blog post does not substitute for medical advice. Before undertaking changes to your lung cancer diet ask for a referral to the dietitian at your cancer centre or speak with your oncologist.

Lung Cancer at a Glance

Lung Cancer Facts: 

Statistics have shown that lung cancer is more common in men living in higher-income countries on a worldwide scale. On the plus side, higher-income countries have noted that there is a downward trend emerging in the data. Although, sadly,  lung cancer in women living in less developed countries has increased in comparison. The cause of these changes is due to changes in lifestyle and smoking habits (Wiseman, 2019). 

Describing Lung Cancer: 

Primary Lung cancer:

Cancer cell growth that originates in the lung. The two main pathological types are small cell (SCLC) and non-small cell (NSCLC).

Small Cell Lung Cancer:

15% of lung cancers. Originates in cells located in a central region of the lung and are often more aggressive. This type is more common with exposure to radon gas, arsenic, chromium and nickel.

Non-small Cell Lung Cancer:

70-85% of cases. Originates in either the glandular cells that are responsible for mucus production (called adenocarcinoma) or the thin squamous cell that lines the airway (called squamous cell carcinoma). This one is more common in women exposed to cooking fires or frying fat at high temperatures.

Lung Metastasis:

Originates elsewhere in the body but invades the lungs. The lungs are the most common place for the spread of cancer. This is often described simply as “mets to the lung”.

Metastatic Lung Cancer:

This is cancer that began in the lungs but has now metastasized (spread) to other parts of the body.

Pleural Mesothelioma:

Originates in the pleura membrane that covers the lungs. Exposure to asbestos is the main risk factor and can develop 40 years after asbestos exposure. Other chemical exposures such as erionite and volcanic lava minerals as well as radiation are also risk factors (Canadian Cancer Society, 2021). 

Known Causes of Lung Cancer: 

Smoking tobacco is the number 1 cause of lung cancer. Approximately 72% of all lung cancer cases in Canada originate from smoking. The second most common cause is secondhand smoke which is the biggest cause of lung cancer in non-smokers. 

Other causes include: 

• Asbestos
• Radon 
• Air pollution 
• Chemical exposure 
• Family history of lung cancer  
• Personal history of lung diseases such as COPD or Tuberculosis 
• Arsenic in drinking water 
• Lupus 
• Possible cause: long term cannabis smoking 

(Canadian Cancer Society, 2021)

Smoking:

When considering the risk of developing lung cancer caused by smoking tobacco it is important to take into account a few things such as the number of cigarettes daily, years as a smoker and the age you started smoking (Canadian Cancer Society, 2021).

Vaping: 

It is a popular belief that vaping is harmless. Unfortunately, many electronic cigarettes contain chemicals, additives and/or nicotine. Therefore the use of such devices has been found to cause lung cancer and lung disease. Did you know that e-cigarettes are not regulated by the government? (CDC, 2020)

Nutritional Status of Smokers:

People who smoke generally have lower dietary quality and are more sedentary than people who don’t smoke (WCRF, 2018). One particular study evaluated the effects of smoking and alcohol consumption on the development of metabolic syndrome. 

Smoking and Metabolic Syndrome:

Metabolic Syndrome is a collections of findings, including abdominal obesity, high blood pressure, low HDL cholesterol, increased triglycerides and impaired fasting glucose. It was discovered that smoking significantly increased abdominal measurements, lowered HDL cholesterol and increased triglycerides. Smoking was also associated with lower diet quality thus increasing the risk of high blood pressure. 

In addition, smoking was found to be a factor in increasing cortisol, catecholamine, vasopressin and growth hormone which all contribute to the development of metabolic syndrome. It’s important to note that this study found more significant findings in the male population  (Huang, 2015).  Smokers have also been noted to have lower BMI’s, increased fat mass and decreased lean mass in comparison to non-smokers (WCRF, 2018). 

Beta Carotene and Smoking: 

Beta carotene is the name of a naturally occurring pigment in our food that is responsible for orange colour in apricots, nectarines, sweet potatoes and other yellow and orange-coloured fruits and vegetables. The body is able to convert beta carotene into vitamin A. 

While it is known as an antioxidant and was suspected of being protective of cancer, research has demonstrated that high-dose beta-carotene supplementation in current or past smokers increased the risk of developing lung cancer (Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group, 1994). 

Unfortunately, the effects are not well understood but some seem to point towards changes in cytochrome P450 enzymes. Research has concluded that more than 20mg/day of beta-carotene should be avoided (WCRF, 2018).

Diet for Lung Cancer Treatment:

Malnutrition: 

Being well-nourished is important at all stages of lung cancer. Patients with lung cancer are in a hypermetabolic state which means they have an increase in overall nutrient and calorie needs. Malnutrition can have negative impacts on the effectiveness of treatment as it can increase post-operative complications, lung cancer side-effects and it can reduce survival (Kasprzyk, 2021). 

It’s important to be assessed throughout your treatment for malnutrition  (Moreland, 2012). It would not be unusual that you are malnourished, as 26-40% of lung cancer patients are malnourished before the start of treatment (Kasprzyk, 2021) 

Nutrition During Treatment: 

A patient’s overall prognosis is dependent on pre-treatment nutritional status and health. Many symptoms related to lung cancer and treatment impact nutritional status. 

The most common symptoms of lung cancer are (Kasprzyk, 2021);

• General weakness (90% of patients)
• Loss of appetite (98% of patients) 
• Problems breathing (94% of patients)

Other symptoms include;

• Cough
• Severe shortness of breath (dyspnoea)
• Chronic pneumonia
• Hoarseness
• Weight loss 
• Difficulties swallowing 

Patients undergoing treatment often find milder flavoured, soft textured foods are easier to eat especially if they have throat irritation. It’s important at this time to focus on obtaining good-quality nutrition to avoid becoming malnourished. 

If the appetite is low, focus on eating is biggest meal when most hungry and having numerous small meals throughout the day. Maintaining hydration is critical, especially if there is fever, vomiting and/or diarrhea (Lung Cancer Canada, 2020). 

Current Research on Diet for Lung Cancer:

There are over 100 clinical trials on lung cancer diet listed on clinicaltrials.gov right now to test a variety of diets and supplements during lung cancer treatment (Clinical Trials, 2021). The protocols being studied include;

• Fasting Mimicking Diets
• Metformin and low carb diet
• Low fat diet
• Ketogenic diet
• Flaxseed supplementation
• High protein/high dairy diet
• Vegetable and herb mixtures
• Lindera obtusiloba extract
• Methionine-restricted diet
• EPA and DHA supplements
• Sulforaphane supplements
• Broccoli sprout extract
• Total parenteral nutrition with SmofKabiven® E plus oral diet
• Pre-op carbohydrate loading
• Remune supplement to prevent muscle wasting (cachexia)
• Vitamin D 
• Berry powder supplement
• Beta-glucan supplement
• Green tea extract 

This is definitely an exciting area of study and as results are published, this will be reported on in the Cancer Bites blog, be sure to sign-up to receive updates about new blog posts so you don’t miss out. 

There are currently some blogs already on some of the topics listed above including;

• Fasting Mimicking Diets
• Sulforaphane supplements and Broccoli Sprout Extract
• Methionine Restricted Diets

Nutrients for Lung Health: 

Until the results of more trials are published, evidence remains limited for the benefits of specific foods or nutrients for lung health. The following recommendations are based on an understanding of lung physiology and nutrition put forth by the World Cancer Research Fund; 

• If you get water from a well, have your water tested for arsenic as arsenic has been linked to a higher risk of lung and kidney cancers
• Avoid high dose beta-carotene supplements
• Have a diet that is rich in fruits and vegetables
• Choose foods containing beta-carotene, retinol, vitamin C and isoflavones. Beta-carotene is the plant-based vitamin A building block while retinol is the animal source vitamin A building block. Sources for beta-carotene and retinol include;
  • Sweet potatoes
  • Apricots
  • Mangos
  • Bell peppers
  • Citrus
  • Tomatoes and tomato products
  • Soybeans
  • Soy milk
  • Edamame
  • Salmon and other fatty fish
  • Eggs
  • Liver

Foods to limit are; red meat, processed meat and alcohol, in order to reduce the risk of lung cancer include  (WCRF, 2018).

Saturated Fats and Lung Cancer

Higher levels of saturated fat in current smokers have been shown to increase the risk of lung cancer. Saturated fats are those that are solid at room temperature. This includes fat on meat, dairy fat (like cream, ice cream and cheese), coconut and palm kernel oil. Newer evidence has found cigarette smokers who consume more saturated fat have higher rates of lung cancer – this is thought to be due to both DNA damage and inflammation (Yang, 2017). 

While too many saturated fats increase the risk of lung cancer, polyunsaturated fats can help prevent it (Yang,2017). Polyunsaturated fats include vegetable oils, nuts, and avocados. But not all polyunsaturated fats are anti-inflammatory. Read the blog High Oleic and Other Important Considerations When Choosing a Vegetable Oil to determine the best anti-inflammatory oils to choose.

Anti-Inflammatory Diet and Lung Cancer

Inflammatory lung conditions like chronic obstructive lung disease (COPD) and emphysema are risk factors for lung cancer (Mittal, 2015 and Bozinovski, 2015). 

In fact, the inflammation from COPD is a key driver in the initiation stage – characterized by the change from a normal lung cell to a cancerous lung cell and the growth of a cancerous tumour. Inflammation is considered central to the risk of lung cancer, independent of smoking (Bozinovski, 2015). 

Cellular inflammation can be measured with blood tests and the two main inflammatory markers associated with increased risk of lung cancer are SAA (serum amyloid A) and IF-17A (interleukin 17 A) (Bozinovski, 2015). 

In addition to COPD and emphysema, smoking is another cause of inflammation in the lungs due to carcinogenic materials found in cigarettes (Fabbrizzi,2019). 

While no research has been done specifically on anti-inflammatory diet and lung cancer risk, it seems prudent to use an anti-inflammatory diet, which has been shown to effectively reduce blood levels of inflammation. For more use this link to read about anti-inflammatory diets and to download an anti-inflammatory diet PDF.

Lung Cancer Diet Plan for Prevention 

(WCRF, 2018, Kasprzyk,2021 and Yang,2017) 

Lung Microbiome

Discovery of the Lung Microbiome: 

A large study called The Human Microbiome Project set out to analyze the living species that colonize the human body from the skin to the gut. These small bacteria have proven to have many benefits to the human body. 

Initially, researchers had decided to exclude the lungs from the human microbiome project because the lungs were difficult to study. It was also believed that a healthy lungs were sterile. We know now that this is not the case (Moffatt, 2017). Studying the microbiome of the lungs gives us a good insight into new areas of lung health. 

Gut Lung Axis: 

Studies have shown that there is a two-way interaction that takes place between the gut and the lungs. When the gut microbiome is unregulated (dysbiosis), this often accompanies lung conditions such as asthma and lung infections. 

Immune system cells in the gut have the ability to migrate to the lungs. Since the gut microbiome is highly dependent on diet, we can assume that diet could play a role in overall lung health. At times, the bacteria in the lungs can become harmful. For example, Cystic Fibrosis is a lung disease that consists of the production of thick mucus in the lungs. This mucus is rich in protein providing an ideal growth medium for bacteria to overgrow and cause infection.

The takeaway here is that our gut and lungs are intricately connected. The microbiomes present in both systems speak to one another and work together to create harmony or disruption. In addition, a healthy microbiome helps to maintain equilibrium in the immune system and reduces inflammation (Fabbrizzi, 2019). 

Impacts of the Lung Microbiome and Chronic Health Conditions: 

The microbiome can be seen as an ecosystem; throwing off this ecosystem leads to a diseased state  (Moffatt, 2017). Currently, research has been able to find 2 types of bacteria; Veillonella and Megasohaera, that are possible biomarkers for lung cancer. The presences of other bacteria have also been found to have a specific association with small-cell lung cancer, including; Acidovorax, Klebsiella, Rodoferax, Comumonas, Polarmona.

Inflammation as a whole is carcinogenic. When inflammation is present it changes the activity of the immune system leading to an unstable bacterial community. Many microorganisms can cause inflammation such as Haemophilus influenza, E-coli, Pneumococcus, Legionella and Enterobacter Spp (Kovaleva,2019). 

Ayurvedic Treatment for Lung Cancer:

What is Ayurveda?

Ayurveda is a traditional way of healing. It originates from Southeast Asia and is Sanskrit for the science of life. It involves healing the mind and body with the help of foods, herbs and lifestyle (Gokani, 2014). 

Curcumin: 

Curcumin is widely used in Ayurvedic medicine. It is the active ingredient in turmeric, the bright orange spice used it cooking. It is very popular for its antioxidant, anti-inflammatory and antiseptic properties.  The interest in curcumin for cancer management stems from possible chemopreventive and treatment management use. 

Unfortunately, more research is needed to confirm the effectiveness of curcumin in humans (Mehta, 2014). It’s important to note that curcumin is only one component of turmeric, while it is considered the main active ingredient in turmeric, it is not the only active ingredient. 

Curcumin has poor bioavailability due to poor absorption and rapid metabolic rate (Devassy, 2015). Research on both animals with lung cancer and lung cancer cells have shown positive outcomes with cur cumin, but to date, human studies are not available (Leilli, 2017). Correlations have been positive thus far but unfortunately, more information is needed (Devassy, 2015). 

References for Diet for Lung Cancer: 

Bozinovski S, Vlahos R, Anthony D, McQualter J, Anderson G, Irving L, Steinfort D. COPD and squamous cell lung cancer: aberrant inflammation and immunity is the common link. Br J Pharmacol. 2016 Feb;173(4):635-48. doi: 10.1111/bph.13198. Epub 2015 Jul 8. PMID: 26013585; PMCID: PMC4742298.

Canadian Cancer Society. Risk Factors for mesothelioma. Accessed Feb 17, 2021. 

CDC (Center for Disease Control and Prevention), About Electronic Cigarettes (E-Cigarettes) | Smoking & Tobacco Use,2020, Accessed Feb 19,  2021. 

ClinicalTrials.gov. Diet and Lung Cancer Search Results. Accessed Feb, 18, 2021. 

Devassy JG, Nwachukwu ID, Jones PJ. Curcumin and cancer: barriers to obtaining a health claim. Nutr Rev. 2015 Mar;73(3):155-65. doi: 10.1093/nutrit/nuu064. Epub 2015 Feb 13. PMID: 26024538. 

Fabbrizzi, A., Amedei, A., Lavorini, F. et al.The lung microbiome: clinical and therapeutic implications. Intern Emerg Med  14,1241–1250(2019). doi:0.1007/s11739-019-02208

Gokani T.  Ayurveda–the science of healing Headache. 2014 Jun;54(6):1103-6. doi: 10.1111/head.12363. Epub 2014 Apr 25. PMID: 24766404.

Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med. 1994 Apr 14;330(15):1029-35. doi: 10.1056/NEJM199404143301501. PMID: 8127329.

Huang JH, Li RH, Huang SL, Sia HK, Chen YL, Tang FC.Lifestyle Factors and Metabolic Syndrome among Workers: The Role of Interactions between Smoking and Alcohol to Nutrition and Exercise. Int J Environ Res Public Health. 2015 Dec 16;12(12):15967-78. doi: 10.3390/ijerph121215035. PMID: 26694434; PMCID: PMC4690971. 

Kasprzyk A, Bilmin K, Chmielewska-Ignatowicz T, Pawlikowski J, Religioni U, Merks P.The Role of Nutritional Support in Malnourished Patients With Lung Cancer. In Vivo. 2021 Jan-Feb;35(1):53-60. doi: 10.21873/invivo.12231. PMID: 33402449. 

Kovaleva OV, Romashin D, Zborovskaya IB, Davydov MM, Shogenov MS, Gratchev A. Human Lung Microbiome on the Way to Cancer. J Immunol Res. 2019 Jul 29;2019:1394191. doi: 10.1155/2019/1394191. PMID: 31485458; PMCID: PMC6710786. 

Lelli D, Sahebkar A, Johnston TP, Pedone C. Curcumin use in pulmonary diseases: State of the art and future perspectives. Pharmacol Res. 2017 Jan;115:133-148. doi: 10.1016/j.phrs.2016.11.017. Epub 2016 Nov 22. PMID: 27888157.

Lung Cancer Canada, Nutrition, 2020, Accessed Feb 19, 2021. 

Mehta HJ, Patel V, Sadikot RT.Curcumin and lung cancer–a review. Target Oncol. 2014 Dec;9(4):295-310. doi: 10.1007/s11523-014-0321-1. Epub 2014 May 21. PMID: 24840628. 

Mittal V, El Rayes T, Narula N, McGraw TE, Altorki NK, Barcellos-Hoff MH. The Microenvironment of Lung Cancer and Therapeutic Implications. Adv Exp Med Biol. 2016;890:75-110. doi: 10.1007/978-3-319-24932-2_5. PMID: 26703800.

Moffatt MF, Cookson WO. The lung microbiome in health and disease. Clin Med (Lond). 2017 Dec;17(6):525-529. doi: 10.7861/clinmedicine.17-6-525. PMID: 29196353; PMCID: PMC6297685. 

Moreland SS. Nutrition Screening and Counseling in Patients With Lung Cancer in an Outpatient Setting. J Adv Pract Oncol. 2012;3(3):191-193. doi:10.6004/jadpro.2012.3.3.9 

WCRF. Lung Cancer How diet, Nutrition and physical activity affect lung cancer risk. Last updated 2018. Accessed Feb 16, 2021. 

Wiseman, M. (2019). Nutrition and cancer: prevention and survival | British Journal of Nutrition | Cambridge Core 122(5), 481-487. doi:10.1017/S0007114518002222

Yang JJ, Yu D, Takata Y, Smith-Warner SA, Blot W, White E, Robien K, Park Y, Xiang YB, Sinha R, Lazovich D, Stampfer M, Tumino R, Aune D, Overvad K, Liao L, Zhang X, Gao YT, Johansson M, Willett W, Zheng W, Shu XO.Dietary Fat Intake and Lung Cancer Risk: A Pooled Analysis. J Clin Oncol. 2017 Sep 10;35(26):3055-3064. doi: 10.1200/JCO.2017.73.3329. Epub 2017 Jul 25. PMID: 28742456; PMCID: PMC5590804.