You don’t hear much about pancreatic cancer, but when you hear someone is diagnosed, you should be alarmed. While pancreatic cancer is rare, it’s one of the more fatal types of gastrointestinal cancers and is on the rise. Unfortunately, many people with pancreatic cancer are asymptomatic until it’s too late and in its final stages.

A recent study published in JAMA this year showed that unintentional weight loss and diabetes may be signs of this deadly cancer. The study tracked 160,000 adults for close to 30 years. Individuals who had been diagnosed with diabetes for 4 or more years had twice the risk of pancreatic cancer while those with a new diagnosis had triple the risk. The risk was still considered low, 3 cancers per 1,000 persons. ¹

In addition, unexplained weight loss was also a signal for pancreatic cancer. Individuals who had lost over 8 pounds had a 69% higher chance of pancreatic cancer compared to those without weight loss. Those with both diabetes AND weight loss saw their risk increase by 6 times compared to those with neither diabetes nor weight loss. ¹

A weighty matter

Rather than waiting for the diagnosis of pancreatic cancer, prevention is key. One risk factor common to multiple cancers is obesity. Researchers believe obesity plays a part in the diagnosis of pancreatic cancer due to chronic inflammation, insulin resistance and changes in the gastrointestinal microbiome. Excess fat also produces adipokines, inflammatory compounds that impact DNA and cellular growth. While seen as drastic for some, bariatric surgery on those with diabetes may reduce the risk of pancreatic cancer. In patients with diabetes, the risk for pancreatic cancer was .19% VS .32% in those without surgery according to a study presented at the European Gastroenterology meeting in October this year. Previous studies also support weight loss using bariatric surgery. ^{2, 3}

Weight loss can also be achieved through diet and regular exercise and is advised for the reduction of several types of cancers. The American Cancer Society suggests a minimum of 150-300 minutes of moderate physical activity or 75-150 minutes of intense exercise weekly to aid in cancer prevention^{. 4}

Exercise may also improve quality of life in those dealing with pancreatic cancer. A small study on pancreatic cancer patients showed that resistance training for 3 months improved physical functioning, sleep and quality of life. ⁵ In addition, exercise during chemotherapy treatment increases efficacy of treatment by improving tumor vascular function. In animal models, exercise hampers the regrowth of pancreatic duct adenocarcinomas. More studies in humans are needed. ⁶

Kick the can and don’t smoke

The consumption of soft drinks is not only related to obesity, but also linked with pancreatic cancer. A 2010 study of over 60,000 people in Singapore found that those consuming 2 or more soft drinks per week were 87% more likely to develop pancreatic cancer. Other high glycemic food and beverages (such as juice and high sugar sweets) may also impact weight and risk for pancreatic cancer. ⁷

In addition to avoiding or limiting sweetened beverages, smoking cessation and reduction in alcohol are also advised in the prevention of pancreatic cancer. According to a recent study, smoking cessation and other alterations in lifestyle may reduce the risk of pancreatic cancer by 27%. Alcohol impacts the microbiome, which affects the risk of gastrointestinal cancers, including pancreatic. ⁸

What to eat?

There is data to suggest a low-fat diet in reducing risk for pancreatic cancer in women. A randomized control trial in nearly 49,000 postmenopausal women aged 50 to 70 was completed in 1993 to 1998. An intervention group and control group were compared with the intervention group being advised to cut down on fat and increase consumption of vegetables, fruit, and grains or continue their usual diet. ⁹

Compared to the intervention group, 165 women in the control group developed cancer while 92 developed pancreatic cancer in the intervention group. Reduction was seen in women with BMIs that were at or above 25, meaning those that are overweight or obese would see the most benefit. ⁹

Despite limited data on foods to consume to prevent pancreatic cancer, it’s still prudent to focus on more plant-based foods to provide fiber, vitamins, minerals and other phytochemicals that may offer protection against all cancers. A plant-based diet also aids in weight control, blood sugar management and diversity of the gut microbiome, which may aid in reducing risk. Dietitians can offer the following suggestions to their patients.

• Focus on nutrient-dense foods including green leafy vegetables, seasonal fruit, whole grains, beans and lentils, nuts and seeds.

• Avoid or limit intake of soda, sweetened beverages and alcohol.

• Reduce fat in your diet by limiting intake of beef, pork, full-fat dairy products, fast food, processed food and refined grains or dessert.

• Get moving. Aim for 150-300 minutes of moderate exercise each week. Take a walk, ride a bike, play tennis, dance, whatever.

• Prevent diabetes through regular screening, weight management and regular exercise.

References

1. Yuan C, Babic A, Khalaf N, et al. Diabetes, Weight Change, and Pancreatic Cancer Risk. JAMA Oncol. 2020;6(10):e202948. doi:10.1001/jamaoncol.2020.2948

2. Xu M, Jung X, Hines OJ, Eibl G, Chen Y. Obesity and Pancreatic Cancer: Overview of Epidemiology and Potential Prevention by Weight Loss. Pancreas. 2018 Feb;47(2):158-1623.

3. United European Gastroenterology meeting, news release, Oct. 11, 2020

4. https://www.cancer.org/healthy/eat-healthy-get-active/acs-guidelines-nutrition-physical-activity-cancer-prevention/guidelines.html