Carl (Host): Welcome to Live Greater, a University of
Maryland Medical System podcast.
I'm Carl Maronich and I'm joined by Dr.
Susan Kris, a registered dietician at the Cancer Center
at um, capital Region Health.
Today we're gonna be talking about nutrition and cancer care, exploring
how diet can play a key role in a patient's cancer treatment and recovery.
Doctor, welcome to the podcast,
Susan Krische, PhD: Hi Carl.
Thanks very much for having me today.
Carl (Host): when we're talking about cancer patient's and
treatment and, diet there are a lot of things that factor into it.
What side effects might a cancer patient experience when they're
going through treatments?
Susan Krische, PhD: So cancer treatments have progressed so significantly And
the science continues to make progress.
But hearing the word cancer can be really scary.
Um, it's.
think it's important to realize that what each person experiences with that
cancer diagnosis can really depend on the type of cancer, what part of
their body is affected And the type of treatment and how that person, as a unique
individual responds to that treatment.
so while all of That is going on medically from a nutrition perspective, it's
useful to remember that people should really continue to follow generally
healthful eating guidelines unless or until something gets in the way.
Now much of the time when people think about those side effects to a
treatment, they're thinking about a systemic treatment like chemotherapy.
So even then side effects can vary depending on the particular chemotherapy
medications, but there are some common ones just as you suggested,
like fatigue or general loss of appetite, maybe because of some nausea
or dry mouth or changes in taste.
We're generally speaking, I'd say we're watching out for changes in
how much we might appreciate food And in how well we digest our food.
Carl (Host): Are there food strategies that might make
things easier during, treatment?
Susan Krische, PhD: So I often end up emphasizing the fact that
during treatment, our bodies are sometimes giving us mixed signals
about how much food we need.
Most of our energy and our protein needs come from just maintaining
ourselves, our organs breathing in and out throughout the day.
So even though a person may not.
Feel hungry during treatment.
We still need to provide our bodies with the energy and protein to
maintain our overall strength.
So if you're not feeling hungry, you are probably not going to just
sit down and eat a regular meal.
One of the most common recommendations that I make is to have small.
But frequent attempts at eating and drinking.
So that might be a few bites or a few sips at a time, but at least it's something.
Since I mentioned particular side effects, so if you're feeling nauseous
again, you're probably not gonna sit down to a meal, but you might start with
clear liquids like broth or ginger ale, or maybe some juice diluted with water.
And of course if you can't tolerate even those clear liquids, please contact
your oncology team because that's a sign that something more serious is going on.
But if you're doing okay with those clear liquids, then some plain, simple
starchy foods like crackers or toast or pretzels white rice or noodles, or a
banana applesauce very easy to digest.
Very easy to tolerate.
From there plain preparations of foods including protein foods, like, some boiled
or baked chicken or well-cooked eggs.
And yes, that does actually mean that chicken noodle soup
does really tend to fit in well.
Carl (Host): yeah, we hear at times that how people taste food when they're
going through treatment can change.
How do you address those issues with patient's?
Susan Krische, PhD: it may sound really simple, but actually rinsing
your mouth regularly before and after meals can be really helpful.
That's basically trying to get rid of any debris that might be in your mouth and
getting in the way of your taste buds.
So oftentimes just a homemade baking soda, rinse to rinse.
Swish And then spit out before and after meals can be really
useful for the food itself.
Focus on tastes that are still coming through.
That will vary from person to person.
So from some folks it might be really sweet.
Tastes are still appealing.
Other folks might find that the salty, savory flavors are still coming through.
So depending on what it is you might try a sweet or tart beverage.
Something like cranberry juice or a really tart lemonade or eating bites.
Of naturally sweet foods like watermelon or sweet potato as a bit of a palate
cleanser in between bites of other foods.
Then of course you can also add some extras into your food.
So, sprinkling a little bit of lemon juice or vinegar that tartness, that
acidity can sometimes be picked up a little bit more easy from our taste buds.
And so we start to appreciate that food a little bit more.
Or just adding extra marinades, extra herbs and spices to see if those
flavors can start to come through.
Carl (Host): As you mentioned earlier, everyone's the way they
deal with all That is it can be different from patient to patient.
So probably some experimenting with, with some of the things you
just mentioned would be effective.
Susan Krische, PhD: Absolutely.
Everyone does react a little bit differently.
And of course, we're coming to this, time with all of our own
history and our food preferences.
So from that perspective, all of these are suggestions for people to try to put
into place and see what works for them.
What might work for one person really well.
Another person might.
Just hear that suggestion and go mm, no, not gonna do that.
And that's okay because we do have our own preferences and a lot of
the time what I end up doing in conversations with patient's or their
caregivers is to try to figure out what might work for that individual
with their preferences And what they're currently going through at the moment.
Carl (Host): We know food is often a, comfort source for folks.
We talk about comfort foods when someone's going through treatment and they're
having all the, these dietary issues.
What, suggestions can you make about being able to stay with their comfort foods
while they're going through treatment?
Susan Krische, PhD: This is something of a mixed question because as we
just talked about with those taste changes Those taste changes may mean
that some of our previous favorite foods just aren't gonna taste right.
And so trying them now when you're feeling nauseous or everything is tasting
funny, that may actually not be what you wanna do because it, just might
affect that memory of that favorite food.
So realizing that our comfort foods.
Change as we go through this journey is really useful.
So comfort foods are whatever brand's, comfort in that moment, foods that
you feel like you can tolerate well, that you're comfortable with
that can still give you comfort.
And as I mentioned, that, bowl of chicken soup although it.
The old wive's tale is actually really fitting in a number of different
situations and can work really well.
Or depending on how you are feeling, maybe you wanna try something That is a
little bit heavier if you can tolerate it.
So mashed potatoes and gravy, or macaroni and cheese.
And then trying to add those little extras in where you can, can really
be useful so that mac and cheese is a really dense source of energy
and some protein with the cheese.
So finding those little moments of nutrition as you're going through
your day can add up over the course of the day and be really beneficial
for trying to make sure that you're getting enough nutrition overall.
Carl (Host): So, it sounds like through this process, a lot of it's trial and
error, really seeing what, works what, still tastes good And what you enjoy.
It sounds like that's kind of the course for patient's.
Susan Krische, PhD: It is within a set of guidelines.
So for example, we do know that if someone's feeling nauseous.
They probably need to stay away from heavy, dense foods, spicy foods, and
starting with those clear liquids, like I mentioned if someone's
having diarrhea, there might be another set of recommendations.
So for example, again.
Sticking with very plain, simple foods, staying away from most higher fiber
foods including some foods that can help thicken our stools, like the banana, the
applesauce the plain starches or yogurt.
But within each of those recommendations.
There absolutely is a range of foods that we would suggest working towards
and another range of foods that we would suggest staying away from.
But within that range it is a lot to do with personal preference because of
so much of how we deal with food boils down to those personal preferences
and those personal experiences that we've had over the years.
Carl (Host): Are there certain foods you can say or habits that cancer
patient's should avoid during treatment?
Susan Krische, PhD: This question comes up a lot and I will say that the
only foods you absolutely need to stay away from are the ones that you are
allergic to or you cannot tolerate.
So, for example, if you, you.
Previously we're lactose intolerant.
You should obviously stay away from lactose.
But beyond that, it really depends on what you're going through at the moment.
So while you're tolerating foods and your treatment, well, we do
recommend that you follow just generally helpful eating guidelines.
But when things start to get in the way, that's when we start to make those
recommendations about what you might stay away from, depending on your symptoms.
And what you might start to focus more on, and when I'm talking to folks, I
really do try to focus a little bit more on things to include in their
diet when I can, because otherwise it does seem like it's being restrictive.
Generally speaking, as we're going through cancer treatment so much is
acting potentially against getting enough nutrition that to the extent we can, we
try to liberalize and add flexibility rather than try to take it away.
Now, occasionally there'll be other things that come up like for example,
if your medical oncology team has mentioned that your white blood cell
count is low and you need to take extra precautions from trying to prevent
infections there, we might also start to include some food safety recommendations.
So, Since we're talking about it, I might as well mention most of
us have become a lot better about washing our hands since COVID.
But that's a large part of it.
But since the question that you just asked was about things to stay
away from This is a good example of where things that we might normally
eat, we might want to stay away from.
In certain circumstances.
So for example, if we're trying to be extra cautious about our food safety
because of that compromised immune system staying away from rare or undercooked
foods like sushi or a rare steak or.
Personal favorite raw cookie dough that might not be the best choice because
of the possibility of something being introduced through that undercooked
foods so similarly things that we might typically enjoy, like a buffet
we might wanna be a little bit more cautious about and choose to order
off of the menu rather than going to that more open salad bar, open buffet.
Carl (Host): some great suggestions there.
Patient's and their caregivers may hear about superfoods.
they seem to be kind of in the news a lot.
How should they approach some of these claims And what truly matters most when
it comes to nutrition during cancer care?
Susan Krische, PhD: So the term superfood is actually a marketing term.
It is supposed to convince the listener that that particular food has
exceptional health benefits, usually because of some component of its makeup.
Now oftentimes That is based on an actual component of the food,
but focusing on any one food or.
any small group of foods is likely to mean that on an overall basis,
that diet isn't well balanced.
So typically I will try to encourage people not to focus on particular
foods, super foods or otherwise.
But if they're able to eat a diverse diet, so that includes a broad range,
whole grains, vegetables, fruits, proteins, which can include land,
animal-based proteins, but also fish, plant-based proteins like beans And so on.
And that diversity is so much more likely to provide the whole mix of nutrients
that our bodies need to function well.
Carl (Host): Yeah, maybe we could talk a little about caregivers and,
and caregiver support around food.
And I know it may be pressuring the patient, making sure they're eating,
but with some of the things you've mentioned you, that's probably, uh,
you have to be careful with that.
Susan Krische, PhD: So many of us grew up in families where food is really
an expression of caring and of love.
But That is a, Choice.
It may be a generational choice.
It may be a cultural choice, but it is a choice.
So particularly when someone is struggling with food, recognizing that.
We can express our care and our love for that person in many other ways that
handhold the hug just smiling at them.
And I would certainly encourage caregivers to continue to offer that
support through other expressions, not necessarily stressing the food
aspect so much because that stress.
Can also lead the individual to feel more stressed and correspondingly
to possibly even eat less.
So trying to make mealtimes, pleasant music, flowers a nice place setting
can help to relax and downplay that stress even if the caregiver
is still feeling some of that.
Overall just.
Offering a variety of foods, something that might catch your loved one's
attention and interest, and even if that's something that you would
normally consider a treat because.
If they're not eating much, at least they're eating something.
as I did mention, oftentimes eating a traditional meal just isn't going to
work well for that person because of the various issues that they're going through.
So eating multiple snacks nutrition breaks, small meals
often, much, much easier than eating a traditional larger meal.
One other thing to mention, I just as I'm thinking about it sometimes drinking
is easier than eating solid food.
So if you or your loved one doesn't necessarily feel like they wanna
face solid food, having a high calorie, high protein nutrition
drink as a snack or a meal substitute can actually work pretty well.
There certainly are commercial products that you can talk to your
medical team about but you could also try a homemade higher calorie high
protein smoothie for those times too.
So offering different options, again, based on what that person is feeling
like they can tolerate at that time.
Just making sure that they're getting some nutrition on regular intervals and
as consistently as possible, but relaxing a little bit about what specifically
that nutrition is coming from can be a really useful way to make sure
that they're getting enough calories and hopefully enough protein too.
Carl (Host): As a nutritionist, Susan, how would you uh, offer advice if
someone wanted to have a relaxing glass of wine when they're going through
treatment or something like that?
Susan Krische, PhD: Well, This is a difficult question because honestly,
from a cancer prevention, cancer survivor perspective the research
recommendations, for example, from the American Institute of Cancer Research
is to avoid or abstain from alcohol, And that includes wine and other spirits.
That differs somewhat from our generally healthful.
Eating guidelines.
So for example, from the American Heart Institute, where we generally
hear recommendations to limit our alcohol intake to one standard survey.
So for those who may not be aware, there are standard definitions
of what a drink consists of.
So five ounces for a glass of wine, or only an ounce and a half
if you're talking about a spirit.
Alcohol has the potential to interact with so many medications.
And so from that perspective, my first go-to is to make the individual aware that
the recommendation really is to abstain.
But if they're going to.
Choose to have some to talk to their medical team first to make sure that it
is safe for them to do so from a medical perspective, from the medications that
they're taking, the chemotherapy that they might be taking, And then that medical
provider can also provide a little bit more clarification about how much or under
what circumstances that might be allowed.
Carl (Host): Great advice there.
And as we wind down, let me ask about beyond treatment.
What kind of long-term recovery for cancer survivors do they need to be
mindful of with regard to nutrition as they continue on their journey?
Susan Krische, PhD: So this could be an entire podcast on itself.
And in fact, I have an entire one hour class related to this, but generally
speaking, we are talking about generally healthful eating guidelines and how
to apply those through their lives.
From that perspective as we're recovering, we're really just trying to keep our
strength up And that ends up being my main focus as I talk through those
recommendations and those guidelines.
In my case, I base the class on the recommendations that are
research based from the American Institute of Cancer Research.
And if anyone is.
Interested in that.
I believe that there is a link to our community calendar events provided in the
description of this particular podcast.
But certainly they're not gonna be limited to my offerings.
There are some strong nutrition resources out there supported by oncology
dieticians like myself that are publicly available, whether it be through our
cancer center And the community events calendar or through other cancer centers.
so from that perspective, talk to your oncology team.
See what resources are available, where you might be having your own care
and whether it's you or a loved one.
Again, if you're experiencing any side effects, definitely talk to your
oncology team so that we can help to provide the support to help make
that journey a little bit easier.
Carl (Host): Very good registered dietician.
Susan Critio gave us a wealth of information today.
We really appreciate a lot of great tips for those going through cancer treatment
and how they, should view their nutrition.
Susan Krische, PhD: Thank you, Carl.
Carl (Host): And find more shows just like this one at OMFS dot
org slash podcast on YouTube and your favorite podcast platforms.
This is Live Greater, a Health and Wellness podcast, brought to you by the
University of Maryland Medical System.
We look forward to you joining us again, and please share this
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Thanks for listening.