Eating Smart: Practical Tips for Cancer Prevention and Care, Pt. 3

In this podcast, Lisa Jones RDN, LDN speaks with Amy Bragagnini RD, CSO, a clinical oncology dietitian at Trinity Health Lacks Cancer Center in Grand Rapids, MI, about the role a balanced diet plays in cancer prevention, long-term survivorship, and preventing recurrence, as well as practical tips for caregivers who support their loved ones' nutritional needs. This is part three of a three-part series on cancer nutrition.
 

Additional Resources:

Listen to part one of this three-part series here. 

Listen to part two of this three-part series here. 

TRANSCRIPTION:

Lisa Jones RDN, LDN: We are back again today with another episode on cancer nutrition. Today's topic is eating smart practical tips for cancer prevention and care and we are lucky to have with us again, Amy Bragnini. Joining us today, welcome back Amy.

Amy Bragagnini RD, CSO: Thank you.

LJ: Last time when we were together we were talking about hot topics in oncology nutrition. We talked a lot about myth versus reality and the whole thing with people asking to sugar feed cancer. So what would you say will be your top takeaway from that episode in case anybody didn't get a chance to listen to it yet?

AB: Yeah, so if if a claim seems sensationalized, it's likely a myth. So, you know, if you do read something here or something and it says anything that they're recommending is going to be quick, easy, you know, for the simple cost of $19.99, just be a little skeptical, you know, always read the fine print, always know if they're science based research, somewhere involved in what they're trying to sell or recommend. And definitely, you know, kind of, again, put your thinking cap on and always ask a registered dietitian, you know, for feedback or to do a little research for you.

LJ: Yes, the best, best takeaway and consult with a registered dietitian insurance companies cover it these days. So great tip. All right, let's talk about eating smart. And our first question today is how important is maintaining a balanced diet for cancer prevention?

AB: Oh, it's, you know, what I was going to say, very, very important. You know, following a balanced diet is one of the best ways to obtain all the necessary nutrients that will support our immune system, support our microbiome, you know, to give us energy to help with the growth and repair of our tissues. Because we know from a cancer diagnosis perspective, there are certainly things that people can do to prevent, to let's say lower their risk of cancer with nutrition. And one of those things is to be at a healthy weight for you. Now, I am not a big fan of the BMI chart. I think that is something that is for another episode. But being at a healthy weight for you just means getting the right amount of nutrients so that you are kind of close to what your body feels comfortable at a set weight. And that the best way to do that is by getting plenty of plant-based foods in your diet.

And that's another one that's really important for survivorship. If you can get at least a minimum of five servings of fruits and vegetables a day, if not more, in addition to choosing a lot of plant -based proteins that is exponentially gonna help lower your risk of recurrence of cancer. Also getting the right amount of nutrients for bone health, I think is super important. So from a calcium and vitamin D standpoint, obviously getting some resistance training in there that really helps strengthen our bones. So it's, again, it's not just one food or one food group that's important. It is the entire balance of eating.

And I always like to tell my patients that, you know, Rome wasn't built in a day. And so basically, if you really say, quote, eat a well-rounded perfect diet, now there's no perfect diet, but let me start over. If you eat a well-rounded diet in a day and then the next day you don't and you eat things that are maybe not that nutrient dense, that one day isn't going to negate all the good you did. The point of registered dietitians is to help patients find sustainable ways to add really healthy foods in their diet and keep them going.

LJ: Yeah, so I loved your analogy about when I wasn't built in the day, your diet's not built in the day. So that's incredibly helpful because how many times, and I'm sure you've heard this as well, Amy, when somebody says, "Oh, well, I was doing good on my diet and then I messed up and then I had to wait until Monday to start again." So like there's continuous in this perpetual cycle of waiting until Monday to start.

AB: You're absolutely right. You know, and I always tell people there's no falling off a wagon, right? There's no good food or bad food ... unless you have a peanut allergy. Fine. Peanuts are bad for you. But you know, all food really in a balanced way can can be included in your diet. But what we want patients to do is choose foods that are gonna make them feel good, that are gonna give them the energy that they need to do the things that they love, to be with the family that they love. And again, that is more in a balanced way.

LJ: Yeah, and maybe the word diet is, I shouldn't have used it, maybe it's more lifestyle, balanced lifestyle for cancer prevention.

AB: I struggle with the word diet as well. So you used it just fine because it's kind of like our intake, our food intake, or it's a diet and lifestyle. It's basically, I don't want you to be on a diet, but I want you to follow more of a well rounded, healthy intake of foods. Yes, well rounded.

LJ: I like that. So how about this? How about we talk a little bit about nutrition and how it plays a role in long term survivorship and preventing recurrence?

AB: Yeah, the specifics definitely are right down to the, you know, the plant-based foods. So, you know, looking at, I mentioned red meat in another episode, but certainly we have research that says that people that eat, you know, a lot, let's say, of red meat might have a higher incidence of diagnosis of colorectal cancer. So one way that you can use diet in food is to say, all right, I am gonna do my best to kind of reduce the amount of red meat and processed meats in my diet. And that will help, again, lower risk of potential cancer that way. Also would be good for your from a cardiovascular standpoint.

Again, across the board, we know that eating more fruits, more vegetables is beneficial from every cancer site to help reduce risk. So if you can get in a good balance of colorful produce throughout the day, that's going to be another important step. Making sure you're hydrated is another really important thing. And hydrating with beverages that are not sugar-filled, that aren't containing a lot of added sugar. And consuming a lot of good sources of fiber that could be coming from produce, but also whole grains, that plays a big role in how healthy our gut health is. So that is an important thing to help reduce cancer, but also to help us live our best life.

LJ: Yes, which is so, so important. And then the whole colorful produce thing. And it's, I think it's a little easier today because the way that they've kind of rearranged supermarkets. I mean, I know at least where I live, you kind of walk in and you see it. And it's like this colorful produce is right in your face. So like you kind of drawn to it.

AB: Yeah, agree. I agree and that's how mine set up too and I always feel so powerful when I'm walking into say the frozen food section because my cart looks just beautiful and I'm always thinking I really would like to run into every human I know right now before I get it further into the grocery store but but yeah and I also want to remind people that eating fresh is great but if you can't afford it or if it's not frozen, canned, any way you can get the fruits and vegetables, get them, it's just as beneficial.

LJ: Yes, Amy, you just brought up another kind of, I don't know if we want to call it a myth, but people will say like, I shouldn't because the canned is so much sodium and all that kind of stuff. But yes, there's a really great point you bring up. Yeah. Yeah, so good. And the hydration, so important. And would you say, I'm just curious, like what your thoughts are of this with the patients that you have. And this might not, you might not even be able to provide a statistic on it 'cause I do know that like most of us, most Americans aren't getting enough fruits and vegetables. Would you say that that is true with your patients as well? Or do you have, I don't know if you do any tracking on that or any type of?

AB: Yeah, I don't necessarily track, but I do, I do keep track kind of based in my initial conversation with a patient and what I record into my notes. And I can kind of do when I do follow ups, a little bit of just simple, you know, did you, did you follow my recommendations or, or it might be as simple as, you know, to my patient that eats one serving of fruit and vegetable a day, you know, just saying, I know that this is your go to, you do like to eat, let's say, maybe you have, you drink one half cup of 100 % orange juice a day, if they were able to just increase that to two, that's movement, right? I mean, I don't necessarily need them to go from zero to 100.

But if they can just slowly start to find other things that they like and start to incorporate them. But yes, by and far, the vast majority of the people I work with really are kind of deficient in a fruit and vegetable standpoint. And really the easiest way, I tell people, if you already sit down to dinner every night. You have the you have the fortune of sitting down to dinner with your family every night and a vegetable to serve. Just have more of that vegetable. Have a bigger portion of it You can get two servings maybe if you have a bigger portion than having to find another part of your day to include a fruit or vegetable. There are little ways you can kind of sneak them in and kind of pad your stats a little bit.

LJ: Yeah, what about sneaking them in and like a smoothie?

AB: Oh, I love that idea. Yep, I absolutely love that idea. I think you can get such a good variety of different nutrients if you can find the balance from a taste perspective. The only caution, not caution, the only thing I want people to kind of be aware of is smoothies are great and they're easy for breakfast. You can just quick drink them on the way to work. For me, drinking things that are nutrient dense. It does not make me feel satisfied as a low satiety point. So I want to make sure if somebody says this is my breakfast or having a smoothie, number one, make sure there's more vegetables in it than you would normally put and make sure it tastes good because that will help lower the, you know, the total carbohydrate amount of the whole thing and give it some fiber, but also make sure after you drink it that you think, yeah, I'm full. That's great. I feel good versus for me, where's my breakfast? That was just a drink, you know.

LJ: I'm right there with Amy, but I do have to confess that that's how I sneak in a lot of spinach in my afternoon. I do one in the afternoon.

AB: I love it. No. And I think that's wonderful. And you're right. That is an easy way if you were going to have one anyway, to sneak in some vegetables and that can, you know, up your, up your servings per day.

LJ: Yeah. You're right, I can't count it as a meal 'cause I still feel like, oh, I didn't have a meal yet. But yeah.

AB: I think it's the chewing thing. I don't know. Yeah, and there's a lot of research that they've done on just the mouth feel and the chewing factor in our brain and how ever someone feels satisfied is how I want them to feel satisfied with what they're eating. And if it's a smoothie, great.

LJ: Yes, so true. Now how about, let's talk a little bit about practical tips. So if you're a caregiver and you want to support your loved one in meeting their nutritional needs during treatment, can you provide some tips on that? Like what should they do?

AB: So one of the first things that usually happens when people get chemotherapy is they'll tell me that they don't have much of an appetite. And they'll tell me that I don't even know what I want. And so their caregiver, their loved one is really trying to be helpful and nurturing by saying, well, what sounds good? What can I get you? The majority of the time, the patient doesn't know what sounds good.

So I try to educate caregivers and say, try not to ask them. Well, I mean, you can certainly ask them what sounds good. But if notoriously, their answer is, I don't know. Pick something you've seen them eat in the last few days and just give it to them. A lot of times, if it's familiar and and if they, you know, they can tolerate it, then they might be more apt and so they don't have to make the decision to go get, get the food themselves. Another thing that I kind of really think works well, especially between spouses is it's, I call it the three-bite rule. So if the person getting say chemotherapy is, is saying I do not feel like eating, I am not hungry, I do not know what sounds good, I can't pick anything out. And the say this spouse is the wife is always like, Well, I just I'm nervous, you haven't eaten all day. So, you know, blah, blah, blah, what can I get you? What sounds good? So I usually tell them have the three-bite rule, right? Maybe just say a patient is allowed to say, I don't know what sounds good, I can't pick anything out. Well, then the spouse is then going to say, I'm going to pick two things. I'm going to put them down in front of you. The patient's only job is to take three bites of one of them, right? If they can start and take three bites, because it's easy to think, all I have to do is take three bites, majority of the time they can finish what's in front of them.

It's the picking the food, the getting started that is the hardest. It's kind of like going, it's exercising, you know? It's, if I have my exercise clothes on and somebody drives me to the gym and puts me on the treadmill, I'm gonna exercise. But it's the getting my clothes on, arriving to the gym and getting there, that is always the rate limiting factor.

So if that decision can be removed from the patient and all the patient needs to do is take three bites, the majority of the time they can. I find that when people are not hungry at all, finding like your  smoothie in the afternoon, finding a liquid form of nutrient dense beverage is the way to go because it tends to be easier to drink things when you're not very hungry than it is to sit with a knife and fork and eat. So that's when people can get savvy about making balanced smoothies or finding maybe an oral nutrition supplement drink that that they like the taste of. Sometimes keeping and eating schedule that works for some people where if they're not hungry and they live alone and they maybe they have a loved one pop over every now and again having like some cues as a reminder to eat or maybe the loved one providing little you know meals that are in a very small portion in a Tupperware container that way the patient doesn't feel overwhelmed by a great being container but it's in a small portion they can microwave it and then it's done.

LJ: Wow that's such great tips that you just gave us thank you so much and my favorite I would have to say is the three bite rule And I think that can go, it's pretty much, that could be applicable to anyone, really. Like if you think about kids that have trouble with eating veggies.

AB: Yes.

LJ: If that would be the perfect thing, like here's the three points. Like instead of playing a little game, you could do this.

AB: Absolutely, and I do find too, with some of my patients that don't like to get out and maybe try to get a little walking in or anything. I just say, maybe in your mind, just the only step you have to do is is put on your walking shoes, that's all you have to do. And if you don't want to go, you don't have to go. But again, sometimes it's just that first step that can help people keep going.

LJ: Yeah, well, perfect. Thank you so much. I appreciate everything that you shared with us and all the different segments that you did and your expertise on cancer. Thank you so much, Amy. Is there anything you want to say to the audience or final takeaway?

AB: Yeah, I enjoyed myself very much. And always the takeaway is if you have specific nutrition questions, and you're looking to make some changes in your diet, don't hesitate to look at eatright.org. There's a section on the website that you can find a professional, you can find a local registered dietitian in your area. And I always recommend trying to make an appointment and get a tailored one on one time with a registered dietitian, you won't regret it. Yes, see the registered dietitian.

LJ: Well, thanks again Amy for being on the show and sharing your insights with us We will share all the the resources that we discussed and to our audience Thank you for listening and please tune in again and share your comments and feedback on our site Have a great day and enjoy a healthier lifestyle with a 4 -1 -1 in mind

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