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Dos and Don’ts of Supplement Intake During Cancer Treatment

What are the dos and don’ts of supplement intake during cancer treatment? Registered dietitian and oncology nutritionist Julie Lanford discusses potential issues and strategies to help ensure the best care if taking nutritional supplements during cancer treatment.

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Related Resources:

How Is Hydration Managed During Cancer Treatment?

What Are Practical Tips for Managing Taste Changes During Cancer Treatment?

How Do Nutritional Deficiencies Impact Cancer Treatment?

Transcript:

Lisa Hatfield:

Navigating supplement intake during cancer treatment could be complex. Knowing what to include and what to avoid is crucial for supporting your health and enhancing treatment outcomes. As part of the Patient Empowerment Network RESTORE program, we’re exploring the best practices for supplement use during treatment.

Julie, what are the key dos and don’ts when it comes to taking supplements during cancer treatment, and how can patients ensure that they’re choosing the right supplements without interfering with their treatment?

Julie Lanford:

Yeah, well, I guess the number one do is to make sure your medical team knows what you’re taking. And the number one don’t would be, don’t hide what you’re taking from your medical team. Maybe the number two do is follow their advice. A lot of us in oncology care are very cautious about supplements, and the reason we’re cautious is kind of twofold. One, there’s not a lot of great data suggesting that taking nutrients in pill form is beneficial.

When you have a nutrient deficiency, that’s when you need to take a supplement, and you take it for a period of time and monitor that clinical outcome to see is it helping? And do I need to stay on it or not? The things that I don’t want people to do are to just take supplements because someone told them it would be good for them, and they just take it, and they don’t even really know what they’re taking. Those are, to me the situations where we’re like, eh, let’s not do that.

The supplement industry is not regulated in the same way that food and pharmaceuticals are, so they’re sort of free-range industry. They don’t have to show the same kind of data that pharmaceuticals do. They don’t go through the same quality standards that food does. So my biggest concern is actually that a supplement would be contaminated with something harmful, which we have seen happen many times. But you won’t know necessarily that what they say is on the bottle is what’s actually in it.

So what I want to do with people is to make sure that they’re only taking, nobody wants to take extra pills. Especially people who are already taking lots of medication, they don’t want to take extra pills. So let’s not take extra pills if we don’t have to. So a lot of times, we’ll actually take people off any regular supplements that they’re taking if we don’t think that they’re necessary, or if we think they might be harmful. So really pairing it down can be helpful. And then always showing the bottle to your treatment team, so they can find, look, and just see if there’s anything questionable in it that you want to be concerned about.

Lisa Hatfield:

All right, thank you. Are there any specific supplements that should definitely be avoided or carefully monitored? We hear a lot of cancer patients, and I hear a lot of suggestions. Take turmeric or tauroursodeoxycholic acid (Tudca). Are there any that you would say not to take in general?

Julie Lanford:

Yeah, antioxidant supplements are generally things we don’t want people to take. And then things like St. John’s wort can commonly interact with a lot of different oncology medications. So those are kind of two major ones that we often tell people not to take. I don’t think that it’s necessary to take anything more than just a regular multivitamin if you want to be taking something. And most treatment centers will kind of have that as their policy that during treatment they don’t want you to take anything except a multivitamin.

And then after active treatment is over, then you can have a discussion about what might be safe to sort of restart if you feel like you really need them. So those are the ones that we would want to be cautious with. But then again, if somebody is deficient, so if you’re low in iron or low in vitamin D, you do need to take a nutritional supplement. Sometimes you can get pharmaceutical versions of those, which I think is nice because then it guarantees a safety standard but sometimes, then the price is off the roof. So definitely, in partnership with your medical team is what you really need for those supplement and sort of herbal strategies.

Lisa Hatfield:

You heard it here straight from our expert. Thanks for joining us on the RESTORE program. I’m your host, Lisa Hatfield.

How Do Nutritional Deficiencies Impact Cancer Treatment?

Registered dietitian and oncology nutritionist Julie Lanford discusses nutritional deficiencies for cancer patients, monitoring of deficiencies, and advice to help address nutritional deficiencies for optimal patient wellness.

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Related Resources:

How Much Protein Should I Consume While Undergoing Treatment?

What Are Practical Tips for Managing Taste Changes During Cancer Treatment?

Dos and Don’ts of Supplement Intake During Cancer Treatment

Transcript:

Lisa Hatfield:

Nutritional deficiencies can significantly impact your health and treatment outcomes, but identifying them early and managing them effectively is key. As part of the Patient Empowerment Network RESTORE program, we’re exploring how to recognize these deficiencies and the role of regular follow-up with a dietician.

Julie, how can patients identify if they are experiencing a nutritional deficiency, and what tests or assessments are typically used?

Julie Lanford:

Yeah, so it really depends on what type of cancer, what type of treatment and sort of each person’s medical history in terms of what we might monitor. In general, first of all, we want people to maintain their weight. We want them to get enough calorie and protein needs.

So, that’s one sort of major thing that we look at. But when it comes to nutritional deficiencies, most people think of sort of micronutrients, so vitamins and minerals that their body needs to function. If they don’t have enough of it, your body just doesn’t function as well. And there are some common deficiencies that we do see with various types of treatments.

So, that’s a great question for your nurse, your chemo teaching nurse, or your nurse navigator or your physician team is to ask, hey, are there any things I need to know about risk for nutritional deficiency with this particular type of treatment or this particular type of cancer? The general things that I would be watching for, iron is a big one.

And I recently read a study that a lot of people are sort of underdiagnosed in the oncology population regarding iron deficiency. So, that can be picked up on with regular lab work. Just hemoglobin often can give that picture. But if there are some physical signs of iron deficiency and hemoglobin is normal, you can still ask for an iron panel if it’s warranted.

So you can always mention that to your doctor. The signs I would be looking for is, if you have a lot of fatigue, which…that’s always another thing. How do you know if you have more fatigue than the normal person getting cancer treatment? But you should kind of know yourself and if you’re adequately getting enough calories and enough protein and hydrated, but you still really feel like something is off with your energy, I think it’s a valid reason to at least check into an iron panel and see if that’s contributing to it.

So that’s one thing. A lot of the other labs are being checked pretty regularly for most people who are currently under treatment. Now, if you’re somebody who’s on like an active sort of maintenance treatment or you’re done with treatments or on a treatment break, you may not be getting lab work nearly as often.

And so really paying attention to whether if something off, you can always ask for lab work and typically it’s paid for if there’s a good reason to do it. So oh, I’m having a lot of fatigue or I’m feeling muscle soreness or things like that where it might trigger a thought that, hey, is your potassium low? Is your magnesium low? They’re pretty easy to check for though.

So most of the time, what I find with oncology active treatment people is that they are getting lab work done regularly, and they can look over their labs if they don’t see some of the things they want to see. They can always have a conversation with their medical team to say, hey should I have an iron panel checked? Should I have vitamin D checked? How is my just general lab work? And they can go through it with you, so that you have an idea. Usually it’s, people are pretty on top of it, but I also say that asking is always a good idea.

Lisa Hatfield:

Okay. Thank you. Julie, what role does regular follow-up with a dietician play in managing and preventing nutritional deficiencies? And if I did want to see a dietician and my oncologist has not recommended that, can I just ask for a referral to the dietician at our cancer center?

Julie Lanford:

Yeah, so it really is going to be cancer center-specific. A lot of the larger cancer centers tend to have full-time dietitians, more than one available. A lot of times, they specialize in certain types of cancer. But if you are at a smaller cancer center, they don’t always have the resources to pay for a full-time dietician. They may have dieticians in other parts of the hospital that they can sort of pull on when they need it. So it can be challenging just depending, but I always tell people to start with their treatment center.

Even in my area, there are two treatment centers here, and I work at a local nonprofit, so I’m not even part of any of the treatment centers. And both of our treatment centers here have two or three dieticians on staff for their treatment center. So whenever somebody local to my area comes to me, I always point them back say, have you asked at your treatment center? Because they may not even know they have a dietician available.

So definitely asking even if the doctor has not recommended it, you can still ask if nutrition consults with a dietician are available, and they should be able to answer that question. And then if you don’t have access to one at your treatment center, you can look for a local dietician. There are a lot of dietitians in private practice. They may or may not have oncology experience, but they probably can help troubleshoot some things.

Like all dietitians should be able to help you meet calorie needs with some various food ideas. So those are also, I think, good options. And eatright.org is also a national organization of all types of dieticians, and they have a find an expert search as well. So I would start with your local treatment team, and if they can’t find you somebody there, then you may have to kind of dig around a little bit.

Lisa Hatfield:

Well, you heard it here from our expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

What Are Practical Tips for Managing Taste Changes During Cancer Treatment?

October 16, 2024/in RESTORE, RESTORE Interviews /by Kara Rayburn

Registered dietitian and oncology nutritionist Julie Lanford discusses common taste changes that may occur during cancer treatment and practical strategies and resources for managing taste changes for patients.

Download Resource Guide

See More from RESTORE

Related Resources:

How Can I Stimulate My Appetite During Cancer Treatment?

How Do Nutritional Deficiencies Impact Cancer Treatment?

Dos and Don’ts of Supplement Intake During Cancer Treatment

Transcript:

Lisa Hatfield:

Dealing with changes in taste perception can make mealtime challenging. What are ways to make food more enjoyable? As part of the Patient Empowerment Network RESTORE program, we’re diving into practical tips for managing taste and appetite changes. Julie, what are some practical tips for dealing with changes in taste perception that can make food more palatable? And do you have any recommendations for flavor combinations or cooking methods that might help enhance the taste of food for those of us experiencing a metallic or altered taste from our treatment?

Julie Lanford:

Yeah. So there are some different strategies for affecting taste. And different people tend to have different challenges with the taste changes. So like you mentioned, the metallic taste. Some people don’t tolerate really sweet food where they used to. So it all depends on the type of taste change. Some of the common tips that we give people is to sort of clear your palate before you eat by drinking some water with fresh lemon squeezed into it. That tends to somehow sort of reset your taste buds. And then if you notice you don’t like the taste, sweet taste or that sweet tastes off or coffee tastes off, of course, avoiding those foods.

And then doing if sweet is bothering you, you can do things like having more of a sour type of marinade. For people who have to drink the nutrition supplement drinks, they tend to be very sweet. And if you’re not tolerating that taste so well, you can get bitters, drops of bitters, and add those just to help tone that sweetness down a little bit. And then for some people, it’s adding a different flavor to the food. So if something is really bland, and you don’t have much of a taste, the taste receptors aren’t working very well, can you add like an acid, like the lemon juice or tomato sauce? Can you add spices to it that make it a little bit of a stronger flavor so that your muted taste buds can maybe pick it up?

Or if you have mouth sores or things that are making those types like spicy foods not tolerable, how can you make it more like creamy and bland? So it sort of depends on the taste change. There are some great tips from Rebecca Katz, who’s a chef. So I will say, I find that the chefs tend to have a little bit more expertise around the taste change issue, because that their expertise is like tasting of food.

Like as dietitians, our expertise is the nutritional value of food and how you meet your needs, whereas the chefs look at the taste piece. So Rebecca Katz is sort of a specialized chef for oncology. And she has a whole system that works around fat, acid, salt, and sweet in terms of how you can tweak things in order to meet those needs. So that’s if you need more sort of troubleshooting, I think her resources are really helpful. And she’s got great, very fancy foodie-type recipes for cancer patients, which is fun.

The other thing, though, with metallic, I mentioned squeezing lemon into water is avoiding metal silverware sometimes helps as well. So I think all of us have at some point tasted like a fork that you can just taste the metal in your mouth. And for a lot of cancer patients, that’s just magnified.

So using plastic silverware, or there’s some bamboo silverware or things that don’t involve metal can help with that in terms of trying to avoid that. And then red meats tend to have more a stronger metallic flavor. So probably staying away from having your favorite steak at this moment might be another wise thing to do.

Lisa Hatfield:

You heard it here from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

How Can I Stimulate My Appetite During Cancer Treatment?

October 16, 2024/in RESTORE, RESTORE wellness /by Kara Rayburn

Registered dietitian and oncology nutritionist Julie Lanford discusses ways for cancer patients to stimulate appetite and strategies for improving calorie intake to help maintain wellness.

Download Resource Guide

See More from RESTORE

Related Resources:

How Important Is Calorie Intake During Cancer Treatment?

How Much Protein Should I Consume While Undergoing Treatment?

How Is Hydration Managed During Cancer Treatment?

Transcript:

Lisa Hatfield:

Managing appetite loss during cancer treatment can be a significant challenge, but are there strategies that can help? In this Patient Empowerment Network RESTORE program, we’ll explore practical tips and techniques to help stimulate appetite and hopefully make mealtimes more enjoyable.

Julie, what are some effective ways to stimulate appetite during cancer treatment? And are there specific foods or meal strategies that can help make eating a little bit more appealing?

Julie Lanford:

Yeah, so I think the most effective way is to allow yourself the freedom to eat what sounds good to you, no matter the time of day or whether it’s a food that typically goes at that time of day. So for people who are facing appetite challenges, remembering that any food is better than no food lowers the bar on your expectations. I think a lot of people get caught up in like, well, I should only eat “healthy foods.”

Well, at this point, if you are in a position where you don’t have much appetite, I just want to remind you that any food is better than no food. So things like milkshakes are okay. If that’s all that sounds good to you, go ahead and eat them. All the things that maybe you historically might not have let yourself or your children consume at breakfast, you could just go ahead and, like, throw the rules out and give yourself the freedom to eat anything that sounds good to you, which can be kind of fun, I think, in a way. It’s not fun to not feel like eating, so I think that is a significant issue.

And then, so I would say don’t eat your favorite foods, thinking that you might not tolerate them so well. But anything that sounds like you could get it down would be my first thing to think of. And then there are some strategies around meals that can help.

If you notice that you tend to be able to eat soft foods better than foods you have to chew a lot, then we might suggest more of a soft food or liquid diet. If you notice that hot foods don’t go so well for you or cold foods don’t, then finding either room temperature foods or hot foods or cold foods, depending on what it is. I think so those are kind of sensory-type things. And then the other thing is just that we know that yellow and red colors can help stimulate the appetite. McDonald’s and Burger King aren’t stupid. They have chosen colors for a reason.

So we will also recommend, like, do you have plates or cups or table, table, I say tablecloths, if you have placemats in that color, so yellow or red, that can sometimes help just, like, give one little extra boost that your appetite needs to get to get that down. There are some medications that can help with appetite. Of course, there are always side effects. And for a lot of people in cancer treatment, it’s like you’re already on so many medications. Do you want to spend one more?

So I do like trying out all these other strategies first to see if we can sort of put together some kind of formula that works for you, that just gets you enough motivation or your body enough receptivity to the food to get it down and meet your needs. But if those aren’t working, definitely talk to your medical team about what types of pharmaceutical options might be available to help get that food down.

Lisa Hatfield:

Okay, thank you. And just a side tip that I learned from an occupational therapist, she told me if I either have a bread maker or can borrow a bread maker that the smell of fresh baked bread can sometimes stimulate appetite. So I didn’t have a problem with appetite on my high dose steroid days, but otherwise I did and it did seem to help and maybe just feeling like I was productive and made a loaf of bread helped too.

But anyway, that’s just a tip for patients, they might want to try it also for stimulating appetite.

Julie Lanford:

Yeah. And then you have fresh bread, and that’s amazing.

Lisa Hatfield:

Great, yeah.

Julie Lanford:

Fresh food itself that can really be much more appetizing than something that’s maybe not so fresh.

Lisa Hatfield:

Right. Yeah. Thank you. Julie, are there specific types of foods or meal patterns that might help make eating more appealing and manageable?

Julie Lanford:

Yeah, I think that, again giving yourself freedom on the food choice, but also give yourself freedom on the portion sizes of food. So what you might be used to is larger portions on your plate, but maybe you can’t tolerate a lot at a time. Your stomach is just not settling so well, and you need to eat smaller amounts more frequently.

So often setting a timer for every two to three hours and eating a small amount each of those times might be more effective at meeting your calorie needs without causing too much overfullness for your appetite. And then making sure that the foods you consume are as high-calorie as possible. So choosing the higher fat versions of things, choosing the things that don’t have artificial sweeteners in them, because we are going to want all the calories possible in the food choices that you eat, especially if you’re not able to eat as much volume as you have been before.

And then using beverages to get extra calories in is also important. So it can hydrate you, but also provide extra calories. So juices, milk, even some of like Gatorade will give you a little bit of calories in with those electrolytes. So those are types of things. And then, of course, protein shakes or any types of smoothies you can make yourself will help get extra calories in.

Lisa Hatfield:

Okay, thank you. You heard it here from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

How Is Hydration Managed During Cancer Treatment?

October 16, 2024/in RESTORE, RESTORE wellness /by Kara Rayburn

Registered dietitian and oncology nutritionist Julie Lanford discusses general hydration needs, how needs may vary during cancer treatment, and tips for maintaining hydration levels.

Download Resource Guide

See More from RESTORE

Related Resources:

How Important Is Calorie Intake During Cancer Treatment?

How Much Protein Should I Consume While Undergoing Treatment?

How Can I Stimulate My Appetite During Cancer Treatment?

Transcript:

Lisa Hatfield:

Hydration is a crucial aspect of supporting your body during cancer treatment. But what should patients know? Can side effects like vomiting and diarrhea make you lose too much fluid? I’ve connected with a leading voice on this topic, and we will get some answers right now on this Patient Empowerment Network RESTORE program.

Julie, it may seem like a silly question, but how much water should patients be drinking each day while undergoing cancer treatment? And can too much or too little trigger side effects?

Julie Lanford:

Yeah, so we talk in general about water intake. And we often, the guideline is eight to 10 cups per day, which is somewhere between 64 and 80 ounces, if you do your math. And that’s the general good guide.

Now, if you have a treatment regimen, where the doctors are like, Make sure you hydrate really well for the next two days, somesome chemos are pretty toxic to the kidneys. And so they want you to take in lots and lots of extra water to kind of flush that out, then you would want to be doing 10 cups and maybe a little bit more. You know, technically people can consume too much water, it would take a lot, and it would take you consuming a lot at one time in order for you to cause a lot of problems.

The other sort of risk in terms of taking in too much water is if you’re not eating very well, and you’re not getting your electrolytes, and you’re just drinking plain water, sometimes that can cause a balance issue with the electrolytes in your blood. So if you are somebody who’s nauseated, having lots of diarrhea, and you’re just drinking water, I would suggest you have some type of oral rehydration beverage, you can make some yourself. But the easiest thing is something like Gatorade or Pedialyte, or even just diluting juice and adding a little bit of salt to it, something that helps get your body those electrolytes in addition to the water, because that’ll just help everything function better.

But let’s assume that you can eat okay, then generally eight to 10 cups of a beverage a day should meet your needs. You definitely can get too little water, that is always a challenge. And usually a sign of not enough water is when you get lightheaded standing up, or you have lost weight really quick, like, I don’t know, two pounds over a day, or five pounds over a day. That to me is a sign of fluid loss without being replaced, which can happen if you are having a lot of vomiting and diarrhea, which just pulls a lot of water out of your body.

And so those oral rehydration solutions, which have the electrolytes mixed in with the water really can help you from sort of getting overly dehydrated, because the last thing you want to have to do is go over to that hospital. But if you have lost fluids really, really fast, and you are nauseated, you can’t keep anything down, or you cannot stop the diarrhea, you will feel better if you go over there and get hydrated.

That’s what I always tell people, especially if it’s a Friday. Nobody wants to have to deal with the hospital, but you can feel pretty awful if you’re dehydrated, it’s very risky. So it can be challenging. But unlikely to get overhydrated, probably more likely to get dehydrated.

Lisa Hatfield:

Okay, thank you. Julie, are there specific hydration strategies or recommendations to follow? And how can patients address common hydration challenges and ensure they’re meeting their fluid needs effectively?

Julie Lanford:

Yeah, so I think the challenge often is that you don’t realize how much time has gone by since you’ve had something to drink. So a couple things, monitoring your weight, if this is a significant risk for you, you want to pay attention to if your weight is staying stable. And then the other thing is to go ahead and fill up a big jug.

So if it’s 64 ounces, or you want to do two jugs a day, and drinking from that, so you know how much you’re having, it is also perfectly fine to get your water from juice, from different beverages, even coffee and tea. I know some people like to say, well, if it has caffeine, it’s dehydrating you. It’s not really that much anyway.

And if that’s all that tastes good to you, it’s better off to get that. So I think spreading your beverages throughout the day. So setting a timer, have four ounces or eight ounces every hour or two, and allow yourself the freedom to choose whatever beverage you think will taste good to you.

If you’re tired of the sweet stuff, let’s say you’ve kind of existed on like Ensure and Gatorade for days, and you’re so sick of the sweet taste. Broths are something that can help hydrate you. Milk is a great option to give you nutrition and hydration. You can get lactose-free if you don’t tolerate lactose, but those also give you that water along with the nutrition. So those are kind of my basic guidelines for doing that. And then just making sure that you’re letting yourself have things that taste good to you so that you’re more motivated to get it down.

Lisa Hatfield:

Okay, thank you. You heard it here directly from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

How Much Protein Should I Consume While Undergoing Treatment?

October 16, 2024/in RESTORE, RESTORE Interviews /by Kara Rayburn

Registered dietitian and oncology nutritionist Julie Lanford discusses protein needs during cancer treatment and advice for boosting protein levels for optimal wellness during treatment.

Download Resource Guide

See More from RESTORE

Related Resources:

How Important Is Calorie Intake During Cancer Treatment?

How Is Hydration Managed During Cancer Treatment?

How Can I Stimulate My Appetite During Cancer Treatment?

Transcript:

Lisa Hatfield:

How can patients undergoing cancer treatment ensure they are meeting their protein needs when facing taste changes or digestive issues? Are there certain meats or protein drinks that should be avoided altogether? I’m getting some clear answers from a respected expert in this Patient Empowerment Network RESTORE program.

Julie, what are some practical tips for those of us actively undergoing treatment when it comes to protein needs? And can you share some of the best practices that have been successful, particularly for those of us who have experienced taste changes or digestive issues?

Julie Lanford:

Yeah, so protein needs can be challenging to meet, because a lot of our favorite sort of comfort foods that we usually go to when we’re sick are not necessarily high in protein. So the first thing to, I think, do is to kind of speak with your medical team to see how much protein you might be needing. Or if you think you’re having enough, they can usually do a simple calculation, or you yourself can actually calculate. And we do this in kilograms, for whatever reason, us dieticians work in kilograms. So if you take your body weight and divide it by 2.2, that will get your kilograms.

And then generally, we would say for people during treatment, aiming for 1 to 1.5 grams of protein per kilogram body weight is something that I think can give an easy range. The typical person, we would actually put more at 0.8 grams per kilogram body weight, but because when people are under treatment or have active treatment going on, that often uses more of our stores, then we sort of bump that suggested range up a little bit. So once you kind of have an idea what that is, then you need to know, well, what are the foods that I’m eating that have protein? So you mentioned meats, you mentioned some protein drinks, so those are pretty easy ways to get quick protein.

There are plant proteins as well, nuts, seeds, and beans. But when you’re talking about digestive issues, sometimes those higher fiber forms of protein are not the easiest to digest. And I know a lot of treatments do cause people digestive issues where they are just not able to sort of break down some of those more complicated foods.

So meats and protein drinks tend to be the easiest to digest, as well as the dairy-based protein, which you can find in milk, yogurt, cheese. Those are ways, as long as you tolerate lactose in the milk, but even if you don’t tolerate lactose, it’s pretty easy to get lactose-free options. Milk is a really simple thing to throw in smoothies that helps to add more. And I think any types of meat are fine, as long as you tolerate them and they taste good to you.

Some of the ones that are just easier to eat will be some of the softer meats, things you don’t have to chew as much, so more like chicken or like shredded meats or anything that might be in a soup where it kind of just goes down with the liquid. Protein drinks are great. I would pay attention to how much protein you can get per, usually they’re in 8-ounce containers, so finding like the plus version, so things like BOOST Plus or Ensure Plus will have higher levels of calories and higher levels of protein, so per 8 ounces, you get better bang for your buck.

And then you can make your own sort of protein drinks at home, like I mentioned, using milk, or you can buy protein powders. The actually most affordable protein powder you could get would be like a dry milk powder that you can just toss in with extra things. So I think those are really simple, easy ways, but the most important thing is that you make sure you’re eating regularly and you’re including protein regularly throughout the day.

So if you’re not eating much, then having something every two to three hours, like with an alarm, and making sure that when you have something, it does include protein, it’s much easier to meet your needs when you’re doing that several times a day than if you’re relying on like one or two sort of eating sessions a day to get them all in.

Lisa Hatfield:

Okay, thank you. Julie, how can patients safely incorporate protein powders or shakes into our diet without disrupting treatment? And is there any risk of getting too much protein?

Julie Lanford:

Well, you can get too much protein. I don’t see that very often, unless somebody is using a ton of those protein powders, which I just don’t really find feasible for people who are having digestive challenges or appetite issues. So it seems unlikely. I would be cautious with protein powders that you get from like a health food store, because they’re not regulated in the same way that food is regulated. I wouldn’t take that risk if it were me or my family member. If I were going to use a protein powder, I would purchase one, either from the grocery store, like the dry milk powder is regulated and controlled in terms of there’s not going to be contamination. The other challenge with some of the protein powders at the health food stores is that they’re typically not designed for the sort of typical oncology patient.

They’re really more designed for people who want to be like bodybuilders. And so they’ll throw in lots of this other stuff, creatine or different things that they claim are boosting performance that I wouldn’t be comfortable throwing into the mix of my oncology treatment regimen. So I tend to be pretty basic. I just, if I want protein, I want to include things that only have protein. I don’t want to add a lot of extra other stuff. If I’m going to add fiber to my day and I need to use a fiber supplement, I actually don’t want any extra stuff. And I don’t want the flavorings with it. I just want it plain.

And so I feel that way about protein as well. Ideally, you will get it from food sources. If you can’t meet your need from food sources, protein powders from legitimate sort of food-based sources, even if they are, in shake form at the grocery store sold on the shelf, they should be pretty well-checked and monitored. And so that’s what I tend to tell people to look for when they’re trying to make sure to get enough protein.

Lisa Hatfield:

Okay, that’s great information for patients. You heard it here directly from our expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

How Important Is Calorie Intake During Cancer Treatment?

October 16, 2024/in RESTORE, RESTORE Interviews /by Kara Rayburn

Registered dietitian and oncology nutritionist Julie Lanford discusses the impact of calorie intake during cancer treatment, a simple calculation to use for caloric intake, and nutrition advice for common dietary needs for boosting during treatment.

Download Resource Guide

See More from RESTORE

Related Resources:

How Much Protein Should I Consume While Undergoing Treatment?

How Is Hydration Managed During Cancer Treatment?

How Can I Stimulate My Appetite During Cancer Treatment?

Transcript:

Lisa Hatfield:

Nutrition plays a crucial role in supporting the body during cancer treatment. Proper nutrition can help manage side effects and maintain strength and energy. What should my caloric intake look like? I’m diving deep into this topic as part of the Patient Empowerment Network RESTORE program to uncover how best patients can best support our bodies through nutrition during treatment.

Julie, how can patients accurately determine their specific caloric needs during cancer treatment considering the increased energy demands and perhaps the patient’s existing treatment plan?

Julie Lanford:

Well, calculating caloric needs is not an exact science. So as a dietitian, we were trained in this, but even being trained, each person is very different. Treatment regimens are different, and the foods they like are different. So, we often don’t actually calculate someone’s needs, unless there is some kind of problem going on.

So typically the sign to that would be unintentional weight loss either before a diagnosis or after diagnosis and because of treatment. So if people start with losing weight and feeling like they can’t quite keep it stable, that’s when we will go through these calculations.

And someone’s medical team can do this for them, but it’s also a pretty simple sort of range that you can come up with for yourself just to see how you’re doing. So we always calculate things for whatever reason in kilograms, per calorie per kilogram. So if anybody in the audience is wanting to try to figure out some kind of range for what would help them maintain their current weight, they can take their pounds, their body weight in pounds divided by 2.2, and that will give them kilograms. And then what we use for calculations, it can be pretty broad.

So, but let’s just say in general, I might calculate for somebody a range between 25 and 35 calories per kilogram. And that is, it might seem like a lot for some people. Some people might not be familiar with how many calories are in different things. It’s really mostly meaningful if you’re somebody who’s not eating well, and you’re taking a lot of supplement drinks or things like that, that have the calories listed on them. Of course, it’s easier to figure it out that way.

I often use a calorie range to help people like that figure out, well, how many, supplement drinks like Ensure or BOOST or Carnation Instant Breakfast might you need to drink in a day if you’re not able to eat in order to help maintain your weight. So it can be helpful to have that range, but it’s not always easy for patients to figure out how many calories they’re taking in. And that’s just a general guide.

Some people’s treatment regimens or types of cancer will actually put them in more of a hypermetabolic state. And we may even estimate up to 40 calories per kilogram. And then if somebody is a small individual, not very active, and they’re not in a hypermetabolic state, even down to 20 might be something we work with. So it is quite a range, but I do think for some people it’s helpful to really compare those numbers.

Lisa Hatfield:

Julie, what are some practical tips for incorporating high-calorie, nutrient-dense foods into my diet, especially when I’m experiencing a lack of appetite or nausea?

Julie Lanford:

I’m always encouraging people to just make sure if they are nauseated to the point where it’s affecting their intake of food, then they need to be sure they’re taking nausea medicine. Whatever it is, if it’s a once a day, or the sort of quick-acting nausea medicine, or both, and making sure to take those 30 minutes before they plan to eat. And that way, once they approach the table, the nausea’s sort of settled down, and it’s easier to take those foods in.

The last thing we want is for somebody to not take their nausea medicine, then get to the table, then the smells or the looks of the foods make, they feel nauseated, they can’t eat it, then they take their nausea medicine, but then it’s like another 30 to 45 minutes before it’s kicked in, and now you’ve missed a window of opportunity to put those calories in.

So that’s your first, and I think most important when it comes to nausea. And then the second thing actually ties in very well with the poor appetite challenges, is that you just want to maximize the volume of the food you’re eating. So you may not be able to eat as much as you normally do, but if you can make those meals or snacks as calorie-dense as possible, then that way even if you eat less foods, you’re getting as many calories. And the most dense version of calories is actually fat. So as long as you’ve got your nausea under control, and your digestive system is basically kind of working okay, you can get more calories per volume by having higher fat foods. So that’s why we’re always telling people choose whole milk, choose the highest fat cheeses, peanut butter, which is a good source of healthy types of fats, heart-healthy fats, avocados.

Anytime you can include those types of things into the foods that you know you like, you’re going to be able to boost their calorie content. Other people find that actually drinking foods or calories is easier than eating them. If you don’t have much appetite, it somehow just feels like you’re eating less if you’re drinking it through a straw. So making things like smoothies, or cream soups or anything that you can think that you’ll be able to swallow.So even if it’s that you’re drinking chocolate milkshakes all day long, that is going to be better for you than not having enough to eat. Because if your body does not have the calories and the protein to sort of recover from the treatments and the challenges that you’re facing, there’s really not much no tools your body has to help with that. So I always say eating something is better than eating nothing. So don’t take any foods off the table. If you have a wide variety of choices, given your appetite challenges, of course, we want people to consume lots of nutritious, healthy, or traditionally healthy foods.

But if you can’t do that, any food is better than no food. And that’s kind of the bottom line. And remembering that the higher fat versions of things are likely to have higher calories. If you’re choosing a supplement drink, I would look at the calories and the protein to make sure and, it’s going to be higher calorie if it’s using things like real sugar rather than artificial sweeteners. So some of those drinks are kind of tailoring to the people who want to do more keto-type diet for people who are in cancer treatment and just need more calories. You need the drinks with the highest calorie content. So I would not be using those. We want the sugar that will help to add more calories into it.

Lisa Hatfield:

Okay, thank you. Julie, how often should patients reassess their caloric and protein intake with their healthcare team? And what signs should prompt them to seek adjustments to their nutritional plan? And are there any tools that patients might be able to use for screening and monitoring nutritional intake during cancer treatment?

Julie Lanford:

So there are some screening tools that treatment centers will often be using. There’s like a three question malnutrition screening tool that a lot of cancer centers have integrated, and they would be using that pretty regularly, maybe not every week, but a few times throughout treatment. But generally, the things that they’re asking on that are things that any patient should, I think, be monitoring for self-monitoring or caregivers monitoring for them, which is just what is your weight status compared to what your usual weight is. And I like to compare to someone’s usual weight, as an adult and before any inkling of cancer came around. So if somebody lost weight, significant amounts of weight before diagnosis, I’m not looking at their usual weight as at diagnosis, I’m looking at their usual weight going back. And so that’s one thing is just change in weight.

If your weight is changing, that is a sign that your nutrition strategy might need a little tweaking. If your intake is not very good, that’s another sign. So those are kind of the key things is just are you able to eat? And are you maintaining your weight? Usually people are getting weighed once a week if they’re coming in for treatments regularly. Now, if somebody is not coming in very often, you probably will need to monitor your weight at home. And yes, you need to advocate for yourself in the doctor’s office, because sometimes they just don’t pick up on those changes or they don’t see them as particularly important.

So I would say that you are somebody as a patient or a caregiver that needs to kind of bring up that conversation. If you have noted a drop, and then it some drops some more, if you’re going down and up and down and up and generally staying the same, that’s okay. But if we’re seeing drops and drops and drops, even if it’s just two pounds here, two pounds there, but you’re not rebounding, then that to me is a sign you need to make a change with your nutrition strategy.

Lisa Hatfield:

Okay, thank you. And are there any tools that patients can use to monitor that? Or do you recommend just basically using the scale and identifying if there’s weight loss and notifying their health care team? Is that the best way to monitor?

Julie Lanford:

Mainly yes, the scale is the easiest. You can do fancy things like body composition analysis, which honestly, some of those that they’ll sell to you at home probably aren’t very accurate. Perhaps they might be accurate, if you’re always comparing to yourself or if you do any workouts in the gym, and you notice that you’re just not able to do as much, but there’s so many things that impact your strength, given that you’re under cancer treatment, it’s really hard to tell. So weight is kind of the key thing. If your clothes fit differently, sometimes that can also be a sign of body composition changes, or you may notice that your body composition is changing. I would say if your body composition is changing, that also may tip you to think that your sort of exercise approach may need to be adjusted as well.

That’s the pairing of nutrition and exercise is that if your weight staying stable, but your body composition is changing, or you’ve noticed muscle loss, either through strength, or just by looking at how your body looks, you can eat enough protein, but that’s not going to build muscle, what builds muscle is using your muscles. So it needs that combination of both being physically active and perhaps using a trainer or somebody who can help you focus on different areas where you’ve noticed muscle loss, and also making sure to provide your body with those nutrients that need to build the muscles.

Lisa Hatfield:

Okay, thank you. You heard it here directly from the experts. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

What Is an Oncology Dietitian vs. a Nutritionist?

October 16, 2024/in RESTORE, RESTORE Interviews /by Kara Rayburn

Oncology dietitian Dr. Cynthia Thomson from the University of Arizona discusses the differences in education levels, training, and continuing education for dietitians versus nutritionists and the meaning of registered dietitians and registered dietitian nutritionists.

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Transcript:

Lisa Hatfield:

Dr. Thomson, can you explain the difference between a dietitian and a nutritionist, and why it’s important for patients to seek out the appropriate person, maybe in their cancer center and oncology dietitian when receiving care for cancer?

Dr. Cynthia Thomson:

Yeah. Definitely. So a registered dietitian, or what we call an RD, similar to a registered nurse, RN, right, they have had a four-year undergraduate degree that is extremely heavy in the sciences, chemistry, biochemistry, physiology. They understand how nutrients are metabolized and how the body processes nutrients to optimize health. In addition, after all of that four-year degree, which is pretty much equivalent to a pre-med degree, they will then go through an internship where they’re supervised by professionals in the field and spend quite a bit of time in the clinics with patients, learning the day-to-day application of all that knowledge that they’ve learned. It’s a five-year commitment for most individuals.

And then they have to pass a registration exam. And then on top of that, they have to stay up-to-date in terms of continuing education, right? They can’t just walk away and then for the next 30 years practice nutrition without being up-to-date. And so it’s a pretty intensive process and a lifelong learning process. In contrast, the nutritionist could be anybody. Lisa, you could decide today, you’re a nutritionist. Technically, in many states, you could hang up a shingle and say, come see me, I’m a nutritionist. And so it gets a little confusing, because people assume that people who say they’re a nutritionist know nutrition.

And, unfortunately, over the years, it has been very difficult to convince people or even educate them on what a registered dietitian is. So about a decade ago, the Academy of Nutrition and Dietetics, which is the professional organization that registered dietitians belong to, decided maybe we should opt to call ourselves registered dietitian nutritionists RDN, because then people would start to put it together that there are different kinds of nutritionists. And so many dietitians have moved to the title of RDN, others who’ve been in the field longer may have chosen to stick with the RD only. And so really look for an RDA or an RD when you’re looking for professional help, because you know you have a highly qualified individual.

When I became an oncology dietitian, my whole day was about taking care of cancer patients. I wasn’t seeing one cancer patient and five heart patients and two pediatric patients. I was seeing oncology patients, inpatient, outpatient, all different cancers at all levels of care. And so I really understood the disease process and how it affected the nutritional status of my patients. And so it’s just a matter of an oncology dietitian is really going to have that certification above and beyond the RDN that says, I know my stuff, and I’ll share it with you. And they also have to go through an exam, a special exam to be an oncology dietitian, and they have to repeat that exam every five years, so very intense. You get what you pay for, and the dietitians who put them through, themselves through all that training do so because they know that’s what’s best to meet the needs of their patients.

Lisa Hatfield:

You’ve heard it straight from Dr. Cynthia Thomson. Thanks for joining us on this RESTORE program. I’m your host, Lisa Hatfield.

Julie Lanford: Why Is It Important for You to Empower Patients?

September 4, 2024/in EPEP, EPEP Videos /by Kara Rayburn

Why is it important to empower patients? Registered dietitian and oncology nutritionist Julie Lanford discusses her perspective about empowering patients and her approach to shared decision-making.

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Transcript:

Julie Lanford:

I think it’s super important that patients feel like they are in control of decision-making regarding their treatment regimen and how they want to approach their treatments. So I always spend time just trying to find out what are these patients’ goals for their life and for their treatment? What does their quality of life look like? So that we can tailor their treatments towards that and not only focus on eliminating cancer from their body, but rather seeing them as a whole person that wants to enjoy whatever time they have left and to tailor our treatments towards that.

So really in conversation with the patient, like what is it that they want to get out of the time that they’ve got left? Are they one that’s going to just go all for it and whatever it takes for treatment, or do they have other goals that they want to work towards, that maybe will define how we go about treatment? So those are the things that I like to make sure that patients feel like they are in control in the decision-making or very much informing the process, rather than just taking our sort of prescription as is.

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