Can you please tell us a little bit about your career so far?
The first year of being a dietitian, I hopped around from inpatient clinical to hospital employee wellness to a primary care office doing diabetes, cholesterol and weight management. Within a few months on the floors at the hospital, I knew that I did not want to make that my career. When offered a full-time position, I turned it down even though I didn’t quite have something else lined up.
Lucky for me, I had 2 outpatient options within a few weeks. I was in the primary care office for a year and then decided I was ready for a new challenge and moved over to help establish the hospital’s nutrition care program for the outpatient oncology department.
It was while I was in that position that I was involved in the cancer survivorship movement in NC and answering my patients’ questions inspired me to start www.cancerdietitian.com. Actually, it was a good friend that I met at a survivorship event who had melanoma and helped me understand what cancer survivors are looking for when it comes to nutrition information. He was a small business entrepreneur and helped me think differently about how to reach others with my expertise.
In addition, my husband’s aunt and uncle were pioneers in internet marketing and helped me understand the strategies behind good content and how to market online.
Soon after, a position came open with a local cancer non-profit where I live and I made the leap into non-profit management and brought my blog along with me, which became part of our programming.
I’ve been at Cancer Services since then (10.5 years), my blog is about to turn 11 years old (Nov 2018) and I’m still not bored at work!!
Where has your interest in the link between nutrition and cancer treatment come from?
I got a Christmas letter one year ago stating that a former neighbour of mine had been diagnosed with blood cancer and was getting a bone marrow transplant. I decided to do an endurance event fundraiser in his honour, and that same spring my grandmother was diagnosed with lymphoma.
These situations made cancer more real to me as I watched from afar as my grandmother went through chemo and radiation at the age of 85. She recovered and lived many years after.
I also formed a close friendship with a melanoma survivor which also gave me the unique experience of being a friend to someone going through treatments, tests, recurrence, anxiety and all the other ups and downs that cancer survivors experience in their journeys. This gave me a unique understanding that nutrition is one piece of a larger puzzle of maintaining well-being despite a cancer diagnosis.
What are some of the general top priorities for nutritional management for individuals with cancer?
First and foremost, maintaining adequate nutrition. Getting in enough calories, protein and essential nutrients for the body to function is always the focus of building the foundation of a good nutrition plan. On top of that foundation, we then think about the quality of nutrients and sources and how to make them more nourishing.
What are some of the ways people can get around barriers like nausea and lack of appetite, to best meet their nutritional goals?
Medication management is huge! Making sure that side effects are addressed early and often will help to make nutrition intake possible. Beyond that, many people tolerate small, frequent meals better than large meals spread further out.
For people undergoing chemo, often their symptoms come in waves. Should people periodise their diet in any way, or is it more about consistently trying to get calories/protein/nutrition in to the best of their abilities?
I say maximize intake on good days. When survivors are feeling well, that’s when we want to focus on choosing some of the healthier sources of nourishment. When it’s a down day or a treatment day and nothing sounds good except milkshakes, then we go with whatever they can get down. So each day might have a different strategy.
It also depends on the patient and how concerned they are about the sources of their nutrition. If they are someone who wants to eat as “natural” as possible, our strategy will be different than someone who is more interested in consuming their favourite comfort foods.
I have seen evidence that megadosing antioxidant supplements during chemotherapy can “protect” cancer cells during chemotherapy, prolonging the overall process. Does the same thing happen with food, or is eating as many fruits and vegetables as possible still encouraged?
We do not recommend antioxidant supplements during treatment as there is debate as to whether the antioxidants would counteract some of the intended oxidative effects of treatment, especially radiation. I see no issue with encouraging patients to get food sources of antioxidants, rather than supplement form.
There are people doing research on the ketogenic diet for cancer who believe it is the best nutritional option for certain situations – particularly certain types of brain cancer, or other forms of cancer where traditional treatments haven’t been as effective as hoped for. What is your take on this?
My take is that we do not have results yet, and the ketogenic diet is a VERY difficult diet to follow. If a patient is interested after hearing all the challenges, pros and cons, then I would be ok with them trying it with medical supervision. I happen to think that it’s so difficult and so restrictive that it would have a net negative effect on the patients’ quality of life. But that is a decision that is best left up to the patient.
In a similar vein, I have heard discussion about fasting for 24-48 hours prior to chemotherapy has benefits. Any truth to this that you know of, or is weight maintenance a larger priority?
Weight maintenance is a priority. If someone can maintain weight and wants to try the fasting then I’m fine with that. Due to the lack of clinical data regarding outcomes in humans, it’s not something that I would recommend per se, but I don’t see it being harmful in someone who otherwise doesn’t have any trouble with weight maintenance.
Do you ever have a personal worry that the nutritional management that dietitians typically go with for cancer management isn’t the best option available?
I do not worry that dietitians aren’t giving the best option. I worry that most cancer patients do not access an oncology specialized dietitian and therefore get their nutritional management from well-intentioned, and not qualified, health professionals or even worse, NOT health professionals giving misguided advice. Of course, there are rogue dietitians here and there giving not great nutrition advice, but that is not my biggest concern for survivors!
Is there anything else you would like to add to wrap the interview up?
I think the only other thing I would add is about oncology dietitians having to deal with so much misinformation around nutrition and cancer. It can be overwhelming to feel like there’s more misinformation than you can ever correct.
Also, if dietitians have any kind of presence on social media, we have experienced the people who are downright rude or question our intentions or credentials. I encourage dietitians to humbly remember our training. We don’t have to claim to be right or have all the answers, but we are trained as experts in nutrition and keep that in mind. Also… it’s not our job to convince others that they are wrong.
I have to constantly remind myself that I have my professional, expert opinion, but it is NOT my job to convince someone to see things the way I do. It’s ok for them to believe something different. Find that boundary and when to let things go and your mental and physical well-being will be much improved!