Care Partners Compass: Navigating CRC

S2Ep5 Gut Reactions: The Importance of a Dietitian, pt 2
Care partners Compass: Navigating CRC
Elsa Lankford

Elsa 0:01
Welcome to Care Partners Compass Navigating CRC. My name is Elsa Lankford. I am the care partner to my incredible wife, Kristine, who has stage four colorectal cancer. As a disclaimer, this podcast and its content is for entertainment purposes only. The views and opinions expressed by any hosts or guests on this podcast are their own personal opinions. Reference to any specific product or entity does not constitute an endorsement or recommendation. This podcast does not contain medical or legal advice. Please consult your medical professional about any medical questions or concerns.

Elsa 0:46
In the last episode, I was talking with Lora Silver, who is a dietician who works for Smilow Cancer Center, which is part of Yale New Haven Health. She had so much important and interesting information to say that I had to make it into two episodes. So here's part two. Now, if you didn't listen to the first episode, um, I think you can listen to these in either order, so you can check it out after you listen to this one. But now, we're gonna jump right in.

------ Gut microbiome ------ 1:18

Elsa 1:18
Gut microbiome comes up a lot in the colorectal cancer community. Can you talk a little bit about that?

Lora 1:26
there's a lot about inflammation that's mediated by our gut. And we've all heard a lot now about the gut microbiome, right? it's the composition and balance of bacteria in our gut. And we all have beneficial

Elsa 1:44
Hmm.

Lora 1:45
gut bacteria and less beneficial gut bacteria. There's always a balance of those things and they're always in flux. We can either be feeding the beneficial bacteria more or feeding the less beneficial bacteria more. Um, and the preferred food and the best source for the beneficial bacteria seems to be the fibers from the plant foods that we eat.

2:11
Um, still doing a lot of research to figure out which ones exactly and in what proportions. But the takeaway, I think at this point, from all the research that's out there, is really the more fiber in our diets, the better. We can get in a lot of different ways. Um, you know, a lot of folks with history of colorectal cancer may have had also a history of bowel obstructions. And in those cases, fiber is is an area of concern and something we need to dive into and, and clarify so that everyone's on the same page about it.

------ Fiber! ------ 2:42

Lora 2:43
it's actually more nuanced than that. So if I've had a history of bowel obstruction, I don't actually need to follow a low fiber diet per se. I need to follow a diet that's low in insoluble fibers, which are really the hardest to digest fibers. Some of the foods are a little more obvious where they have a lot more roughage and kind of are stringy and fibrous. But there's a lot of foods that have that easier to digest soluble fiber that you can incorporate safely and that's still really good and protective for you. And that's a workaround, right? So even if I've had a history of bowel obstruction that way, I can still benefit and have a lot of good sources of fiber.

------ How to get more fiber, even if you can't eat fiber ------ 3:21

Lora 3:21
The other thing that makes any kind of fiber or plant food more digestible is, well, chewing really well. But also, even if I don't do that, if I'm able to peel it, if I'm able to cook it, if I'm able to blend it down into a smoothie or a shake or a soup or a sauce, any of those things are helping to give my body a head start and to pre-digest it, so to speak, and make it more easy to digest and break down. So those can be some workarounds. If I've been told to be careful with fiber, the sources of fiber, and again, the whole fiber question can be really tricky if you're not working with a dietitian, because I think it can get complicated. But again, sources of soluble fiber can be things like rolled oats, like regular oatmeal. It can be peeled fruits and vegetables. It can be, you know, a lot of fruits and vegetables that actually have a kind of fiber that's pretty easy to digest. Carrots and greens mean, most of the fruits are actually good with that soluble, easy to digest fiber. The only exception would be berries because berries are pretty high in that harder to digest, insoluble fiber. So they're good for us and are okay if we have not had a history of obstruction, for

------ Food source info ------ 4:43

Lora 4:43
example.

Elsa 4:44
Okay. That makes sense. Okay. That is a very helpful way to describe gut microbiome, which can be so complicated.

Lora 4:57
Yes.

Elsa 4:58
I use Google Alerts to, like, send me, you know, like, links for different things, a gut microbiome is one of them, and certain foods are other things. And I, so I end up seeing a lot of

5:20
really helpful information. Some of it's super scientific, but then I also see the, like, tabloid headlines of certain foods that eat this. So I guess the question here is when friends or the internet or AI tell you that a particular food will, air quotes, cure cancer, I know you talked about AICR as a trusted source of information. Any other suggestions, especially for people that are using AI a lot?

Lora 5:59
I admittedly need to do more learning and education myself when it comes to using AI. So I don't know a lot about this area, but I know more and more of us are using it. whether I tell you to or not, we're going to be using it, right? More folks are using ChatGPT or things like that. One of the best tips I have heard that I will pass on is that if you're not already doing this, if you're asking ChatGPT to answer something for you, Make sure that when they answer you, ask for the references or the sources. It's a really easy thing to do that a lot of folks don't necessarily do when they're doing their searches. you don't have to be super familiar with all the references

Elsa 6:37
yeah,

Lora 6:37
that they give but check their references and see if they're know, websites with that extension .gov or .edu, um, as opposed to just any old blog on the internet as their reference, that can be one of the ways to, to try to get more reliable It's so common to get well-meaning, well-intentioned advice from family and friends and from other online networks and support and it's a really tricky space because I know it's coming from a good place and everyone means well and wants to help. And what's tough is that everyone's body is so different and unique and everyone's cancer is different and unique. And what's worked for me really may not work for you. And there's not a good way for us to know certainly not in the context of a, of an online thread of a listserv or a Facebook group or something like yeah, it can be really tricky. And I think sometimes there's good times to take advantage of those resources and support networks. And then there are some times to step away away from that so that you are protecting yourself filtering the information that's coming in. Because again, I know folks are meaning well, but it can be overwhelming and not necessarily accurate or particular to your situation.

------ Spoiler alert: Sugar does not feed cancer ------ 7:57

Elsa 7:58
Yes. Can I ask you the burning cancer nutrition question that I always hear and it drives me nuts? I know the answer to it.

8:14
does eating sugar give you cancer? Does eating sugar give you cancer? I shouldn't laugh when I'm saying this, but it drives me nuts.

Lora 8:22
Yeah, yeah. Um, yeah. Um, does eating sugar give us cancer? No. The answer is no. And I actually wish it were that simple. I actually wish that were true because if it were, then we could more easily study it. We could more easily help people and eliminate it from our diet and then have an immediate impact. So, and I think that's why that myth persists.

Elsa 8:51
Yeah

Lora 8:52
And gets a lot of attraction and attention and headlines. but anyway, that's a no. some of the reasons why that may have taken off and persisted the way it does is because of the activity of our cells on a PET scan, for example, there it's sugar is the fuel that all of our cells use cancer cells and the healthy cells alike. Um, and so it can look like on particular scans that may look like cancer cells are

9:27
hyperactive in the presence of sugar and

Elsa 9:28
Hmm,

Lora 9:28
are leveraging more sugar than the healthy cells. Um, but there's actually not a way for us

9:37
preferentially or divert nutrients that we eat to certain cells and not others.

Elsa 9:42
Yeah.

Lora 9:43
What

------ Inflammatory foods part 1 ------ 9:43

Lora 9:43
does seem to have some impact and some relationship is the way that

9:51
inflammation pathways respond to food. So this connects to that nutrition session at ASCO this year that everyone's been talking about, right? About, um, the inflammatory potential of our diets and the eating patterns. So if I eat in a way that is generally more balanced and is promoting anti-inflammatory pathways, promoting more balanced blood sugar in my body. So I'm eating in those ways that seems to generally create an environment where, cancer does not thrive or cancer grows more slowly.

Elsa 10:27
Yeah.

Lora 10:28
and then the opposite of those go in the other direction if I'm eating many foods that seem to increase. the levels of the inflammatory biomarkers that are circulating in our bodies, if I eat foods that are, tend to increase those.

10:46
if I eat in ways that are more imbalanced or for other reasons, I'm eating in a way that promotes a more, more irregular blood sugar response. or there's more spikes and crashes to it chronically over time, there is ongoing research in that. And we are thinking that there is some relationship between that and the diagnosis of cancer and also the progression of cancer. But you can see, like, it's actually really complicated and there's a lot of different inputs when we try to study nutrition and diet and cancer, So the bottom line for me when it comes to sugar do I need added sugars to be healthy? If I never touched ice cream, cookies, candy again, I would be healthy and I would not need those foods. So if you want to cut out all added sugars from your sure. I don't, I don't think anyone would argue with you that is a, that can be a healthy move.

11:48
However, you don't actually need to cut them out completely to eat in a healthy way. and again, especially when you're going through treatments or you're going through a rough patch where you have a lot of symptoms and side effects, it actually can be counterproductive. If you're really focused on cutting out added sugars, cause that can often happen at the expense of eating foods that in general are going to provide you with enough energy and protein and overall nutrients to maintain your weight. And again, maintain your muscle mass and strength and all of that. Um, so you don't need added sugars to be healthy, but you also need to be fearful of them. Um,

Elsa 12:24
Yeah.

Lora 12:24
and eating them in a balanced way. So eating them as parts, you know, having added sugars and desserts, for example, as part of a meal or shortly after a meal or part of a snack where they're balanced out. You want to think of anything that's got sugar in it. You want to think of other foods as diluting it, balancing it out, tipping the scales.

12:46
those, those are some of the ways to work around it you still get a net benefit from that meal. or from that day's worth of food. I hope that makes sense.

Elsa 12:57
Yeah, no, that totally makes sense.

------ ASCO session on inflammatory foods and CRC (and pizza?) ------ 13:00

Elsa 13:01
So I do want to go back for a second because you mentioned ASCO and a really interesting abstract that came up there. So ASCO is the American Society of Clinical Oncology and they have a conference, an annual conference every June and they had a very interesting session about diet and stage 3 colon cancer, where basically patients had worse outcomes if they had pro-inflammatory diets. I'll put a link to the abstract in the show notes,

13:44
So I posted about this session on some groups and the one thing that kept coming up was about

13:56
pizza. That pizza was listed as anti-inflammatory Um, I'm like, that's, that's your takeaway from this. Although I am also curious and I'm going to ask you that. Um, cause it just, it seems like such a promising thing. I mean, it's, it's a direct correlation between as a care partner, I, I can assist my loved one, maybe providing the nutrition that might, who knows, it might be helpful, not just for her quality of life, but there might be more to it than that. So,um , yeah. What's, what about pizza? What's up with pizza as, as a household that eats a lot of pizza.

Lora 14:39
Going back to those tabloid headlines, right?

Elsa 14:45
But tomatoes are inflammatory. That I think is what was blowing people's minds is they had tomatoes as inflammatory, but pizza is in anti-inflammatory.

Lora 14:55
Well, so yeah, so I can explain that. So the technical answer there, so cooked tomatoes are a good source of lycopene, which folks may or may not have heard of, but it's one of those. Uh, protecti compounds that's actually available in a lot of different red colored fruits and vegetables. Watermelon is another good source, for example. Um, so when we cook tomatoes, the lycopene is more available to us or bioavailable. Our bodies absorb it and make use of it. Um, when it's cooked, when it's raw, the tomato, when I eat a fresh tomato, it's still good for me. There's other, there's still other good stuff in there.

Elsa 15:34
Yeah.

Lora 15:35
I just, it's going to have less lycopene compared to the cooked tomato.

Elsa 15:39
I

Lora 15:39
And

Elsa 15:39
see.

Lora 15:39
I would never call a fresh tomato inflammatory.

Elsa 15:44
Yes.

Lora 15:45
And that's why we got to be cared. That's why there's like, there's nuance and it's complex. This, this, this, um, diet scoring tool that they used for the session. And it's one of the validated tools that you can use out there. And, um, all the food, you know, it's this, it's a scoring system and all the foods have to have a score relative to each other. And,

16:10
It's tough because we like to study food in terms of isolated nutrients and specific foods, right? But pizza is a great example where it's actually a whole package and combination.

Elsa 16:21
yeah. Yeah.

Lora 16:21
And the composition of that pizza can be quite different depending on what toppings I put on, exactly how much cheese, what does my pizza crust recipe have in it? Some of the debate I've heard about that session and this paper is, you know, alcohol is a common in pizza crusts.

Elsa 16:41
Oh.

Lora 16:42
In some places. So that's an interesting question because there's a lot of solid research at this point that alcohol of any kind increases our risk for a variety of chronic conditions, including cancer. And so how does, if our pizza has alcohol in it, how does that, how do we, how does that weigh in to this question of this pizza anti-inflammatory? So again, the cooked tomato, the reason why the cooked tomatoes are there is because of that lycopene that becomes more bioavailable when we cook it. But pizza can be anti-inflammatory when we load it up with plants. It's as simple as that. If you're able and willing to try lots of different veggie toppings and, or if you're able to eat a salad or soup or something else that's got fruits and vegetables along with the pizza, those are all steps you can take to make that meal more anti-inflammatory.

17:41
So it really depends on how much you're eating at one sitting, but also what the composition of that pizza is. And then the cheese kind of falls somewhere in the middle. You know, it's a, it's a higher fat content in a, you get more fat. You know, there's a lot of fat packed into a small portion when we think of cheese. So a little can go a long way, but that falls somewhere in the middle when it comes to inflammatory potential. But in general, the veggie toppings and the sauce and certain aspects of the crust, you know, if it's a whole grain crust, they're using whole grain flours that increases the anti-inflammatory On the other hand,

------ Pro-inflammatory foods ------ 18:18

Lora 18:18
there's really clear evidence for certain foods increasing the inflammatory biomarkers that are circulating in our body. And this is very consistent with the existing research we have. So again, on that list would be red meat, and that includes beef and lamb and pork.

18:41
highly processed meats that are like cured, salted.

18:47
And I think I'm pausing on the highly processed meats because it's a common ingredient for a pizza, right? A lot of us will have pepperoni, ham, sausage on our pizzas, right? So adding those toppings would be increasing the inflammatory potential of that slice of pizza, right? So you've got on this list red meat, highly processed meats,

19:11
sugar-sweetened drinks or sugary beverages.

19:16
Refined grains like white flour, for example, and products made from white flour. And then alcohol and all of those things. There's growing research that all of those categories do increase the level of inflammatory biomarkers that are circulating. Still not the end-all of diet recommendations, right? But the more that we can be aware of what those foods are, what those categories are, and limit them in our diets, it does seem to be more protective when it comes to incidence of cancer, but also progression and recurrence and our response to treatments.

Elsa 19:55
Okay. Oh, that is fascinating.

------ Teaching Kitchens and learning how to cook for cancer patients ------ 19:58

Elsa 19:59
I'm pausing for a second because it's a lot to keep track of. When you're a care partner, when you're a patient, know, thinking about inflammatory, anti-inflammatory,

20:14
nutrition, protein, all of that, it can be overwhelming, especially if you don't cook.

20:22
Luckily, Lora addressed this too.

Lora 20:24
depending on, again, where you're seeking care, you might have a teaching kitchen So Yale actually has a relatively new teaching kitchen where you can take classes, some in-person, some virtual. And

20:42
many hospitals and healthcare centers around the country, this is a growing trend. So I would look for a teaching kitchen in your area or perhaps through the hospital or cancer center where you are and see if you can access any of that. Because teaching kitchens, the whole idea is that they are providing evidence-based nutrition information and making healthy recipes that also taste good and are flavorful. But they're really based first in, you know, recipes and therapeutic approaches to nutrition and your diagnosis.

Elsa 21:12
That is fantastic. but I was going to say, wouldn't it be awesome if they, if there were cooking classes for people and families?

Lora 21:19
Yes.

Elsa 21:19
Answer, and there are, that's amazing.

Lora 21:22
That is a thing. Yes, yes. I know it's not, you know, it may not always, it may not be available everywhere yet, right? But you might be able, and I can share, I can do a little research and share some resources that you can share. But this episode, so that folks can explore that but yeah, this is a growing area, and I think it's a great, that's another great resource to think about. there's a well-known chef named Rebecca Katz, and she has written The Cancer-Fighting Kitchen. It's a cookbook, there's a website, um, I think she has a couple other resources and cookbooks now too, but, um, her materials, you can access many of them online. And for free, or you can get her printed cookbooks, I think she does a nice job of pairing recipes with, again, evidence-based nutrition recommendations. What are the basic nutrition principles that we do have enough research to support and that you can be following to help yourself and nourish yourself as we go through treatment.

Elsa 22:19
That's great.

------ How care partners can help through food ------ 22:20

Lora 22:20
the last thing I would say I really appreciate knowing that your podcast is out there. And I nutrition is such a natural place for care partners to fit into and to support. because for some of the reasons we were saying earlier, where food holds, you know, such a special role in our lives and also can be very complicated, you know, the idea of food and eating enough and getting enough protein and, you know, minimizing weight loss and avoiding dehydration. Like a lot of it can feel like a lot of it can feel like a lot of pressure from the healthcare team. Um, and food can be, it can be a source of tension and pressure, I think, in a lot of relationships and in a lot of families and even between patient and care partner. it's really natural phenomenon that we see all the time around it can be a really helpful area for care partners to help with because your job as a care partner, I think, is to really provide an environment that is supportive the patient reaching their nutrition goals and nourishing themselves well. And you cannot actually do the eating and drinking for them. It's important to remember that, right? it's important to remember that. And, um, your job is to continue to offer and provide that supportive environment to be as flexible as you can be. I tell patients this directly too, as a patient, be patient and flexible with yourself as much as you can be. but I also tell that to take care of partners and other loved ones that are, that are part of the team. I hope that helps too. I think, I think this stuff can be pretty complicated, but I think care partners can really plug in and be really supportive, even just in navigating a lot of the, you know, evidence-based We've talked about sifting through recipes and really knowing what flavors and really knowing what flavors and what kinds of meals are going to appeal most to their loved one. Um, it could be a great area for support so that patients aren't having to do all of that on

------ Sometimes you need a little help from your friends (or a carryout) ------ 24:13

Lora 24:13
their own.

Elsa 24:13
mean, because, um, I mean, cause at times, you know, as a care partner, I'm putting on different hats. It's like, am I putting on my,

Lora 24:18
I

Elsa 24:19
you really need to gain weight hat? And,

Lora 24:22
um,

Elsa 24:23
and, and, you know, making sure that, um, that that's happening. you mentioned in the beginning about quality of life and it's

24:33
having, you know, delicious food that, ticks off all the boxes. And then as a care partner, I'm going to also say that

24:43
sometimes I don't have the capacity to, to cook because I'm like, there's a stress sometimes. And then, and also there's like celebration sometimes it's like

24:56
finding delicious food that somebody else has made either from, you know, within your friends and family that are helping you out or, you know, a restaurant. I just see that people sometimes are saying like, it, it always has to be homemade and it's like in a, maybe in a perfect world, but.

Lora 25:13
you Yeah, there, you know, processed foods have been getting a bad rep, uh, especially lately. And there's a lot of processed food, like many things, is actually a spectrum.

Elsa 25:28
Hmm.

Lora 25:29
there's many examples of processed food or processing that do not remove any nutrition and actually only increase the convenience and have time-saving effects for us. I can help you with lots of tips and tricks to save money and eat healthier. And, um, but there, if I'm going to cook everything from scratch, if I'm cooking everything from scratch, there just is a year. At some point you're trading time and money.

Elsa 25:57
Yeah.

Lora 25:58
There's, there's no way around that in our current food system. I don't have any special tricks up my sleeve to help you around that. I wish. Um, so I think that's important to, to acknowledge and remember. And I think there can be some degree of convenience food. There can be lots of healthy options that are out there available. So, and also some, um, you know, so what I would call like lightly processed foods that you can get at a grocery store that you can get at the belly counter where they might've pre-chopped some things. Um, you know, whenever you're getting canned or frozen or packaged items where they've not added salt, not added sugar, or they've added minimal amounts of salt and sugar, it actually might still be a really good, healthy, nourishing option for you.

Elsa 26:43
Yeah.

Lora 26:44
That's just saved amount of time and has made the healthy option, the more convenient option. And that's really, like, that really important.

Elsa 26:54
A big thanks to Lora Silver for being on the podcast.

27:01
In reflecting back, because I've had a little time a couple weeks since I recorded this interview, I have to be in a special frame of mind to edit podcasts, especially listening to my own voice.

27:18
But I have to say that this was really inspiring to me in terms of food selection at the grocery store, what I'm cooking, how I'm cooking. And I hope that this helped inspire you as well.

27:34
Sometimes there's only so much that we can do as care partners, and cooking makes me feel like I'm being really helpful, and I hope that when I cook that my,

27:51
that that care comes through in the food. It's not just nourishment, although it is that. I think that it's more. And I hope that these episodes helped inspire you too.

Intro/outro 28:13
Thank you for joining me for this episode of Care Partners Compass: Navigating CRC.

28:25
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28:48
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28:50
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