Simon Floss (Host): Hello, and welcome to One in Eight, a podcast series brought to you by the experts at Sanford Health. I’m Simon Floss with Sanford Health News.
One in Eight is a podcast geared toward increasing breast cancer awareness, as one in eight women will be diagnosed in their lifetime.
Today, we’re tackling the topic of nutrition as it relates to a cancer diagnosis. Here to help paint the picture and tell us what we need to know is Dr. Keely Hack, a medical oncologist for Sanford Health in Sioux Falls, South Dakota.
Dr. Hack, thanks for sitting down with me today.
Keely Hack, MD: You’re very welcome. Thanks for having me.
Host: We’ll start with nutrition, obviously. It’s the main thing we’re going to be talking about. Why is this so important during cancer treatment?
Keely Hack, MD: It’s an excellent question. And probably one of the most common questions that I get from my patients. Nutrition is really important for all of us. We need nutrition to fuel our bodies, to be able to do all the things that we need to do. And when going through cancer treatment, your body’s got a lot of things to do.
We’re trying to kill cancer cells and we’re trying to help the normal, healthy cells to continue to function in a normal manner. And so we need to give those cells those building blocks that they need in order to help us to stay strong and get through that treatment.
Host: So, what should a patient eat after a cancer diagnosis? Anything in particular?
Keely Hack, MD: That’s a great question. But, it’s a really hard question to answer. In some cases there’s no magic food, so to speak. So, in general, I would tell people really you want to eat what we kind of tell everybody to eat. You really want to eat good wholesome foods. I generally recommend for people to eat as much whole foods as they can, minimal processing of foods.
But also, a lot of times when you’re going through chemotherapy, there’s a whole lot that doesn’t sound very good. And so, in the midst of cancer treatment, we really talk about trying to eat those things that are not going to make you feel sick to your stomach. And that are going to help you kind of maintain the strength that you need. And so, if you’re craving mashed potatoes, then you probably should eat mashed potatoes.
Host: And who isn’t craving from time to time? It’s a Midwest staple.
Keely Hack, MD: It totally is. And there is something about, I don’t know if it’s just the potassium that’s in those potatoes, but it’s a very comforting, nurturing food. And it’s one that’s commonly craved during chemotherapy. And so if that’s what you’re craving that’s definitely what you should do. A lot of people tend to stay away from meats when they’re going through chemotherapy, just because they aren’t tolerated very well. They don’t often taste like they normally do, and they just feel heavy in people’s stomachs. I don’t put people on a strict diet during treatment. I say listen to your body, but try to maintain a healthy diet. Don’t just eat Cheetos and ice cream all the time because that’s probably going to make you feel pretty crummy too.
Host: I was just going to ask when it comes to like a balancing act, you don’t recommend a specific diet. I know you mentioned whole foods, the latest craze – well it has been for a little while – is the Whole 30 diet. People normally do it during January. How tough is it to find that balance of eating foods that you know are going to be good for you, and foods that you truly want to have during this difficult time?
Keely Hack, MD: A lot of life is about balance and, all things in moderation and really, I think finding a diet that is sustainable for you is very important. So, I generally – like getting through treatment and chemotherapy is hard enough if you’re also trying to all of a sudden change to a diet that’s really hard to stick to. That’s just going to make everything in your life more difficult at that time. And so balance, eating a balance of healthy foods, but a treat now and then is OK too. Again, moderation and balance are very important.
Host: You kind of alluded to it earlier, but what are some of the best and maybe worst foods during cancer treatment and survivorship?
Keely Hack, MD: So, some of the – this is a little bit counterintuitive. I don’t necessarily tell people you’ve got to eat a lot of this, or you’ve got to eat a lot of that. Now somebody is low, like when we do their labs for their cancer treatment, each time, if they’re low in certain electrolytes like potassium, then I might say, OK, let’s look at the list of foods that contain more potassium and try to get more of those in your diet. And I don’t really tell people, you have to stay away from this food, or you have to stay away from that food.
I do tell people sometimes to please not take high dose antioxidant vitamins, which is counterintuitive. And the reason for that is that there was a study that was done a few years ago, looking at using high dose antioxidant vitamins to help people feel better through chemo, to really help their healthy cells to recover better in between the cycles of chemotherapy, worked great for that.
Unfortunately, it also helped the cancer cells to recover better in between cycles of chemotherapy. And so we didn’t see as good a response to chemotherapy. And so, getting antioxidants is helpful and important, getting them through your diet, but taking those really high doses, those kind of super-therapeutic doses is probably not a good idea. I do recommend not to take those. I do sometimes have people bring in like bottles of supplements for me to look at, to say, is this something that’s OK for me to take when I’m going through treatment or not? And I have to almost say maybe later, but while we’re in the midst of chemo, let’s hold off on that.
Host: When it comes to like some of the best foods to eat is there any specific foods that could potentially be good in preventing cancer, or any lifestyle choices? I’ve personally read a lot on a cellular autophagy and how through long fasts and cellular autophagy you’re killing those dead cells, which in turn cancer can grow off of those dead cells. How would you respond to that? That’s a whirlwind question, I know.
Keely Hack, MD: So kind of a couple of things, right? There’s a couple of questions in that question. So one thing that I would say about a lot of the studies that we have as far as nutrition in cancer is it’s hard to come to a really conclusive outcome with those studies, because there are so many other variables. I mean, like with a medication, you have two groups and you put one group on the medication and the other is not, and you can try to control for a lot of other things. With diet, it’s usually self-reported, people eat a variety of foods. And so it’s really hard to pinpoint what the effect of one particular food is, or isn’t. There have been studies looking at that. And so some studies will show that maybe one food A has a benefit and then another study might show that that same food A is a problem.
And you don’t know, boy, is it due to other things about their diet and the people on that study? So it’s really hard to sort that out. There have been recently a lot more studies about intermittent fasting, kind of those prolonged fasts and whether that’s beneficial or is that detrimental. The jury, I think, is still out. There is some exciting data in some types of cancers that intermittent fasting may be beneficial. I think the most research we have on that right now is actually in glioblastomas, which is a type of brain tumor it’s being studied in breast cancer. We don’t have conclusive data yet as to whether it’s beneficial or harmful. When I’m meeting with somebody, when they’re first diagnosed, I don’t tell them to go start a fasting program. But if somebody is already doing fasting, then I say, I think it’s probably OK that you keep doing that through your treatment if you feel well.
But sometimes it’s hard to do that during treatment because with the nausea that goes along with chemotherapy, often that nausea is better controlled if you have a little bit of something in your stomach. For women who’ve had morning sickness before they kind of will say, yeah, this feels a lot like morning sickness, where if you have just a little bit of something in your stomach all the time, it’s a lot easier to control that nausea. So, trying to do a fasting program when you’ve got this nausea, that’s better if you got something in your stomach. It doesn’t go together terribly well.
Host: Well, in addition, correct me if I’m wrong here, fasting can produce a lot of added stress on your body.
Keely Hack, MD: It can. Yep. But, it also turns on certain cellular programs that aren’t on when we’re in the fed state. And so that’s where the jury is out is to say, is that protective or is that harmful when your body is also, so I will refrain from saying absolutely one way or the other, cause we don’t know.
Host: Sure. Man, I love talking about this stuff.
Keely Hack, MD: Right? It’s super fascinating. They’re also looking at the benefits of intermittent fasting with diabetes and heart disease and dementia, and so many things. Really as a society, we in general eat more calories than we need. And that causes us a lot of harm that increases our risk for a lot of chronic diseases. And so if intermittent fasting is kind of one way to break that cycle, then there’s a lot of potential benefits to that.
Host: Let’s talk now about how different treatment options impact appetite and diet recommendations.
Keely Hack, MD: Yeah. It varies a lot if we’re really focusing on breast cancer. So, a lot of times, when I’m meeting someone and we’re talking about starting chemotherapy and there’s this kind of idea that there’s going to be weight loss through chemotherapy and that actually is usually the opposite of what happens. A lot of times people will kind of slowly gain weight through chemotherapy. So, after each dose of chemotherapy, like when we’re doing an IV chemotherapy, every two or three weeks, when there’s that nausea and the fatigue and just the feeling like you’ve been hit by a truck for the week or two or however long that lasts, usually the appetite is pretty suppressed. And then as you start to feel better and your body’s like, “Oh, I got to make up for that.” And then the appetite comes back. And so you kind of have this up and down cycle and each time you kind of go back up, you might have a little bit more weight that you’ve regained each time.
And so by the end of chemo, you’re up a little bit. With breast cancer we also use a lot of hormonal therapies and those are more long-term that’s five or 10 years or sometimes more and different, whether we’re talking about the curative setting or if we’re talking about maintaining metastatic disease. But those are treatments that can affect the metabolism. They can affect appetite. And so we can see a lot of weight gain with that too. Not necessarily a lot for everybody. Some people have no weight gain. Some people have a little bit. Some people have a fair amount of weight gain with that. And that is hard. I often tell my patients, if I knew the secret to sustained weight loss, I would be very wealthy. I mean, the diet industry is multimillion dollar, billion dollar industry because it’s really a hard thing to overcome.
Host: I know you said you don’t recommend too many high antioxidant supplements or things like that, but are there any nutritional supplements that you would recommend during cancer care?
Keely Hack, MD: I generally recommend that people avoid supplements unless we can see on their labs that they really need something. Potassium or magnesium are the most common things that we will recommend supplementing with during treatment. Because those are ones that we tend to use up more of as we’re going through treatment with the processes that go on in the body during chemo, we can really see the potassium and the magnesium go down. I also do recommend often to use a calcium supplement during treatment because of the effect that their treatments can have on the bones. Now we have to be a little bit careful of that if people have kidney disease or if they have heart disease and have a lot of calcium in their in their vessels. But those are the things that I recommend most commonly.
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Host: Do you have any tips for caregivers specifically?
Keely Hack, MD: One tip for caregivers is find help. So for respite. Caregiving is a hard job. And so making sure that you have a backup of somebody who can help you out when you just need to do some self-care and make sure that you’re getting your own nutrition, that is very important and really helps with longevity. When you get on a plane and they say, put your own mask on before you put the next person’s, help the next person with their mask, and caregivers really need to do that too.
If we’re kind of focusing on nutrition for caregivers, it’s kind of the same things. Trying to get that good quality nutrition. That’s hard to do. I mean, it’s a lot quicker and easier to get a bag of Cheetos than it is to prepare a meal that’s made from fresh, whole vegetables. And it’s also more expensive to eat and to cook that way. I think there are more options available now than there used to. There are more restaurants that offer that. There are more kind of food delivery, things that are available for that.
Host: I’ve heard really good things about HelloFresh. So, when it comes to caregivers too, I mean, would you have any tips for them when it comes to helping their patients along the journey of nutrition through the cancer diagnosis?
Keely Hack, MD: Nutrition is often a source of stress in a patient-caregiver relationship and dynamic. Oftentimes, if someone who’s going through cancer is not hungry, and that causes a lot of distress for their caregivers because they feel like, “I need to make sure that you eat. I’ve got to make sure.” And so, there’s sometimes a lot of pushing to say, “You’ve got to eat this,” and a lot of pushback to say, “I don’t want to, I don’t need it.” And so, as we’ve seen more data with intermittent fasting coming out, I have been a little bit less aggressive in saying, “You’ve got to eat.” You know what, if your body’s saying “no” right now, then listen to your body. It’s OK to skip a meal. Your body’s going to say, “OK, I need that later,” in most situations, not in all situations.
And that’s definitely something that I would talk with your doctor about, but that can be OK sometimes. For people who are really having a hard time tolerating kind of anything, making sure hydration is there – that’s very, very important. Making sure that your kidneys can work well enough to flush out the toxins that are accumulating as we’re doing treatment. We also can provide recipes for different shakes and smoothies that have a good high protein content.
We have some tips that we can give people for making like a high protein jello, where you just mix basically it’s egg white protein powder with jello. And that makes a high protein jello. So you can get a little bit more of that muscle maintaining nutrition in something that’s not so heavy and difficult to tolerate. And the other thing is never hesitate to ask for help. We are here to help people through this. I think sometimes people feel like they don’t want to call, they don’t want to be a burden. That’s what we’re here for sure. To help people through it.
Host: A few more questions here. Some common questions that someone may ask: Does sugar feed cancer?
Keely Hack, MD: That is a very common question. I get that very, very often. Yes, sugar feeds cancer because sugar feeds everything. And kind of the follow-up to that question often is then should I cut sugar out of my diet? And I say “no.” And the reason for that is your brain cannot live without sugar. Our brain can’t burn fat. Our brain can’t burn protein. Our brain can only burn sugar. So if you completely cut sugar out of your diet, your body’s going to say, well, I better make my own sugar because I got to have sugar. And so your liver is going to start making sugar. And so you can’t completely eliminate sugar from your body.
Now, I don’t recommend eating like ice cream and donuts and cookies every meal of the day. Sometimes sweets are what’s better tolerated, like tastes better and things. But, having a little bit of a treat here and there is okay. As I said, moderation is very important. So I typically say try to get a lot of good nutrient dense foods. Your vegetables and your lean proteins and your fruits have more nutrient density than processed sugars. And so, we try to lean toward those more, but I don’t recommend to people to like do everything they can to eliminate every bit of sugar because it just isn’t worth it.
Host: What about soy? Is that safe?
Keely Hack, MD: Soy is a good question too. And I get that often too, and that’s another area that’s a little bit hard to sort out. So generally what we recommend is whole soy, so tofu or other whole sources, up to three servings a day is probably OK. I do tend to recommend that people try to avoid the really processed, like the powder, soy powder protein or those things. We try to avoid that. But whole food sources of soy is thought to be safe.
Host: How do you treat nausea?
Keely Hack, MD: We have a lot of ways of treating nausea. I’m so thankful that we have come such a long way in how we are able to treat nausea. It used to be – before the time that I was in practice – but I remember my attendings and fellowship talking about the days when they would have to admit people and essentially sedate them to the point that they just slept through their nausea because they didn’t really have any other way to control nausea. And we have come so far from that.
So, we really tailor our nausea treatment to how high the risk of nausea is with a chemo regimen, and how prone somebody is to likely develop nausea. So, we know that people who are more likely to get motion sick or who had a lot of morning sickness with pregnancy and some other things that they’re more likely to have nausea.
And we know that certain chemotherapies like Adriamycin or cisplatin, those are more likely to cause nausea too. And so in people who are really at high risk to get nausea, we give usually three or sometimes four anti-nausea medicines in an IV before the chemo is given. We have people take a medicine called Zyprexa at bedtime for four days after chemotherapy.
We sometimes also have them take a steroid in the morning for three days after chemotherapy. And then we give them usually a couple of different prescriptions for nausea medications to have on hand if they need it. We also, as I said, often recommend to have a little something in their stomach, kind of all the time. I often tell people it’s a good idea. As long as you don’t have a dog that will steal them to have some crackers on your nightstand. So that when you first wake up in the morning, you can just pop that cracker or two in and just get something in your stomach to get it settled. Nausea is easier to control if we stay ahead of it than if we try to catch up to it.
But occasionally we still have to get people into the hospital if they just, we can’t get control of their nausea. And sometimes we get to do IV anti-nausea treatments. Sometimes I will have people come in maybe a week after their chemo and get a bag of IV fluid here. And sometimes we’ll give a little IV anti-nausea medication along with that. And it’s sometimes amazing how much better somebody feels after getting that. So I, when I’m, again, talking with people in the clinic and I say, OK, these are the things that we’re going to do for your nausea, but if we’ve done these things and you’re still having nausea, please call us because I don’t want you to suffer at home when we have other things that we can do to help you out with that.
Host: Sure. Any closing remarks that you’d like to make? Or things, topics that you think that we missed on or you think is just important people need to know?
Keely Hack, MD: I think we covered just about everything. I think my biggest thing that I would say is don’t be afraid to reach out for help. Please don’t suffer in silence and don’t wonder about things. We are here to help. We love to help people, which is why we went into this field. And so please don’t hesitate to ask your team what you can do for symptom control. But also those nausea questions.
We also have dieticians within our team. And so that’s another option for people who maybe have some more in-depth questions that they want to ask, or they need help with certain things, whether it’s having trouble tolerating foods and needing some help with what to do, or maybe it’s advice on things to help with a lot of diarrhea. Like if you’re having a lot of diarrhea from your treatment, meeting with a dietician might be helpful, say, “Hey, let’s add some fiber. Let’s do some other things that might also help with that diarrhea.”
Host: Sure. Well, thanks again for taking the time and joining me today.
Keely Hack, MD: My pleasure. Thanks for having me.
Host: Absolutely. And, thank you for listening. Sanford Health produces podcasts on a wide number of topics. If you like what you heard here today, give us a thumbs up and a follow-up. We’d love if you became a long-time listener.
A reminder for all of your medical news, you can head over to Sanford Health News’ website, which is news.sanfordhealth.org. Thanks again for listening. I’m Simon Floss with Sanford Health News.