Listen, I think it’s fair to say that nutrition isn’t the first thing in mind when it comes to cancer but eating well can make a huge difference in dealing with cancer, during treatment and in recovery. Today, I’m talking to Julie Lanford. Julie is a cancer dietitian who is going to describe your nutrition needs during cancer. Whether you find it difficult to eat at the moment, or you maybe you’re relying too much on comfort foods, or maybe you don’t really know much about eating well during cancer. You’re going to get tons of fantastic in-depth practical advice from Julie that you can apply right now, including:
- Do we now have to give up bacon?
- What is evidence based advice and why it’s important
- Key myths and misconceptions about nutrition and cancer
- Dealing with taste changes during treatment
- Why plant based eating is important to you right now
- Simple rules of thumb for choosing good food sources
- The importance of exercise during cancer
- What is moderation when it comes to alcohol
- Great, healthy ideas for snacks
- What to do when you are not getting the results you want
Joe: Julie, thank you so much for doing this. I really appreciate your time.
Julie: Sure, yes.
Joe: Julie, I just heard that bacon and sausages are now considered to be on the grade on carcinogen by the world health organization. That really ruined my week. What’s with that? Is that even true?
Julie: It is true, they were upgraded. It’s been a couple of years, upgraded, whatever you want to call it. It is a class one carcinogen, but I think it’s important to understand really what that means. Just because something’s a class one carcinogen, you also have to have a lot of exposure before it will cause a problem. Tobacco or cigarettes, they are also a class one carcinogen, but by smoking regularly, it increases your risk by double-digit percentages for cancer. Eating things like bacon and processed foods, which is the sausages, they have the preservatives and additives. It does increase your risk specifically for colon cancer, the increase in risk is small but it is something. I always tell people, you know, I wouldn’t make a habit out of eating bacon right now. It seems bacon is pretty popular. I went to a restaurant the other day and it was like every other menu item had bacon on it. I say somethings a habit if you do it three times a week or more, bacon is not something that I would make a habit out of, but if it’s something you eat once a month, I’m not too worried about it. It comes down to how often or how much are you having at a time.
Joe: That’s fantastic, Julie. I think that makes me feel a whole world better.
Joe: Julie, I know you’re big on providing information that is evidence-based, can you talk about what that is and why is that important?
Julie: Yes, so I think many people are confused about what evidence-based really means. Just because a scientific study happened doesn’t make something evidence-based. Evidence-based recommendations mean that there have been multiple well-designed studies showing the same results. Enough to the point where we have consensus among scientists or medical professionals that there should be a recommendation around that particular issue. I think where a lot of people get confused is just because a study was done, if that study was done in mice or rats or an animal model, or it’s only one study and there aren’t multiple studies going on about that topic.
It doesn’t make it evidence-based. It might make it interesting, but it doesn’t mean it’s something that we absolutely have to change our lifestyle around. Evidence-based means that a body of experts have gotten together, and they rank the evidence. If there is consensus that say something like fruits and vegetables are good for us, which generally everybody agrees upon. There’s lots and lots of data on that.
Julie: Exactly. There is an evidence around cancer and eating more fruits and vegetables and plant foods. I think some of the other topics are interesting, but I think we should build our foundation around healthy eating on evidence-based recommendations from reputable medical bodies. Then if you want to layer other things on top of that, that may have less evidence, but maybe it makes you feel good, or it makes you feel like you’re doing something additional, I think that’s fine. We definitely want to focus on the things that have the strongest evidence.
Joe: Yes, that makes so much sense, Julie. How do you incorporate it into your daily practice? Do you read research journals? How does it work?
Julie: Well, there are way too many research studies for me to ever read them all, because I have to actually go out and educate people and not just sit in an office and read all day long. What I do is rely on the strong science-backed evidence-based bodies. In the U.S. anyway, we have the U.S. preventive taskforce for more screening type tests. When it comes to nutrition and cancer, I spend a lot of time with the American Institute for Cancer research. They have great information.
Their website is: aicr.org. They have actually an expert report where they rank evidence and they do updates, continuous update project is what they call it. They have them around different types of cancer. I tend to stay on top of what they are recommending and also, American Cancer Society has some good research, briefs and then the National Cancer Institute are also great places to go. I tend to rely on people smarter than me to direct me in those things.
Joe: As we all do. Absolutely, because it’s so important to really look at the real data out there. There are a lot of myths and misconceptions around nutrition and cancer. What would you say are some of the biggest ones?
Julie: I would say the number one myth would be sugar feeds cancer. People are constantly coming in asking me about that. I call it a myth because there might be a little piece of truth that, yes, glucose is an energy source for cancer cells but it’s also an energy source for every cell in our body. When you think about the term: Sugar feeds cancer, there’s nothing you would do about that. It’s not like if you quit eating sugar, then the cancer cell will stop growing, it just doesn’t work that way.
The way I describe it is that every cell in our body runs on glucose, or that building block of carbohydrates, which some people term sugar. We don’t get to pick and choose which cell gets what fuel. From a practical standpoint, it’s not helpful of a thing to say except to scare somebody and make them very anxious about the foods that they eat. Of course, we want to use common sense, certainly we don’t want people to eat a whole lot of sugar-sweetened beverages and desserts all the time. There is a common-sense balance. That’s one of the top myths.
More recently, I would say at least around the people that I see, some clients are a little bit afraid of eating meat or dairy products right now, based on some popular documentaries that are not sharing the strongest information. I’m fine if somebody wants to not eat meat at all. That’s a personal choice, but we don’t have good strong evidence that you shouldn’t eat meat. You do have lots of evidence showing that you should eat lots of plants. Whether you eat meat or not, you should still eat lots of plants.
Joe: Okay, that’s great. We know that the immune systems shuts off during chemo, is it a good idea to take vitamins or minerals that can boost your immune system?
Julie: Well, I would say there’s not good evidence to show that taking pill forms of nutrients actually does boost your immune system. There is some evidence that shows that we don’t want people taking anti-oxidants supplements during treatment. That it might counteract what we’re trying to do with cancer treatment. There are mixed studies on anti-oxidants during treatment and so we air on the side of caution and we say, “If you want to eat food sources of anti-oxidants, or tea, like green tea, that’s perfectly fine.” We don’t want anyone to take really high doses of them in pill form.
Joe: Yes, because chemotherapy is actually pretty good at changing your taste buds. Sometimes you’re in treatment and sometimes beyond. What advice do you have around managing that?
Julie: Yes. Everybody’s experience is different, and it depends on what type of chemo and how your body reacts to it. We do have strategies for all different types of issues that may come about when it comes to nutrition. Specifically, around taste changes, a lot of times, we will have people, if you have a metal taste in your mouth from chemo, some people find it helpful to drink lemon water before they eat. To not eat with metal silverware because that makes that metal taste worse. You can use plastic silverware.
For some people, their taste buds are real muted, so they don’t taste very well, so they need to use more spicy foods. Some people have mouth sores and spicy foods bother them, so they need to eat bland foods. There’s no one across the board recommendation. It really depends on each individual and what they’re dealing with. Then we troubleshoot based on that.
Joe: Yes, right. I remember there was a guy in my oncology ward who pretty much stopped drinking coffee, just because he had it during chemo and to him it was just disgusting. Then I think he just stopped drinking it.
Julie: Yes, a lot of people, if it’s not a good habit, then it’s a positive thing that it forces them to change their habits. Especially around those comfort foods that you’re really used to and then your chemo makes it, so they don’t taste good, that’s like adding insult to injury. Well, I enjoyed drinking that coffee every day and now it doesn’t taste right. That’s one more thing that I have to deal with. When people lose their taste buds, they start coming back, I usually recommend that they try to optimize that and take advantage of that opportunity to train their new taste buds to really like healthy foods. If they had habits that they’d been wanting to let fall away, they can train their taste buds to like better foods.
Joe: Yes, that’s a great idea, Julie, because that could a conscious beginning of a new phase of life, where you eat better. Absolutely. What are some of the most important things to keep in mind when it comes to diet before and after treatment?
Julie: For most people who, let’s say, during treatment they didn’t have too many side-effects that prevented them from eating normal foods. They’re looking at after treatment and the way I say it, how can they optimize their nutrition and optimize their survivorship. I do programs here at the non-profit that I work for, and we focus on nutrition, exercise, stress management, and then medical management, which I think all are really important pieces of optimizing survivorship.
From a nutrition standpoint, I really focus on the recommendation that cancer survivors follow the same things that we recommend for cancer risk reduction, which is essentially eating a plant-based diet, not eating too much of the sugar-sweetened beverages. Not eating too much added salt and not eating too much of the red and processed meats. I think what’s most important for people is to really focus on getting the nutrients that their body needs to function. Especially as they’re healing up after treatment, where they might have had their treatment affected not just the cancer cells to get rid of those, but it also had effects on other parts of the body.
There’s a lot of healing that’s going on. Supporting that healing with good nutrition choices, good quality sources of nutrients that come mainly from food. When you choose food sources of nutrients, you get a lot of variety of nutrients. You choose lots of different colours in your foods, you’re getting a variety of nutrients and they’re all really important to promote good growth of healthy cells and also supporting the immune system. We do promote a plant-based eating, whether that includes small portions of meat or not is a choose your own adventure. Definitely focusing a lot on plant foods and making sure to get plenty of fruits and vegetables every day.
Joe: Yes, also, Julie, you touched on colours and the fact that you should be mixing up foods of different colours, so how does that work?
Julie: By colours, I mean the colours in the foods as they’re grown, not like do you have Cool Aid there? We’re not talking about fruit punch or colours like that. What we want from the colours are things like red in the tomatoes, red in the watermelon, orange from sweet potatoes or carrots. Oranges, yellow from a variety of things but squash. When you eat all of those different colours, the colours really represent the type of plant nutrients that are in that food.
You don’t have to have a degree in nutrition to figure out that when you eat a variety of foods, you get a variety of nutrients and your body will get what it needs. We don’t want people eliminating all of one food group. We want you to eat a little bit of every food group and we want you to eat a lot of fruits and vegetables.
Joe: Yes, that makes a lot of sense, Julie. Another area where we could open another can of worms here, but I know exercise is a good, and we could probably talk about that for hours. It’s such a huge area and exercise and diet go hand-in-hand. What is some of the advice that you would have on that front?
Julie: Exercise isn’t my speciality, but they do go hand-in-hand. What I know is that people can eat all the right nutrients but if they’re not utilizing their body the way it needs to be used, your body won’t need all of those nutrients. Especially when it comes to protein, people will say, well, should I take a protein drink, or should I use protein powder? Well, at least in the U.S., most people eat more protein than they need anyway. The reason you want protein is to rebuild your cells, to rebuild muscle, but a lot of people aren’t exercising and so exercise is what builds muscle.
It’s a perfect complement but your nutrition plan is only going to go so far. Especially after treatment, a lot of their body composition has changed as a result of treatment or the fact that they were less active during treatment. To get their body composition back to a healthy balance where we have plenty of muscle tissue and lean body mass, it really is going to require – nutrition is never going to build muscle. Nutrition can help to build the cells when you’re exercising.
I focus a lot on helping people recognize their need for exercise. I know exactly what types or how to do it, but especially weight bearing exercise can help build muscle. It helps build bones, which can be a big side-effect for a lot certain types of chemotherapy are risk for bone loss. It also just helps you feel better. Fatigue is much better management when people are physically active. All of those things, I think exercise is fun and also very much beneficial.
Joe: Fantastic. You spoke about plant-based eating, can you talk about why that’s important and why would you go incorporate this into your daily life? What is the best way to do it in a practical way? Many people, myself included, may not be used to that.
Julie: With the plant-based eating, I think that the most important thing is to think about every time you sit down to eat, that you have the opportunity to give your body some nutrients it needs to function. For the most part, we need a lot of phytochemicals. Phyto means plant. These are just plant nutrients that our bodies need to function. You need a lot of them every day. When you sit down to eat, half of our plate should be covered in fruits and/or vegetables. A quarter of our plate would be covered in some kind of whole grain, which is also a plant food, so that counts as part of your plant intake.
Then you have a quarter of your plate that would be protein. That’s where you get to choose. Do you want to have meat or dairy products on your plate for protein? Or do you want to have more plants, which is what vegetarians and vegans do. They get their protein from beans and nuts and seeds. What I encourage people to do is have one cup of fruit at breakfast because most people don’t want vegetables at breakfast. A cup of fruit at breakfast. A cup of vegetables at lunch. A cup of vegetables at dinner and then most people enjoy fruits and they snack on them throughout the day.
That will help add up your total and if you’re getting to four to five cups a day combined with fruits and vegetables, that’s what we’re aiming for. The other key indicator of a plant-based diet is, are you having plant proteins every day? Even if you’re a meat-eater, you should still be having beans, nuts and seeds at least one serving a day. Then the other things will fall into place. If you have fried foods occasionally or if you have desserts occasionally, that’s not a big deal as long as you’re still meeting the core of getting all of those plant nutrients, so that you can make sure that all of your cells have the tools that they need.
Joe: That’s great, Julie. What about the times when you’re in treatment and eating is physically difficult, what can you do?
Julie: When eating is hard, then we sometimes say, okay, maybe we should just find whatever we can. Especially during treatment, if someone really cannot tolerate any of these healthy foods or plant foods, having something to eat and getting enough calories and protein is more important than anything else. We need them to get those calories and protein in, if it’s a milkshake and that’s all that they can get in, if it’s one of those canned nutrition beverages, if that’s all they can get down, that is better than nothing. The last thing we want is for somebody to not get enough food.
If you’re not getting enough calories and you’re not getting enough protein and you have a diagnosis of cancer and you’re going under treatment, we have plenty of studies showing that that will lead to malnutrition and that malnutrition leads to poor outcomes. We want to do whatever we can to make sure that people get enough food in. If they can’t tolerate fruits and vegetables and all of the healthy things that we’re talking about, then it’s time to think about, well, can we add calories with healthy foods like nuts and avocados and olive oil and heathy fats? If we can do that, great, if they can’t even tolerate that and all it is ice cream, then it’s just going to be ice cream for a little bit of time until they get through it.
Joe: Absolutely. Speaking of drinks, what’s your take on alcohol. I know I’ve heard a lot about drinking in moderation and what is that and how can you apply it in practical terms?
Julie: Yes, so we know that alcohol increases risk for cancer, several different types of cancer. It increases risk. Again, it comes down to how often and how much are you having at a time. That’s where moderation comes in. I find a lot of people don’t know what moderation really is. They can’t actually define it.
Joe: Or can’t stop themselves.
Julie: Yes, or they start, and they can’t seem to stop at moderation. The definition of moderation when it comes to alcohol is one drink a day for women, two drinks a day for men. You don’t get to save those up for the weekend. It’s once your day is over, that’s your drink or not. I tend to think I would not have a drink every single day. To me, that is a habit and that’s not a habit that I want to make every day. A drink is considered 12 oz of been, 5 oz of wine, which is like not that much. Or an oz and a half of liquor. Really, finding that balance is important.
Joe: Yes, that makes so much sense. If we go back to food, I know you have so many great recipes on your website. What was your favourite one when you don’t have much time?
Julie: Yes, so I – gosh, I have a lot of favourite recipes. There are a couple of ones that I use all the time. I have a smoothie recipe. It’s a green smoothie with bananas and peanut butter and spinach and it’s delicious. I use a cup of milk and two tablespoons of peanut butter and two teaspoons or dark coco powder, a cup of spinach, and a frozen banana is really important. That blended up is delicious. That would be a breakfast meal.
Or if it’s a snack, I’d probably have half of it. I also love making granola. I have a granola recipe on my website I do a lot of crockpot recipes because that tends to be easy. I do chilli, bean chilli, I don’t put meat in my chilli. Bean chilies in a crockpot is something that I really like to do a lot. I like to do curry recipes. A lot of people ask about turmeric.
All types of herbs and spices are good for us. Curry is a great way to include that in your foods. You don’t have to be fancy to eat healthy. Sometimes I just go to the grocery store and I grab a piece of fruit, I grab some carrots, I grab hummus and crackers. Maybe a little thing of yogurt. That’s a lunch. It doesn’t have to be fancy.
Joe: That’s fantastic, Julie, because I think that’s actually misconception that it does have to be something really fancy and elaborate. I think that puts a lot of people off, doesn’t it?
Julie: Yes, it puts me off. It makes me feel like, never mind. Forget it, I’ll just go to a drive-through and get whatever I feel like getting. When you try to lower the bar and make it simple. At least here, I live in the southern part of the U.S., and when I moved here, people would eat peanut butter and banana on a sandwich. It was like peanut butter and jelly, only you put banana instead of jelly. It’s really good. Also, it’s cheap and it’s easy. Most people like it. Finding those really simple things I think is the key to making healthy eating fun and also simple.
Joe: Yes, I think that’s an especially important point if someone’s dealing with treatment or after treatment, because you’ve got fatigue, you’ve got all of those things. You’re really not in the mood to spend hours in the kitchen, right?
Julie: Unless someone really likes to cook. That’s their hobby and that’s what gives them purpose and meaning, and they like it. Life is too short to stress out and spend half of your day in the kitchen chopping things. We’ve got to figure out how to nourish ourselves but also allow ourselves time to do other things.
Joe: Yes, exactly. There’s another stigma that comes with healthy eating, is that people think that it’s all about denying yourself food that you love? Is that true?
Julie: Well, it’s definitely a stigma. I think people have a hard time figuring out that, hey, a special treat is okay sometimes. You should have a special treat sometimes. It shouldn’t be like, oh, I do a really good job, but I never ever treat myself. That’s not fair. We should be able to find that balance, but I also know people who tend to fuel or feed their emotions with food. That’s not healthy either. They might be eating junk food too often, like every single day, or it becomes this habit where they cope emotionally with challenges by eating certain things. It’s hard to figure out what that balance is, but certainly we should be able to enjoy desserts and special treats on occasion.
Joe: Yes, exactly, it also comes together with having great intentions in mind. Sometimes you want to do the right thing, but I guess we have trouble sticking with it. That’s why most New Years’ resolutions go out the door a few months later. Do you have some thoughts around how you can stay on track with and build on healthy habits?
Julie: Yes, for a lot of people, we’re not really aware of what our habits are. The first thing, if somebody wants to come in and see me and get some nutrition advice, I say they have to show me the money. That’s not dollar bills, the money that I ask for is they keep a food record for a whole week. Where I don’t want them to just write down kind of what they ate. I need them to specifically write down what exactly they ate and how much of it and what did they drink and how much of it did they drink? We don’t have to memorize everything that we eat. If we’re looking at wanting to make some healthy changes, we need to do an audit. By writing down what we eat for a week, it shows us, I don’t want people to make changes before they write it down.
I want them to write down what they’re actually doing, so that we can pick out what are the habits that maybe aren’t so good? What are some things that we could make substitutions for or change up a little bit? Or, maybe they have a habit, they’re eating treats too often and we just need to cut it back to a more reasonable amount. Really, that’s the first thing I would do, is keep a record for a week, to figure out what they’re actually doing. Then, to count up the number of fruits and vegetables they eat every day, that’s another simple place to figure out, maybe they actually need to eat more fruits and vegetables to improve their nutrition. Those are the first things I start with, as I count up the fruits and vegetables when somebody brings me a week-long food log.
Joe: Absolutely, Julie. It makes so much sense because we’re really not honest with ourselves. If you were to ask me on the spot, I would probably immediately, like what I had last week for example, I would immediately discount all the snacks that I had and would easily half the amount of alcohol that I had. Yes, you really do have to have a log and keep yourself honest.
Julie: Yes, definitely.
Joe: Is there something that people often miss when they try to have a healthy diet, but they aren’t really getting the results that they want?
Julie: Let’s see. I think sometimes people skip meals or they don’t get a full meal, if that makes sense. They would eat something at lunch, but it might not be the right combination of foods. We want to make sure that at meal times we have fruits and/or vegetables. We have wholegrains and we have protein. A lot of times at breakfast, people hardly have any protein at all. Then maybe at lunch they might have a salad, but they don’t have any carbohydrates. They’re not balanced throughout the day. We need them to eat consistent amounts throughout the day.
The other thing that happens is, they often ignore their hunger and fullness ques which is a big problem. If their body is actually hungry, we want them to eat. We also want them to stop eating when they’re full. A lot of people eat so fast that they get through their food before their body can even tell their brain that they’re full. Slowing down meal times, tasting their food, making sure they have a variety of nutrients on their plate. Then really paying attention to if they’re hungry, then they should probably have a snack. Then do not skip meals. That’s a red flag.
Joe: Yes. What are some of the books or other resources that you’d recommend for a person who’s dealing with cancer or maybe they want to build a healthy life after cancer?
Julie: Yes, there are a few. I think there’s a lot of really not quality books on nutrition. I’m always cautious about that. There are some cook books that I think are really good. One of my favourite cook books, it’s not specifically cancer-relate but it is called: Lickidy Split Meals. It’s a dietitian here in the U.S. that wrote it. Very practical. Lots of quick and easy healthy meals. I think people need more of that. There are some eating well through cancer cook books that I think are pretty good by Rebecca Cats. It talks some about side-effects but also healthy eating. Here at the non-profit that I work for, I host a mindful eating program. We contract a dietitian to come teach that. The books, her favourite ones to help people get more in touch with their hunger and fullness ques and to try to avoid emotional eating is called: Intuitive eating. It even has a workbook with it now, which is really handy. Those are things that I really think are great tools to help guide people.
Joe: Yes, I love those PDFs that are very simple and clear on your website. I’ve got one on my fridge right now that really helps guide you through making these decisions on what to eat better. If somebody wanted to check out your products online or work with you individually, what would they do?
Julie: Yes, the website: cancerdietitian.com has lots of recipes. I have all kinds of different things on there. I do have some printable handouts on a variety of different topics. Those are available. Some of them are free some are for purchase. They support the non-profit I work for. I think that’s a nice thing. People can email me. I usually respond pretty well. I don’t do online consultations, but I do know some dietitians who do that, some oncology dietitians. On social media, I’m happy if somebody sees something on Facebook and they’re wondering, is that true or not? I get a lot of followers who will send that to me or ask my opinion. Those are easy things to do and to engage with some of my programs.
Joe: Yes, that’s fantastic advice, Julie. I think that nutrition during cancer is an area that really doesn’t get enough attention.
Julie: It’s true. The interesting thing is, there’s just not a lot of us oncology dietitians compared to the number of people who are being treated. At least in the U.S. insurance coverage doesn’t pay for it. A lot of cancer centres might have one or two dietitians if you’re lucky for a lot of patients. Sometimes it falls on the healthcare providers that aren’t dietitians and they don’t always know how to respond. I always encourage, when somebody emails me, I encourage them to at least ask their cancer centre for a referral to a dietitian. The more they hear that, the more likely they are to start staffing someone on-site to help with that.
Joe: Yes, absolutely, because I only found out about oncology dietitian pretty much after the fact. I wish I found that earlier because I put on a whole lot of weight during treatment because I was on steroids. It made me eat a lot of food and not necessarily the best food. I think a lot of folks need advice around that. I think it would be great to have a lot more awareness around it.
Julie: Yes, for sure.
Joe: Thanks so much for your time, Julie. I really appreciate it.
Julie: Yes, thanks for asking me to come on.