Women with HCL Webinar Series: Diet and Nutrition
November 18, 2021
Hosted by the Hairy Cell Leukemia Foundation with speaker Lindsey Wohlford, MS, RD, LD from MD Anderson Cancer Center. Moderated by Adi Weber (HCLF Board Secretary), Sarah Naperala (HCLF supporter) and Anna Lambertson (HCLF Executive Director).
Presentation Materials
Note: Slides of Ms. Wohlford’s presentation can be accessed using the link below. The link will open the file via a new window. You do not need a Box account to view these files.
View Ms. Wohlford’s presentation >>
Transcript of Webinar Presentation and Q&A
Presentation from Lindsey Wohlford
Lindsey:
I know we're talking today about nutrition within the context of cancer, but I want to emphasize that a lot of times, good nutrition is really going to be the same across the board.
You know this, that nutrition and cancer have a very close relationship. Nutrition is one of those things that is important and essential for both the prevention and risk reduction of cancer. It's also vitally important when we're going through treatment and for that healing process during treatment. And then finally, nutrition is so important after treatment to kind of rejuvenate our bodies and help us to get in a better place and continue healing and also through our survivorship. So nutrition is one of those things that is really tightly linked the entire pathway when we think about nutrition and cancer.
Lindsey:
So where do our recommendations come from as far as nutrition and cancer?
I don't know if you have heard of the American Institute of Cancer Research. MD Anderson always refers to it just as AICR, and this group is a cancer research and education organization, and it's part of the World Cancer Research Fund. They are solely focused on developing and understanding the intricate links between nutrition, physical activity, and cancer prevention. And so what they have done is they have released their third expert report, and this is from 2018. And basically they have some of the smartest people in the world (when it comes to understanding cancer) get together. They review all the evidence. When we say evidence, we're talking about all those studies and research done on cancer prevention, and they determine what has the most evidence, the strongest evidence to show us some kind of link between nutrition, physical activity, lifestyle factors, and cancer prevention. And then they come up with their list of recommendations periodically.
And so this is where we get our primary recommendations, and this is what we use at MD Anderson. So the interesting thing, is that six out of the 10 recommendations in this latest report are related to food and nutrition. So right there that shows you what an important role nutrition plays across the board as far as cancer prevention goes.
Lindsey:
The other thing that we see from this report is that there's not one thing that you have to do. Even if you did all 10 things, there's no guarantee. They really want to emphasize the fact that it really is your overall lifestyle and your overall habits. And a lot of times when I'm working with clients on anything, as far as nutrition and wellness is concerned, what I usually like to point out is what I call the 80/20 rule. What you do 80% of the time is what forms your lifestyle. We all have that 10 or 20%. Those are the speed bumps, those are next Thursday, Thanksgiving, or maybe we're not following the recommendations perfectly. That's not what's going to really impact your overall health. It's that 80%. What you're doing the majority of the time, what you're doing most consistently in your life. I always like to say that because we dieticians get a really bad rap. I want to reform our perspective of dieticians and let you know that we're just trying to get you to be more consistent most of the time. There's certainly room and space for moderation and some indulgence.
Lindsey:
Here's the 10 recommendations from the AICR and I won't sit here and read each one for you, because we'll kind of go over the primary nutrition ones. You can find this very easily. You can simply Google AICR or American Institute of Cancer Research. They are a wonderful, wonderful resource. And they'll have all of these listed for you. And you can read in more detail.
Lindsey:
The first recommendation, which is not directly nutrition linked, although nutrition is going to have the largest impact on this. And that's we want to encourage being a healthy weight. Now this doesn't mean you've got to be back to your high school weight. It doesn't mean that you've got to be what magazines and other things tell us we should be. It simply means that we are a healthy weight. And the best way to look at that is honestly, what do our bodies biometrics tell us? In other words, when you go to your doctor and you get your labs, is your cholesterol and your fats and your A1C and other things, are they within a normal range? Are you getting regular exercise and consistently eating well most of the time? Then you're good. So this isn't about being skinny.
What we want to do is really work on being lean. And we know that body fat is kind of what we call a hormone pump and that the more body fatness we have, the higher our insulin levels are, the higher our estrogen levels are, as well as some other hormones which can contribute to cancer. We also know that being overweight is linked to about 13 different kinds of cancer. And then we also know it's a common known fact that our weight can affect our cardiovascular disease. It can affect our risk for diabetes and other chronic diseases. So we just want to work on getting ourselves into a healthier place. And a lot of what we're going to talk about next is going to help you do that.
Lindsey:
Be physically active. Again, not necessarily a nutrition-related thing, but I always like to point out the fact that our physical activity is really tied again to our nutrition. So is stress. So is sleep. They're like a domino effect on each other. If you move one, you're moving the others. If you are eating healthy, getting good sleep, managing stress, you're going to feel more like going out for that walk in the afternoon. Also, we know from the research that when we exercise, we're more likely to make good nutrition decisions. And guess what else? We're also more likely to feel that our stress is relieved a little bit, because we get all those good endorphins released. We're also more likely to sleep better. You see how they are all connected? That's why I can't leave physical activity out in a nutrition presentation. Again, it's going to help with that weight gain or help us to maintain our weight. Physical activity, a regular physical activity routine is actually the best way to maintain weight after you've lost weight. And it keeps those hormone levels in check too.
Lindsey:
Now we'll get on to more of those nutrition-based recommendations. If you take nothing else home with you today, this would be what I would want you to focus on. That eating a variety of those plant-based foods, vegetables, fruits, whole grains, legumes, things like lentils, beans, nuts, seeds, all of these foods should be the vast majority of your diet. Which for us Americans, that's hard because we are used to 50% of the plate being meat, another probably one third being carbohydrates and processed carbohydrates at that. And then maybe I'll toss in something green on there just for good measure. And for some people it's just the parsley on the side of the plate that we don't eat anyway.
So what we really want to focus on is kind of reproportioning that plate. We want to aim for two thirds of it to come from plants. Now that doesn't mean it's got to be two thirds all kale, but 50%, that might be good, fruits and vegetables, a little bit more from whole grains. The benefits of this are phenomenal. We know that fruits, vegetables, all these plant-based foods are what we call nutrient-dense foods. They are low in calories and they are jam packedwith your vitamins, your minerals and your phytochemicals. They're also really high in fiber, which is so important for so many reasons. One, it fills you up, you feel fuller longer. So you're less likely to eat quite as much. We also know that fiber is essential for our gut health, which will get to later, because that's so vital for our immune response in our body.
Lindsey:
And then also with fiber, is it's really important for maintaining stable blood glucose levels. And for those of you going through treatment, a lot of times, many of the medications used for treatment and just the stress and the emotional toll of it all can cause the blood glucose levels to get a little out of whack and be a little high from time to time or even more consistently. So what fiber does is it almost acts like a time release capsule for your food. You know how when you eat a cookie, your blood glucose is going to go really high, really fast. When we have foods that are loaded with fiber, it makes your blood glucose slow down because it's going to take longer to digest. So we get just small portions of that glucose in our bloodstream over a long period of time. So we have a lower and more stable blood glucose, which is really important for weight gain. Also, just for feeling satisfied after meals, and then just our overall metabolic health.
Lindsey:
So the new American plate is what the AICR really promotes. And that's what we promote at MD Anderson. And you can see here, we've got some chicken on that plate. We're not saying you've all got to become vegetarians or vegan, especially the week before Thanksgiving. That would be no fun, but we want to make sure that the vast majority of that plate is full of plants, full of color and variety.
Lindsey:
Also, the other really awesome thing about plants are phytochemicals. You may have also heard them called phytonutrients. Has anyone heard of the phrase eat the rainbow? Yeah, most of us have heard of that. And we're not talking about Skittles and M&Ms unfortunately, what we're talking about is all the beautiful colors that we find in those plant-based foods. Phytochemicals are generally associated with the colors of foods. So as you see here on this screen, green vegetables are going to have a similar phytochemical makeup, red vegetables, similar phytochemical makeup, and different ones. We know that there's over 4,000 different phytonutrients that have been discovered and what those are, are plant-based components that we don't have to have to survive like water and carbs and protein and such. But they've been found to be very beneficial and in particular, many of them have cancer-preventative qualities.
The other interesting thing is, that they don't all offer the same benefits. What does that mean? That means we can't just eat broccoli and get all the phytonutrients that we could possibly benefit from. What that means is we've got to eat a large variety. And by eating the rainbow each day or each week, if that's where you can start, or even each month, if that's where you can start, you're going to start to nourish your body with that variety of phytonutrients and the benefits that come with it. So eating lots of color. I love it when I see... We'll have challenges and stuff sometimes at work and people will say, "Send in your pictures of your plates." And I love it when we see these beautiful colorful plates. So make sure you've got a rainbow on your table next week.
Lindsey:
The next recommendation is to avoid sugary drinks and energy-dense foods. Energy-dense foods are those foods that are completely opposite from nutrient-dense foods. When we're talking about energy, we're talking about calories. In other words, an energy-dense food is something that has a lot of calories, but not much nutrition. And that's again, a sugary drink is one of the best examples of that, like a soda or some punch or juice, things like that, Frappuccinos. So they have a lot of carbs. They've got a lot of added sugars, which are sugars that aren't naturally in a food. They also tend to have a lot of bad fats.
And so the problem with these, as you can imagine, because you know this and have heard this before, they can lead to a lot of weight gain, which we know can contribute to cancer. They also, we know sugar is one of the number one inflammatory agents that we can possibly ingest into our body. So too much sugar, especially when it's not paired with some fiber and some of those other beneficial nutrients can increase inflammation. So we want to try to avoid all those sugary drinks and energy-dense foods.
Unfortunately, a lot of those energy-dense foods are those processed foods. I usually explain processed foods like this. If you think about it, they come from real food, but it's basically like the manufacturers have predigested it for you. So your body doesn't have to do all the hard work of digesting that food, which makes it taste really yummy and very palatable, but the issue is that our body digest it like this. And then our blood sugar is high, we're hungry 10 minutes later. We're eating more of those same kind of foods and it's really easy to get into this rollercoaster ride as far as eating and our blood glucose levels and weight gain.
Lindsey:
The next recommendation from the AICR is to limit red meats and avoid processed meats. Now, again, we're not trying to make you vegetarians or vegans, but there is considerable research that shows us, in particular with processed meats. So your hot dogs, your lunch meat, your salami, things like bacon, smoked meats, that kind of thing, that they do have carcinogens and they are an increased cancer risk. So as far as processed meats go, the recommendation is really to just completely avoid them as much as possible.
As far as red meats, they're slightly more lenient. We know that the iron and the heme that's in red meats has shown some convincing evidence as far as risk of colorectal cancer. But 18 ounces a week, which to me doesn't seem extremely... I'm not a red meat eater, so that doesn't seem extremely conservative to me, but it really is in the grand scheme of things. Because if you think about it, I mean you could have a six-ounce steak three nights a week and still be within these guidelines. So just trying to be conscious of it, remembering that we want the majority of your plate to be plants, but you can indulge in this area.
Lindsey:
If alcohol is consumed, we want to be really cautious. The recommendations out there now are to avoid it. We know that cancer is connected to alcohol use and especially certain forms of cancer like esophagal, stomach, things like that. So the best advice is really to try to avoid it. But if you do choose to drink, really take into account those guidelines and for women, unfortunately it's only one drink, but for men it's two drinks a day. And I always like to point out that drinks aren't how much you can fit in your glass or how much the waiter pours you at a restaurant. It really is like a four to five-ounce serving of alcohol. So keeping in mind that it's a rather small portion.
And some people ask me, particularly as we approach the holidays, "Well, how do you do this? There's frequently alcohol and things like that readily available in a lot of places." And my recommendation is usually mix it with something that... You can always take wine and mix it with just some sparkling water to make more of like a spritzer. So you get a little bit of that festive feel, but not necessarily as much alcohol. Also, if you are going to be drinking multiple drinks, pair it with a glass of water of some sort or maybe some ice tea that's unsweetened and drink them simultaneously. So we're diluting that, also making sure that you're also consuming it while you're eating and not just by itself. All right.
Lindsey:
The next recommendation from the AICR is really about supplements. And very often, and I see this very frequently, particularly with people who are going through the journey with cancer, it's such an emotional and upsetting diagnosis can be. It kind of takes over your whole life and it's just emotional. There's a weight to it more than some other diagnoses. We know that at a cancer hospital. And so a lot of times there's this seeking of some kind of help or some kind of miracle product out there. And what we know is that there's a lot of evidence to support that taking various supplements is really not going to minimize cancer risk and in any way. And a lot of times supplements can be problematic, which we'll get to in just a minute.
But what I want to point out to you about supplements is very often in the research, and turmeric is one of the best examples of this. You have probably heard about turmeric. It's certainly... They're putting it in everything nowadays. I keep joking that it's going to be like the new ingredient in Cheetos here pretty soon because of the orange color and that doesn't make it a health food. But a lot of times with turmeric supplements, for example, the active ingredient that they have determined to be responsible for reducing inflammation is called curcumin. And so a lot of times they will isolate that ingredient or that component, and they will package it as a supplement and they will sell it for more than some people make in a week's salary.
Lindsey:
The problem is this, what we see in the research is that what's most effective is eating whole turmeric. And the thing is, is there may be that component that is the actual effective part of the food or of the supplement, but it acts better if it is given synergistically with the other component of that plant.
So what we see is that it's going to be more effective for you if it's taken in whole form, along with the other parts of that food or that plant. And that sometimes isolating things doesn't necessarily make it the most effective if that all makes sense.
Also, some supplements can really be dangerous. So if you are in current treatment or even if you are through your treatment and in survivorship, I would certainly caution you to speak with your doctor or physician before starting any kind of additional supplement, because there can be some contraindications and some bad side effects, depending on what you're dealing with.
I also want to point out when it comes to supplements that the Dietary Supplemental Health and Education Act, which was established in 1994, basically said that dietary supplements do not need FDA approval. Manufacturers do not have to go through any kind of jumping through hoops to prove efficacy or safety of supplements. And you'll see this, all of your supplements, no matter where you get them, whether you go to the fancy supplements store or you get them at Walmart or the grocery store, they're all going to have this little tiny box on there that lets you know, "This is not FDA approved." Manufacturers don't have to register their products. They can just produce them and market them. So this is very much unlike our drug and our other kinds of pharmaceuticals, which go through... As we've seen with COVID and all the vaccines, they go through very rigorous testing to get approval for use. Supplements do not have to go through those kinds of regulations.
The problem is we know supplements in many cases can be medicinal. They actually have medicinal effects, which means they can, in many cases, act like a pharmaceutical, but they're not being regulated. The other thing that this can mean is I can produce a supplement of turmeric and I can produce a supplement. Someone else can produce a supplement and we can all say one pill or two pills as a serving, but the makeup of those individual supplements can be completely different. I may have 25% actual turmeric in mine, Anna could have 75, and someone else could have 2%. And then there can be other fillers. So I really caution you to use some restraint when it comes to supplements and always be sure to check with your physician.
Lindsey:
The last recommendation that really deals directly with nutrition as far as the AICR guidelines. And this is kind of not necessarily our personal nutrition, but the nutrition of babies is... And I wasn't sure I included this because I wasn't sure if we had some women here that were of childbearing age, but breastfeeding your babies exclusively up to six months is the recommendation. And this has been shown to not only be beneficial for infants, but also in particular for mothers and lowering a lot of those hormone-related cancers. So estrogen-related cancer, such as breast cancer. We also see from research that children who are generally breastfed are less likely to be overweight. So that can be cancer preventative for your children in the long term.
Lindsey:
Now I wanted to also say that the AICR says that while these recommendations are primarily geared towards cancer prevention, they are the same and they encourage cancer survivors to follow the same exact recommendations. So no matter where you are along this cancer journey, as I said at the beginning, these are the recommendations that you really want to focus on.
Lindsey:
Then I wanted to also give just a few minutes dedicated to our immune system and the microbiome. When we're talking about the microbiome, I don't know if you are aware of what it is. It's been pretty trendy in recent years to talk about this and we're seeing more and more research coming out all the time about it. But the microbiome, when we say that big word, it's really talking about your gut, your GI system. So everything from basically your stomach, through your small intestine, your large intestine and your colon. This is really an amazing thing. It's like a whole nother little world or planet in there that we have going on that most of us don't even realize. 25% of the immune cells in our body are located in this area, but even more impressively is the fact that 50% of the immune response that our body has to something come from these cells and there's 100 trillion different bacteria cells that live in your gut.
Now most of us get our first dose of this variety of bacteria at birth. When we go through the birth canal, we're actually kind of immunized, if you will, with bacteria from our mothers. We also get some from breastfeeding or what? Formula feeding. But the key is that we are what we eat. The research has shown that what you eat influences the bacteria and the variety of bacteria you have in this gut. Now just like with everything, there's the good, the bad and the ugly. So there are beneficial bacteria in there. There are bacteria that basically are just kind of communal and they're happy to be there, but they're not kind of good or bad. And then we have harmful bacteria and things that can cause us to have problems.
So when we eat a healthy diet, what that does is help those good bacteria to really thrive, which is exactly what we want. And it keeps those bad bacteria at bay and minimized so that they're not a problem.
The other thing is that when you eat a wide variety of different foods, you're going to enhance the number and variety of the good bacteria that we have in there. And we now know from the research, the more variety of bacteria in your gut, the healthier you are, and a stronger immune response your body is able to launch.
So how do we make sure that our guts stay nice and healthy? Well, you're going to be so surprised to know it's following a lot of these guidelines that we've already talked about. In that nice, I do like it when everything aligns, and then there's fewer things that we've got to put on our to-do list. So variety truly is the spice of life. I don't think they were talking about enjoyment. I think they were talking about gut bacteria when they coined that phrase. So spice it up. Let's have a lot of variety, the color. Also, the way we cook.
Back to the phytonutrients briefly, we know that there's different phytonutrients when you eat raw foods, versus when you eat cooked foods. A great example is tomatoes. Tomatoes contain a phytonutrient called lycopene, which won't help the ladies out too much because its real claim to fame is helping prostate health, but in raw tomatoes, it's fairly minimal. There's not a lot of the lycopene. But when you have cooked spaghetti sauce or cooked tomatoes, the lycopene content goes through the roof. So again, eating a variety of cooking methods can also be beneficial to your body.
And then we're going to re-cycle that whole idea of fiber. We want to try to aim for about 30 grams of fiber a day. And that's really what the recommendation is for maintaining gut health and all the other benefits that I discussed earlier. Also, limiting artificial sweeteners, as well as any kind of flavors and preservatives as much as possible can be very helpful for your gut health. We know that artificial sweeteners and all the different kinds of additives and things that we find in those processed foods have a negative impact on our gut bacteria. So the more we can keep that at a minimum, the better.
Processed meats, which we've already heard that we need to minimize, and trying to increase sources of plant-based protein, which nowadays it's much easier, I think that's a much more generally known thing, sources of plant-based protein. 20, 15 years ago, meat was considered the end all be all as far as protein. So add some beans into your diet regularly, add nuts and seeds daily, eat things like tofu, yogurt, stuff like that regularly as well.
And then finally, kind of trying to segue from yogurt is consuming fermented foods. Fermented foods provide us with what are known as probiotics and when you eat probiotics or foods that contain them, you're essentially eating that good bacteria that we want in your gut. And so what that's going to do is help to replenish those colonies of good bacteria and help to keep them thriving. And this can be things like yogurt or kiefer, also things like kimchi, kombucha, tempe. So there's a lot of different foods out there, even if you're wanting to avoid dairy, if you do.
And again, just like with the supplements, I would rather recommend getting those probiotics through food. You can take a supplement, but you want to be cautious and make sure you're getting it from a reputable source. You also want to make sure that it has at least 20 billion CFUs, which are known as colony forming units, per serving. If it's less than that amount, it's not going to be effective and it's going to be more money down the drain than it is beneficial for your gut.
Also keep in mind when we're talking about probiotics, I don't know if anyone's heard of prebiotics. These are the foods that these good bacteria eat. It's what helps keep them thriving and doing well and strong. The good news is we've already talked about them today, but you didn't realize it, it's all those fruits and vegetables and that fiber, okay? That's what this gut bacteria really loves. So when you choose those high fiber foods, you're not only managing your blood glucose, keeping yourself full, managing your weight and those kind of things, you are nourishing the good bacteria within your gut, which is going to enhance your immune system and that immune support for you because particularly again, no matter what phase you're in of your cancer journey, keeping that immune system strong and healthy is going to be key.
Lindsey:
And then finally I want to talk about omega three fats, which you have probably heard of and they're known most widely for being really great for our cardiovascular health. They are something that enhances that good cholesterol, the HDL cholesterol. They also help in making sure that all of our blood vessels and everything stay nice and healthy and clear. But what they've found more recently in the research is that omega three fats are one of those wonderful ways that we can reduce inflammation and everything seems to cause inflammation nowadays, right? Stress can cause inflammation, the air we breathe sometimes if you're from Houston like me and there's a lot of pollution can cause inflammation sometimes. Omega three fats are one of those things that goes in and helps mitigate that inflammatory response. So including some of these foods regularly can also be very beneficial.
And again, they fall into the categories of the foods we've been talking about. And what I usually point out too is that healthy fats in general come from plants. So omega threes are going to be in pumpkin seeds, chia seeds, flaxseeds, walnuts, okay? Canola oil in smaller amounts and some other vegetable oils. The one exception of good fats is fatty fish like salmon. Your bad fats, which increase inflammation and disease risk, primarily come from animal sources. The one exception is going to be coconuts, okay? So trying to focus on those healthier fats and in particular, some great sources of omega threes on a regular basis.
Lindsey:
So that is all I have for you today as far as nutrition basics and eating healthy, particularly in the scope of cancer and the journey that comes with that. So I'm happy to answer any questions that you ladies may have today.
Question & Answer (Q&A) with Webinar Participants
Sarah:
Thank you, Lindsey. This is Sarah, just helping to set the stage for our Q&A. Thank you so much. I hadn't heard of the AICR report so I'm excited to maybe dive into that a little bit more myself, just to get even more details.
Sarah:
I thought it'd be interesting to jump into this one question someone asked regarding cancers and how they are linked to nutrition and is leukemia, that of you know, one of those cancers linked to nutrition as far as research goes?
Lindsey:
Since cancer is not my primary focus, I know that seems strange with being at a cancer hospital, but to my knowledge, I can't really speak on any kind of particular link. And so I would not want to put any information out there that's not extremely correct, but I would actually point you to the AICR site and you can actually read through the recommendations. And I would just say read the layman's part on the actual website, you don't necessarily need to do the deep dive into their report, but it will take you through the rationale and the evidence basically that they have that links to each particular recommendation. So in my reading of them, there's some where there's a definite connection, but there's some where there could be a connection but there's not a definitive one that's been established. We just know overall, nutrition can impact our disease risk in a number of ways.
Sarah:
Okay. Yeah. Thank you. Maybe Adi might have asked this one, but I thought it was a great question around breakfast and if there's certain foods that sort of set the stage for the day.
Lindsey:
Yeah. I love that question. That's a great question. So thank you to whoever submitted it. Because breakfast is one of those that we've had kind of a mixed relationship with, right? We used to say it's the most important meal of the day and that sort of thing and now we've kind of rolled into this whole intermittent fasting trend that is going on, in whichmost people skip breakfast and that sort of thing. So the short answer is it depends, okay? And I'll give you a little more explanation than that.
But basically what we do know from the research is that people who eat breakfast regularly tend to be lower in weight. And with my clients, what I usually recommend is, I know there's those people out there that can't eat first thing in the morning and you don't necessarily have to hit your feet on the floor and go straight to the kitchen, all right? What we're talking about is generally eating within about two hours of waking so you can give yourself a little time where if you're like me, I need to have a little coffee first before I'm ready to eat and that's okay.
But you want to make sure that you've got some protein at breakfast and that you've got some fiber. Those are two really important things. And the reason the research shows that people who eat breakfast tend to have lower BMIs overall in general is because what we find is those people who skip breakfast, they think they're cutting calories, but they really tend to make up for it later in the day. So when I'm working with clients, my recommendation is usually this I'll ask, "Tell me when you eat," a lot of times, this is what I see in particular with women trying to lose weight, they'll say, "I skip breakfast, I have a little tiny salad, I eat like a bunny at lunch and I start snacking and I get tired and low energy in the afternoon and so I eat in the afternoon and it just kind of continues going into this whole grazing thing and a big dinner in the evening."
And that's kind of that typical pattern, right? So if you can get yourself to eat something, try to eat more of your calories earlier in the day. That is going to reduce overall calories, keep from the late evening snackies, munchies, binging, that kind of thing. And we also see that people, like I said, in the research typically lose weight or maintain a lower BMI.
Sarah:
Are there certain types of breakfast foods that you recommend? You’ve heard fiber for breakfast is a helpful one or does it matter?
Lindsey :
I do recommend having some sources of good fiber at breakfast. The classic is really like oats or whole oats, oatmeal, steel cut oats, those kinds of things. Add some fruit, berries. It's a great way to get in some good not only phytonutrients but fiber and sweetness, right, in that oatmeal. Because when I say oatmeal, I'm hoping that you're not buying the little packages of brown sugar and cinnamon and then adding extra honey or whatever. We want to try to sweeten a little more naturally. You can also toss in nuts and seeds and stuff like that. You can make oatmeal with water. You can also make it with things like almond milk if you want, or soy milk, you can stir in peanut butter or almond butter into it. You can also do it more savory if you're wanting. So something like that is a great example.
You could also do something like a low fat, low sugar, Greek yogurt for good protein, good probiotics that we were discussing. And again, add that fruit, add those nuts. Maybe eggs, that's a great source of protein as well. For those of you who may be vegetarian or vegan, tofu scramble is another great option as well. So hopefully that gives you some ideas. We want to try to steer clear some of those traditional breakfast meats, right, which are all processed, like the sausage and bacon and things like that.
Question from webinar participant about managing weight: (text of question redacted)
Lindsey:
I want to make it clear that when you're in active cancer treatment, the focus is not on weight loss whatsoever, right? These are going to be things that are more preventative or something that you might do during survivorship and that sort of thing, because we all know that if you are in active cancer treatment, that's the focus and just caring for yourself and allowing yourself to kind of heal physically and emotionally, right?
But the best thing that I can tell you as far as weight loss, weight management, is that it is a journey, right? And it's not something that we want you to do overnight. And probably the best way to explain it to everyone is the Academy of Nutrition and Dietetics, which is the governing body for dieticians, they did a large meta-analysis some years ago. And what they did is they collected about 300 different studies all on different weight loss methods and they were trying to figure out what's the best way to lose weight, right? Because everybody does this lose weight, gain weight, lose weight, gain weight, that type of thing. What they found was that the most effective weight loss method is what is most sustainable for you.
In other words, you can lose weight on any number of diets, but the important part is, can you sustain it? So what we're really looking for is what's a lifestyle that's realistic for you, right? So scrap the idea of crash diets or restrictive diets. They work, we all done that, right? We're in for like two months, that kind of thing. After that, it gets too hard because we're changing too much at once. It's like a complete overnight overhaul of your whole life and you're supposed to just buckle down and pull yourself up by your bootstraps and stick with it. And that's impossible, I mean, for everyone. So forget about that kind of stuff.
When I'm working with clients on an individual basis, our focus is on making small changes. So we say, "What is one or two things we could do initially?" The qualifications are this for it to be a goal when you're working with me, it's got to be realistic. In other words, what's something that we know you can be successful at? Okay? Because if we can set you up with something that you can be successful at, even if it's really, really small, eventually you keep doing that small thing, you're like, "Wow, that is no big deal." And I've increased to one serving of vegetables a day for two months now, right? Now I have a little bit of confidence and I feel like I can be successful and I feel like I have some agency over my behaviors in my life. So now we can up the ante a little more. It's a slower process but what I find is people are able to be more successful and we are changing lifestyles.
Our food habits did not just happen during COVID 19, right? We didn't just initiate that. Some of them maybe we did, but there are things that come from our families of origin and so they are deeply ingrained in us so they are not going to change by next weekend so it's better to give yourself some grace when we're talking about losing weight.
And another thing that I do with all of my clients is we do not look at numbers on the scale. We are focused solely on other measures of success and we'll decide what those are, we write those down and report those. So it may be, "My clothes are fitting better and I feel good about myself." It may be, "I'm sleeping better." It may be a fitness goal like I walked 10 minutes every day after lunch, okay? So it's kind of tied to the goals, tied to the small changes we're trying to make, but it's all set up to focus on health, feeling good, taking care of yourself.
Another great thing that I like to do with clients is rather than have them track food, which is that normal dietician thing like we've got to track your food, which we see that in the research too, self-monitoring particularly tracking what you eat is something shown to help with success and weight loss, but it's tedious, right? And then when you stop doing it, you feel bad and you beat yourself up. So an easier and better tool is to just keep a running list of your self care, right? So, "Wow. I went for a walk today. I'm going to write that down. I ate an apple today, I'm going to write that down. I went to bed 30 minutes earlier. I took some time to meditate or just to read," or whatever today, call a friend, read a book, keeping track of all those things in a journal, get a journal and start doing that. In fact, Thanksgiving's a great time to start writing all that stuff down.
And I find when my clients look back and they see these things, it's very fulfilling for them, they feel successful, right? We're also addressing a lot of the other sides of the weight issue, right? Because it's not all what you eat. Hormones that get out of whack because of stress and poor sleep over long periods of time are probably one of the larger impacts for weight gain, okay? Why do you think everybody's talking about that COVID 19, right? And we're not meaning the virus, we're talking about the 19 pounds or more a lot of people have gained because all the pleasures in the world were taken away from us except food, and we've all been anxious and stressed and not knowing where we're going and grieving the life that we had that's not going to happen ever again.
So stress, emotional reasons, poor sleep really impacts it. So focusing on those other ways to take care of yourself is another great way to just initiate a kind of a lifestyle of caring and health for yourself. That's kind of a long explanation.
Webinar participant:
I'm from Mexico and I was diagnosed five years ago of hairy cell leukemia. I'm in remission. After that, my energy has dropped a lot. I have to take a nap after eating. Here in Mexico, we eat a big meal at two o'clock, we eat breakfast then the big dinner is at two o'clock and then at night at around eight o'clock we eat less. So what I noticed is that after eating, like three, four o'clock, I had to take a nap. And then after that, then I can go through the day. But my energy has dropped a lot and I don't know if it is a hormone thing, or it's what I'm eating. I try to do some exercise, but if I do that, then my energy is even less.
Lindsey:
So you're wondering about energy levels? And how long has it been since you've finished your treatment and have been in remission?
Webinar participant:
Five years.
Lindsey:
Five years. Well, congratulations. That's exciting, that five year mark is always an important one. So without knowing all the real specific details of your situation and things like that, it can be hard for me to say exactly. But a couple of thoughts here is that your body may take a while to heal. And if you're still dealing with some of the repercussions of going through treatment, or if you're still taking certain medications in your remission.
Well, and the other thing too is that just in general, we all naturally have as part of our circadian rhythms and natural body rhythms, we all have a dip in that late afternoon between like two and four. So it's not unusual, so even the healthiest person in the world is still going to feel a little dip in energy during that time. It can also be too if you're having a large meal, particularly one that is higher in things like red meat or really high in carbohydrates, both of those things can sometimes cause you to really slow down the digestion.
You know the effect, we're all going to have it next Thursday, right? Everybody says, "Oh, it's the tryptophan in the turkey that makes you sleepy after Thanksgiving." No, it's not. It's the fact that we eat too much food, right? And all that blood flow is concentrated on our belly rather than our brains. So it could be because of that. I wonder if you try reducing the size of lunch just a little bit and see if that helps. And then, like I said, it may be that large meal and then you hit that afternoon natural lull and it can cause that also.
As far as things you can do nutrition wise for energy levels, we usually recommend eating consistently, which it sounds like you're doing so breakfast, lunch, dinner, snacks in between if you need it, adding exercise can also help and actually taking like a 10 or 15 minute walk after your lunchtime meal may also be helpful. We know that exercise following a meal can actually help reduce what's called your postprandial blood glucose. So that's your after you eat glucose levels in your blood. And so it can help reduce those and help the digestion process. So something like that may be helpful as well.
But if it's an ongoing issue and you feel like it's really not right, I would encourage you to go to your doctor, they can always do some lab work and tests and make sure that everything's off. I mean, there's a number of reasons. We can feel low energy, things like thyroid and stuff like that can be out of whack.
Webinar participant:
I’m an 80 year old female diagnosed this year and just finished six months of pentostatin. I was finding that I was not eating enough vegetables and so I decided to start juicing and I'm feeling much better since I started that. How do you feel about juicing?
Lindsey :
Well, let me ask you this, with your particular juicer that you have at home, does it take the pulp out? Is it just the juice or is it one of those that includes some of the pulp?
Webinar participant:
It does not include the pulp.
Lindsey :
Yeah. So that's my biggest issue with juicing. I'm more of a smoothie fan, I'm kind of on team smoothie more than I'm on team juicing. And it's just for that reason. Now with juicing, it does not mean that you're getting no benefit or causing major harm or anything like that, you're obviously getting wonderful nutrients and phytochemicals through that, which is probably part of the reason you're feeling so much better, which is wonderful. But when those juicers remove the pulp, they're removing that fibrous portion. And if you remember what I discussed in the presentation, that fiber is really needed to help with blood glucose control and then it's also so beneficial for our microbiome so for our gut health. So I usually encourage people, take those same fruits and vegetables that you're tossing in the juicer and just put them into a blender and make more of a smoothie so that you're still getting the fiber.
Webinar participant:
Oh, okay. I'll try it. I'm putting turmeric and garlic and ginger and everything in it.
Lindsey :
That's wonderful. Well, and the other thing that you can do too is, I don't know if you make your juice fresh and immediately, but I've had some people who are kind of like, "But I invested in a juicer, I own this juicer I don't want to just forget about it and I really enjoy it." So I'll tell some people, if you make up a glass of juice or a bottle of juice and you can alternate, have some juice one day, maybe put part of the juice in the fridge and use it as the liquid base for your smoothie the next day so that way we're kind of getting the best of both worlds.
Anna:
There was a question in the chat that I was hoping you could get to because this individual just had a baby and she's breastfeeding and she was just diagnosed with hairy cell leukemia. And so she's thinking, "My gosh I have these increased demands for nourishing my child," and she hasn't yet gone through treatment. Have you worked with women who have been in a similar situation, even if it wasn't with HCL, if it was a different cancer or a really serious diagnosis? How did you advise them with regards to diet or nutrition?
Lindsey :
Yeah! That's a tough situation. And I'm so sorry to hear that, whoever posted that question. So first and foremost, kudos to you that you've had this baby and you're nursing, because it's certainly not an easy task to nurse.
I manage all our working moms lactation rooms on campus, and I run a support group for new moms as well and manage a lot of our breastfeeding policy and things like that at MD Anderson for moms. So I have a lot of experience with that. Here's one of the things that I want to tell you, and I usually tell all moms who are nursing, no matter what their situation is...So the fact that you even nursed is tremendous and you've given your child a gift and you've helped your own health as well as your baby's.
Yeah. And the other thing is you've got to give yourself some grace. So if it's really taking a toll on you, if you've got to start treatment and, that would obviously probably be contraindicated with the nursing and that kind of thing, you have still done a tremendous amount. And the most important thing for your baby is having a healthy, happy mom. I see moms all the time and they're back at work. They're trying to pump three or four times a day, manage their job, and they're stressed out to the max and they're hanging on for dear life to keep nursing because we make it sound like the end all be all, right?
Here's the thing you've already given her that she's gotten the most important part, which is that colostrum that's at the beginning. And it's more important for you to take care of yourself and be not so stressed and healthy and able to enjoy your time with her than to worry about being the world's greatest breastfeeding mom.
The other thing too, to keep in mind is that when our body is producing breast milk, it's really, if nutritionally, let's say we're kind of off or we're lacking in certain areas, our body is going to still produce high quality breast milk for that baby. The person that's going to suffer is going to be the mom. Okay. So you want to try to maximize your nutrition as much as possible, but you may get to a point where you've got to focus on your care and making sure that you're getting the nourishment you need for energy, for healing, for all of those reasons. And that's going to become the bigger priority than with the baby. Right?
Well with the modern nursing moms, you've really got to kind of go to almost that six meals a day. And they're not necessarily your normal big sized meals, but kind of eating more frequently smaller meals throughout the day. And also doing some things if you find that you're hungry all the time but you get full quickly, you can do some stuff to make your foods a little more nutrient dense. So in other words, we've got, we pack in more nutrients in the same volume. And healthy fats are a great way to do that. So adding extra nuts and seeds or peanut butter, almond butter, things like that onto stuff. Doesn't take up that much volume space wise in your belly, but it's going to be rich in nutrients.
And protein too. Make sure you've got good sources of protein because that's going to help preserve your protein. It's going to help with immunity. That type of thing.
Webinar participant:
I was diagnosed in '08 and I was treated with Cladribine, which worked wonderfully and I didn't relapse until this year. But one thing that happened is, all of my fingernails developed vertical ridges and they crack and they split. And I'm wondering if there's a nutritional thing I should be doing that would help those little nail cells finally make normal nails again.
Lindsey:
Yeah. That's a great question, do you take a multivitamin?
Webinar participant:
I take a variety of those nasty supplements you were talking about.
Lindsey:
Well, I'm going to hope that you checked with your doctor before doing that. So a lot of it can really have to do with, sometimes it can have to do with various nutritional deficiencies such as iron deficiency. Sometimes it can be a result of stress. I would really probably refer you to your doctor. It's probably not anything extremely serious, but because it's going to be due to one of a handful of different deficiencies, it could be, it's definitely a physical signal that nutritionally something might be a little off. So I would have your doctor run some lab work, maybe visit with a dietician if there's a dietician that you have available to you to find out what's going on and what are some great food sources that can help with that.
Well, biotin, when we're talking about nails and hair growth, biotin is one of the nutrients that's key in that. However, taking excessive amounts of biotin with any other vitamin, more is not necessarily better. Because many of them can have toxic levels or sometimes we get too much of something and it can unfortunately influence other nutrients because they all kind of act in synergy together in a special way within our bodies. So I would not recommend anyone go out and just start taking high doses of biotin.
I'm more of a believer in just a general multivitamin for women. Again, check with your doctors before starting something, because it could be contraindicated depending on what kind of medications or treatment plan you're on. But you know, none of us eat perfectly. And when you think of our food system and the manufacturers it just doesn't have of everything. And if you think of it, a multivitamin is just kind of a nice baseline to kind of fill in those gaps when we can't quite do it ourself. And a lot of times you always hear pregnant women when they start prenatal vitamins and things like that saying, wow, my nails are so great and I've always had terrible nails and it's that biotin and just making sure that we get that nice fill of all our nutrients.
Sarah:
There was a question in the chat from someone who said that they were five weeks off from Cladribine, their white blood cells and neutrophils are up. Their hemoglobin and red blood cell counts are still a little low and they’re asking about iron supplements. The person who posted the question said, “I have been eating spinach, but you can only eat so much.” So what other foods are high in iron to help with some of those issues?
Lindsey:
So I will use caution again. I would go and if you're concerned or thinking of iron supplements, have your doctor run labs. There can be different types of iron deficiency, there's iron deficiency anemia and then there can be pernicious anemia, which is a different thing. So have some labs run before you start supplements. Let your doctor give you a prescribed iron supplement. Couple of reasons for that. One, it's going to be an amount that is going to be better for you rather than just a generic.
They're also usually a lot more tolerable. Iron supplements can upset stomachs and be kind of nasty overall. And usually the ones that are by prescription are better tolerated than over the counter. But some other sources, spinach does certainly have iron in it. Unfortunately it also has a lot of, some of the fibers that are in spinach. One of the downfalls of fibers actually bind some of that iron and making it not bioavailable for absorption. So when we're talking about plant sources of iron from greens and things like that, they're not always the sources. So I don't know if the person who posted that question is a meat eater, but there's what we call heme iron and heme comes from the word, meaning blood.
So in other words, iron from blood, and then we also have non-heme iron, iron not from blood. Spinach is an example of a non-heme iron source. All of those are just not going to be quite as available. And so you've got to eat a little more of them and you've got to eat it with more frequency than your heme sources. Your heme sources are going to be your meats and animal-based protein.
So if you do eat animal foods, making sure that you've got some animal protein of some sort, whether that's beef, turkey, chicken, darker meats are going to have higher content of iron than your lighter meats, but adding some of those sources in a little more frequently or at most meals will help with iron. Some other great sources of iron are actually beans and things like nuts, like your peanut butter and stuff is a great source. Also a lot of your packaged cereals are fortified with iron. So if you can find some kind of healthy whole grain packaged cereal that's fortified, that would be another great source.
A couple other things with iron that you can do to enhance that is cooking in a cast iron skillet. Kind of crazy but when you cook in a cast iron skillet it actually leaches iron into the food. So get out that cast iron pot and cook in that for a little while. And then finally we know that vitamin C enhances the absorption of iron. So anytime you have an iron source, if you pair it with a food that's also a good vitamin C source. So for example, if you make spaghetti, your meat is going to have iron. A lot of times, pasta is also fortified with iron and then that tomato sauce is going to be a great source of iron or vitamin C. Things like chili, where you've got meat and beans and tomatoes. Okay. A little glass of orange juice or some kind of smoothie with some fruits and vegetables along with maybe an egg in the morning or two. Or some kind of omelet with some of the spinach and other grains and things. So hopefully that helps.
Webinar participant:
My wife is two years in remission. She suffers from irritable bowel syndrome, where if she eats too much or it goes too heavy on the fiber side or too much on say fresh vegetables. So do you have any recommendations on how to deal with that?
Lindsey:
So yeah, irritable bowel can be really finicky. And it's also individualized because it can, it manifests itself in so many different ways for, for different people. The unfortunate part is a lot of that fiber, whereas it can be really beneficial in some ways and can be really bothersome as a trigger for IBS in other ways. So usually what we do is try to spread it out in smaller amounts. Focus particularly on things that she does tolerate well and making that kind of the core of a lot of her meals and adding in just smaller amounts of some of those foods that are more bothersome.
You might also experiment. Sometimes people with irritable bowel tend to do a little better with having their foods or their vegetables, their triggers cooked in different ways. So whereas sometimes eating a salad where it's raw, maybe particularly bothersome, but having cooked vegetables where they're a little bit softer, a little bit easier to digest may be easier. And then also looking at some ways to like slip fruits or vegetables into other foods. So for example, let's say she can tolerate some kind of pasta or soup or something like that. Really easy to kind of nestle in some smaller amounts of those fruits and vegetables in those other foods.
Webinar participant:
I was diagnosed in 2018 and I was treated. I'm in full remission now. My question is about alcohol intake? What do you think about alcohol overall?
Lindsey:
Thank you and congratulations on your remission. That's exciting. So with alcohol, the current recommendations from the Institute of cancer research is to avoid it if at all possible, because it is a known carcinogen and linked to various cancers. But if you do, decide to have some alcohol. I had discussed earlier about keeping it to the one serving for women, two servings for men and a serving is only about four to five ounces of like wine, that type of thing, one beer it's one ounce of any kind of hard liquor. And I usually instruct my clients to combine it in a way that kind of lessens the impact. So in other words, let's say, you want a glass of wine, if you combine that with something like some sparkling water or something like that, or a little bit of fruit juice to dilute it Then you are able to drink less rather than having the full portion. Also drinking it simultaneously with some water or some tea to kind of help again, dilute the impacts of it and then also having it with food so that those are, those are kind of the current recommendations.
Webinar participant:
The AICR.org website actually shows you all of the keys to prevention, all the foods that you were speaking about and how to prepare them. So the information is right there for everybody, which was great. And I just wanted to make sure that everybody understood that to help them research what they're eating based on your recommendations.
Lindsey:
Yes. Thank you for pointing that out. They do. You can actually go in and look up an individual food like onions or tomatoes or that kind of thing. And it will talk about it. They have a whole recipe section as well on that website.
Webinar participant:
So I became a type one diabetic at the age of 11. I was diagnosed with pernicious anemia this year and then I was diagnosed with HCL. I took Cladribine. Is there a possibility that the pernicious anemia diagnosis could have been misdiagnosed? I'm vegan,
Lindsey:
That would really be something that you would want to revisit with your doctor. However, being a vegan makes you a little bit more at risk for pernicious anemia. It's generally due to low levels of vitamin B12, which typically comes from meats. There are virtually no sources to speak of, of B12, that come from plant-based foods.
Your doctor, they're obviously going to be the expert in that area With following a strictly vegan diet, depending on how you eat, it's easy to be deficient in B-12, which could contribute to that. But I'm not an expert by any means of the intricate relationship between B-12 with HCL. So, I can't really say if it would be a misdiagnosis.
Sarah:
Well, thank you so much for all the helpful information. I appreciated the tip on going to the AICR website to get some specifics with regards to some of the questions.
Anna:
Lindsey, thank you again. This has really been a tremendous presentation.
Lindsey:
Well, thank you everyone. It's been a pleasure being here with you today, such great questions, and I really appreciate your time and your interest in the topic of nutrition, because it's certainly near and dear to my heart. I wish all of you the best in your journeys. Take care of yourselves and have a very happy Thanksgiving as well next week.
Transcript has been edited for clarity.