2021 Hairy Cell Leukemia Patient Seminar Session
Webinar: Diet and Nutrition
October 12, 2021
Hosted by the Hairy Cell Leukemia Foundation with expert speaker Mr. Kyle Dent, Senior Clinical Dietitian at MD Anderson Cancer Center. Moderated by Anna Lambertson, HCLF Executive Director.
Session Materials
A synced recording of the webinar can be accessed using the link below. The link will open a new window. You do not need a Box account to view the recording. Click ‘download’ if the video doesn’t open.
Please note that the Q&A is available through the written transcript only.
Transcript of Presentation and Q&A
Transcript of Presentation from Kyle Dent
Kyle Dent:
Thank you everybody for joining. We're just going to go over what I do when I talk with my patients about before, during, after treatment with HCL. So it can be pretty tricky sometimes, it just depends on what they're going through, depending on treatment.
But one of the first things is, plant-based diets are usually the best, essentially for most patients. The Mediterranean diet's most popular, and usually it is one of the best for most of my patients.
We try and just make sure you go with a variety of plants, vegetables, fruits, etc., but you always want to make sure you still have your protein with that as well. And we'll get into that here in a second, but just wanted to give some quick little examples. Try and limit your processed foods, things like that. But at the same time, sometimes you might need them, especially with some of my patients who are traveling. So it's understandable that they might have to stop at a Subway, so I don't push that too hard.
So if you remember the MyPyramid from quite a while ago, they changed that to the MyPlate method several years ago. And this is essentially going more towards trying to make sure you balance your plate.
And it's not a vegan diet, it's not a vegetarian diet, it's just making sure you have a good variety of fruits, vegetables, and making sure you still have your protein, too. So look at the right side, you can see an idea of roughly what three ounces of cooked protein is like. So think about it as salmon. Most protein sources, they're going to lose a little bit of fluid when you're cooking them, essentially. So they're not going to be quite as much as what they say they are. So roughly about three ounces cooked is about the size of a deck of cards, just an idea. And that's roughly about 24 or 25 grams of protein or so. And every patient's different, so everybody needs a different amount of protein.
Kyle Dent:
So I always recommend patients to limit their fried foods and limit their bacon, but at the same time, everybody's unique and has their own likes and dislikes. So I can't always completely have people stop eating bacon, that's normal, but I usually try and steer them towards turkey bacon, if I can.
One of the biggest things is, this is coming from the American Institute of Cancer Research, is trying to limit your red meats. So less than 18 ounces cooked a week, if you can. But red meat does incorporate pork, lamb, beef, buffalo, things like that. Pork is one of the ones that's kind of argued about over the years, but realistically it does still have a higher amount of fat in it, and that's why we're trying to kind of limit the amount of red meat.
Kyle Dent:
So you can try and do grass-fed, it usually costs more but it cooks a little bit better too. Try and avoid your processed meats, things like sausages, hot dogs, salami, et cetera. I'm not going to read the entire slide to you because that would be boring. I'm from Chicago, so I will admit that I will eat a hotdog on occasion, that's just normal.
But the thing is just avoid it, not completely never have it in your life. And then be very cautious with charred foods. So cooking in the very high temperatures, essentially just think of it as like blackened foods, if you just cook it very high. It's essentially very dark. (Cooking in high temperatures) creates carcinogens and that could potentially lead to cancer. So we usually try and limit that as much as possible.
This is one of the biggest things that I work with, with my patients. This is side effect management. I want to make sure that they're able to maintain their weight throughout treatment. That's one of the biggest, hardest things to do sometimes with patients. And realistically, they're going to lose muscle mass first if they start losing weight. Early satiety is very common, especially in HCL, and especially nausea, bowel management, those type of things are two big things that I work with my patients frequently.
Once weight loss starts happening, it's very, very, very hard sometimes to start regaining and start working your way back up to gain the weight after you've lost it, especially during treatment.
So that's why a lot of times I'm a little bit more lenient with things. So that's why I usually go for healthy, but at the same time I might have to kind of open up my recommendations. If someone's losing a lot of weight and I need to focus on things like, okay, they can have some ice cream. Usually we aim for healthy diets, but at the same time depending on treatment, that can vary.
Then essentially one of the biggest things is with a loss of appetite, and especially thinking of HCL, it leads to kind of what's called early satiety, is the medical term for it, but patients aren't able to eat as much at a meal that they're usually capable to eat.
So it's kind of working around that and trying to find ways to do it, and usually trying to do small frequent meals every two to three hours, if you can, walking and stuff as able. But keeping little snacks available, I find, is pretty easy for my patients. Even a thing of mixed nuts or even little protein bars, stuff like that. Just trying to keep that in sight, because it's one of those out of sight out of mind type situations. So if you keep them available, you're able to have it and you can say, okay, I haven't eaten in a little while and I have something. So that little bit every two to three hours can equate to how much you're supposed to have in an entire day, say if you're eating three meals per day, like most individuals. And then just pay attention to if you're hungry. Pay attention to those cues. If you're hungry, go for it, have something.
I encourage my patients to eat when they are hungry, but don't feel like you have to do too much. But sometimes choosing smaller plates is something that's a little bit out of mind sometimes. But choosing something instead of going for the usual portion they do, try and go for something smaller, start smaller. And if you're able to do a little bit more, then you can have a little more, second portion, those type of things, so that's helped quite a bit for many years with my patients.
And weight loss, this has been difficult. It's very difficult. Usually we have to use some form of supplements. Boost, Ensure, those types of things. Boost is made by Nestle, Ensure is from Abbott.
But then there's several other types of protein sources. You see the gold standard whey one on the various bottom side, that's just basic whey protein. But then you think about the different other ideas of things that you can use, like Boost or Ensure. Boost Plus, Ensure Plus, they're a little bit higher in calories, not as high in protein. And then they have the higher protein ones. Boost came out with, I believe it was, Boost Max. That has roughly about 30 grams of protein, but it's just not as much calories. So it's just choosing those. But then I also have other things that I utilize with my patients such as adding like butter, cream and avocado, things like that, into their diets, to kind of just add a little bit extra calories and not add too much bulk.
Because when they have early satiety, it's kind of hard to increase calories because they really have a difficult time eating more. So trying to find ways that we can do it without adding too much bulk, I guess, is the best way to say it. So ideas for you right there, just adding black beans plus cheese on top. So little things, even though it's not the healthiest in the world. Baked beans, that would be a protein source, and add a little bit of cheese, it's got some fat in it, a little bit of protein as well. So just some ideas, little things they can do to kind of increase a little bit and try and stabilize the weight during treatment.
Kyle Dent:
Just focus on healthy eating and the lifestyle, especially afterwards.
So I wanted to include some things; realistically, we're always looking into different types of foods and things. So some of the most common ones that I see are green tea, mushrooms, turmeric. Typically, I don't push supplements or added supplements to patients, but I always want to at least know essentially what the benefits are to them. Because some patients do like to have them. Really, mushrooms, that's not going to cause a problem with most treatments that I know of. Green tea should be fine, even though sometimes that can be a diuretic, and then turmeric.
Turmeric's one of the bigger ones that kind of comes out, it's in a lot of places online. But it's not one I specifically recommend, but it's usually not something that's going to cause any harm or problem to my patients. And it does have some anti-inflammatory prospects to it from some studies that I've seen too. So yeah, just to give you some ideas of some healthy foods.
Then some other cancer-fighting foods. This goes along with the Mediterranean diet, like cruciferous vegetables, of course, and leafy greens, garlic, onions, leeks, those types of things are great. If you use olive oil, it's the healthiest source you could use for a type of oil, but you can use different types of oil. I like grape seed oil. Something to try and do though is just make sure, word to the wise, keep your oils away from the oven. Because if they're closer to the oven, it's very possible that it can become denatured. So fats become denatured once they get to a higher heat level. So try and make sure your oil is just not sitting directly next to the oven.
But then otherwise there's some different varieties of vegetables. Berries are very rich in antioxidants and then stone fruit, things like plums, peaches, those type of things are great. They're also a rich source of fiber, which is recommended for most of our patients unless they're having diarrhea, but that's a whole different story. Those are very healthy and great for you to kind of sneak into your diet. You don't have to have it every single meal, but ways to kind of just slowly improve your diet, I guess you could say, make it more well-rounded. Go ahead.
And then another thing that comes up a lot with my patients, and I always like to bring it up when I do actually have presentations, is just organic versus inorganic. It's truly up to you, it's your choice.
I can go more into it if you do have questions about it, but just wanted to let you know usually it's not one of those things I'm going to go in and tell my patients to have organic foods because realistically it's going to cost you two more dollars for an apple than a regular apple, and I'd rather you have an apple than no apple. But at the same time, it's your preference, or if you're able to do it financially, usually it's a little bit better. Nutritional components, they're pretty much the same. It just depends. Organic or inorganic is how they're made pretty much or how they're grown.
I just wanted to give you some information regarding this. I want to say reduce your exposure to pesticides and chemicals. It really is patient preference when it comes down to this. So just wanted to share this with you because it is, either after you're going through treatment, it is something that's kind of big and it's all over the internet.
So just wanted to give you a little just information nutritionally about it.
Then I wanted to include some references for everybody. I mentioned earlier how they switched from the MyPyramid with the MyPlate. So choosemyplate.gov is a nice, easy website you can go to. Fruits and veggies matter, that's fine. Aicr.org is an awesome website for the most up-to-date nutrition research regarding cancer. And then there's several others as well. And then others, like Sloan-Kettering, they have some awesome information on the website as well, too. The next one, I believe, has our website and a couple others too. And then the American Dietetic Association, that's where I'm credentialed. And then the American Cancer Society is another good one too.
Transcript of Question & Answer with Webinar Participants
Anna Lambertson:
There’s an individual asking about diet recommendations that you might give to patients who are still in the watch and wait phase. So, they are being monitored for their HCL, their blood counts are not such that a doctor is yet recommending that they begin treatment. Is there anything specific that you might recommend a patient pursue with regards to diet and nutrition, if they're still being monitored and aren't yet ready for treatment?
Kyle Dent:
Food safety. Especially if you have low white blood cell counts. If your platelets are low, food safety is a huge one. Food safety is just making sure your foods are cooked thoroughly. Usually, I tell patients not to go to any salad bars, or things like that, but those aren't really around at the moment due to COVID. But washing your fruits and vegetables thoroughly, that really is always important. It's just being cautious. You can still have your fresh fruits and vegetables, but just making sure you wash them thoroughly and be very careful.
Anna Lambertson:
And is that because the patient, while not yet ready for treatment, might be immunocompromised and therefore more susceptible to infection. Is that why?
Kyle Dent:
Yep. Trying to avoid foodborne illness. It's very easy for a lot of us. Anybody is susceptible to it. But when you're immunocompromised, you're more susceptible. So that's where we become a little bit more cautious with it.
Anna Lambertson:
Another interesting question from someone joining the webinar today. They were diagnosed with hairy cell leukemia about 20 years ago. And at the time, a member of their family sent them an article discussing the benefits of mushrooms for boosting one's immune system. They have since found a product called Myco-Immune. I'm actually unfamiliar with it, but you may have heard of it. And this individual says that they've been taking it daily ever since and has not needed to be treated for their HCL since. So, they're curious if you're aware of any evidence or studies with regards to mushrooms and their ability to boost one's immune system.
Kyle Dent:
Mushrooms have been studied pretty extensively, recently too. I've seen some pretty positive studies about them as well. So I have nothing against them. Regarding specific products; be very careful about over-the-counter products. If it's a proprietary blend, you should kind of stray away from it. I did some research on that in grad school. Just be cautious with over-the-counter products, but I'm not going to say yes or no to your product. If you feel that it's helping you, I'm not going to say no to it. If it's not hurting you, that's a good thing. I'm pretty open in that regard, but I'm also not going to be somebody who's going to say, you've got to start taking this, you got to start taking this, you got to start taking this.
Anna Lambertson:
If I could just add, we always encourage patients to discuss with their hematologist or even their general practitioner about any supplements or, like you said, any over-the-counter products that they may be interested in taking. Because there could perhaps be a negative interaction between a supplement and the treatment that they need specifically for their HCL. It's important to have an open conversation with one's treating physician.
Kyle Dent:
Very true. I highly recommend it. I also cover targeted therapy, clinical trials here at MD Anderson, and there are specific foods and things that need to be avoided with specific treatments. So it's always important to discuss that with your doctor if you are taking specific supplements and things like that.
Anna Lambertson:
Another interesting question from an individual in the webinar. So you talked a bit about issues that some patients might have with feeling full early, and you provided some recommendations to help the patient make sure that they're getting enough nutrition and not overdoing it. This one individual chimed in and said, well, loss of appetite is not something that he's experiencing. He has, however, been reading some information about the benefit of fasting or intermittent fasting and cancer management. He even has some references. None of these are specific to HCL. What do you know about, or what research out there are you aware of with regards to fasting, intermittent fasting and any possible benefit or, vice versa, detrimental impact on one's cancer management?
Kyle Dent:
Great question. I do work with clinical trials, and I've seen some working with fasting as well, which is kind of interesting, but there's nothing official that I'll ever say, “you need to start intermittent fasting, you need to start this”. Everybody's different.
I like reading the research about fasting. So I usually don't have a problem with it, unless if I have a patient that's malnourished, I might make some recommendations to change it, but otherwise I don't have a problem with it. If it's helping you and if you're healthy with it, go for it.
Anna Lambertson:
One individual on the webinar today points out that you are discouraging highly processed foods or things that are over-the-counter, but at the same time saying maybe occasionally integrating protein powder into your routine could be beneficial. Do you mind clarifying that for everyone listening?
Kyle Dent:
It’s just what's recommended by the American Institute of Cancer Research about processed foods. Processed foods. Think about chopping up, we were talking about mushrooms, even, chop up a mushroom, even slicing that, that's essentially processing it in a way. Don't want to say certain brands because I don't want to say anything negative. Certain foods, like you say, you're buying in the frozen section are usually quite highly processed and not as healthy. But you could do things like, even if you're getting, say, sliced meat, try and choose things that are nitrate-free that are usually a little bit healthier for you. But the thing is, know that those nitrate-free foods are not going to stay in your refrigerator as long because they process them in order to keep them good for a longer period of time.
Anna Lambertson:
I think what you're saying is, avoid these highly processed foods. If someone is struggling to get enough protein in their diet through natural unprocessed foods, it might be okay for someone to occasionally add some protein powder to just aid in getting enough protein. But you're not suggesting that someone make protein powder a regular part of their daily diet. I think that's where the person was trying to understand the protein powder component.
Kyle Dent:
Protein powders typically are pretty good. There are certain ones I like better than others. It just depends. Certain brands, I think I mentioned proprietary blends. Try and avoid those.
I do have patients who utilize protein on a daily basis from protein powders, etc. I like to know what it is, double-check, make sure it's a good one, and go with that. Because everybody has their own likes and dislikes, flavors. I know one that's chicken soup flavored, which is kind of interesting.
Anna Lambertson:
We have received some interesting questions about fruits and vegetables. One individual said that they were advised by their medical team to eat only cooked, so not fresh, fruits and vegetables during treatment until their blood counts came back up. I'm curious about your thoughts on that?
Kyle Dent:
Good question. It's actually another project I'm working on currently. Two years ago, we switched away from what's called the neutropenic diet.
It's never officially been proven to be successful, I guess you could say. What I have found over the years in my patients, when they're on a neutropenic diet, they have much less availability to foods. Or say if you have taste changes, mucositis, things like that, that can of course change what you want to eat or what you may be desiring to eat.
So here at MD Anderson, we don't go right towards a neutropenic diet for anybody. We go towards a regular diet now. And that's why I mentioned food safety earlier. That's the biggest thing. We do allow fresh fruits and vegetables, which is a great thing for my patients at least.
My recommendation is to follow your medical team. If you're not my patient, I wouldn't go with my recommendation. I'd say follow with your medical doctor's recommendation. I think I said it earlier, I don't like stepping on toes. It's one of those things. Some hospitals allow it, some don't. Here, we do.
Anna Lambertson:
It’s interesting, you mentioned taste and flavor. Someone specifically asked a question about this. How normal is it after treatment, which is usually chemotherapy, does food no longer taste as it did before? Do you encounter that with your patients? How long do you feel that that loss of taste lasts?
Kyle Dent:
I see it very often. I have a patient here in about two hours that has the same problem, but the thing is, the taste changes, they're different for everybody. Sometimes it depends on the treatments. There are certain chemos that cause metallic taste changes. Other taste changes are very hard to get around. Nothing tastes what it should. Sometimes it comes down to working with you as a patient trying to work towards what you can tolerate best and find ways around it. Because it might not taste the way you're going to want it to taste, but are you still able to eat it and is it still beneficial for you?
I'll give a quick little tidbit that can help sometimes with taste changes for many different types, and this can go with any taste changes. Just use a little, like a mint or a hard candy or something before you do your meal, it's going to kind of tweak your taste buds a little bit and it helps quite a bit. It's nice. There are supplements sometimes I can recommend, but I'm not going to get into that right now because that's patient-specific. But doing little hard candies or, if you're nauseous, ginger can help a little bit. So there's a cool product out there called Gin Gins, they're Laffy Taffy-type ginger products that are kind of easy. You can just chew on them before a meal a little bit, and it helps ease nausea a little bit, and then you can tolerate that.
Or if you're having a metallic taste change, switch from metal spoons, metal forks to plastic, that is another way. You'd never think of it, but kind of an easy way to tweak it. And it usually helps quite a bit. One of the hard things that I'm currently coming across, which kind of ties into this, is COVID also does typically lead to taste changes. So that's something that I'm experiencing with patients, that might not even be due to their treatment or HCL. They do have long-standing taste changes from that. Taste changes are very common, we'll put it that way. Everybody's a little bit unique so it's just working with them, going through it and seeing what works or let's try this, let's try that.
Anna Lambertson:
We've had a few people ask about alcohol consumption. Is an occasional glass of wine or a beer once or twice a week okay? What are your thoughts on that? What do you tell your patients?
Kyle Dent:
It's a good question. I go by the recommendations by the American Institute for Cancer Research. So they recommend to abstain, if possible, but realistically we're all humans and every once in a while you want to have a drink. So it's recommended no more than two a day for men and no more than one a day for women. We'll say you have to pay attention to the actual amount. So when I say one drink, I'm not saying 12 ounces of vodka, or I'm not saying an entire glass of wine. Typical wine glasses are quite large and a serving size of wine, like one serving, is five ounces. So just pay attention to how much you're having if you do have it.
I just say don't over-consume, especially if there's any liver involvement. That could cause more decreased appetite. That could cause more problems. I'll say it again, no more than two a day for men or one a day for women. No one's going to like that comment, but that's just what they recommend. So I go by that one.
Anna Lambertson:
Any thoughts on dairy? Is there anything about dairy that you generally advise your patients about in terms of safety, before, during or after their cancer treatment?
Kyle Dent:
Make sure it's pasteurized. Really, that's a big thing. Dairy is okay. If you're lactose-intolerant, that's probably not okay. You can use Lactaid, which is an over-the-counter oral supplement. It's chewable. Or you can use Lactaid milk. Otherwise, I have patients who have, say, high triglycerides, cholesterol, et cetera, I'll say, okay, high fat milk is probably not your best choice. So going down to 1% skim milk is usually a little bit better. But when it comes to cancer, with dairy, you're okay. I've seen the stuff out there and it's not conclusive. So you can have dairy.
Anna Lambertson:
Do you have any thoughts on the sweeteners that patients might use, such as sugar substitutes like Stevia or honey? How do you advise your patients in that regard?
Kyle Dent:
I'm usually not too strict on that one, to be honest. There are sugar substitutes that in the past have been linked to colon cancer and then they came back to be found that that was incorrect and that was not true. I usually try and say just don't get artificial sweeteners, if you can. Truvia and Stevia, they're actually from a plant, but they’re still considered an artificial sweetener.
Your body doesn't recognize the artificial sweetener as a sugar. My diabetic patients, they tend to utilize those a little bit more frequently just because it gives them that sweetness,. If you want to be a little bit more on the healthier side, Truvia and Stevia is definitely the better way to go, if I can say that.
Truvia or Stevia, that's roughly about 400 times sweeter than one grain of sugar. Or if you have, say, Splenda, that's 6,000 times sweeter than one grain of sugar. So there's a reason there's a little bit of an aftertaste with Splenda. It's extremely sweet. But the more you use of it, the more you're going to want of it. It's kind of like caffeine. The more you have of caffeine, you're going to want more.
Anna Lambertson:
There are several individuals who have posted questions in the Q&A. They have the understanding that sugar is bad for cancer in the sense that it feeds the cancer.
Kyle Dent:
Our body utilizes sugar all over the place. So every cell in our body utilizes sugar. I can't just tell you to not eat sugar to stop eating cancer, that's the easiest way to put it. Think about it this way, I was just recommending earlier to eat a variety of fruits, vegetables, berries. Those are the simple sugars. They're good for you. Your body's going to break down that sugar and I can't direct where that's going to go. So I can't tell you if it's going to go to a cancer cell or if it's going to go to another cell.
I don't want you to living off of Hershey's. I once told a patient that he could have a little bit of chocolate every once in a while. It was right around Easter time. His eyes just lit up immediately. He was thinking of that gigantic Easter bunny that you can see at Walmart. So I was just like, "No, you don't want that entire thing. Just maybe a piece of the ear, but you can indulge every once in a while." If it's your birthday, by all means, have some cake, but don't over-indulge on sugar. That's my best recommendation for it.
Anna Lambertson:
I think so. Some individuals I've been in communication with prior to the webinar and then who are participating today, they feel that there might be some research that shows that the HCL reacts differently to sugar than some other tumors or some other types of cancer. HCL is a rare blood cancer. But let me ask it this way, are you aware of sugar reacting differently with some cancers than with other cancers? Are you aware of anything that might say, yeah, if you have this type of cancer, you should definitely be more strict about your sugar consumption compared to, say, another type of cancer?
Kyle Dent:
Say, am I aware of that, have I heard of it? Yes. Do I agree with it? Not always. Because I work with a lot of different cancer types. But I've not seen it cause any specific change in one cancer or the other. So if that answers your question.
Anna Lambertson:
I think what I hear you say is the focus should be on balanced nutrition. One question that someone had here in the Q&A was, is there anything to avoid really specific to HCL? We did recently communicate with some of our Centers of Excellence about this question, and some of the hematologists in our network have advised their patients to avoid meat while they're going through treatment because of the way that it gets into the body and might affect this or that. But, I think what you're saying is all individuals should be looking at balanced diet in general.
Kyle Dent:
The red meat one's interesting. I've never seen anything specifically about red meat related to HCL. But the overall consensus is less than 18 ounces a week. So I lived down here in Texas, so having a steak night every once in a while is pretty normal. Just be moderate with it, if you can.
Live question from webinar participant:
I have a quick question. We've always been very much into probiotics. When my husband was diagnosed, his neutrophil was 0.1, very, very low. But prior to that, were doing our kefir for our overnight oats, which I ferment on the counter. But at what point in time can I reintroduce probiotics, natural probiotics or supplemental probiotics into his diet?
Kyle Dent:
Good question. I've been a proponent of probiotics for years, but usually I utilize them around the time of antibiotics or if somebody's having a lot of diarrhea. I can't specifically say if they're going to affect his neutrophils, but I don't want to say anything negative against your current doctor. So double check with your doctor if it's okay to re-introduce them. I'm okay with probiotics. It's just making sure it's okay with the doctor. Every oncologist is different on what they prefer with their patients. Every doctor I work with has their own specific way they like to practice, and I work with it. So, double check with your oncologist.
Webinar participant:
I read a couple of articles online. And it said something about the live microorganisms in some probiotics could cause bacterial issues with him. So I did go to a commercial organic yogurt to make us overnight oats. I guess that was my concern with low neutrophils. Does that introduce bacteria in his system that could cause any kind of infection?
Kyle Dent:
I can't say yes or no to that. Probiotics are introducing positive bacteria back into the environment. Because our gut utilizes bacteria to break down a lot of things. So I can't say yes or no to it.
Live question from webinar participant:
I saw an integrative oncologist and, I know you talked about turmeric a little bit. He also recommended Resveratrol, vitamin D, some other kind of herbal supplements. I was curious if you had any more thoughts on pairing those with more traditional treatment after recovery from chemo.
Kyle Dent:
Naturopathic doctors are going to take a different approach, typically than I do. Regarding the one I can say is if you're thinking about vitamin D, make sure you have it checked first, prior to starting a supplement. Your vitamin D might be completely fine. I've worked with vitamin D for years and it depends on where your vitamin D is at, what the supplement needs to be. It depends on the prescribing individual. Usually most of my patients, their vitamin D is managed by their primary care physician. I don't just randomly go out and say, hey, start this vitamin D, start that, I'm usually not too keen on starting a lot of new supplements unless it's necessary. Unless it's going to positively affect my patient, I'm not going to start somebody on something.
Anna Lambertson:
We've had a couple of questions come in because you're really underscoring the need to properly clean fruits and vegetables before consumption. There have been a few questions about how, so is there a particular kind of vegetables spray that you would use? Are you just talking about a mild soap and water? How do you advise your patients to make sure that their fruits and vegetables have been properly cleaned?
Kyle Dent:
Even just warm water and just having a good brush. There are different mixtures and things you can use, like vinegar mixtures and things to kind of clean them.
Anna Lambertson:
There was someone who, similar to the question about probiotics, was talking about the gut issues and recommendations for how to get their gut back in proper health. Could you speak to that because you did mention it and it’s important.
Kyle Dent:
I unfortunately don't have a quick answer for it. It really is patient-specific and we just work on it over the course of, say, follow up every couple of weeks or so and see how you're doing. Does this work, does this not work? Sorry, I don't have any specific answer. That's a tricky one. But there's so much research going on right now about the gut flora, things like that.
Anna Lambertson:
Kyle, thank you so much. We really appreciate the information that you presented and all the time that we had today to get through quite a few questions that came in.
Kyle Dent:
My pleasure. Thanks everyone for coming. It's exciting.
Transcript edited for clarity.