Deborah Howell (Host): Welcome to the show. I'm Deborah Howell. And today we'll be talking about the importance of nutrition during cancer treatment. Our guest is Crystal Vila, Clinical Nutrition Supervisor at Orange Coast Medical Center and a Registered Dietician. Welcome Crystal.

Crystal Vila, RD, CNSC, CLT: Hi, Deborah. Thanks for having me.

Host: Wonderful to have you today. So why is nutrition so important to a newly diagnosed cancer patient?

Crystal Vila, RD, CNSC, CLT: Oh, well, when you first hear you have cancer, you may think what can I eat? What should I be eating? What will help? The idea is to eat a healthy and balanced diet, however, meeting those nutrition needs may be difficult or become difficult when treatments start due to the side effects and the effects on nutrition intake.

Host: Sure. So what are some of the common nutrition treatment related side effects?

Crystal Vila, RD, CNSC, CLT: As it really depends on what type of treatment or combination of treatment and what kind of cancer and body parts affect it. So some side effects may be loss of appetite, nausea, vomiting, mouth sores, dental gum issues, taste changes, GI complications, and body changes. This is a very brief list, but a dietician can definitely help review side effects with a patient based on the type of treatments they are receiving.

Host: Sure. And how does dietician help optimize a diet plan for a cancer patient?

Crystal Vila, RD, CNSC, CLT: A dietician will perform a nutrition assessment, which is an in depth analysis of the patient to provide a personalized nutrition plan. The earlier the individual's plan is created, the more effective it will be to prepare them for nutritional changes and impacts. Interventions start to become more difficult and challenging if someone has already developed severe malnutrition or nutrition depletion, so basically don't wait, come see a dietician as early as possible when diagnosed.

Host: For sure. Now, what would you recommend for a patient experiencing no appetite and early fullness?

Crystal Vila, RD, CNSC, CLT: These can definitely lead to weight loss and weakness. So some suggestions would be to eat small frequent meals, snacks six to eight a day, sticking to a scheduled timing for these meals and snacks would probably help more than waiting to feel hungry. Add nutrient dense foods and liquids. And that just means in smaller amounts you get items that are packed with vitamins, protein, fats, and carbohydrates. So if you're eating little amounts, you're at least getting more nutrients. Add in some oral nutrition supplements. And another thing would be physical activity may help food move through the GI tract.

Host: Okay. Now you mentioned this, but during cancer treatment, people may experience changes in taste and smell. What would you recommend for someone experiencing those symptoms so that they're receiving the nutrition that they need?

Crystal Vila, RD, CNSC, CLT: This would depend on what type of taste change you're experiencing. So it's something tastes a little bit off, try fruity or salty or things with extra seasoning. If something tastes metallic, you can try sweet or sour, ahm sucking on lemon drops or mints. Instead of metal silverware, try plastic utensils. For salty, try naturally sweet foods like fruits and choose low sodium products.

If something's too sweet, tried bland dilute juices, mix oral supplement drinks with milk or milk alternatives. And if the smell is your issue, try avoiding food with strong odors. But if you're the cook, try to maybe cook items that are pre-made or open a window and use good ventilation.

Host: Now some may also experience constipation or diarrhea during treatment. What are some nutrition recommendations for patients with thes symptoms?

Crystal Vila, RD, CNSC, CLT: Definitely both with constipation and diarrhea, hydration is extremely important. So look for reaching up to like 80 ounces, which is eight to 10 cups a day, sipping on clear liquids, which are your hydrating liquids. For constipation and start slowly adding in insoluble fibers like bran, flax seed, vegetables and fruits with the skins, legumes.

Talk to your physician about adding probiotics. Also a laxative or stool softener, and definitely report if you've had no bowel movement for more than three days. For diarrhea, small frequent meals, help. Low fat items. Low lactose. Avoiding fried and greasy foods. Increase your soluble fiber, which is applesauce, bananas, sweet potatoes, rice. Try to avoid things like caffeine, alcohols, including sugar alcohols, which is anything that ends in an OL on the ingredients list and spicy foods. And definitely make sure you replace your electrolytes.

Host: So interesting. Now are there any nutrition recommendations for nausea, vomiting, and indigestion?

Crystal Vila, RD, CNSC, CLT: Okay. Yes, so trying smaller, again to smaller frequent meals to help, try bland dry foods without strong odors. Cool items. Liquids may be better tolerated between solid meals instead of with them. Stay hydrated with the clear liquids often. Start with very small sips after vomiting, maybe about 30 minutes, sucking on hard candies may help with the nausea and just that if there's a bad taste in the mouth. For indigestion, avoid eating two hours before going to bed, keeping your head elevated after meals. Lying down, wear loose fitting, especially around the abdomen. Some things that may irritate are things like chocolate, mint, alcohol, caffeine, and high fat foods.

Host: Yeah, the Romans used to dine while reclining on their couches. So they look at it their ceilings and see how their beautiful artwork, but not such a great idea. So how does oral mucositis and esophogitis affect a patient's nutritional intake?

Crystal Vila, RD, CNSC, CLT: So these two definitely cause some inflammation and that inflammation can cause mouth sores, painful swallowing and irritated throat. Food items that may irritate are things that are acidic, citrus-y dry, scratchy, spicy, peppery. So try more bland, soft items, cooler like Popsicles. Try mouth rinse without alcohol in the mouthwash. And definitely ask your doctor about a numbing mouthwash to help.

Host: Okay. How does person's body weight affect cancer and cancer treatments?

Crystal Vila, RD, CNSC, CLT: So higher levels of body fat and low lean body mass have been associated with poor outcomes affecting insulin, growth hormones, and making it a nice area for cancer to grow. If fat loss is desired, make sure this is monitored under an oncologist and a professional to ensure that the preservation and of that lean body mass. If somebody is at a normal body weight, then the goal would be to maintain that body weight.

If somebody's experiencing weight loss, try increasing the calories and protein with nutrient dense items. Cancer causes inflammation, which will affect how the body metabolizes and uses protein, carbohydrates, and fats, which would decrease lean body mass. So early nutrition interventions to preserve that lean body mass, at any weight is what's recommended.

Host: Sure. You know, I find it hard even as a person who does not have cancer, finding those protein dense foods, especially in the morning. I mean you can only have so many pieces of turkey bacon right, in your life.

Crystal Vila, RD, CNSC, CLT: Yeah.

Host: Do you have any recommendations?

Crystal Vila, RD, CNSC, CLT: I would recommend looking for more plant-based incorporation with animal products besides, dairy protein, animal-based protein. Some plant based proteins would be like legumes, soy, trying, incorporating a different mix of your protein items, not just relying on animal proteins and you don't necessarily need to have the breakfast food proteins. If you like beef stroganoff for dinner, and you want that for breakfast, go with what feels good for you. And what's desirable at the moment.

Host: Okay. Are there any recommendations for post-treatment nutrition.

Crystal Vila, RD, CNSC, CLT: Yeah, definitely, overall healthy dietary choices, physical activity, any behavior modifications would be good strategies to help reduce risk of developing another cancer. So some suggestions would be getting at least the five servings of fruits and vegetables, the more colorful, the better.

Yeah. And, you know, try challenging yourself to try something new, every grocery trip and adding those plant-based items and meals throughout your week. Trying to reach the 25 to 30 grams of dietary fiber, reduce your processed foods as high fat foods, fried foods and anything cured would be some recommendations.

Host: Oh prosciutto.

Crystal Vila, RD, CNSC, CLT: Yeah.

Host: Oh, I'm sad. Okay. All right. Got it though. So are antioxidant supplements safe?

Crystal Vila, RD, CNSC, CLT: I would not recommend adding any antioxidants when starting treatments unless discussed with an oncologist and a dietician as there is potential for tumor protection and reducing the effectiveness of the current treatment.

Host: And what resources does Memorial Care Orange Coast Medical Center provide to patients about specific cancer nutrition interventions.

Crystal Vila, RD, CNSC, CLT: Since symptoms really vary from person to person and may include such a combination of other medical conditions as well; it is highly recommended for somebody to meet with the dietician for individualized nutrition interventions, and evidence-based recommendations to meet their specific nutrition and health goals. Also if somebody wants to ask about current trends and topics and cancer specific questions, or do you know, just something they heard about; at Orange Coast Medical Center, we have a nutrition outpatient service. They are one hour initial visits with the dietitian and 30 minute followup sessions.

If interested, they can call 714-378-7650 for more information.

Host: Wonderful. Well, thank you so much, Crystal, for your time and expertise today. Is there anything you'd like to add before?

Crystal Vila, RD, CNSC, CLT: No I, I would just really want to emphasize anybody to really reach out for these services that they could really help and bring family members along for extra support to meet their needs.

Host: That's a really good idea because you do need a support system. There's so much information coming at you that it's great to have a team to at least figure out, Hey, we need more color in our food today. Thanks again. We really enjoyed having you on the show Crystal.

Crystal Vila, RD, CNSC, CLT: Thank you.

Host: For more information about nutrition during cancer treatment, please call 714-378-7650.

To listen to any of our informative health podcasts, please visit Memorialcare.org/podcast.

That's all for this time. I'm Deborah Howell. Have yourself a terrific day.