Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole, and joining me today to talk about what patients should eat before and during and even after colorectal cancer surgical treatment is Dr. Dorna Jafari. She's an Associate Professor of Surgery at Weill Cornell Medical College, Cornell University, and Chief of Colorectal surgery at New York Presbyterian Brooklyn Methodist Hospital. She's also the Director of Clinical Research in the Department of Surgery at Weill Cornell Medical Center.

Dr. Jafari, thank you so much for joining us today. As we get into this topic, and it's really an important one, and also very interesting, because you're going to tell us about some things that a lot of the listeners have never heard before. But can you start by telling us a little bit about the prevalence of colorectal cancer and especially the trends that we're seeing in our younger people? What are we seeing there?

Dr Mehraneh Jafari: Thank you so much, Melanie. So, colorectal cancer is a third leading cause of cancer-related death worldwide, in fact, second in the U.S. And it is estimated that colorectal cancer will be the number one cause of cancer-related mortality in patients younger than 50 by 2030. So, it's really quite becoming an epidemic. We don't know the exact reasons why, but that nutrition could actually potentially be one of the causes of this increase that we're seeing in young-onset colorectal cancers.

Melanie Cole, MS: Yeah, it's really interesting. And when you mentioned nutrition and all of the preservatives in our food, and I've always thought this was an issue. And I'd like you to tell us a little bit about a new study that suggests that excess consumption of fructose and high-fructose corn syrup can both promote obesity and colorectal cancer. And, you know, we've heard about high-fructose corn syrup for quite a while, but now there are studies. Tell us about Dr. Goncalve's research for the prevention of colorectal cancer.

Dr Mehraneh Jafari: Absolutely. So, the Colorectal Surgery Department at Weill Cornell works very closely with his research team that is award-winning for this type of research. And we know that dietary factors play an important role in because these tumors develop within the intestinal lumen and receive direct exposure to ingested nutritions, chemicals, and microbiome throughout the day. And there's been clear associations established between food we eat and the development and progression of colorectal cancer.

A lot of studies, we know that healthy eating, such as high intakes of fruits, vegetables, whole grains, nuts, legumes, fish, and other seafood, milk, and other dairy products is associated with actually a lower risk of colorectal cancers. And we know that unhealthy eating such as high intakes of red meat, processed meat, sugar-sweetened beverages, refined grains, desserts, and potatoes is associated with a higher risk factor. And in fact, the rise in the consumption of the sugar-sweetened beverages and high-fructose corn syrups, which is a primary sweetener in these drinks, over the past four decades, has been paralleled by an increased incidence of colorectal cancer among young and middle aged adults, suggesting potentially a leak.

And Dr. Goncalves has been doing a benchmark research and we have been doing it actually on a clinical trial as well to see the tumor updates for high-fructose sugar to find this link more closely associated because we know that our bodies cannot process a lot of these processed sugars well, and most of it end up being dumped into this intestine. And that's the idea behind healthy eating habits, to avoid increasing your potential colorectal cancer risk.

Melanie Cole, MS: Well, we've long looked at that link between diet soda and obesity. And we know obesity is an epidemic and now we're kind of tying all of this together. I find that study so interesting. But we're here today to also talk about nutrition for surgical interventions. So, can you start with if somebody is diagnosed, and we're preoperative nutrition, you're going to do surgery on this person, what are some dietary recommendations that you have for the weeks before surgery? Are there specific foods that they should focus on? I mean, we have our colonoscopy. We know we do a liquid diet the day before and then the prep and everything. Are there certain things you want them to know?

Dr Mehraneh Jafari: So for the average patient who is not obstructed, our recommendation is essentially to go to healthy eating, like I described before, which is high intake of fruits and vegetables, because we know that the healthy bacteria does better on a high-fiber content. So, we like patients to be on a good amount of fiber. But the most important thing to get ready for surgery, I think of surgery like running a marathon where you need a lot of protein to basically heal the surgical areas and help you get back on your feet faster. So, the better those dietary habits are before surgery, the easier they'll be able to sustain. So essentially, 30 grams of protein is what I like all of our patients to be on. And that's fairly easy to do with the addition of yogurt, et cetera, into your diet to be ready before surgery.

At Weill Cornell, as you spoke, we actually don't have patients not eat or drink the day before surgery. We allow them to eat the day before surgery while they're doing their bowel preps because we do want the colon to be clean. So, we do have an entire protocol for that. But the two weeks before are very important to sort of build your reserves for healing after surgery.

Melanie Cole, MS: Well, thank you for telling us that. How about weight management? As we were talking earlier about obesity and the links to colorectal cancer and all sorts of other diseases, what about weight management? Does that play a role? Is this something that you discuss with your patients before they are getting ready for surgery? Is there anything they can do, or do you not want them to think about that at that time?

Dr Mehraneh Jafari: So, we do speak to patients because, as you know, obesity does increase the risk of surgical complications. That's well-established. However, if someone is diagnosed with cancer, especially colon cancer, we have to take the patients to the operating room and we don't want to delay it for patients to lose weight.

So again, the most important thing is really to have healthy eating habits and getting rid of soda out of your diet, sweeteners and going to a Mediterranean diet, which has actually been the only diet shown to improve survival rate for cancer is important. So, we say a lot of olive oil, fish, legumes is the way to go. So from a weight management standpoint, we don't anticipate that patients are going to lose weight, but we do want to get them on healthier eating habits for their future cancer care.

Melanie Cole, MS: Dr. Jafari, what about any supplements or is there anything that you would like them to do? And we've heard about things like enhanced recovery, to make post-surgical complications less, that sort of thing. Is there any supplements, anything you want them to do since this is intestinal, since this has to do with nutrition and our colon? Are there any supplements you want them to take or no?

Dr Mehraneh Jafari: So, generally not. I think if patients are taking a multivitamin before, they can continue to do so. We will be conducting a study because patients are generally started on a low fiber diet postoperatively, but that's based on no data. So, starting in a couple months at Cornell, we will be giving everybody a regular diet because fiber has been shown to improve actually in anastomotic leak rates in a subset of other studies. So as far as I'm concerned, again, healthy eating habits that includes a healthy amount of fiber and protein, low in sugar and fat is our approach to our enhanced recovery systems. And in fact, all of our patients get started on a diet right after surgery.

And what we like to reiterate to patients is really listen to your body. If you're hungry, you eat. And if you're not, you modulate that. The patient's appetites go down, and if your appetite is down, it's better to eat the things that have a high-protein content rather than extra carbs that are just sugar content that don't promote healing.

Melanie Cole, MS: These are such important points, Dr. Jafari. After surgery, when can patients start eating again? And I know it depends on what you did during surgery, but what's acceptable to eat during that post-operative period. Are there specific foods? Are they on a liquid diet, a bland diet? Tell us a little bit about that.

Dr Mehraneh Jafari: Our patients are just started on their normal diets, so we have no restrictions. A lot of the reasons we were starving patients after surgery is based on dogma and no actual data. And like I reiterated is that we just let patients modulate themselves and we educate the patients in clinic before surgery and after surgery. And as long as they listen to their body, we allow patients to eat essentially whatever they want. It's important that it actually has been proven to decrease hospital length of stay and improve outcomes.

Melanie Cole, MS: Wow, I never would have thought of that. That's really cool to learn, doctor. And what about advice for patients who are facing challenges in maintaining a good diet during their recovery? Obviously, this can be traumatic and it's a scary time. Tell us a little bit about the best advice that you give your patients every day in their recovery period. And how should they follow up, how often when they're talking about nutrition and surgery?

Dr Mehraneh Jafari: So, all of our patients have the opportunity to see a nutritionist in the hospital to help them. There's a lot of anxiety with intestinal surgery and eating because patients feel that what they eat may hurt the surgical healing and that's not true. So, a lot of it comes with us giving a reassurance that if you eat a salad or an apple, it's not going to hurt anything.

 The most important thing is for them to get adequate nutrition to heal all their surgical stuff. By the time that the food really gets into the intestines where we operate, it's essentially liquid and has dissolved on its own. So, patients don't need to worry. And I think reassurance is the most important thing. And if our patients need more help, we always get nutrition involved so they can work with their dietary restrictions, whether it's, religious or otherwise to get them the most appropriate, nutrition, especially a high-protein diet for postoperative healing.

Melanie Cole, MS: We've given a lot of information here today, Dr. Jafari, and so important and also really interesting as we're looking towards the future, where we're really discussing those links between what we eat and nutrition and the prevalence of these cancers. So, thank you for all of that. Do you have any final thoughts you'd like to leave listeners with as far as If somebody is diagnosed with colorectal cancer and they do have to have surgery, what you'd like them to know about the whole nutrition end of that.

Dr Mehraneh Jafari: I think that anxiety plays a lot of roles in it. I don't think people need to deprive themselves from eating a birthday cake. I think everything in moderation and read the labels. the more natural and less toxic substances you put in your body in general, it's better. So, that's my number one thing, is eliminate the anxieties from it. You don't need to go full no sugar or full non-fat. You just need a diet that has good nutrition and everything in moderation. And the most important thing is really to get rid of the high fructose sodas, et cetera, and the sweeteners that are artificial out of your daily routines.

Melanie Cole, MS: Be all natural and whole foods and that is absolutely great advice. Dr. Jafari, thank you so much for joining us and sharing your expertise with us today. And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcasts, Spotify, Pandora, and Google Podcasts. For more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. Lots of great podcasts there. I'm Melanie Cole. Thanks so much for joining us today.

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