Intersections of Nutrition and Cancer

00:05.57
Janice
In um.

00:18.45
Dustin Mesick_ RDN
Has experience in clinical acute care outpatient eating disorder treatment home Health orthopedic other preoperative surgery education and oncology nutrition. She also has a private practice and consults with a variety of corporations welcome to our podcast janice.

00:34.63
Janice
Hey thank you so much for having me. It's really a pleasure to be here this morning.

00:40.97
Dustin Mesick_ RDN
Yeah, ah so how long has have you been in the field of nutrition now.

00:46.84
Janice
Well, it seems like a long time because it has been um I started working as a dietician in 1983? Um, but you know got into kind of the interest of nutrition during. Um, my life growing up I grew up with family that struggle with issues with diabetes and with you know, back in the 60 s and seventy s there was not a lot known about it. Not a lot of great therapies and a lot of people my family really had some. Awful complications with managing diabetes and I just didn't you know, really get it. So when I got into college tonight picked nutrition science as a degree I didn't even know what that meant at the time that much it was just a lot of chemistry as you know, a lot of anatomy physiology sort of like a pre-med degree in a way. And it was a great foundation and then as um I got experience in my postgraduate internship. Um, you know I just ah saw the evolution of how we manage not just diabetes but other um. Chronic disease management and at the same time we were learning a lot about eating disorders. This was back in the early eighty s remember when we just didn't know much about that at that very parallel at the same time and everything seemed to overlap to a great extent which.

02:06.62
Dustin Mesick_ RDN
Man.

02:18.74
Janice
Fascinated me and then um, getting through my career again 40 years. That's a long time of you know, seeing a lot of stuff evolve. Um, it just ah, really just maintained being a very big interest a big passion and. You know the learning never stops I'm still studying for ah exams and continuing education Even at this point. Um, so it's a fascinating field. But um, it's a lot to keep up with because there's a lot of nuance to it and. A lot of opinions and a lot of take and um, it's exploded in many ways. So Conin Never stops. Yeah.

03:04.84
Dustin Mesick_ RDN
Yeah, that's really interesting ah of what brought you into the nutrition field. Ah you were also you know talking about you know before our interview you were telling.

03:09.25
Janice
Um, yeah.

03:15.80
Dustin Mesick_ RDN
Mean Colin about ah your first exposure to oncology nutrition through hospice. Could you talk a little bit about that.

03:17.15
Janice
Oh yeah, Oh yeah, that was one of these experiences. You know when you have this imprint in your mind about you know things that influence you that you will never Forget. This was. While I was in college during the summer I'd work at a local hospital where I grew up very small hospital but um I got a job as an assistant to the Dietician a diet technician and my job was just to deliver food to patients and to help. In the kitchen and make tube feeding formulas. Um, um, but I Um, visited with the patients they had an inpatient hospice unit. Um, which is you know comfort care for people at the later stages of life with. Terminal illness and I visited these patients every day and I was never exposed to this before and just sat with them asked them and their families. What kind of foods they would like comfort foods things that would help them. You know, get through. Um this part of their care. And you know you develop relationships with people you want to do things that help um, support them and their families and it was a profound experience because you realize nutrition is not just about carbs protein Fat It's it's Connection. It's Love.. It's comfort and as a maybe a.

04:51.28
Janice
21 year old at the time. Um it was profoundly influential and it still influences me today knowing how food and nutrition is so meaningful in so many ways to people. It's not just about meeting the calorie needs and protein needs. Um, it's much more than that. So um, that was a very very important part of my education even though it wasn't a formal part of my education.

05:19.30
colinyourbluff
What can you tell us about your work as a nutrition support clinician.

05:23.47
Janice
B yeah so when I started my career as a inpatient hospital dietician um, you know I had to to have some training in my internship as a nutrition support team dietician. And this is just when the use of um, what we call. Um, you know all artificial nutrition and hydration start coming to play otherwise known as parentoral total parental nutrition nutrition. Um, delivered through feeding tubes and. Through um, central lines you know ib nutrition and that was just starting to really come online more and more for nutrition support for people who couldn't take nutrition by Mel. Maybe they had had a stroke or maybe they had a gi tract that was not functioning. And then um, starting in a hospital in the early eighty s when this was really ramping up I worked in the intensive care unit critical care medical surgical where people had um, all kinds of different. Um, pretty. You know severe medical issues. Gi surgeries. Um, so I got to what felt that in real time and also at the same time started consulting with home health companies that were then also supplying people.

06:51.71
Janice
On the outpatient faces or home Health basis. Um, feeding tubes through um, ah you know Gastro G Tubes Gastric Tubes Jjunal ah tubes who couldn't otherwise eat normally tube feedings and then Also. Iv nutrition um through their veins because their Gi tract was not able to be used for one way or another and so I had to learn very quickly and then I that's what prompted me to get additional certifications as a um.

07:29.88
Janice
Nutrition Support Clinician to really understand this because this is not just about you know, preparing meal plans and um, helping people with education about what to eat This is about providing nutrition support when they couldn't eat normally otherwise. This was also coincidentally at the time when um, the Aids crisis was really really high. This is when Um H I V and Aids was really at the crisis Level. We didn't have therapies for it I worked. In home Health I worked with inpatient Aids patients who were really suffering from terrible malnutrition and Gi issues This was profound and something I'll never forget, but it taught me a lot along with the compassion that. They were going through so much that we couldn't do a lot about at that time. Um, and so um, you know again learning this other part of nutrition support. Besides just meal planning and um things with diabetes. Ah you know that I do a lot of. And I still am working in this area too still maintaining my credentials in this area. So again, this is a whole nother level of nutrition support. This is Iv This is feeding tubes This is um, helping people transition off of those therapies. Um, helping people.

08:58.13
Janice
And their medical professionals decide. What the best um plan of care for these patients are and this also includes oncology patients because a lot of oncology patients. Um depending on what the therapies are and the site Of. Um, the tumors are need this type of nutrition support as Well. So it overlaps across a lot of nutrition issues.

09:26.51
Colin Goodwin_PsyD
So can you tell us about the oncology nutrition practice group that you're a part of.

09:32.70
Janice
Yeah, So the oncology and nutrition practice group is one of my um practice groups through the academy of nutrition and dietetics which I find Extremelydinaly valuable because it involves a lot of practitioners who are specialists. In the oncology ah world and you know a lot of them. That's exactly what they do all the time. So this shared information support and education and resources not just for us as professionals but also for ah, patients that are available through that practice group is. Very valuable because we do know um, just like in diabetes. Um very similar. Um the nutrition um information and questions in the oncology world can be extremely confusing. Extremely distorted and ah must be very individualized. There is a just like in diabetes again. Ah which that's my specialty. There is a lot of fear a lot of anxiety a lot of issues with. The impacts of therapies on taste on appetite. Um, so it's It's a very very great resource to support us as professionals. But Also it's a resource for patients to sift out and help make sense of.

10:59.38
Janice
All of that information that they're getting maybe from a lot of sources that are not so credible.

11:07.51
Dustin Mesick_ RDN
Yeah, that's really, ah, great to be a part of that group I feel you you are a great marketing for them because I am after this podcast I'm going to sign up I need to be a part of that.

11:11.51
Janice
It's so helpful. Yeah yeah.

11:17.38
Janice
Do you got to? it's it's worth it. It's only worth it. Yeah.

11:23.19
Dustin Mesick_ RDN
Ah, can you speak on the intersection of diabetes and cancer.

11:25.70
Janice
I sure can and so because of this podcast you know before we you know, got on here today I pulled up a couple articles I'm just a real nerd I love reading journals I read all my journals and I read them all covered cover because I really love the sign. And of nutrition and all the things that entails so I have a couple of articles here. Um that I kind of brought up. Um, for example, um, with cancer. Um, you know sometimes there are um, therapies used in cancer treatment. Called steroids and steroids are used in a lot of different um disease management areas I am one of those I have asthma that gets bad sometimes and I every so often have to take high doses of steroids to manage my asthma. You know it's it's one of the therapies and it's not pleasant. And it has side effects but listen sometimes we just don't have a choice we have to do this to get through um, certain issues whether it's asthma or or cancer or other other types of diseases. So what happens with the use of steroids. In in cancer patients is that steroids like prednisone or there's other steroid formulations that can um cause a side effect that causes some what we call hyperglycemia high blood sugar. Um, it's it's a profound side effect among other things.

12:58.22
Janice
And um, what we know is that these side effective steroids that can cause your blood sugar to go high can have effects that can um cause things like higher risk of infection dehydration. Um. Ah, you know, just other um stresses stressors and maybe poor wound healing. Um, so you know these elevated blood sugar levels that can sometimes ah because be Called. Ah you know. Even secondary diabetes. This is also used in um ah lung disease patients like people with emphysema they get secondary diabetes because to chronic Steroid Use. So um, we are seeing that this calls for Perhaps. Treating the hyperglycemia the high blood sugar levels um with diabetes medications and there's definitely um, you know reasons to treat this because hyperglycemia again can cause symptoms can cause um, ah. Increased incidence of infection secondary infection because that's part of the problem and so there is ah different therapies that may be considered to be used depending on the patient. Um, you know in Diabetes. We used to just have insulin and one pill.

14:30.56
Janice
And now we have all kinds of different therapies so we have oral agents which are like metformin. We have all different classes of oral medications. But we also have insulin therapy which sometimes is really the best therapy and when patients. Um.

14:50.40
Janice
Here The word Insulin. They're really scared. They think once I'm on Insulin I'll never get off of it but actually Insulin is sometimes needed very temporarily in the case of high blood sugar. Um secondary to treatment for cancer or other um issues. And it's a temporary therapy. Um, that can be really flexible actually because we have a lot of newer Insulin formulations now and just to to help them get through that time when their blood sugars are excessively high and can be harmful. Um, and then once the Steroid therapies. Um, are discontinued and blood sugars are Normalized. It can be stopped so people often think oh I'm using Insulin I'm diabetic I have to use this for so much longer than I thought I would but it's not always that case now again, um, a. Just like with diabetes and cancer. It's not just the medications. It's also um, you know what we call the lifestyle things that can be adapted to the situation. So certainly helpful eating supportive helpful eating. Is important regular consistent eating to support I Sorry why are you right? I think fill off okay, are we Back. We're back. Okay, yeah, my my yeah so um, my um, my point was.

16:12.19
Dustin Mesick_ RDN
Yeah, you're you're here ease it support.

16:21.53
Janice
Lifestyle like nutrition. Um, medical nutrition therapy like we do in diabetes and with oncology so you want to make sure people are eating nutritiously sufficiently regularly to maintain their nutritional status. You know so regular meals. Um, a variety of healthful foods meeting their calorie needs. Um, adjusting to their appetite and to maybe taste changes perhaps looking at um, the types of components of their meals to help. Mitigate spikes in their blood sugar and maybe using foods with a good amount of what we call soluble fibers you know like oats and beans and um these type of Fiber-rich foods that also supply the gut with fuel to. Make sure that blood sugars are stabilized enough protein to maintain lean body mass enough hydration because dehydration can cause high blood sugar in Itself. You know dehydration can be a problem so helpful. Regular meals adjusted to.. People's tolerance and taste level. That's where a registered Dietitian really is important to look at all these nuances of meal planning with diabetes and cancer or high blood sugar in cancer and then also which I emphasize a lot is um, also movement So being.

17:52.66
Janice
As active as possible. It doesn't need to be Crazy. It doesn't need to need to be excessive or tiring but we also know that maintaining lean body mass maintaining muscle with some resistance exercise with breaking up sitting that really helps. Glucose Metabolism and it helps maintain lean body mass that can be really zapped with both cancer and hyperglycemia one of the biggest risks to health and we know health outcomes in cancer and diabetes. Loss of lean body mass otherwise known as Sarcopenia which really gets us accelerated with chronic disease and we need to keep that lean body mass there as much as possible because muscle tissue is an endocrine organ it processes glucose it really is part of bone strength. Fractures and falls and frailty are a key. So Both those things um, nutrition hydration as well as movement resistance Exercise um combined are very synergistic in maintaining good outcomes. Um, good quality of life. Yeah yeah, Oh yeah.

19:10.60
Dustin Mesick_ RDN
I could relate to so much of what you just shared just from personal experience. Um I was on I was on deca drawing a steroidal medication in my in our first episode we introduced ah ourselves as well as our cancers and. Since I had a ah some of my cancer is my brain. They put me on decadra and they did not ah anticipate how high my blood sugar got like got over it. It. It just hit me one day. My whole family was out at ah universal studios like city walk.

19:27.50
Janice
Is there.

19:33.64
Janice
Oh yeah, yeah.

19:42.82
Janice
Um, oh.

19:44.52
Dustin Mesick_ RDN
And all of a sudden I was like super loopy terrible headache and I honestly I think that my blood sugar was probably above 300 so we went to the hospital and they gave us insulin and then from then on I was testing my blood sugar.

19:55.45
Janice
Um, ah yeah, yeah.

20:02.33
Dustin Mesick_ RDN
Like 3 times a day in taking insulin and then and then also when you're on steroids you gain weight a lot of times. Um, so yeah, it's just it's really interesting I mean obviously steroidal medication also helps with so many of the other side effects that you're having like that.

20:05.80
Janice
Um, yeah, yeah, yeah.

20:19.25
Janice
Yeah.

20:19.59
Dustin Mesick_ RDN
Headaches that I was having the pain. It really is a helpful ah treatment and intervention during cancers treatment. Those are the side effects side effects but it's kind of like worth the side effects and it is short term like eventually got off the medication and I did want to speak to.

20:34.68
Janice
Then.

20:39.28
Dustin Mesick_ RDN
Ah, earlier my experiences with nutrition support I Actually I think I was on Tpn during some of my chemotherapy. Um, which I believe is more higher risk but I was not able to ingest anything at the time. So.

20:44.79
Janice
To hear. Yeah, yeah, yeah, yeah.

20:56.50
Dustin Mesick_ RDN
Um, and I do remember also being on an Ng tube which is like really uncomfortable and I feel like they probably messed up on my formulation because after so I had chemotherapy and there was a cyst in my intestines and like split open. So.

21:02.74
Janice
Um, go yeah from like.

21:12.60
Janice
Ah, oh.

21:14.76
Dustin Mesick_ RDN
Yeah, they did a surgery and they put me on it in G two and then I lost so much muscle like right before this chemo in this surgery I was going to the gym like every other day I was like really muscular and I remember as soon as I got discharged I was like.

21:19.35
Janice
Oh yeah, yeah.

21:29.95
Janice
Oh so fast. It's amazing. How fast that happens and it takes it. It goes so way fast and it takes some longer time to come back. You know.

21:30.57
Dustin Mesick_ RDN
Where did all my muscle go like how could it disappear in like a week or 2

21:45.34
Janice
Rehabilitation after is so important and so underrated but prevention of loss of lean body mass. It's a big focus now. Um in in a lot of um you know nutrition support now we are really focusing on that um disuse of muscle.

21:48.97
Dustin Mesick_ RDN
Um.

22:04.98
Janice
You know immobilization the stress of illness um sepsis hyperglycemia it just muscle gets eaten up so fast So they're starting now and now more and more um to um, you know, involve like physical therapists and intensive care Units. Um. Getting people up and out of bed moving around um resistance exercise even in icus because we know what a hit that is um but it's got to be very proactive. This is why when we were talking about my experience when I would do classes for our pre-op patients and I worked with pre-op.

22:30.25
Dustin Mesick_ RDN
Yeah.

22:43.51
Janice
Orthopedic patients I would say this is your time This is Prehabilitation. We call it. You're going in for a surgery you know joint replacement or whatever This is the time to you know, build up your muscle become as wellnurished as you can If you have a planned surgery. This is like getting ready for the olympics. This is the time to build that up because you are going to lose something with the stress of search rate stress of illness stress of infection. So build up as much as you can beforehand so that you know it's like money in the bank. Um, so prehabilitation. There is actually a. You know, a lot of interest in something called Erras enhanced recovery after surgery. It's ah again, a pre pre-op programming to get people strong for surgery. This is a very big passion of Mine. We are all going to get something. We are all going to have a surgery. We're all going to get sick.

23:40.91
Dustin Mesick_ RDN
Yeah.

23:41.71
Janice
With something. It's a done. It's a default setting. So why not just be ready for it. It can't hurt. Um, and I think that needs to be emphasized more.

23:47.37
Dustin Mesick_ RDN
Yeah.

23:54.41
Dustin Mesick_ RDN
Yeah, absolutely I I Definitely ah agree with you? Um, so what? what? Um sorry I'm feeling jumbled for a moment.

24:10.49
Dustin Mesick_ RDN
And it will probably edit out me feeling Jumbled um I Actually think you know you kind of touched on ah wasting like muscle wasting. So I'm wondering if there's anything else you can share about wasting. Um.

24:12.17
Janice
That's okay, yeah.

24:20.72
Janice
Yeah, yeah.

24:29.33
Dustin Mesick_ RDN
Around because you know Cancer Kaki Kakesia which I wonder if Hiexia see there's that pronunciation issue I have my beach impediments coming out in our podcast. Ah ah so I feel like you were kind of speaking to that just now or I could be wrong. Um.

24:32.37
Janice
Kickex yeah, yeah, yeah, yeah, it's all right.

24:44.26
Janice
Um, yeah, no, no, that's it's part of it. Yeah yeah.

24:48.50
Dustin Mesick_ RDN
Yeah, and but ah so you know what can what are some of the challenges like as far as nutritional planning around this.

24:56.38
Janice
Yeah, yeah, so you know this is a double whammy because you know we know there's an altered metabolism in cancer like you just give people with cancer just tons of food and everything there's still going to be It's an inflammatory issue. And there's still going to be you know muscle wasting it's like you know it's just a part of the altered metabolism and cancer just sort of depends on where you're at what the stage of cancer is where you're at in the part of um, the progress. You know when everyone's in a different place and cancer happens in different. Parts your body. Um, so and in your different ages right? You're at you know 20 year old is different than a ninety year old breast cancer because of the altered metabolism of aging and um so the point is is that um, earliest. You can in the game like again with anything is to understand that. Um you know malnutrition helps nothing um, over restriction helps nothing people are getting so afraid to eat and so restrictive and again that fear and anxiety is so real. But we know that. Really good nutrition support and advice from a registered dietitian who knows what they're talking about in this area and can help sift out food fears and all this and make sure that we're adapting to maybe taste changes and.

26:28.18
Janice
Chewing and swallowing problems and digestive issues and budget issues and access issues and ability to cook and energy to cook and all these things are really taken into Account. There's a lot of things we look at but making sure people are well-nourished regularly Nourished. Um. Regularly hydrated you know meeting their estimated nutritional needs that can change over time depending on what the therapies are if there's surgery if there's other things going on and then also this is just what in my perfect world would be um, working If. It's possible with somebody like a um you know licensed ah trained physical therapist who I love as therapist for so many reasons who really knows how to assess people How to you know, assist them with. Developing a program of movement to maintain lean body mass if that's at all possible I think that would be a great part of this should maintain um, lean body mass again in your skeletal muscle mass and inside you know and to reduce the risk of falls and injury prevention.

27:38.68
Dustin Mesick_ RDN
And.

27:41.95
Janice
So I think that would be an amazing combination in anyone who has a diagnosis of cancer and is going to go through cancer therapies or surgeries or things like that because again, it's better to get ahead of the curve than try to catch up which is sometimes really difficult to do.

27:59.35
Dustin Mesick_ RDN
Absolutely you know and I know that can't when people have cancer. Their methaolism is isn't as efficient so the energy needs go up and I know that there has been an argument made that. Ah.

28:07.90
Janice
Um, yeah, yeah, um.

28:14.70
Dustin Mesick_ RDN
Like eating less food might actually be helpful. Um, but then there's a risk amount of nutrition which as you said is only going to make things worse. So it's kind of like a catch 22 in a way like.

28:16.49
Janice
Oh.

28:23.57
Janice
Me Yeah I I you know I can I've heard and I've seen those things about you know the fasting and cutting out foods. But I just don't see that ending. Well honestly because again.

28:39.73
Dustin Mesick_ RDN
Yeah.

28:43.25
Janice
You know malnutrition is really hard to reverse in so many cases for so many reasons and you know malnutrition and this is my from my work in the eating disorder field restrictive diets under nutrition. Um.

28:47.38
Dustin Mesick_ RDN
Um, yeah, absolutely.

28:54.80
Dustin Mesick_ RDN
In.

29:00.20
Janice
Really kind of affects the gastrointestinal tract you're starving the gut and then it freezes up and then you get more Gi issues because of starvation you get constipation you get bloating you get dysbiosis because you're not getting enough food into the gut.

29:03.80
Dustin Mesick_ RDN
Yeah.

29:18.48
Janice
And then you know you know your appetite decreases and then it affects your brain malnutrition affects your brain and then you just keep restricting and restricting and that's a really hard thing to Unravel So while.

29:25.78
Dustin Mesick_ RDN
Yeah, yeah.

29:34.50
Janice
Maybe temporary things you know, maybe in some people made the Benette benign. Um, it's it's sometimes you know the downstream effects are just really damaging and I've seen that I've seen that happen and it's it's terribly sad and you know nutrition is supportive. It's not curative right. Um, but it's an important support of of this whole thing and um, you know the bottom one we want to maintain functional status Independence Mobility quality of life and as I said in the beginning Joy. Eating is super important the emotional components of eating eating foods that are lovely delicious Have meaning um you know, bring joy to your life. That's nutrition too. If. It's not joyful if it's not Pleasurable. It's not Nutrition. You know, um. It's it's got to be a very big part of quality of life issues.

30:33.55
Dustin Mesick_ RDN
Yeah I could yeah I totally agree with you it. It definitely seems difficult with you know there is this this book out there right now. Ah that I definitely think it's really great just talks about the history of cancer. Um, it's called cancer code by Dr Jason Fong

30:51.80
Janice
Um, ah.

30:51.21
Dustin Mesick_ RDN
And it's really interesting because he talks ah in the book about how our body is like you're losing appetite and one would wonder if maybe that's your body's defense is to eat less food not to feed the cancer but he kind of you know he says in his Book. You know like what. How would How could there be a nutrition or intervention around that and I don't and I don't plan for us to really speak on that because as you just you just shared. You know, especially because I have experience with eating disorders as well is that I have seen it as Well. You know people who are in their mid 20 s and they have the early.

31:14.95
Janice
And.

31:23.10
Janice
Um, yeah.

31:29.26
Dustin Mesick_ RDN
Onset of osteoporsis because they've been restrictively eating So it's like some of these theories out there. Maybe that there's some merit to it but it's like when you see some of the negative set effects of disorder of eating patterns and eating the disorder. It makes you wonder like okay like.

31:29.37
Janice
Further.

31:41.83
Janice
Yeah.

31:47.61
Dustin Mesick_ RDN
Ah, when what what kind of environment is this a safe approach. How would they do this without hurting the patient worse and with that in mind what I'm saying right now I did want to ask a little bit more about.

31:50.67
Janice
A.

32:01.80
Dustin Mesick_ RDN
Ah, what disorder eating patterns have you seen with cancer patients.

32:04.00
Janice
Yeah, yeah, I have seen that for sure. Well you know this this sits personally because good. You know I've had a couple of good friends passed from ovarian cancer in the past couple years and both women a few years younger than me and. You know, very intelligent, highly educated. One was a family physician. In fact, and you know listen I can't blame them to wanting to do everything they could to get through this but I saw you know them going to such great lengths to a. Avoid certain foods and to um, you know just restrict their diets and and ultimately you know likely didn't make much of a difference at all and again just the fear and the expense. Following certain diets and restrictions. It really took a toll on them psychologically as well as physiologically and so yeah, this can really spin off into what we often call orthorexia or even a restrictive eating disorder because we know the nature of eating disorders is. Biopsychosocial you know a starved brain becomes much more anxious and then there could be genetics coexisting with that and that in itself is dangerous. You know malnutrition eats away at your heart. You have cardiac issues you have.

33:39.25
Janice
Bone density issues and that on top of a cancer diagnosis. You know, just adds to the complications. So You know again that you know the online. It's flooded with fear mongering and all these things and misinformation fasting but is that really right. For this individual is that going to contribute to quality quantity of life. Um, um, a likelihood of ah remission you got. We got to really question these generalities that we find in books and online and you know while it sounds oh well.

34:12.66
Dustin Mesick_ RDN
Yeah.

34:18.92
Janice
Your appetite's bad and nuts mean your body just doesn't meet the food. No. It doesn't mean that at all because you know appetite can be affected by so many things it doesn't mean you don't need nutrition support because you're still going to have profound muscle wasting you're still going to have. Ah, Gi tract that locks up because it's not getting anything and um muscle tissue That's going to be wasted away because it's being used to supply your body with Fuel. So appetite is very powerfully impacted by many things hormones and other things we're seeing that in other settings too. But it doesn't mean your body doesn't need nutrition support to get through a pretty severe situation.

35:06.28
Dustin Mesick_ RDN
Um, yeah, absolutely and I also wanted to comment that I notice in diet culture in particular there seems to be a lot of like anecdotal evidence which is like really based on personal observation I know when I was younger it was easier to fall into these traps like oh well.

35:10.77
Janice
A a.

35:22.28
Janice
Um, oh yeah, oh yeah.

35:23.55
Dustin Mesick_ RDN
They're saying if it works for them. It could work for me. So I think I'm going to be the all banana diet like you know food is good I Guess protein is toxic like I don't want the nitrogen like and it's it's not science or evidence-based. It's just this personal experience and.

35:40.33
Janice
Um, yeah.

35:40.76
Dustin Mesick_ RDN
Scientific community. We know that you know there's different weights of different evidence I know that Metaanalysis is usually like some of the highest weight as far at these are but I feel like case studies is like the lowest evidence on the spectrum of research.

35:45.53
Janice
Okay. The yeah.

35:57.38
Dustin Mesick_ RDN
But at someone outside of the research world a regular person who's just like engaging with different things on social media. They would see this anecdotal evidence and be like well they're credentials they say they're a scientist or they're an expert. So I think that you know what they're saying is true.

36:04.89
Janice
Plan.

36:13.66
Janice
Yeah, well everyone can be an expert in their opinion right? Just like I can say to myself I'm a celebrity. So um, you know that that's the thing is you know there was this whole thing of you know, eat like me move my like move like me.

36:17.56
Dustin Mesick_ RDN
Yeah, yeah.

36:30.63
Dustin Mesick_ RDN
Yeah.

36:31.11
Janice
Look like me right? does that lay out eat like me move my move like me look like me. It doesn't work that way because there's so many other dynamics at place. There's social determinants of health. There's genetics. There's so many individual variations. There's age you know, um and these things change. Time goes on as well. So um, there's these influencers I you know I really took a long time for me to even understand what that word influencer meant because I was aren't brought up with the support influencer I was like influencers. You know it just means they have a lot of people who kind of. Look at them and follow them. Does it mean they have actual credibility. No, but they're powerful and marketing is often much more powerful than the truth right? You see that every day when you shoping. It's automatically a holiday season because Costco put up the ribbon in their you know hopes.

37:17.23
Dustin Mesick_ RDN
Um, yeah.

37:28.11
Janice
That's marketing. It's holiday season because you know the decorations are out is that really true. So we're influenced by a lot of things and it's just using critical thinking questioning you know and curious like really does that make sense. You know who's trying to influence me. What's the agenda here. What are they trying to.

37:37.16
Dustin Mesick_ RDN
Yeah.

37:47.22
Janice
Sell me and that's really comes in when you mentioned you know I have an Mba which I got a long time ago, but it's really like you know what's the agenda here. What's the outcome they want look at people's agenda when they're a nutrition influencer or professional. What's what are they trying to sell me um because you know that's always an answer that's going to bring up some potential red flags.

38:16.57
Dustin Mesick_ RDN
Absolutely I also wanted to ask since we're on the topic. What is Orthorexia This is like a term I feel like a lot more recent and I definitely think Cancer survivors ah could.

38:24.19
Janice
Um, oh yeah, oh yeah.

38:30.72
Dustin Mesick_ RDN
Kind of become orthorexic so I wanted you to speak on this.

38:32.40
Janice
It's I could I could see how they could because you know seeing this you know being in the diabetes world overlaps a lot with um because with with cancer and we do See. Um. Being said, you know diabetes can increase your risk of certain cancers along with weight related influences of certain cancers. Potentially it doesn't mean you know it's um, you know correlation versus Causation. We got to look at that and consider that but um. You know there is a lot of fear mongering in the diabetes world too like don't eat this don't eat this and you shouldn't have this if you have diabetes and is that you know is that really True. We got to sift that out as well similar similar kind of question. So yeah, you know we do know that. Um. You know, healthful eating including I often talk about adding in you know, including in to the best Reviewability Health supporting foods. You know, fruits, vegetables, nuts, beans, legumes you know, whole grains things like that. We know those support great health including Heart Health which affects both oncology. And diabetes patients. They support a healthy gut. Microbiome We know these fiber rich foods from fruit speggies, Plant foods support good bacterial diversity in our gut which is associated with better health. They feed the Good. Um.

40:02.17
Janice
Bacteria They create what we call short chained fatty acids that protect the lining of the gut help reduce the risk of bacterial translocation protect your liver protect your Kidneys I mean it's all Great. So adding in I like this phrase again add in pressure off. Adding in fruits, veggies, Nuts. Plant-based foods oatmeal. You know, Ah, they could be fresh frozen canned All those things are great. Nothing wrong with any of them. Um to the best of your ability and then you know when there are foods certain foods that I. Sometimes call you know these are foods that bring us joy which is part of nutrition too say you go to birthday party or there's holidays coming up. These foods are not going to hurt you you know, enjoy these foods in context of an overall helpful dietary pattern and they're not going to. Hurt you but when you see a piece of like a special piece of pie that maybe your mom made or a special dessert for a holiday or celebration. This is something That's just as important to include without shame fear or guilt. In spite of what we're told that really adds to join quality of Life. So this Orthorexia comes from just being so um, so just so fearful and anxious about food and all the things that's going to do to you? Um, you know and that's.

41:35.36
Janice
Stress and anxiety about food hurt you more than the food itself. This is what I tell my patients with diabetes the stress anxiety and fear about this whatever dessert piece of pie that probably raises your blood sugar more than the food itself and so. This is where we're at right now is this over over anxious, ah problem about enjoying food in the context of healthy dietary pattern which includes also movement sleep hydration all the other things that impact our health. Food is just one part of it. Um, we have to kind of pull back and look at the context of things you know so that's kind of some of it but Orthorexia is a thing because again, it's it's fueled by all this. Um.

42:29.72
Janice
Profitable fear mongering fear sells stuff you know and that's kind of what we're saying happen.

42:34.47
Dustin Mesick_ RDN
I Agree about the context is key I feel like a lot of nutrition information is true based on the context but when taken out of context. It could be completely and inaccurate So that's like a common debate I see in the nutrition field.

42:37.20
Janice
Yeah, yeah.

42:45.79
Janice
Yeah.

42:51.45
Janice
Is.

42:53.43
Dustin Mesick_ RDN
Especially from different ah disciplines of nutrition is like it's like what's the context like what are we talking about here.

42:59.40
Janice
Yeah, yeah, do we have to make do we have to make it so complicated. You know if you're going to your Grandma's house and she made a pie for you because you know that's her way of showing love and you're saying no grandma I'm not eating this like you know. Working out for you. It's not. You know it's not It's sad to me that's sad that you have to um, you know, be that way unless there's something really medical going on or whatever which is you know I'm not talking about that but you just got to look at. But bigger picture. You got to Zoom out look at the wide angle lens and see how this falls into place.

43:45.33
Colin Goodwin_PsyD
And Janice can you speak to some common nutrition related problems that you've seen in the cancer field or with cancer patients.

43:54.75
Janice
Oh yeah, so um, first of all, you know, depending on the therapies we can see um taste changes right? So certain medicines and this this goes for many medicines in different areas. You know people Lose. Maybe sometimes sense of taste. Um, ah you know things just don't taste right? And that's that's a big deal when you can't taste things right? It's like ah it's not as appetizing. Um, there can be sometimes issues with like dry mouth. Um, which makes it hard. To chew and swallow things so chewing and swallowing issues sometimes dental issues that can limit um, oral intake and you know that can have a downstream effect to you know, deteriorating nutritional status. Um, so again, appetite changes. Um. Yeah, or intestinal changes again. Medications can cause these side effects. This is why? um I always love as 1 of our team members is pharmacists. They can tell you about side effects they can tell you about sometimes how to address these side effects of any medications. Um, so. If your appetite really takes a hit. Okay, how do we fill in the gaps to make sure we're not um, losing important. Um you know, nutrition intake and maintaining your lean body mass and maintaining your nutritional status. So if you now know your appetite's taking a hit. How can we.

45:27.20
Janice
Um, make up for those gaps maybe other ways in terms of filling in between meals with high nutrition calorie Density snacks. Maybe sometimes oral nutrition supplement drinks maybe just other creative ways to make sure we're getting in the calories and the nutrients. To maintain your strength to get through the therapies because sometimes therapies need to be stopped because people become so weak and debilitated or get secondary infection. So remember nutrition is supportive. It's sort of a life. Jacket's a life reserveer to get you through these therapies. Um. Other nutrition issues that may come up as a side effect of medicines or poor oral intake could be constipation I can't talk about constipation enough because that's a really miserable thing for a lot of people. Um sometimes pain medications can cause that. So definitely having a conversation with your physicians either your oncologist or your general doctor about um therapies for constipation. There's different therapies that can be helpful. What the best ones are really depends on the person maintaining good hydration. So um, that could be part of constipation part of also making sure you're getting good nutrition. So a lot of my patients who are dealing with these things I'm recommending listen liquids sometimes can be easier ways of getting nutrition in.

46:59.99
Janice
So things like juices or all nutrition supplements whole milk. Um other ways to get liquid forms of nutrition in because it's not as burdensome. Sometimes it's solids. It still gives you calories it still gives you great Nutrition. It can keep you Hydrated. Gi Tract moving along so those are some things I use. Um and then again making sure you're getting um, adequate just overall adequate fuel in your body just overall adequate calorie intake. That you do have the energy to move and to um, you know do the activity to maintain your lean body mass remember also and this is what I see in my eating disorder patients inadequate calorie intake screws up sleep. If You're not getting enough fuel enough calories your brain becomes very anxious. This is a biological wiring thing and I think it's fascinating but our brain is primed just prehistorically to stay awake if it's not getting nutrition because it's primed to seek out. Food. So if you're adequately nourished. It's more likely you're getting the sleep that you need and sleep. Um Also is a determinant of hormones that control blood sugar blood pressure, blood cholesterol and appetite regulation and sleep is.

48:31.95
Janice
Ah, very big hit on quality of life and health so getting adequate nutrition. However, we can really helps getting restful sleep. So you feel like doing things and moving around during the day as well. So that's sort of a summary of things.

48:49.25
Colin Goodwin_PsyD
And I think that kind of speaks to I think one of the most common than side effects with cancer treatment is fatigue you know and I'm curious if there's any other recommendations you might have for cancer patients that are experiencing chronic fatigue. Um.

48:54.96
Janice
Oh yeah.

49:06.93
Colin Goodwin_PsyD
As far as ah, then prepping for meals or then adjusting their their diet.

49:13.35
Janice
Yeah, yeah, so fatigue again happens for many reasons. Um you know, just that the stress First of all the stress is really tough the the medication side effect just being ill makes makes it really tough. So. With fatigue again getting enough rest. But um, you know, breaking up sitting during the day you know, just gentle movement doing stuff around your house. You know, just household tours and things that can again stimulate. Um, you know your energy levels and maintain your muscle tissue. So fatigue can like add to itself if you're just really super sedentary but again with cooking and eating be gentle on yourself. Don't be afraid to get um and use. Um pre-made meals frozen meals. Prepared things you know, chopping and cutting and cooking and standing and over a stove. that's that's exhausting it doesn't need to happen so getting pre-made meals. Um, ah you know things that are already prepared There's lots of choices out now. Um to. To help conserve energy whether it's foods you order out or things that you can just pick up at the store and reheat. Ah you know, oral nutrition supplement drinks. There's a variety of those make it easy on yourself cut up fruits.

50:40.86
Janice
Vegetables canned fruits and vegetables are fine. Frozen fruits and vegetables are fine. Um, really save yourself the labor. Um, there's nothing wrong with that at all. It's very important to conserve your energy.

51:00.78
Colin Goodwin_PsyD
I Understand you were a guest speaker for a breast cancer support group and I was curious if there was ah a particular approach that you had um taken to the the topic of a supportive nutrition.

51:04.75
Janice
Um, yeah, yeah.

51:14.78
Janice
Yeah, so um, that was a great group because again, um, these these patients came in with a lot of very similar questions. You know they were anxious about eating certain foods. They've heard things they were worried about this. So basically it was first of all listening that was the most important thing I do listening to their fears listening to what they're told a very important thing this just was a very hot topic that's come up in the last day in some of my newsfeeds about supplements. Um vitamin and minra supplements. You know. I should take tumeric I should take vitamin c I should take this and I you know, really want to emphasize listen. Um this is a really concerning area. There's just not a lot of good evidence that all these supplements that are being hawked are helpful and. In fact, they may be dangerous just in the past day I have an article that I've just seen a couple different ways that xs in takes of vitamin c and other um these antioxidants actually promote tumor growth because they promote vessel growth in the tumors themselves. They're actually promoting tumor growth. They're not. Helpful, um, turmeric and other supplements you find are unregulated. They may be infiltrated with damaging and um, harmful substances because who knows where they're made and so all these supplements that are touted. It's a very big business ninety cent

52:48.80
Janice
90% Profit Margin Unregulated um, you know can cause liver damage other side effects but you know the promises in the marketing are so Powerful. So all these supplements that are being promoted and hawked by people again who only want to make money off of you That's another whole. Issue in itself that I often address so getting nutrition through food and um, you know, nice meals and you know food that you eat is safe and you know very important. But the supplements can actually cause liver damage and your body's already going through stress with the medications that your liver has to process you know so you know natural does not mean safe remember natural is a shark bite natural is Poison Mushrooms natural does not mean safe. So natural is a marketing term but it doesn't mean anything about safety.

53:48.92
Colin Goodwin_PsyD
It just count him make me think if a Dustin did go full banana.

53:57.34
Janice
Up.

53:59.71
Dustin Mesick_ RDN
Yeah, or that's that snake oil that you're going to take that's going to really help ah cure the cancer. They always. Yeah, it's like oh they're suppressing the truth here is this secret thing I Remember the big thing was goji berries. It was like this.

54:04.30
Janice
Um, ah, it's so promising right? Yeah, go G bear and there's always something.

54:17.31
Dustin Mesick_ RDN
Yeah, super antioxidant that was going to cure all of cancer. It's a superfood I'm like you know broccoli' is a superfood like broccoli sprouts we already have tons of superfoods that it's they're always looking for something new. That's better.

54:20.11
Janice
Um, it is yeah, always it's never going to stop you know? um, actually in my opinion Prunes are superfo.

54:38.79
Dustin Mesick_ RDN
I've been drinking a lot of Prune juice lately I Really like the flavor. Ah yeah, you got to be careful though because you know I was getting a little too into it and it can lead to a lot of bathroom visits.

54:41.32
Janice
Ah, they're good for your bones. Yeah, it's.

54:42.38
Colin Goodwin_PsyD
Do you feel super.

54:50.23
Janice
Yeah, oh it can't yeah yeah, you know anything can be overdone right? ah.

54:54.17
Dustin Mesick_ RDN
Yeah I mean even like the Magnesium Salt supplements you know and it's cold. They're like takes some magnesium you're like Wow I can move so well and then pretty soon you've taken too much and you're in the bathroom a lot again.

54:57.64
Janice
Yeah.

55:07.15
Janice
Yeah, yeah, exactly exactly right? you can overdo everything ask? ah.

55:09.79
Colin Goodwin_PsyD
Tell us about your weekend Dustin Not you

55:16.88
Dustin Mesick_ RDN
Um, yeah, it.

55:18.12
Colin Goodwin_PsyD
What Janis we wanted to thank you so much for being able to then share your expertise and and just talk about these these topics on nutrition with us today.

55:29.78
Janice
It's my pleasure. This is great.

55:31.60
Dustin Mesick_ RDN
Did you have anything else you wanted to say but at as we wrap up things or before we wrap up things.

55:39.82
Janice
Sure? Well you know we were talking a little bit before so aside from um, really still loving my career after 40 years you know I'm still very fascinated by it and love science. um um I rescue reptiles so ah one you know this is sort of it somewhat related. Um, so I have four tortoises in iguana you know I have a few other pets too but learning about reptile nutrition and I have an amazing reptile vet one of 12 in the United States happens to be here in San Diego um I have had to learn a whole new. Area of nutrition in a different way because of their unique physiology and habitat needs and um, it's given me a whole new respect. You know it's really got me out out of my my lane and whole whole respect on you know, um, you know this. Veterinary aspect. My daughter is of that technician. So I've learned a lot from her too. But you know taking care of these amazing creatures. Um, that have very different metabolisms that have very different ways of um, living they live a lot longer ah in many reasons. And need special care. You know, really, it's it's very humbling right? where you know when you're so focused on human side of things and then you learn about this whole other species I think it's really cool to do that to give you perspective on. You know the bigger picture as well. So that's my little side gig.

57:13.65
Janice
Is being a reptile enthusiast I you know what I I am thinking of a second career. Ah.

57:14.34
Dustin Mesick_ RDN
Wow, You could be a reptile Dietitian have you thought of that. I Totally could see it. People are really into their pets.

57:28.14
Janice
They are and they want the best for them and um, you know it's It's a big responsibility right? You don't just get in a guana sticking in a you know glass thing and you know throw in Lettuce. It doesn't work that way you you got to know what you're doing if you're going to be um, a humane. And responsible um keeper of these these beautiful creatures. So um, anytime you want a podcast on reptile nutrition you know I'll bring up that book and we'll do that.

57:55.70
Dustin Mesick_ RDN
Ah, yeah I You know we might we might have something you know the intersections of of diet and cancer and reptiles that could be ah another episode. You know I do I do think that there's a lot of validity around reptile nutrition. You know.

58:03.55
Janice
We can do that.

58:11.83
Dustin Mesick_ RDN
I've been hearing more and more that dog food is not good for dogs. So I think that there's a lot of validity there like we're like wait but it's the only thing we have access to and it's like talk. It's like Taco Bell or Mcdonald's processing or.

58:13.51
Janice
Oh yeah, yeah, yeah, yeah, yeah, yeah, well you you you will need to get my daughter is set fincier credentialing as a registered vet technician. She's. Very well versed in this. She works in a that clinic. She would be the one to talk to? Um, she would be a brilliant person to have on and can address this. She's very good at this and this is her um her focus. So you're more than welcome to invite her on she's she would be amazing and she works with with some great bets who can address all these um fallacies and facts about dog and cat nutrition.

58:59.10
Dustin Mesick_ RDN
Wow. Well you know if we ever are able to find some intersections there. Maybe we'll have a random pet up. So the intersections of cancer and diet.

59:03.30
Janice
Yeah, yeah, yeah, my daughter Leah would be great. She's very well spokenken I'm very proud of her so you know here's the mom thing coming up.

59:14.75
Dustin Mesick_ RDN
Yeah, calling you have any questions about ah any any other things you want to add before we wrap up.

59:21.12
Colin Goodwin_PsyD
No I just wanted to thank Janis for being here.

59:23.23
Janice
Thank you so much for having me.