nutrition and cancer webcast january 26, 2010 teresa dixon...

Nutrition and Cancer Webcast January 26, 2010 Teresa Dixon, M.S., R.D. Please remember the opinions expressed on Patient Power are not necessarily the views of M. D. Anderson Cancer

Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care

from your own doctor. That’s how you’ll get care that’s most appropriate for you. Introduction Andrew Schorr: In the media you often hear about superfoods. This can prevent cancer if you eat this or eat that. And then there are other things you hear that can help you have your immune system be stronger if you're fighting cancer. Well, what's correct? Coming up on our Patient Power program you'll hear from a registered dietician who specializes in helping cancer patients, and we'll sort all that out. Hello and welcome to Patient Power sponsored by M. D. Anderson Cancer Center. I'm Andrew Schorr. So there you are. You pay attention to things in the media, and you hear all these claims over your lifetime: This will cure cancer. This will prevent cancer. This will boost your immune system if you're fighting cancer. It is very hard to sort out. So people take supplements and they go on special diets, or if you're diagnosed with cancer your friends or family say, oh, you must have carrot juice every day or you must do this. What's right? It is so confusing. Well, fortunately at M. D. Anderson they have a whole department devoted with specialists to help you, and we're going to hear from one of them in just a minute. But first let's talk to a patient who is on that journey right now. That's Juanita Henderson. Juanita is in Lake Conroe, north of Houston. She's 66 years old. She's a retired nurse, a retired healthcare professional, so she thinks about health and has her whole life. And in the summer of 2009 she was diagnosed with breast cancer and she had a bilateral mastectomy and then began chemotherapy, which she continues on now. Juanita, so you were someone who really paid attention to your health and took a lot of supplements your whole life, many years, right? Juanita: Oh, yes. Over 30 years now I've taken vitamin C. Andrew Schorr: And some of this was because you had some intestinal issues where you didn't absorb maybe all you needed, so you wanted to supplement that, right?

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Juanita: Yeah. About 12 years ago I had a bowel resection which removed about two foot of bowel right where it absorbs a lot of your nutrients, so therefore I felt like if I took triple the RDA in supplements I might possibly absorb at least what I should be absorbing, the RDA. Andrew Schorr: Sure. So you were taking megadoses of vitamin E, vitamin C, and I know you especially liked garlic oil, too, right? Juanita: Yes. Andrew Schorr: All right. Juanita: Yes, it boosted my immune system and lowered my cholesterol very, very well. Andrew Schorr: And that's advertised a lot. Now, you have an ongoing conversation of course as you begin treatment with your oncologist, and last fall, in 2009, you started talking to your oncologist about what were you taking. What did your oncologist say? Juanita: Well, she informed me that while what I was taking might under normal circumstances be an excellent combination the fact that I was now on chemotherapy, several of the things, specifically the ones that were very high antioxidants, would work against the chemo. They would be strengthening the walls of the tiny little cells that we're actually trying to kill off, and this would not be a good thing. Naturally, I wanted to have the most benefit from my treatments, so I went on the internet and I started looking at the various things, and it was very, very confusing. One said yes. One said no. And luckily that evening at a Breast Friends support group that I was at Ms. Dixon had been invited to speak to us about oncology and nutrition combinations. And it was like a light bulb moment. It was like this is a person I really, really need to talk to who has individualized help. Andrew Schorr: Right. And this is Teresa Dixon, registered dietician with M. D. Anderson who works individually with cancer patients. So I can imagine you're one of those people who runs up at the end of the meeting and said, I need to see you individually. Help me sort this out, right? Juanita: I think you might have been there listening. That's exactly what I did.

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Andrew Schorr: Well, let's meet Teresa Dixon, who is a cancer senior clinical dietician at M. D. Anderson. She works specifically at the Woodlands Radiation Center and the Katy Radiation Center, but she's part of a whole team of specialists throughout M. D. Anderson that work individually with cancer patients. And it is individual, isn't it, Teresa? And it seems like one is you have, with Juanita, her past, and then you have the drug therapy she's on and the type of breast cancer she was diagnosed with, and then sort of other assessments of her weight and her lifestyle. You have to really individualize it, don't you? Ms. Dixon: Yes. Yes. And, first of all, thank you, Andrew, and Mrs. Henderson for being with us today and I'm thrilled to be part of this. Yes. I had the pleasure of meeting Mrs. Henderson in November, perfect timing, as she said. You know, being a cancer patient is such a challenge on many fronts but I think especially nowadays more so. It is a blessing, all of this information that is out there for us, but also at the same time, as you can imagine, it leads to a lot of confusion and potentially even less than optimal outcome if not danger in certain circumstances. And like you said, Andrew, I do work with specifically with radiation therapy patients, but many are also undergoing chemotherapy, and both radiation and chemotherapy just in brief, their aim is to kill the cancer cells. Chemotherapy is most effective at killing the cells that are rapidly dividing. Radiation therapy directly is aimed at destroying the cancer cell. Many of our supplements, their claims are antioxidants or cell protective activity, and so that is why in general at this point we are recommending the avoidance of megadoses. And these are single nutrient isolated megadoses of these specific antioxidants. So with Juanita I have been and continue to be so taken by her intelligence, her proactive nature, and just hearing her history all that she has managed to do for herself in maintaining and restoring health with the battles that she has had. And she's actually very amazing with what she has come up with dietarily. She's spoken already of the research she has done and the supplementation that she has done on her own, but also she has come up with a diet that is very supportive, and we've tweaked a few things. One of the interventions that we have had at this point is the allowance back in of foods that contain antioxidants. Because one confusion that many cancer patients have initially when they are told that they need to avoid antioxidant supplementation is does that apply to food sources of antioxidants? And in general reasonable amounts of foods that contain antioxidants are allowed if not recommended.

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Andrew Schorr: All right. Well, there's so much more to talk about. Now, Juanita, one of the things that I have noticed is that when people do their own research and particularly if they're taking megadoses of this or a very specific diet they become real passionate about it, and sometimes they don't even want to disclose it to her their sort of traditional, Western medicine cancer doctor or don't even want to go near the dietician because they don't want it undermined because I'm right and I've read these books. But it sounds like you were open to a dialogue and maybe questioning some of the things that you had been committed to before. Juanita: Well, I've been extremely fortunate that both my oncologist and Ms. Dixon have been exceptional people to work within that they really, really listened to what you said and then gave very clear explanations of why their way was necessary. This made it much easier to swallow. Although I've got to admit I really, really wanted to keep my garlic, and thank goodness the type that I take is just a very natural, with odor, unprocessed garlic oil which they felt that since it was so natural, so close to the basics it would not be a harmful thing. Andrew Schorr: Whenever we talk about garlic and odor I think, well, it's very important that everybody in the room ate garlic so they're all smelling the same way. Juanita: Well, quite honestly, I've been taking it about eight years now and I've asked many, many people, can you smell garlic on me, and no one has ever said that they could. So I think that's one fear that should be laid to rest. The Balanced Diet Andrew Schorr: Okay. All right. Well, after we ate a big pasta meal with garlic my wife would always joke about that. But, right, there are some healthy things typically naturally. But, Teresa Dixon, does it come down to really a balanced diet? Now, I know that may have to be changed. For instance, if somebody has radiation or surgery for head and neck cancer, for example, there may be things that are difficult to eat, and we'll talk about that in a minute, but generally are we talking about a balanced diet? And what does a balanced diet look like today for the American plate, if you will? Ms. Dixon: Well, the American Institute for Cancer Research has designed a visual for us to use as a reference, called The New American Plate, and just by looking at it you see that two-thirds of your plate is plant-based foods, preferably whole grains, and then of course lean meats. And even the Food Guide Pyramid, the new food guide has liberalized in that basically what it's saying is not so much eat this much of this or that much of that and certain calorie levels, it's much more individual. We've come

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to realize that everyone's situation and calorie needs are different, protein needs are different, and particularly one who is trying to prevent a disease or battling a disease, it needs to be case specific, more so. But basically a wide range of fruits and vegetables, whole grains, the more variety the better to be covered in the nutrients that have been identified with disease prevention and wellness. Andrew Schorr: Now, I know my mother was diagnosed years ago with advanced colon cancer, and my dad immediately got a juicer and he was juicing everything, and those are advertised on TV, you know. What about those kinds of approaches. She would have juice, juice, juice. That's really all she had. Ms. Dixon: Well, juicing is fine and juice is good, but when you're juicing I know there is fiber still that is spared, but we have realized especially recently in the past few years how valuable that fiber is, and not only is that fiber valuable in particular with colon health and prevention of colon disease, but that that fiber also has components itself. It's not just an inert ingredient. Consuming Whole, Fresh Foods Andrew Schorr: So you want to eat things as best you can in the freshest, most natural way. Ms. Dixon: Right, the whole food. We have a whole new respect for the entire food in its natural habitat, so to speak, and what they call synergy or harmony, those nutrients working together. Andrew Schorr: Now, that leads me to something I mentioned a minute ago though. There may be people who have various cancers or treatment that make digestion affected or chewing affected. So you deal with that certainly at the radiation center every day. How do you work with people individually to try to give them the nutrition they need but yet make an adjustment to foods or types of foods so that it's more comfortable or doable? Ms. Dixon: Well, the bottom-line goal for a patient undergoing radiation and chemo, really, any intervention, surgery as well, is to maintain what they call the host. Maintain that person, maintain their strength so they can get through the treatment. It's a temporary time where the aim is what the specific treatment aim is at managing the disease, but, that being said, the person needs to maintain their strength, their immunity and as much as possible their ability to heal and get through the

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treatment most optimally. So we find that making sure that--that it's critical to make sure that the patient has adequate calories, protein, and as much as possible still maintain the variety in their diet. And this does become a particular challenge with again radiation therapy. Depending on where the person is being treated, there is damage to the cells that ranges from the mouth all the way down the gastrointestinal tract. It can affect their digestion, their absorption. So what we do is have a one-on-one consultation, looking at their past, any what they call co-morbidities or problems that they have as well as the cancer such as diabetes or, like in Mrs. Henderson's case, the intestinal resections. Those needs are not put on hold during the treatment, so they're factored in as well. But we design a plan to best meet the basic, bottom-line supportive needs of that patient during that critical period. This can range from diet manipulations of texture, seasonings, to the need possibly even for nutrition support such as tube feeding or IV feeding. Andrew Schorr: All right. Well, it's important to keep somebody strong in their fight against the cancer and hopefully then send them on the way as a survivor where they have a good nutrition plan going forward. We're going to talk about all of that as we continue our discussion on nutrition and cancer right after this. The Multidisciplinary Team Andrew Schorr: Welcome back to Patient Power. Andrew Schorr here and our M. D. Anderson patient, Juanita Henderson, now undergoing chemotherapy for breast cancer and managing her nutrition with the help of one of the 31 people who are in the department at M. D. Anderson who help patients individually with their diet. We have registered dietician with us, Teresa Dixon. Teresa, M. D. Anderson has made a tremendous commitment as far as personnel with people who really specialize in cancer nutrition, right? Ms. Dixon: Yes. Yes, I just feel so fortunate to be a part of the group at M. D. Anderson. We have 31 registered, licensed dieticians, many of them with board certification in oncology, and also certification in nutrition support. And we have the ability to work both inpatient and all the clinics including the area satellites in radiation and chemotherapy as well as integrative medicine and the cancer prevention clinic. Andrew Schorr: Well, it seems to me, and, Juanita, I know you've thought about this. It seems like M. D. Anderson, and I think any cancer center would be wise to do this now, thinks about the whole person. So obviously with your oncologist and as you did with your surgeon there's this ongoing discussion about is the treatment effective. Is it

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working? Is it doing what we thought it would do? Do we need to adjust it? How are you doing with side effects? So there is that sort of clinic discussion, but then it's all happening in a body that you give fuel to all the time through you nutrition, so it seems like this discussion with a professional such as Teresa is really an important part. Juanita, you agree? Juanita: Oh, definitely. Well, I spent 50 years studying nutrition myself, but I still feel like there is so much more. When this particular thing comes up you need more information right now about what you need right now so you can work with your doctors trying to overcome many of the side effects that are coming in. And, like Ms. Dixon, said each individual has their own package. I came in before chemo with a bad problem with anemia, with bad immunity protection, and with a great deal of inflammation generalized in my body. And now the chemo has only made it worse, much worse. So it is something that I had been using nutrition to fight these three problems, and how much more of it should I continue doing. And to know that I had someone that I could turn to that would not just give me a party line, that this is what everybody should do, but who spent a great deal of time and attention to say this is what you particularly need to do has been wonderful. I think it would have been great for any, any oncology patient. Whether you think you need it or not, you do. Andrew Schorr: Yeah, I think so too. You made a great point. First of all, you used the word "now." And if you read those reports in the media or do further research, and there's been this study or that study, unfortunately there's often conflicting information about this will prevent cancer, this will cure cancer, this did this in mice or in the lab, and, you know, there are different views, and often it's not known yet. Yet, Juanita, in the summer of 2009 you were diagnosed with breast cancer and then began chemotherapy over many months. You needed expert opinion and consultation for now, right? Juanita: That's right. Reading all these things, trying to figure it out for myself, which is what I had always do in the past, I didn't have the time. I didn't have a year, two years, to try this, try that, see what was good, what was bad. I needed someone who had the answers right this minute. And it was very scary, extremely scary, and thank god, she's really helped. Andrew Schorr: Well, you have a whole team working with you. So, Teresa, just so understand, how does it work? So is this something if you become an M. D. Anderson patient that you the patient need to ask for, or is part of the assessment that M. D. Anderson does is is either the patient requesting, or does the clinical team advise that there should be some nutritional consultation? How does that work?

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Ms. Dixon: Actually, all of the above. When a patient enters the M. D. Anderson system they are automatically screened with multidisciplinary screen, not just nutrition, and through that any concerns are flagged, and they are referred to the dietician that happens to be in that area. Not only is this flagged if there happens to be a clinical objective concern, such as weight loss or nausea, vomiting or anything such as that, but if the patient requests, like I believe, for example, Mrs. Henderson was questioning, not only did I happen to meet her, but she also was screened out, and we did receive a screen as well, so she was caught through a couple nets. But, yes, every patient is screened for nutritional need, and this is outpatient and inpatient. Once they are identified, they are hooked up with their dietician and further screened at that point, but as level indicates a nutrition assessment is done and then intervention begins at that point. And it's not a one-time counsel usually. It is ongoing, as need, really, as need based. We do have a classification system that is objective that sort of, quote, mandates when or how often they are seen, and of course this is graduated based on need. Of course the higher level need is seen more frequently for both inpatient and outpatient. And, you know, the nice thing, again, is it's a very multidisciplinary approach where we are doing this intervention as a network with many other disciplines and considering everything. Andrew Schorr: Well, it's the whole person, and as we've done on other programs, it's somebody's psychological well-being as well, even their caregivers. There are lots of aspects that are looked at, and you, the patient, should welcome it. One other point I wanted to bring up, and I say this all the time, we, the cancer patients, are on a journey through life but also as we go through that very intense period of treatment. Juanita, you'd agree, we're on a journey, right, and things change? Juanita: Right. One of the things that's just recently developed for me is because of my immune system being depressed and my white blood count being down I developed an abscessed tooth, and I will have to have it removed. And because I also have a subclavian catheter which gets Heparin lock on it, my dentist is worried about bleeding when he removes the tooth. So Teresa Dixon and I discussed it, and she recommended that I eat some dark green leafy vegetables that will have vitamin K in them, and it will help with clotting, that this would not harm my chemo and that it would help. So I'm eating a lot of spinach between here and next week when I have my tooth removed. Andrew Schorr: So, Teresa, it's a journey, and so the plan evolves and changes.

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Ms. Dixon: Yes. Yes, most definitely. As Juanita pointed out, just using her case for example, you know, it's important that the patients have guidance, that, yes, in the media, and we do talk about the plant-based diet and all the preventive measures or the preventive recommendations, you know, high fiber, low fat, but when you are in the thick and in the battle of fighting your cancer and experiencing the many side effects, nausea, vomiting, oftentimes bowel changes, sometimes that has to be put on hold and that's okay, but we need to help them keep the primary focus at the forefront which would be keeping that body nourished, keeping the calories coming in so that the body is not breaking its own muscle stores and nutrient stores down. And I predict that, for example, in Mrs. Henderson's case we will be shifting gears and teaming up through her course of treatment and optimizing, trying to keep her immune system and her health optimized during all phases of her cancer treatment. Listener Questions Andrew Schorr: Let me fire some questions at you just for a second, Teresa Dixon, and that is ones we've gotten in via e-mail from M. D. Anderson listeners. Jan from Conroe, Texas, wrote in, "I'm currently undergoing chemotherapy for breast cancer, and I've all been a healthy eater. What would you say is the most important component that I should include in my diet every day?" Now, we don't know her exact situation so I know we can't personalize it, but is there anything she should particularly keep in mind? Ms. Dixon: Well, and like you say, that is a tough question in that I'm not sure if she is experiencing any side effects at this point that would limit the range of foods that she's tolerating. But if she is currently receiving, say, chemotherapy treatment and has maintained a good appetite, no nausea, vomiting, seemingly no side effects, my comment or I guess if I have to pick one phrase I would say variety, plant-based, lean meat. I would recommend she look at the website, the American Institute for Cancer Research and review The New American Plate guidelines and just see a visual and some comments about the plant-based eating. Andrew Schorr: Right. And if she's an M. D. Anderson patient ask for that dietician she can talk to as well. Ms. Dixon: Right. Exactly. Juanita: This is one of the things that I thought was so fabulous and was so impressed with M. D. Anderson is the My M. D. Anderson website, where I can go and view all

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kinds of little videos that tell me about all kinds of things, and I can ask questions, and I've never seen anything like this with any hospital that I've been to before. They really seem to care about me as a person. Ms. Dixon: Yes. Yes. Andrew Schorr: That's true, and that's part of why we get to do these programs too, which I'm delighted that M. D. Anderson supports. Heidi from Houston wrote in. Teresa, she wants to know, "What are your thoughts on artificial sweeteners and cancer? Are there any that are safe, or should I avoid them altogether?" I know every time I reach for one of these pink packets to sweeten my tea my wife looks at me funny. So any comment about that? Ms. Dixon: I would say, especially if you are currently undergoing treatment, I would really try to strive to avoid them altogether unless you're diabetic and that's something that you and your endocrinologist have discussed, because certainly your blood sugar control is priority, but keeping them to a minimum as much as possible. But for the general public we really emphasize and strive for natural food sources as much as possible. A lot of the studies have been animal studies, so we're not quite sure. We don't have anything one hundred percent definite to say that it's dangerous, detrimental, but we just don't know yet on them. So I would just say keeping them at a minimum to avoiding is your best bet. Andrew Schorr: One last one, and this really relates to where I wanted to conclude with and that is so we go through treatment and at some point then we need a nutrition plan going forward as a cancer survivor long term, I hope, and that is how do we go and hopefully our cancer has been cured or knocked back to undetectable levels and we live a long, long time, or like with you, Juanita, hopefully the breast cancer has been cured and the last thing you want, now, you've had a bilateral mastectomy, but for a woman who didn't she'd worried about a recurrence. So that brings me to obesity and just weight control. There is information, isn't there, Teresa, that obesity can be a factor in cancer so we want to control our weight, right? Ms. Dixon: Yes. Yes, there is some good information on the American Cancer Society website, www.cancer.org. Basically the concept is that the more fat cells, the more weight one carries, especially postmenopausal the more circulating estrogen and hormones, and there are many cancer that have been shown to be hormone sensitive so that reducing the body weight, reducing the fat cells is beneficial. Andrew Schorr: And, Juanita, I know that's something you're working on.

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Juanita: Yes. Andrew Schorr: Okay. Well, we've covered a lot in 30 minutes. I think the important point is here's Juanita Henderson who knew a lot and had spent years, you know, very consciously taking this pill and this supplement and having this in her diet for a variety of reasons, but she was open to taking advantage of the ongoing personal consultation of a cancer registered dietician, in this case, Teresa Dixon, who has been with us. And you're glad you did, right, Juanita? Juanita: Oh, it's been a godsend to me. It really has. I was ready to eliminate all antioxidants from my diet, all of my blueberries, everything, you know, hold off. If they don't want antioxidants I can't eat any either. And that was my first question, and she clued me in and has continued to. It's just been a godsend, yes. Andrew Schorr: Well, there you go. You have a happy fan, happy patient, Teresa Dixon. Teresa, I want to thank you for what you do and that team of, what did you say, 31 registered dieticians? Ms. Dixon: Yes. Yes, and we have much support staff as well within the clinical nutrition department, so we are very fortunate. Andrew Schorr: Yes. A tremendous commitment M. D. Anderson has made to the whole person, your diet and the drugs that are used, the surgical approaches, your psychological well-being, your family health, the whole enchilada, if you will. And it's covered in our library of programs on the M. D. Anderson website, so take a look at the others. Particularly, I want to call your attention to the one we did on supplements with Dr. Wendy Demark-Wahnefried. She's a world expert. And then earlier we had done a program on complementary therapy for cancer care with Dr. Lorenzo Cohen. Thank you so much for being with us. Juanita, all the best to you in your fight against breast cancer, Juanita: Oh, thank you. Andrew Schorr: A long life, happy life in retirement with Aaron, your husband, and grandchildren. And, Teresa Dixon, thank you for all you do and your whole department.

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Ms. Dixon: Thank you, Andrew. It's a pleasure to be here. And I would like to also point out the M. D. Anderson website, mdanderson.org/education. You can find a lot of supportive information to this and an elaboration on this that can be very helpful. Andrew Schorr: Right. Much more to cover and then that personal discussion you can have with a registered dietician. Ms. Dixon: Yes. Andrew Schorr: Who specializes in cancer. Thank you. Well, this is what we do time after time on our programs on Patient Power, and I learn so much from them with these M. D. Anderson experts and very inspiring, very wise patients like Juanita Henderson. Thank you for joining us. I'm Andrew Schorr. Remember, knowledge can be the best medicine of all. Please remember the opinions expressed on Patient Power are not necessarily the views of M. D. Anderson Cancer

Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care

from your own doctor. That’s how you’ll get care that’s most appropriate for you.

nutrition and cancer webcast january 26, 2010 teresa dixon...

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