I promised those who attended the Colon Cancer Alliance National Meeting that I would type up the answers to any of the nutrition questions that were submitted for our panel. Here they are! I think they are probably questions that many of my readers have. Of course, you can email me or post on my facebook page to ask a question anytime!
Q: What are the differences/benefits of dietitians vs. nutritionists?
A: In most states anyone with an interest in nutrition can call themself a nutritionist. There is no specific level of education, training or certification required to counsel people on nutrition in most states. However, someone who is a Registered Dietitian (RD) has a minimum of a four-year college degree as well as an internship training program and pass a national industry test. On top of that, an RD can be certified in a variety of areas of practice that show additional knowledge and experience. In oncology, RD’s can become Board Certified Specialists in Oncology Nutrition (CSO). The advantage in seeing a Dietitian (RD) is that you can be confident that they have training and education you want in getting nutrition and health advice. By seeing a nutritionists that isn’t licensed or who hasn’t gone through training, it will be hard to have confidence in what they are telling you. It’s always important to check the credentials of someone that you are going to see for health advice, and find out what training that person has had in the area of health that you will be seeking advice in.
Q: Comments on probiotics?
A: Probiotics can be found in food and in supplement form. Probiotics in food have been shown to provide benefit (read more here: http://cancerdietitian.com/2010/12/probiotics-for-a-healthy-gut-a-practical-way-to-prevent-disease.html and here: http://cancerdietitian.com/2008/05/foods-that-provide-probiotics-and-prebiotics.html). In supplement form, you need to be cautious. I would recommend only using probiotic supplements under the guidance of a professional who can guide you to a quality product and have a way to evaluate whether it is benefiting you.
Q: What is the scientific evidence re: a high salt/sodium diet and increased cancer risk?
A: The expert panel at the American Institute for Cancer Research found that salt and salt-preserved foods probably increase the chance of developing stomach cancer as high salt intake can damage the lining of the stomach. You might be surprised by how much salt the average person eats. I covered salt intake in an article here: http://cancerdietitian.com/2011/01/whats-the-link-between-salt-sodium-and-cancer-risk.html.
Q: Assuming there’s a difference, why the switch from antioxidants to phytochemicals? Sounds like trend is moving away from antioxidants. Don’t antioxidants reduce cancer risks?
A: Experts actually haven’t switched, although with all the terms we throw out, I can understand your confusion! Antioxidants are one subcategory of phytochemicals. When we talk about phytochemicals, we are including antioxidants and well as other categories of phytochemicals.
Q: How much soda/sugary drink is “allowed” in a day? No soda at all sometimes is so difficult.
A: Our bodies do not need soda or sugary beverages, it’s our taste buds and our emotional satisfaction that tell us to drink it. However, having none is not something most people are interested in! It’s fine to have as a special treat sometimes. How often is “sometimes”? There’s no recommendation, that I know of. Personally, I think 2 times a week would be fine. Sometimes more often, sometimes less. If you do something 3 times a week or more, it’s a habit. So you have to ask if it’s a good habit or a bad habit. I like to “reward” myself with 1/2 juice, 1/2 seltzer water, with some flavored water (see ideas here: http://cancerdietitian.com/2011/07/is-vitamin-water-healthy-plus-a-recipe-to-make-your-own-1.html) or with an IZZE Sparkling Juice (I buy them at Costco). If having one soda a day is cutting back for you, start there. As time goes on, switch to once every two days and so on.
Q: Do you have an opinion on the concepts that certain foods suppress blood vessels that feed cancer – angiogenesis? (Dr. William Li – eat to defeat cancer website).
A: I am not an expert on the complexity of cancer development and growth. I leave that up to oncologists and researchers! So my first thought is that you need to ask your doctor(s) for their thoughts. From a brief review, I did not see any red flags, and his list of foods looks very similar to mine! The concept that we need to be looking at disease prevention is also one that I agree with. The specific model that he talks about is not my area of expertise, so I’ll leave it up to your doctor.
Q: Is it true that some veggies have protein? Which ones?
A: That’s a complicated question! If you consider legumes (black beans, kidney beans, garbonzo beans, pinto beans, lentils, soybeans, peanuts, etc.) a vegetable, then YES! Many just consider them a protein. Either way, they give you protein AND phytochemicals since they are a plant food. Therefore they are a very healthy choice for protein! Nuts (peanuts are technically a legume) and seeds also provide protein, but aren’t typically considered a vegetable.
Two questions answered in one!
Q1: I have a history of bowel obstructions and was put on a low fiber, low fat diet. How can I best eat for minimizing recurrence?
Q2: What do you suggest for people with short bowel syndrome that can’t eat some of the healthier choices? Are supplements the best option if you can’t eat certain healthy foods?
A: Something that is definitely a challenge for survivors of several different types of cancer is managing side effects from treatment. Trying to follow recommendations for the average public on top of that can be a challenge. The first thing to try is to meet with a Dietitian in your area that could help you come up with a personalized plan. Your oncologist or gastroenterologist should be able to refer you to someone who is used to dealing with some of these issues. My recommendations are to find the plant foods that you can tolerate, in the forms that you can tolerate. Then focus on getting as much of those as you can. Options might be juicing, cooked veggies/fruits and/or blending. Supplements are not a better option although they may be helpful if you are deficient in anything. Your do
ctor should be able to check nutrient levels.
Q: What evidence exists regarding alcolhol use? Everyone mentions it but never the quantity or quality.
A: I don’t know of any recommendations about quality. However, the recommendations on quantity are clear – no more than 1 drink a day for women or 2 drinks a day for men. One drink = 5oz. of wine, 12 oz. of beer or 1 oz. of liquor. Personally, I probably don’t drink more than 2 or 3 drinks a week.
Q: With diet, do you differentiate between eating for prevention vs. eating to minimize recurrence?
A: It depends! (Never an easy answer, right?). The easy answer is no. The recommendations are the same and I give the same tips to both groups. HOWEVER, there are cases of survivors that would have special recommendations, depending on the cancer type, treatment and side effects that they are dealing with. Just like with anyone else, I take the overall recommendations and then tailor it to the individual. Not sure how to do that? Find a Dietitian in your area that could help you come up with a personalized plan. Your oncologist should be able to refer you to someone who is used to dealing with cancer survivors.
Q: The healthcare professionals who treat me are often obese or smokers or eat poorly. What can be done with this group so they set a better example for the rest of us?
A: Wow, this is a very complex issue that is facing many communities. It is a challenge when people don’t make the connection between their daily choices and their health. It is up to each of us to make the healthy choice for ourselves and our families. There are ways that we can encourage others though. First, advocate for employee wellness programs that focus on healthy behavior choices. NOTE – the behavior is more important than the outcome. It’s also important to remember that what someone looks like does not necessarily tell you what kinds of choices they make. They could be losing weight, or quitting smoking and you wouldn’t necessarily know. Also – skinny is not the only healthy body type. For more thoughts on body types, check out my article here: http://cancerdietitian.com/2012/01/is-it-possible-to-be-fit-and-overweight-healthy-at-every-size-debate.html. My bottom line= Do what you can to influence good health for yourself and your family, support healthy lifestyle programs in your community and the workplace and give people the benefit of the doubt that they are doing the same!