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You’re listening to the Cornwall Cancer Cafe podcast with me Matthew Clark and and Mia McComb
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Thanks to the National Lottery Community Fund for supporting this podcast. So this week we are looking at a
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Subject which I think everyone has got an interest in is food
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But I suppose with food
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there’s something a bit more
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Important when it comes to going through cancer. Did you Emma? Did you have any?
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One telling you what you should be eating whilst you were going through your cancer journey
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No, but I’ve had people telling me what I should be eating all my life because I eat too much of everything
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Everything’s so tasty. Oh
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Yes, I know I do remember
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With my first lot of chemotherapy, I was told to steer clear of things like
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Junette’s just gone out my head. You know how problems with chemotherapy pineapple. That’s it. Well, I was gonna say wasn’t it grapefruit
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Oh, no, it’s grapefruit. It’s grapefruit. Yeah, I think I
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My brain grapefruit for me to make maybe maybe the pineapples
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Screwed my brain up. Well pineapple and grapefruit. They look the same don’t they? That’s it
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The only other food advice I think during treatment I had is I was being
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getting ready for a stem cell transplant and they told me to eat lots of fatty foods and
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Lots of cream cakes and things like that
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They wanted me to eat lots of things like that and I and I said, oh, can I get cake on prescription?
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That’s brilliant Cornish cream tea, please
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anyway, so
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We are actually talking about
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Nutrition in the podcast today and we are talking about nutrition with Annalisa Brigo
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Or I’m gonna put the Italian Brigo on that and you’re a dietician a registered dietician
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So just tell me about how you came to doing nutrition for cancer patients
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Hello everyone. Well, thanks for having me on this podcast today
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First of all, and so I am a registered dietician here in the UK
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I have been for about five years and
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Last year I moved down to Cornwall before these I was always doing acute
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dietetics, which means I would see
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Patients on the wards mostly and then when I moved down to Cornwall
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This job was available and I was very interested in it
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So I went for it and I’ve been working in oncology here at the Macmillan Center
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for almost a year now and I love it and
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You must deal with so many different types of patients with different
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Diagnoses you must be really knowledgeable about what they need to be eating or or is it something that goes across?
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All of the patients that they’ve got this really the same
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dietary needs I
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would say
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Every patient has different needs in that sense and that’s why we really like to do patient-centered care
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Individualized plan based on what each different person needs because there’s no diet
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Advice that will be good for everyone. We were talking about cake weren’t we? We were a cakey tea
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Yeah
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No, is there any ever a case for a cakey tea apart from when you’re having a stem cell transplant?
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A hundred percent you’ll be surprised but a lot of dietitians often recommend things that are quite and calorie rich
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especially for patients that are quite malnourished losing weight and
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Where it doesn’t matter where the calories are coming from at that point, you know that stage of life or or disease and
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So yeah, we would recommend cake and clotted cream quite often actually for that specific patient group
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I seem to remember coming to a first time I met you was doing a smoothie workshop
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Now tell me a bit about smoothies and what they can provide for someone
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100% so that was part of a well-being event that we had here at the cove
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I will say is not the majority of the time. I don’t spend it making smoothies, but it was quite a fun evening and
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And I think you know in summer with the weather getting a little bit hotter
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You can get you can pack a lot of nutrition into a smoothie
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Especially for people that don’t have the energy to spend a lot of time cooking out a full meal
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And so putting a lot of things in a blender you can achieve a balanced
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You know almost like a meal in a quick and easy way and tasty as well
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Have you ever done smoothies Emma?
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So I’ve had smoothies and they always tended to be based on a banana
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An apple juice and then everything else added to it. I’ve not been to your smoothie workshop
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What what do you tend to use as a base?
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You should come next so we have lots of different recipes, and I always like to tell patients and
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that come and join to
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Make it different based on what the needs are right for some people they will need
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Fortification of the smoothing so adding extra protein and calories to that
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Because maybe perhaps they need to gain a little bit of weight and there are people who
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Are advised to manage their weight a little bit more so maybe perhaps losing weight
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And so then we can adapt the smoothies to be a little bit less calorie dense in that sense
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The recipes were all different because obviously people have different taste preference
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I always recommend to adding a good source of protein in there
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So obviously you’ll have your your fruit maybe some vegetable as a base
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but mostly fruit and then Greek yogurt is a really good source of protein and
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Again, depending on what your goal is. You can go for the full fat version. You can go for the zero percent fat
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and then you can add things sweet like nuts seeds and
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protein milk or you know some sort of
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Protein liquid in there you could add juice if you were and if you don’t really like dairy for example
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So you can really customize them based on what your needs and your preference is
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I remember you putting porridge oats in
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Yeah, so that would be a good way if you’re trying to increase your fiber intake or if you just try and increase your
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a little bit of carbohydrate for energy and
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Blueberries so they’re a good one aren’t they?
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Yeah, they’re also full of fiber full of antioxidants and in general fruit and vegetables. We always promote them as dietitians
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Okay, let’s hear your best your favorite smoothie recipe. I am a big fan of
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Banana and peanut butter. I love that flavor combination
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And it’s a it’s a really great way to get lots of calories in and a little bit of extra protein
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For patients that need a little bit more nutrition support in that sense
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Just not a fan of peanut butter
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Okay. Well, it’s not my favorite either, but I’ve had a jar in the fridge, which I really need to eat
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So I’ve been going through it. So okay. So how would you make that?
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Smoothie
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Yeah, so you get a blender and you can get them for quite cheap in most stores to be honest
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And then you just literally put everything in so a few tablespoon of Greek yogurt
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For example and a liquid base again
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That could be like a milk or a high protein milk a banana and then a tablespoon of peanut butter
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At the end towards the end you can add some
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Whole peanuts as well if you like a little bit of crunch in there as well
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You could add some coconut flakes if you like a bit of a tropical flavor
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You can add whatever you like really and then blend it all together
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Okay, so let’s now just look at how you go about working out
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When when a patient comes to you, what’s their dietary needs are?
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Yeah hundred percent. So here at the Cove I see patients one-to-one. They need more specialist advice
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They are referred to me
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But it can also be self-referred if they are struggling with
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Anything related to their cancer or their cancer treatment or if they’re having side effects
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I tend to see people either in pre-hab or rehab or if they are on maybe treatments that don’t require
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Really close monitoring from the oncologist
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So as dieticians we have a standard modeling process to go about our assessment
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So we start by checking
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Obviously, you know their well-being in general, but to be structured we start by checking their anthropometric measurements
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So that would be your weight your height and their BMI not as a sole source of nutritional indicator
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But just as a checking whether they’re underweight or overweight perhaps
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Then we check any recent weight changes. We calculate whether there are risk of malnutrition
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For example, we check the recent blood test if they had any biochemistry done and we analyze that from our specialty
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Okay, so obviously we’re not an expert in all of them like a doctor would be but we do know
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What’s relevant to nutrition and dietetics then we go into more the clinical side of things
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So we check all their symptoms nausea vomiting their bowel movements dieticians love to talk about bowel movements
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You get so used to talking about bowel movements, don’t you?
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When you’ve gone through cancer, you can almost tell someone who has had a diagnosis by their comfortable
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Nature of talking about poo. Yeah, and dieticians are exactly the same
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We have a Bristol stool chart in every clinic and because that’s because bowel movements tells a lot about our health as well
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And how our gut is functioning
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So we go and check their medications as well
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We check just the clinical picture what treatment they’re on what there’s their past medical history might be anything that they might be
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Suffering from at the moment and then we go into the dietetic bit of the assessment. So we check their current diet
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We estimate the current requirements for energy for protein for micronutrients, you know
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So your vitamins and minerals we check if they’re meeting their requirements and they are
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Calculated based on specific things like their age the BMI their condition
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You know their current weight obviously and then we we check if what they’re currently eating meets those requirements
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And if not how we can help with that. Sometimes it’s not just about nutrition support. Sometimes it’s about symptom management
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So people for example, they had a colorectal cancer and a stoma formation
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We can help with that advice if someone had pancreatic cancer, we can help with the advice on pancreatic enzyme replacement therapy
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So it’s very very individualized based on who we have in front of us and what they’re struggling with
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Because I remember when I was going through, you know the peak of my treatments
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I mean I’d lost quite a bit of weight and
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Also
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Because I was not able to get around the room much
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I was sitting on the sofa a lot or lying in bed a lot and
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I was thinking I don’t need to be eating as much because I’m not moving around and that’s what I was thinking
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and I suppose you then
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Liaise with the patient about actually how much they do need to be taking in at that time
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100% you’re correct
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And I get that a lot from people that come to see me that because they’re not moving as much or for example
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If they’re in hospital, they don’t need to eat as much
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But what I try to make them understand is when you are going through an illness or something like cancer
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your body’s requirements for energy and protein do increase because your
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Protein your muscle get gets broken down more easily
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So we need to make sure that your body has the right nutrients to prevent that muscle loss and to have enough energy
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Tolerate the treatment or just to provide energy, you know to get up from the sofa
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The sofa is just so nice. It’s my one of my favorite friends
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apart from Emma
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Yeah, I was going to us so you obviously deal with patients that are suffering with nausea vomiting and also we mentioned
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Pooh earlier so diarrhea etc. So I’m guessing that you would also be recommending foods that would be
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That would help them through that
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Yes, yes
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So side effect and symptom management is a big part of our
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Consultation and we try to help them from the dietetic side of things as much as possible
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Obviously some patients will need medication, you know, like anti sickness medication or
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Anti-diarrhea like low-paramid for example medication is outside my scope of practice
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So I often signpost and people to their GP or their cancer specialist nurse
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in terms of nutrition if someone is very nauseous, sorry and
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We recommend trying to eat little and often because that helps and making sure that what they are eating is very very nutritious
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You know so high in calories and protein
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We recommend not to go long periods of time without eating because that actually can make nausea worse
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There are some anecdotal stories about ginger and peppermint being quite beneficial for settling the stomach
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I don’t know what’s the scientific evidence behind it, but some people find it really helpful and
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And
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Keeping hydrated also helps a lot. Oh, yes hydration. I knew it gets a hydration at some point. Okay, let’s get the lowdown on
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Hydration needs
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Yeah, so the average recommendation for the adults in the public health guidelines are six to eight glasses
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Day if you want to be more specific as dietician we estimate fluid requirements based on weight
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most of the times and age so I hope I’m allowed to say this but and if you’re
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Below 60 years old. We’re looking at 35 milliliters per kilograms. While if you’re over 60 years old the recommendations are
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30 milliliters per kilograms
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Obviously you need clinical judgment in that sense because if someone is underweight
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So if their BMI is below 18.5, they might need a little bit more
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But if someone is overweight, then if you follow those
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calculations, they might be
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Having four liters a day which might be a little bit too much
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So average Lee like two liters a day will be good for the majority of the population and have more if it’s really hot
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Outside if you’re sweating exercising or if you’re having loose stools, which will cause used to lose fluids
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Because you probably remember being in treatments
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I mean, I certainly do this the amount of times the tea and coffee trolley came around and the
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Excitement at the seeing the tea and coffee trolley and my mother would say well, that’s not that’s not hydration tea and coffee
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And I think I mentioned this to you before and you say well, it is it all counts apart from alcohol. So and
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So hot drinks tea coffee
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You know hot chocolate milk soups water squash. They all counts towards your fluid intake
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And obviously if you have too much caffeine or caffeinated drinks, it can actually make you pee more which can lead to dehydration
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In that sense, so obviously be reasonable with your coffee and tea intake
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I love that in the I know that in the UK you love your tea and I do too
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But alcohol I would say avoid it if you can if you really want it try to limit it and stick to the government
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guidelines any thoughts
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I haven’t come to you just because of alcohol. Oh, okay. Oh
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Actually the thing is is that I found that’s going through chemotherapy I
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kept describing it to people as having the worst hangover ever and
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It was it was just so bad thing and I just almost equated it to a hangover and
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It put me off having alcohol it because it was so bad was thinking. Oh, I’m never gonna drink again
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I’m drunk. No, but I’m never gonna drink again
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So it didn’t take much to not drink I have alcohol at the time
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But I was also aware that it could interfere with some medications
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Yeah, I agree with that. I’m sorry. You had to go through that and feel that awful
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It’s probably best, you know that it pull you off alcohol in general
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Here to support you the Cornwall Cancer Cafe podcast
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Share this podcast on your social media. So others may benefit
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So I know people have gone some people that have gone through treatment and their tastes have changed
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So obviously their taste buds have changed. Do you know why that’s happened? Or?
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Do you know if they might ever get their taste back?
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I mean one lady I was chatting to has gone off chocolate and I was just amazed I did
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What I went off chocolate during treatment. Oh
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Yeah, it was strange really weird. I had a patient in this morning
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They actually told me the same thing specifically about chocolate
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But yes, so taste changes is a really common side effect from cancer but also cancer treatment, especially things like chemotherapy or
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Radiotherapy in the head and neck area sometimes and I’m not entirely sure about the causes specifically
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It could be because the radiotherapy can damage the cells on the top of your tongue
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And chemotherapy is quite toxic to the body as well
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So yes, there is something that patients do complain about quite often and it’s very different
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Some people find they have a very metallic taste. Some people find the food is bland
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Some people find it too sweet or too salty
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So there is different advice for different people
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What I would recommend is making sure that before someone is eating they are rinsing their mouth with like a homemade mouthwash
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And you can make that with one pint of water with a teaspoon of baking soda
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By carbonate of soda in it and just swish around the mouth. Don’t swallow it
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Just spit it out, but it helps to keep the mouth fresh and clean
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So that sometimes can help with taste changes. If people are experiencing a metallic taste
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I would recommend using something that quite sharp that cuts through that like a citrus for example
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So you can add lemon juice or lime to fish for example or marinate meat in pineapple juice
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Yogurt sometimes also helps with that. If people find the food for example is a bit bland or lacking taste
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I recommend to try different spices, different seasonings, different herbs that they might have not tried before
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And I also recommend that taste changes. Sometimes they change themselves, you know
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Week to week or month to month
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So I always recommend patient try things again that you might have found that were disgusting a month ago
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You know, you might find that it actually gets better
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Macmillan online on the website has really good information about taste changes specifically as well
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I have to
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Draw myself back to going through my stem cell transplants because I was told
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Apart from all the cake issues. I was told that during the actual stem cell transplants
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It will taste like you have just eaten lots of sweet corn. Oh
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And I thought no that’s a whole load of rubbish and then I had my stem cell transplant and this big
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Lots of taste of sweet corn came into my mouth and
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I was very surprised and I can’t eat sweet corn now because it just reminds me, you know
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I’ve never heard that before. No, that’s a new
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Did it go away on its own? It did go away, but the memory of that sweet corn just takes me back to then
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Okay
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Can we talk about poo now because you mentioned it. So
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Okay, you mentioned the the Bristol chart
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Just just can you give us an idea of how important that is?
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Yes
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So that is one of the chart that we use to make it easier to understand between professional and patient on what someone’s stools look
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Like so it goes from type 1 to type 7 type 1 would be the hardest
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So someone might be a little bit more constipated and type 7 is completely watery diarrhea
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So asking about someone’s bowel movements can be a really good
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Indicator of their health or you know, if they need a little bit more nutrition advice
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Specifically or perhaps some medication to help with that. It also really depends on what the cause of the bowel changes
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I
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Did notice that the toilets in the low and ward?
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Notice these things they’ve got sir that they’re good for
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Going to the loo and then being able to look in and
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Analyze your poo before flushing it away and I found that so useful because the toilets at home
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You just flush it and it goes away
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You know what I haven’t been on long wayward toilets, so I didn’t even know about this
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But I imagine it’s because maybe doctors and nurses need to be able to analyze
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Visually in that sense without having to send a stool sample to the lab if it’s not needed and
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Okay, it was it was that too much well, it was it was an interesting insight
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Isn’t there one of the nations you I don’t know whether Anna might know there’s a nation who their toilets are designed like that
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So when they poop it goes on to sort of a flat surface so they can actually
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Monitor it before they flush. I’ve got it in my mind that it’s the Dutch but I might be wrong
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We need Dutch toilets in this country don’t we that I wasn’t aware of that
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But there are two things that I can think they’re very useful for one is to see if you’ve got any blood in your stools
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Which can happen quite frequently with for example colorectal cancer and the other thing would be to check if you have any steator
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Rhea which would be quite oily stools like fat is a sign of fat malabsorption and people with pancreatic cancer might have that
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So again in that if that happened, then we know how to adjust the advice and the medications
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I do remember before my first before being diagnosed at first that I had a floater problem
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And my my mother said there’s something wrong because I couldn’t flush my poo away
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But um, is that something as well sort of a very floaty poo
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So the signs of steator Rhea so like this fat malabsorption
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Would be something like floating stools or very hard to flush or leaving a streak in the toilet and very smelly as well
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As well as obviously this oily fatty streaks on the on the surface. Okay, I’m gonna move off poo now
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Okay, unless you’ve got another question. I was just gonna add to that when I had my general anaesthetic
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I
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Had real problem passing for days and days and days and it was really really tough
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And I just wish I’d been told before because I think I would have started taking
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What they called laxatives? I would have started taking laxatives as soon as I woke up
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Because it was really really painful. Is that normal for a general anaesthetic or was it just I think this is more of a
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question for the doctor
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Well, look actually that this is
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moved me on to the next thing about
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When you get diagnosed about asking your
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Consultant about what and what you shouldn’t eat like I was told tonight
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I’ve forgotten was it pineapple wasn’t it and I think there’s grapefruit. Oh for goodness sake grapefruit
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I think someone said star fruit as well. Just star fruit something like that. I can’t remember
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it was grapefruit the grapefruit was one of them and
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There was another fruit and I can’t remember what it was
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But I suppose it’s important what I’m trying to get to it’s important to check with your
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Consultant when they say what you get what?
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Treatment regime you’re going to be on to check with the consultant about that sort of thing
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I agree and it’s not just with food
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I want to mention is also with supplements a lot of people nowadays take supplements off on the counter
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So it’s always good if you are taking vitamins or minerals or certain herbs check with your medical team first with your oncologist
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because some herbs or you know vitamins or minerals can actually make the treatment and
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They can interfere with the treatment make it stronger or weaker
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Which is obviously we don’t want that if it’s calculated precisely for you
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So always be honest with your oncology team about what you’re taking and what you’re eating
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That also leads me and we were discussing this earlier on on all these cancer support groups
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They say oh you should try having dried apricots
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They’ll get rid of your cancer or chaga mushroom or something like that
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There are a lot of myths out there
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Unfortunately, and I think it’s because cancer is a really big thing and nutrition is another big thing and everyone feels like they’re
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An expert because obviously we all do it at least three times a day
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I always recommend people that come to visit me if you are getting nutrition information online
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Make sure it’s evidence-based make sure it’s got a scientific base to it
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And get it from reputable sources like World Cancer Research Fund, Macmillan or any specific cancer charity
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You know like Pancreatic Cancer UK
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Prostate Cancer UK, Breast Cancer Now, you know those groups that have evidence-based and not just charlatans on the internet telling you that
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Food or a supplement is going to either give you cancer or cause you cancer and cure your cancer
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And once again, I did this with a few things check with the consultant check with the doctor
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Yeah, 100% and they if they don’t know they will be able to refer you on you know, like to a dietitian for example
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Because there’s there’s a lot of conspiracy theories out there aren’t there on this sort of thing as dietitian
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We do a lot of myth busting as well
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And I think you know there are as health care professional
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We need to give patients the advice that has been tested before has been studied with really good robust evidence
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You know meta-analysis and systematic reviews
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It can’t just be a story from the neighbor because it worked for them. Then it will work for everyone
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We would lose our registration if we did that
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Okay, so we’re getting near the end of this show
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Um, so it’s time to get some tips from you
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What would you say is a is a key tip for someone to take away from this?
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I would say if we’re thinking about general health
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There are some things that we can do to help reduce the risk of cancer from a nutrition point of view
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And that’s making sure you’re eating lots of fruit and vegetables
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Try to limit or you know, very processed meat and red meat
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Limit alcohol as well because those two things are the only two foods that have been linked to an increased risk of cancer as well
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And then from a non-nutrition perspective try to keep as active as possible, you know as tolerated by your
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Energy levels and mobility and another tip make sure that you’re asking for support early on whenever you need it
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Whether it’s a dietitian or something else that brings me to saying well, thank you very much
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For being a guest on the coral cancer cafe podcast. So emma, what did you make of all that information?
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There’s a lot to digest there. Do you get that?
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Digest oh my goodness
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Do you know i’ve learned so much today listening to you? Thank you so much for sharing so much
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Um a good information and good advice. Thank you so much. Brilliant. Absolutely brilliant
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Just really we’ve got to do the things that emma and myself. We’re not experts
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Although we’ve been talking to anna who is an expert
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We are cancer
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We’ve got cancer diagnoses. We have lived experience. We’re not doctors. We’re not
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Counselors, we’re not psychologists. We’re not consultants or anything like that
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But we’re talking to some amazing people such as anna to get that information
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It’s also important for us to talk about the emotional support that we do every week, isn’t it?
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Oh, you’re talking about the hugs. Yes the hugs so we send you a big hug
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And you can send us a big hug back because you can’t give a hug without getting a hug
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That is that is wisdom. You nearly got it wrong there didn’t you? You were struggling there. How is it the other way around?
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Um, and I just want you to uh, if you got time to go and have a look at the website
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we’ve got some
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places you can get help from on the website and
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There’s also a diary of lots of events and support
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organizations doing things
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And there’s our podcast. There’s some videos and hopefully you’ll be feel that you want to share that on your social media
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Or email with people who might benefit
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From what we are putting out there and you can contact us if you want to ask any questions
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As well, we’ll pass those on to the experts to answer them and well, I’d just like to say have
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a healthy
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And a fruitful week
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These are just coming off the top of my head, but don’t become a vegetable
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No, don’t become a mushroom. No, oh that no, this is going down the toilet pan now
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There’s another one
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Goodness, I I think we just ought to say goodbye before it really deteriorates
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Okay
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So goodbye until next week from myself mathy and emma be safe
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Here to support you the core more cancer cafe podcast. Thanks to the national lottery community fund for supporting this podcast