Cancer Dietitian Talks Food, Patient Care and More

June 16, 2010

Mindy Athas

By Mindy Athas, RD, CSO, LDN
UMGCC Outpatient Oncology Nutritionist

What Does a Cancer Dietitian Do?
Hang out and eat bonbons all day? Nah (I wish!). An oncology nutritionist, also a registered dietitian (RD), in the outpatient setting at the Greenebaum Cancer Center does many things. Primarily, we are available as needed to see patients in the three major oncology treatment areas: clinic, infusion and radiation. This means you may see me running from one end of the building to another; hopefully, with time to catch a hot tea in between. Patients may also be contacted by phone or seen in the waiting areas or other ambulatory units in and around the hospital. I have also been known to catch up with patients on my cell phone while at the food store; less ideal but nonetheless still helpful.

Patient contact usually involves discussion of the nutrition issues or concerns, current food intake and tolerance, ability to take in nourishment and digest it, and nutrition support options. I also communicate the plan of care to the team(s) involved with each patient. And patients receive nutrition education handouts, references and resources. I do like to talk (can you tell?), so I got that goin’ for me, which is nice.

What Do You Talk About?
The most common nutrition issues affecting cancer patients include nausea, vomiting, diarrhea, constipation, swallow dysfunction, lack of appetite, loss of taste, sore mouth and throat, and the need for small portions. Many patients also need nutrition support, often in the form of tube feeding, but some even need intravenous nutrition. Food, however, is much more interesting to talk about than canned tube feeds. Alas, I try to make Osmolite (a tube feed formula) enticing! Complications of cancer treatment, past medical history and co-morbidities (such as diabetes, heart issues or kidney disease) also need attention.

One of the most difficult aspects of nutrition therapy involves prioritization of issues: Do we focus on the blood sugar and carbohydrate intake, the need for increased calories (much of which come from carbs) or both? The proof is in the pudding. Finding high-calorie, low-carbohydrate foods may be the answer. The most challenging is discovering which foods the patient likes, will eat and tolerate, which also meet the nutrition needs and fit into the plan of care. Like rocket science (not really).

Beyond Food
As part of the Clinical Nutrition Services Department, we all contribute to departmental and hospital-wide goals. This includes sitting on committees, attending meetings, helping peers and staff, educating the public, coordinating events, reviewing (and often revising) education materials, and developing resources for both patients, visitors and staff. Makes me sound smart, huh? One of my favorite things to do is design and develop nutrition education handouts. I also love to lecture and present information (as you can see) and my ultimate goal is to write a book (hopefully that will land me on Oprah’s couch!)

A Plan of Action
The outpatient nutrition plan of care needs to cover all the areas surrounding cancer treatment: Before, during and after. Patients often lose weight prior to starting treatment, then have tolerance problems during treatment, and pain issues afterward — all of which compound their nutrition troubles. Talk about life giving you lemons! And mud! Luckily, I have a very nice lemon-meringue mud-pie recipe. Cancer treatment may include chemotherapy, radiation therapy, hormone treatments, surgery, or a combination of these. Side effects from these treatments may impact the patient’s ability to eat normally, digest, and metabolize both food and nutrients. Stress, fatigue, pain, fear, and anxiety, as well as family and economic and social issues may all further exacerbate the poor nutrition picture. Makes you want to take a vacation!

Getting Down and Dirty
The outpatient oncology dietitian is able to take the time to discuss various options with patients and their families to troubleshoot nutrition concerns and help find a variety of answers. Nutrition handouts, references and resources are ways we provide ideas and solutions to numerous nutrition-related issues. For example, if you are feeling full quickly after eating a small portion only once daily, of something like chicken broth (a low-calorie food), this may be due to multiple factors. These may include:

  • Poor appetite
  • Sore throat
  • Slow gastrointestinal (GI) tract (from pain medications)
  • Fatigue (from treatment, stress and lack of sleep)
  • Heavy mucus/phlegm build-up
  • Constipation
  • Mouth ulcers

The nutritionist may suggest these options:

  1. Take a walk outside (to perk up your appetite, relieve stress and fatigue)
  2. Sit down with your comrade (someone you like to eat with), and
  3. Snack on some homemade Mac-n-cheese (high-calorie, easy-to-swallow food) or creamed soup with added heavy cream
  4. In a 4-ounce cup (small portion)
  5. Surrounded by a nice setting (pretty tablecloth or window view)
  6. And repeated every 2 to 3 hours (small but frequent eating)

Fix It
The RD may suggest discussing your medications with your health care team: pain meds may increase constipation by slowing down the GI tract, so you may need a laxative. Constipation can also affect your desire and ability to eat well. Medications can cause or help treat nutrition troubles. It is important to tell your team about all your medications and how they interact with you, your food and digestion, and each other. Don’t be shy about alerting your team to your problems! We may not work at Lowe’s but we can still build something together: a healthier YOU!

Eat Like a Kid (Seriously!)
Generally, eating smaller, more frequent meals and snacks is the best option. Choosing high-calorie, high-protein food gives you more bang for your buck. Think kid-friendly foods, which are often high-density (calorie/protein-rich) items in a small package. Remember Aladdin’s genie: All the power of the universe in a teeny little living space. Choose foods and drinks based on this premise. Read labels and compare. Think like a kid: eat small and often, but you don’t have to watch iCarly or Spongebob (unless you want to: they’re both really funny!)

Some Kid Favorites:

  • Peanut butter and jelly
  • Tuna salad with real mayo
  • Cheese omelets
  • Drinkable yogurt
  • Ice cream with bananas, chocolate syrup, caramel and sprinkles
  • Fruit topped with honey and whipped cream (yum!)

Other High-Calorie Ideas:

  • Juice — especially nectars
  • Creamy dressings (Ranch & Caesar)
  • Dried fruit
  • Nuts & seeds
  • Chocolate
  • Oils
  • Butter
  • Cheese
  • Bananas
  • Avocado (and guacamole-ole?!)
  • Milkshakes
  • Fruit Smoothies

For Nutrition handouts, contact me at mathas@umm.edu or 410-328-5462.

{ 8 comments… read them below or add one }

1 Gus De La Calleja June 16, 2010 at 8:24 pm

I am Nutritionist, and I think this text is excellent, nutritional support is the Key for the pacient with cancer and other differents kinds of sickness!!1

2 Medicare and Medicaid Services June 25, 2010 at 9:32 am

Interesting read. Worth sharing with your near and dear who is suffering from cancer.

3 Dr. Michael Haley September 16, 2010 at 4:58 am

If I write the truth, and it contradicts this article, will you still publish it? I would never recommend nutrition like this to anyone, especially someone with cancer. Ice cream with bananas, chocolate syrup, caarmel, and sprinkles is not going to help someone beat cancer. You should focus on recommending natural nutrient dense foods instead of just macro-nutrition. Your recommendations of Juice, creamy dressings, oils, butter, milk shakes, etc. focus on giving the needed calories but aren’t even good choices of the macro-nutrients. The carbohydrates are too simple. That is, they are too small and similar to pure sugar. They should be more complex and nutrient dense. The recommended foods make no distinction between organic vs. industrialized even though we know organic fruits and veges have 40% more nutrients. People with cancer often have cancer because of poor choices they made; though this may not always be the case. Making better choices improves your chances of not getting cancer. It also improves your chances of beating cancer once you have it. Interview cancer survivors and ask them what they did to beat it. Eating ice cream will not be on the list. Juicing and adding superfoods like barley grass juice, aloe vera gel, fruit and vegetable powders, and the like will be on their list.

4 David Lam September 16, 2010 at 5:53 pm

You’re a chiropractor. She’s a dietician who specializes in oncology? Interesting to see that you link to a product that you sell. I think I’ll side with the expert who doesn’t have a financial interest. Thanks “dr.”

5 Dr. Michael Haley September 18, 2010 at 7:40 am

Regarding who you side with is up to you. I link to my site because it is the right thing to do. I sell what I sell because it is the right thing to do. Phytonutrition works. Go to PubMed.gov and do a little research. You can search her recommendations (macaroni cancer) or mine (aloe cancer) and see whose recommendations makes the most sense. You can side with the dietitian who specializes in oncology if you want. But even a brief scan of the research will show that her recommendations are not justified. I am confident that with a little research she will change her recommendations. It’s not about degrees and credentials; it is about science. The science tells you whose recommendations are better. But your still free to treat or prevent cancer with ice cream, bananas, chocolate syrup, caramel and sprinkles because a cancer dietitian said it was the right thing to do and a chiropractor said it was not.

6 Dr. Michael Haley September 18, 2010 at 8:32 am

She too links to her financial interest. Notice the link in the third sentence and the contact information at the end. Regarding the advice given, think of it this way: Someone you love has cancer. A dietician recommends a diet of macaroni and cheese with an ice cream desert and similar meals and a chiropractor recommends superfoods including barley grass juice, aloe vera gel, fruit and vegetable powders, and the like. Remember, you love the person who is dying from cancer. Who is giving the better advice? What counts – the advice based on science or the credentials? Go to pubmed and search aloe and cancer verses macaroni and cancer. Your welcome “david”. (lol)

7 Greg August 14, 2011 at 8:51 am

I think it’s a well known fact that cancer feeds off sugars. I’m not a doctor but I’ve read enough to know that I would not use this author’s nutrition advice. Sorry.

8 Michael Morning August 14, 2011 at 9:21 am

I have to take serious issue with this article. Mainstream nutritionists really need to get with some real science and stop following the Allopathic low-fat, high-carbohydrate plan that’s been leading the downward spiral into obesity, diabetes – and cancer – for decades now! Food is your first defense against chronic disease and the greatest weapon in your arsenal for beating disease once it’s taken root. To eat junk food like ice cream (with sprinkles, no less) and Mac ‘n Cheese while engaged in a fight for your life against cancer is simply throwing gasoline on a burning fire. There is a mountain of evidence that this is the case. As a nutritional consultant for the past decade and a fitness trainer for the past 20 years, I find this article completely abhorrent. Dr. Haley is absolutely correct in his advice. While fighting against cancer, both food and water should be of the highest quality, highest nutrient density and highest purity possible. Food is medicine because we are what we eat. To think otherwise is to perpetuate our downward spiral of chronic and degenerative disease.

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