Shireen Abdullah: [00:00:00] In today’s episode, we sit down with Isabella, a registered dietician specializing in oncology nutrition to explore the powerful link between food and cancer prevention, treatment, and even recovery. Originally from Venezuela, Isabella shares her journey into clinical nutrition and the insights she’s gained from working exclusively with cancer patients.

We discuss common misconceptions. The role of diet in chronic illness, key nutrients for cancer prevention, and how tailored nutrition strategies support patients through treatment and into survivorship. Stay tuned. 

Shireen Abdullah: Isabella Ferrari is a registered dietician who specializes in cancer nutrition. She’s originally from Venezuela and moved to the United States to complete her master’s in clinical nutrition.

After working clinical and outpatient jobs, she now sees only oncology patients while managing their registered dieticians at Dougherty Nutrition. Welcome, Isabella. 

Isabella Ferrari: Thank you. Thank you so much for having me. 

Shireen Abdullah: Such a pleasure to have you on. So, Isabella, I want to understand a little bit more about oncology nutrition.

Can you tell us a little bit more about how you came to study and specialize in such a niche space within nutrition?

Isabella Ferrari: So my first job was in a clinical setting, so I worked at the county hospital here in Dallas. We had a cancer floor at the time, and it was also covering the outpatient oncology clinic here and there.

And I realized that I loved working with cancer patients. I also personally, like through my family, had a lot of experience with cancer as well, and I realized that it was a great place to be at and to help. To be able to get your advanced practice in cancer, you need to see at least 2000 cancer patients and then take boards or take an exam that we need to take every five years just to make sure that we’re keeping up with [00:02:00] all the new information out there.

So I started doing that in about 2021 while I was still working in the clinical setting. Then I just started doing that in that outpatient setting as well. So it’s a combination of what I liked to do in my day-to-day. And then also personally, I just really like working with patients with cancer.

Shireen Abdullah: So it’s a very specific field.

And I assume the nutritional needs also, are very, very different. How do you help others really understand this connection between food and health and really help them bridge that gap?

Isabella Ferrari: Yeah, I think, working with patients with cancer is actually a lot easier for them to understand that–if you compare it with someone that’s trying to like lose weight or do something more long term.

I think cancer patients have a very sudden awakening of like, ‘oh, what I do in my life can affect certain things.’ So they usually come really ready with like, okay, [00:03:00] tell me how. Or what can I do with food? So it’s important also to not make them feel bad about any choices that they might have done in the past, because we can’t really say, oh, because you did this, this is the reason you’re going through what you’re going through.

So they usually come ready to learn and ready to listen and ready to do whatever they can. What I always say is food is really the only thing that a patient with cancer can control because the doctors are telling them when to go in, what labs to take, what chemo to take, how often, so they’re controlling their whole health for them, which is what they should do.

I’m not saying that they should not be, you know, doing that, but the patient is left with. ‘What can I control? What can I do?’ And usually food is one of the things that they can, so they usually come like super eager to learn.

Shireen Abdullah: I imagine the question I’m gonna ask you next is probably not a blanket answer, but may also differ for the types of cancer as well.

But how do dietary [00:04:00] habits influence any kind of progression of cancer?

Isabella Ferrari: Yeah, so there’s not really any research that says if you eat this and this, then your cancer is not gonna grow. Or if you eat this and this, your cancer is going to grow. The main thing we try to focus on, especially like during cancer treatment, like while someone is going through chemo or surgeries or immunotherapy…We try to make sure that during that time they are getting the food and the nutrients that they need so that they’re able to go through that period of time without having too much weight loss or a lot of side effects that sacrifice quality of life. So I think it’s also very individualized.

For example, if someone has head and neck cancer, they’re gonna have a lot more issues eating and a lot more issues like swallowing. So we need to be a lot more specific with that. If someone is going through breast cancer, they’re probably not gonna have a lot of issues swallowing. And a lot of the chemos, some of the chemos might not be asked aggressive as others.

So we can try to focus [00:05:00] on more healthy eating. And then for other people, it’s more like. You gotta eat what you can, and these are recipes and tips on how you can do that. So it really depends on the cancer, and there’s not a specific food that can progress or make cancer worse or better. There’s general eating patterns, so you know, always a more plant-based fiber rich diet is what’s gonna help in the long-term survival in general, not only for cancer patients, but also with people that are trying to avoid cancer. That would be what we would recommend in general once someone is out of the treatment phase.

Shireen Abdullah: Which takes me to what I nuanced in the previous question, which is, as you’re thinking about certain types of cancer, you mentioned someone who’s having trouble swallowing, depending, again, depends on the different types of cancer.

What are some of those modifications that you recommend or that you suggest across different types of cancer?

Isabella Ferrari: Yeah, so for example, if someone that has issues swallowing [00:06:00] food, the first thing is they have to go see a speech therapist, and they’re the ones that are gonna know more about the texture of the food that’s safest for them to eat.

And once we know what the texture is, then we can make sure that whatever they’re eating is calorie and protein dense. So we can make sure we give them recipes on how to do this. So it would be in that case, people that have issues swallowing, that would be the case. There’s a lot of people that have nausea, bloating, low appetite, fatigue.

So then we can help them as well. If your appetite’s low, let’s, for example, try to eat something small every two hours instead of trying to think breakfast, lunch, and dinner. Everything you eat has to be nutrient and calorie dense. So for example, a lot of people love like, oh, I’m gonna have some chicken broth, or I’m gonna have some jello.

That’s great. And I love that people are craving things, but that’s really not gonna nourish us as much. It’s just gonna create space in our stomach that’s not providing us with a lot of [00:07:00] nutrients. So a lot of my job is trying to make whatever they’re eating or whatever they’re craving more nutrient dense.

Shireen Abdullah: And what are some ways that you’re able to make it more nutrient dense?

Isabella Ferrari: Yeah, so I’ll give you an example. Oatmeal, right? People usually eat their oatmeal. Put it in water and maybe they add a little bit of sugar or a little bit of butter depending on that. So I’m like, okay, let’s grab your oatmeal, that you do in the mornings, and let’s add some high protein yogurt, right?

So let’s find a yogurt on the shelf that is 20 grams of protein, or let’s add some milk, some whole milk. Totally fine to add. Again, you’re getting more nutrients with that. Let’s also add some chia seeds. Let’s add some peanut butter. Let’s also add some fruit to it. So we’re adding protein, we’re adding fiber, we’re adding healthy fats with the same meal that someone does already.

Or for example, if someone’s drinking like a protein shake, you know, one of those pre-made liquid ones, I [00:08:00] always say pimp your shake. Kind of like pimp by car show, but pimp your shake. So I’m like, okay, you already have your shake. We know you like it. Let’s add a tablespoon of peanut butter. Let’s add some milk to that and let’s blend it and let’s freeze it so that it tastes more like ice cream and you want it more.

So whatever people are eating and craving, how can we make that more nutrient dense? I also don’t like giving them like a complete new thing that they’ve never done before, because they’re probably used to and find comfort in what they’re doing already. So I just try to make that better. Of course, if they’re open to trying different snacks or meals, I’ll give them options for that as well.

Shireen Abdullah: I love that in your approach, you’re really incorporating the needs and preferences of the individual and types of foods that they’re used to eating according to their taste palette. When we talk about foods in that relationship with something like cancer, I would be remiss [00:09:00] not to mention something around cancer prevention.

So I know this can also be an interesting question, but do you recommend any key foods nutrients that play a large role in cancer prevention as well?

Isabella Ferrari: Yeah, so the main foods that for now show and it’s important to. Notice a couple of things there. So the diet for cancer prevention is actually the same kind of diet for cancer survivorship.

So someone that already went through cancer and is trying to make sure they don’t get cancer again, this diet that they’re gonna be eating is the same one for someone that has never had cancer. So what we recommend is a fiber rich diet. That is the main nutrient. Nutrient, depends on who you talk to, if it’s considered a nutrient or not.

Then high in phytochemicals, in antioxidants, and that’s basically fruits and vegetables because they’re the ones that gives us a lot of vitamins. And then fiber can help just our GI system in general. Uh, protein [00:10:00] also plays a huge role. I believe that the role that protein plays is more related to how we can help muscle.

Muscle growth and how having enough muscle can help just in the long run for anyone trying to be healthy. But I would say focus a lot more on fiber. We should be getting about 25 to 30 grams of fiber a day, and it’s, I think the latest study showed that the average American eats about 11 to 14 grams of fiber a day.

So we have a lot of work to do on that. The good thing is that it’s really not hard. To include extra fiber. If we know what someone is eating on a day-to-day basis, it’s easy for us to be like, okay, let’s add a snack, two snacks that each have eight grams of fiber, and then boom, you can go from 14 to 30.

Shireen Abdullah: So what I’m also hearing you say is that there are quick and easy wins here. You just have to know and you just really have to understand your food better in order to increase some of that fiber in this example.

Isabella Ferrari: Yeah, and if I can add [00:11:00] something to that, a lot of people think that they need to revamp completely and try this super new trend that someone said or go completely keto or go completely plant-based or do all these different things. You can do really small changes that have a huge impact as well. And it’s also important to always look back at the basics, right? Are you sleeping okay? Are you drinking enough water? Are your stress levels contained and good? If those things are not the basis and are not being taken care of, food can’t fix all of that.

So it’s not only food, it’s like lifestyle as a whole. ‘Cause you can be eating the most plant-based diet that you want. But if you’re stressed all the time, you don’t sleep properly, you get three hours of sleep at night, you don’t have a community around you–that’s also super important. You’re really not helping your cancer risk as much.

So I like to think about it [00:12:00] as a whole.

Shireen Abdullah: You know, I’m finding, with everything you’re mentioning, I’m finding a lot of overlap with what we do in diabetes prevention or even in cardiovascular risks. Everything that you’re mentioning. For instance, the fiber rich foods or looking at overall lifestyle like stress and sleep and all those things, I’m seeing a lot of intersection points there between like general chronic conditions and even something like cancer in particular.

Isabella Ferrari: Yeah, for sure. And one thing that I wanna mention too is that because it’s not only food and there’s also like exercise and sleep. Cancer specifically, and really any other chronic disease–but because I work in cancer, I’m gonna try to talk about that–it has to be a multidisciplinary approach. So I am very, very conscious about this.

And if a patient comes and they’re like, yeah, I just find you on Google. I’m like, did your doctor say you need a dietician? They’re like, no. I’m like, okay, well give me your doctor’s number ’cause I’m gonna talk to them because they should be referring everyone that has cancer to someone that’s gonna help them with food, [00:13:00] The same way that I always tell them, are you seeing a physical therapist and are you seeing a mental health professional?

Most of the time the answer is no. And I’m like, here’s a number for one, here’s a number for the other one. So we should be approaching movement, mental health and food the same way that we’re like, here’s your chemo drug. Right? Like there’s a lot more that goes into it than just your chemo treatment.

Shireen Abdullah: Sometimes the conversation just stops at the chemo or just add the nutrition. And what you’re saying is all of these other facets have a huge role to play in that disease progression as well.

Isabella Ferrari: Yep, 100%.

Shireen Abdullah: How does having a healthy diet affect symptom management and even weight loss that are common in patients with cancer?

Isabella Ferrari: Yeah, so I wouldn’t necessarily really call it like a healthy diet can help, I think like a personalized diet is what I would call it really. Because sometimes I say like, okay, add whole milk and then add ice cream, [00:14:00] so it’s not necessarily considered healthy, right? But for that patient, that is what they need during that time.

And I think symptom management is what I do most of the time because that is what affects like quality of life really, and really affects the fact, for example, if someone’s like extremely weak and they’ve been losing weight, they might delay chemo treatments and that’s the main thing that we want to avoid.

So it’s mostly like, okay, are you keeping your weight? Are you keeping your food down, which kind of correlates to the weight as well? And are you staying physically active? I’m not saying that people have to run marathons or like lift super heavy, but are you walking, are you going to your physical therapist to see what we were talking about?

So it depends on the symptoms. So if someone has a lot of nausea, then you know, a lot of the things that I recommend that people don’t think about that much, it’s like, okay, stay away from the kitchen. If you have someone that cooks for you, have them cook, and you be outside. Don’t try to smell anything [00:15:00] and then eat outside or eat with the fan on where you don’t have to smell those things that can make you nauseous.

The other things like try to eat your food on the colder side so that they don’t, you don’t smell those things when the food is warm. That can help a lot. Ginger candies and adding ginger to your foods can help. Peppermint tea with even some ginger can also help with that. 

Also, not drinking your liquids with your meals. Having your liquids just be in between the meals can be super helpful. Again, you don’t wanna have your stomach full of liquid and food that can make you more queasy, right? If you think about it. So those are certain things that we try. If someone is feeling full, very quick, which can happen, then I can talk to them about, okay, let’s go on a 10 minute walk around the house midway through your meal.

That can help you move your food down a bit. So that’s helpful. It can also be like, okay, stop thinking about, like I said before, like breakfast, lunch, and dinner. Your new meals are meal 1, 2, 3, 4, 5, and [00:16:00] six, and they are served in a six inch plate and you can eat whatever you want from that plate. Right?

So it just, and it depends also on how much help the patient has with food. The great thing that people don’t really think about, and I think a lot of cancer patients do not like asking for help or receiving help because they feel like, I don’t want people to see me a certain way. But if you put yourself in your friend’s shoes, the only thing they can do, like they wanna help as much as they can.

So I always tell them like, accept help. And if someone says, how can I help you? Tell them, can you make me food, please? And people are gonna be. The happiest that they can to help you and provide you with something that’s helpful. So I think having people cook food for you, that you don’t have to expend the energy mentally or thinking what am I gonna eat?

Or physically trying to cook things. I think that’s super helpful as well. So I try to go through all this like diet history with my patients and try to see where they’re [00:17:00] at and where are like tidbits of things that I can add that can make their life easier. And at the end of the day, again, my goal is for them to not lose weight so that they don’t need to delay treatment.

That is like what I’m always thinking about.

Shireen Abdullah: And that’s one of the pivotal things because if the diet is not aligned or if it’s not helping the person like gain weight or be healthy enough for chemo, that has an effect as well because then it’s delayed chemo, which has its own. Which of course has its own impact itself.

Isabella Ferrari: Yeah.

Shireen Abdullah: During cancer treatment, what nutrition strategies are used to address different stages of cancer?

Isabella Ferrari: Yeah. I don’t think it’s necessarily dependent on the stage of cancer. It depends more which, what treatment they’re getting. If someone is getting, for example, like radiation. Radiation really does not have a lot of nutritional implications.

For example, if someone’s getting like radiation because of their breast cancer, that’s really not gonna have a lot of [00:18:00] nutritional things that we can do. So that’s a great time to say, okay, because you don’t have nausea, vomiting, your weight is fine. Let’s start talking about how we’re gonna eat after we’re done with this.

So let’s talk about how you can incorporate more fiber and fruits and vegetables and movement as well. So it’s not necessarily related to the stage of cancer, ’cause people can also be stage one and have really bad side effects from the chemo or have some people that are stage four but are super stable and they don’t need a lot of help.

I think the other thing that we play a huge role in doing; there’s a lot of drugs that patients can be put on that affect their blood sugar, so steroids, and there’s a lot of other ones that can affect your blood sugar in general. So we help a lot with making sure your blood sugar does not go over the roof and not have those like chronic effects of having a high blood sugar.

Shireen Abdullah: There’s so many different things to take into account is what I’m [00:19:00] learning here. What kind of long-term nutrition plan is recommended for cancer survivorship? I know you, you mentioned that it’s a lot of intersections with even cancer prevention, but just broadly as we’re talking about cancer survivorship, what would you recommend?

Isabella Ferrari: Yeah, I think in general, keeping a healthy weight is a huge one. So for example, if someone comes into cancer and they’re overweight or didn’t have a super healthy lifestyle before coming into cancer, and now they’re coming out, it’s totally okay to lose weight after treatment and actually probably encouraged.

I like to see it more again as a lifestyle thing of like, okay, your lifestyle before wasn’t great. Let’s change your lifestyle here. And I always say weight is a consequence. So if the reason for someone being overweight is their lifestyle, then they’re gonna lose weight if we change that lifestyle. 

I always tell people that come in for weight loss in general, like cancer or no cancer. They’re like, I wanna lose 20 pounds in a month, [00:20:00] and my answer, which can be annoying sometimes I’m like, cool, drink celery juice for a month and you’re gonna lose weight. Right? If that’s your goal, we can do that, but people really–that’s not their goal, right? If you talk to them further, their goal is, I wanna be healthier, I wanna live longer.

So we try to change the tone into like–it’s not weight loss, it’s the lifestyle, and the weight loss that comes as a consequence of that. So it’s definitely a conversation that can happen after cancer. A lot of that weight loss, I also want it to come from muscle building, so the more muscle that we have, the easier it is for us to lose weight and the stronger our bones are.

That’s another huge thing, especially with breast cancer. If someone’s put on things like Letrozole or those meds that come after cancer, those have a huge effect on our bones. So, super important for them to do strength training and eat enough to make sure that bone issue doesn’t continue. So, again, very individualized, but I would for sure recommend [00:21:00] healthy weight loss through lifestyle changes to someone that went into chemo.

For being overweight, I would also recommend, again, including extra fiber, strength training. And it depends on their long-term goals too. I love that some people are like, I just wanna be able to play with my grandkids when I’m older. So I’m like, great, let’s call the physical therapist. Make sure that you’re able to do all the things that you want to do.

And my role is to make sure you eat enough protein to support that muscle and eat enough fruits and vegetables as well to make sure your body is not in an inflammation state to try to get you to that place. So I really like to work with them and what their goals are, but I would say weight loss is totally okay.

Extra fiber, extra protein and movement for sure.

Shireen Abdullah: Lovely. So Isabella, we are toward the end of the episode. Can you tell us, how can our listeners connect with you and then just learn more about your work?

Isabella Ferrari: Yeah, so you can Google or go through our website, dohertynutrition.com. You can book through there. You can also call our office. For me specifically, because I only see cancer patients, I would ask for me if you wanna be seen by me. There’s also other dieticians in the practice that can see cancer patients. And then if someone’s interested in general health and wellness are, I would say, we all eat. So we all have issues with eating and we have someone that can help and also match what you are looking for.

So on all socials and our website is just Doherty Nutrition.

Shireen Abdullah: Lovely, and we’ll link that up in the show notes below. With that, Isabella, thank you so much for your time. To our listeners, thank you for joining us for another episode of the Yumlish Podcast. Head over to our social media at Yumlish, either on Facebook or Instagram, and find this podcast post and comment below to tell us, how have good habits helped you sustain a healthier lifestyle?

So just general healthier lifestyle habits is what we’re looking for. So, we’ll continue the conversation there. Again, Isabella, thank you so much [00:23:00] and we appreciate your time here.

Isabella Ferrari: Thanks for having me.

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Website URL: https://dohertynutrition.com
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Other promos (books, publications, speeches, etc.): https://www.lls.org/es/patient-education-webcasts/cafecito-con-lls-hablemos-nutricion