Shireen: Podcasting from Dallas, Texas. I am Shireen, and this is a Yumlish podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type 2 diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

In this episode, we talked to Danielle Meyer, a registered dietitian nutritionist, and a certified specialist in oncology nutrition. We talked to her about the important role of nutrition in cancer care, including strategies for optimizing nutrition before, during, and after treatment. We also discuss different factors that can impact a person’s ability to adhere to recommended diets.

Stay tuned.

Danielle Meyer is a registered dietitian nutritionist and a certified specialist in oncology nutrition. She’s currently the program director of the undergraduate Nutrition Science degree program at the University at Buffalo. Prior to working in higher education, she was a clinical oncology dietitian working with patients undergoing radiation therapy.

Welcome Danielle.

Danielle: Thank you for having me!

Shireen: And absolute pleasure, and I can’t wait to dive right in. Danielle, first tell us how has studying oncology changed your perspective on nutrition, and how has this really impacted the way you view making nutrition choices and foods to eat or avoid?

Danielle: I would say once I started working in oncology, it definitely firmed up my philosophy to nutrition and how I teach nutrition and just how I appreciate it. What oncology does when you’re working with folks who have cancer or have gone through cancer treatment, or you’re working with their families and you’re working in support of that, it’s very humbling. And one of my favorite things that I did, besides just helping them make with answering nutrition questions was I got to spend time and I got to know them. I knew going into work every day that I was going to help somebody.

And that was extremely rewarding. And so, with that, and I was able to help them with my knowledge, with my expertise, with my knowledge and expertise in nutrition in particular. So I would say it has made me truly believe that nutrition and food should not be a point of stress, and it really can be, and it does not have to be.

It has maybe even loosened me up as a dietitian coming from my traditional schooling and training to really embrace the fact that people should not be denied the foods that they want. And how sometimes being able to meet their needs by whatever it is, by listening to them is what’s going to be more powerful.

So, I helped people get through treatment by any means possible and usually really letting them guide how I was going to provide them, very precision nutrition is a buzzword. Patient-centered care is what healthcare is all about, and I definitely embody that in the role of nutrition oncology.

Shireen: I appreciate that so much. Can you also help define what oncology nutrition really is?

Danielle: So, it’s a larger scope. So, my role in oncology nutrition was helping folks who were undergoing active treatment. That’s really where I interface with them. But I also was able to participate in community events. So, I would do talks or help people to do general information and general education and nutrition, which might be able to, if you wanted to talk about for those who maybe before they get cancer.

And then I did a lot of survivorship work. So, I worked with a lot of folks after treatment as well. And so, it’s really where we’re supporting this oncology journey, whether it’s in prevention, whether it’s at diagnosis during treatment, and in survivorship. That’s oncology nutrition.

Shireen: That is so interesting. And speaking of those phases, can you help us understand what is the role of nutrition through these phases? How is it different perhaps?

Danielle: So, they’re actually not. They’re not very different. The recommendations for survivorship and oncology nutrition is to follow the prevention guidelines. There’s not actually something inherently special or different, and that can be really jarring for patients sometimes.

They just went through this life-changing event. And to think that what do you mean my recommendations aren’t different? I went through all of this. How could they not be? But when you think about what the prevention recommendations are, you can understand why they’re helpful in survivorship. It’s being, eating a lot of fruits and vegetables.

It’s also increasing your physical activity. And those we have in prevention. Then they also work to help you in survivorship. So, there’s not actually a lot different. And I would say during active treatment, and this is very dependent upon what you’re being treated for and what type of treatment you’re receiving.

I tend to loosen up during treatment because I need folks to be able to do whatever they can. And if I were to put limits on that or say dos or don’ts or cant’s, I think it’s going to add a layer of stress and anxiety that they don’t need. They already have that. So, I actually find that during treatment we also have different goals and different treatment, different cancer diagnoses have different nutritional goals.

Some are to prevent weight loss. Some are to prevent weight gain. In some cases, we need to regain any weight that was lost. We just need them to maintain the whole time. I don’t want it to change, don’t want to go up, don’t want to go down, and whatever I need to do in order to meet that goal is how I’m going to tailor my nutrition recommendations during treatment. So even just personally, someone’s goals can be very, very different. So, oncology nutrition is very personalized nutrition.

Shireen: That is so interesting. You did mention some basic things that apply. So, you mentioned the fruits and vegetables. And the default questions already what should I eat and what should I avoid? And you see, you already saw me going here. What are some of those recommendations that you provide to patients around foods to eat or foods to avoid?

Danielle: In the context of active treatment. So, we’ll think of someone who’s going through treatment. You know, what to avoid, whatever doesn’t make you feel good.

If it hurts, you know, if it hurts to swallow. My primary patient group were those who had head and neck cancer. So, if it hurt to eat, if it hurt to swallow, if it stung, if it tasted bad, because taste changes are also very common with that, then that’s what you should avoid. There isn’t any one food group that you should avoid.

It’s very much very personalized in what it is you can and can’t stand during treatment. To put anything else on that I think would be doing an individual patient a disservice. As much as I want to always encourage them to eat fresh fruits and vegetables, sometimes this is even out of their ability to afford those kinds of things.

So, when it comes to, and usually now. Now in nutrition, we’re coming away from wanting to talk about avoiding things in general. There’s a push for there are no bad foods and I do prescribe to that. Life without ice cream is not worth living. So, it’s one of those things where if it bothers you during treatment, then don’t eat it.

Don’t feel like you should be forced to. This also happens during cancer treatment, especially when you have very well-meaning loved ones. They might find something on the internet, and it ends up being just awful. And it’s not going to help. An example was I had someone tell me about a canned asparagus smoothie, and asparagus had to be canned and it was designed to fight cancer.

And the person who was taking it absolutely hated it. But the caregiver really felt that they were doing something in support of their care. So, like, what should I do? And usually you start those conversations with, well, does he like it? No, he does not. Maybe we don’t need that. Maybe this is something that I think it would be okay if he didn’t have that.

If he liked it, by all means. But no, he doesn’t like it. No. Eh. Maybe that is something you can skip. So personal preference is what should be driving your food choices during treatment.

Shireen: Just for the record, you’re not recommending canned asparagus smoothie.

Danielle: Oh, no, absolutely not. And stirring it cold does not help.

Shireen: I never thought I would ask that question and here we are. Alright, well, having said that you know, you talked about you know, certain different treatments. You talked about radiation when people are in chemo. How does, and you talked about if it hurts to swallow, don’t eat it. Right?

Like that’s a great place to go. Like, what do I avoid? If you can’t digest, just don’t even. How do you instruct people to think about food and nutrients? As people are going through this very difficult time of radiation chemotherapy? And how do certain treatments really affect their ability to digest and absorb nutrients?

Danielle: So, when it comes to cancer treatment, so as I alluded to before, even every diagnosis, it’s unique for an individual. Two breast cancer patients are not the same. Two head and neck cancer patients are not the same. So, when you’re dealing with someone who’s receiving radiation treatment, the side effects that they’re experienced are very localized.

So, wherever it is being treated, that’s where they’re going to feel those kind of side effects. Chemotherapy is systemic. So, if you are a breast cancer patient undergoing chemotherapy, some might cause you to lose your hair even though we’re treating a tumor in the breast. That’s how you think of systemic therapy in that way.

But when you move on to having radiation, if that’s in your treatment plan as well for breast cancer, you’re not going to lose your hair associated to radiation unless there happens to be hair in that area. So, you have to think about, and this is where working with your nurses and your oncology nurses and your medical team to help you understand the side effects and the effects of treatment can really help.

So, this is definitely an interdisciplinary team approach when we’re helping our patients through active treatment. So, my goals again are, if I’m looking, I’m never really looking for a specific nutrient. There isn’t one thing I need them to do. I need them to get as much many calories and have them be as balanced as possible.

And I would say hydration tends to be one of those things that I don’t think is appreciated when people understand oncology and nutrition as well. Sometimes dehydration is what can really send you sometimes into the hospital just before being dehydrated. Taste can change that can affect the taste of water and fluid.

And neck cancer, like I mentioned before. So, I would say in order to make sure people are hydrated, I got to do brainstorming sessions with my patients every time and like, oh, you tried, that didn’t work. Hmm, let’s try this. And I always encourage them to tell me what is working for them. And I explain it.

I’m like, you tell me what’s working for you. So, when I meet another patient who’s going through this, because I obviously have not been through it. So, I never try and use the word “I”. I cannot relate to their, so I asked them to share with me what’s working for them so I can then share that with other patients, and I can say, you know, oh, this isn’t working for you.

You know, I had a patient who really enjoyed watermelon when they were trying to get more hydration, and that was something that they really enjoyed. I had head and neck cancer patient who really enjoyed oysters, too. It’s not really applicable to other people, but I was going to share it. He found that this was really useful for him, so please tell me what’s useful for you.

And that’s how I was able to really navigate making sure people were able to get the nutrition that they could by working with them on an individual level in this more holistic, well-rounded for nutrition. I’m not looking for just one nutrient in particular. I’m kind of looking at the whole picture.

Shireen: I do want to shift to talking about cultural and socioeconomic factors that impact a person’s ability to access and adhere to a balanced diet. You know, as a dietitian, how do cultural preferences and identities really affect oncology nutrition?

Danielle: So, it comes from what it’s like to be a dietitian in general, where the onus is on me to understand my patients and their cultural.

I do encourage them to share with me, tell me what they like, tell me if there’s anything that I need to be aware of. But I do feel that it is my responsibility to learn as much as I can about their culture and any food beliefs that are associated with them that will help me navigate that.

You have certain cultures who have the idea of like using hot foods and cold foods to treat certain conditions. So, knowing about how that works within that culture can help me actually make more relevant recommendations by having a background in that type of understanding. So as before I even see a patient and I try and learn as much as I can from their chart, I’m reading what the doctors say, what the nurses say.

And one of those sections is their cultural section, so I can make sure that I am going to approach them with at least a basic knowledge. I try not to assume, but at the same time I should be coming in for something. So, it’s the onus is on us to understand. And as far as helping someone navigate regarding any type of their socioeconomic backgrounds or their cultural preferences, it’s also understanding where they live.

They might only shop at maybe the local grocery, their local ethnic grocery. And I need to know that those places are there and that’s where they’re going to get their food from. Being aware of my own community, being aware of those around me and who I’m treating is what helps me be able to be a better dietitian and supporting those folks who are going through cancer treatment.

Because again, it can really throw a lot of their understandings or their food beliefs upside down. They might have heard that now they can’t eat one of their cultural foods. If they tend to have a very spicy diet and now, they’re receiving cancer treatment that’s going to make them have some wicked heartburn.

It’s going to be hard to kind of talk to them and help them adjust through that and kind of support, support that through that experience.

Shireen: And that is interesting. And you know, I like that you’re really taking that approach to get to know them and specifically I like that you mentioned that the onus really falls on you, right? Versus the other way around. Well, if you don’t tell me, I don’t know, right? It’s like, well, let’s put the onus on the healthcare provider. How can healthcare providers and other dietitians really work with their patients from different backgrounds to overcome such barriers?

So, I think it starts with, like I said, knowing your community and knowing about local resources. So, part of the education that I provide to my students here at the University of Buffalo, it’s we teach them about being able to go into a community identifying the resources. Because a lot of them will come here for training and education and then they go elsewhere.

So, it’s like one of those first steps to working within a community is knowing what’s available. So, one, just educating yourself and two, like I spoke before, cancer care is interdisciplinary. So, I was able to help my patients when I worked hands in hand with the oncologists, with the nurses, and in particular patient navigators. Patient navigators and social workers are really the workhorses of helping patients navigate this really complicated time.

And a lot of times they have a background as well where it’s in nursing, maybe even public health. And so, they too will know about those resources. There were plenty of times when I’m like, I think this patient needs this sort of assistance. How can I help them? I think they’d be a snap benefit. I think they, you know, where and how can I help them get transportation?

I know there’s a food pantry here. I would then seek out the patient navigator or the social worker. So, it’s working together as a team. I can’t know everything. I don’t know everything. So, I’m going to work and lean on my colleagues who can help me through that. And I, that’s why I’m a big supporter of the patient navigation programs.

So, this is when you get assigned a caseworker, its usually someone who was a nurse or is a nurse. And they help patients navigate their cancer experience they become a touchpoint for that patient. And I work really tightly with them to help support or help overcome the barriers when we can.

Shireen: I do want to shift to misconceptions real quick. What are some misconceptions or myths about oncology nutrition? And I’m sure you’ve had a fair share of hearing some of those particularly for people where that have a diverse background.

Danielle: I think we’re coming from those who have a diverse background. It’s getting mixed messages. It’s thinking that they’re hearing, oh, you have cancer now you have to eat organic. That’s not correct. But it’s still respecting cultural differences. One of the prime cancer myths is sugar feed cancer. Which is a really oversimplification of a really complicated metabolic process.

So, but what I do is, if I am a patient, and that’s what I’m saying, what is it that I’m thinking? I’m like, okay, sugar, I’m thinking white sugar, table sugar. That must be it. Eating a cookie is doing this thing to me. So, I try to, because I have not gone through cancer, I do try to look at what is my patient hearing?

What do I think they’re hearing? How am I going to gauge their understanding, which will then help me better explain those things. Sometimes you can’t change their mind, which is, which is fine. But you can work, you can still support people, even if they maintain some of these myths. So, I try and fix what I can while helping to support them.

Because the last thing you want to come and do is you just blow it up and you’re like, no, that’s totally wrong. They’re not going to come back and talk to you. But when they say that, I’m like, would you like me to explain maybe why that’s not correct, or let me tell you why you don’t have to eat organic if you choose not to.

And a lot of times when you open it up to seeing if they want that information, too. They might not actually want me to go in and say, you don’t have to do these things. So, it’s also really touching base with my patients, seeing where they were coming from before I just went off and offered all of this information. I got to be sure that they’re going to want to receive it to begin with.

Shireen: Fair, fair point. And again, I’d love the concept of just like meeting them where they are. How can dietitians provide guidance on what steps a person with cancer can take to ensure food safety and minimize the risk of food-borne illnesses, especially during treatment?

Danielle: Food safety is one of my favorite topics to talk about. It’s my favorite topic to teach. You can ask any of my students, they’re like, she gets really passionate about foodborne illness. Because it’s the one thing in many cases you can control. When you are going through cancer treatment, you are not in control over a lot of things.

And that’s why sometimes people get really into nutrition and eating because it is one of those areas that they feel like they can have some kind of control over that. And so, I kind of capitalize on that. Like, okay, well let’s talk about the safety, you know, of your food. So, it’s ensuring that you know anyone who’s around you is using proper food handling techniques. You know, washing hands, cooking things to the proper temperature, using thermometers to check the internal temperatures of things.

If you have gone through or if you’re going through, and your doctors or your nurses have said you have a certain lab value that’s going, that might means you get sicker a lot easier. Like more susceptible to maybe catching a cold. Then it’s also taking some steps to maybe, maybe you’re not going to go to the buffet.

You’re going to maybe limit some of your interactions during that time when you’re the most susceptible. So, it’s really basic food safety, even for folks who aren’t going through cancer treatment. Proper hand washing techniques, making sure we’re avoiding what’s called cross-contamination. Using a clean plate when you’re using raw meat versus putting the cooked meat on another clean plate. It’s very much the same, but I would say when you have a loved one or you yourself going through cancer treatment, you just become a lot more aware of that. And I think to advocate for yourself and be really insistent that those around you who want to prepare things for you are doing that.

We do a lot through food. We communicate through food. We celebrate through food. We do lots of things and we support people by bringing them food. And someone who’s going through cancer treatment, you do tend to have people show up with casseroles, show up with food. And you want to make sure if you’re going to do that for someone, one, that you’re actually making something they’re going to eat.

So, please call them and ask. And second that you are then taking all proper precautions before you do that. And sometimes even providing like reheating instructions. Even to that person, like, here’s my casserole. You want to make sure you reheated at this temperature for this long, versus just handing them and hoping they know what to do with it.

So those are things that we can do when we can support cancer survivors going through food safety. But it’s all our responsibility and it’s just really foundational food safety, so you take extra care when you’re more susceptible to getting sick. But just because you have cancer sometimes also doesn’t mean you’re more susceptible.

It’s really dependent upon your treatment and what you’re going through. But I never have any problem with anyone being even more safe with their food safety. So, it’s just eating irreparable places, you know, ensuring that you know that people are washing their hands, you’re washing your hands, that you know your food is being handled properly. I think we should all be advocates for that regardless.

Shireen: Yeah, certainly. Can you discuss the role of dietary supplements in oncology nutrition and which supplements may be beneficial or even harmful for people with cancer?

Danielle: This is one of those questions that you kind of, you get…. it depends. Yeah, it really depends. Is it someone who has a pretty well-balanced diet? Maybe their nutrition’s not going to be impacted so much through cancer treatment. They probably don’t need any. I will say that when it comes to supplements during treatment, oncologists tend to err on the conservative side, and I would agree with them.

They know that their treatment regimen is going to work the way they know it works without anything interfering. That’s why you’ll have a lot of recommendations to stop taking any extra supplements, and it’s because we maybe don’t know how that supplement could. Interact with your treatment.

So, we tend to err on the side of caution of could you please stop during treatment, but you’re welcome to start afterwards, you know, after a certain period of time. So, I definitely air on the side of maybe putting a pause on those things during active treatment. However, there will be people who will insist, and so I, again, play the role to help them navigate that.

I ask them to bring them in. I’m like, let me take a look. I will look at them. I do my due diligence. I’ll try and look them up as much as I can. Generally, if it’s not going to harm someone. I’m more likely to let it go. But if I find something that’s high risk, very harmful, then I would encourage them to discontinue.

Sometimes you’ll get people like, I’m taking blueberry pills, you know, the high night antioxidants. It’s like, yeah, but you’ll get so much more if you actually eat the blueberry. And blueberry supplements are actually way more expensive than actually buying a bunch of blueberries. And if you buy a bunch of blueberries, you’re going to get what’s called the synergistic effect of food.

Like there’s going to be other things in that blueberry that makes that antioxidant. Maybe as powerful as it is, you’re getting water, you’re getting fiber, you’re getting more vitamins and minerals than just consuming a powdered blueberry. So, that’s how I tend to navigate that.

But if they insist, is there any harm for that? Unlikely, that doesn’t mean no. That means unlikely. And I would really just encourage patients, if they insist on taking supplements that they first tell their oncologist, they tell the nurse and then they really go over them with a dietitian. And if we find that there’s maybe no harm in it, we might not have a problem with stopping it.

But it is better that we know so we can better help you navigate. There have been plenty of times I have one in particular, a patient did not want to stop taking a supplement that we knew could have interference. And so, I went to her, I said, this is this, you know this. She goes, yep, I know that’s, I’m going to keep taking it.

I said, okay. I’m just going to document accordingly. If you have any questions, you can just let me know. I will help you with anything else. You know, you just know why we have to. This is the spiel. Why we don’t think you should do this during this time. She goes, yep, I know. I said, okay. Patients are in charge of their own care.

I cannot make them do anything, but I can support them to the best of my ability as long as they’re not going to hurt themselves.

Shireen: With that, Danielle, we are toward the end of the episode at this point. Can you tell us how our listeners can connect with you and just learn more about your work?

Danielle: So, there are, you can find a certified oncology dietitian in a lot of different places, a lot of cancer centers.

I am now primarily in a faculty role. I can be connected with professionally, if you wish, on my LinkedIn. I don’t have much of a social media presence, though. I’m actually pretty busy as faculty, but there are so many other prominent dietitians that are out there and in support of cancer care.

And if you, if you can find someone especially with the RD credential, with the CSO credential you’ll get some really solid information from those from those folks.

Shireen: Lovely, lovely. And with that Danielle, thank you so much for your time. This was a very insightful conversation. Lots of nuggets here that we can learn from and adopt in our lives. And for our listeners who are listening, who have battled cancer or know someone who has, how hard was that journey for you to really adjust your eating habits?

Head over to our social media, Facebook, Instagram, answer this quick question of anyone that has battled cancer or know someone who has how hard that journey has really been for yourself, for your loved one to really adjust your eating habits. Again, head over to our Facebook, Instagram. Find this podcast post and comment and let us know below. Also, to our Spotify listeners, you can totally mention that you can totally answer that in the poll within Spotify.

And with that, Danielle, thank you so very much for your time.

Danielle: Thank you. It was a delight. Thank you.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media at Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions, and to chat and connect with us about your journey and perspective.

You can also visit our website, Yumlish.com for more recipes, advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember, your health always comes first. Stay well.

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