"As a student, I really appreciate Alida’s role at the Comprehensive Cancer Center. In comparison to dietitians at other work sites, she is truly part of the health care team, working directly with the nursing staff, social services, and physicians to provide the best possible care to the patient. I like the idea of nutrition being an integral part of treatment as opposed to an ancillary one, and Alida takes it upon herself to make sure that it is so." -- Steve Baldwin, Dietetic Intern, CSUN - Spring 1999

What happens the first time you meet with a patient?

In the beginning, I’ll give patients general guidelines on what a patient going through treatment would need regarding calories and protein. High calorie and high protein diets are recommended, and often women will hesitate when I mention this because they’re worried about weight gain. I explain the reasons behind it, and why maintaining adequate nutrition is important. In addition to an increase in metabolism during treatment, adequate nutrition helps to prevent body tissues from breaking down, as well as rebuilds tissues that are harmed by treatment, and side effects are better tolerated. I give them ideas for sources of good protein and how to add them to the diet. If a patient is very new to treatment, he or she may not experience the barriers to eating yet. However, anxiety can affect appetite, and I’ll begin discussing symptom management tips; how patients can get adequate calories and protein while bypassing the barriers they may be experiencing.

I frequently suggest eating small frequent meals and snacks, every hour or every 2-3 hours.

How do you interact with other members of the psychosocial and pain management team at the Cancer Center?

Because treatment is multi-faceted in terms of the ways patients get along, we rely on each other to make sure people are getting all the services they need. If I see a patient who hasn’t seen a social worker yet, and the patient expresses to me that he or she needs help at home, or that he or she is feeling depressed, I’ll consult with the social workers. If patients meet with the social workers first and tell them about problems with appetite or eating, they will refer to me. We have weekly staff meetings where we can communicate with each other. With the pain team, the same things apply. If a patient is in pain, it’s a big barrier to eating well, however once that’s under control, we can move forward from there.

What are some strategies patients can use at home if they’re having trouble eating?

Family and friends can play a big role in helping patients at home. Sometimes cancer patients need encouragement, or a reminder to have a snack. Patients know themselves, and may find that appetite is best in the morning, and can take advantage of the times when they feel the most like eating. A relaxed, comfortable environment can also help. I encourage drinking fluids if eating is just not possible at a particular time; perhaps a liquid supplement or a milkshake that a patient creates. It helps to prepare and store meals and snacks ahead of time when people feel good, so that it won’t take much effort when in need. Pre-packaged foods, like custards, puddings, and applesauce are very convenient at these times.

What are the most important nutrition rules to follow for cancer patients going through treatment?

I don’t give patients specific numbers in terms of grams or calories unless they ask for that. I feel that patients have multiple tasks to remember, from medication to self care, and asking them to reach specific protein and calorie goals may become overwhelming. Rather than focusing on specific amounts of grams and calories, general information is easier to achieve, and that is my goal, to provide small yet achievable goals. The most important I believe, is approaching food in small, frequent amounts, and trying to maximize the protein and calorie content of the meal or snack, by adding additional protein and/or calorie items, such as dry milk powder, cheese, eggs, whipped cream, butter or margarine, mayonnaise, etc. Patients who are having a very difficult time can try having a high protein and calorie snack every two hours, such as cottage cheese and fruit, or a small peanut butter and jelly sandwich. Bland, soft, cool foods are often tolerated better, such as ice cream, mashed potatoes, applesauce, jello with whipped cream, pudding or custard. And, I strongly encourage frequent sips of liquids, more specifically caloric fluids, like juices and milkshakes, so that they are getting calories at the same time.

What breakthroughs in treatment have occurred recently?

A change in mentality from "more is better" is taking place now. Specifically, mega-doses of vitamins or minerals are not necessarily beneficial during treatment. Much of the information in nutrition stores and from other sources is not always reliable. I try to be a reference of sound information for patients, giving them the information I have as well as good sources of information they can research themselves. I give guidelines on safe upper limits for antioxidants like Vitamins A, E, and C. The interest in herbs continues to grow, and I provide patients with recent data on these supplements as a way to help patients make more informed decisions. There is still not enough scientific evidence to show which herbal supplements are truly safe and effective, especially for patients going through cancer treatment. Quality standards are not yet fully established and I emphasize avoiding those herbs that have documented harmful effects.

I always encourage fruits and vegetables, because of the growing evidence that phytochemicals (substances found in fruits and vegetables) play a role in cancer prevention. I believe strongly in that. The best source of nutrients is food itself, and the best way to attain a balanced diet is to eat from a variety of foods. Supplementing with a multi-vitamin is usually adequate.

Which foods may help prevent cancer and how can we modify our diets to include them? How much of what we hear in the news about tomatoes and green tea is good sound information?

We’re constantly exposed to these kinds of "breakthroughs" and conclusions to studies. It always comes back to a balanced diet low in fat, high in fruits and vegetables, and whole grains, as well as physical activity. In 1997 a report was issued by the American Institute for Cancer Research and the World Cancer Research Fund based on a review of 4,500 studies related to cancer and nutrition. The major conclusion from this review was, while there are no guarantees, there are many steps we can take to reduce our risk of cancer, and one of them is increasing the amount of fruits and vegetable we eat, which is associated with a 20% lower cancer risk. The experts estimate that 30-40% of cancers may be prevented with a healthier diet. Of course there is a lot of variability in individuals. As mentioned earlier, although there are no guarantees because there are multiple factors in the cancer process, I think that the guidelines provided by the American Cancer Society, increasing physical activity, eating less red meat, choosing a more plant-based, low-fat diet and limiting consumption of alcoholic beverages (if used), are beneficial for everyone.

Regarding tomatoes and green tea, these contain substances called phytochemicals, lycopene and polyphenols respectively, in which preliminary studies are finding protective effects in the cancer process. The media takes advantage of this and has claimed "kethcup may help reduce cancer," and this is when a nutrition expert, the dietitian, can play a vital role in distinguishing between hype and sensibility. It doesn’t make sense to encourage more ketchup; on other hand, eating more tomato based sauce (which tends to be lower in fat compared to cream sauces), soups, tomato juice (choose low-sodium of course) or even fresh tomatoes makes more sense. Polyphenols in green tea act as antioxidants, and in this way may help to reduce damage of cell DNA from cancer-causing agents.

Nutrition is not a solid science. There is still much to learn. The studies that have been or are currently being studied should be viewed as stepping stones to a pathway, or pieces in a puzzle . Access to information is much more readily available now and it’s confusing to read conflicting information, but we need to keep in mind that any piece of information from a study is not the final answer.

American Cancer Society Guidelines on Diet, Nutrition and Cancer Prevention

1. Choose most of the foods you eat from plant sources.

• Eat five or more servings of fruits and vegetables each day.
• include fruits and vegetables in every meal.
• choose fruits and vegetables for snacks.
• Eat other foods from plant sources, such as breads, cereals, grain products, rice, pasta, or beans several times each day.
• include grain products in every meal.
• choose whole grains in preference to processed (refined) grains.
• choose beans as an alternative to meat.

2. Limit your intake of high-fat foods, particularly from animal sources.

• Choose foods low in fat.
• replace fat-rich foods with fruits, vegetables, grains, and beans.
• eat smaller portions of high-fat foods.
• choose baked and broiled foods instead of fried foods.
• select non-fat and low-fat milk and dairy products.
• when you eat packaged, snack, convenience, and restaurant foods, choose those low in fat.
• Limit consumption of meats, especially high-fat meats.
• when you eat meat, select lean cuts.
• eat smaller portions of meats.
• choose beans, seafood, and poultry as an alternative to beef, pork, and lamb.
• select baked and broiled meats, seafood, and poultry, rather than fried.

3. Be physically active: Achieve and maintain a healthy weight.

• Be at least moderately active for 30 minutes or more most days of the week.
• Stay within your healthy weight range.

4. Limit consumption of alcoholic beverages, if you drink at all.