March is National Nutrition Month. What activities do you have planned at the Center?
On a larger scale, Cedars-Sinai Medical Center is having an information booth each day in the cafeteria. There are approximately 40 dietitians in the Cedars-Sinai Health System who serve both inpatient and outpatient areas. Dietitians from various areas will staff the booth every day and present information on nutrition and disease prevention to the community, patients and staff. Here at the Cancer Center, my colleague Nichole Matsuura, RD and I will present a lecture for staff summarizing current scientific literature on complimentary therapies used by people with cancer. Our intent is to discuss openly with our staff about trends, ethics, and new therapies to make sure we're all on the same page with regard to the information and resources that we give our patients.

What new developments in nutrition information for cancer patients are most important for people to know?
A lot of promising new research is being done currently, mostly related to symptom management and complimentary therapies. It seems that 50% of my job is combating misinformation, and debunking myths that patients may have heard about. There is a lot of quackery and mass marketing of supplements that may potentially cause harm, and we have an ethical obligation to educate patients and offer evidence-based information. Regarding supplements, we spend a lot of time educating patients and families about quality assurance, safety, and efficacy. We try to direct them to reliable resources to review and offer safe alternatives. One of my favorite Internet resources is www.quackwatch.com. It's a good place to look when you hear about something new that sounds too good to be true. Another great resource on the web is cancerrd.com which is a site created by another dietitian, Diana Dyer, M.S.,R.D. who is a cancer survivor and research dietitian for the American Cancer Society. She includes meal plans, cookbooks, and reliable Internet resources on the site. Diana has also written a book called A Dietitian's Cancer Story and the funds for that book all go to nutrition and cancer research. Two other books I recommend are Dietary Options for Cancer Survivors by the American Institute for Cancer Research and Complimentary and Alternative Cancer Methods Handbook by the American Cancer Society.

How are nutrition services coordinated for patients at the Cedars-Sinai CCC? What would a typical experience be for a new patient at the Center?
There are basically two methods by which a patient may see a dietitian here at the cancer center: A referral, either from a doctor, nurse, or our psychosocial team is the procedural method, identified by nutrition triggers on a screening form; the other method is through our own case finding, where we search for patients by diagnosis or treatment with a high nutrition-risk on the computer or in the scheduling office who would potentially benefit by our services. A patient with Head and Neck cancer starting radiation therapy or a Lung Cancer patient getting concurrent radiation and chemotherapy would be a high priority. A patient with GI cancer would also be a priority for us. It is best to see high risk patients within the first week of their treatment, but ideally on their first day. We don't prefer to do damage control; we'd rather be proactive and talk to patients in advance about what they can do to cut their symptoms in half. We prefer our patients to not know what they're missing when it comes to symptoms.

Since the majority of my patients are actively being treated for cancer with surgery, radiation or chemotherapy, a typical visit with a dietitian would include a review of the medical chart, a brief diet history, and a complete nutrition assessment. We educate the patient and family on an individualized meal plan to assist with symptom management with the goal of maintaining or improving their nutrition status. We occasionally meet with patients who are finished with their treatment to discuss healthy lifestyle changes to reduce risk of cancer recurrence. If someone is not a patient here at the cancer center, we either refer them to Cedars-Sinai Nutrition Counseling Center or refer them to the American Dietetics Association's web site, www.eatright.org where there is a link to "find a dietitian" by zip code and then specialty.

How can patients best get proper nutrition and maintain a healthy diet while undergoing chemotherapy, having nausea or loss of appetite?
Along with the diet history, we ask patients what they're experiencing at the moment and discuss what may occur over the next few days or weeks. If a patient gets chemo today, they might have a normal meal tonight, but as the chemo begins to take hold within the system, it may start to affect the entire GI tract. If a patient is not taking in enough fluids on a frequent basis and ultimately becomes dehydrated, they may develop severe symptoms along the GI tract such as taste aversions, nausea, vomiting, and bowel changes. I must admit, however, that symptom management with medications has improved greatly in the last several years. I heard a nurse say, "If a cancer patient is experiencing symptoms, then we are not doing our job."

In terms of Medical Nutrition Therapy for cancer therapy, we need to look at nutrition priorities since all cancers, treatments and people's reactions may be different. We use behavior modification techniques when counseling patients-change is hard, especially when experiencing the challenges of a cancer diagnosis and treatment. For example, if someone is not used to drinking a lot of water, our primary concern, we explain the benefits patients will feel from all fluids in any form (Popsicles, fresh fruit or sparkling water) and get patients' buy-in with encouraging them to sip every 15 minutes to flush the chemo and the remaining dead cancer cells out of their bodies. A transitional diet from some of these easier to digest liquids to small frequent feedings of protein-containing liquids like soups and milkshakes work very well. Chicken and rice soup, for example, is much easier to digest than solid chicken and rice on a plate because the food is already broken down in the soup. Grandma knew what she was doing when she gave us chicken soup when we were ill. This transitional diet works until solid foods are tolerated, but may not be a traditional "healthy diet" right off the bat. If a person can flush out the system, they will ideally regain their appetite days before coming in for the next treatment. Mint, ginger, or chamomile tea can help curb nausea, as can peeling an orange under your nose. Eating near an open window for fresh air or ginger candy may also help settle the stomach.

What advice would you give to people who want to know more about using proper nutrition as cancer prevention?
I like the "New American Plate" that the American Institute for Cancer Research has developed (www.aicr.org). Picture a circle, and think of it as your plate, and split it into four quarters. Use one quarter for protein, one for starch and the other two quarters for color, either fruits or vegetables, or both. If you visualize that circle, three of those quarters or 75% of the plate is plant-based. The more color the better. This will increase your intake of antioxidants and phytochemicals reported to decrease cancer risk. If you are at home or at a cafeteria, this may help you to make better choices. If you are eating fast food, you may not be choosing a lot of color because there may be few colorful choices. The key is planning ahead and not falling into impulse eating or victim mode. If you know you need to have a grab-and-go kind of day, grab some fruit or some carrots to take along with your fast food. Cancer risk has been linked to obesity, inactivity, and lifestyle. A healthy lifestyle includes nutrition intake that is 75% plant-based, and this model fits any meal. Breakfast, for example, could be cereal, milk and two fruits (or one fruit and a small juice). You may notice that this method of meal planning cuts back on the meats and animal protein portions that some of us were raised on. Remember that most saturated fats are found in animal protein sources, and that's not a problem if we keep portions under control. Most dietary fat, believe it or not comes from things we add to our meals, such as sauces, gravies and salad dressings. This is another area to implement portion control and that popular request, "sauce on the side".

We hear a lot about specific foods, such as soy, that may have cancer-preventing qualities. Is this true, or just a fad at the moment?
We certainly have a lot more to learn about soy foods and soy products. We do know that soy supplements may not be beneficial, and too much may even cause harm in estrogen-positive breast cancers and possibly prostate cancers. However, I think we will see that the nutrition inherent in soy foods may be very beneficial in the general diet. It is important to say here that the American way of "more is better" does not apply here. Seven servings of soy per day is not the way to go; but two to three servings of soy foods per day may be a very healthy alternative to animal protein.

What is your favorite part of being a dietitian? What led you to your current career?
My favorite part of being a dietitian is the wide variety of tasks I get to perform in my job. I can focus on clinical aspects, administrative work, research, and counseling with patients and family members…all in the same day. I have a Bachelor of Fine Arts degree in performance and speech, and as many actors do, I became a restaurant manager. That is when I got very interested in food and nutrition. Around this time, my father passed away from heart disease and I had many friends who were dying from complications of HIV/AIDS. I saw that many people are told to "eat right" but do not know how to do it. I transitioned from that job into getting a Master's degree in nutrition and immunology and immediately started in oncology. I have seen how lack of nutrition information can lead to the demise of many loved ones and this has become a passion that led to my career.