Eat well with confidence: Simplifying breast cancer nutrition

In this free, 60-minute webinar, oncology dietitian Julie Lanford, MPH, RD, CSO, LDN, breaks down the most common nutrition myths and national dietary guidelines using current scientific evidence. She also answered questions in a live Q&A. You’ll leave this session with easy ways to add more nourishment to your routine with less fear.

What you’ll learn:

• Common nutrition myths around sugar, soy, dairy, supplements, and fad diets
• What the latest research and dietary guidelines actually say
• Simple, realistic ways to nourish yourself during and after treatment

Who should attend:

People diagnosed with breast cancer, those living with metastatic breast cancer, caregivers, and anyone seeking clear, evidence-based nutrition guidance.

Watch or listen to the recording below, or read the transcript here.

Transcript

Julie Lanford, MPH, RD, CSO, LDN (00:10):

I am very happy to be here. Thank you to LBBC for the invitation. I always enjoy getting to talk with you all and to answer your questions and hear what are the things that you guys are most concerned about.

(00:24):

I will cover some top myths and then go through some truths and I look forward to your questions.

(00:31):

Here we are, “Eat Well With Confidence: Simplifying Breast Cancer Nutrition,” which sounds easy, but of course is not always simple. Hopefully by the end of today though, you will have at least some tools to wade through the nutrition information that is out there.

(00:48):

I actually came up with a breast cancer myths and truths email series because I had friends and clients who called me as they were first diagnosed with breast cancer asking me some of the same questions over and over again.

(01:05):

And it’s often some of the same things that I heard when I was working specifically in a cancer clinic. I’m now in a community setting, but people email me the questions. Some of them are the same questions I was being asked 20 years ago that I thought, “Oh, this is just a fad.” So I’m sure these are things that you all have heard or had recommended to you. And so I hope that the myth busting will help you feel confident in knowing why something may not be the truth around nutrition, but also helping you pivot to, “Well, what do I do with that information?”

(01:40):

So that’s what we’re going to start with is we’re going to bust myths first, because when I do sessions with people who actually are in person and can respond, they always want the myths first. So I always tend to do that.

(01:52):

This hands down is the number one, top cancer nutrition myth. The idea that sugar feeds cancer is not true. Although I say there’s a little tiny piece of truth in it that technically, I guess sugar does feed cancer. But it feeds every cell of our body, and cancer cells are no different. However, the truth is that sugar is an important energy source for your body and does not directly cause cancer growth. So there’s no studies that show, oh, if you eat sugar, that that somehow causes a cancer to grow.

(02:28):

All of our cells are given energy by glucose, and glucose is that building block of carbohydrates. Sugar, as we typically refer to it, we usually mean that simple sugars like table sugar or syrup or those types of added sugars, but glucose itself comes from all different types of carbohydrates.

(02:50):

So there is nothing wrong with consuming some simple sugars. I think we all have a little bit of common sense that yes, we want to eat nutritious carbohydrates a lot of the time, but there is room for you to enjoy some of your favorite foods and still have a very nutritious diet.

(03:08):

This statement is one that I call the number one myth. The number two myth is around soy and flax.

(03:18):

Many breast cancer patients and survivors have heard, “Oh, you shouldn’t eat soy.” Soy has “estrogen” in it. And if you especially have a hormone-positive cancer, then that estrogen may cause problems. But the truth is that consuming moderate amounts of soy does not increase risk for breast cancer recurrence. We actually have good studies on breast cancer survivors that does not show an increased risk for breast cancer recurrence. We also know that populations of women who consume soy foods on a regular basis actually have lower rates of breast cancer.

(03:58):

What we generally know about soy is that soy has what we call phytoestrogens in it and “phyto” means plant. So these are plant estrogens. And chemically, from a chemical structure standpoint, a plant estrogen is chemically similar to human estrogen, though it’s not identical. Plants cannot actually grow human estrogen. So when somebody says, “Oh, soy has estrogen in it,” that’s not the same estrogen that our bodies make.

(04:29):

And the other thing to know is that the amount of plant estrogen in soy or in flax is nowhere near anywhere close to the amount of estrogen that our bodies make internally. So that is not something I’m concerned about. Now, I do recommend that you consume soy, if you do consume soy, that you have it in a whole food version. Soy milk, soybeans, soy nuts, tofu, tempeh, those types of things, as opposed to the processed soy powders that they often use to make like protein bars. Those are less whole versions. And so you just don’t get the benefits from the whole soy plant when you only consume the soy protein. We want you to get all parts of that plant.

(05:19):

All right. Now I will also, what I say about this too, is that I can sit here and tell you from a certified oncology dietitian that it’s perfectly fine for you to eat soy, but if your oncologist who saved your life told you not to eat it, I can sense that tension. And you can sense it, not just in your mind, but like in your whole body like, “Well, I don’t know.”

(05:44):

So if you are uncomfortable with the idea of consuming soy or flax, I do encourage you to look up some great information. The American Institute for Cancer Research is one of my favorite resources, and I’ll show that link at the end of my slideshow. But they have some great evidence-based resources around soy and flax that you could take into your next oncology visit and just have that conversation with your doctor. And if your doctor is still pretty sure that they don’t want you to eat soy, I also say, You know what? You don’t have to eat soy to have a healthy diet. There’s lots of other — soy is a legume, so we’ll talk some later about getting legumes into your day.

(06:23):

Myth number three, you should only eat organic because pesticides cause cancer. The truth actually is that both organic and regular produce is good for you. So there’s no reason that you have to eat organic. If you want to, that’s totally fine, but the amount of pesticide residue that’s on conventionally grown produce and other foods is very, very, very small. So it’s regulated by the government, and the farms, conventionally grown farms, can only use pesticides at certain times during the growing process and then the food is tested. And you can even look up how much pesticide residue is on various produce and that can be found at safefruitsandveggies.com, or also the EPA puts out lists and the amount of pesticide residue is really, really, really small.

(07:22):

And in organic farming, it’s not that they don’t use pesticides, they just use organically approved pesticides. And so there’s some discussion on are those necessarily any safer than the synthetic pesticides.

(07:36):

Those are all farming questions, food production questions. That is not my expertise, but my expertise is being current on the data regarding the outcomes, health outcomes, nutritional outcomes from organic versus conventional. And I will tell you that both are good for you. When you’re at the grocery store, I don’t tend to worry about it. If you like the taste of organic or you have an organic farmer in your town that you like to buy from, great, but you don’t have to avoid anything just because it’s not organic.

(08:09):

And I’ll say the same thing about genetically modified or genetically engineered foods. There’s not that many of them, but also we have a lot of data currently that suggests that the genetic engineering helps to increase our food yields, which helps keep food prices low and does not cause harm to consume those foods. So those are, I would say, you want to know the data behind that, and then you can make your own personal choice with what you’re comfortable with.

(08:39):

Myth number four, hormones in meat and milk cause cancer. That is not true. The truth is that the FDA regulates the amount of hormones allowed in beef and dairy to make sure they are safe. Even the cow’s milk that sometimes they do give some growth hormones to the cows to increase their milk production so that we can have a solid milk industry and keep prices low. And they use those hormones just like we do in terms of taking birth control. So they are things that are pretty much typical use in dairy farms.

(09:24):

And there’s nothing about giving a cow a cow hormone that means when you drink the milk that cow hormone is biologically active in our bodies. So that is not something that I am concerned about or think that you need to necessarily be concerned about.

(09:41):

Again, it’s your buying decision that you can make when you’re at the grocery store or wherever it is that you get your food, but that’s not something that I think you have to necessarily look for or shape buying decisions around.

(09:54):

And then meat is perfectly healthy to eat. I know there’s a lot of misleading labels — antibiotics, no antibiotics used ever — in some foods. When it comes to chicken and poultry, they can’t use them anyway. So sometimes those marketing claims that are on the outside of the packaging is really there as a sales pitch. And you don’t know just because one doesn’t have that on the outside doesn’t mean that they use hormones in the alternative product, but they usually can charge higher price point if they put some of those labels on the outside.

(10:30):

I usually encourage people not to get caught off by the marketing claims on the front packaging of food products. I tend to encourage you to just turn it around and look at the ingredient list and check out the nutrition facts label and try to pause or ignore the marketing claims because they do tend to give you a little bit more anxiety around food choices.

(10:56):

And myth number five is that supplements are necessary during cancer treatment and survivorship. The truth is that supplements are often not necessary and can sometimes be harmful.

(11:08):

I often hear people talking about, “Well, I take this supplement or that supplement,” assuming that taking pill form of nutrition is important. And the data actually shows that it’s not necessary to take supplements unless you have a reason, like a clinical reason to do that. And that would be if your lab levels are low. When you get your lab work done, do you have low levels of certain nutrients that need a supplement to bring them back up?

(11:35):

Or do you have risk for some particular condition that will require you to take a supplement? So for a lot of breast cancer patients, you have risk for bone density issues, and so they really want to make sure you’re getting enough calcium, enough vitamin D. And so that would be a preventive evidence-based recommendation around taking supplements. But I tend to recommend people stay away from a lot of herbal supplements or just other high doses, especially. I don’t like it when supplements are higher than a hundred percent of your daily value, because it is hard on your body to have to process through all that extra.

(12:18):

Currently, what we want is for you to consume a nutrient-rich diet from the foods that you choose, and then you use supplements when necessary rather than thinking that supplements are going to provide you something that is necessary. Because for the most part, we don’t need supplements, we just need good food.

(12:38):

All right. So speaking of good food, I am going to go through the current evidence-based recommendations that come from the American Institute for Cancer Research. So I mentioned them before. It’s aicr.org. They’re an excellent organization. They’re a nonprofit entity that looks at nutrition, exercise, lifestyle, and cancer risk, and they get really smart people, of course, in the room. They look at all the studies that have ever been done regarding nutrition and cancer and lifestyle. And then they say, “Hey, which recommendations have consistent evidence to show benefit for cancer survivors and for cancer prevention?” That’s how they come up with their evidence-based recommendations. It’s not based on just one study here or there; it’s based on consensus of multiple studies. That’s where we really want to focus our energy and our nutrition decisions is around where does the most evidence point us.

(13:35):

And so these guidelines are very similar to the guidelines that the American Cancer Society puts out and the National Cancer Institute. I think that they’re really great and especially an important place to start as you’re thinking through, “OK, what is my nutrition strategy?”

(13:52):

Truth number one, and honestly, I could just stop here. If it were up to me, I would have one recommendation for everybody. We wouldn’t even have to go through eight or nine. It would just be this one, which is eat a diet rich in whole grains, vegetables, fruits, and beans. And the reason for that is that our bodies need lots of plants. Now, you can have meat and dairy with your plants. But the bottom line is that our bodies are designed to get nutrition, and we need the nutrition from plants mostly.

(14:25):

So a diet rich in whole grains, vegetables, fruits, and beans — nuts, and seeds, I would include in that as well — is going to meet your nutrition needs. It’s going to give you plenty of fiber. It’s going to give you plenty of vitamins and minerals and all the things that your body really needs to function along with lots and lots of phytochemicals. And phytochemicals — so “phyto” again means plant — and chemical. We have a little bit of a thing with the word chemical. A lot of people are afraid of chemicals, but chemicals are really just those building blocks of things.

(15:01):

All foods are made up of nutrients, and nutrients work together better than they work independently. And that’s why a carrot or a sweet potato or we have spinach in this picture or radishes or beets, they have lots of different plant nutrients in them. Yes, they have vitamins and minerals, but they also have lots of different phytochemicals that are good for us. And so when we eat lots of different plants and different colors and different types, we get a variety of plant nutrients and you cannot get those phytonutrients anywhere else but in plants.

(15:37):

That’s why we talk a lot about plant-based eating or plant forward eating, and it just means eating lots of plants. And when we talk about plants, we’re talking about whole grains, fruits, vegetables, beans, nuts, and seeds. That’s the core of what we’re eating.

(15:55):

That said, I will also say that one of the AICR’s current recommendations, evidence-based recommendations, specifically for cancer survivors is to follow the recommendations for cancer risk reduction. The same way that we encourage the general public to eat in order to reduce their risk for cancer is the same way we encourage cancer survivors to eat, to reduce their risk of recurrence, and to just have good overall health and well-being.

(16:24):

I always point that out because sometimes people feel like, “Oh, I faced a cancer diagnosis. I have to eat differently.” You might be motivated to eat better, which is a great thing, but really everybody needs to eat this way. Does the typical American eat this way? No. And that is our challenge, I guess, is that it doesn’t have to be complicated, but it does require a change for many people.

(16:50):

Now, for you all who are on here today who are clearly interested in nutrition, sometimes I find, you know what, my clients that want to come in and talk to me about nutrition are the ones that are doing a really good job. So I hope that you find some things that I talk about today to pat yourself on the back and say, “Oh, I’m doing that. I’m doing a good job.”

(17:09):

Eating lots of plants is truth number one that I think is most important.

(17:15):

Truth number two, which is the stuff I don’t love, talking about what you have to limit or eat less of, but that’s just honesty. The recommendation is to limit consumption of “fast foods” and other processed foods that are high in fat, starches, or sugars. And I would say the reason for that is not because fat, starches, or sugars are particularly bad. It’s just that most fast foods — and we say processed or ultra processed foods — what makes them not nutritious is that they’re actually lacking nutrients. Because the way that they process a food to make them, they’re removing nutrition.

(17:58):

You think about whole grain versus white bread. So in this picture, the bun that’s on there is probably a processed, white, refined-grain bread, which means when they do the refining process, they take it from whole wheat to white wheat and they’ve removed nutrients. That’s what’s happening in the refining process. They’re making it fluffier, but you’re losing some of those plant nutrients that we really want.

(18:25):

And then the fries that you tend to get at fast food restaurants or that are ultra processed, they have stripped off the skin of the potato. They’ve kind of maybe made it into potato starch and then smushed it into a fry shape. Now, if you took a potato at home, you took a whole potato and you cut it up into strips and you tossed it an oil and roasted it in your oven, I would actually count that as just a whole potato. And I would consider that to be a nutritious carbohydrate. But the kinds that you get when you order them out to eat tend to be processed to the point where they’ve removed a lot of the nutrients.

(19:07):

That’s the point is that processed and fast foods tend to be — they give you the calories, which is the energy that you want from your food, but they do not have a lot of the other nutrients that your body needs to function at its best.

(19:23):

Truth number three is to limit consumption of red and processed meats.

(19:27):

I talked just a bit about the idea that it’s a myth that hormones in meat cause cancer. So that’s not true. However, what we do know from data is that high intakes of red and processed meats do increase risk for colon cancer. And so what we say is that red meat, while it’s not necessary to eat it to have a healthy diet, it is a good source of protein, iron, zinc, vitamin B12, but our recommendation is that you would eat no more than 18 ounces a week.

(20:04):

A lot of people feel like, “Oh, well, that’s not a problem. I don’t eat red meat that often.” It kind of depends maybe where you live or what your family culture is in terms of how much red meat you eat because I have done presentations in Kansas or ranch land where they’re thinking, “I eat a lot more red meat than that.” Whereas where I live, we tend to be more moderate. So it kind of depends on your personal habits.

(20:30):

When it comes to processed meats, which is bacon, deli meat, sausage, those types of things, we don’t have sort of a safe threshold. There’s no clear signs from the data regarding at what point does your risk go up more significantly than another time. And so we say limit processed meats. I know that’s not helpful. I tell people there’s no reason you have to avoid processed meats completely unless you just don’t like them, so you don’t feel like you need to include them. But if you love bacon and life is not worth living without bacon, then you can find a way to have bacon in moderation that still maybe keeps your risk for colon cancer at a more moderate level.

(21:18):

Limit consumption of sugar-sweetened drinks. We talked about some sugar is OK. Even added sugars or simple sugars is OK. However, what we find is that sugar-sweetened beverages can be a significant source of added sugars in the typical American diet. And so we encourage limiting consumption.

(21:39):

What your body needs is water. That’s the bottom line. So some of us, I have my water bottle here. We’re always carrying around our water bottles because we want to stay hydrated. And ways to hydrate yourself best is plain water, unsweet tea, unsweet coffee, putting lemon in your water, infusion kind of things. And then if you do have sugar sweetened beverages, they’re more of a special occasion type of thing rather than something you do on a regular basis.

(22:11):

And then similarly, alcohol, and this is probably maybe one of my less popular slides. The current recommendation around alcohol and cancer risk is to limit alcohol. There used to be this idea that red wine’s good for your heart and so then you should have a drink every day. And honestly, it’s probably been 10 years now. They removed that. The American Heart Association stopped saying red wine is good for your heart. It was the plant nutrient in the skin of the red grape that was particularly good for you called resveratrol. And it’s just one of those phytonutrients that I talked about before that you find in plants. So it turns out that the alcohol itself is a carcinogen, or something that increases risk for cancer. So if possible, you want to limit your exposure to alcohol.

(23:04):

And I always point out that you know what? You can get the skin of the red grape without drinking wine. You can eat red grapes.

(23:12):

For the most part, I do encourage people to consider do they want to include alcohol in their diet. And if they do, what kind of amount is comfortable to them? For some people, they completely eliminate alcohol. Thankfully, thanks to the sort of younger generation these days, there’s lots of non-alcoholic options available that didn’t used to be available. So what I tell people is we’re always taking risks. All of us are always balancing risks, whether we want to admit it or not. For some people, having a glass of wine with dinner might be worth the risk to them. And for other people, they might feel like, “You know what? I don’t really care.”

(23:59):

I had a breast cancer survivor who was a client who realized it actually wasn’t the wine that made it special. It was drinking something out of a fancy wine glass that made her evening special. And so after her breast cancer treatments, she actually just started putting water or lemon water or just different sort of spritzers in a wine glass and that she got the same feeling out of that as when she would drink wine. So I always tell people, this is up to you.

(24:32):

The health guidelines around alcohol generally is moderation is one drink a day for women. And that’s one drink is 12 ounces of typical-alcohol beer, 5 ounces of wine, or 1 ounce of liquor.

(24:51):

And truth number six, which we sort of talked about, do not use supplements for cancer prevention. Why? Because to reduce your risk of cancer, you want to actually consume foods that provide your body the nutrients it needs to function. And the way I see supplements is that they are like the most processed version of food that you could possibly get because usually they’re just giving you one individual nutrient. Whereas food on our plates is going to give you so many different nutrients. Like just that salmon that’s on this picture or the mixed vegetables that are in here, there are so many different nutrients that come from food, you could never get that amazing balance from a bunch of pills.

(25:33):

Besides the fact, Who wants to take more pills? Most people, they’ve got the ones they have to take and that’s all they want. And food can hopefully, ideally, you find foods that you really like that also provide nourishment to your body.

(25:49):

As I say, your body prefers nutrients in food, not pills.

(25:54):

The other thing that I would say for anybody who’s in treatment or having challenges with treatment is that a lot of these recommendations can be followed during treatment if you have minimal side effects, but if you’re having significant side effects that are affecting your appetite, your digestive system like nausea or constipation or diarrhea, we put some of these recommendations to the side for your season of treatment. And during your season of treatment, we want to focus on you getting adequate calories, adequate protein, because those are the building blocks of what you need to tolerate treatment and to really have the best outcomes.

(26:37):

We do know when people are malnourished or have malnutrition, their outcomes tend to be worse because they often are dehydrated or undernourished and that results in missed treatments. We don’t want you to miss treatment. So we tend to liberalize the diet a little bit during the seasons of treatment where you’re not feeling so well and you just have limited appetite, and we just want you to get enough calories and protein however we can.

(27:02):

And then if you’re feeling OK during treatment or you’re done with that season of treatment and you’re moving into your survivorship phase, that’s when we really focus and key in on these nutritious recommendations where we’re trying to get you lots of good, solid nutrition because you’re healing from treatment. You’re probably having to build up muscle again, you’re having to heal up from radiation burns or from chemo that’s kind of attacked some of your healthy cells too. And so all the best nutrition that you can will just help to make that healing process better.

(27:37):

A couple of places that I do recommend that you get on their email lists or follow their information for good, solid, science-based nutrition information: AICR, I already told you that one; cancer.org is a good one as well; and then if you like good recipes and there’s even ones related to treatment recipes, cookforyourlife.org is a really great resource for that.

(28:04):

And then Memorial Sloan Kettering has a really good herbs. If you are somebody who tends to want to do maybe some of the supplements, maybe some of the things that don’t have super strong scientific evidence, but there’s some thought that it might help and you’re wanting to try it, they have a great herbs database. So that’s mskcc.org and “About Herbs” is their database to look up just the facts around things. Because supplements or pills tend to have a lot of sales around them and it’s hard to tease out what is a claim that’s not true. They’re not regulated the same way other things are regulated like pharmaceutical medications or even food. I am very cautious about supplements because of the possibility for contamination and the lack of evidence for benefit.

(28:55):

And then if you want more information around some of the myths, the sugar, the soy, the webinars, my website has those and also printable handouts. I have a client who mentioned that she has well-intentioned family members who try to maybe guide her nutrition choices in ways that aren’t so evidence based, or maybe they’re pushing some of these myths. You can just link this cancerdietitian.com/sugar, text that right over to them and have them do their own reading rather than you having to take on the responsibility to educate them that that is not evidence based.

(29:35):

And I have other webinars at cancerdietitian.com/webinars, but really I kind of want to get to the point where we are getting to your questions so that I can make sure to answer what it is that you’re most interested in.

(29:50):

So Lynn, if you want to switch over to the Q&A, I’m happy to do that at this point.

Lynn Folkman (29:56):

Sure. OK. Got a lot of good questions coming in. All right.

(30:04):

Someone had a question and a comment, but I’d love your opinion. How to get more fruits and veggies in? Because they’re not a fan of smoothies. So can you give maybe some tips and tricks, and how many servings too?

Julie Lanford, MPH, RD, CSO, LDN (30:20):

OK. I’m glad you asked that. Thank you, person.

(30:24):

My recommendation, so the guidelines are really — like when they used to say servings, they would say 8 to 10 servings of fruits and vegetables every day. I find that servings doesn’t make sense to most anybody. So I just talk in cups. We’re talking 4 to 5 cups of fruits and vegetables. That’s combined. So whether you want more fruits or more vegetables, I really don’t care. What we need you to do is eat fruits and vegetables. So yes, you want to find the easiest ones.

(30:52):

Now what I do, what I recommend for people, is that you include at least 1 cup of fruit at breakfast. So when you’re having breakfast or whatever, have fruit. Whenever you eat, you should have a fruit or a vegetable present. And it doesn’t even have to be like you measure how much it is. It’s just a question of do I have a fruit and vegetable with my meal or snack. And check: yes or no.

(31:18):

I find it simple as that. Almost every morning I have a banana because it’s really easy. It doesn’t require a plate. I don’t have to cut it. It comes with its own packaging.

(31:27):

I tend to buy the simple, easy to eat fruits and vegetables. And if possible, I eat them raw. There’s nothing that is better about raw fruits and vegetables than cooked. Nutrients are activated in the cooking process, and some nutrients are deactivated. So you don’t have to get into like, is it raw or cooked. The nice thing about raw fruits and vegetables is they are convenient and easy. They don’t necessarily require prep.

(31:57):

So fruits, most people, I would keep fruits around and have them breakfast, lunch, dinner, and snacks. And then vegetables, find the ones you like and figure out. For me, I buy the baby carrots. I buy the baby cucumbers. I buy the baby tomatoes. All the things that essentially are just wash them and eat them, that don’t require — and salad kits. I love some salad kits. They really are the best things since sliced bread because they cut your veggies for you. The whole thing is right there. It makes it really easy.

(32:29):

Now you can make your own, of course. You can make your own salad kits, salad in a jar, all those things. But I tend to recommend keep canned vegetables, keep frozen vegetables, keep the salad kits and the ready to eat fruits and vegetables in your house.

(32:47):

Then sometimes it’s a mental thing where you just have to remind yourself, “Oh yeah, I’m eating. I should include a fruit or a vegetable,” with whatever you’re eating. It doesn’t mean you have to change what you’re eating. It does mean add a fruit to it if possible.

Lynn Folkman (33:02):

Right. I’m glad you touched on the frozen because I feel like now it is easy because sometimes you can’t get what you want fresh.

Julie Lanford, MPH, RD, CSO, LDN (33:10):

Hey, and tip on the frozen section. You can buy diced onions in the frozen section. So if you’re somebody who likes the sauté things with diced onions, saves you time right there.

Lynn Folkman (33:21):

Great. Thank you. All right. Someone has a comment, sort of a question. I’m sure you run into this in your practice. They’re not hungry. That could be for treatment. But do you have any tips or tricks or what they could do in that situation?

Julie Lanford, MPH, RD, CSO, LDN (33:37):

Yeah. So poor appetite is a pretty common issue with certain types of treatment. And also some people, when you’re stressed or you’re depressed or you’ve got some mental angst, you tend to be somebody … some people eat more in that situation and some people eat less.

(33:55):

I think the first thing is, yes, to be aware of your appetite, that’s the first step. And then the second thing is realizing I am going to feel better when I eat. And so having something to eat every 2 to 3 hours is usually what we recommend. That way it doesn’t have to be a big amount. Because when you have poor appetite, it’s like you don’t really feel like eating. You can’t imagine eating a lot. So you’re going to eat a smaller amount, and you’re going to set a timer or have somebody remind you if it’s been 3 hours since you ate.

(34:28):

I do encourage people to eat within an hour of getting up in the morning so that they kind of get that started because if you don’t eat anything until lunchtime, you’ve missed a lot of hours of potential nutrient intake.

(34:39):

So having even small things. And then if you can maximize your calorie intake at those meals. If you’re somebody who has poor appetite and you’re dealing with losing weight unintentionally and you need to keep your weight up, then we want you to consume the higher calorie foods. So that’s going to be like if you can get whole milk or you can get things that have cheese, or nuts are also high in fats and fats are more calorie dense. And so those tend to be the things that we want. Avocados are another source of more plant-based and healthy unsaturated fats but very concentrated in fats. So even just part of an avocado can give you a lot of good calories that will help sustain your calorie intake but also be a smaller volume of food.

Lynn Folkman (35:32):

Right. I know when I was in active treatment, my sister would take what would be one large meal and she would make it like three small ones because I was one who had trouble eating. So it was just in the freezer and I could grab it.

(35:46):

All right. Can you address farm-raised fish and the healthiness of farm-raised fish?

Julie Lanford, MPH, RD, CSO, LDN (35:54):

Yeah. I mean, from a nutritional standpoint, fish is generally fish. Salmon that’s farm-raised versus wild is for the most part nutritionally going to be pretty similar. There might be nuances in like, “Oh, well, is there more of this omega-3 and this omega-6?” But I mean, that’s the way with all our foods, how your food’s grown in the ground, it’s going to depend on how the soil quality is where it’s grown. So the same thing with fish. It’s going to depend on what the water quality is that the fish is in. Now, farmed fish, they can control that really well. So they’re going to be able to control some of the potential for toxin exposure in a farmed fish over a wild-caught fish.

(36:39):

Again, I don’t think that even if you get a wild caught fish that might be in maybe not the cleanest water, it’s not going to be enough in that fish that you eat to cause you problems.

(36:49):

And some people just really like the taste. Right? There’s a certain taste that you might get from sockeye salmon or whatever versus farmed. Honestly, to me, it doesn’t matter as much. I think fish is a nutritious choice. And so if you can get the kind you really love and you have a very positive sort of experience eating it, I think that’s awesome. And if you just buy the frozen farm fish from the Walmart, also fine. They’re both going to offer you protein and nutritious vitamins and minerals that are good for you. And the differences between them are nuanced to the point where I don’t think it makes a significant difference in your nutritional status.

Lynn Folkman (37:41):

OK. Thank you. All right. I know you talked a lot about sugar in the myth-busting, but someone had a question. Isn’t sugar an inflammatory food?

Julie Lanford, MPH, RD, CSO, LDN (37:51):

So there’s no one food that can cause inflammation in your body. That I think is a myth in general, that somehow certain foods are going to cause your body’s inflammation. Our bodies have different types of inflammatory responses. If you get cut, you’re going to have an inflammatory response, and that’s part of healing and that’s good.

(38:14):

But the idea of chronic inflammation is really more where people are interested in terms of diet. How can diet and lifestyle influence your chronic inflammation?

(38:24):

And there’s no one food that you’re going to eat that’s going to cause chronic inflammation in your body. It’s about the pattern of foods that you eat. So if you eat a pattern that includes lots of sugar-sweetened beverages, lots of high fat, fast foods that are processed, lots of baked goods with added sugars, and you don’t eat a lot of fruits and vegetables and you don’t eat a lot of fiber, you perhaps might be at higher risk for a chronic inflammatory environment in your body.

(39:00):

But it’s not that eating a brownie today is going to result in inflammation later tonight. It’s not like a one-on-one kind of situation. And so I always encourage people to … Overall, we’re encouraging you to eat a mostly nutrient-dense diet while allowing yourself the pleasure of enjoying the foods that you love. And I think that’s where I kind of help people figure this out is that if you cannot go to a birthday party and have cake and you can’t go to the family picnic and eat a hot dog and drink some sweet tea like here in the South, that’s what they do. If you can’t do that because your diet decisions have restricted that and you’re missing out on these important aspects of life, I would question if your nutrition strategy is actually supporting your quality of life.

(39:52):

Because the whole purpose in eating nutritiously is to enjoy your life every day that you’ve got, let’s enjoy it. And part of enjoying it is being with other people and eating those foods that you eat just because they’re pleasureful. So finding that balance is what we’re going for. But in terms of the data, there is no evidence showing that if you drink Kool-Aid, you’re going to have inflammation tomorrow. It’s that pattern that we see that results long-term in poor health.

Lynn Folkman (40:27):

Thanks for saying that because I think a lot of times there’s guilt with people who have been diagnosed about, Did I do the right thing? Did I do the wrong thing? And I want to do the right thing.

(40:37):

And once again, at the start of the program, like we talked about, sometimes really confusing, but I want to say in the chat, there were so many comments thanking you for distilling things down and just making it more simple. So before I forget that, I wanted to mention that.

Julie Lanford, MPH, RD, CSO, LDN (40:53):

I hope so. Yeah. I know it’s hard. It’s so hard.

Lynn Folkman (40:58):

Again, we had this question before we got started, but postmenopausal breast cancer survivors should eat a diet based on higher protein. What’s your guidance based on that research and your experience? And I’m going to just also add: Can you do it through purely plant-based?

Julie Lanford, MPH, RD, CSO, LDN (41:21):

Yeah. So I mean, I think the postmenopausal thing just generally goes with aging. And we know that as people age, their energy needs — and calorie is just a unit of energy. So their energy needs, or their calorie needs, actually go down because they don’t have as much muscle mass, their metabolism is just slowing down. That’s how it happens. And that’s perfectly normal. The thing is your protein needs are still about the same.

(41:50):

So if your energy needs go down, but your protein needs stay the same, that means you have less flexibility and you want to make sure that you get enough protein. Now, the typical American actually eats as much protein as we would recommend for bodybuilders or marathon runners. So I would argue that probably a lot of postmenopausal women actually maybe already consume enough protein. The thing is, some diet trends have not been the most protein dense, even though people think they are.

(42:23):

What comes to my mind is people who are like, “Oh, I’m going to switch from cow’s milk to plant-based milks,” and they do almond milk, which is zero protein, whereas cow’s milk was 8 grams of protein per cup. Well, now you’ve substituted something for a plant-based alternative that’s zero.

(42:41):

Now, if you had substituted cow milk for soy milk, they are equivalent in protein, but some people were having this issue with soy and they didn’t — soy is perfectly fine. I do recommend if you want a plant-based milk that you go for soy milk. Or if you just don’t tolerate lactose, then you go for a milk that has good protein in it. It could be Fairlife milk. It could be Lactaid or whatever.

(43:06):

There is some truth to like you need adequate protein. I’m not sure I would say you necessarily need more, but you need enough and you might not even be aware of what you’re currently eating.

(43:21):

And so sometimes it’s like, let’s just do an audit. You don’t have to do an audit on your entire diet, but focus in, maybe you want to focus in on how many fruits and vegetables you eat for a week and just write it down. When do you eat a fruit or a vegetable and how much are you getting? Maybe you want to focus on water for a week. Maybe you want to focus on protein. So really paying attention to, “OK, what protein am I eating?” Double checking the nutrition facts label to make sure that what you think has protein actually has protein. Reading the ingredient list to make sure you know what type of protein you are getting. Because they’ll advertise all over it, “plant-based proteins.” OK, there’s a lot of plants that can give you protein, specifically what plant-based protein is in this whatever package.

(44:07):

So really paying attention to those things. I would say yes, you can get your protein needs met even if you don’t consume animal products, but you will probably need to eat a pretty high volume of beans, nuts, seeds, and some of those things that if it’s not a typical part of your diet, that’s going to take some work.

(44:32):

And then the other thing I would say is, yeah, animal products are more protein dense, so sometimes it’s just easier to kind of “well, let me have those here and there,” to top it off.

Lynn Folkman (44:42):

Right. And I was just adding there’s so many free apps if people want to track out there that are completely free, you don’t need to upgrade, if you want to start there. OK.

(44:54):

Question about breads. So is sourdough bread OK to eat? What about wheat bread? They get confused about which wheat bread is nutritious and which ones aren’t.

Julie Lanford, MPH, RD, CSO, LDN (45:08):

So wheat is just one grain. So when we talk about eating whole grains, there’s lots of different grains: oats, wheat, barley, popcorn, corn in general. Those are all different grains. So wheat is one type of grain, and it grows really well in the U.S. So that’s why we have a lot of products based on wheat because it’s cheaper if it grows here, which is great. We want to grow our own food when possible.

(45:34):

What matters in terms of the breads that you eat mostly is you want 100% whole grain and you find that by reading the ingredient list. So whether that’s 100% whole wheat or 100% whole wheat and 100% whole oats and some kind of mixture.

(45:50):

If you see the words enriched, that means processed. And so what we’re looking for is on that ingredient list, we’re looking for 100% whole grain or whole wheat. And then you can also look on the nutrition facts label where they list fiber. But I always start with the ingredient list because nutrition, they can throw fiber on top of enriched wheat flour and then the nutrition facts label will show fiber, but it’s not 100% whole grain. And we are going for 100% whole grain because we want all the parts of the grain. That’s what we want to eat. Whether it’s wheat or some kind of mixture of different grains is fine.

(46:30):

Sourdough. I love sourdough bread. OK. I grew up in the Bay Area in California, so I’m a little bit snobby about my San Francisco sourdough, but now there’s southern sourdough too. So I eat a little of both. It is really hard to find a whole grain sourdough bread. I have found it here and there, like Trader Joe’s sometimes. So I do consider it a white bread, but that doesn’t mean I don’t eat it. It’s just finding that balance. Sometimes we want the fancy artisan bread and sometimes we just want plain old whole wheat bread.

(47:05):

I would say we want whole grain whenever possible, and then sometimes we want special bread.

Lynn Folkman (47:13):

Thank you.

I know you already talked about the non-alcoholic versions that are out there, but question is, because a lot of them are full of sugar too. So what’s your recommendation? Just look at the label. If you’re going to do that, that’s great? Any tips there?

Julie Lanford, MPH, RD, CSO, LDN (47:28):

Yeah. At some point it’s just a sugar-sweetened beverage. If it’s made with sugar and it’s not made with alcohol, it’s just a soda. So yes, they’re correct, just like the energy drinks. The energy drinks are just kind of another version of high caffeine soda.

(47:54):

If you choose the diet versions, they don’t have sugar in them. They have artificial sweeteners, which have been proven safe for the food supply, so you don’t have to avoid them, but you just have to find out if you’re comfortable consuming them. Again, those are things that I feel like they’re fine to have on occasion. I wouldn’t make it my habit to have them every day.

(48:18):

So it sort of depends. How often is somebody having a, whatever, sugary mocktail? Is it once a week? No big deal. If it’s every night, eh, I wouldn’t make a habit out of that.

(48:29):

But things like non-alcoholic beers, generally, they’re 40 calories. They’re not going to have a lot of added sugar. So yes, you do need to watch that piece.

(48:42):

The other challenge with alcoholic beverages, they don’t have to label them. They have to tell you it has alcohol in it, but it doesn’t tell you how many calories is in wine. And so the non-alcoholics, I think they actually are a little bit more like real food where there’s an ingredient list and nutrition facts that you can’t get on the alcoholic beverages.

Lynn Folkman (49:07):

So I know this is a big topic with weight gain. For some people, you touched on sometimes it’s weight loss, sometimes it’s weight gain. But GLP-1s are becoming more accessible for weight loss. And how do you approach that with your clients if that is something that someone wants to do?

Julie Lanford, MPH, RD, CSO, LDN (49:26):

There’s a lot of push around the idea that if you gain weight, that means you have worse health. And I think sometimes we have to tease those apart a little bit. Sometimes having a larger body does not mean worse health. It just means that you have a larger body. And for a lot of women, our bodies do get larger as we age. And that’s OK as long as you’re working with your medical team, you’re monitoring your outcomes, you’re looking at all the different factors related to health.

(50:05):

If your medical team is like, “Hey, we think your weight might be a little higher than is healthy for you.” Then you want to have this conversation about what is it that we want to do about that.

(50:19):

When we look at the data around GLP-1s, generally you might get 5%, 6% weight loss, which is good. We’ve seen good data out of people who lose not super-significant amounts of weight, but some weight. That’s similar to what you would get with other healthy lifestyle behaviors. And the best results that you get if you’re on a GLP-1 is that you combine it with healthy lifestyle behaviors. So that’s the one thing is that I see it as a potential tool, but I don’t love that you’re still going to need to make some healthy changes.

(51:00):

OK. So let’s say you’ve done healthy changes already and you really kind of feel like my things just don’t look good, my diabetes isn’t well managed or my cholesterol’s high.

(51:12):

The risks of taking GLP-1 that most concern me are that there seem to be muscle loss with people who take it, which I think is significant. I mean, we’re constantly trying to get women to build muscle, especially because as you age, your muscle mass goes down, your metabolism goes down, you need your muscle to keep your metabolism up. And you want to keep your muscle because from a functional status, aging and losing muscle are not good combinations. So from a functional standpoint, I want you to keep or build muscle.

(51:47):

Those are things that are discussion points that need to be had if you’re considering GLP-1s. First of all, is my weight unhealthy? I might be a larger size, but can I still be a larger size than healthy? I think there’s something to be said for that. If you exercise, you eat well, you can be in a larger body if that’s your type.

(52:07):

Also, if you’re going to consider a medication, what are you going to do to make sure that you don’t lose muscle and that you’re still nourished? Because they will also affect your appetite. It’s how they work. So if you have poor appetite already, probably not a good idea to have it. If you have any diarrhea or constipation, they can affect that.

(52:29):

And then also, what’s the long term? Are we going to take this long term because the data shows when you go off of them, you gain that back typically. And what we don’t want is up and downs. You’re better off staying at one stable level and eating nutritiously and being active than you are going down and up and down and up because we actually see that the number one cause of weight gain is people following yo-yo dieting.

(52:58):

So we want it to be a long-term strategy, and that’s something that you have this conversation with your doctor, you ask them for a double appointment. “Let me have an extra 15 minutes this time because I really want to talk through this.”

Lynn Folkman (53:09):

Well, I wish we had way more time because we weren’t able to get through so many of the questions. But thank you so much, Julie, for joining us today. It was a great discussion, so much helpful information.

(53:25):

Was there anything that you want to close with? I have a couple comments, but I just wanted to send it back to you.

Julie Lanford, MPH, RD, CSO, LDN (53:32):

Well, I do want to say that for everybody who’s on, you are doing a great job. You’re getting the information that you need and that I do love the idea of lowering your anxiety around food. And you can’t do it wrong. That’s what I’ll tell you is that I think there’s lots of ways to do it right and that you can figure that out. And you’re doing an awesome job just by being here and getting information.

Lynn Folkman (53:58):

Thank you, Julie. Two things that stood out to me: Always make sure to talk to your doctor. That was one, if there’s questions that come up. And I liked what you said, ignore the marketing claims. Eating has become really confusing, and I love the way you split it up in the myths, the myth busting, and then what you can do. So thank you.