Cutting through the noise and cost of healthy eating

Transcript

Aubrey Redd, MS, RDN, LDN, FAND (00:00:09):

I’m really excited to dive in and get started. So as you heard, my name is Aubrey Redd and I am a registered dietitian nutritionist, owner of Aubrey Redd Nutrition, and also former registered dietitian of Unite for HER. So I know many of us in the room are very familiar with Unite for HER, which I’ll bring up as we get through.

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Today, I’m very excited to present to you Cutting through the noise and cost of healthy eating. And so what I mean by the noise, the noise is all of the information that we are getting from so many different sources every single day. And the cost, I think that one’s pretty self-explanatory, but our rising food costs and how we can combat that and make healthy eating affordable.

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I want to first talk about why nutrition information is confusing. And so I want everybody to take a look at the screen and raise your hand if you have heard at least one of these things. Go keto, don’t eat soy, cut out sugar, buy organic only, eliminate dairy, detox. OK. So I saw most of the hands go up. Raise your hand if you’ve heard 2 or 3 of the things on the list. Raise your hand if you’ve heard all of the things on the list. And still most people had their hands up.

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I think the key here is that it’s hard to know what nutrition information you should believe. And I think that so much information comes from very well-meaning sources. By no means am I here to discredit any type of source. However, we want to learn how we can have a critical lens when it comes to deciphering nutrition information and understanding what is applicable to us because what is important to someone or what is valuable or what is researched for someone may not be researched for everyone. And so we want to be really mindful about understanding what applies to us.

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The best nutrition advice is going to be based in research, and it is not going to be based in fear. If there’s one thing I want everybody to take away today, it is absolutely that.

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Nutrition information is so confusing, I think solely because of the volume that we get each and every day. Every day, every week. And just to give a few examples, maybe a friend of yours says, “Oh, I read this article. They were talking about breast cancer. You should try this.” Or a family member comes to you and said, “I started this diet. It’s been really working for me. Maybe you should try it too.” Maybe your medical provider says something in passing about some lab work and some adjustments you should make. Or you read something on social media, how an influencer tried something in particular.

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Maybe it’s a news headline and they’re talking about a brand new study saying you need to eat this for the most optimal health. Influencers telling you that a supplement they bought cured everything. Advertisements trying to sell us something to say that we need this in our lives. Books giving us research information, but also anecdotes. And then that 2 a.m. Google search. So we have that deep dive and now we have AI where we’re getting more information as well too.

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These are so many avenues for receiving nutrition information. And so we want to be sure that we’re finding credible, valuable resources. And I think it can be really hard to decipher what that is when everything feels very timely and very pressing. Nobody wants to make a mistake when it comes to nutrition. Nobody wants to do something that’s potentially harmful. And I think if there’s one key here I can say is that it so much more matters the wider scope of everything you’re doing than one specific thing in particular. And we’ll dive into that in a little bit more detail.

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So we’re going to talk about some red flags and green flags when it comes to nutrition information. And if you haven’t heard the term before, red flags or green flags, red flags just means where we want to stop and we want to pause. Maybe it’s something that’s not necessarily as credible. And a green flag, green means go if we’re thinking about a stoplight.

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When it comes to the red flags of nutrition, and really I would say just any health information as it is, my first point of skepticism is when something refers to a food, anything as a cure or a miracle. Those are two really powerful words, and I think anybody in the research community would say most research articles don’t typically use those words. They’re using words like risk, they’re using words like associations and connections or improvements, but they’re not using cure, miracle, breakthrough.

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I think those words can be used to elicit a specific response. It feels very powerful when something is a miracle and we want to believe. And I understand that, but I think that’s a point where we can be skeptical. If we see that, we can say, “Well, let me get a little bit more detail,” and we’ll talk about on the next slide how we can do that.

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One food being blamed for everything. I feel like I see this all the time. Has anybody in here heard that? One food being blamed for everything? I’m getting a couple nods and a couple hands. Really what we know is that it matters so much more about the variety and the larger scale of everything that you are doing in your day and your week and your life than one particular food as a whole. I always used to say, and I still say now that there is no one food that causes just as there is no one food that cures, kind of goes with the point above it. So we want to look at the bigger scope of everything we’re doing and be critical of any time we see one specific food being blamed for something.

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Extreme restriction. I think, as you’re navigating a cancer diagnosis, your body needs more nourishment. Right? It doesn’t need less nourishment. I think there are very few clinical scenarios, there are some, but there are very few clinical scenarios where extreme restriction or restriction as a whole is really truly warranted and necessary. And so what we want to do is we want to add nutrition. We want to add abundance. We don’t want to take away nutrition because then we’re depriving ourselves of very valuable nutrients that are going to ultimately support our overall health and get us closer to our goals.

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A personal story being presented as proof. I am not anti a personal story or an anecdote because I think those are really helpful to understand something in context. And I also think I’m so happy for those people, if something worked for them and that was what really helped them through a particular diagnosis or a particular treatment. But one person’s story is not everyone’s story. What they’re eating every single day is going to be different from what you’re eating every single day and how you’re moving and how your stress is and how your sleep is and your lifestyle. There are so many other factors that we have to think of that one person’s story cannot be indicative of everyone.

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If a product is being sold, I always like to say that then you are kind of the one being sold. And what I mean by that at the end of the day is that if somebody is trying to sell you something for your health, they are ultimately gaining something from that and they cannot truly be neutral. Even if they wholeheartedly believe, understand, take, utilize the supplement, what have you, they still cannot be fully neutral if they are accepting some sort of financial compensation. And even if that’s an affiliation, perhaps let’s say “Use my code to get this much off of a supplement,” they’re getting that percentage from the supplement company. Now, if your doctor says, “I think you need to take more vitamin D, there’s a brand that I typically recommend to people because it’s cheap and it’s at the grocery store,” that’s a different story.

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And last but not least is one study saying that the science proves. So I was practicing last night and I was trying to remember the details. I looked them up this morning. I don’t know if anybody remembers a few months ago, I will not call out the specific podcast, but there was a podcast in which they were talking about how mixing bananas and blueberries in a smoothie together was detrimental. Did anybody see that? I’m seeing a couple like whispers. The summary here was that somebody was saying that there was a new study published that if you put bananas in your blueberry smoothie, the polyphenol oxidase in the bananas cut out the benefits of the blueberries. Well, if you look at the study, the study had less than 10 people in it and they actually didn’t even put bananas and blueberries in the same smoothie. So I always think it’s important to think about the context. You can be your own detective when it comes to the research. And I know research studies can be hard to read, but looking at the summary or the results can be helpful to get more information there.

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An important statistic to live in the back of your head is that 1 in 3 — one-third of articles or social media or blog posts that you see are going to contain misinformation.

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And this is not just nutrition specific, this is all information specific. And so I think we need to be really critical about the information we’re consuming and not let it bring harm to us mentally with our stress, our emotions, and try to kind of be that navigator.

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Now the green flags, these are things that we want to pause and check to get a green flag, to get a stamp of approval. So it’s the W’s of figuring out your green flag nutrition information. So first is who. Who wrote it? I am by no means saying that credentials are necessary, but if it’s done by a doctor, a registered dietitian, or maybe a researcher, those are going to probably be a bit more credible than maybe somebody’s personal blog, for example.

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Where is the information coming from? So is it coming from a nonprofit? Is it coming from a government agency? Is it coming from a cancer center? Or is it coming from an influencer? Is it coming from social media? Is it coming from a blog post?

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When? Nutrition information is always changing. We’re always learning more. I like to use the example in this of soy and breast cancer. Maybe this question will come up. However, there has been historical, very long time ago, research on soy and breast cancer that led us to believe soy was connected to breast cancer negatively. However, there’s a lot more new research that shows us actually the opposite, that it can be protective of cancer risk even in hormonally positive cancers. It can actually be protective of recurrence.

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That’s why it’s really important to think about the timeline. If this research article you’re looking at, it was written by a doctor published by a healthcare company, but it was written 50 years ago and it hasn’t been updated since then, I would probably look for something a little bit more recent. Usually I try to note research that’s been in the past 10 years or so. Even 10 years can be a long time. So the newer the research, the more updated it’s going to be.

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What was the evidence? So that story that I just told you about bananas and blueberries, I think that is a perfect example of what truly was the evidence. Again, we’re typically not noting cause and effect directly in nutrition research because it is so nuanced, every person. It’s not like a medical study where you can give someone a pill and someone a placebo. Everyone is going to have different lifestyles, different experiences, different food preferences, different cultures, different genetics. And so when we’re talking about nutrition research, we’re talking about risks and associations. We’re not necessarily talking about cause and effect. So I always pause if something directly states a cause versus an association, and you want to be critical about what really was that evidence at the end of the day.

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Last but not least is why. Why are they telling me this? And I think that circles back to the selling something and neutrality. Are they telling this to me generally just to give me information? Think about your cancer center. Think about Unite For HER, think about a nonprofit. You’re getting that information just to look at them as a safe space for information, whereas maybe another scenario, someone is ultimately trying to sell something to you at the end of the day. So think about why are they trying to tell me this information? Now, if this is passing all of the check boxes on your green flag checklist, you can say without a doubt that this information is most likely reputable.

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So I’ll give everyone a second and I’ll kind of keep going, but I would say this is a great screen to take a screenshot of, like take a quick picture of. So the next time that you find yourself in a scenario where you see a headline that says avocados cure colorectal cancer, you might say, “OK, Aubrey told me to be a little bit more critical. Who wrote this study? Why are they telling me this? What was the evidence?” And you’ll be able to look at it with a little bit more of a clear lens.

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Registered dietitian nutritionists, RDNs, you might hear registered dietitian as well too. They are going to be your qualified nutrition experts. Many other people know about nutrition. I am by no means saying that other people don’t, doctors, certified nutrition specialists, et cetera. But what I want to highlight here is that the term just nutritionist is not a protected term. Everybody in this room today could leave with this information or no information and say, “I’m a nutritionist.” Registered dietitian is a protected term. You have to do a 4-year bachelor’s degree, a master’s degree, 1,200 hours of supervised practice, take a board exam, and do 75 hours of continuing education every 5 years.

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That is really important in context of where you’re getting your nutrition information from. So I always tell people when somebody says they’re a nutritionist and they’re giving you information to just be mindful of that fact. It could be very factual and reputable information that they’re providing you, but just keep that in the back of your head. Who am I talking to? What information am I getting from them?

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Let’s talk a little bit about the nutrition research, and we’ll move more into the noise moves into the cost side of the presentation. The World Cancer Research Fund and the American Institute for Cancer Research have ongoing research in which they’re reviewing all of the studies put out about lifestyle factors and cancer after diagnosis. Their most recent report pulled 432 studies on lifestyle and cancer. And so this is not nutrition specific. It also could be movement. It also could be smoking cessation. It could be a lot of things. But I think if there is a take-home for today, it’s that the consensus is that no single food can protect you for cancer by itself.

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It’s about the bigger picture. I know I’ve already said that, but that’s one thing to just keep and hold dear. Because I think while it can sometimes feel overwhelming thinking about I have to have this, “I have to do that, I can’t do this, I can’t do that.” I think having that information of no single food can be really freeing because it helps so that in the context of your life, you can put in practice these nutrition tendencies in a way that makes sense to you.

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Think about your family. Maybe you have little children at home, so the way you have to eat looks different from somebody who doesn’t, or maybe treatment you’re going through changes your appetite so you have to eat a bit differently. Or maybe you have tons and tons of time and so you want to really double down on the way you’re cooking and what you’re preparing. Or maybe cultural foods are dictating what you’re eating.

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Just understanding that, again, it is so much more about the overall diet pattern than one single superfood or one specific diet plan because everybody is different. And this isn’t to say that there aren’t foods that are really healthful because there are so many foods that are really healthful, but just having blueberries every single day isn’t going to be the make or break. But maybe having blueberries and many other nutrient dense foods will make a massive impact.

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So I want to flip the script here and I want to talk about how I want you to start approaching your own nutrition with a little bit more nuance and a little bit more openness, I would like to say, because I think that in this space, nutrition can feel really confining, it can feel scary, it can feel restrictive. And so these are some questions that, I quite often get asked.

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What food should I avoid? I think I get asked that once a day at the minimum. And I think the thought is what can I get rid of so that I can be or feel safer. We’re thinking about safety and health, but I think based on the fact that we’re talking about overall diet patterns improving our outcomes, we want to ask: How can I nourish my body consistently? What can I add to support my health?

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I think most people know generally the kind of things we should be eating for our health. But how can we optimize it? How can I nourish myself the best without restriction? Instead of asking, “What supplements should I buy?” And I’m not anti-supplement, but ask yourself: How can I support my health every day? What nutrients am I lacking? When I got my lab work, maybe my iron was a little bit low. So what are some iron-rich foods that I can choose every day? Or I know that antioxidants are really supportive of cellular health, so what are some antioxidant-rich foods that I can consume every single day?

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And then instead of asking what’s the perfect cancer diet, ask: What eating habits fit my lifestyle and my budget? I think that that’s so important because I think sometimes the cancer diet that I think can be marketed is something that is very expensive and it can be very granular and specific and everybody’s body has different needs. Everybody’s going to have different desires in terms of their preferences, cultural foods, et cetera. So we really want to be mindful of how I can put this nutrition information into play for myself in a way that makes sense for me, my family, et cetera.

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So this is, it’s called the Harvard Healthy Eating Plate. It’s by the T.H. Chan School of Public Health at Harvard. And I love this graphic because I think it’s just helpful to get a bigger picture on how we can add some balance of these nutrient dense foods that we really want to consume into our day. And the big picture here is that a balanced plate does not need to be an expensive plate. And I’ll say “does not need to be,” because I think at the end of the day, it can be if you want it to be. If let’s say organic produce is your preference or pasture-raised eggs are your preference, and those things are a little bit more expensive, then absolutely. If it makes sense within your budget and your lifestyle and your preferences, make those changes. But you also don’t have to for the best health outcomes.

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This plate is just a visual representation. We’ll talk about most of these groups with just a little bit more detail and I can tell you some of the best practices and strategies when it comes to the cost side of the things that we’re cutting.

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First I want to talk about fruits and veggies. I think this is what everybody thinks of first when you hear plant foods. A lot of times in the oncology space, I’m talking about eating more plants. It doesn’t need to be vegan or vegetarian. We just need more plant foods. However, with that in mind, fruits and veggies, as you saw on the last slide, we wanted to take up about half of our plate for every single meal. This may not be achievable today, tomorrow, a month from now, but it’s about making that portion ever so slightly bigger whenever you’re grabbing your food.

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Whether you choose your produce frozen, fresh, canned, they are still nutritious. And so that could be something that’s so important in terms of budget. Fresh produce can sometimes be quite expensive or maybe it’s not in season, what you’re looking for, so it’s a higher price. A watermelon in the winter is going to cost much more than a watermelon in the summer, but frozen cubes of watermelon might cost the same winter, spring, summer, fall. Frozen produce is frozen at the peak of freshness, and so it contains just as many nutrients as fresh produce. When it comes to canned, for vegetables, I always just say try to get low- or no-sodium options where you can. When you can’t, give it a good rinse, it doesn’t get all the sodium off, but it gets a little bit off of it. And when it comes to fruits, getting fruits that are canned in water or 100% fruit juice instead of canned in syrup. And they’re all going to be nutrient-dense options.

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Some budget tips to make your life a little bit easier. Consider opting for seasonal produce, and look at your local farmers markets. A lot of farmers markets accept things like SNAP benefits, and they oftentimes will have a little bit of a lower price tag than the grocery store on seasonal produce. So this can be a fun challenge even for yourself to get in the kitchen more, explore new recipes. So for example, right now apples, winter squash, greens are all in season, and so they’re going to be a little bit more cost conducive than some of our summer squash and things like that that we see a bit more often in the warmer months.

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Pick frozen and canned to reduce waste, but also again, reduce that cost. I know that I’m probably not the only one in here who has bought a bag of spinach thinking that they were going to eat the whole bag of spinach only to find the really stinky spinach in the back of my crisper drawer 2 weeks later. And then it goes to waste because we’re not eating it. So in that regard, buying maybe frozen spinach would be a much more thoughtful way to purchase it if you know that you only put a little bit in your smoothie every single day. Then you don’t have to worry about working through all of that spinach fast enough before it expires.

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Same with canned, this could last for years. And then if you’re in a pinch and maybe you don’t have a vegetable for dinner, you have some canned options in the pantry.

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Store brands always are going to save you money. So look for the store brands of anything. Typically with fruits or vegetables, you can get some of the store brands when you’re getting larger bulk items. So you might be able to get, let’s say, a fancy hybrid of an apple that has a brand name, but you also might be able to get a store brand of gala apples, and that will have typically a little bit of a lower price tag. Same for canned, same for frozen.

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And then choosing conventional versus organic, which I think this question comes up a lot in context. And really there is not research showing us that organic produce is more nutrient dense than conventional produce. I think the key here is washing your produce. I’m sure we all are maybe a little bit more diligent about that after this summer and some of the foodborne illnesses that have been coming around. However, what the research shows us is that the volume of fruits and vegetables we eat is much more important than if we choose organic over conventional.

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So give it a wash, get what makes sense to you. If you go to the grocery store and you love blueberries and the conventional blueberries do not look good ever, and they’re always moldy, but the organic ones are ripe and beautiful and plump, of course, make that shift where it makes sense, but don’t make the organic price tag or buying only organic be what changes you actually getting that fruit or vegetable or not.

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Protein, worth prioritizing. I think protein’s having a moment. I like to say that there’s villains of the month when it comes to food, but there’s also heroes of the month. And so protein I think is a hero of the month here.

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When it comes to protein, that’s about a quarter of your plate. Protein is important for a lot of different reasons, right? It’s important for healing and recovery after things like surgery. It helps us preserve our lean muscle mass, especially if we’re not as active as we historically have been. It keeps up our strength, so we want to make sure that we are strong enough for our daily activities. It gives us energy. So protein digests a little bit slower than carbohydrates, and so it’s going to help with sustained energy throughout the day. And then it also can support immune function. So a lot of our immune cells are born in our gut and protein can be supportive of that because those amino acids helps to build your immune cells.

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Some affordable options when it comes protein. Eggs, beans, whether it’s dried or canned, same with lentils, dried or canned. Peas I feel like are kind of having a moment right now. Peas, good source of protein too. Greek yogurt, tofu, chicken, and this could be even getting a little bit of a cheaper cut of chicken. Maybe you do get boneless, skinless chicken thighs instead of breasts because it’s a little bit cheaper. Cottage cheese and canned fish, like canned salmon and tuna. These can all be much cheaper than I think some of the higher cost meats that we see in the grocery store, like beef and pork and fresh fish. So getting some of these options or frozen proteins can be a really easy way to adapt your protein and also stretch it a bit too.

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A good example is let’s say you’re making some tacos and you want to use ground chicken for your tacos. You also could get some lentils or some beans, mix those in with the mix. Now you’ve added protein and fiber and now instead of two meals, you have 3 or 4 meals. So definitely consider those options when you’re thinking about how to prioritize protein.

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Last are going to be our whole grains. So whole grains provide us with a number of different key nutrients. They’re going to give us fiber, which I think is also having a little bit of a heroic moment currently. Fiber is really important for our gut health. And what we learn more about every single day and as more research progresses is that our gut health is just so important to so many other body systems. Our immunity, our hormones, our mental health. They’re going to be rich in vitamins and minerals, particularly things like B vitamins and minerals like iron, for example. They’re going to have plant sterols, which are compounds that have been shown to actually lower your body’s cholesterol. So if you have high cholesterol, having whole grains will help with that.

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And then they’ll give you steady energy. Just like our protein, fiber-rich carbohydrates digest much slower than refined carbohydrates. So they give us much longer-lasting energy.

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Some affordable options in terms of our whole grains: oats, brown rice versus white rice, barley, getting wheat pasta or wheat bread instead of white. Popcorn is a whole grain. Bulgur, quinoa, farro. And I think it’s about picking the ones that you like and picking the ones that make sense for you. I talk to people all the time that are like, “Aubrey, I just don’t like quinoa.” OK. Don’t eat quinoa. We can pick something else. We could pick farro, we could pick brown rice.

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A tip here when you’re thinking about the wheat options is look at the nutrition facts label and the ingredients. You want to see the word “whole” in that ingredient. Something that’s listed as like a wheat or a multi-grain product may not have as much fiber as a whole wheat product in which they’re using the whole wheat bran and you’re getting all of that delicious fiber. So just like we’re going to be a sleuth with our nutrition information, we also might sleuth a little bit with our nutrition facts labels.

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Some tips across the board for saving money without sacrificing nutrition, because I think something I hear all the time is that healthy eating is expensive. And I think I would change that narrative to say healthy eating can be expensive. I think less than optimal, I don’t like to use the word unhealthy, less than optimal eating can also be expensive. I think both sides of the coin can have cost prohibitive and cost inducive sides to them.

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Meal planning before shopping can make a massive difference. So bringing a list that you know of all of the things you need. For some, that looks like ordering your groceries online. So maybe you don’t go off the script when you’re at the grocery store. This will help so you can prevent waste. I know similarly to the spinach, there have been times before where I’ve bought, let’s say a big bag of potatoes. I only needed 2 or 3. The rest of the potatoes never ever see the light of day and get used. So if you’re meal planning, you know what you need and you can use the remnants of everything else.

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Compare the unit prices. So the bigger bulk option is not always the most affordable, but it may have a better unit price. And so what I mean by that is you usually see the label which says $5 for the bag. You can see that at the grocery store. And then in teeny tiny print, you have to get out your magnifying glass practically, it will tell you the unit price and it will say something like 10 cents per ounce. Now you can look at every other product in that area, let’s say canned beans, and it’ll say 12 cents per ounce, 30 cents per ounce, 50 cents per ounce. So the cheapest option, maybe there’s a can that’s a dollar, it might be the smallest can and costs the most per ounce. So making those types of decision can be helpful to save money in the long run too.

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We kind of already said this, but buying store brand or generic instead of getting name brand is a really great way to save a little bit of money.

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Choosing frozen produce over fresh produce and stocking up on pantry staples. Those things that don’t go bad, well, they don’t go bad for a while, I guess I should say. Canned goods, grains, beans, et cetera, they can last for quite a long time and they can be easy additions into any menu item.

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Using leftovers, we don’t want our leftovers to go to waste. So I always like to say cook once, eat twice. Maybe some people in here, your mom has said that before or somebody has said that to you as well too. But I always love the idea of cooking a little bit extra for what you need in the moment and then freeze 1 or 2 portions as what I call a hero meal. A day that you don’t feel great and you don’t want to cook and you’re thinking, “I’m just going to go out and get takeout. Oh wait, I have my hero meal in the freezer.”

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Buy bulk proteins on sale. I love Costco. I love getting my bulk proteins at Costco where I can see the unit price and I can see that perhaps getting 12 chicken breasts is going to ultimately cost me less than buying two chicken breasts per week for 6 weeks. So if that is something that is cost effective for you and it is able to be purchased in the moment, I would always recommend getting some larger bulk proteins and then freezing the extras. And then skip expensive superfoods. There’s going to be flashy labels on so many different foods and most of them are not verified with any type of stringent backing. So if something says healthy, there’s no necessarily law that says healthy means X, Y, Z. The company just wants to make it look really good. And maybe it’s a really healthy food, but I think be critical of all those flashy labels because that’s what draws our eye in. And then typically those labels come with a bit of an elevated price tag.

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Last thing is I just wanted to highlight a couple grocery saving apps. If you’re a tech and phone user, Flipp is an app in which you can compare weekly circulars. So instead of driving from store to store to store and picking up the circular or going through the newspaper and trying to figure out where to get this, where to get that, you can put it all into one place. And then if you’re somebody who shops at multiple places, you can have all those lists ready for when you go to the store.

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Flashfood, this is good for marked down, ready-to-expire items. So I see this a lot with produce, proteins that are going to maybe go past their sell by date in a day or 2. Grocery stores will list them and you can pick them up. And maybe the apples don’t look phenomenal, but if you’re using them in a baked item, it doesn’t necessarily matter if they look like the prettiest apples in the bunch.

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And then Too Good to Go is really good for affordable meals. So what they do, it’s restaurants and grocery stores alike. They will list mystery bags that you can pick up at the end of the day of unsold goods. So this is great in a pinch. If you’re looking for a dinner, you could go on and see that your local Honeygrow has a $2 mystery bag. Now you don’t know what you’re getting, but it’s a nice affordable way to eat out and get a little bit of surprise as well too.

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My key takeaways before we get into our Q&A is focus on the pattern, not being perfect or not the perfect food. Again, from our slide before, there is no one food. There are lots of foods that are healthful and protective, but there is no one food alone.

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Be really curious about nutrition claims. Be a sleuth. Be cynical about everything you see because 1 in 3 pieces of information is misinformation.

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Prioritize nourishment instead of thinking about what you have to avoid and what you have to stop doing and think about what you can start doing.

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Healthy eating does not have to be expensive. Again, I think it can be, but I think it also doesn’t have to be.

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And then last, give yourself grace and flexibility. You want to not feel overwhelmed and like nutrition is something adding stress to your life because stress is no better for our health either. You don’t have to eat perfectly and especially not every single day. You just need nutrition information you can trust and you need to understand that in context of your life, your culture, your preferences, your budget.

(00:40:49):

Some places you can find verified information so you don’t have to look it up afterwards. The American Institute for Cancer Research and the National Cancer Institute are two good places for information on cancer as a whole, but they also post nutrition information. And then registered dietitian support. Unite For HER has three wonderful dietitians on staff. Your hospital or cancer center likely also has a dietitian. They might be a CSO, which is a certified oncology-specific dietitian who goes through even more rigorous training. And the Academy of Nutrition and Dietetics, which is the governing board of registered dietitians. They have a website called Find a Nutrition Expert. You can put in your zip code. If you want to use insurance, you can put in your insurance and it will show you all of the people in your area that you can connect with.

Lynn Folkman (00:41:42):

So I’m going to start with, you had touched on this too as far as food safety right now with what’s been going on this summer. So the question came in: With the FDA lowering safety requirements, how do you suggest we stock our fridges with safe foods, farm shares, frozen foods or some other foods, greenhouse grown? Any thoughts on that?

Aubrey Redd, MS, RDN, LDN, FAND (00:42:04):

Yeah. So I think a good first path, if it’s accessible to you, is trying to shop locally wherever you can. So going to your local farmer’s market, a co-op, a CSA, community supported agriculture, because these smaller farms typically are not having the same outbreak scenarios that these larger scale farming industries are having. I think also prioritizing giving any produce you get a good wash. And so what that means is if it’s something firm, like an apple, you can really give it a good wash under cold water and scrub for about 30 seconds. That gets a lot of the bacteria off of it. If it’s something softer like berries or leafy greens, you can soak them in a bit of warm water with some baking soda or some vinegar. That will help to dislodge any of the dirt and the bacteria. And then in both of those scenarios, giving it another final rinse at the end.

(00:43:07):

Whether you get it from the farmer’s market or the grocery store, I always think that is a good path forward, and it’s easier when you’re getting whole items versus prechopped, preminced, diced. Although they can be prewashed, I think sometimes you have that peace of mind when you can do it again yourself.

Lynn Folkman (00:43:28):

And just to add, when you say soak, how long do you soak it?

Aubrey Redd, MS, RDN, LDN, FAND (00:43:32):

I would say for about a minute.

Lynn Folkman (00:43:35):

Great. Thanks. Kendra?

Kendra Ajuba, MS (00:43:39):

OK. Thank you for everything so far. I’m going to start here with one that’s specifically… Oops, sorry. If my CDK 4/6 causes diarrhea, how should I include fiber? More or only soluble fiber?

Aubrey Redd, MS, RDN, LDN, FAND (00:43:56):

That’s a really great question. And I think when it comes to treatment and diarrhea as a whole, I do think that that is something that can be so specific to each person, their tolerance of fiber. So a lot of times the way I phrase it is that whenever you are, let’s say, getting active treatment, let’s say maybe there is a time where you have a lot more of flares versus fewer flares of your diarrhea, that’s when we’re being much more simple with our diet. We’re eating lower fiber, we’re focusing on things like soluble fiber like oats, bananas, et cetera. And then if your diarrhea symptoms start to improve, very gradually and slowly adding in other sources of fiber, so adding in more insoluble fibers and just more variety. And you can almost eat in waves.

(00:44:48):

Typically we know, let’s say we’re getting treatment every 3 weeks. Typically, we know when we’re going to feel great, when we’re not going to feel great, maybe we don’t feel great for all of the 3 weeks, and I think it’s about adapting and understanding what your body can tolerate.

(00:45:04):

In that respect, I would say during the worst of your flares, focusing on lower fiber and soluble fiber only, and then gradually increasing the fiber because going from zero to 100 with fiber, even if you don’t have diarrhea, is not going to be ideal for your digestive system. Your body isn’t primed to digest all of that fiber, so you’re going to have a lot of gas, a lot of bloating. You might go the other way in the constipation realm. So I would say that as well as just generally not part of the question, but staying well hydrated is equally important.

Yvonne McLean Florence (00:45:43):

The next question is, what are good ways to hide veggies and meals and snacks if you don’t like them and/or your kids are picky eaters?

Aubrey Redd, MS, RDN, LDN, FAND (00:45:55):

It’s tough. Sometimes people I think will say, “My kids are picky eaters.” I’m like, “I think you might just be a picky eater.” And that’s OK. I think first and foremost is starting with what you like. I think most people can say there’s at least one vegetable that they like. Maybe it’s broccoli, maybe it’s carrots, and just start integrating that regularly. Now, when it comes to adding extra vegetables when you don’t really love them, I would say prioritizing getting them into mixed dishes where maybe you won’t notice it as much. So for example, like a soup, really easy way to add some extra vegetables, and typically they’re cooked very thoroughly, maybe they’re very small, in a mince, and so it’s hard to even distinguish maybe the vegetables you like versus the vegetables that you don’t like from that soup. Adding something like spinach, greens, cauliflower rice to a smoothie is a really easy way to get it in.

(00:47:03):

Shredding your vegetables very finely and mixing that in can also be a simple way to get in vegetables where you don’t notice it too much. A good example is zucchini bread, for example. Zucchini bread, the zucchini adds a lot of moisture, but at least in my opinion, I don’t think it tastes a ton like zucchini. It just tastes like a muffin, like a typical muffin. So I think sneaking it in wherever you can to mixed dishes and in small forms, chopping them up very finely or shredding them or grading them are going to be some best practices for sneaking in vegetables when maybe you or your children don’t necessarily love them.

Lynn Folkman (00:47:50):

Great. Thanks. All right, let’s talk alcohol. Is there a recommendation regarding an appropriate amount of alcohol? This was specifically during immunotherapy for treatment for MBC, but then I’d like you to talk about alcohol overall too.

Aubrey Redd, MS, RDN, LDN, FAND (00:48:07):

Yeah. I think the key here is there technically is no safe volume of alcohol, and that isn’t supposed to be scary or harmful or fear inducing. It’s just the science and the information that we have. Now, does that mean that nobody can have alcohol ever? No. I think it’s very much about personal preference and personal acceptance. So the recommendation typically during any active treatment, immunotherapy or otherwise, is avoidance of alcohol as a whole.

(00:48:46):

But also, I think generally, even beyond that or through continuous treatment, we’re thinking about alcohol and considering it, what I would say is for women, usually the recommendation is less than 1 to 2 drinks per week, not built up either. So not, “I’m going to a wedding at the end of the month and I’m going to have eight, so I’m going to save my two drinks per week.” And for men, less than 2 to 3 drinks per week.

(00:49:17):

And so with that, I think we can definitely make better choices when it comes to our alcohol and opt for whether it’s beer or wine or a distilled spirit that doesn’t necessarily have a soda or something with added sugar mixed into it. It will be a slightly better variation than maybe a cocktail with a lot of extra sugars in it. But again, ultimately there is no safe volume. I think the best practice is using it in a social format. So maybe you go out to dinner once every other month with your girls and so you have a glass of wine then versus having a glass of wine every night with dinner or Friday, Saturday, Sunday, every single week. Putting it into more of a social situation I think makes it even a little bit more like a luxury and then helps to leave it in more of that as minimal as possible context.

Lynn Folkman (00:50:14):

Thank you. I love that suggestion. Kendra.

Kendra Ajuba, MS (00:50:18):

Yeah. I think you set this question up in terms of sugar. So we’ve got a couple questions about sugar. So if you could comment on sugar and cancer and then also another person had advice for sugar cravings. So if you really love sugar, I guess depending how you answer the first one, will you also talk about sugar cravings?

Aubrey Redd, MS, RDN, LDN, FAND (00:50:35):

I sure can. So sugar and cancer, hot topic, I think. And I think what I oftentimes see or what I hear from people, I suppose I would say, is sugar feeds cancer. Anybody heard that before? OK. A lot of people. So in terms of sugar feeds cancer, I like to take a step back. Sugar is the byproduct of every single carbohydrate we eat. So whether it is a cake or a sweet, fun latte, or maybe it’s quinoa, or maybe it’s beans, or maybe it’s a starchy vegetable like corn, those are all going to break down into glucose. Glucose is your brain and your red blood cell’s primary source of energy. Your body needs 120 grams of carbs every single day just to turn the light switch on.

(00:51:41):

So with that, sugar feeds all of our body’s cells, healthy, non-cancerous cells, but potentially also cancerous cells. It doesn’t discriminate. It doesn’t say, “You, I choose you. I’m giving you fuel.” That being said, what we know is that things like fiber and then our proteins, our healthy fats, they can help with the way our body utilizes some of these carbohydrates. So instead of spiking our blood sugar, it gives us more steady energy. So my recommendation is to always try to have fiber-rich carbohydrates versus refined carbohydrates or added sugars.

(00:52:31):

Now, this isn’t a blanket. You can still enjoy white rice, white pasta, et cetera. In that context, I would try to make sure you’re consuming some source of protein or healthy fat with it to curb that blood sugar spike to help your body utilize the glucose in the way that we want it to be used, for energy. That means if you want to have white rice with your dinner, maybe you also have some beans to get some fiber, maybe you also have some chicken, maybe you have some avocado to get the protein and the healthy fat. That is going to be a really elevated option.

(00:53:10):

When it comes to sugar cravings, my first assumption when someone tells me they have sugar cravings is that they’re not eating breakfast. I don’t know if somebody asked that question here and is like, “Wow, I don’t eat breakfast,” but our body has what’s called our basal metabolic rate. You maybe have heard that term before. It’s how many calories your body needs just to survive, just for your organs to function. If we skip breakfast and maybe we have a little lunch and then dinner we start to eat, we haven’t hit that basal metabolic rate yet. Maybe you need 1,800 calories per day. What ends up happening is your body is like, “Oh my goodness, I need to catch up. I haven’t had my 1800 calories yet.“ And sugars, like added sugars, for example, are the most easily digested form of energy. So a lot of times that craving is truly biological. It is your body saying, “I have not had enough energy yet today, and I know that sugar is going to give me energy the fastest.” So you start to crave sweets, you start to crave chips, you start to crave pretzels because your body knows that these things will give you the quickest form of energy.

(00:54:38):

So my first guideline would be to have breakfast if you’re not having breakfast. Eat your meal spaced throughout the day. And then I think it’s important to still enjoy the sweets that you love and maybe put them in the context of situational enjoyment. Have a slice of cake on somebody’s birthday, but maybe not necessarily a slice of cake every day. Or put it into a format in which you can still get other functional benefit from it. If you love chocolate, maybe in the evening as a nighttime snack, you have chocolate covered almonds, because the almonds are going to give you vitamin E, magnesium, healthy fats, and the chocolate will give you the food for your soul, the joy.

(00:55:21):

So I think it’s important to still incorporate the things you love. And then yes, when you have sugar cravings, the first step would be make sure you’re eating enough during the day.

Lynn Folkman (00:55:32):

Yvonne?

Yvonne McLean Florence (00:55:36):

We want to talk about caffeine and then bring it into the context of a cancer diagnosis. Thank you.

Aubrey Redd, MS, RDN, LDN, FAND (00:55:45):

When it comes to caffeine, what the research shows us, and this is across numerous studies, not necessarily just one study, but what the research shows us is that caffeine is safe within a critical limit. So typically I say less than about 400 milligrams of caffeine per day, which is about four average to small cups of coffee. For best support of health and also things like sleep and regulation of your sleep and wake hormones, I say usually less than 200 milligrams of caffeine per day.

(00:56:21):

Most of us, when we think about a cup of coffee, we’re probably thinking about a pretty big cup of coffee. So 200 milligrams and me saying it’s two cups of coffee, that would probably be most people’s average one cup of coffee.

(00:56:38):

So just keep that context in mind. When we get to higher doses, that’s when we start to potentially see some of the health risks coming through. But overall, what we know is that caffeine as a whole is safe and things like coffee, tea, matcha, these caffeine bringers, they actually have a lot of antioxidants and antioxidants that are unique to them. So I love my morning coffee and I would never take that away from someone as well either. I think the thing I’m more worried about sometimes is what are you putting in your coffee? So are you putting six sugars and sweetened creamer in your coffee? Maybe there’s a way we can sidestep that. And thinking about that in terms of how you approach your caffeine.

Lynn Folkman (00:57:28):

Someone had a question about the difference between an integrative nutritionist and a nonintegrative one. And then part two of the question is: Do you have thoughts about blood tests performed to identify foods that cause inflammation in the body and gene testing that can claim to identify impacts on cellular and cardiovascular health?

Aubrey Redd, MS, RDN, LDN, FAND (00:57:55):

I will try to remember the whole question, but I may have to circle back.

Lynn Folkman (00:57:58):

I’ll repeat it.

Aubrey Redd, MS, RDN, LDN, FAND (00:58:00):

So first question was integrative nutritionist versus not an integrative nutritionist. So a registered dietitian nutritionist can get additional training to become a certified functional and integrative nutritionist. And so that is kind of an advanced level of credential where I would say that practitioner typically is looking a little just bit deeper in terms of the medical root causes of some of your issues.

(00:58:32):

Typically with that, we’re talking more around testing, we’re talking more around specific target supplementation. That being said, that isn’t necessarily wholly necessary for everyone. And also a just run-of-the-mill registered dietitian nutritionist is also still going to have a lot of comprehensive information.

(00:58:55):

I would say seeking out a certified integrative and functional nutritionist would be maybe a next step on if you’re working with a dietitian or a healthcare practitioner and you just feel like you need a little higher level of care, maybe somebody who understands a nuance a little bit more, that’s when I would say taking that next step.

(00:59:14):

What was the next part of the question?

Lynn Folkman (00:59:16):

Sorry, I shouldn’t have bundled them. OK. Thoughts about blood tests performed to identify foods that cause inflammation in the body and gene testing that claims to identify impacts to cellular and cardiovascular health.

Aubrey Redd, MS, RDN, LDN, FAND (00:59:34):

So when it comes to blood tests, there are very specific blood tests that can help and identify allergies and intolerances, and that is something typically you would do via an allergist. You wouldn’t necessarily be doing it through your nutritionist. You could, theoretically. However, I think for the broad scope of most people, most foods are not inherently inflammatory. So I hear a lot of people talk about, I know this is slightly different, but saliva testing for allergies, intolerances, inflammation, and people will say, “Oh, all of these things that I normally eat came up in my testing.” And that’s because, at least from the saliva perspective, typically that actually just shows exposure to certain foods versus true intolerance or inflammatory response.

(01:00:36):

A blood test can take it a step further and it can show inflammatory response. But again, I think for most people, there isn’t an inflammatory response outside of some of the things that we know to be pro-inflammatory for everybody, which is alcohol, sorry, are processed meats like bacon, sausage, cured meats, deli meats, and then added sugars, not natural sugars, added sugars. Things like gluten, dairy, et cetera, I think they can be inflammatory to some, but they are certainly not inflammatory to all.

(01:01:14):

In terms of blood testing for inflammation, it’s not necessarily something I’m typically recommending to people. And usually when you get your blood work done at however frequency you’re getting it done, they do test for what’s called your C-reactive protein, your CRP, which is a blood indicator of inflammation. So your provider is likely getting a baseline on that every single time they check your blood.

(01:01:39):

When it comes to gene testing in terms of cardiovascular risk and things of that nature, I think we’re really just kind of starting to get into that space scientifically. I do know, for example, you can have a blood test to determine if you have a genetic predisposition to have high cholesterol. It’s called your lipoprotein (a). I always laugh because it is actually called “little A,” but your lipoprotein (a) will help to determine do you have more of a genetic predisposition for cardiac issues. And I think that can be helpful in context to just be more targeted with how you approach your nutrition. But at the end of the day, I think getting that information is helpful, but then can also sometimes be a bit fear inducing. It’s like, “Oh no, I have the genetic predisposition for this.” So I think trying generally to eat that well-balanced diet for overall health will kind of capture all of these things.

Lynn Folkman (01:02:38):

That’s such a great point where it’s like you get more information, and is it helpful? Or is it stressing you out more? Yvonne?

Yvonne McLean Florence (01:02:49):

Can you explain why it is important to eat during recovery and treatment and what helps you heal good cells?

Aubrey Redd, MS, RDN, LDN, FAND (01:03:00):

Yeah. It’s really important to eat during treatment because treatment takes a lot out of your body. Typically, during various stages of treatment, whether it’s chemotherapy or radiation, surgery, immunotherapy, your body actually has increased metabolic need, which means you need more calories per day. Your body is using more. So it’s really important to focus on getting adequate amounts of food or even liquid if you’re struggling with food to try to hit those calorie needs.

(01:03:38):

When it comes to nutrients that will help you heal, I think it’s definitely dependent on exactly which stage of treatment you’re in or where you’re at. However, protein across the board is going to be helpful for a wide array of different treatments. So making sure you’re getting adequate protein during the day, whether it’s from plant sources, animal sources, or both.

(01:03:59):

When it comes specifically to things like radiation, making sure you’re staying well hydrated is really important for skin and cellular health. When we’re having surgery, things like vitamin C and zinc are really important for wound healing, and they also can help with immune function. So thinking about during chemotherapy, when we may have a bit of immunosuppression, we want to emphasize those nutrients as well.

(01:04:27):

Vitamin C, I would say is in almost every single fruit and vegetable. I usually don’t discriminate. If you wanted to pick some, think of reds, oranges, yellows. They’re typically kind of some of the best, tomatoes, strawberries, red, orange, yellow bell peppers, carrots. Zinc is in most of our protein rich foods, plant or animal based. So if you’re getting enough protein, check that box, you’re also getting enough zinc too.

(01:04:50):

Those are some of the key nutrients that we’re emphasizing when we’re thinking about recovery.

Lynn Folkman (01:04:56):

Thank you. Kendra?

Kendra Ajuba, MS (01:04:58):

Yeah. Do you have any foods that you recommend for people who are having joint pain issues? That’s one of the really common side effects. What would you recommend for that? Yeah.

Aubrey Redd, MS, RDN, LDN, FAND (01:05:06):

So joint pain, this kind of almost ties back to the inflammatory blood test because joint pain typically is a symptom that presents from inflammation. So to even take a step back on inflammation, inflammation is your body’s really normal response to some sort of trigger or stimulus. Let’s say you get a cut. This is a very good visual example. You get a cut, at first you’re bleeding. Over time, your skin comes back together, you get a scab, et cetera. That’s inflammation at work in a positive way. We want that to happen. When we have continuous treatment that’s targeting all these different cells in our body, our inflammation can become a bit more chronic, and that means it can be potentially a bit harmful just to some of our body processes. So it can make blood sugar regulation a little bit more tricky. It can impact our gut health and our GI system, and it can cause joint pain.

(01:06:07):

So in that, I typically recommend eating more anti-inflammatory foods, which are pretty much all of our plant foods: fruits, vegetables, beans, lentils, nuts, seeds, whole grains, even herbs and spices, although we typically have herbs and spices in such small quantities. So I still like to add them in there. With the additional caveat of fish and seafood. Those are also going to be really rich in what’s called omega-3 fatty acids, which is extremely helpful for our inflammation. Top sources being fatty fish, nuts, and seeds. So increasing your intake of those three even can be really helpful for joint pain.

Lynn Folkman (01:06:49):

Thank you.

(01:06:53):

I’m going to see if we have time for one more question. Yvonne or Kendra, did you have one? I had one. One last question! One last question.

Yvonne McLean Florence (01:07:03):

There are a lot of good questions here, but this one is: What are the recommendations on red meat? Good

Aubrey Redd, MS, RDN, LDN, FAND (01:07:10):

Good question. Also, I know I’m so long-winded. I’m so sorry.

(01:07:16):

When it comes to red meat, the American Heart Association recommends no more than one serving of red meat per week.

(01:07:25):

I think for a lot of people that sometimes comes as a shock because sometimes I’ll say, “Oh, minimizing red meat.” And they’ll say, “Well, oh, I only eat it once a month.” When it comes to that one time a week recommendation, I usually say the fewer you can get it, the better. Once a week is kind of that critical high limit that we want to keep it under.

(01:07:46):

I like to say red meat kind of like an alcohol scenario, have it situationally. You go to a barbecue and you have a hamburger, you go out to eat and you get a steak.

(01:07:56):

If you eat red meat contextually more often in your household, the biggest thing to be mindful of is the fat content. So choosing leaner types of ground beef and pork, so things like 96 / 4 ground beef instead of 80 / 20, that’s what those numbers are if you never knew. The first number is the lean, the second number is the fat. And then choosing cuts of meat that don’t have as much visible fat on them or trying to eat around them if you’re having a steak and you see a bunch of fat on it.

(01:08:27):

Otherwise, I think trying to keep it under that one time per week or less, that’s going to be your best bet for just kind of overall health, but specifically heart health too.

Lynn Folkman (01:08:38):

Thank you. I guess I just want to close with a few things that stood out in your presentation. What you do consistently and really taking into consideration what eating habits fit into your lifestyle and budget because everyone’s different, their lives are different. So really thank you so much for really honoring that and presenting that information and distilled down. It’s such a great important presentation and discussion, so I just want to thank Aubrey. I want to thank everyone for their thoughtful questions. I wish we could have gotten to them all.