Survivorship: The Importance of Nutrition and Exercise in the Cancer Journey


Good evening. On behalf of Stanford Health Care
and the Cancer Supportive Care Program, I would like to
welcome you to our first lecture series in the South
Bay, Survivorship, the Importance of Nutrition and
Exercise in the Cancer Journey. It is my pleasure to
introduce our first speakers of the evening, Julie
Grosvenor and Regan Fedrick. Thank you. [APPLAUSE] Hi everybody, thank you. Thank you coming. I am an American College
Sports Medicine cancer exercise trainer, and so is
Reagan and we are pleased to be here
tonight to speak to you about your
plan for exercise and through survivorship. So first question that
we like to start with, if you want to just raise
your hand, how many of you are already
incorporating exercise into your weekly lifestyle? Great, great. Good. Gives us a good start. Thank you, good for you. True. Yeah, I would say
the first– the fact that you showed up
tonight is good, it means that you’re
interested in these two topics. So that’s kind of like, at least
the first step toward success, yes? And then hopefully
you’ll leave tonight with a few motivational
tips or we’ll be able to plant few seeds that
you can walk away with and then put some things into motion with
both nutrition and exercise. So to get started, we’re
going to talk a little bit about the guidelines
of cancer and exercise. They actually just came
out a few years ago. Three, are we on it? Yeah. So they just, a couple of years
ago, had a specific guideline, some guideline
protocols come out. And this was with the
Department of Human Health and Sciences or Human
Health and Science, as well as American College
of Sports Medicine, American Cancer Society, and
just a panel of experts. So oncologists were
involved, epidemiologist. They based it on hundreds
of research, or data from research that’s been
done on cancer and exercise. Strength training,
two times a week, and I’ll go into detail on
few minutes, a little bit more on the– Is it written
anywhere or do I have to keep notes do you think? Um. Because I won’t remember
a thing you’re saying. OK, we will actually
get your information– that’s a really good
question was, did we make actual printouts
of these slides. We did not, but we
can send them to you. We could do that through email. Is that okay for
me to say, Sarah? So Sarah has your email
information if you signed in, and we will follow up with
everybody with the slides. Is that OK? Thank you, that’s good question. So two times a week,
strength training. That incorporates, trying to
recruit all of the major muscle groups, and again I’ll go
into a little more detail with that topic and few minutes. Cardiovascular,
150 minutes a week. So I always like to tell people,
you take five days a week, 30 minutes and or you
go seven days a week, that’s like 21, 22 minutes
of exercise, right? I’d like to think that we
could all find 20 minutes a day or 30 minutes a day to
just move our bodies, to elevate our heart rate,
to breathe more oxygen. And then flexibility,
range of motion, every day. Just stretch a little,
just move the joints, I’ll tell people like
with the spine, you know, fold forward, extend, move
your shoulders a little bit. But try to keep
the joints fluid, try to keep mobility
in the joints. And I guess go on
to the next slide. Sure, we’re going to do that,
you can roll it, there you go. OK, thank you. Sorry, now I’ve got it. So benefits of exercise. So, so many
benefits, but we just wanted to kind of
highlight a few of them, and especially, which is
from the years of experience and what we know from
research and data, things that can
help with people who are going through
cancer treatment, and/or beyond treatment. So and over all, it improves
the quality of life. So there are short term
effects of treatment, so while you’re going to
treatment and/or beyond, but improve your
quality of life. So you’re more functional,
typically more energetic, because of just the general
benefits of stamina, and endorphins that are
released with exercise, psychological benefits
that come with that. So typically, the
positive attitude and some of the feeling in
control, the strength, the gains that you get. Reducing fatigue and stress. There’s tons of data on that. So fatigue, stress,
anxiety, helping to manage the fear that
sometimes can be associated with the diagnosis,
and treatment plan with the diagnosis. And even after you go through
the treatment, the worry. So just helping
to sort of create some calmness and stability. It helps with weight management. And we put weight
management, because it help with weight gain
and/or weight loss. We can use exercise kind
of on both fronts there. Supporting the
cardiovascular health. So cardiovascular exercise
is one thing, and then like I said, strength training. But on a regular basis,
doing cardiovascular exercise to support the heart, just
to kind of on a regular basis bring in oxygen, the capacity of
oxygen. As we train over time, and we’ll speak to
that some in a moment, the importance of progressing as
you start an exercise program. So you can start
wherever you are, but in time you want to make
sure you continue to progress and challenge yourself. Enhance sleep. There’s a lot of
data on that as well. It’s just typically known that
people have a regular exercise program sleep better, or
have better patterns of sleep with more regular hours and
such was less interruption. And increasing bone density. Strength training, especially,
weight bearing activity. One. So that means
anything where we have our body weight
in motion, that’s considered weight bearing. Also strength training programs. So using, for example,
my bicep muscle part of my arm, when I’m
using, doing this exercise, as the muscle’s contracting
and then releasing, it’s a little bit of tug that
happens in the joints that affects the bones and can help
increase bone density over time with regular exercise. Do you want to add
anything to that? I will do it in a minute. So the next thing– Components
of a good wellness programs. I love to talk to
people about this. I think, in general, when
you think about your exercise routine, it’s important to have
variation throughout the week. But the five components
I like to stress, one being strength
training, and I told you I’d come back to that. So, how many of
you are currently doing a strength training or
resistance training program? Used to do and stopped. Used to and stopped? Used to and stopped. But I’m going to start
with those pull ups and– Perfect. Good Is swimming part of
strength training? Is what? Swimming? No. Yes and no. I mean, some of
the resistance that comes from using the
pull against water, but the challenge there
is your body weight, when your body’s in water, sort
of the negative effect of not having weight in the activity. But I think it’s a
great– in general, I recommend swimming in an
overall exercise program. I think if it’s something that
you do once or twice a week, or if it’s part of your
overall routine, great. There are a lot of
benefits to swimming. So, strength training. You can use your body
weight, for example, push-ups or squats, doing those
type of things, that’s one form of strength training. At home you could
have set of dumbbells, you could use a resistance band. Just, like those cost,
I think, $8 or $10. You can find them
kind of anywhere now, I think Walgreens
sells them, Target, you can get them online. So, a resistance band, to target
all the major muscle groups. If you have a
membership to a gym, you can use equipment,
resistance training equipment. Yoga, for example, you’re using
your body weight in motion. So that’s a form of
the strength training. So, lots of different
ways to incorporate that into your regular routine. And we want to try,
basically, to target all of your major muscle groups. So make sure you’re doing things
for chest, for the shoulders, for the arms, for the back,
for the midsection, the torso, the core, your abdominal
muscles, your legs, a lot of big muscles
in the lower body. So, your quadriceps
are in front, hamstrings in back, gluteal
muscles, lower legs, calf muscles. So you want to try to,
as you’re designing that program, whether
you’re doing it on your own or you work with
someone to develop it, make sure that you’re recruiting
all of the major muscle groups in the body. So I typically
tell people to try to find a program with
10 to 15 exercises, and you want to work
those muscle groups within kind of a zone
of 10 to 20 repetitions of certain exercise. So for example, if I
were doing a chest push, I would want to do
that for at least 10, if not 15 or 20 times,
with the weight I can manage without
fatiguing myself completely. And over time, your body
will respond and adapt, and you’ll continue to
sort of push with and grow. Cardiovascular exercise, again
we said 150 minutes a week. That’s the general guideline,
the recommendation, a starting point. So you know, but you
start wherever you are. If that feels like too
much in the beginning, because of stamina, fatigue,
and/or you’re deconditioned, or you’re just
beginning a program, anything is better than not. So if it’s 10
minutes a day, great. If I walk the block
five times, great. Whatever you can do, you do. And then the hope is if
you consistently do it, you’ll get better. And it will, your
time will grow. Balance training,
so that is, I think you’re going to speak to
this a little bit more. But one of the
push there, we want to create more
stabilization in the body, and ultimately prevent
injuries, prevent falling, we hear way too often,
so-and-so fell and broke a wrist or broke a bone, or
a shoulder injury. So if you train your body
to be better balanced, it actually will get
better, will respond, and you’ll be more
reactive and more stable, just as we sort of walk through
our daily activities of life. Relaxation, well I
should say flexibility, we talked about
earlier that earlier. So stretching, range of
motion exercises, just trying to keep the body is
as mobile as we can. And then relaxation rest. So I think whatever you do,
if that means reading a book, if that means taking a nap,
taking walk on the beach, having lunch with a
friend, having a cup of tea with someone. However you do it, just
make sure you don’t lose that balance in life. You know we talk about like to
do, with exercise especially, it’s like go and do something. But I think a big part
of the whole equation is also to make
sure you have time to slow down and relax, and
just sort of restore yourself. All right, so next slide. So we kind of laid
out the framework that you be looking at for
a general composition of, I need to do exercise. But then the next question
comes, quite often for anybody, but especially if they’ve
faced any type of change in their lifestyle
or their body, whatever’s happened, how
do I get this started? And I think sometimes
your knowledge is there, you know, OK I got to do this,
or I’ve done this before. But I’m tired, I’ve just
gone through something major, how do I get this going again? Where we want to come
from, and certainly our choice in being
cancer exercise trainers, is saying sure
find somebody who’s got some knowledge
that can motivate you, but it’s also find
somebody who understands the path that you’ve been on. That doesn’t mean
you have to spend all your time of the
cancer exercise trainer, but it does mean find somebody
who is sensitive to the changes that your body has gone
through, just like you are sensitive to the changes
that your body’s gone through. And you need to have
a safe place to begin. So before we would
even get started in saying, this
day you’re walking, we’re going to want to know
where you’ve come from. So find a place and
time to get started, to acknowledge where you’ve
been, pat yourself on the back and say, I did it. Here’s my next goal, I’m going
to get started with exercise. And that’s going to be, I’m
going to step up the door and walk today like I
haven’t walked before. I’m actually going to
wander down and see what gym program there is. I’m going to pick up
the Stanford catalog and see what I can
do, or maybe I’ll make an appointment with
the cancer exercise trainer. And the program–
and we can help you layout that program, right? I mean, I kind of did
that in a fun way, but I’m actually
being quite serious. Because sometimes, it just
takes a little bit more planning to get that
foot in front of you, that motivation to
try this exercise. But over everything else,
it’s to keep you safe. OK? Do no harm is the
biggest message that we want to send at the same
time they were saying, you can do it. All right? So part of this on this
slide is saying, mix it up. As you’re looking
at your plan and we looked at the
different varieties of, it would be walking,
it would be swimming, it would be finding a
dumbbell at a Target store and buying that two pound
dumbbell and saying, OK twice a week I’m
going to try it. Because there’s going to
be a place and time where you’re going to have to
kind of schedule this. so the getting started
is making a plan. It’s going to include
simple things of saying, I want to change my health
through physical activity, I want to be strong
through physical activity, I want to sleep better. It’d be all of those
goals are going to come into deciding where
that mixing it up and trying new things is going to come in. The balance and the stability
exercises, I definitely want you to think
about, that’s part of what I need to start saying
to myself in getting started. Chemotherapy has an
effect on our balance. You probably know this
if you’re sitting there as a caregiver or a survivor,
there’s something that changes. It’s not only
going to treatment, but sometimes it’s
just the rest, it’s the inactivity
that we’ve had. Your balance will change. A simple place to
start which, as you would want to work
on your balance, would be brushing your teeth. Everybody has to brush
our teeth, right? You’ve brushed in the morning,
if you’re a good boy and girl, and you brush in the
evening, two minutes each. But the safety comes in,
you’ve got a counter. So if I can challenge myself,
I’m brushing my teeth, I can hold onto this counter,
and I can hold my left foot up. Electric toothbrush is a
lot easier, but come on, you can handle it. And you have the safety of
being able to put that foot down or hand on the counter. That’s my morning brush. My evening brush, brushing my
teeth, my right foot goes up. Again, safety. So this is kind of
the simple steps. How do I get started? We say, we’ll do a
balance activity. You’re left going, where
would that come from? Start with brushing your teeth. So it’s things like this that
we need to start thinking about, how do I mix it up? How do I challenge myself
to return to the place that I want to be
in as a survivor. It’s different. This last piece, getting
a medical clearance. So this is unusual for us
when we’re training people. It’s not usually
something that you need to have when you’re going
into an exercise program, but we’re putting it in
because the place where we would want you to make sure
you’ve talked to your doctor is if you have the situation
with say a cardiac event. Are you in combination of having
gone through chemo as well as statins? Clear it with your
doctor, talk to us. The biggest one is
really if you’re in a situation from
hematologic cancer and you need to be
more cautionary. That, we will say, make sure
that your doctor knows which are doing, come back
and tell us or show us a note that says it’s OK. Other than that, it’s
pretty much a choice that you’re making, right
then and there, to begin to take care or yourself. And most practitioners are
pretty excited that you’ve thought about it. And I would actually
recommended, in working with oncologists
that you tell them, because sometimes
they completely forget that that’s
part of the program. If we could have any impact,
not only on survivorship, it would be an impact
on the oncology world, that that becomes the
prescription pad of you’ve done it, good for
you, your strong. Now we need to work on
the muscles and the bones, because regardless of how long
or how much, any type of chemo is going to put a stress
on that bone density. That’s where that conversation
with strength training comes in again. No matter what journey you’ve
been on, but especially if it’s that long term
care of chemotherapy, you have to find a
way to get resistance exercise into your life. I can’t tell you
how much that just makes me so excited to
sit in front of somebody and they’re interested
in lifting some weights. Tends to be my wheelhouse,
but still even beyond that, it means that you’re working
on a place inside your body that needs you to focus on it. So if I can emphasize
anything, strength training is going to be a big one. Let’s roll– oops, sorry,
playing with the mouse. Next statement,
exercise can be a part of every survivor’s lifestyle. So it has no barriers
to the type of cancer, has no barriers to age, it
has no barriers to gender. So why wouldn’t we, right? We can go back definitely
to that medical clearance of saying, OK I might have
a little barrier depending on the safety where
I am right now, but in every survivors
life there is something that you can do in a form
of movement or activity that will have an impact on
the condition of your body. It can be starting slow. And if I could use
a mantra that’s from our cancer
exercise training. It’s from Dr. Katie Schmitz. It’s kind of a play on
a Teddy Roosevelt quote. And what she says is, you
start exercising by going slow. Do what you can,
use what you have. What does that mean? It means that in
my plan today, I can just get up and walk
around the dining room table, that’s all I’ve got. Thumbs up from us, that
was a choice to move. And maybe two days later, it’s
two laps around the dining room table. Go slow. Or if you’re beyond that, and
you’re able to take a walk, you wouldn’t start
by saying, I’m going to go back to
where I was before. Because if there’s
anything that we’ve learned in example of
looking at cancer survivors, it is a new you. And it is a new choices
that you need to make and you can, quite
honestly, I’ve seen survivors do this in
the training that I’ve done. Sometimes you can come
out stronger and healthier on the other side,
post-diagnosis from the choice to exercise. But start in a
place that’s safe. Go slow. Do what you can,
use what you have, and then make an appointment
with a cancer exerciser. But again, we go
back to that phrase that anything is better
than nothing, right? It seems kind of a flippant
way to express it sometimes, but if we put some
meaning behind it and say, it really does matter that
you get up out of the chair to walk across the hall, or
you voice to your family, I need to go on a walk
today but it’s only going to be half a
block or so, do that. We’ve had certainly, a different
exposure to different survivors and their needs. I’ve trained people where the
program may go on for months, but it might take 2 and 1/2
months to get in the front door to the back of the gym. To me, that’s success, because
that’s trying each time, and that’s getting to a
place where you know where you are, and you’re
able to say OK, I tried, I’m going to try again. That’s a big part of
that plan, and that’s a big part of that choice. Overall message from
American Cancer Society, from the American College
of Sports Medicine, as well as the
roundtable discussion of what cancer survivors
can do in exercise, was what we talked about. It really is the general
information of 150 minutes, but backing up and going into,
go slow and do what you can, the overall message is,
just avoid inactivity. There are places in the journey
of cancer where you know that cumulative effects are going
to make it so you just can’t. And that’s OK. And that’s where a
trainer or a group has the understanding to
know where you’ve been. It’s a serious
component of looking at either the person that
you’re helping taking care of, as a care giver, or as
a survivor, that you listen to those days. Pushing past it isn’t worth it. And there’s times
where you’re just going to need to have the rest. One day, one week, one
month, maybe three months. That is completely
understandable, it really is, and it’s OK. It’s finding that place, again,
in the mindset of when I can, I will try to do this. Try often leads to do. My little Yoda, that’s
my Star Wars input there. So again, we’ve started with,
how do I get my plan started? And then the next
part are saying, let’s talk about this,
what are my goals? And I think that’s a
good place to start. When we sit down with
survivors and we’re making a plan for
exercise, that’s one of the places
where we start. What is your goal? Is it simply walking the block? Is it returning to
a marathon status? We have the whole variety. Many times it’s, I wasn’t
doing any exercise before, now I’ve got to, you’ve
got to get me started. So find out where
those goals are. Talk about them with your
doctor, find a family member, find a friend to say, can I
just talk this out with you? I mean, I’m feeling like I just
need to organize my thoughts. Use the people around you. Quite often, there’s people
who are wanting to help anyway, and maybe that’s
the conversation that you can use
that friend for. I just need five
minutes of your time. I’ve got these goals, can
you help me lay that out? Is it two to three days a
week that I’m taking a walk? Or is it making the goal
of, when you come see me, you’ve committed
to come visit me, will you make sure
that I get outside, and I just go around the block? So this is part of what
we’re talking about of getting started and getting
connected with exercise. It’s finding the plan, and
then the next step, of course, is, OK I made a plan,
how do I stay motivated? So I think my usual
direction in that is finding what is
a high value to you? What motivates you? Is it times that you’re
going to see your friend, is that motivating you? You want to walk,
and you want to talk. You asked that friend to change
that time you spend together to incorporate some movement. Whatever that might be,
trying a yoga class, maybe that doesn’t
sound very good. Maybe it’s just going on a walk. Again, we keep
saying the walking, because the walking is
the most accessible. Most people can handle that. But it’s also incorporating
the big picture that we talked about before,
which is the bone density part. Win-win. So motivation is also
part of the whole picture of how am I going to get
this exercise plan going. Couple suggestions we
talked about together, walk and talk, making a play
date with grandchildren, with children. Making a family plan, quite
often that’s very useful. You’ve got kids in your
house, old or young, and you can say to them, I
have to walk two to three times a week, OK? OK! Write it on the board,
on the refrigerator, put it on the mirror. We need to get Mom or Dad out
the door, or brother or sister, out the door three times a week. It’s a household thing. Sometimes that’s motivating. Maybe it’s the
opposite thing of, this is my time when I
finally get to get left alone. Is that what motivates you? It motivates me. I get out the door, and
I just go, and I’m quiet. My earplugs go
in, or I’m walking my dog, that motivates me. If you have a dog,
that’s really useful because your dog always want
you to go take them on a walk. So again, it’s finding
what’s important to you, and trying to find
a way to make that intrinsic for the
choice of exercise. And the last one is
trying something new. So a little bit of a back-up
in trying something new. I’d love for people
to say, look, I’ve never done yoga before
and I’m going to try this. Or, I just bought a weight
set because I know I need to work on my bone density. Again, an emphasis, go slow. Because above all
things, we want you to be safe, and find
out what that’s like. So if your enthusiasm is there
in making the plan, right on. Be spot on with just knowing
where your safety is, and getting some advice
from friends or doctor for a little bit of
help along the way. So I crossed into
this a little bit already, of finding the
value of your exercise plan. By finding out
what motivates you and being sensitive
to what’s actually going to help you get going
in the morning, in the evening or what’s going to be
in that travel time. When you think about
it, we’ve given you a little bit of an
example in the back, is trying to write it down. As much as you’re talking about
it with family and friends, put in your calendar. Aren’t we all attached to
our phones a little bit? iPhones? There’s a great alert on
a calendar on an iPhone. Even if you’re looking from
a week ahead, to two days before, to the day before. The hour before? Oh yeah! I got to get out there
and I got to walk. Use the tools, right? That’s kind of what
we’re thinking about with planning the exercise. Because that’s going to get
you back into your routine, your body is going
to get used to it. Another side of that
plan is I’d like you to think about the
mind-body connection to where your goals are,
and that healing process. Which is when there’s a
day that it doesn’t work, forgive yourself. It’s OK. I just think that
sometimes people can rob themselves of
their initial goals by punishing themselves
when it doesn’t work out. No fair. There’s good days and there’s
bad days for everybody. And some days the schedule
just doesn’t work, or my dog chewed a
hole in my couch. I can’t take a
walk now, I’ve got to call– whatever
that might be, right? Forgive yourself
when that happens. And just look at that
calendar and make it a priority to try again. Big part of exercise,
especially when we’re recovering
from something, is to say I’m just going
to try that again. If I could give you any
wish, it would be having that internal voice change. To change your thoughts, to
change your mind, that one, this is going to be good. Potentially it’s
going to be fun. In addition to the messages
that say, I need to do this. My body says I need
to do this, my doctor says I need to do this,
these exercise trainers are constantly telling me
I need to do this, please. It’s having that whole picture. It’s looking at
exercise, as a survivor, as a mind-body-spirit
connection. I’m going to work on my muscles. I’m going to work
on my bones, I’m going to work on all
those different things that I have to do. But somewhere in that journey,
I want that choice to be, it’s going to make me feel good. And it will. It is one of those
amazing things, that even when you’re tired
and you’re battling fatigue, and we see it
happening all the time. Putting out energy actually can
regain energy within your body. It might take some time, but
it’s this wonderful cycle. And if we get really
lucky, we can find a place where we actually find what
those endorphins feel like. That’s a pretty high scale. Sometimes those endorphins
have to switch, again, changing your mind. Of saying, success! Last month it was just
to the kitchen and back. This month, it’s
to the front door. In three months, I’m
going around the block maybe two or three times. Progress, go slow. Do what you can. Use what you have. Make a plan. Talk about safety
with your doctor. Talk about a plan
with your friends. Find out what is
going to motivate you. What’s your value? And putting this into movement,
putting it into exercise, I believe you will
find some success. And again, you always got us. Through the cancer
supportive care program we also have
counseling sessions. So if it comes to
a time when you’re feeling like I just
can’t make this plan, or it doesn’t make
any sense to me, there is an option in both
Palo Alto and in the South Bay to come and meet with a
cancer exercise trainer. Trying the classes,
so certainly we’re here as part of the program
with the catalog in the back. And we’re here to answer
your questions in the end. Think about what it
might take to get going. And that is where we’re going
to close up, because we’ve got a tight schedule tonight. And our next phase is
the other gigantic topic, is going to be
cancer and nutrition. And I’m going to welcome Erica
and Alaina back to the podium. My name is Erica Connor. I’m a registered
dietitian and certified in oncology nutrition. And Alaina? My name’s Alaina, and I’m
also a registered dietitian. And I’m certified in
nutrition support, and I’ve been working on
getting my knowledge up for certification
in oncology as well. Excellent. So the topic of
nutrition, well we could talk about this for days. So we did our best to
kind of consolidate things and try to make things
as streamlined as possible. A couple things. So what we’re
going to talk about as far as stages
of survivorship, we’re going to
touch on recovery. Talk about proteins, people
always have those questions. Go into survivorship
as far as nutrition with regard to
survivorship specifically, and then sugar and cancer,
which is always a hot topic. And usually, if
this is a big forum, I guarantee that that
question would come out within the first three minutes. Usually less, so I
know everybody has it. So hopefully we touch on
everything and you guys get all your questions answered. So the stages of survivorship. Typically, survivorship
really actually starts, it sounds a little
strange but it really starts as soon as you’re
hit with a diagnosis. There are different
stages, though, obviously. The active treatment,
long-term disease-free living, where really people are
just like, OK now what? Reducing risk for recurrence,
and/or progression. So that sounds a
little bit confusing, but some people actually
told, you have stable disease, and then it’s just monitored. So that’s kind of
where that fits in. Prevention, and then
as far as looking at prevention and treatment
of the comorbidities. Which basically, is
sometimes your side effects, sometimes underlying
history that you already have prior to treatment. So things like heart
disease, diabetes, sometimes kidney disease. And whether you’re dealing
with it before or after, but obesity as well. And then there’s
advanced cancer and end of life, which as you
can see and imagine, in all of those
different stages, there’s oftentimes
different goals. And then also
different– well, first of all, sometimes even
how you tolerate nutrition is a big one. So the reality as far as living
with cancer, through cancer, and beyond cancer. So it just depends on
where I am, what do I need, what works for me, and how am
I feeling through the process? These are quite a few–
and this can definitely change– common challenges
within the survivorship reality. And this can happen any
time from right outside of treatment, through
treatment, sometimes, actually, these things will happen
several months after. Weight loss or gain,
and that literally is one extreme to the next. And they’re both
incredibly difficult. Incredibly difficult.
Oftentimes in this adventure, as I usually will
say, people maybe have been fighting to keep their
weight down all their life. And then all of a sudden,
the switch is flipped and they’re fighting
to keep weight on. And you never think
that you’d ever get– I don’t even know
how to deal with this. It can be a very
frustrating process. Fatigue, which is
usually number one. Taste changes, which actually
can last quite a bit, quite a long time. Swallowing difficulties,
and that actually could include something
like a tube feeding or anything like that. Diarrhea, constipation, and
other digestive changes. So what that means
is bloating, it could be things like
bloating and gas. It could be cramping,
it could be noises. It could be just noises. I know some people who say, I
eat and then I have to get up and I have to walk away,
because it’s just so loud. So those all fall in the
other digestive changes. But that’s the
reality of it all. So some solutions. The thing about it
is, one of my goals, and I can speak for actually
all of my colleagues, including Alaina, and our crew
up at Palo Alto. I just want to help to reduce
anxiety when it comes to food. Oftentimes, people say, I
read that this is good for me and I have to eat kale. And I have to eat this. But when you’re dealing with any
of these possible challenges, it can be extremely difficult.
And that anxiety kicks in because you’re
not eating salads, or you’re not able to eat
this for whatever reason. It taste terrible,
you don’t digest it. So that’s where we try to help. That’s where we can come in, as
far as to help you, number one, think of solutions
to these challenges. And also help you move on. Of what isn’t working. And how can we find
something else green that you can consume. So we’re always looking
for a healthy balance. Just like with exercise,
you want balance. We want balance here as well. Very, very important. So usually, smaller,
more frequent meals. I tend to say that is the number
one solution to any problem. With regard to any kind
of eating challenges. And it really is. I mean, whether you’re dealing
with any kind of nausea, loss of appetite, diarrhea,
constipation, you name it, that’s actually the key. Weight loss or gain, that’s
also– it fits in there. So sometimes it’s just
simply spreading out. Realizing I can’t meet
my needs in three meals. I need to spread things out. I give permission to graze. That’s oftentimes what I’ll say. Finding a fiber level that
is appropriate for you. That’s what a lot of
this comes into play. This isn’t about the
front page of the paper. This isn’t about
an article that you read about this
extraordinary person who starts their day with kale and
ends with– I don’t know what. But that’s the thing. It’s important to
realize that this is an individualized adventure. And a lot of times
it’s just knowing that it’s OK if your new system
has to be brought down as far as with regard to fiber. Otherwise what
happens, is people have this perception of
what you should be doing. You keep pushing it, keep
pushing it, keep pushing it, and all you’re doing
is taking steps back. Meaning that you’re ending up
with incredible diarrhea, which leads to dehydration,
which leads to more fatigue and blah blah blah. So there’s a lot of
really important pieces of how to find a balance
with eating healthy, and how things are all
getting along with you. Fluids, often a
need for variety, meaning that there’s
life beyond water. If water taste terrible, we
need to flavor that water. We need to find other
fluids, sometimes teas and things like that, to help
you meet your fluid needs. Whether you’re in active
treatment or after treatment, and you still need IV hydration. So it’s just trying to think of
a variety of things like that. And then as far as changing
the consistency of food, also. FASS, on this other side, is
fats, acid, salty, and sweet. This is a concept
in Rebecca Katz. she has many, many books. And we actually have
all of her cookbooks listed on our resource list. Whether you’ve picked it up in
the back– handout in the back. This is also where we
manipulate the tastebuds. So if you are dealing with
any kind of taste changes, it’s really, really important
to play around with that. Because, oftentimes,
what I will ask is, when you take
a sip of water, what does that taste like? Water is bland, right? Or it tastes like nothing. If it tastes bitter
or if it tastes salty, you’re not going to drink it. So we need to manipulate that
in order to get the fluids down. Same thing as far as with
regard to any kind of food. Sometimes it is as far as
adding a little bit of sea salt, sometimes it is adding
some maple syrup. But the other thing
about that is, it’s not pouring the maple syrup on. It literally is a drop. In fact, my husband asks
me to make kale now, because he likes it. And that’s a little trick
that Rebecca taught me, putting a little
dab– and literally, I put a drop of a grade B
maple syrup on the kale. It completely changes and
eliminates that bitterness. And my husband’s like,
what did you do to this? Never mind, just eat it. So it’s something that’s, again,
it all comes back to balance. OK, so that’s really key. OK, so going into the proteins. We do absolutely want to focus
on your plant-based– plant proteins. Your nuts, your
seeds, your beans, vegetables, whole grains. Now again, finding balance
with regard to that as well is super,
super important. We want to choose
lean animal proteins, organic chicken, organic
and low-fat dairy is really important. And then as far as including
your rich omega-3 fish sources, salmon, herring,
mackerel, sardines. Those are all the top ones. With fish, however,
omega-3 levels vary, so it’s not that–
you know, halibut, I could have listed that. It’s just a little
lower on the list. But all of those
important pieces. The other thing, too, is
using for omega-3 sources, things like your walnuts,
your chia seeds, your ground flaxseed. The only difference
with those is they are– basically it’s the
alpha-Linolenic acid, the ALA, and your body– we actually
have to convert that. Which we’re OK at, but we still
get some great, great benefits from those non-fish sources. So the key factor with
regard to the proteins is we want people to
limit your red meat, which is beef, pork, and lamb. Pork is not the
other white meat. They got in a lot of trouble
for saying that, actually. Looking at and avoiding
processed meats. Sometimes it actually
takes that step back of how many– what do I eat? How much do I eat? And what kind, like
the quality of it. Quality and quantity are two
super, super important factors when we’re talking about– as
far as red meat, specifically, processed meat. I always say go as
low as you can go. If that’s once a
week, if that’s once a month, that kind
of thing, that’s really in your best interests. One reason, I’ll give
you just a little tip. Everybody says, what’s
the deal with red meat, ? Couple different things. The saturated fat. Red meat consumption is also
associated with higher weight. Obesity. And actually, it’s sort of
linked to all kinds of things. It’s linked to inactivity,
it’s linked to all this– the other thing is also how
it’s cooked, and the quality. I won’t even go into the
antibiotic-resistant stuff. So the quality is key. One thing that we will
always say about protein is, it’s not necessarily
a specific number that you have to shoot for. One thing that people
say when I say protein, is they say, well I don’t like
meat, or I don’t like chicken. OK, well, let’s talk
about the other proteins. And so this actually
kind of gives you a good example of
how to fit it all in. Now an important piece, too, as
far as based on serving sizes. Oftentimes I say to people is,
when you sit down to a meal or even a snack, just
simply ask yourself, where’s my protein coming from? It really helps you
to kind of stabilize not only how you feel
physically, your blood sugar levels, but mentally, from meal
to meal throughout the day. If you’re trying to start
an exercise regimen as well, that’s also going to
help keep your stamina, keep your endurance up. Where’s my protein coming from? Is it coming from peanut
butter or almond butter that I’m eating with my apple? Is it coming from a yogurt
that I’m having as a snack? Maybe it is fish or
chicken, or maybe a good quality of red meat
at a meal of some sort. Oftentimes too, people
say, oh, I’m blending. I’m doing a blend, a
fruit and vegetable blend, or I have a big salad. I still want to throw
out that question, where’s your
protein coming from? Are there beans? Are there nuts or
are there seeds? Where’s that
protein coming from? Very, very important,
especially in this situation. And your goals, as far as to
regain strength and exercise and all that. And now talk about survivorship. Well, we’ve been talking
about survivorship. All right, so there is
a handout on nutrition for healthy survivorship. So we’re going to be
talking through this handout and elaborating a
little bit on it. If you didn’t grab one, you
can grab one on your way out. And so these are
some bullet points, and I’m going to
elaborate on them. And some of them
there’s some more slides that we’ll chat about. The first bullet point
is plant based diet. Eat your colors. That’s not your Skittles. It’s your fruits and veggies. So eating a variety of
different fruits and vegetables. They all have
different benefits, they’re all higher in certain
vitamins and minerals. They all have
different benefits, and so eating a
variety of them, you get to experience and
have all those benefits. And I’ll go more into
that in the next slide. Healthy fats. So that’s talking about
your unsaturated fats. Choosing those over your
saturated or your trans fats. So unsaturated fats
are going to be, a lot of times coming
from plant sources. So your nuts, your seeds,
your avocados, your olives, your vegetable oils. All those are great sources
of unsaturated fats. Anything that’s
liquid at room temp. Fish is also a good source
of some of the really good unsaturated fats. And then again,
the saturated fats are going to be coming from
more animal-based products, so your well-marbled delicious
meat, your butter, your higher-fat dairy,
and cheese and milk. And then Erica
already went over it. Limit red and processed meats. There was even some big news
break about the whole processed meat recently,
and so some people might have questions about that. But the American Institute
of Cancer Research recommends that you
limit these foods because of their connection with
certain types of cancer, particularly colorectal cancer. And some of the ways you
cook them and process them can also increase their risk of
potentially being carcinogenic or causing cancer. Limiting alcohol. So a lot of different
cancers have been associated with increasing the risk. Or, a lot of
different cancers have been associated with alcohol
increasing the risk of it. So some of those would be
breast, ovarian, endometrial, liver, colorectal, esophageal,
and then head and neck cancer. So with some of the more
hormonal-based ones, the breast and ovarian and endometrial,
alcohol actually increases the amount of
estrogen in a female’s body. And that can turn on some
of those cancers that have the estrogen-positive
connection. And so alcohol is
definitely a risk factor in limiting to maybe two
drinks per day for men, and one drink per day for women. Or maybe even less
than that, depending on if you are at high risk for
breast cancer or ovarian cancer. Next one is healthy weight. Which has kind of been a theme
throughout the whole night is maintaining a
healthy weight through a healthy, balanced diet and
a healthy, balanced physical activity regimen. So having extra fat
tissue also increases estrogen in your
body, so that again is going to put
people who are at risk for estrogen-positive
types of cancers, the breast, the endometrial
and the ovarian, potentially, at higher risk. So keeping your fat tissue down,
maintaining a healthy weight, can help reduce the
estrogen your body and put you at lower risk
for some of those cancers. And then the last one. Being physically active. That is, of course,
very important and it’s already
been emphasized. You guys should, at
this point, understand why physical activity is
important in reducing your risk of cancer and for survivorship. All right, the next slide. So this is about phytochemicals. And there is another
handout back there that was all about phytochemicals. It’s pretty sweet. So what are they? They are the plant chemicals. Phyto means plant in Greek. The plant chemicals
or nutrients that provide the color, odor,
and flavor in our plants. So when you pick up that
melon and you smell it, and it’s like, yes
this is a cantaloupe. You are smelling some
of those phytochemicals. And then you eat it
and it tastes good, you are tasting
those phytochemicals. And those little buggers have
some really great side effects. So I listed all the ones,
they’re listed on here, too. But just to reiterate. They can stimulate
the immune system. They can block
substances we eat, drink, and breathe from
becoming carcinogens. They can reduce the
kind of inflammation that makes cancer
growth more likely. Prevent DNA damage and
help with DNA repair. And so on and so forth. So this is just reemphasizing
that eating from the rainbow can be very important and
these are the reasons why. This handout really goes
into the science behind it, and the specific things that
are in those foods that actually are helping prevent cancer,
and reduce our risk of cancer and recurrence. The back of it,
there’s a great list of what those
phytochemicals are called. They’re big long names. Carotenoids might be one
of the more common ones that you’ve heard of. But if you can’t pronounce
them, that doesn’t matter. The more important thing is
looking at the plant sources and putting them on
your grocery list and buying them when
you go to the farmer’s market or the grocery store. And then the last column goes
over the possible benefits. So again, kind of going
over this list and specific to each food source
and figuring out, wow, if I eat red,
orange, and green fruits, I may inhibit the
cancer cell growth. So this is a cool
little handout. You can really get some meat
into why fruits and veggies are important for you. All right, so now we’re going
to go onto the big topic. Sugar. So how many of you have heard
of a connection between sugar and cancer? OK. How many of you have heard
that sugar feeds cancer? That’s a big one. How many of you get anxiety
looking at this slide? Yeah, definitely. So those are all things– I
get asked this all the time. Every day. Every day. So I’m going to try
and keep it brief, but what’s wrong with sugar? So let’s talk about that. When you have foods
like refined grains, that’s going to be
like your white bread, or your white pasta, not
the whole wheat varieties. Or concentrated sweets,
that’s going to be everything you saw on that last slide. Your blood sugar spikes, it
goes up, and it comes down. And that can be a pretty
high-calorie blood sugar spike. You can get a lot of
calories in there. And so when you go up,
you’re full up here, and then you’re hungry when
you get back down here. So you end up being
hungry more quickly, and so you end up maybe
eating more calories. And so what happens when you
get hungry a lot and eat a lot, is you tend to gain weight. So you get extra
calories and your body wants to store those
extra calories as fat for when you no longer
have those calories available. So you get weight gain. When you start gaining
weight, your body becomes resistant to the
insulin that it produces. And that puts you into that
stage of maybe pre-diabetes or diabetes. Hyperglycemia just
means high blood sugars. And so that situation where
you have this insulin floating around in your blood, and these
blood sugars that are high, are kind of what set the
stage for potentially some other hormones, growth
hormones being released. And that situation may be
associated with some increased risk of cancer. And that’s looking
also at obesity. There’s a lot of factors
that are contributing there. Because when you’re obese,
you might be sedentary, you might not be having
a high-fiber diet, you might not be doing some
of the other things that contribute to having a
well-balanced diet and well-balanced lifestyle that
reduces your risk for cancer. But the situation of having
high blood sugars and insulin resistance has
been– there’s been some associations with potential
increased risk for cancer. So what’s right with sugar? It tastes really good. When I’m not feeling well,
it sits well in my system. It goes through– maybe
I’m having saltine crackers when I’m feeling nauseous. That’s a refined
carbohydrates, but that’s what you’re going to
go for when you’re not feeling the greatest, because
you know it’s not going to make you feel more sick. Nostalgia. My mom, every day, on
my first day of school, made me chocolate chip cookies. I love chocolate chip cookies. I have a great memory, it’s
very warm, makes me feel good. So there’s a lot of
nostalgia with sweets. Around Christmas
time, cookie day. There’s stuff everywhere. So there is some
right with sugar. And when you’re going through
treatment, what do you want? You want some comfort, right? You’re feeling uncomfortable. So there are some different
things to look at. Sugar is not all wrong. The bottom line is,
going down to the bottom, it’s not just sugar. It’s the lifestyle. So having some
sugar in moderation, and in that big picture
of being physically active and having a well-balanced meal. If you have a milkshake because
that’s what you feel like, that’s all you
want to eat, that’s not the end of the world. I really liked what
Julie said earlier. She said if you have a bad day,
it’s not the end of everything. You haven’t ruined it all. You can pick up and move
on, and the next day you can make better choices. But it’s not even a bad
choice to have that milkshake, if that’s all that
you’re going to eat. You need some sort of calories. So is there a connection
between diabetes and cancer? Maybe. That is something that
they’re looking at, but it’s more of that
picture of insulin resistance and hyperglycemia that
comes from obesity that is more associated with
the increased risk of cancer. It’s not having that
milkshake that one day that’s going to give you an
increased risk of cancer, or feed that cancer. It’s about the lifestyle and
how everything fits together. So the USDA 2015 dietary
guidelines just came out. And that was another
big news break on NPR and all over the place. And it said, limit your
added sugar consumption to less than 10% of your
total daily calories. I thought this was awesome
that they were finally addressing added sugars in
our government nutrition recommendations. 10% of your total
daily calories, what does that look like? I wanted to break it
down a little bit. So they always use this 2,000
calorie per day guideline. Not everyone needs
2,000 calories per day. A lot of people don’t. But 10% of that is about
12 teaspoons of sugar, and 12 teaspoons of sugar is
about one 12-ounce can of soda. So they’re saying one
12-ounce can of soda a day is what you should limit your
daily intake of added sugars to. Not very much, when you
consider some people have much more than that every
day, just with the soda. Not including all their other. Foods. What was that? If I don’t drink soda,
how many cakes can I have? [LAUGHTER] You can look up
how many– you can convert the grams to teaspoons. 12 teaspoons for a
2,000 calorie diet. So if you’re on a
1,500 calorie diet, it’s going to be 75% of
that, which is what, 9 grams. So if you were on the opposite
end of the scale, where you’re trying to gain weight, because
you’ve been losing weight, you shouldn’t feel guilty eating
some of those white foods. Like the milkshakes,
or the white bread. Correct. Correct. There’s a time and a
place for everything. But still, when you’re
trying to gain weight, incorporating all those
fresh fruits and veggies however you can, whether
it’s in a smoothie. But if you can’t tolerate
them because you’re having GI issues, and what you
can tolerate is the white food, then you need to
eat the white food, because you’re in a better
place being well-nourished than letting
yourself wither away because you can’t eat the foods
you think you should be eating. So that’s a great question. Bottom line with pictures, eat
more of this instead of this, but it doesn’t say eliminate
this and only eat that. It just says eat more of
that, instead of that. I see a Brie cheese in there. [LAUGHTER] Balance. Remember, balance. It’s a whole food. No, I’m serious. I love Brie cheese. Do I have permission
to eat a lot of it? You have– not a lot, but
permission to eat some of it. That “a lot” just went over
the balance, the teeter totter. So cheese, one ounce, I always
say, is the size of your thumb. You can include the knuckle. And that’s about a
good portion of cheese. So this kind of wraps it up. This is from the American
Institute of Cancer Research, obesity and cancer. It goes through the cancers
that have been associated with being overweight or obese. And there’s quite a
few, like it says. And the AICR, the American
Institute of Cancer Research, estimates that
excess body fat is a cause of approximately 112,000
US cancer cases every year. And yet, almost 70% of Americans
are overweight or obese and half of people
don’t know that there’s a connection between the two. And so they haven’t really
isolated the reason, but, like I said,
there’s this picture of hyperglycemia and
insulin resistance and sedentary
lifestyle that they feel like might be
contributing to that. So protect yourself. Move more, eat smart. And then this is
another summarization. I love these little images,
because they’re fun, and they really
summarize everything. And focus in on the topics
we were mentioning today. And then the last one, fun
little– make food fun! And there’s a really
good resource guide, like Erica was mentioning. These are all
really good websites and some of these
images are pulled off of the websites
that are on here. And you can go on there and
get updated information, reliable information. There’s good
cookbooks, newsletters, these are things
that we reference every day in our practice. And so they are things that
we’re sharing with you, and if you take the time
to look through them, you can find some really
good stuff in them. On the resource
list, too, for those who do come to the
cancer centers, whether it’s the South
Bay or Palo Alto, the ones with the
asterisks actually are available in
the health library. So you can come and
borrow the books. Not that you have to go
out and buy a new cookbook, but you can borrow those. You can also look online
for a lot of these, and get information. Like Rebecca Katz actually
has a lot of her recipes online that you can access. So just as an example. OK. No we move on to questions. Yeah. I have a question, and it’s
really about smoothies, because I just started
drinking a lot of smoothies, to try to get that kale and
spinach, and everything else. And when you put all that stuff
in there, including, like, turmeric, and green
tea, like the matcha green tea powder,
and the nuts, is it as healthy for you
as eating spinach, just eating the
spinach and the kale? Is it as healthy for you? And the frozen
fruit, like if you’ve got frozen fruit
in there, you’ve got the protein
powder, and all that? I’ll start with
the frozen fruit, since you mentioned that. I love frozen fruits and veggies
because oftentimes they’re picked at their
prime and they’re higher in some of the
vitamins and minerals. Not all of them. And then they’re
frozen, and they get this
under-appreciated, they’re in the frozen food,
processed aisle. But there are some
good ones in there, and they don’t have
anything to preserve them except for just being frozen. So I like frozen fruit. You are reducing your fiber
intake when you make– Or if you put flax, I do
flax, ground flax and chia. Yeah, that’s great,
so you’re really, you’re adding some extra
fiber that’s probably not getting chopped up. So every time you take
a food and process it, whether you cook
it or you chop it, you’re breaking down
some of the fiber and making it easier
for your body to digest. So it’s a really
good way to get some of your fruits and
vegetables when you’re not feeling very great. And then it’s cold,
which can also help if you’re not feeling great. You can make it
really nutrient-dense, and add lots of fats to it,
healthy fats, hopefully, or you can make it a
little bit lighter. But it’s still very much a
good, nutritionally complete way to get all your
fruits and veggies. But the fiber content
does go down a little bit. You don’t get as many
of the sticks and stones fiber, as I like
to call it, which can be good for your colon. If you’re doing it, like,
just breakfast every morning, and then eating your salad
and greens during the day. I think it’s perfect. That’s a good
example of a balance. So I get nervous when somebody
says that they’re blending or juicing several times a day. So the only thing to watch
for is, if your goal is not weight gain, is be careful
because that shake can be a lot more calories
than you’d ever think by adding all that. Oftentimes, I say, as you’re
adding it to the blender, think, would I eat this? And people say, well, no that’s
why I’m making the shake. However, would you be
eating all of this? Because it does blend up to
be quite a lot of calories for a lot of people. You mentioned organic. How important is that? Good question. There’s a lot of
research with regard to what is important
with regard to organic. I can’t say everything
has to be organic. I would probably break
everybody’s pocketbook. But the important
thing, a lot of people do suggest going organic when
it comes to animal proteins. I usually will say, go
organic when you can with dairy, certainly with
your red meats, with chicken, with your eggs, so there’s
your animal proteins. Again, listed on our
resource list, as well as, actually, you can get it from
the Environmental Working Group, who puts out the Dirty
Dozen and Clean 15 every year with regard to produce. So that’s also
something that I like to share with people because
it’s interesting to know which fruit and vegetables have the
highest amount of pesticide residue as opposed
to the lowest. So the number one on
the list is apples. So most of the things on what’s
called the Dirty Dozen list, they have thin skin
or they’re delicate, like your berries, your
peaches, nectarines, your apples, lettuce. I think I’ve seen bananas
there, and I was wondering why. No. Bananas actually fall in the
middle, towards the bottom. So the Clean 15, which actually
have a lower pesticide residue, tend to have a thicker
skin, or I say, are gas producers,
like your onions. Those sorts of things. I say they have their
natural pesticides, bugs are like, whoa! So those are some
interesting things to– because again, in
the reality of shopping, I do always support local
farmer’s markets too. So when you’re going to farmer’s
market and you’ve got your $20, most farmers
markets are organic. Not all of them. But it’s important to know
where do I spend that $20, whether I’m at
Safeway or whether I’m at a farmer’s market. So that’s where I say go
with like your thinner skinned, delicate things,
choose organic, I would suggest. And with a thicker things
like your melons, avocados, those types of things,
you can go conventional. Would that eliminate
GMO-type foods? If it’s organic, yes. And that’s actually– that’s a
whole other topic, with regard to labeling and
things like that. That’s also a bigger topic. But organic tends
to pull in that. Yeah. Can you explain, there’s organic
cottage cheese, organic yogurt. How is that
processing, how is that different from non-organic? Good question. No, go ahead. So the organic
industry, actually, is very– everybody’s kind
of on the same page with all the different
industries, whether it’s dairy, whether it’s meat,
and those types of things. So according to as far as
the organic regulations, like with organic
dairy, the cows can only actually
have organic feed, so it starts with the feed. No antibiotics, or pesticides
or those types of things. So it really kind of
starts from the ground up, or whichever way you want to go. And so it actually ends
up being less chemicals and less– all those added
things in the actual end result product. Same thing as far as with
regard to organic meat, is the no antibiotics,
pesticides with regard to feed, and those types of things. A really important piece,
especially depending on what the media
wants to grab hold of, is issues with
antibiotic-resistant chicken and meats and things like that. So organic actually steps
us away from those issues. Does that? Are those easier for the
body to digest as well? Not necessarily
easier to digest. What it does is it’s exposing
us to less chemicals, and things like that. Environmental risk factors. Yeah, exactly. Does that answer? I just– with my body,
organic dairy products seem to give me diarrhea. And the taste is different. The taste is different. In fact, most people say that
organic, everything taste better. Some people– My nephew says the opposite. And he lives up by Redding. And I’m like, your neighbors
grow all this stuff, and, oh, we don’t like it. It doesn’t taste good. So I’m going to
give him that list. It’s really interesting to
get people’s perceptions. My turn? Sure. I tried every time,
measuring with cup, one-ounce, several ounce,
is there any better way? Cooking something that’s
a recipe, that’s easy. But in my daily
meal, how do I know how many ounces I should eat? Of protein? Whatever. With regard to? I– He wants to know
his daily measure. How would he measure, a
measuring cup for his ounces. [INTERPOSING VOICES] Tablespoon, or
get a small scale. Did you like my
hand thing, where it’s like a piece of
cheese is about the size of your thumb with the knuckle? There’s some guides to hand
models that you can use. So for carbohydrates,
a fist is about a cup. So if you have really big
fists, maybe use your friend’s. [LAUGHTER] Or don’t use a kid’s fist,
because then you’d be sad. So that’s a good serving
of carbs per meal, about a fistful. And hopefully you’re
choosing the whole grains if you can tolerate that. If not, choose the more
refined ones, that’s great too. And then for meat, it’s
about the size of your palm, is a good size. And we recommend three ounces,
depending on what’s going on. I don’t know your history,
but sometimes with diabetes we might actually encourage
a little bit more protein. But lean proteins. For nuts, it’s
always the small– a portion size is about
the size of if you were to palm your hand like
this, just to fill that area. Nuts you can eat like
popcorn, they’re so good. You just keep eating. So that’s a good portion size. So you might even
Google, because I don’t have a guide
to hand models, but you could Google
hand model portion sizes. I shouldn’t say
Google, you could Bing. You should research online. I shouldn’t be plugging anybody. But you can research online
different portion sizes using hand models. And that can really help
when you’re eating out, if you’re trying to
restrict your portions and figure out what’s
actually a good portion size. Purple. Just going back to the sugar. Is fruit included
in that 10%, or is that in addition to the 10%? That would be in addition to. Added sugars are going to
be anything where you’re adding this extra
sugar, not sugar that’s innately in our food. So milk has sugar,
your grains are going to have sugar
or carbohydrates, your fruit, your
starchy vegetables. All them are sources
of carbohydrates. But it’s your soda,
your cake, your cookies, you could even, maybe,
cross into juice. Some of those are what
we’re trying to limit with that recommendation. Included your honey, or anything
that you add to tea, anything that you add to your
plain yogurt, maple syrup. Yeah, that’s exactly what’s
considered an added sugar. Thanks. Sure. In the back? How do you define
a healthy weight? Is it according to BMI,
or how do you define that? Yes, actually. We generally will use the
BMI, because it really kind of captures
everybody who we encounter on a day-to-day basis. It pushes out anybody
who comes in who is like muscle, weightlifting,
that kind of thing. Sorry, I was like word finding. Or really the elderly,
frail, elderly. That doesn’t capture that. They kind of are off the scale. But yeah, BMI chart is actually
your best resource– reference. Can I break in with that a
little bit, as a trainer? Understanding the BMI
chart is a tricky thing, because you can be a very
well balanced body, muscle structure, bone structure. And some of that can be
genetic, some of that can be the effectiveness
of your exercise, and you can be in
the obese category. That’s when the
BMI chart may not be the right answer, and doing
a little bit more depth of size, lifestyle, diet, makes
a little more sense than just finding
that one category. And that’s where the
elderly and the fitness– hyper-fitness
people don’t fit in. But also the average
person can sometimes get in a funny category
on the BMI chart. Yeah, I actually– In my opinion. Absolutely. Brings up a good point. I generally will say
that it’s a guideline. What’s important to
do is to– some people look it and be like, I’ve never! So there we go, is looking
back, to the future, where did you come from,
where are you going, what is realistic. But it’s just a guideline,
because we do get that, the I’ve never been that. It’s tricky. It is tricky. Yeah. Oh, go ahead. One thing you haven’t
touched upon is soy products. And I’m coming at this from an
estrogen-positive breast cancer survivor and I’m
also a vegetarian. And I know, I’ve heard
both sides of the story. And I made the decision myself
that I didn’t eat a ton of it before, I’m not going
to change anything now. I’m just going to leave
things as is in moderation. I just wanted to– because I
know of the whole phytoestrogen end products of soy
products, so I just wanted to hear what you
had to say about the topic. Good question. Yeah, like I said,
nutrition is a huge topic. We could talk about it for days. Do you want to answer? I could start and then
you could maybe elaborate. The current
recommendation is based on a large group of
long term studies that up to three servings
of whole food soy, so that’s soy milk, tempeh,
tofu, soybeans, edamame, per day, three servings,
is considered safe, is potentially safe. That’s what the
current research says. It’s not, I don’t
think, conclusive, but that’s what it says. And there are some other studies
that show that it potentially has a protective effect
for that specific type, the estrogen receptor
positive breast cancer. The things we don’t know as
much about are the supplements. So your soy protein
supplements, or anything where there’s soy that’s
been concentrated, processed down and added. We don’t know what effect
that has on that type. So we tell people to avoid–
encourage people to avoid those types of products. But maybe you can
add some more to it. Well, it goes back to,
again, balance, first of all. And also looking at just
whole foods in general. So when you bring up a soy
supplement, it’s processed. And it’s heavily processed. Your fake chicken
nuggets, your patties, especially when you look at
the ingredients, first of all, it’s a long list. And it usually starts with
concentrated soy protein. Can you buy concentrated
soy protein? No. If you find a product
that is like a patty and it starts with tofu,
bean sprouts, carrots, you go, well I could
make this at home. There’s a good
example of something that, sure, has been
processed, but it’s actually made of whole foods. So same thing is, we’re
not going to suggest that you have hot dogs. If you’re going to have meat,
have a good quality meat. Same thing as far as
with your soy foods. Start with the soybean, even
though there is a processing to get to the soy milk
and to get to the tofu, those are actually
really whole soy foods. They’re minimally processed,
and they can absolutely be in a balanced diet. Absolutely. If you choose–
here’s the one thing I will say, segue, because
I’m looking at your face. This is where, number one,
it’s an individual choice. That is also where
anxiety is our enemy. If that makes you nervous,
and some people will walk out from an hour with
me, going mm-hmm, she didn’t know what
she was talking about. I do know what
I’m talking about. But if you don’t feel
comfortable with changing something, don’t. If you’re not used
to having soy at all, maybe you’re just used
to having it be edamame when you go out to a restaurant
or something like that, then leave it at that. Some people say I don’t even
know what to do with tofu. So leave it alone. Focus on your other plant-based
proteins, and go that route. And that’s decision
I’ve pretty much made. I’m not eating any
more than I used to, which is not a whole lot. And just leaving it alone. And if I happen to have
tofu in my whatever it is, tomorrow night– There you go. Don’t be afraid of
it, but, again, you don’t have to go
seek it out either. Yes. As far as organic food,
especially vegetable and fruit, I notice sometime when I
buy it, I read the label, it’s made in Mexico,
or other countries. China, Canada. How trustworthy is that? Can you trust that it’s really
organic, that came from Mexico, or there is a doubt? That’s a great question. Do you want that one? Well, I mean, that’s maybe
more of a political question, because you’re getting into
how we import our fruits and veggies, and how
closely monitored those farming practices
are in other countries. And the regulations
that go with it. Yeah, and the regulations
that go with it. And I can’t really
speak to that. The one side, for fish there’s
some really good guides out there as far as getting
your fish from good sources that might be international
versus here, that’s monitored
by the Monterey Bay Aquarium, the seafoodwatch.org. But I know what you’re talking
about, when you go into a store and they label where
your apples came from and it says it’s organic. One thing I will–
to be quite honest, I’m not going to
necessarily answer the organic piece of that,
but the location where it came from, that’s a longer way away. So not only was it
harvested, whatever it was, but then it had to
travel to get to you. So oftentimes I’ll
say to people, and I’ve actually done this,
and this actually kind of segues into the frozen thing, too. I’ve been in that situation
where I need broccoli or I want broccoli or
whatever, and I’m at the store, I’m not at a farmer’s
market, and I pick it up and it’s rubbery. And I think, thank
you, no thank you. That’s telling me a number
of different things. It’s probably, could be two
weeks old from the time it was harvested. It obviously wasn’t
stored correctly. There’s a number of things going
on with broccoli that I pick up and it’s going. That’s where, in that situation,
if you need broccoli for, maybe a dinner party, go frozen. Absolutely, hands
down, go frozen. So again, that’s a difficult
question with regard to the organic and the
different practices, but the location is a
good indicator of hmm, do I want that? We have just– how are we doing? Just a few more minutes. Yeah. I have a question specifically
around inflammation. There’s a lot written,
and we’ve gotten a lot of detail about
foods and how they drive inflammation or cool it. What about exercise and
the benefits from that? Is there a correlation? I haven’t read it. Of exercise and inflammation? Yeah, inflammation, being
able to reduce inflammation. So the only thing I could
think of is that being active, and the exercise reduces stress,
which fuels inflammation, and go down that road. But I wondered if there was
anything– that’s my opinion. I think in general,
the body needs to move and so if you think about
oxygenation, circulation, systemic support,
we start there. So a body in motion,
I think that working with anti-inflammation, I think
there are some studies that point towards that. And that people who are active,
again, healthier typically, healthier body weight or
weight maintenance, rather. As well as less joint
irritation, because joints aren’t as stiff, they’re more
fluid, they’re more mobile. More stability in the body. I think that thing to
consider is what are you doing with exercise? There are higher impact
exercises would be harder for the body to
tolerate, and can have a reactive or
inflammatory response. So, for example, lower impact. So swimming program
occasionally, or making sure that you have
variation in your program. You’re not doing the
same old, same old, same, so that’s one of the keys
with a varied activity routine or weekly program. Less wear and tear, less
stress on the body in general. I think those things can
help you manage or help work against inflammation with
the exercise routine. Do you want to add to that? Well, I guess I want to dissect
the question a little bit. Is it going into exercise
to reduce inflammation, or are you wondering
does exercise contribute to inflammation? The benefits. So we see a lot and we’re told
a lot about the benefits of diet for reducing inflammation,
which drives cancers, et cetera. So when you’re dealing
with damaged cells and things on this part, I
know exercise is important. And I’m just wondering
if there aren’t side benefits that come to both
helping healthy cells grow. Is it blood flow movement? It’s all of that. So it’s necessarily anecdotal
in that type of answer because there’s not actually
specific data per cancer. I mean, the diversity that
we have in cancer also goes with the
diversity that we have to consider in
exercise for survivors, as well as just
regular population. The thinking is, as we
know, the oxygen that flows, the blood increase that’s
going through the heart, you also may have
that benefit that goes into the mucosal system. So if we’re thinking about
all systems functioning and raising up and
working together, yes. The theory is it’s
going to help. Just like it would help in
a slow, progressive motion of helping lymphedema. So all of these variations– Side effects, is
what I was wondering. Right, OK, so if we go
specifically to that topic, it goes back to
the slow progress. But it also goes back
to studies being shown, and this is now very
accurate from a study that’s done with weight
lifting for women, who tend to be at a higher risk
for lymphedema, inflammation, yes. Strength training will benefit,
but it needs to be progressive, and it needs to be built
up gradually to getting to that weight,
to the point where you can lift a good
amount of weight, it’s just not starting in
at an aggressive place. The progress is where
they’re saying yeah, we see these things. They’ve shown even some studies
that are saying potentially with stomach cancers, getting
those epithelial cells, getting the mucosal cells
going, is the same process that we’re seeing in exercise
with the blood and oxygenation. So can I give you hardcore data? Not really, it’s
just that yes, we believe that as we
understand exercise and we understand the
physiological benefits, it will aid in altering,
changing inflammation. The flip side is if you
do too much too fast, and you know this, you’ve
maybe even done it. I think we’ve all done it
where you’ve got to go back. You can create inflammation. It doesn’t mean that forever,
you’re just taking it slow, but it means being mindful about
the progress and the intention of where exercise is going
to come in your life. Did that answer your question? Absolutely. Thank you. I’ve heard that doing
high-impact exercise at shorter duration is better
than doing exercise, like on a bike for 20 minutes. That’s all over
the news right now. You want that one, Regan? Do I want that one? Are we answering this
question in regards to survivorship, or as a
general question for fitness? No, survivorship. And I keep hearing these
are what athletes are doing, these are what the
49ers are doing, how they’re training them. Right. Not all of them are doing it. First of all, it’s
never a place to start. You have to build up to any sort
of tolerance for that level, because there will be
a pretty high reactive response from your body in
starting to train like that. It’s a big one. It is a big one. I heard that by doing that,
you’re killing cancer cells, you’re killing cancer cells. OK, so the biggest,
broadest thing I think that we
can say for sure, is that there’s
not a cure, right? So when somebody comes
out with any kind of book or any kind of theory, this
will disperse cancer cells. We’d be handing it out. I wouldn’t have a job. That’s going to be the
best day of my life, when I don’t have
this job anymore. But we’re not there. And so that alone should kind
of pull us back in thinking, by looking at the
broader scheme of thing. Where they’re saying, yes you’re
going to burn more calories, all you need is that
15 minutes every day. Sure, to a degree, you need
to move 15 minutes every day. But do I want you to actually
pull out that three foot box, and stand there
and go up and down, up and down for
that high intensity? No, because the fallout’s
going to be you’re more likely to get
injured, and then not do any activity for
months past that. So when you’re looking
at that article, and I read those articles, too. You can have an efficient
workout quickly. Yes, it’s true. But you have to
decide who’s doing it, why are they doing
it, and are they safe? To me. It’s not sustainable
for everyone. So a way to begin, if you
have a walking program, let’s say it’s 30 minutes,
every fifth minute, potentially, just to walk a little faster. So you start working
with intervals before you dive
into anything that’s like a full program at
a high intensity level. Does that makes sense? So you start at a smaller
scale and you just add like a 60-second, I call
them a boost, like a burst. So every fifth,
like five minutes, 10 minutes, 15 minutes,
just go a little bit faster, or go up a hill or walk
up a flight of stairs. And then carry on. And over time you’ll
start responding to that. And your workout will have
a higher intensity level. And that’s part of the progress
we’re talking about, too. When you’re talking
to a friend, you’re deciding on your walking
program, walk with intention. Make that plan, make that goal. Because we can stall. If we keep doing the
same thing every day, the body’s just going
to adapt and we’re going to stay
right where we are. You’ve got to mix
it up a little bit, you got to walk a
little bit faster, or on one day of
the week, you’ve got to take a load of a hill. Challenge yourself. And that can be
slow to progress, and again, know where you are. Be responsible for
what you’re feeling, and what you know
potentially is a risk, or where that
vulnerability may come. Surgery site, chemo,
medication you’re on, you’re going to have
a lot of variables. Just be wise and talk about it. Talk about it with a friend. Make a plan. Thank you, guy! Thank you.

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