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Ask a Cancer Nutrition Specialist | Amber Thomas RDN

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  • Jee_wozJee_woz Posts: 2

    Hi Amber

    Thank you for getting back to me. I’m going to try and fill in some details for you.

    6 years ago I had been suffering with chronic back problems and ended with a spinal fusion. I’ve since had polyarthritic flare ups which ended up making me start to put weight on, after a year at slimming world and a new thinner me. To help they put me on steroids and every time we tried to wean me off them, I would get a flare up. These flare ups basically stopped me in my tracks from as much as moving. 9 months of steroids and I was finally able to reduce down off them and Was free of steroids. 3 months later I got my cancer diagnosis by this time the weight had already piled on. Although I wasn’t as big as I am right now. After many tests for arthritis as I have a positive rheumatoid factor and raised inflammatory markers, they couldn’t confirm it was Ankylosing Spondylitis so diagnosed Fibromyalgia.

    I also don’t eat bread or pastry as I have terrible stomach cramps and a sudden urge to rush to the toilet with diarrhea if I eat it so I am pretty sure I am gluten free or IBS d.

    I had 3 cycles of FEC and 3 cycles of Docetaxel, Pertuzumab and Herceptin, I suffered with chronic diarrhea all the way through and I am still no better. Last chemo was July 8th. sometimes I was barely eating as I couldn’t taste anything. I seemed to survive on leek & Potato soup most of the time. I was on a lot of steroids throughout those cycles and I ballooned from the steroids. The weight is very much over my stomach and face. I look bloated.

    I admit I have had days when I felt sorry for myself and ate sweets or crisps as a form of comfort. My husband has been brilliant but I cannot really talk to him about hating myself and not wanting him to see me looking like this.

    I have had a full auxiliary lymph node removal 2.5 weeks ago so I am recovering from that as well and the area is very painful and quite swollen. Mastectomy was in January.

    i wasn’t the most mobile before cancer but it is 100% worse now. I managed a walk with my husband the other day but In June I got a nasty Picc line infection and I I was neutropenic and ended up being left with clots in my arm and a pulmonary embolism in my lung so I get quite breathless quickly. It was so hard to finish the walk, my chest was tight and I was completely out of breath but I did it, that was a week ago but haven’t felt fit enough to do it since. I am so scared about becoming fit again, I’m worried I can’t do it, that I’ll never be able to get back to what I was before all of this.

    Slimming world made me feel great and I enjoyed it but when I went before I wasn’t this big and I had two people going with me so it almost became a competition to see who could loose the most. They gave up after 6 months but I continued for a year. Now the idea of slimming world makes me feel anxious and overwhelmed like I don’t have the motivation or the mental ability to stick to it this time. It’s all just too much but I hate how I feel too.

    I hope I have explained things a bit better and you can get a better picture of where I am.

    Thanks for reading.

    😊😊

  • Amber_Thomas_RDNAmber_Thomas_RDN Posts: 42 Cancer Nutrition Specialist

    Hi @Jee_woz . Thank you so much for the additional information! You've really helped me understand better.

    First, you've experienced so much! Please allow yourself both the space and time to process this 💜

    I see two particular pieces of information I would like to explore further.

    1. Your weight increased dramatically while on the steriods given with chemo (and previously for the polyarthritic flares), and in areas of the body typical of steroids (face and abdomen) AND
    2. The types of foods you were able to eat during that time (leek and potato soup) if any, and the side effects you experienced (no taste, diarrhea) likely left you malnourished. Your side effects from chemo may have felt stronger, and you may have felt weaker/more fatigue from the lack of consistent nourishment.

    Your food consumption didn't affect your weight, but the steroids did. Trying to solve the problem with further diet rules and restrictions will likely not serve you and the goals you've mentioned here.

    It seems that one of the biggest goals you mention is becoming fit again. Feeling like you'll never be able to do the things you once did while you are in the middle of some very tough treatments and surgeries is so very real, so powerful, and so common. It's hard to see the light at the end of the tunnel when you're right in the middle of it!

    What if we explore some other questions and begin to build a foundation.

    1. Are you able to eat fairly normal right now, and has the taste changes and diarrhea resolved? If so, we can discuss foods to increase in your diet to help you feel stronger.
    2. When will you see your surgery team next and/or how can you get a referral for a physiotherapist to both address strengthening exercises and likely lymphedema you have from the axillary lymph node surgery?

    From my perspective, trying something like slimming world right now would both not do anything for your steroid-caused weight gain, and would cause additional stress on your healing body.

    Please let me know how you're eating and drinking right now, and I can provide some guidance from that perspective.

    Talk soon!

    Registered Dietitian | Cancer Nutrition Specialist | Online Nutrition Coach

    websitehttps://www.cancernutritionsolutions.com

    instagramhttps://www.instagram.com/amber.thomas.rdn/

  • Amber_Thomas_RDNAmber_Thomas_RDN Posts: 42 Cancer Nutrition Specialist

    Hi everyone!

    Thank you to those who joined us last week on our LIVE Q&A video chat! I had a great time, and hope you found the session valuable.

    Here are the resources I spoke about as part of that session.

    Iron In Food

    If your oncology team suggests you eat more foods high in iron due to anemia, here are some ideas of foods to try! If you can tolerate the types of foods high in vitamin C, they can help your body absorb the iron in foods better.

    Nausea

    When you don't feel well, ginger is a natural product that can help calm your stomach. But if you find most ginger products too intense, what can you do? I encourage clients to try a product called Tummy Drops! They have super intense ginger flavors for those who love the taste, and less intense flavors made with ginger and other fruits/flavors if you desire less of that ginger flavor. Try the Sweet Blackberry Ginger, or choose another drop low in the intensity scale!

    I have checked directly with the company, and they do not yet have these products available in the UK :( They hope to change that within a couple of years, but that doesn't really help right now. You still may be able to buy directly from their website. If you're looking for a different type of ginger product, it may be worth it!

    Poor Appetite

    It's common for treatment to affect your appetite and make it harder to eat. The strategies listed in this handout may help you make some adjustments to how often and what you choose to eat, to support your strength and nourishment during treatment. 


    I encourage you to check out my video library and additional handouts located on my website for further information coping with treatment side effects.

    If you couldn't join us for this live Q&A, I hope you'll be able to attend future ones! As always, continue to ask me questions right here. Talk soon!

    Registered Dietitian | Cancer Nutrition Specialist | Online Nutrition Coach

    websitehttps://www.cancernutritionsolutions.com

    instagramhttps://www.instagram.com/amber.thomas.rdn/

  • Eve96706Eve96706 Posts: 2

    I have metastatic breast cancer and started keto (my Onco is aware) 3 weeks ago... I’d like to know your thoughts and any advice as I’m going back and forth on continuing this or how long I should keep it up. I feel good but just unsure if I’m being smart or not

  • Amber_Thomas_RDNAmber_Thomas_RDN Posts: 42 Cancer Nutrition Specialist

    Hi @Eve96706 ! Thank you for your thoughtful question! I know many people are curious and want to know more about eating keto.

    I have a number of follow up questions to gain more clarity on what you hope and expect from following this diet.

    1. What led to you trying the keto diet in the first place? - When I've asked this of others, the most common response I've heard is "it's [the diet] supposed to starve my cancer." While that seems to be a common answer, it's likely not accurate. While we have data from cell studies (putting cancer cells in a petri dish, introducing compounds, and seeing what happens) and animal studies (usually involving mice), we don't have much reliable human data that states using a high fat/moderate protein/low or very low carbohydrate eating plan works in an actual human.Our bodies are meant for survival, and can make glucose (our primary fuel source) from the protein and fat we eat. It's just not as easy, and takes more energy from your body to convert non-carbohydrate sources to glucose.
    2. You mention a timeline for using this approach. If this type of eating plan feels temporary, what do you hope to accomplish on the time you are following the eating plan vs. the time you're not? Would it feel different to make some smaller changes that can fit into your long-term plan?
    3. How does this diet fit into your values? What in your life do you value? What brings you joy and peace? Does following this type of diet align with that? For example, if being close to your family and sharing time with them is an important value for you, will following this diet make that value harder? Will you be able to enjoy time with them, while worrying if your meal will be keto-friendly or wondering what you can eat while visiting?

    I'd love to hear your thoughts on these questions, and see how I can guide you further!

    Registered Dietitian | Cancer Nutrition Specialist | Online Nutrition Coach

    websitehttps://www.cancernutritionsolutions.com

    instagramhttps://www.instagram.com/amber.thomas.rdn/

  • puppy3puppy3 Posts: 20 ✭✭

    Hi Amber, my father has been diagnosed with colon cancer. He has a tumour in the descending colon and will go for surgery to remove it in a couple of weeks. They don't yet know what stage it is as they need to test the colon that is removed and then see. We are also waiting for MRI results to see if it has spread to the liver as there are cysts visible in the CT scan but it's unclear if they are cancerous or not. Given the tumour is quite grown in the colon (an endoscopy tube couldn't go past), he has been advised to stay on a low fibre diet until it is removed, in order to make sure that there is not too much roughage, leading to a blockage if the stool can't pass through. He is struggling with a couple of questions though:

    (1) what does this mean in practice though - what should he avoid and how can he stay healthy if he can't eat fruit and vegetables and cereals? If he cuts out a lot of what he normally eats and loses weight then that doesn't seem good either.

    (2) does cooking/blending food mean they are digested more easily?

    (3) what kind of foods are good to eat more of in the two weeks before surgery so that he is in the best health?

    Thanks in advance for any help you can give us.

  • Amber_Thomas_RDNAmber_Thomas_RDN Posts: 42 Cancer Nutrition Specialist
    edited September 12

    Hi @puppy3 ! Thanks for reaching out with some great questions.

    The most important thing before surgery is to avoid the blockage. It appears that his surgery will be in about two weeks? The way he needs to eat right now is only temporary. While his diet won't have loads of variety, it should focus on enough protein and enough total energy to maintain his weight and lean body tissue.

    1. The majority of his food should be low fibre in this time period. If the endoscopy cannot pass, large bulky foods won't be able to pass either. I've included a list of foods for your reference. While these type of "white" foods aren't generally considered "healthy" choices, they are the types of foods that will keep your dad nourished while also limiting the chances of a blockage.
    2. Yes, cooking the veg will break down the fibre, making it softer and easier to digest. Blending those cooked veg will further limit the risk of bowel blockage. If he wants to get in some veg during this 2-week period, I recommend cooking/roasting vegetables he enjoys, and blending them into a drinkable soup. You will likely need thin the blended veg with broth to make it drinkable.
    3. I recommend he try eating smaller meals more often, in order to provide his body enough calories and protein to help him prepare for surgery and recover after. If he can, a smaller meal 4-5 times daily may help. Each meal should contain some fat, an easy-to-digest grain or carbohydrate, and an easy-to-digest protein source. Fat sources could be some butter, cream, plant-based oils like avocado oil and olive oil added to his foods. Please refer to the list for his best low fibre grain options. As for protein, eggs, fish, and white meat (chicken/turkey) will likely be best tolerated.

    Please let me know if you have further questions. I'm happy to help!

    Registered Dietitian | Cancer Nutrition Specialist | Online Nutrition Coach

    websitehttps://www.cancernutritionsolutions.com

    instagramhttps://www.instagram.com/amber.thomas.rdn/

  • puppy3puppy3 Posts: 20 ✭✭

    @Amber_Thomas_RDN thank you so much for the reply to my message. What is your view on alcohol at this time pre surgery?

  • Amber_Thomas_RDNAmber_Thomas_RDN Posts: 42 Cancer Nutrition Specialist

    @puppy3 , you are most welcome!

    It really depends on your father's history with alcohol prior to surgery, and what level of drinking he wants to continue in this short time before planned surgery.

    In general, I recommend he refrain from drinking from now until his surgery. If your father has a strong history of alcohol use (more than 3 drinks/day), please let his surgical/medical team know so they can make sure he is properly prepared for surgery.

    Here is a short article that explains how alcohol can affect surgery. Hope this helps!

    https://my.clevelandclinic.org/-/scassets/files/org/patients-visitors/information/prepare-for-surgery/2018-04-10-alcohol.ashx?la=en

    Registered Dietitian | Cancer Nutrition Specialist | Online Nutrition Coach

    websitehttps://www.cancernutritionsolutions.com

    instagramhttps://www.instagram.com/amber.thomas.rdn/

  • puppy3puppy3 Posts: 20 ✭✭

    hi @Amber_Thomas_RDN thank you again. He's having 1-2 drinks per day, around 4-5 days/week, so less than 3 but still...is there a reason I can give him why you recommend he refrain from drinking from now until his surgery?

  • Amber_Thomas_RDNAmber_Thomas_RDN Posts: 42 Cancer Nutrition Specialist

    @puppy3 , thanks for the follow-up information!

    Ideally, his medical/surgical team is aware of his drinking history. They may be able to guide him more specifically on goals to decrease the amount of alcohol prior to surgery to avoid withdrawal symptoms.

    There are studies that show limitng/avoiding alcohol prior to surgery can help with post-recovery and lessen surgical complications.

    I hope that helps!

    Registered Dietitian | Cancer Nutrition Specialist | Online Nutrition Coach

    websitehttps://www.cancernutritionsolutions.com

    instagramhttps://www.instagram.com/amber.thomas.rdn/

  • Mary78Mary78 Posts: 27 ✭✭

    Hi Amber, just wanted to say I watched your video about diets and I found it very helpful. Thank you so much. I'd love your advice on managing aches & pains please, sometimes my entire body just aches. Is there anything I can eat that's naturally anti-inflammatory / that could help? I read salmon and berries are very good for this. Thank you in advance and for the opportunity to ask a question!

  • Amber_Thomas_RDNAmber_Thomas_RDN Posts: 42 Cancer Nutrition Specialist

    Hi @Mary78! I'm so glad you found the video helpful 😊

    It's hard to know how foods labeled anti-inflammatory can help in a practical way, such as mitigating those aches and pains. Most of the research implies that certain foods may affect inflammation in the body, but we really don't have information on real food affecting inflammation markers (certain compounds in the blood) AND aches and pains.

    Here are some of the general food recommendations, but keep in mind the research doesn't really point to these foods helping directly with aches and pains:

    • cold-water fish like salmon, tuna, sardines, and anchovies contain omega 3 fatty acids that may help with inflammation
    • nuts like walnuts, pine nuts, pistachios, and almonds
    • colorful fruits and vegetables like blueberries, cherries, spinach, and kale
    • plant oils like extra virgin olive oil, safflower, and walnut oil

    Keep in mind this list is not exhaustive and also focuses on foods that contain high amounts of antioxidants, implying that those compounds may affect inflammation as well.

    Bottom line is that if you enjoy foods labeled as anti-inflammatory (like the ones above), feel free to include them in your eating pattern and see how you feel!

    Keep in mind that adequate sleep and gentle movement (moving your body in a way that feels good and is sustainable) can support your body as well.

    I hope this information is helpful! Feel free to reach out again with other questions!

    Registered Dietitian | Cancer Nutrition Specialist | Online Nutrition Coach

    websitehttps://www.cancernutritionsolutions.com

    instagramhttps://www.instagram.com/amber.thomas.rdn/

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