Are you or a loved one dealing with the side effects of chemotherapy or radiation? Struggling with a new diagnosis and unsure of how to best support your body through treatment? Tune in to hear Ali and Becki discuss food-as-medicine therapies that can aid with common side effects of treatment as well as ensure best recovery and remission. From creative ideas for dealing with loss of appetite to nausea and digestive changes, this episode will provide useful tools for optimizing nutrient intake so that you can truly fight with your fork!
In this Episode, Ali and Becki explore the nutritional priorities during active cancer treatment including supporting the immune system, ensuring adequate cell membrane and gut lining support as well as optimizing overall nutritional status. The side effects of cancer treatment can often seem as bad as the cancer itself and malnutrition is a common barrier to getting best outcomes. From immune support with adequate protein and optimal micronutrient status to navigation of taste changes, dehydration and oral sores, this episode is jam packed with practical tips to empower patients in active treatment as well as their caregivers!
Also in this Episode:
- Ensuring Adequate Protein Intake
- Naturally Nourished Grassfed Whey (use code PODCAST20 at checkout)
- Navigating Nausea, Oral Sores and Taste Aversions
- Digestive Health Concerns
- Naturally Nourished Digestaid
- Dealing with Diarrhea
- Coping with Constipation
- The Importance of Hydration and Electrolyte Balance
- Dealing with Neuropathy and Preventing Neutropenia
- Resources to Support your Food-As-Medicine Journey
Welcome to the Naturally Nourished podcast, that delivers cutting edge food as medicine solutions for optimum health. Ali Miller is a nutrition expert sought out by the media and America’s top medical institutes for her revolutionary functional medicine interventions. From disease treatment to prevention, every episode will empower you with ways to put yourself back in control of your health. Please note, the topics discussed are for educational purposes only. Now welcome integrative dietitians Ali Miller and her co-host Becki Yoo.
B: Welcome to the Naturally Nourished podcast this is episode 53, Coping with Chemotherapy. This is Becki here with Ali.
A: Hey everyone.
B: And we’re so excited to share this very necessary resource with listeners. In fact, I was shocked that Ali doesn’t have a general episode on cancer by now.
A: I know and this is exactly why we need you all to be giving us feedback, right? So you know, on our website if you go to the Naturally Nourished podcast, which is on the Nav under the podcast tab on Alimillerrd.com, there’s a box at the bottom called AskAli we have been getting a lot of fun questions and we will be doing a Q&A episode coming up but these are exactly the reasons why we need feedback from you guys. Becki and I were shocked that we were already in 50 plus episodes and don’t have one specifically on cancer so today will be really helpful to go into coping with chemotherapy. I know there’s a lot of clients and friends and family that this will be very helpful for. But before we get into the meat today, I want to just stress to you guys beyond giving us information of what you want to hear about with new topics, how helpful it is to us to get your reviews on ITunes.
B: Yes we were just reading a bunch of reviews this morning actually and there’s some new ones on there which is very exciting to me, having started as a cohost a couple of months ago now. And I wanted to read this one and give a shout-out to Mel Ruth Tx so she said “I’ve been a listener since day 1 and I look forward to each new episode. Unlike a lt of health podcasts that are focused on wellness that provide with little in the way of evidence, Ali and her cohost consistently demonstrate their evidence based approach to food as medicine. I don’t have a biology or chemistry background so every now and then they lose me to the scientific underpinnings of their recommendations, but it allows me to learn a lot and stretch my understanding.” So thank you so much Mel Ruth we really appreciate it and we appreciate all of the reviews.
A: Yes so if you all can take a moment while you’re listening and jump on over to ITunes and leave us, even if you just leave us just the 5 stars it really helps with our ratings and helps to spread the food as medicine message further, and it helps to show that you appreciate Becki and I taking our time to spend digging into the research, ensuring we’re giving you the most updated information and sharing the message with you.
B: Yes so thank you in advance for doing that. And I know it’s not accurate to say we don’t have an episode on the topic of cancer so I know in episode 36, Ali, you interviews Dr. Lorenzo Cohen with whom you had worked as a developer of a food as medicine protocol in a stage 3 breast cancer research study.
A: Yes absolutely and so that study was done, and this was work back in 2012 and the study was developed by Dr. Lorenzo Cohen and it was based off of David Servan-Schreiber’s AntiCancer book and the study had 4 different elements: it had yoga, mindfulness, cognitive therapy, resistance training and exercise and then nutrition. So I developed the food as medicine and nutrition protocol which comprised of 6 different sessions that were hands on therapeutic food culinary sessions and then 6 didactic or educational and counseling sessions and then we also worked with tracking and accountability and developing actually the protocol for which foods were recommended and those to avoid to maintain in a remissive state after a treatment with stage 3 breast cancer. And the study is still being intermittent right now and is funded through the National Institute of Health. So we should start to see the outcomes probably in the next 2-3 years of so. Super excited and I was really honored to be asked and recruited to develop that element and I’m excited to see the outcomes.
B: Yes and I know we still use a lot of your protocol and plan that you came up with in clinic and with patients as well.
A: Yes I mean cancer prevention, treatment, and survivorship are so significantly impacted by diet and lifestyle so having a food as medicine plan cannot only ensure that you have nutritional support for prevention, it can also ease treatment side effects and it can prevent recurrence.
B: Right so I know during my clinical rotation I had some exposure to cancer patients and it seemed like the side effects of chemo can really be just as severe, almost, as the disease. So I’m really excited to provide these food as medicine therapies to help with common side effects and ensure best recovery and remission from cancer.
A: Yes so there are a lot of tools that we want to share as far as prevention and mechanism of action or the pathology, or how cancer comes about and I think that that’s something that we have in the works especially, today is October 2, I think this episode will go live at the middle or end of October but being mindful during breast cancer awareness month. This is a time when we’re probably going to delve a little bit deeper and give you all some more resources on how to prevent. But today, I really want to ensure we put together a nice package for those of you listening to share with loved ones going through active treatments and today’s primarily focused on chemotherapy btu we’ll also be helpful for radiation as well.
B: So, Ali, let’s get into what the priorities are with treatment beyond, of course, eradication of tumor activity and cancerous cells. What other priorities are there with cancer treatment?
A: So one of the big ones is supporting the immune system. So the immune system is truly the surveillance system of the body and so when cancer is in some theory, and immune dysregulatory concern where the immune system did not determine that there was abnormal tissue, abnormal activity and tumorigenic function in the body and it didn’t upregulate its natural killer cells or the immunoactive compounds that should have pretty much gone through processes of apoptosis or cellular suicide to kill off cancer. So the immune system was not surveillancing appropriately so we want to support the immune system to rebound and be able to detect tumor activity and then we also on the immune system piece, want to recover from being compromised because during treatment the white blood cells get a huge hit, we’ll talk about that later in the episode and how to support and why that’s important but we’re really beating down on that immune system during active treatment so we end up being immunocompromised and this makes us more susceptible to virus, bacteria, and such and so supporting the immune system during treatment for recovery and supporting that compromised immune system as well as upregulating the surveillance elements of the immune system are really key.
The second thing that I look at is protecting our barriers. So our barrieres, we’re thinking of, like, our cell membranes. So protecting our cell membranes with fats; healthy fats help to play a role in that bilipid membrane which keeps and protects the cellular integrity, it helps to protect the mitochondria, the energy factory of our cells, and all of the interworking elements to maintain our body’s optimal function and it keeps toxicity out if we have healthy barrier function. Also when we’re speaking to barrier we’re thinking of things like supporting the gut lining so supporting more of a mechanical barrier, if you will, and this goes all the way from the tender tissue that lines our esophagus, along our intestinal lining, so we’ll talk today about things that can support our gut lining, which can prevent ongoing inflammatory process or prevent that leaky gut and gut lining integrity often takes quite a beating with both chemotherapy and radiation so a big thing to focus on as well, protecting our barriers. And then the third thing we look at is optimizing our nutritional status. So we tend to be under a lot of oxidative distress from, agian, active treatment so this could be from the toxic chemicals in chemotherapy or the radiation, both of them cause oxidative damage and so we tend to get a lot of depleting and cellular damage so we want to optimize our nutrient status by getting an abundance of antioxidants and then also optimize our nutritional status with some specific nutrients that help with coping with side effects so we’ll talk today about things like alpha lipoic acid and its role with neuropathy and other nutrients that tend to get depleted during treatment.
B: Ok so sounds like we’ve got a lot to cover today.
A: Yes. Always do.
B: Yes. And before we jump in, let’s just talk about some of the common barriers to these areas of focus, or why they might not be the first thing we’re focusing on.
A: Yeah so we’re looking at supporting the immune system, protecting our barrier, and optimizing our nutritional status and I guess that last one was quite vague and kind of encompasse s all of this because malnourishment is the biggest barrier for why these 3 things don’t occur. And this is a combination both from drug nutrient interactions, so some of the drugs actually causing depletion. Also, it’s a 2 part influence because we tend to have inadequate intake with a lot of aversions, taste aversions, or nausea, retching, and this can make it difficult to get in what the body needs in higher demand and so this is why we often tend to get side effects of treatment. It’s important.
B: Ok and then loss of appetite, retching, aversions to certain textures and temperatures can really make this quite difficult especially when we think of our nourishing foods being warm.
A: Yeah, yeah absolutely.
B: And then I know that protein deficiency specifically can cause a lot more side effects.
A: Yes so protein actually is one thing that I think from working with MD Anderson and being Oncology rotating with their dietetics, protein is something I think across the board most people in Oncology are going to be on the same page on emphasizing its important stance, you know, this is really interesting I think that this episode piggybacks a couple after that “What the Health, What the Hell: Take on What the Health” where I was really concerned as a public service announcement of the disservice of saying that protein doesn’t matter because we do know that the #1 cause of death from complications of treatment of cancer care is from protein malnourishment so we’re actually getting mayalisa, muscle wasting, sarcopenia and the protein is important not just for our structural health, like our lean body mass, but protein is the biggest supporter of our immune system and so preventing wasting of muscle and actually maintaining or skeletal muscle mass while also getting enough of our amino acids to support optimal immune function, is really the emphasis of getting ample protein. And beyond that, remember as we spoke to protein in the past, it also plays a role with amino acids that can convert into neurotransmitters so another side effect of cancer care and treatment can be depression, and anxiety and this can be higher propendency during malnourishment seen with protein deficiency.
B: Got it, so how much protein, Ali, are we talking about?
A: Generally speaking, I like to make as a minimum standard, 80 g a day or more of protein and emphasizing clean sources. So we’re looking for sources that are free of growth hormone and antibiotics and then, that’s the first level of defense, and then if possible, to look for sources of protein that are wild caught, grass fed or pasture raised, as these will have the most nutritional density. So when we’re looking at achieving that 80 grams or so, we’re getting this value based on a calculation of 1.2 – 1.5 grams per kilogram of body weight.
So as an example if I’m looking at 150 pound person, their kilograms are going to be 68.2 so if you just take your little calculator out or you guys don’t have to do it, you can just listen to me so 150/2.2 is 68.2. So that would be that 1 gram but I want you to get when you’re in active cancer care, 1.2 – 1.5 grams per kg so we would take that kilogram amount of 68.2 multiply that by 1.2 and we would know that their minimum need to be at that 1.2 grams per kg is 82 grams. So, again, 80 grams or more generally speaking for someone about the range of 150 pounds obviously as our body weight goes up, our protein intake needs go up as well and one ounce of biological protein, meaning protein from an animal product, yields 7 grams of protein.
B: Ok and then if we think about the visual of that, let’s give listeners the visuals of, so one ounce would look like one egg for example.
A: Yes. So maybe in a day, if we were looking to get that 80 plus grams and you can help me tally, Becki.
A: So if we’re doing 2-3 eggs, so maybe we’re doing a Broccoli Frittata or a Farmer’s Market Frittata 2-3 eggs would be yielding that 14-21 grams we’d be almost a third – I guess a quarter of the way there, I suppose with our breakfast and then we could be doing a snack of maybe some vegetables and hummus so we’re not going to get much protein from there that’s maybe going to give us 4-6 g of protein, give or take, from the garbanzo bean in there and some of the tahini nut butter.
And then, let’s say that for lunch we’re going to do Skip Jack Tuna so we could do a whole can of Skip Jack Tuna which is 6 ounces so that would be giving us 56 grams there on addition and that could be stuffed in an avocado with a bed of leafy greens, like arugula and such and then for the afternoon maybe we’re dealing with a little bit of fatigue so we’re going to do our cold brew coffee protein shake so we’re going to do a little bit of cold brew coffee, about 4 ounces, we’re going to do a tablespoon of almond butter in there, maybe 2 teaspoons of cacao powder to get more antioxidants, maybe 2-4 ounces of full fat coconut milk to get some creamy mouthfeel and then blend in a scoop of Grass Fed Whey so that’s going to give us another 24 grams of protein there and I think that that’s pretty close and then that would still give us the option of for dinner doing about 4 ounces of protein on our entrees so we could do, like, a grass fed bison patty with some sweet potato wedges and some sliced avocado and could even do, if needed, another vegetable like grilled asparagus. So what is that looking like, Becki? If we did a burger that was about 4 ounces on top of that? That’d be about 28 on top of that.
B: We’re definitely very close to that 80 grams if not above it actually so maybe –
A: I think we’re above.
B: We’re above. Especially with that protein shake.
A: So we had 70 grams with the tuna and the eggs and then we’d be at 94 with the protein shake and so I did give us a hefty lunch with that full can of Skip Jack Tuna whereas most people for lunch are only getting 20 grams of protein and that’s where we’d really need that protein shake to amend, and so most of us would probably, I guess, I’d backpedal and say 2-4 ounces of protein in that salad and then that would be the need for that protein shake. Otherwise, if you do that whole can you might not need to do the whole shake, but I do like that as a tool because the grassfed whey is the Naturally Nourished Grass fed Whey is non denatured and so that means that it is low heat processed and contains active amino globulin compounds and this is what goes back to our primary goal to cancer treatment and outcomes in supporting the immune system.
Immunoglobulins have actually been shown in research to help upregulate that surveillance system as well as the barrier defense system so those immunoglobulins can help with our secretory IgA, the mucosal lining that lines our gut and our oral areas so it helps to prevent the exposure of toxins to our healthy cells, helps to support our immune function and then our Grass fed Naturally Nourished Whey has glutathione, which is the granddaddy antioxidant which glutathione has been shown in a whole gamut of research studies in helping to support best clinical outcomes with chemotherapy as an adjuvant it actually can protect from damage to otherwise healthy cells.
B: Ok awesome and that all sounds delicious but I know I’m not dealing with any nausea, or taste changes so how would you suggest coping with these symptoms if you are dealing with them?
A: Yeah absolutely so that day was a lot for one day if you’re dealing with a spotty appetite and so taste aversion is the first struggle that we see and that can happen as soon as 48 hours after first treatment and it can even take a delay of up to 2-3 weeks and its varied based on the individual but we want to really navigate those foods that are best accepted and often it’s recommended which is very frustrating to me, to eat bland food and bland foods tend to refer to refined carbohydrates or otherwise sweetened foods so these foods are not going to give you the nutritional density to support your system in recovery from treatment and/or upregulate your body’s defense mechanisms to fight against cancer.
And so we really want to be mindful or trying to play with, instead, more new flavors and spice combos that maybe you don’t have a taste expectation of- a lot of people have metal mouth when we’re getting treatment and it varies based on what chemotherapy agent is being used but this metal mouth, sometimes there can be a really more highetened aversion if you eat something that used to be a favorite food, so let’s say it used to be spaghetti and meatballs, even if you’re healthifying that and doing spaghetti squash dish with a bologneses, if you have metal mouth or significant taste changes, you’re going to feel much less satisfied than stepping outside your box and tyring like a tikka masala roasted chicken dish with different flavor profiles. So using curry powder or garam marsala or these new different seasonings will not only not have that nostalgia of “oh this isn’t’ what I remember, this tasting like or this doesn’t taste normal because it’s new, but it also is going to have a huge abundance of antioxidants that support your detox process and protect your health cells so we can definitely get food bang for our buck by trying new flavors. Both by getting new expectations and by getting that full punch of nutritional density.
B: Ok and then adding acid to foods as well might be helpful.
A: Yes so as long as there’s no oral sore, and that’s why sometimes things like citrus is avoided, and that definitely is something that we’ll want to address today as well but if they’re not oral sores, adding acid can really brighten up the flavors in a dish. So even something that you didn’t put acid on previously, so thinking of a stirfry or even more of a traditional dish, so I’m thinking of a beef stir fry or something like that , adding a little bit of lime juice or vinegar or balsamic to your brussels sprouts, brightening up apple cider vinegar, all of these things will brighten up the flavors and help to evoke a brighter flavor profile and, again, something different which can really help with the taste aversion. And then the third thing I would think of, so beyond new flavors and adding acid, is try to eat in times when you do experience the most natural or organic hunger and that’s where you really want to pack in your punch of nutritional density so, you know, it’s reasonable to eat only 2-3 times per day. Some people recommend eating small frequent meals, it really depends on your body, but if your body is ready take in what you can so you can store and hold onto your nutritional density for those times when you have more aversions of nausea.
B: Ok so that’s super helpful for if we’re dealing with taste aversion or appetite changes. What about specific recommendations for dealing with nausea?
A: Yeah so my go-to, which I use both with the first trimester women dealing with pregnancy, nausea, as well as cancer, nausea and just across the board is ginger. Ginger really is a powerful root so it’s anti inflammatory and it does have antiemetic or anti nausea effects and it also can help with digestion, it can help with the peristalsis or the pumping, that involuntary movement along the GI tract. So a couple ways to work ginger in is you can sip on ginger tea. If you don’t have food in the belly and are dealing with a lot of nausea, you might do a hot ginger tea although sometimes heat can create a little bit more nausea so you might want to do an infusion or do a chilled, you could make the tea at room temperature and chill it in the fridge and then do that with slices of lemon and that’s a very refreshing tonic.
You can also put freshly chopped or grated peeled ginger under your tongue in bouts of nausea so having that chopped and ready to go and keep that in a ball jar, that can actually have almost a direct onset of relief and this is the severe nausea where we’re experiencing the pooling of saliva and so that ginger right under the tongue or biting down or putting in the cheek like a squirrel can actually help with preventing that pooling of saliva and that desire to retch or vomit. And then considering a ginger shooter is another thing. So a ginger shorter would be talking about an inch of ginger and blending that with 2 ounces of water and that would make 2 different shooters and so you shoot it back like a shot so you could make double doses of that. You could add a little bit of apple cider vinegar to that or even a little bit of honey to that and either of those things would work just fine and that can be taken at onset of nausea or preemptively if you know there’s a time of day when you’re typically nauseous. And then there is a supplement that I really like from Thorn and I’ll have Becki add this to the show notes and it’s called Gingerol. It has been research- studied, actually, compared to placebo and does have significant reductions in nausea and vomiting and can be a very therapeutic tool for you and/or family members in need- it’s called Ginger All and so we’ll put a link to that in the show notes and you can just take as prescribed.
B: Ok I think those are really helpful tips for how to incorporate ginger and then of course we could also be adding it to a smoothie or shake,
A: Absolutely, yep.
B: Or stir-fry – any of those dishes as well.
A: And then beyond, if you’re not dealing with nausea, it’s going to still be beneficial for its anti-inflammatory effects so absolutely a great thing to add in throughout the week.
B: Ok. And so we also have a note here about considering cooler dishes, and how hot and actually create that- and worsen sores and exacerbate the nausea you mentioned.
A: Yes. So just thinking of like a pot roast which is super nourishing but beef especially there’s also some aversion to that so that’s where I really like to push to, I forget the name of it, Becki, but you did one when you returned from Thailand it was – or was it a Korean beef dish? Something spicy?
B: Indonesian short rib – I think beef Rendang.
A: Ok so that would be a good thing to consider but you might even consider, then, eating that cold, more like you would cut up that beef and put that on a salad because when things are warm there tends to be a stronger smell, of course, and that can cause, if you already have a little bit of nausea or sour stomach, that can cause a little bit more of that nausea and so using these kicks of different flavor profiles and then segregating the time, it’s prepared for consumption and trying more cold applications works really nice and then also, like you said, if there’s an oral sore, also cooling temperatures are very helpful directly on contact so that can help with pain and inflammation in the mouth.
B: Ok and we keep mentioning these oral sores so let’s’ talk about why this is a concern, why this happens, and how it can be addressed.
A: Yes so when we’re dealing with noxious compounds, so toxic chemicals in chemotherapy, it’s damaging our cells and that’s why we get hair loss, that’s why we get malnourishment, but that’s also why we fight against cancer and radiation is giving radioactive waves to damage cells as well, targeting and damaging cells. So the epithelial tissue, the thin cells that line the inside of our mouth unfortunately also get damaged and there is a pretty rapid turnover so we can rebuild and create healthy cells quite rapidly especially if we are supporting with nutritional needs, so vitamin C is really important with collagen formation, using collagen in the diet and bone broth can really help to repair ulcers, but we also want to use cold temperatures to be soothing.
So we can actually play with using an anesthetic or analgesic of pain relievers as therapeutic foods so we can actually freeze frozen fruit. I like to blend fresh fruit with coconut oil for clients and have them put them in molds and then they can actually suck on these prior to mealtime, which can numb the tissues just liek if you have bumped your elbow or have a bruise and you’re’ putting ice on the wound, that’s really what you’re doing so you’re sucking on a fruit and coconut oil ice piece and that numbs the tissue in the area of the mouth so prior to mealtime, you’ll be able to eat with less pain so it can actually be a direct pain reliever. Another thing you could try freezing, which I would recommend, is our Cacao Peanut Butter Gelatin that we just put up on the blog, so that could be frozen into scoops and could be eaten like a sorbet or, again, could be put in a mold and be sucked on.
Another thing that you can consider, so beyond just actually topically applying frozen is rinsing your mouth out with a solution of baking soda so you can use a teaspoon of baking soda and a teaspoon of himalayan pink salt and dissolving that in a glass of lukewarm water and then just swish that in the mouth orally about 3-4 times daily. Another wash I like to recommend to people is called Periowash. So Periowash has a lot of organic and wildcrafted herbs and it works as a natural antibacterial and helps to reset your periodontal gum bacteria state which can help with bad breath, but also can prevent infection with any of those open wounds so another really great thing to bring in and it is alcohol free so it will not cause further irritation to that tissue.
B: Ok and then what about something like aloe vera juice for helping to heal ulceration?
A: Yeah I think that’s great so you can do the aloe vera juice, they now have so many beverages available on the market or you can get the pure aloe vera juice, it’s not the gel that you’d use topically but that aloe vera juice in the supplement section in your natural food store, that’s what some people use for, like, heartburn and reflux and definitely that’s going to be more anti inflammatory direct tissue support and could be using that for an oral swish. And then the last thing I’d recommend for oral sources which can help to repair ulcerations and coat them is Kudzu root.
So we actually have, on our website, if you go to Alimillerrd.com and you go under Books and Programs and you click on our Cancer EBook there is a free download for our ginger Kudzu Root Pudding and this is a pudding where Kudzu works as a thickener so it’s a thickener that can also help with bowel regularity, it can help with diarrhea and loose stools and urgency, but it also helps in tissue and repair and repairing ulcerations and so this is something that can be sued very therapeutically. It has the kudzu for the ulcers and the bowel regularity, it has the ginger in there for the nausea, and then digestive support, and then you can even use that same flavor profile, I think it has coconut milk in there as well as the base, you can use that same flavor profile rather than let it set in the fridge you can blend in a scoop of the Grassfed Whey and drink that as a smoothie. So both of those would work really nice, especially if you’re having difficulty getting in your calories and protein.
B: And if you haven’t heard of this Kudzu root before, it can actually be used as a really quality thickener, way better than something like cornstarch or other proinflammatory thickeners that are used in sauces like flour.
B: It has lots of applications.
A: Yes I use it in every gravy that I make, actually. So most of the time I’m trying to buy the meat that is bone-in, skin-on for a good balance of amino acids so to help with that glycine methionine balance in the amino acids and get back to more nourishing components from the animal products so that’s why we go for the tendons and organs of course, there’s much more nutritional density but when I’m doing bone-in skin -on proteins, there’s often those nice brown dirpigns in the pan so I’ll reduce that with a little bit of bone broth and whisk in a little bit of kudzu and I’ll get a really nice pan sauce. Sometimes I’ll use a little bit of white wine to reduce the drippings or red wine if it’s a red meat dish, and it makes a really awesome gravy that you can put on top of your protein or on top of roasted veggies so Kudzu is a favorite in my household regardless of ulcers or diarrhea. It’s a therapeutic add on and a great thickener.
B: That’s a really good tip for Thanksgiving coming up -we’re thickening our gravy.
A: For sure that’s what I use.
B: Ok so let’s talk a little more about texture. So beyond having oral sores in the mouth, there can be difficulty swallowing due to either dry mouth or difficulty chewing or even the esophagus being ulcerated as well.
A: Yeah so I talked about the epithelial tissues and how the cells actually get damaged and that’s when we’ll have some sores or wounds in the oral cavity but this can actually happen throughout the entire GI lining so both chemo and radiation can damage these delicate follicles, which line our GI tract and this is what we can find in the intestinal lining the brush border, and this can make things really difficult as far as swallowing because we don’t have that passive support of scooting the food particles down because those poor follicles are damaged so we don’t get that finger-like push of the food particles down the esophagus and so things can kind of sit or feel heavy. Also this means, like I mentioned, the brush border, which is where most of our digestive enzymes are released is also hindered so our digestive enzymes start to be produced in our saliva and saliva can be reduced from many oral medications so this whole process can really play a hit to our GI tract. So if you have hindered salivary production, we’re going to have a difficult time chewing and making a bolus and a bolus is literally like balling up your food to be swallowed so this saliva helps to emulsify or create broken down food particles into, like, ball to be swallowed and then also that saliva should come full of nutritional enzymes to break down food particles.
So when we’re low on saliva, we’re having a difficult time swallowing so adding moisture into foods can be important, so this would be things like adding in bone broth or even adding in a little bit of pureed fruits like pureeing peaches into playing with a really soft cooked carnita, or pork tenderloin, we may even, if we’re dealing with severe oral sores, break that down or use ground pork during that time instead of a biological meat piece so kind of predigested, if you will, if it’s ground, and then adding in some peaches would work really nice as a flavor profile to that and that would add more moisture into the dish, or I like to use bone broth a lot as well. And then beyond this, I would emphasise going back to my initial thing, digestive enzymes so digestive enzymes would be really important – I put all my clients on DigestAid which is our digestion product that has the whole gamut of our enzymes to break down carbohydrates, proteins, and fats so it has your cellulase, your amylase, your proteases, your lipase, so breaks down all of your vegetables fibers, all of your protein, fats, and carbohydrates and then it also has hydrochloric acid to optimize the pH in the gastric pouch and it has ox bile which helps with emulsification and breakdown, so these are really important keys and this is a very safe supplement that can be used during treatment pre, post, during with cancer care and it supports the absorption of all the nutrients that you’re consuming and it can also prevent nausea so really important, that would be a big big loud emphasis is get going on digestive enzymes because this is going to help your body, which is comprised in the breakdown to breakdown and absorb nutrients. And this also makes less irritation along the gut lining when the gut doesn’t have those delicate follciales to support and optimize the digestive process.
B: And I’ll link to DigestAid in the show notes as well.
A: Awesome. I think that that’s important and then another thing I’d consider is blending foods so we don’t have to go to the level of, maybe, a truly ground everything but doing smoothies and soups is a great way to ensure a pack of nutrition punch, and inure optimal absorption because it is, basically, predigested so adding greens into our smoothie is typically better accepted than doing a big, green salad and then we don’t have to chew as much because it is already mechanically broken down. I would will take that enzyme with the smoothie so that we are ready to absorb the nutritional density but it’s a lot easier on our GI tract and soups can be a great thing for that reason as well and then in soups, you’re able to get the 2-for-1 of getting in the bone broth which is definitely a therapeutic food during treatment.
B: And then the blending and adding bone broth and adding moisture is another way to get in more water, which is always good as well so talking about dehydration and electrolyte imbalance, this can cause nausea, dizziness, fatigue in cancer treatment as well. So what are our approaches to hydration?
A: Well when you’re going in for an infusion, often your med tech will ask you if your urine is clear and that’s alway a big hit they’re always looking to ensure that your hydration status is optimal because that helps with successful administration of chemotherapy agents. If we are dehydrated, it can be a heavier hit on the body and that can really throw electrolyte balance off and so optimal hydration is really important and this also helps with the health of our white blood cells which allows us to be more resilient during treatment, and, remember, that’s where all the army of our immune system lives. So – and the hydration status is going to support our stress response in the body as well so we looking to get about half our our body weight in fluid ounces each day so, again, going back to that 150 pound person that’s eating 80 grams of protein, they’d be looking at about 75 fluid ounces of water or more so that’s the minimum is about half the fluid ounces per pound. So somethings that I work with clients to get their hydration up, is doing infusions. So in the Naturally Nourished Cookbook we have a whole section in our therapeutic foods section where we devote different combinations of water infusions so whether we are adding fresh herbs such as basil or mint or rosemary or using green tea as a vehicle, all of these are ways to add flavor and antioxidants and also add in a compound that drives more of the fluid intracellularly so when you have a solute that helps verall with our water stability.
B: Awesome and then soups as well we mentioned, but let’s give some more ideas of different soups that can be used.
A: Yes so soups are great because we can pack in a lot of organic produce, we can use bone broth as a vehicle which is going to have that collagen which is going to support our connective tissue so form our hair, skin, nails, joints that lining of the gut that I mentioned and even in the oral cavity so definitely supportive of getting in the bone broth and then add in our vegetable scraps. So any time we’re cooking our carrot tops, our onion skins all of these things from organic produce can go into a freezer ziploc bag and then be dumped into our stock pot to make a dense mineral broth. And then we can add in more therapeutics like turmeric root and the ginger root, and all in delivery you let this simmer for about 24-36 hours and add a pretty abundant amount of sodium as well and so you’re’ going to get the sodium from a himalayan pink salt or a sea salt and this is going to really balance our or electrolytes and minerals and be very vitamin-rich especially if we puree in additional produce. So we could do like our Cream of Spinach Soup that we have in the Eat Fat Get Skinny Book where we take 4-5 hands of greens, blend that in the blender from a heated base of a chicken stock and then you can top that with a little bit of coconut milk if you’re going dairy free, or you could top that with a dollop of greek yogurt and then even some shredded rotisserie chicken to have a nice meal in a cup. And then also if you’re looking for something that isn’t hot because you’re having some of that nausea or taste aversion, using that Avocado detox soup would be another good recipe that you could incorporate and add in that Grassfed Whey or add in that rotisserie chicken or poached white fish to get a full meal in a cup.
B: Yes I just made a big batch of bone broth this weekend and we actually used some chicken feet in there to get more fo the gelling.
A: Awesome I saw that i was thinking that would be a good Halloween post.
B: Yeah it was pretty creepy, pretty weird looking.
A: Yeah but that is where all the good stuff is, in the chicken feet is going to make is significantly much more gelatinous so much more than the back and the other bones and not beef broth you tend to get more gelatin from the bones after you roast them than the chicken bones so adding the feet in is definitely key to getting a gelatinous broth. And then also you could add gelatin after the math, so using the vital proteins, beef gelatin and adding that to your soup stock can get a little bit more of that therapeutic compound as well. But soups and ensuring that you’re optimizing your hydration is key and salt is something to not be overlooked because if you’re eating really clean, you have high tendency, especially when there’s electrolyte fluctuations and high stress to the body from toxic compounds from chemo, to get hyponatremia or low sodium, especially if you’re not eating a processed diet so adding salt to your foods is really important just as much as getting optimal fluid intake.
B: Ok so I think those are all really helpful tips for hydration status and electrolyte balance, so let’s now transition and talk about changes in digestion and in the bowels, so both diarrhea and constipation being potential side effect of chemo.
A: Yes. And radiation as well for sure, and diarrhea can happen also because of being immunocompromised so having susceptibility to foodborne compounds like moderate amounts of E.Coli or Salmonella, things that would not influence someone with a strong immune system. So being immunocompromised and also diarrhea can happen from just damage to the lining and distress in the GI tract and it can also happen when electrolyte status is off, and when so we’re looking at diarrhea, we’re looking for foods that will slow down the transit time, so soluble fibers, slowing gumming foods, so we’re looking at things like rice, we’re looking at things like cooked fruits, stewed pears with ginger is a fantastic option, we have the Poached Pears with Coconut, we’ll link that recipe on here and that’s also on the Naturally Nourished Cookbook but there is a great recipe to work with diarrhea and slowing down the bowel, as is Kanji. So Kanji is a traditional rice dish that I use therapeutically with clients all the time.
It’s made with about 4-5 times of cooking liquid as rice would, so usually rice is 2 to 1 so 2 cups of water to one cup of grain. When we’re looking at kanji we’re using double that so 8-10 cups of water or, I’m sorry, 4-5, not double the double, so we’re looking at like 4-5 cups of water and instead of water, I like to recommend bone broth so we’re adding in more nutritional density and it’s going to create this really gel-like porridge. It’s very nourishing and we can add into this things like, we can add burdock root to help tonify the liver and help with nausea, we can add ginger back in here, we can adds scallions, we can add turmeric we can also add in garam marsala and different waring seasonsins so using this kind of bland porridge that has this bone broth, the gelling of that helps to slow down the urgency in the loose stools so that’s definitely something to look at.
B: Ok and what about supplements that we can use?
A: Yeah so I mentioned that we can get the diarrhea from susceptibility to bacteria and this is where we can both eat the same spinach which can be moderately contaminated with salmonella and E.coli and one person will get sick and the other one won’t and that’s because we are introducing that pathogen to our own ecosystem of our microbiology. So if our gut microbiome is damaged by radiation, or our gut microbiome is sterilized through chemotherapy or prophylactic antibiotics, god forbid, even then we’re going to have really low baseline good bacteria and probiotics work as an army of defending against bad bacteria as well as supporting optimal digestive function, and upregulating natural killer cells in the body, we’ve seen in research that probiotics alone can be antitumorigenic so they can actually fight off cancer themselves. So I’m a huge fan, beyond, Imentiend, the emphasis of the digestive enzymes, also getting everyone going through cancer care on a good quality probiotic.
So we could start with our Restore Baseline Probiotic as a good start. This has a 50/50 blend of lacto and bifido cultures, which are the most well-researched and so I like to start there, however, if we have been on antibiotics as of recent, I like to go into the Spectrum, which has a wider, as it sounds, spectrum, or wider coverage, of more than 11 different strains of probiotics and also includes friendly yeast strains so if we’re dealing with any yeast flares in the body like oral candidiasis or thrush, or if we’re dealing with a vaginal yeast infection or have been on an antibiotic, then I would go right for the Spectrum Probiotic and the other one to consider for dealing with loose stools or constipation, and it’s become chronic is a little more potent of a probiotic and that’s our Targeted Strength Probiotic. So, Becki, I’ll as that you put a link to all 3 in our show notes and an explanation as to why people would require each one. So that would be between the Restore Baseline for just your insurance policy, if you will to the Spectrum if you’ve been on an antibiotic or if you’ve had any yeast flairs to the Targeted Strength which is the same thing as the Baseline Probiotic but it’s 4 times the potency so that would be if you’re having actual bowel distress.
B: Ok and I’ll link to all of that in the show notes. What about probiotic-rich foods, Ali?
A: Yeah so probiotic foods can be great as well, so if we’re talking about bringing things like Gut Shot by FarmHouse Cultures or if we’re going to be doing kombucha you could probably get kombucha locally as well at your farmers’ markets to kombucha will have a combination of both good bacteria and yeast and that is that symbiotic colony of bacteria and yeast. We can also get good probiotics from kefir and our yogurts as well as our raw aged cheeses, so food forms of probiotics can be great, the only thing I would state is if you are dealing with neutropenia or a specific risk of immunocompromised, we do recommend using the third party assessed colony forming units as a pill first then the whole food forms which do have potentiality to have wild strains and could have a little bit more of a dysbiotic influence on someone that is severely immunocompromised.
B: Ok that makes sense and we’ll talk about neutropenia a little bit in a couple minutes. So what about the opposite problem? How about speeding things up or getting things moving if we’re dealing with constipation?
A: Yeah so first things first, make sure you’re getting enough water, you guys, because you got to get something to move the tubes, and then fiber. So you know fiber can be a brick or a broom so we want fiber to work as a broom and that means that it needs enough water to create that flushing. So getting fiber upwards of 35 plus grams per day by eating your whole foods based diet, so 2-3 cups of leafy greens, getting in a good salad third plus cup of nuts and seeds per day, getting in your other 5 choices of non starchy vegetables, especially from your cruciferous vegetables which have a lot of fiber and then 2-3 fruit options should easily cover that, but you may add in a little bit of fiber as a supplemental compound so you could use the phyto fiber, which is a antioxidant rich whole food based fiber supplement or you could add in chia seed or flaxseed to your smoothies and all of that would work really nice. And those all work as prebiotics, so the phyto fiber and getting ample fiber in your diet is going to feed the good bacteria and maintaining a good bacteria base with a probiotic supplement is also a piece of the puzzle of ensuring optimal bowel motility.
B: Ok and then I know you have a little trick that you like to do with prunes so let’s talk about that.
A: Yes so 2-3 dried prunes that you put with 2 ounces of water, heated so you can do this in a little glass cup, and you heat that and then you mix that with 1 tablespoon of coconut oil and you blend that up. And it really pushes things through, it has osmotic properties, it lubricates with the coconut oil, the coconut oil also has antimicrobial and antiviral and antifungal compounds, and supports your healthy cells, and then the prunes are high amounts of that soluble fiber and that warm water can actually upregulate that pulsing, that’s also why people recommend coffee. Coffee can work as a bowel stimulant and adding coconut oil and/or grassfed butter or ghee would be another thing so doing a keto coffee would be another thing where you get the stimulation from the caffeine and then the warmth and then the lubrication. So we’ll put that in our show notes how to do that prune blend and that’s something nice to do before bed, whereas you could do the fat in your coffee or tea in the morning. And then if you’re still having issues, you could add in mag citrate a couple times a week, about 1-2 teaspoons at bed.
Now mag citrate is going to be better quality than something like miralax which can cause depletion and imbalance of your electrolytes, but it is just a stool softener so maxitrate is not a very bioavailable form of magnesium. It’s going to bring water into the colon so if you are having the marble-like bowel movements, where they’re dehydrated or there’s a lot of strain, that would be a go-to for mag citrate and then optimizing your hydration. However when we’re talking about magnesium deficiency and more whole body support during cancer treatment and care, I like to have people start with Relax and Regulate. Relax and Regulate uses a form of magnesium glycinate which is a more of a neuromuscular more bioavailable form of magnesium so this helps to actually get into the muscles to help with relaxation. It helps to work that peristalsis or that pumping of that GI tract to move the bowel matter down the colon, and it also can help with things like insomnia and neurological health so it can be a little more multifactorial than your maxitrate over-the-counter which is going to be more of a stool softener.
B: Ok so starting with Relax and Regulate and then using the maxitrate 1-2 times a week as needed?
A: Yea and you could use it every day as needed, needed but that’s probably a sign of a bigger issue and I would rather support the system with a probiotic and the Relax and Regulate and then using the prune blend with coconut oil, getting your water and fiber in the diet and then as needed use of the maxitrate as well, yes.
B: Ok. And then on that topic of the Relax and Regulate and that maxitrate, working on a more neuromuscular level, let’s talk about neuropathy that’s experienced as a side effect.
A: Yes so neuropathy is a very common side effect that can be quite painful and irritant that can last for years post treatment and this is often tied to deficiencies of particular nutrients as well as dysglycemia or blood sugar irregulation. So the first thing we look at is regulating the glycemic index so keeping the blood sugar in check and always pairing carbs with proteins and healthy fats and then bumping up the fats in the diet so ensuring ample amounts of avocado, coconut oil, olive oil, nuts, seeds and nut florus if we’re doing any baked good we’d want to use as a foundation of a nut flour instead of a grain flour, because not only will it be less inflammatory, it will be higher fiber, higher nourishing, and higher fat which is going to really help to protect that myelin sheath of our nervous coating so the nerve coating can be damaged by toxins which is the primary driver of why we get the neuropathy after chemotherapy or during chemotherapy treatment, but it can also be damaged by sugars. Sugars can actually demyelinate the lining. So when we’re talking about the diet, the first line of defense is carb control and then getting those fats up to protect the nerves.
B: And then what other therapeutic nutrients could be bring in. So the mag glycinate, what else?
A: So also inositol is the other thing that’s in Relax and Regulate and that’s kind of a derivative in the B family. It has a lot of benefits with the nervous system and it can also help with insulin resistance so it works with signaling in the body, so inositol can help with that myopathy and neuropathy so it can help with protecting the coating of our nerves. Also we look at alpha lipoic alcids, that’s probably one of the most well-researched antioxidants which is both fat and water soluble, alpha lipoic acid can also remyelinate or protect the nervous sheath and then B12 is probably the most common – all of the B vitamins can drive neuropathy when deficiency but B12 is probably the most common deficiency trend where we can get a tingly sensation. And, I know, personally, when I was a vegan experienced neuropathy from B12 deficiency. So mag glycinate, inositol, B12 and alpha lipoic acid are 4 big nutrients of focus when we’re looking at trying to prevent and/or cope with and reduce the severity of neuropathy.
B: And then what about food sources of all of these as well?
A: Yeah so you’re going to find your most dense sources of B12 and alpha lipoic acid from your animal products. So definitely ensuring back to that first goal we talked about of getting 80 plus grams of protein again, brewer’s yeast is another good one, it’s a nutritional yeast which we can add into nut ball products, add into smoothies, add into our kale chips. Leafy greens are a great form as well of nutrients that can help to protect our never cating and prevent that inflammatory rocoecess. Bumping up out glutathione and acetylcysteine with oru cruciferous vegetables like brussels sprouts, which are also a great source of alpha lipoic acid and then a total superfood for neuropathy and pain and fatigue is turmeric.
So turmeric is one that we want to get the benefit of both the fat and a water soluble compounds. So if we’re doing that as fresh turmeric root or turmeric powder, we want to incorporate that with a traditional dish which would have coconut milk or coconut oil because there’s going to be water naturally occurring from any times you’re cooking vegetables so you don’t have to add water but you do want to add fat every time you use turmeric so you get the most bioavailable absorption because we see turmeric helping across the board with pain and inflammation, neuropathy, fatigue, and then also taking it a step further, it can increase the natural killer cells and actually fight against cancer so it’s one of the most well-researched bioflavonoids or natural plant compounds, those curcuminoids in the turmeric that can fight against cancer. So it can help with side effects and also maintaining remission.
B: And then I hear a lot of people asking about adding black pepper either in cooking or synergistic- yeah, into a supplement with turmeric? So should that be in your turmeric supplement?
A: Yeah so there’s a lot of products out there that do the biopurine – biorpurine is the fancy way to say black pepper – biopurine and turmeric blends and this was well-researched blood studies that were looking at bioavailability. However, when we selected Super Turmeric which is the Naturally Nourished supplement that we have, it was actually studied against a biorpune curcuminoid blend and the Super Turmeric is the highest bioavailable curcumoind formulation on the market so we’re really proud and impressed. Anything that I’m going to stick my name on, obviously, I’m going to look on heavily and make sure I can stand by it and that’s why we couldn’t’ come up with a better than than Super Turmeric but, yes, it has 3 different bioactive compounds so it has 2 different curcuminoids and then the curcuminoid turmeric whole food oil so it actually blends 3 different curcumins, so curcumin, bysdemoxy, and demoxy itself, all those 3 curcumins and then turmeric oil.
And so they work together to be the most protected and most well-researched constituents of the turmeric root and they’re peak of the amount of anti-inflammatory activity and the sustained effects outperform anything that we’ve seen in the market including those combination formulas. Also culinarily speaking, yes, adding black pepper to your turmeric is just as adding fat that we’ve seen in research-based on this type of emulsification or the way that this is formulated, that this is necessary and it’s really helpful because adding that black pepper can add a lot of reflux so this formula tends to be well tolerated and does not have some of the gastric irritation which is definitely something we want to watch out for if someone’s already dealing with nausea and taste aversions.
B: Ok. Good to know. So this is also a formula, I know, you would recommend to prevent neutropenia so let’s get into what neutropenia is and talk about what this condition is.
A: Yeah so neutropenia occurs when our white blood cell count goes very low. Neutrophils are one type of a white blood cell that fights infection and chemotherapy just slams our body with chemicals and so we tend to get a hit all the way down to our bone marrow, which is where our white blood cells are manufactured and when our neutrophil count gets to a certain level of low, it’s called neutropenia and so when our neutrophil count gets low and infection is higher likely to occur and so we’re more susceptible to bacterial infection, we’re more susceptible to virus, and in this nutripeinic state there’s also a specific diet that tends to be recommended where there is a prevention of raw foods, prevention of especially things like sushi or those that would higher risk for bacteria and that’s where I mentioned probiotics, we might want to be a little bit more focused on getting in the supplemental form for a insurance policy, if you will, and then using the food as medicine as an additional support would be absolutely helpful and warranted but if we are in a higher risk for neutropenic state, we might want to only be consuming from produced foods that are third party assessed versus the wild cultures that you’re growing in your own kitchen or buying at the farmer’s market – you might want to be a little more conservative if you do have a low neutrophil count.
And then, also, we take that a step further where we try to do more cooked foods so even less things like smoothies, because I mentioned you may have more susceptibility to natural influence of E.coli from spill out form contamination of spinach and so we’re doing less raw foods, mostly cooked, cooked fruits and such and I generally will still put greens in smoothies but I might do a quick blanch just to be extremely conservative. But having that Super Turmeric does have natural antibacterial and antiviral and antifungal and antifimallmation influence so it can help with neuropathy it can help with the pain but it also helps to prevent bacteria and viral influence in the body so it can support the immune system while the white blood cell count may be vulnerable or hindered.
B: Awesome and I think we’ve talked a lot about food goals both from preventing neutropenia and then some of the other side effects. Let’s talk about the resource that you developed.
A: So we have on our website, as I mentioned if you go to that free download to alimillerrd.com Books and Programs tab and then Cancer Ebook and Becki right now is working on beautifying it, so I do apologize, it was done as a word document and it may not be the most aesthetically pleasing, depending on when you’re listening to this episode, I‘m sure we’ll have it up by mid November up and running but at this time, it’s $12.95 and it is still a fantastic resource it has so much information on it as far as the pathology of what drives cancer, what are cancer superfoods, and also it has 30 plus recipes to support your plan. But it will be getting a facelift and also more information packed into it and the price also will go up to $19.95 so you might want to take advantage of it currently at $12.95 and then we’ll be shooting out to our email list when it gets the facelift but it is the Cancer Ebook under Books and Programs.
B: And then I’m link to that in our show notes so people can find it even easier. So we talked about everything from texture to temperature to different flavor combinations to coping with digestive shifts, and I think we’ve really covered a lot of ground in this episode.
A: Yeah, I mean the biggest thing I want you to take home is the power of protein because, remember, that recommendation came full circle. Getting our protein up to store also means you’re going to be getting the nutrients like the B12 and the alpha lipoic acid and those compounds that prevent even painful side effects of things like neuropathy, so getting your protein up and the power of protein. Getting in your greens, this is another thing I emphasize, so trying to get those 2-3 cups per day whether you blend it into your bone broth or your smoothie, or you’re able to get it as a salad on the days when the appetite feels well. Working on your digestive support, so big emphasis there on finding a probiotic product that works with your body’s needs so whether it’s that Restore Baseline, or the Spectrum Probiotic or the Targeted Strength, considering the use of digestive enzymes to reduce the inflammatory distress of large food particles while also ensuring that you’re absorbing nutritional density and helping to regulate the bowel and help to cope with nausea with the Digestaid enzyme. And then we also talked about supporting your digestive system with ample fiber and using therapeutic foods like kudzu root and bone broth and then regulating inflammation so whether we’re using the Super Turmeric Supplement or we’re getting in the anti-inflammatory foods, including turmeric as foods, and probiotics, and ginger, I think we’ve left you all with a bunch of support across the board that you can support your system with prevention but also help a family member of friend in need that’s going through active treatment.
B: Alright so we will pull all the active link from this shown and the show notes will be available on this page at AliMillerRd.com\podcast. We hope this episode comes in handy for a loved, so please share it with friends via FaceBook, Instagram., amiale, anyone that could use this free source. And remember that the bet way that you could show gratitude for us, is to leave a 5 star review on ITunes so that others can find us on their health related search.
A: Ok thank you guys so much for listening and tune in next time.
Thank you for listening to the Naturally Nourished Podcast. Visit our blog at Alimillerrd.com for recipes, wellness tips, and food as medicine meal plans. Connect with Ali at Becki at AliMillerRD on InstaGram or Twitter and Facebook. Until next time, stay nourished and be well.