Beth Beckett, RD, CSO, LD, oncology dietitian at the Helen G. Nassif Community Cancer Center, joins Dr. Arnold to discuss nutrition and its impact on cancer risk.
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Host
Dr. Dustin Arnold
Chief Medical Officer
UnityPoint Health – St. Luke’s Hospital
Guest:
Beth Beckett
Oncology Dietitian
Helen G. Nassif Community Cancer Center
Transcript
Dr. Arnold: This is LiveWell Talk On…Nutrition and Cancer. I’m Dr. Dustin Arnold, chief medical officer at UnityPoint Health – St. Luke’s Hospital. Making changes in your eating habits may seem overwhelming, but eating the right foods can help with cancer prevention and help the healing process during and after cancer treatment. Joining us to talk more about the role of nutrition plays in cancer prevention is Beth Beckett, oncology dietitian, at Helen G. Nassif Community Cancer Center. Welcome, Beth.
Beth Beckett: Thank you.
Dr. Arnold: You are what you eat, aren’t ya?
Beth Beckett: Yes. That is very true.
Dr. Arnold: So that does take into account that you could potentially end up with cancer if you don’t eat well. What are some common cancers that are associated with poor nutrition?
Beth Beckett: Well, there are several. Some of the top couple types of cancers are some of the most common types of cancer overall. That would be colorectal cancer and breast cancer. So those are two of the most common types of cancers that we work with anyway. And they are some of the top cancers linked with lifestyle and nutrition and weight.
Dr. Arnold: Yeah. Well, I mean, we’ll set aside nicotine and smoking with the lung cancers and oral pharyngeal cancer that can occur with nicotine, but we’ll focus really on good nutrition with cancer prevention. So there are obviously some things I shouldn’t eat if I want to lower my risk for cancer. What are those?
Beth Beckett: Well, we try to focus on things not to eat and things to eat. So a lot of the recommendations are really more for a plant based diet. A lot of the top cancer organizations have recommendations and have done research that do that, that does show that nutrition and cancer are related. We really encourage a plant based diet. There’s no one specific cancer diet or anti-cancer diet. And there are lots of different approaches, but most of the organizations agree that a plant based diet and that doesn’t necessarily mean a meat free diet or vegan diet, but definitely focusing more on fruits and vegetables and focusing on lean meats, fish, healthy source of fats such as olive oil. And then also staying away from some of those things that are not as healthy, mainly just our junk foods or fast foods, things that are high in sugar, things that are loaded with unhealthy kinds of fat, heavily processed foods, things that we’re finding more and more of in our daily lives.
Dr. Arnold: Yeah, they’re hard to avoid. We’re all busy. The convenience factor is there. Sometimes the cost factor is there because it is really inexpensive to eat fast food compared to high quality fruits and vegetables. So tell me about that. What are some of the concerns that you have with getting people to participate in fruits and vegetables? Is it cost, is it dislike, is it stereotyping that, you know, they don’t like spinach. What do you experience when you work with patients?
Beth Beckett: Yeah, kind of a lot of those things really. And I do work one on one with patients and I do work with patients on healthy, healthy eating pretty often, that’s a big part of what I do. And so I do hear a lot of people’s stories and their backgrounds and kind of what, what, you know, what is causing them to have issues, why are they here to see me? And cost can be a factor for some people. There are ways to work around that. So some of the healthy foods that we have are not necessarily the most expensive. Carrots are fairly inexpensive, beans are fairly inexpensive, but these are plant based foods that actually have research showing that they can help us prevent cancer. So working with people on their budget and addressing that is something that I get to, I get to help people with. I have the time to sit down and spend an hour with people and get to know them and figure out solutions for them. Sometimes it is kinda how we were raised. You know, how our culture makes a big has made a big deal. We’ve had a big change in our culture as far as just how we eat in general and our accessibility to fast foods is so much greater now. So sometimes people have just gotten in the habit of eating fast foods cause it’s easier. And not everybody enjoys cooking either. That’s always a challenge for me when I meet people who are struggling with that because, you know, for me that is one of the ways to being healthier is to cook yourself so that you’re, you know, not being subject to whatever restaurants are making, the kinds of fats they’re using and that kind of thing. So we try to come up with very simple things that people can make at home that are not super challenging and don’t require hours in the kitchen.
Dr. Arnold: Would you consider making a Tombstone pizza as cooking for yourself.
Beth Beckett: That is definitely preparing something for yourself. But I would rather that people stay. I’m sure you can. I’m sure you can. No, really the answer to that I think is just to keep it simple. So we try to make it complicated. I mean, obviously you’re not going to eat an apple for a dinner, but if you can eat whole foods, if you can bake a potato, if you can put a piece of meat on a George Foreman grill or you know, throw something in the oven, it really doesn’t have to be, and it’s okay to use some convenience foods. Like for instance, canned beans is one that I definitely don’t have a problem with. They’re really not heavily processed. They do have a little bit more sodium, but most people are going to add sodium to beans if they cook them anyway. It’s easy. It’s quick. Tuna from a can, salmon from the packet. Those kinds of things are totally fine. And then round out with fruits and vegetables. That’s what we all need to eat more of. And we just, a lot of times, myself included, we don’t always do it. We don’t have to be perfect with our diet. There’s room for things, you know, treats and desserts and things like that in our diets. But I just feel that we don’t necessarily spend as much time and prioritize our health as much as we probably should. We have other things going on. We have stress, we have work-related you know, have a bad day at work and so we let other things kind of get in the way of our health goals sometimes. I think that is something that we can work on. All of us.
Dr. Arnold: Well I think also I’ve always said there’s three things that you don’t talk to people about religion, politics and food and nutrition because people have these set in their mind beliefs that they either will talk to people or read a website that reinforce it and are really not interested in changing. I mean people are pretty passionate about whether or not this or that, etc. Did you run into that sometimes some, some stubbornness that this is the way it should be?
Beth Beckett: Definitely, yeah. People just like you said, people have their opinions. My job, I feel as a dietician or even as a friend when I’m talking to somebody that I know personally isn’t to necessarily project my personal beliefs onto the person. But to get to know the person and get them talking. I think most people have a good sense of what they could improve upon already and they just, they need to talk it out with somebody. I do a lot of listening and not as much talking, especially now that I’ve been doing this for a little while and then you know, oftentimes I’m just kind of guiding the conversation to where somebody can share and a lot of people are able to identify things on their own that they might want to change. If somebody comes to me with a very specific diet that they have in mind, my approach is usually just to listen, talk to them, you know, find out why they’re doing it. Find out if they’ve done something similar in the past. Has this worked for you before? Kind of talk through those kinds of things. I’m not going to change somebody’s mind as much as I am there to support them and to help them kind of come to a plan.
Dr. Arnold: Well you, you, you know, one of the points in thinking about, I knew you were coming in today is to really make people aware of that obesity is associated with cancers. It’s easy to think about it being related to diabetes. Easy to think about it related to sleep apnea, easy to think about it related to coronary artery disease. You know, you always want to lose enough weight that if you should die suddenly people go, wow, I wonder what happened where if you know, otherwise they’re like, just assume that it was something related to your heart. Right. But cancers can be affected by obesity. What are the common ones that are linked to obesity.
Beth Beckett: The breast and the colorectal cancers. There are some other ones. It’s quite a few actually. Thyroid cancer, esophageal, stomach cancer, pancreatic cancer, gallbladder, liver, kidney, ovarian and uterine cancers are all associated with obesity. It doesn’t necessarily mean in my opinion that we know that that’s the exact cause of an individual’s cancer. But it is something that is associated. So we’re seeing those go together. How much of that has to do with nutrition, you know, and exercise. Those are obviously things that play a role in weight and we are finding some research studies are showing that even up to 40% of cancers can be related to obesity. So it is something that’s real. It’s a difficult thing to talk about. It’s a sensitive subject. It’s not something that’s easy to bring up. When I meet with people, I don’t necessarily make any assumptions that somebody wants to lose weight when they come to see me just because their BMI is over a certain number. It’s a very personal thing and I think that is one of the challenges with it. It’s very complex. You know, we know that eating too many calories and not exercising enough is a simple explanation for why overweight and obesity happen. We don’t know exactly. We’re finding more about why, you know, what, what makes somebody more likely to eat because of stress. You know, a lot of people do tell me that their stress eaters, but why do some people eat when they’re stressed? And some people don’t? You know, those, those are questions that are, you know, we’re finding a lot of new interesting research, but we don’t really have all the answers. So that does make it complicated. I do also feel that some people have felt very uncomfortable about talking with their weight. So it really needs to be something that is, somebody really wants to lose weight. They really need to be there and they need to be ready. So we always do that. We assess readiness for, for weight because it is such a challenging thing. There’s not simple medications that people can just automatically get prescribed, you know?
Dr. Arnold: Absolutely. I think, I think two things that I, that I often talk to patients about is, one is they don’t want you to blame everything on their weight. You know, whether they’re tired or their knees hurt. Certainly their weight is contributing that. But I think you have to have the discipline clinically not to just attribute everything to their body weight. Because you’ll miss something. And number two, it, you know, there’s, there’s people that can be big and have, be relatively healthy work manual labor and they’re just, you know, and they eat like they’re still on the farm, which is, you know, that’s a great for them, but you do not want to be obese going into your elderly years. You know, from my standpoint, what I see in the hospital is, the patients that have obesity go in their elder years, do poorly, they can ambulate less and it just is not a, a harbinger of a long life. When you get to that age and you’re, you’re morbidly obese. How about supplements? You hear that a lot with cancer. Free radicals and vitamin C and carotene and etc. What, what’s your position on supplements?
Beth Beckett: Yeah, I think that, that’s a tough question. I do work with a lot of cancer patients who are currently in treatment. That’s actually probably the majority of my patients are people that are currently going through chemotherapy or radiation. So it’s a little bit of a different kind of approach that I’m taking with these patients because many of them are struggling. The ones I see anyway are struggling with appetite, not eating enough. So one thing that we do encourage is, is and most of our oncologists that we work with encourage people to avoid supplements during cancer treatment. After cancer treatment, that’s kind of a little bit of a different, you know, a different topic. Yeah, I do think that some people with the antioxidants and cancer, some people are feeling that they, that they’re, they’re finding things. You know, I think it’s, it’s a personal decision. It’s something that you should talk to your doctor about. It’s something I don’t recommend for people to take supplements. There is, there are some cancers that, that we’ve seen some negative effects.
Dr. Arnold: Yeah. Yeah, I think so. I think beta carotene came out later to actually be associated with lung cancer.
Beth Beckett: Yeah. So it’s a little bit scary. I think it’s a little bit too, there’s too much, too many unknowns, I think. And I think you can, you can get your nutrients from food. There are studies that show out there that when you get nutrients from food that your body actually handles them differently. Whether it’s a synergistic effect of all the other foods that we’re eating, or there’s several of these nutrients that we need fat to absorb. So if we just popped supplements, we’re not necessarily getting the full effect.
Dr. Arnold: You know, that’s so true. This is somewhat related. You’ll have patients that come in with alcohol toxicity that they’ll have all their labs be abnormal, normal from the blood alcohol level, etc. But you can guess on rehydration and come up with these IV fluids that might address some of that. But boy, if you just feed them and it tends to normalize, and I always say that your, your kidneys are smarter than your doctor. You know, your kidneys will take care of you better than I can, provided that they’re healthy kidneys. And I think that’s true when it comes to supplements that above the recommended daily intake. You’re just probably peeing them out. You know really, and you can get in trouble with the fat soluble vitamins as far as toxicity building up. That being said, I do, I do put patients admitted to the hospital, particularly elderly patients on folic acid and thiamine early on because those substrates for red blood cells can, they can get depleted pretty quickly in a critical ill patient and you don’t want it to be an afterthought.
Beth Beckett: There are definitely ones that are very appropriate and are unlikely to cause problems and calcium and vitamin D, even things like Omega three, although there are some potential risks with that. It’s something that we seem to be missing from our diets so much, especially here in the Midwest where we don’t get enough seafood in our diet to really get enough of that. So it’s something that I wouldn’t necessarily recommend, but if somebody asks me, I would encourage them to discuss that.
Dr. Arnold: And I always talk about, you know, don’t be spending a lot of money on these products. Don’t be more taken out a second mortgage or a reverse mortgage…
Beth Beckett: Spend your money on better quality foods.
Dr. Arnold: Because they can just get in trouble that way and they may be wasting that money. One last question. Why did you come a dietician in oncology?
Beth Beckett: Well, this job came open when I was looking for an outpatient dietician position and so I really, that’s what attracted me to it. But in the past several years I’ve really gotten to enjoy working with cancer in general. I’ve learned a lot more about cancer. I had worked with cancer patients previously but not just cancer patients. And that’s what I do now at the Community Cancer Center is work really only with patients who have had cancer or currently have cancer. And I just really find that it’s it’s a good mix. Those patients that I’m helping to eat more and those patients that I’m hoping on weight management or diabetes, even a lot of other things, we try to do more than just focus on cancer. We’re trying to help people live healthier lives in general.
Dr. Arnold: Well that’s great advice, and as we started, you are what you eat. So eat healthy and you’ll be healthy. Really great information. Thank you so much for taking time to talk about this. Again, this was Beth Beckett, oncology dietitian. At Helen G Nassif Community Cancer Center. For more information on this topic or any other cancer related topic, visit their website at communitycancercenter.org. If you have a topic you’d like to suggest for our live well talk on podcast, shoot us an email at stlukescr@unitypoint.org and we encourage you to tell your family, friends, neighbors about our podcast. Until next time, be well.
