Talking Hope: Nutrition guidelines every breast cancer survivor should know

Talking Hope is brought to you by City of Hope, a National Cancer Institute-designated comprehensive cancer center offering Orange County’s most advanced cancer care. We bring together renowned cancer experts, offering grateful patients and leaders in the cancer community to share vital conversations, personal journeys, and unique insights into the disease that is diagnosed in 1 in 3 people during their lifetime and impacts us all.

In this episode, we speak with Kailey Proctor, M.P.H., R.D.N., C.S.O., a clinical dietitian and board-certified specialist in oncology nutrition at City of Hope Orange County Lennar Foundation Cancer Center. Why is eating well during breast cancer treatment important? What should you eat (and drink) to prepare for survivorship? Are popular weight-loss diets beneficial? Where can patients with breast cancer find nutritional support? Kailey answers these important questions and more for patients and their families.

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Darrin Godin: Hey everyone, I'm Darrin Godin. Welcome to Talking Hope. I'm excited to be joined today by Kailey Proctor. Kailey is a clinical dietitian and board-certified specialist in oncology nutrition at City of Hope Orange County Lennar Foundation Cancer Center. Kailey, thanks so much for joining us today.

Kailey Proctor: Thank you so much for having me, Darrin. I'm really excited to be here.

Darrin Godin: Well, I'm excited to have this conversation. I think our focus is going to be on nutrition for breast cancer patients during treatment.

Kailey Proctor: Yes.

Darrin Godin: But I found this great quote in preparing for this conversation with you. You probably know it very well. It's from the father of medicine, the ancient Greek physician, Hippocrates. He said, "Let food be thy medicine and medicine be thy food."

Kailey Proctor: Yes.

Darrin Godin: Is that your favorite quote?

Kailey Proctor: It's definitely my top five. It's a dietitian's favorite motto.

Darrin Godin: Awesome. Well, let's just jump right in. Tell me, what does the clinical dietitian do to support patients during their cancer journey?

Kailey Proctor: Yeah, so, sometimes I even meet with patients before they're diagnosed. They might be predisposed to cancer, have a genetic mutation that, again, increases the risk of cancer. So. We go over a cancer prevention diet. Oftentimes though, a bulk of my day is seeing patients who are on treatment, whether that's chemotherapy, radiation, immunotherapy, per-year post-op from any surgery. And then sometimes I get to follow them through the end and I meet them at the end of their journey. We talk more about getting back to their new normal, how to integrate more healthy options, just because sometimes when you're on treatment, what you're eating is a little bit different than your new routine. So, I just follow along patients throughout their cancer continuum.

Darrin Godin: So, talk to me a little bit more about that then. What sort of differences are there for a cancer patient? Are there certain types of food you recommend? Are there certain types of food you recommend to avoid?

Kailey Proctor: Definitely. So, when patients are on active treatment, chemo, radiation, especially before and after surgery, protein is the most important nutrient for them. We want to make sure there's no loss of muscle mass, make sure that their energy stays nice and stable. It helps with recovery after surgery. It keeps them healthy before surgery. A cancer dietitian is a huge fan of protein. But before treatment and after treatment, we really want to start incorporating more fresh fruits, vegetables, whole grains, beans, all those good high fiber foods. Just because sometimes during treatment, whether a patient's having any nausea, vomiting or diarrhea, fiber and whole grains might not be that center point of their diet anymore.

Darrin Godin: Gotcha. And what about liquids and things to drink? Should you avoid alcohol, or obviously water, soda, things like that. What do you tell your patients?

Kailey Proctor: I get the alcohol question all the time and rightfully so. It's a huge social thing. There's two schools of thought right now. There's the American Cancer Society, which says no alcohol under any circumstances for prevention, treatment or survivorship, which if we're being honest, is very extreme for a lot of people. Most people just aren't going to stop drinking cold turkey. The American Heart Association says moderation. So, moderation would be one, alcoholic drink a day for women, two for men. Keep in mind though the serving size. That's 12 ounces of beer, five ounces of wine, and one ounce of hard liquor per drink. So, I kind of like to go in the middle ground with alcohol and say while you're on chemotherapy, probably not the best option because some of the chemos are taken to the liver to be broken down as is alcohol. So, if you can save alcohol, very special occasions, birthdays, weddings, celebrations, anniversaries.

Water is fantastic. We want to keep you hydrated while on treatment. If you become dehydrated on treatment. Some patients also experience intense nausea, so keeping water with you. I even say if you want, you can put a splash of juice in there, like a fourth of a cup of juice to one, one and a half cups of water, because water can be very boring after a certain point. You can also do electrolyte beverages like Gatorade, Propel, even Pedialyte, especially if you're having excessive losses from treatment like vomiting or diarrhea. So, we want to stay hydrated. Coffee's okay too. Up to 24 ounces is considered hydrating, so that's about four cups of coffee. But yeah, just stay hydrated, try to limit alcohol to very special occasions, and try not to overdo it with the caffeine or the coffee.

Darrin Godin: Great, thank you. And what about some of these popular diets like Keto or Paleo or even Weight Watchers? What are your recommendations there?

Kailey Proctor: So, I know there's a lot of buzz around the keto diet. Unfortunately, there's not a lot of scientific evidence right now for us to really recommend it for patients. There is a small body of research growing for certain brain cancers it might be beneficial. But for right now, not recommending the Keto diet just because too, it cuts out major food groups like fruits, most vegetables, whole grains, beans and lentils, which have been shown to be cancer protective. So, don't recommend the Keto diet too much. Weight Watchers I think is great. I see that more for patients who may be after treatment, they want to lose weight to get down to a healthy weight. We know that being a healthy weight reduces the risk of up to 12 cancers, and even 5% weight loss does a world of good.

So, Weight Watchers, what I like about it is it teaches you portion sizes for your favorite food. So, you don't feel like you're in this diet mentality because most diets fail because they restrict foods or food groups. And then when you do get your hands on it, you just go overboard because you haven't had it for so long, so Weight Watchers. I love the Mediterranean Diet. That's the one I tend to recommend to most patients, because again, it's that plant forward approach to eating more produce, more fiber, leaner proteins, cooking with healthy fats like olive oil or avocado oil.

Darrin Godin: So Kaylee, can you tell us how do patients access nutritional care here at City of Hope?

Kailey Proctor: So, one thing I love about City of Hope Orange County is we have a very collaborative approach. There's a lot of different ways patients can get in touch with me. One, is when patients meet with their oncologist and they say they have a question about diet, nutrition, what to eat while on treatment, or kind of in their surveillance phase. Another one that I get a lot of referrals from is the infusion center. When they do their first chemo teach, the nurse will put in a referral just so I can touch base with the patient, go over more in detail about diet on treatment. And then I also get referrals down from radiation oncology. Even if they're in the clinic and they mentioned to one of our nurses or MAs that, "I have a question about diet," or, "I'm having this side effect and I kind of want to know is there anything I should eat for it," they'll put in a referral for me. So, it's very easy to get in touch with me, again, a very just collaborative approach, which I really like.

Darrin Godin: So, your role is really part of the overall care team? It's part of our care model that we wrap around our patients then, which is a great benefit to our patients. Right?

Kailey Proctor: Oh, I wholeheartedly agree.

Darrin Godin: I think you've answered the question around eat this, not that, but do you have any eat this, not that sort of messages that you shout from the rooftop to people just in general?

Kailey Proctor: Fiber, we love fiber in the nutrition community. I wish more people ate fiber. Right now the recommendations are about 25 grams per day for women, 35 grams per day for men. And again, that's coming from whole foods, fruits, vegetables, whole grains, beans, nuts and seeds. But what's really cool is if you have a hormone sensitive cancer like breast cancer or ovarian cancer, fiber binds with estrogen and then it's taken to the liver to be broken down so there's less estrogen floating around. I think that's really cool. It's cancer preventative. Also, it helps you maintain a healthy weight because insoluble fiber, meaning it doesn't dissolve in water, it expands in your stomach to keep you fuller longer between meals, so you're less likely to snack. Love fiber. Wish people ate more of it.

Darrin Godin: You mentioned specific changes for breast cancer. So, what other things are unique about breast cancer and being a breast cancer patient when it comes to your diet?

Kailey Proctor: So, one interesting thing I think that a lot of people don't recognize or maybe realize is breast cancer has so much research about it. There's a lot of money put into research for breast cancer prevention, treatment and survivorship. One common question I get from breast cancer patients is, "Can I have soy foods?" Just because there's estrogen in the body, so they think soy foods has estrogen. It doesn't. It has phytoestrogen. And I see where this myth kind of came about because estrogen and phytoestrogen, chemically, they look pretty similar, but I think there's a hydroxyl group that's switched out. And they've done research in Asian women and they start consuming soy foods at a much younger age than American women do, if at all. Some American women don't eat too much soy. And they have lower incidences of breast cancer, so it could be protective. However, with that being said, we're talking about whole soy foods, so think soy milk, tofu, tempe, edamame, and miso. We're not talking about the veggie burgers like the Boca Burgers, the Morningstar burgers. We want the whole soy product, minimally processed.

Darrin Godin: Wow. Thank you so much for that. And I know you're a dietitian and you specialize in that area, but it probably would be amiss to not talk about movement and exercise as well.

Kailey Proctor: Of course.

Darrin Godin: So, what other thing would you add around that?

Kailey Proctor: So, physically active and eating a healthy diet, they go hand in hand. You really, in my opinion, can't have one without the other. I find physical activity, especially for patients on treatment, it's really just good for their mental health. I always tell patients, "I'm not talking about going and running a marathon or signing up for this intense triathlon." Even just a 15, 20, even 30 minute walk once or twice a day. You're outside most of the time. I just think it's really good for your overall health. If you're struggling with your appetite, it can increase your appetite while on treatment. But also towards that prevention and survivorship aspect, if you're moving more, you're burning a little bit more calories, creating a little bit more of a deficit. And it can also be a bonding activity. You meet new friends that way. You spend time with your family. They go hand in hand. I don't think you can really truly separate one without the other.

Darrin Godin: That's great advice, Kaylee. Let me ask you a personal question. What led you to this line of specialty? What led you to becoming a dietitian?

Kailey Proctor: Yeah, so I grew up with an Italian mother and grandmother, so food was always pretty central in my home. We were always cooking in the kitchen and I just love food. I think it's so fun cooking and preparing new meals. But I didn't want to be a chef because that would, I think, just steal the joy from cooking and food. So, my mom actually just mentioned, "Hey, you can be a dietitian. That's not cooking all day." I'm like, "Really?"

So, long story short, I did have a two week rotation at a cancer center when I was a dietetic intern, and I just fell in love with the oncology population. I mean, I got to see the same thing what I do now. I saw patients before they started treatment, on treatment, after treatment, hormonal therapy. So, it was just such a blessing that I got that two week rotation. Had I been at another location, I was in Santa Barbara at the time, I wouldn't have gotten that. So, I think everything kind of happens for a reason. But I love working with cancer patients throughout their cancer continuum, using foods as just a way to heal or make them feel good.

Darrin Godin: Well, we're so glad that you're here at City of Hope now. And so I want to ask you this last question. What does the concept of hope mean to you, Kaylee?

Kailey Proctor: I think it means that you have this faith or maybe even desire that tomorrow there will be a new exciting opportunity or some new development. In the terms of the population we see, that there's either a cure or another line of treatment that might be really effective for their cancer that gives them more time or just buys them a better quality of life. I think it's just that desire, that faith, that these patients really have, and it's beautiful to hear them say that, too.

Darrin Godin: Well, thank you for sharing that as well, and we appreciate your time today. We appreciate you sharing these great.

Kailey Proctor: Of course.

Darrin Godin: ... Pieces of advice for all of us, and we hope you all join us on our next episode of Talking Hope. Thanks for joining us.

Kailey Proctor: Definitely. Thank you so much, Darrin. I appreciate it.