Can what you eat make an impact in dealing with cancer? Lifestyle Dietitian, Angela Zaccagnini, MS, RD from The Wellness and Integrative Oncology Program at UPMC Hillman Cancer Center shares insights from the Cooking for Cancer and Chronic Disease program.
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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.
– Can what you eat have an impact when you’re dealing with cancer or chronic disease? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And joining us right now is Angela Zaccagnini. She’s a lifestyle dietician and advanced practitioner at UPMC Hillman Cancer Center. Thanks so much for joining us.
– Thank you, Tonia. Thank you for having me.
– We are so happy that you are here. And, you’re part of the Wellness and Integrative Oncology Program at UPMC Hillman, and begin with telling me a little bit about that.
– Yes. So, our director, Dr. Lanie Francis, she’s a medical oncologist/hematologist. The program has been in the works since about 2016. We have a beautiful space located on the third floor of Hillman Cancer Center. It’s a large space that actually houses a teaching kitchen. It has a movement studio, therapy room. So, we use modalities such as movement, touch, mindfulness, and nutrition to help manage symptoms within cancer care.
– OK. So, can food really make a difference in managing symptoms with cancer care?
– So, as a dietician, absolutely, I would say so. And, it is symptom management-based, but it’s one part of that puzzle. So, I do tell patients that it is one part of that puzzle that they can control. So, obviously with a cancer diagnosis, their treatment plan, those are things they can’t really control, but diet, exercise, and stress management are the things we try to focus in on.
– OK. So, the program, “Cooking with Cancer and Chronic Disease.”
– Is it more so to provide foods for people that they might be losing their appetite while going through chemo, or is it more so to provide healthy foods and foods that we know that can help in the fight against cancer?
– So, it’s definitely a combination of both. So, we promote good, healthy nutrition, nutrient-dense recipes that promote anti-inflammatory foods and properties. And, in addition to that, we certainly touch base about symptom management throughout those cooking classes. So, we really try to dive in on how this particular recipe can help, say, taste changes, or decrease in appetite. So, we definitely try to tie it in and link it to that recipe that we choose.
– All right, so give me a sense of, inflammation, we were talking earlier — that’s key here. So, what sort of foods cause inflammation, and what sort of foods are sort of the power foods that people going through cancer or dealing with a chronic disease? And, when we talk about a chronic disease, that can be, like, what, heart disease, diabetes?
– Definitely. Yep. And those are a lot of things we see because patients that have cancer, they can have heart disease and diabetes as well, so it could be a combination of comorbidities that we are trying to at least manage. So, through diet, we talk about symptom management with, particularly, cancer, but of course we can talk about sugar and diabetes, but also low sodium or low fat when it comes to heart disease. So, we really try to link those with all disease states. But when it comes to anti-inflammatory foods, we really try to push that predominantly plant-based diet. So that doesn’t mean being vegan or vegetarian by any means, it’s just increasing fruits and vegetables, whole grains, beans, lentils, soy foods like tofu, tempeh, edamame. I feel like, and you probably know, too, that here in the United States, we consume a lot of fast foods, convenient, processed foods, and those are actually considered pro-inflammatory foods that could promote disease and infection.
– So, what do we know, though, about fruits and vegetables and all of those things that you just listed that we should be eating? What about them makes them healthier for us?
– Right. So, the antioxidants found in them, or the phytochemicals or phytonutrients found in them. So, they have great properties that actually can fight disease and infection that could help with certain disease states. And, actually, we want to try to be more preventive, and not eat these foods after we get a diagnosis, but try to prevent disease by consuming more of that.
– OK. So, now, explain to me how the program works. Do folks have to be there in person? Can I find this online? Tell me about your work in the kitchen.
– Yes. So, we are actually live every Wednesday at 9 a.m. It is found on YouTube. So, we have a YouTube channel now. We have high-end media equipment that we run, also, and we’re not chefs, so we have a lot of fun in the kitchen, and we cook, and it’s lighthearted, entertaining. And, like I said, we do have a YouTube channel, so it’s live every Wednesday, but all our recordings can be found there as well. And, to actually get the word out, we used a lot of marketing materials and kind of promoted it through the Hillman Cancer Centers, but I also have an email distribution list. So, each week I send out the recipe that we’re going to be making along with the YouTube link. So, patients, caregivers, as well as staff, can have access to it.
– So, tell me about what goes into these recipes. What sort of things are you looking for when you sit down to prepare? And do you prepare just main courses, or across the whole spectrum?
– For a while we were doing breakfast, lunch, dinner, dessert recipes. So, one recipe a week, so that would get us through a whole month. And we tried to send out a survey to patients, and caregivers, and staff to see what they were looking for, and it was a lot of healthy snacking and breakfast ideas, because I feel like that tends to be the hardest when you’re trying to cook at home for yourself. So, we try to take that feedback and run with it, but besides that, more like meal ideas, we look for predominantly plant-based recipes, but also things that are not too time-consuming to make or difficult. I feel like a lot of people get intimidated if they see maybe an ingredient they haven’t heard of, or a long list of ingredients. I know I, I’m like, “Well, if I have to go to the grocery store longer than an hour, I’m not going. I’m not using that recipe.” So, that time factor is definitely a huge thought when coming up with the recipes and determining what we’re going to make.
– And, so, really, you said a lot of them are plant-based.
– Not all of them. And as you are cooking in the kitchen, you’re also explaining to folks why this is a good recipe.
– Correct. Yeah. So it’s a lot of talking back and forth. I do this with our project manager, Danielle Petrina, she’s like my sous chef, and we have a lot of good banter back and forth, but she kind of probes those questions for me. She’ll be like, “Angela, what is the benefits of the ingredient in this particular recipe?” And, “How long are we going to cook that for?” So, she kind of engages the conversation, and then it’s more a back and forth, but we do talk a lot about the ingredients, symptom management as well, and then, in addition, we’re preparing the recipe so people can actually see what it takes to make the recipe at home.
– And, how important, not only for the patient, because you really are saying it’s managing symptoms by using certain foods and avoiding others, how do you think this affects the caregivers as well?
– So, I feel like the caregivers take a huge part of that lifestyle management for the patient. So, they’re actually doing a lot of the cooking, the prepping, the grocery shopping, because the patient themself could be maybe fatigued or nauseated, and they don’t want to be in the kitchen or cook a meal, so I feel like the caregiver has a big responsibility in preparing and choosing the meals for that patient.
– Are there basics? Can you give us a basic breakfast and why that is good?
– Yeah. So, we have breakfast quesadillas, or we’ve tried even banana muffins, or something that’s a little bit more like a pastry, but it’s healthier. So, we have so many variety of different recipes, breakfasts included, different snack ideas that are nutrient-dense, because when people hear snack, they may think potato chips, or cookies, but in reality we want something that contains protein, carb, and fat. So we try to come up with those recipes based on that need. And, also, of course, the population. So, a lot of times, patients can’t really tolerate a large meal if their appetite is off, or they’re just not hungry, or whatever it is. So, these nutrient-dense snack ideas are actually good, and they enjoy them. We also do a lot of healthy desserts because patients tell me, they’re like, “I’m addicted to sugar,” and I’m like, “Well, yeah, maybe, but …” So, just recently we did a silken tofu chocolate mousse recipe, and it was delicious, I’ve had it multiple times now. And that is actually our most viewed video, which I was shocked because …
– Yeah. I didn’t think people would be really interested in that, but yeah.
– All right. I want to hear more about some of the “good for you snacks.”
– And nutrient-dense snacks.
– Yes, yes. So, a lot of, like, energy bites. Have you heard of these recipes that are oats? They use coconut flakes, maybe some applesauce, or peanut butter? So, you use these combination of ingredients to make something like a protein bar. So, it’s quick on the go. So, if you’re running to treatment, or you have to go to a doctor’s appointment, or you’re just running out the door to work or whatever, this is something you can grab that doesn’t require that much time in preparing, but also you can store in the refrigerator for up to a week, have it grab and go, and it’s so nutrient-dense and full of fiber that it’s actually going to make you feel satisfied until lunch.
– When it comes to, we said lots of plant-based, you mentioned earlier before we started Mediterranean diet.
– And let’s tell folks a little bit about what that is and why that’s key.
– So, the Mediterranean diet, because it’s more linked to that predominantly plant-based, lots of fruits and vegetables, lots of nuts and seeds, beans, lentils, but there’s also dairy, seafood, meat, but that’s more in moderation. That’s in limited amounts compared to our fruits and vegetables and plant-based proteins. I feel like sometimes people understand Mediterranean more than plant-based because they’re like, “Well, what does plant-based actually mean?” So, really just trying to explain and not give them a diet, per se, to follow, but just increase those good, healthy foods.
– Is there anything that you say to people, “Stay away from, no matter what”?
– That’s a good question. So, that is a very common question I get, and when it comes to the oncology population, so all my cancer patients, they worry about every single thing they put into their body. And, if you were to Google “cancer and foods,” it’ll say, “Don’t eat sugar.” So, when it comes to sugar and cancer, there is somewhat of a connection, but it’s more linked to simple sugars. So, cookies, candies, pop, pastries, those type of foods, and not necessarily promoting or worsening cancer, but there’s a link to diabetes and insulin resistance. So, it’s very in-depth, but that requires a one-on-one counseling session with me and that patient or their family. So, I do tell them to limit simple sugars, but that doesn’t mean when they go to a birthday party, they can’t eat a slice of cake, or they can’t go out to ice cream with their family. I really want them to live their life and have a high-quality life, but those should be considered treats, and that’s really how I promote it.
– Is there any sort of sweets that, that you tell them are more tolerable than others?
– So, dark chocolates, fruit sorbets, those are actually considered anti-inflammatory, whenever we talk about those anti-inflammatory foods. So, if they tell me they’re addicted to sugars, we talk about maybe switching to dark chocolate instead of milk chocolate, or trying a fruit sorbet or a frozen yogurt instead of ice cream every night. So, trying to make those alternatives, healthier alternatives that can benefit them and not get so much high sugar and high fat, but they’re also getting protein, they can get some fiber. We try to talk about that a lot when it comes to healthy sweets, and goal-setting, and portion control. It’s really about that approach that you’re not going to change overnight, you have to start small and make small changes into a lifestyle that you really want to live.
– And so, mentally, how important do you think this work is? And even from the perspective of just having fun, do you feel like it gives folks another tool in their toolbox when they’re taking on this battle of cancer?
– Definitely. So, the cooking classes in themselves, I feel like it’s fun, it’s entertaining, it’s something they look forward to. But not only that, they learn to expand their food choices and feel comfortable and confident in the kitchen. A lot of patients and even caregivers weren’t into cooking or didn’t really know about cooking or what to cook. And it has really, we’ve gotten so much feedback about how now they’re wanting to try certain recipes and get into the kitchen a little bit more. So, not only that, but the program in itself is just almost like a safe haven for patients. So, it’s obviously traditional cancer care, but, in addition, integrative care, so we offer acupuncture, yoga, meditation, nutrition counseling, also these cooking classes. So, it’s that whole-person care, mind, body, and spirit, that’s our approach.
– Really moving things forward with that. Inflammatory, we’ve talked about inflammatory foods a lot. Is there anything else that you look out for?
– So, going back into foods that I recommend limiting, processed meats and red meats in particular. So, whenever I was sitting for my oncology exam, I read that we should limit our red meats to 18 ounces or less per week. If you break that down, 3 ounces is one portion, and you go to a steakhouse, you can get a 12-ounce piece of steak, and you’re almost at your goal for the week. Three ounces, that’s about six servings a week. If you’re choosing three ounces, which is like the size of my fist.
– So, I try to tell patients that and try to give them other alternatives for protein sources and different options. So, that tends to throw them through a loop, especially if red meats are a big staple in their diet, which being in Pittsburgh, meat and potatoes, that’s a big thing.
– Being Italian.
– Oh yeah.
– Cold cuts are, are the world.
– Huge. Cheese, yes. Processed meat.
– So, what do you say to that? What are sort, so are you pushing people more towards chicken, seafood? Tell me a little bit about what you tell them to eat instead of red meat.
– Yes. So, chicken, turkey, fish, definitely great sources of lean proteins. Also, our plant-based proteins, so beans, lentils, legumes, also whole grains. Quinoa is a complete protein, so if we didn’t want meat at all, that could be a good alternative, but we have to lean into that type of lifestyle, and I don’t expect patients or families to give up red meat completely, and that’s why I don’t like the word “avoid,” but “limit.” I don’t want any negative mindset associated with any food choices, but we know the benefits to those other choices are there. So, the red meats, there are many benefit to red meats, like high amounts of iron and B12. And we don’t necessarily get that from our plant-based foods. So, really trying to educate patients on good nutrition and getting that balance to make sure that they don’t end up deficient in any nutrient.
– Are often, do supplements, vitamins, sometimes go along with this when you’re on a plant-based diet?
– Yes, definitely. So, predominantly plant-based, like I mentioned earlier, not going completely vegan, because when you’re vegan, you don’t eat any meat or dairy at all. And meat and dairy contains vitamin B12. So no, no real vegetables or fruits contain B12. So, I strictly encourage vitamin B12 supplements for those particular people. Predominantly plant-based, if you’re getting meats and dairies in there somewhere, maybe a multivitamin to bridge the gaps to anything you may be lacking, but overall, you should be getting adequate nutrients.
– Is there any cold cut that is good to, to eat? Is there, two questions on that. Is there one that’s the lesser of evils? And then, if you’re going to say no, they’re all bad, how often can one partake?
– So, there’s really not a number on it. We really just recommend limiting as much as possible, but that could include cold cuts, but also like hot dogs, bacon, sausage, all of those processed, they contain nitrates. Those products, though, now you can find them nitrate-free or organic. So, you really do want to try to purchase higher-quality products and cuts of meat. So, I feel like processed and cold cuts of meat, those tend to be convenient, especially if you’re going for a lunchmeat sandwich or something like that, it’s something you can just prepare quickly and go to work or whatever it is. So we talk about alternatives to that, or maybe keeping it to once or twice a week, or keeping the cold cuts and cheese for, like, a special occasion. That’s where they’re going to be for me. So, really trying to determine how much the patient or person is currently eating, and then kind of tailor it based on the need.
– So, you do all these wonderful recipes. What would you say is the favorite part or the most rewarding part of your job?
– I feel like the feedback from patients and staff, even, that are involved, they tend to comment on the videos, or they’ll send me an email, like, “Angela, this was so fun, we’ve learned so much today.” Just, I truly feel that the feedback means so much to me, because obviously the content we want to put out there, and it’s free for everyone, but just hearing their approach, and what their, what they gained from it, feels so good.
– And so we will put on the screen where folks can go …
– To watch some of this.
– Our YouTube channel is called, “The Wellness and Integrative Oncology Program.” So, if they, if you were to go to YouTube and then search that in the link, all of our videos will pop right up.
– Does everybody hang around the kitchen on cooking day? Does everybody come and sample?
– So, during the live show, we kick everybody out because we have cameras, and we have mics, and the whole thing, and we put a sign on the door, “Recording, don’t come in.” But afterwards, when all the food is left out, we have like a staff lunch every week. So, it’s definitely fun, it’s team bonding. The recipes are great, and we try them on our own to really say that this is delicious, and you can make this at home. If we’re making it, you can make it.
– Do you think patients end up being surprised when you say to them you can do something, food is an essence, a tool, when you’re fighting cancer?
– It’s funny because I think the oncology population, and cancer patients as a whole, know how important nutrition is. And they come into me sometimes knowing so much and have done so much research, but the research out there about nutrition, it’s kind of controversial and skewed. So, like I mentioned earlier about sugar feeding cancer, that’s more or less a myth, but when a patient reads that, they’re very intimidated and then scared about consuming certain foods. So, really putting that evidence-based research out there when it comes to nutrition recommendations and making them feel comfortable with foods, and eating, and cooking.
– All right, tell me again, as we close, the dessert that was your highest-rated video.
– Yeah. So the silken tofu chocolate mousse.
– And what was in there? Just tell me
– So, silken tofu, dark chocolate, there was mint, and I forget the, it was four ingredients, and you literally just put it in a food processor. We put a little bit of coconut whipped cream on it with a raspberry, and it looked beautiful, and it tasted even better.
– Well, Angela, thank you so much for coming in and talking with us today. Some really good information. And, again, these videos are available for anyone who just wants to eat healthy.
– That’s right.
– Thanks for your time today, we appreciate it.
– Thank you so much.
– I’m Tonia Caruso, thank you for joining us. This is UPMC HealthBeat.
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