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Cancer Care & Nutrition Featuring the Dr. Yum Project

Cancer Care & Nutrition Featuring the Dr. Yum Project

Dr. Vaughn sits down with two physicians behind The Dr. Yum Project. Dr. Nimali Fernando (Dr. Yum founder) and Dr. Santhi Nair break down the resources and recipes made specifically for HOAF patients by the Dr. Yum Project and answer questions from the community submitted by our podcast audience. Listen now to go behind the diagnosis and learn more about how nutrition plays a pivotal role in general health and cancer care. Learn more at https://www.doctoryum.org/.

Dr. Vaughn:  [Music playing]  Welcome to “Cancer Shop Talk: Behind the Diagnosis”.  Today, we are speaking with two wonderful physicians about how nutrition can be a tool in bolstering your general health and supporting health during cancer treatments.  We have partnered with Dr. Yum, thrilled to introduce Dr. Nair and Dr. Fernando to the podcast. 

Well, I’m so excited today, guys, for this episode.  To all our listeners, we’re gonna talk about food, always a good topic.  But one of the things that comes up a lot when I meet with patients and families for the first time is how they can handle their nutrition, either on therapy or even after therapy, and how that influences sorta their journey through cancer treatments.  And so, I thought, nothing better than having some experts here in the world of food, Dr. Yum Project, which is well known to the Fredericksburg area, with Dr. Nimali Fernando and Dr. Santhi Nair.  So, I just wanted to have you guys kinda introduce yourselves.  And really, to those who don’t know what Dr. Yum is, maybe about your mission and how you guys got started, because I think it’s a fascinating story.

Dr. Fernando: Well, thanks for having us on.  Santhi and I love talking about food, right, Dr. Nair? [laughs]

Dr. Nair: Yes [laughs].

Dr. Fernando: Yeah.  It’s one of the things that brings us together, is our love of food.  So, we are both pediatricians, and we both really believe in the importance of teaching our young patients how to eat, starting from a young age, the best food possible.  Kinda the backstory of the Dr. Yum Project is that Santhi and I both independently were seeing how few kids really are growing up on a whole-food, nutritious diet.  And there’s an extraordinary amount of pediatric obesity that we were seeing, a lot of diet-related illness, independent of obesity.  

And we were both kind of independently trying to figure out how to get our patients to eat better, and I thought about, you know, maybe it’s just recipes.  Maybe – maybe everybody knows that they need to eat better, but they just don’t know how to do that.  So, I started putting some recipes on a website called doctoryum.com, and I started telling my patients about it and saying, ‘You know, these are some of the foods that my young boys like to eat.  And I bet that your kids would eat these same foods, too, if you just present them with a smile and some encouragement.’  And it worked!  And it was really exciting to see how that hands-on approach really does work.  

And so, I got a little bit excited and addicted to this idea of the hands-on information and started teaching some classes in the community, teaching families how to eat local produce and cook with it and invited young kids into the – into a kitchen in downtown Fredericksburg, Virginia, where we’re located.  And then, I got to meet Dr. Nair, and I realized, gosh, here’s another pediatrician who’s as passionate about this as me.  And so, we decided to make our passion a real community project, and we started the Dr. Yum Project, back in 2012 and became an official non-profit in 2013.  Did I get it right?

Dr. Nair: Yep!

Dr. Fernando: [laughs]

Dr. Nair: I can’t – I cannot believe it’s been that long, actually [laughs].  

Dr. Fernando: I know.  I know.  We – we’ve always thought of ourselves as a young non-profit, but we’ve been doin’ this a little while now.  And it became – it started out really very pediatric focused, but what we both realized, and what our – our Board of Directors realized is, we started trying programs and seeing what stuck to the wall, and what resonated with families is that we can’t just teach kids how to eat well.  We’ve gotta really focus on how do we create an infrastructure, and how do we support a family that eats well?  A family can include babies to grandparents, right?  And that child needs a family that knows how to eat well, and they need schools where that’s the culture, and they need a community where there’s infrastructure and access to good food, so that eating healthy food is easier, and we can overcome some of the barriers that are so common.  

So, we started out being very focused on kids.  But we soon grew to realize the importance of including adult medicine physicians in our efforts, so that they can teach their patients how to eat better.  And early on, your practice joined our effort, as a partner and sponsor, and we love practices like yours that use our resources and our programs to teach your own – teach your patients, too.  And it just leverages the message to have partners who are onboard, and it just spreads it throughout the community and beyond.  Because now, with the pandemic, we’re reaching families virtually more than ever, and so, we have lots of partners and programs and participants around the world.  

So, that’s really exciting for us, too.  So, we – we are very focused on how do we overcome barriers to eating well, because it can be different, right?  For your patients, the barriers are different than mine.  For some communities, the barriers may be access and resources.  For some families, it’s time, right?  So, what’s nice about having a physician-led organization is, we get to see the barriers firsthand in our own clinical practice, in talking to patients and saying, ‘Okay.  What is it?  How – why is it so hard to get a nutritious meal on the table?  And how can we  help you?’  I love problem solving, and so does the rest of our Board, and that’s what we’ve been doing, since 2013.  

We have a lot of problem solving happening on our website, a lot of recipes, hands-on information.  We even have Zoom classes now.  So, we have a teaching kitchen in Spotsylvania, Virginia, which I share with my private practice.  And we have all kinds of programs throughout the year, serving children and adults through other non-profits and programs.  And with the pandemic, we’ve really had to make that available virtually, for safety reasons.  And so, we have a whole Zoom cooking class series now that we do, and anyone who’s listening can join us.  The classes are free.

Dr. Nair: Yep!

Dr. Fernando: They’re super fun.  We have them almost every other Wednesday, in the evening.  And it’s — it’s a fun way to join with other people remotely and learn some quick and easy ways to get meals on the table.

Dr. Nair: I know.  Last week, when we were talking in our Board Meeting, there were even people from Canada that had joined in for the cooking class.  So, definitely, we’re – we are hitting a lot of people outside of the United States [laughs], too.  So, that’s [crosstalk]

Dr. Fernando: Yeah.  We – actually, over the summer, when a lot of parents were dealing with the pandemic, those same issues were felt worldwide.  And so, we were approached by a non-profit who serves early childhood issues in the Middle East and North Africa.  And they approached us to do a webinar series for families in the Middle East and North Africa, addressing nutrition during the pandemic, for young children.  So, we were able to do a six-episode webinar to help families who were dealing with [laughs] the same issues that we are dealing with, here.  

How do you get kids to eat good food when you may not have access, and you’re worried about going to the grocery store, and kids aren’t liking the food on the table, and all the same things that we are dealing with.  So, it’s been wonderful to reach a bigger audience.  We hope to get back into the kitchen and have those face-to-face interactions, which are so meaningful.  But in the meantime, we have reached so many new families, it’s wonderful.

Dr. Vaughn:  Nimali, that’s kinda striking you mentioned working with the families over nutrition, because as a oncologist, of course, I don’t really work in the pediatric or child realm, but so many times, it is teaching – almost teaching some of our older patients how to eat, you know, [laughs] and kinda changing their habits.  So, working with the children, who may be in their mid-30s or early 40s, so reaching them, to teach their – their parents how to eat properly, or let’s say change their dietary habits, and then, that also can affect their children.  

So, it is – it is true how – and then, I think in oncology in general, we do kinda center on a family approach, anyway, just going through the treatments of cancer.  It does take a lot of support networks [laughingly] in place to do that.  It is quite – quite interesting how you can reach a broader picture through nutrition, with working with one, single cancer patient, for instance.  I guess –

Dr. Fernando: Yeah.

Dr. Vaughn: — and you mentioned barriers.  As an oncologist, what are some of the barriers that I should – we should be focusing in on, on our patients?  It may not be school system based or other things, I guess.  So, always access to food and financial barriers, but are there other things we should be focused on? 

Dr. Nair: I think one of the things would be, when your patients are on chemotherapy, a lot of them are not able to tolerate regular food, but they still need to have good, high-calorie foods, to maintain their weight and to be able to get through chemotherapy.  And I think it’s – it would be great to be able to offer a resource where they can go to, where as a physician that you trust as well, to go to a resource that you can be like, ‘Okay.  Well, go here.  And go to the Dr. Yum website, and there are resources for you, for high-calorie foods that are healthy and that is going to be beneficial.’  Do you know what I mean?  And not just sending them to go get a milkshake at McDonald’s or – do you know what – because that happens.  Because we want them to gain weight, right?  

So, I think in that way, it’s helpful.  And I don’t – and I – as a physician, I don’t always have time to sit down with patients and have a – an hour-long discussion about how to cook and stuff, because we’re seeing patients on the go.  So, it – it’s nice to have something that you know, like Nimali said, that’s physician led, that you can count on.  It’s – that’s the beauty, I think, about our website.

Dr. Fernando: A lot of the search tags, like Santhi mentioned, “healthy high calorie”, is a search tag on our website.  And we think a lot about barriers when we’re creating those search tags.  And actually, your practice, as an oncology group, really helped lead the charge on that tag, because so many of your patients do need calories, right?  Depending on where they are in their treatment, they could need a lot of calories.  But we want those calories to be high quality, as Santhi mentioned, and not just empty calories, and provide some phytonutrients and some support to their immune system, whatever it may be that they need.  

So, we created that “healthy high calorie” tag, really with your patients in mind.  We also have patients sometimes that need fast calories, kids who may be falling off the growth curve.  And we also want the best quality food for those patients, too.  So, we think about barriers when we’re making those tags.  Some of the barriers that your patients may face are the same barriers that all of us face, so, time, right?  Maybe we don’t have the time, because we’re going to treatments, and we have – we’re tired because we’re faced with a new set of challenges, with a new diagnosis.  

And so, we wanna be able to come up with ways to feed ourselves that don’t take a lot of time and that aren’t too complicated.  So, we have some search tags that are fast recipes, that are quick to make, that are also nutritious.  Another barrier could be cost, right?  So, a lot of people have this misconception that healthy food is very expensive.  And some healthy food is expensive, but you can absolutely make high-quality, nutritious meals that are actually very affordable.  And so, we have a tag that is “budget friendly”.  And there are actually recipes that cost less than $2.50 a serving, which is less than a Happy Meal, but have phytonutrients and fiber and protein and all the things that you need to support yourself, especially in a challenging diagnosis like your patients may have.  

So, yeah.  I think the barriers – there can be specific barriers that your patients may face, but all of us kind of – we feel like, ‘Gosh, is there enough time, and is it gonna be too expensive?’  And the last barriers, does it – is it gonna taste good, right?  So, another barrier might be that healthy food doesn’t taste that good [laughs].  And a lot of people have that misconception, too.  And we – we’re very adamant, and we test – we have a pretty stringent recipe process – recipe development process, where we don’t put a recipe on our site that doesn’t taste good, that we don’t all love.  

So, when you go to the Dr. Yum Project, you are going to find a lot of very delicious recipes.  Many of them are easy to make, and a lot of them are cost conscious.  And so, those are the big barriers that we see, in talking to patients, too.

Dr. Nair: The other thing that I think is really important is, after a remission of the cancer, it’s how do you continue so that you continue to live or to eat a nutritious, healthy meal, going forward?  Do you know what I mean?  To continue to keep your body well.  So, I think that’s really important, too, the aftercare as well. 

Dr. Vaughn:  I think of nutrition as an – and as an oncologist, of course, I’m kinda just kinda narrowminded here, just for a second.  But I think of it in – as being – maybe nutrition, how do you help patients stay on schedule, on therapy, which you guys were talkin’ about, like high caloric needs, which also, not only that, it’s also what’s – kinda can be difficult is, patients have – can nutrition also help certain side effects with treatment, for instance, like – are – or do you guys have any advice or recipes, for instance, like if someone’s really having a lot of nausea?  How can nutrition or meals kinda help treat that?  

Or are there certain foods that would exacerbate nausea?  If – and taste can always be an issue.  Taste changes based on certain chemotherapies.  Some like more sour-tasting foods or sweet-tasting foods, constipation, what – so, it’s challenging to keep their caloric needs up.  But also, maybe nutrition can help manage some of the side effects of treatment.  And I don’t know if you guys – do you guys have any advice or anything on the website to help with that? 

Dr. Fernando: Yeah.

Dr. Nair: Yeah.  I think some of our recipes, looking at – thinking back to some of our recipes, I don’t think we have a specific tag, but it’s something we definitely could think about adding.  Because we – you use a lot of things like with ginger, and ginger is really good for nausea.  When my kids are nauseous, they have a stomach illness, we make this ginger tea.  Actually, Nimali, the sore throat sipper is amazing for nausea.  So, then – and a lot of our recipes – there’s tons of recipes that have ginger in it, and nutmeg is really good for nausea.  

So, the funny thing is, because both of us are also from different kind of cultural backgrounds [laughs], we – this website is full of totally American, Indian, Sri Lankan, all sorts of different cultural foods, too.  And a lot of those cultural foods do have a medicinal kind of healing properties –

Dr. Fernando: Spice profile.

Dr. Nair: — yep.  Turmeric, all of that.  But it is a good thing – Nimali, doing something where we could do something for – especially on your page, on Hope’s page, right, Nimali?  That might be a really good –

Dr. Fernando: Yeah.  I think so.  And I’m – I was just thinking about how maybe there’s some overlap between some of the needs of your patients, when they’re having side effects, and maybe some of our picky eaters, that we deal with.  You know, it might be –

Dr. Nair: Yeah.

Dr. Vaughn: Yeah.

Dr. Fernando: — that some of those intense tastes are challenging for patients when they’re undergoing some of the therapies.  And we have our own set of patients that have trouble with intense tastes [laughs], and those are our pickier eaters.  So, we actually created a tag called “kids club”, and they are recipes that are particularly gentle, for our challenging eaters that have sensory issues, that are sensitive about certain tastes.  And they’re kind of very nutritionally dense but actually, easy recipes, familiar kind of comfort food recipes that a lot of kids like.  And so, perhaps there’s some overlap there, where your patients may enjoy some of those mild recipes during parts of their treatment, when intense tastes are challenging.

Dr. Nair: That’s true.  Definitely true.

Dr. Vaughn: And then, you mentioned, I think, also, taking sort of that initial approach when someone’s on therapy, maybe more – like you mentioned, whole foods or whole-grain [sounds like] recipes, how to cook.  And then, translating that into their what we call survivorship, after therapy, how we try to kinda focus on just a general wellness approach to life, lifestyle.  And I mean, there’s definitely a correlation between cancer occurrence risk, and there’ve been studies on this, as far as – a lot of the stuff you see with metabolic syndromes, things like that, also can kind of correlate with an increase in cancer risk, recurrences.  

I imagine that’s something that – you guys must see some overlap, probably, from your experience with – doing not only adult but pediatric medicine, and the obesity issues.  What are you all’s approach, I think, when you see that, like trying to really focus on a sort of wellness style to eating?  What – when – how quick does it happen?  Do you just find it’s easy to [laughs] adapt to, or is it really a work in progress?  I mean, I always find it’s easy for patients to do it for two or three weeks, but staying on it, how do you – how do you kinda keep pushin’ the needle with your patients? 

Dr. Fernando: I think our approach is not that we wanna change how you eat overnight, nor do we wanna take away the foods that you love, right?  We wanna make this easy, and we want the change to be long lasting.

Dr. Nair: And also, not have – and not be judgmental, right?  We wanna do it in a very –

Dr. Fernando: Right. 

Dr. Nair:  — easy, kind of calm, and not anxiety provoking way.

Dr. Fernando: Food is so much more.  It’s – there’s culture, there’s emotion, right?  And so, we never want food to be a source of stress or anxiety.  So, our approach is never about, ‘You have to eat this way’, but showing families other foods that they may love, that they never thought they would love, and have them slowly incorporate those new foods into their family culture.  And I think that’s a more meaningful way of longer-lasting change than to be really prescriptive.  And nobody likes to be told what to do [laughs].  So, we rather like to show people, ‘Hey, here’s a great recipe.  Try this.  You might incorporate this into your family culture.’  I think that’s the way we do it.  

And multi-generational change, as we talked about before, I think really helps it to stick.  So, when we teach a baby food class, we’re hoping that the parents will start eating differently, and maybe the grandparents will start eating differently, and take on this slow and steady change.  And we want them to continue to use our resources, so that those babies come in for a preschool camp, maybe their parents join a virtual cooking class, maybe the grandparents then come along for the ride, and we really shift the family culture into more of a culture of wellness.  I think that’s the best way for it to happen, honestly.

Dr. Nair: Yeah.  And I know that, for us, this might be – one of the classes that we do is, we do – is it a four-week session, on parenting for wellness.  And that’s a class that we used to do in person, right?  And Nimali can talk a little bit more about that, but it – that’s for the family.  And just like you were – 

Dr. Fernando: Right.

Dr. Nair: — how do – how do you create a culture of wellness?  And there’s this class that’s offered that can help with that.  Nimali, you wanna tell [crosstalk] about that?

Dr. Fernando: Yeah.  Yeah.  A lot of the attendees of that class come to us because maybe there is a diagnosis in the family.  And for the first time, nutrition feels really important, and there’s some urgency to it.  Maybe a child was diagnosed with a food allergy, or someone was diagnosed with cancer, and nutrition, all of a sudden, is taking center stage, but it never has.  And so, they need tools to kinda figure out how to do this, how to cook more.  And so, often, there’s a child in the mix, too, so we build some parenting around food as well . 

But we give a lot of tools on just how to make quick, easy meals, and how to bring some mindfulness into eating as well . That’s really important to us.  So many of us are eat on the go, get that meal in, it’s all about just getting the calories in.  And we forget how important the experience of eating is together, the importance of family meals.  So, we visit important topics like that, in that series.  It’s an all-comers kind of a class.  Anybody really, I think, can get something out of that class.  And because of the pandemic, again, we’ve made that a virtual class.  So, anybody can attend that.  

And I think the other thing that might be important for your listeners to know is that we – we can create classes, too.  So, if there’s a group that wants to come in and learn a specific way of eating or a topic, we’re very flexible, and we can create classes for groups, too.  So, if you go to our website, you can contact us and let us know how big your group is, what kinds of things you’d wanna learn, and we can help create that experience for you.

Dr. Vaughn:  I have seen, and it’s really because of the pandemic, and really, people have not been eating out, I have got a sense, at least from my interactions with patients over the past year, you know, patients have been isolated, but families have been together.  There has been a little more focus on cooking together.  And you’re so right.  I think nutrition is such an opportunity, you know [laughs], when everyone is together.  I think it’s – to see some changes, not only – I guess it’s an opportunity to really focus on health for the whole family.  Maybe their child – like I mention, their grandparents, just a great opportunity – and the ability to have some resources like an online class for – that’s amazing for our patients to have access to.

Dr. Fernando: It – this mission, we’ve been at it since 2012, but it was really in 2020, with the pandemic, that we all looked at each other and saw how much need there was for inspiration and information on cooking at home.  And we kinda looked at each other and said, ‘This is our moment!’ [laughs]  ‘This is our moment to really show people how to eat and cook at home.’

Dr. Vaughn:  Yeah.

Dr. Fernando: And we built this great big toolbox for all of these years, and now it’s time to unleash it.  And so, we got very active on social media.  We did YouTube Lives every week, Facebook Lives every week, Instagram posts, and really tried to put out a ton of content.  My son, who is a freshman in college now, he – because of the pandemic, he had to delay his start of his freshman year.  So, he was home for four extra months.  And he’s a kid who grew up with the Project.  He actually, after years of eyerolling and helping me in the kitchen, he actually honestly likes to cook now.  

So, we worked with him and our dietician, Sarah Moran, to come up with a cooking series on YouTube, called “Cooking on Your Own for the First Time”.  In that series, he covers important topics for people who find themselves cooking a lot now.  Maybe they’re out – in college for the first time or in their own apartment, or they’re living by themselves for other circumstances, and they’re cooking.  And it’s, you know, what do you need to have in your kitchen, to cook a great meal?  And what kinds of things do you need to have in your pantry?  And how can you take a ordinary box of mac and cheese and infuse some flavor and nutrition into it?  

So, it was just opportunity, right, to create that kind of content that people were needing.  There was also so much pandemic-specific challenges, like I only wanna go to the grocery store once [laughs] every week or once every two weeks.  And when I go there, I don’t see the usual stuff that I have, right?  So, how do you improvise?  So, we had a – we had a good time and made the most out of a challenging circumstance to create some new content that we could share, worldwide.  And a year later, here we still are. [laughs]

Dr. Nair: Yep!

Dr. Vaughn: Yeah.  So, guys, I wanna – I want you to help me out in a situation that comes up a lot with me in practice.  And I’ll use an example.  Mrs. Jones, let’s say she’s had breast cancer, just through – went through treatment for breast cancer, about four months.  Was able to get by.  Of course, as usual, some bumps in the road.  But she comes in and now wants to talk about changes in lifestyle, how she can utilize nutrition to maybe help improve her chances of never having breast cancer come back.  

And I just wanted to ask you guys how you approach that.  And it may not only be specific to cancer treatments but just adopting a kind of general wellness approach and how – what you would recommend, from a nutritional change.  And as you – we were talkin’ earlier, it may not happen overnight.  But what are some of the things you really kinda focus on, during those early months, to kinda help her change and kinda begin this kinda lifestyle change, that can last a long time?

Dr. Fernando: In all – in any kind of scenario like that, finding ways to improve your diet, by including more plants, is never the wrong answer.  Right?  A plant-strong diet seems to be a very evidence-based way of reducing risk, in general, from chronic illnesses.  And so, I think that’s a good place to start is, how can you incorporate more of a whole-food, plant-strong diet?  And where I can, I try to find evidence to support that.  And one of my go-to’s – I don’t know, Dr. Nair, do you use this website a lot?  It’s nutritionfacts.org.

Dr. Fernando: It’s such a great resource.  I don’t know, Dr. Vaughn, if you use this, but it’s – it’s kind of my go-to.  Nutritionfacts.org is a non-profit organization led by Dr. Michael Greger, who’s a best-selling author.  He’s written many books.  He is a very evidence-based internal medicine doc who focuses on nutrition literature and posts a video every day, and he has a ton of information on specific diseases and what we know about how nutrition can support those diseases.  And so, I would do a lot of research to find out what it is, specifically, that you could be eating more of.  

But again, a blanket – I think the blanket advice of a plant-strong, whole-food diet is always a good start.  And then, of course, there’s the things that we know, including more exercise, more connection to the people that you love, having more exercise in your diet.  All of those things, I think, support that.  Santhi, do you have any other ideas that I may have missed?

Dr. Nair: Yeah.  I think – I think also just eating well-balanced meals and less processed foods and eating foods that are – have high antioxidants and incorporating some of those traditional spices in your food and kinda steering away from eating – not just fast food, but just eating out, trying to make eating and food preparation part of your family.  I think those are the things that I kind of – at least that I focus on, right, with anybody that wants to kinda change things around.  And I always tell people, ‘Everything in balance’ [laughs], right?  

Because sometimes they – there will be some kind of – for example, coconut oil is good for you.  But then, you have people drinking coconut oil [laughs], people – when you can take something good, and you can go crazy with it, and then, eventually, turn bad [laughs], when you – so, it’s everything in balance.  That’s what – that’s what I think.  Everything in balance.  And yeah.  I mean – and just making sure you eat on time, you’re not – you’re exercising, you – less stress in your life.  I think if you eat well, even your stress level is better.  So, those are the things that I would tell your patient and check out the Dr. Yum Project. [laughs]  And join – and join that wellness class.  So, those are the – or classes such as that, that kind of look at the whole picture. 

Dr. Fernando: One thing about some of these virtual experiences is, right now it’s hard with COVID, I would think particularly for your patients who are immunocompromised, to connect with people in the same ways as we’re used to.  And that support is so important, but it also – we have to be mindful of safety right now and exposure to coronavirus.  One thing we love about our classes is, there is a little bit of connection.  It’s safe. You can talk with people.  You can cook together and have a mindful experience around food.  So, that’s what I wanted to add.

Dr. Vaughn: I was gonna – I was gonna ask, maybe we should bring out the – a color wheel for our adult patients [laughs].  Isn’t it – what I remember is, you wanna have a lot of color, right?  So, the more color, the more healthy –

Dr. Fernando: Yep.

Dr. Vaughn: — vegetables and [inaudible], right?  Maybe we should not only be using that for pediatrics, but [laughs] – 

Dr. Nair: Absolutely.

Dr. Vaughn: — my question is, does it matter – do you guys have any experience on the number of meals patients eat?  Because I get asked a lot, ‘Should I eat three full meals or five, smaller meals, portion size?’  How do you approach that?  Does that change their general nutritional state?

Dr. Nair: I really think that there’s not a one-size-fits-all for nutrition.  It’s interesting, too, if you look at the evidence.  I read articles all the time that are conflicting, about whether breakfast is the most important meal, or you should skip breakfast.  And having kind of a mindfulness about what works for you, individually, is important.  And for some people, the small meals feels more natural, and it feels more comfortable.  For some of your patients, it might be – who are suffering with nausea and other symptoms, having bigger meals may be harder.  So, that smaller, more frequent meal approach might be better.  

So, I don’t think there’s a blanket answer, necessarily, for that.  It may be different, even, as you’re going through different treatments, it may change.  It may flux.  I think it’s just, again, applying a mindfulness.  And making sure that we’re eating to satiety, that we’re not overeating, that we’re listening to our hunger cues and our fullness cues I think is more important than a number of how many meals we’re eating or how long we’re taking to eat, or that kinda thing.

Dr. Fernando: Yeah.  I – no, I totally agree.  Also, you were talking about being mindful.  A lot of the times in people’s lives, we’re so busy that we’re eating while we’re working.  We’re eating while we’re watching TV.  We’re eating while we’re texting.  We’re eating – and there’s no way you can be mindful.  So, we end up overeating.  We end up undereating.  You know what I mean?  So, there’s so many of those kind of issues that happen.  So, making sure that that patient that you were talking about, part of the wellness would be being mindful, being – when you’re eating, try to just focus on each bite and focus on that.  And I think that’s also very important.

Dr. Vaughn:  All right.  So, guys, these are some questions I get, and try to answer them the best you can [laughs] and help guide some of the patients and their questions.  But one that comes up quite a big, and a patient asked me, ‘Do different diets matter?’  And I’ll use an example, like, is a vegan diet better than a ketogenic diet?  Part of it may be, does it help create different inflammatory states or fight cancer?  How – and how – how do you approach when people come at you with different diets?

Dr. Fernando: Again, I – I typically look to evidence for answers like that.  And I – and again, there’s no blanket response.  I think that everybody’s gotta kinda do what is – what works for them, or dependent on their diagnosis, or are there other circumstances.  I would go back to my favorite resource, which is nutritionfacts.org, looking for answers.  If I have this disease, what would be some of the nutrients or foods that would support me?  I don’t know that there’s a blanket answer.  I know there are a lot of fad diets, and there are a lot of diets of the day.  And we don’t really like the word ‘diet’, necessarily [laughs], at the Dr. Yum Project.  We want healthy eating and whole foods to be a lifestyle, more than really prescriptive diet.

Dr. Nair:  Sometimes patients will come in and ask me, ‘Well, what – which one is better, ketogenic, the – what is it?  Paleo diet?’  And to tell you the truth, I don’t know about any of these diets [laughs].  But what I do tell them is, you want to be – you want to have a diet that is lifelong, that is easy for you.  And that – that kinda thing is, you wanna – you want something that is not going to – what we call the ‘springing effect’, where you – for two weeks, you’re – you wanna get into a nice dress.  So, you go – you don’t want that.  You wanna be – you wanna pick something that is a lifelong habit, that you can pass on to your children, right?  And so, whatever you choose you wanna make sure that you’re able to do that, as a lifelong change.  

So, that’s kind of my advice.  I think that every patient – for example, there are patients – if you – if you are – if you’re a vegan, but what if there’s a patient that cannot be completely vegan, because they need certain things?  So, I think it all depends on the diagnosis.  So, I – and I agree with Nimali.  There is no one good thing.  It’s just making sure that you’re eating whole foods.  Try to eat well.  For certain people who have GERD or with nausea, they can’t eat three meals.  So, that might not – that might not be what’s good.  They may need to have smaller meals.  For certain people that have – they need – some people need more high protein.  So, I think it – it’s based individually.

Dr. Fernando: I think you cannot go wrong with a whole-food, plant-strong diet.  Doesn’t necessarily have to be vegan.  There are certainly folks out there who probably would benefit from a vegan diet.  Folks with heart disease and so forth may benefit from a vegan diet, but that is not necessarily a one-size-fits-all.  But a plant-strong diet, you cannot go wrong with.

Dr. Nair:  And so, what does that mean, being plant strong?  That means eat more – in your plate, make sure you take more of the veggies and start with that.  

Dr. Fernando:  Fruits, whole grains.

Dr. Nair:  And – yeah.  Fruits, whole grains, start with those kind of foods.  Fill up on that, before you take seconds on the others.  So, that’s – it doesn’t mean you have to avoid completely. 

Dr. Vaughn:  So, here’s a question that came up.  And maybe you’ve answered this already, but I just wanna make sure this gets addressed.  ‘Are raw nuts, fruits, and vegetables better than cooked?’  Is there anything we lose by cooking them?

Dr. Nair:  It’s an interesting question, because believe it or not, certain plants actually are enhanced by the cooking process.  So, things like tomatoes actually become more nutritious, when you cook them.  So, it depends on the fruit or vegetable.  I think it’s the way that you prepare the food.  The best way to prepare food is the way that you’re most  likely to eat it.  So, if it means you’re gonna eat more broccoli if you cook it, go ahead and cook it [laughs].  If it means you’re gonna eat more tomatoes by making it into a sauce, make it into a sauce.  The best vegetables and fruits are the ones that you eat.  So, don’t – don’t feel like you have to eat foods a certain way.  Enjoy food in a way that you like it.  But believe it or not, some foods are actually better cooked, and others are better raw, nutritionally speaking.

Dr. Vaughn:  How do you – as far as – as packaging goes or when you’re looking at maybe the health index of a food, like the glycemic index, are there any recommendations you guys kinda have on what – what patients should look out for, if they’re really tryin’ to maybe eat healthy?  And it may not be – just may be something more – a conventional food, or something they’re getting at the store.  But is there some guidance on – there’s a lot of numbers on the back of boxes.  I don’t know what to make of them.  But is there [laughs] something that you can look at and say, ‘Okay.  This is maybe a healthier food’?

Dr. Fernando: You know, we talked about colorful foods.  And I think that’s kind of a quick and easy way to discern how nutritious a food is, is how bright and colorful it is.  Colorful foods tend to have more phytonutrients.  A lot of those phytonutrients are important in supporting our immune system.  So, if you can choose foods that have a bright and colorful palette, I think that’s a quick and easy way to find foods to incorporate into your diet.

Dr. Nair: And I also – sometimes there’s that misperception that low fat means it’s better for us.  And so, I think it’s really important to keep in mind, when you – when patients are looking for low-fat choices, like – you have to look at – in order to make something low fat, they  have to make it tasty.  So, usually, they add a lot of sugar.  And what the layperson may not know is that that sugar – yes, that product may have lower calories, but the sugar will turn into fat, eventually [laughs], in  your body.  So, sometimes it’s also –

Dr. Fernando: Right.

Dr. Nair: — you have to kinda keep that engaged, too, because – and that’s – and that’s something that a lot of people don’t know, right?  So, I think it’s important to be aware of that.

Dr. Fernando: Yeah.  And we don’t – we don’t like to necessarily vilify certain nutrients.  But the truth is, the average American does consume too much sugar in a day.  And that overconsumption of sugar can lead to a lot of chronic illnesses or – and so, it’s important to be mindful, I think, just given the climate and the food culture that we live in.  And one thing that the USDA has done to help us discern how much sugar is really in a food is to break out the added sugar from the total sugar.  So, when we talk about sugar in food, we tend to focus on the added sugar.  That’s what the companies put into a food, to make it more delicious, so that we buy it.  

But there’s also natural sugars, which  are the sugars that are naturally occurring in foods.  So, fruit, for instance, has natural sugars.  And before this recent USDA change in the food labels, it was all lumped into one category.  So, you weren’t sure how much of these sugars were added and how much were natural.  So, they’ve made that easier, by breaking that down, and you can see what is naturally occurring versus what’s added.  

And we shouldn’t – generally, a woman – an adult woman shouldn’t consume more than about 6 added teaspoons of sugar, which is about 24 grams, in a day.  And the average man shouldn’t consume, on a regular basis, more than about 9 teaspoons in a day, which is, what, 36 grams of sugar.  So, that’s something else to – especially in processed foods, foods in boxes and cans and bags, might be a quick and easy way is to just look at that sugar content, make sure that you’re not regularly exceeding those recommended limits.

Dr. Vaughn:  Yeah.  That is probably – leads me into probably my most common question I get.  ‘Does sugar feed cancer?’ [laughs]  That is – that is probably the number-one question I get from patients.  And that – my approach is actually — I think what you guys just said was really – really try to focus on eating natural, whole foods, away from the – especially the refined sugars.  Really – I had been able to – I – it’s amazing, trying to get patients off of – we’re so quick to get stuff quickly, and soda drinks are so popular.  But I’ve been able to get patients off that, through – through just kind of general guidelines, like you guys have been talking about.  

It’s amazing to see some simple differences in – it’s just amazing, how much sugar sometimes we drink, not just eat [laughs].  And changing any kind of – focusing on more hydration, water, other aspects, not of just food consumption, but hydration and other things, you can really also change kinda wellness strategies.

Dr. Fernando: We have a great post on doctoryum.org about sugar, and it’s called “Sugar Lives in Sneaky Places”, I think it’s called.  It really kinda takes you step by step through how do you navigate these food labels, and it talks about some of the common health foods that may actually have a lot of hidden sugars.  And it’s interesting, too, how many ways sugar is named on a food label, to help disguise the fact that a food might have [laughingly] a lot of sugar.  

And so, we have a table that shows 60 different ways that the food companies might call sugar on a label, to help you – to help fool you.  So, it’s a good post, if you’re interested in being mindful about your sugar intake.  Think it’s called “Sugar – Sneaky Sugar in Hidden Places”, or something like that.  It’s on – it’s on the Dr. Yum blog part of our website. 

Dr. Vaughn:  I just wanna thank you all for bein’ a part of this podcast.  This is so enlightening, actually.  What I’m excited about, too, is our partnership with Dr. Yum.  And so, on our – on our website, we have a link now, direct on our homepage, to Dr. Yum and all the resources that you guys have.  So, it’s gonna be such a fund of knowledge, I think, for our patients as we continue to promote kinda wellness and good nutritional habits.  I think it’s such an important part of cancer therapy.  So, thank you for bein’ with us today.

Dr. Nair: Thank you for having us.  We’re excited to be a part of this with you.

Dr. Fernando: Yeah.  And thank you for continuing to support our mission, to help break through these barriers to eating well.  We can’t – we couldn’t have done so much of what we do, without support from practices like yours.

Dr. Nair:  Yes.  You’ve been with us till – since the beginning.  So, we’re very appreciative of that support and the fact that you use it, that it’s being used as a resource.  So, thank you.

Dr. Vaughn: [Music playing]  Well, thank you, guys.  Have a wonderful evening, and we’ll be in touch soon.

Dr. Nair:  All right.  Bye-bye.

Dr. Fernando: Goodnight.

Dr. Vaughn:  Thanks for listening to “Cancer Shop Talk: Behind the Diagnosis”.  If you enjoy our show and want to know more, check out hoafredericksburg.com, or subscribe on iTunes. 
Listen on Apple Podcast. Get it on Google Play. Listen on Spotify. Subscribe via Email.

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