Episode 62 | Dr. Suzanna M. Zick, ND, MPH – NUTRITIONAL MYTHBUSTING

Dr. Suzanna M. Zick, ND, MPH is a Research Professor in Family Medicine and Nutritional Sciences and Co-Director of the Integrative Family Medicine Program at the University of Michigan. Dr. Zick's research interests include the investigation of the impact and implementation of integrative therapies including whole food diets for control of cancer-related symptoms of fatigue, sleep disturbance and quality of life. Dr. Zick is the course director of a National Cancer Institute education grant to teach oncology providers evidence-based integrative therapies. 

See Dr. Zick's links below: 

The Journal of Pain  - May 28, 2026 V46 106331
The association between diverse dietary quality measures and the presence of acute or chronic pain in the UK Biobank 

https://www.jpain.org/article/S1526-5900(26)00149-5/fulltext  

Oldways
https://oldwayspt.org/

AICR/WCRF
https://www.aicr.org/
https://www.wcrf.org/

Transcript

SPEAKER_04 0:00

And by the way, I I don't think there's anything wrong with also like diet sodas. They have been, you know, put down as well. But I'm going to say in actuality, yes, the the acidic quality of many of them is a bad thing. But overall, they actually might have good qualities, including like the um artificial sugar in them, actually might be good for your microbiome. It's never, it's like I said, it's never one story.

SPEAKER_03 0:30

Dr. Zick is a research professor in family medicine and nutritional sciences and co-director of the integrative family medicine program at the University of Michigan. Dr. Zick's research interests include the investigation of the impact and implementation of integrative therapies, including whole food diets for control of cancer-related symptoms of fatigue, food disturbance, and quality of life. Dr. Zick is also the course director of a National Cancer Institute education grant to teach oncology providers evidence-based integrative therapy. As always, I can be reached at Afton at AftonHazet.com. Hi, Susie. Welcome. That's one of my very favorite meal partners from years past. I'm surprised it's taken us this long to get together to do this.

SPEAKER_04 1:21

Well, thanks for having me. I feel the same way. I feel like we've talked about diet over many different meals and well enjoying food.

SPEAKER_03 1:30

Yeah. And when I want you eat, I always think, oh, I feel so bad about my dining habits. You always put together the most beautiful, colorful vegetation heavy meals.

SPEAKER_04 1:47

Don't ever feel guilty or shame about food. I mean, I think that's uh that's the first thing to really think about. Yeah.

SPEAKER_03 1:54

Love it. And you know, Susie, I had to on because you do bring this really unique perspective, you know, as somebody who um spends a lot of time thinking about nutrition and more broadly general health, but also how it impacts um nutrition impact pain and symptoms. And I'm really sure that our listeners will appreciate this perspective. Our other episodes on diets and nutrition have been extremely popular because it feels like that's something we can all maybe do a little bit better. But before we go there, um I would love for you to share a little bit more about your backstory. I know a lot about you, but our listeners don't really know, you know, what is a neuropathic physician and how did you come to choose to do that? What does it mean? You know, it's not really a common profession, it's not necessarily a common path. So tell us a little bit about you and how you kind of got to this point.

SPEAKER_04 2:45

Absolutely. Well, you're right. Naturopathic physicians um are not very common in the United States, uh, but they're four-year medical degrees where you become a naturopath or a naturopathic doctor. Um, and you can be licensed as a primary care provider in a little over half the states now. Um, and you do it after a bachelor's degree, just like an MD in the states, and you learn a lot of the same things. Um, but the nice thing, one of the things that really drew me to it is that you get four full years of nutrition, like classes the entire time. And it's seen as a fun foundational thing. And understand, I learned in 1996 things are really different in medical schools than they are in. Um, and so it's kind of like every single person you talk to, you're talking to them about things like wellness, around nutrition, um, also around things like exercise, around sleep, um, around stress. But we talk a lot about diet. Um, and how did I get there? So honestly, ever this is interesting. Ever since I was a little girl, I was really interested in nutrition. And um, it was really different than the rest of my family. I would get books and I would read things and I would try things out. And I remember being 13 years old and reading um, like East of Eden. It's something like it's it's an old new tiny um uh book about natural eating. Um, I would not recommend it by the way, outside of its historical context, but I decided I was just gonna eat like all this vegetarian stuff in like water with lemon juice in it. My parents were like in the 1970s, early 80s, like, what is going on? And so, yeah, I just was really very curious and interested in those sort of things. And I never knew that there was a naturopathic profession. There's no naturopathic colleges that were in Michigan. Um, there were no naturopaths licensed or practicing in Michigan. I didn't find out about it until I was in graduate school where I was studying um a PhD for nutritional anthropology. So the nutrition kept on coming for me. I was interested in the cultural aspects. And when I finally figured it out, um, I decided, yeah, I wanted to go and actually do the training. So I I can't tell you where the original impulse came from, but it did.

SPEAKER_03 5:17

It seems like it's always kind of been who you are, kind of, you know, for whatever reason.

SPEAKER_04 5:23

I think so. Um, who knows? Maybe an ancient ancestor was reaching through time and tapping me on the shoulder.

SPEAKER_03 5:31

And if you talk about growing up in a time where we weren't talking about these topics like we do today, right? There was a lot of fast food and a lot of, you know, um processed food and lots of Coca-Cola.

SPEAKER_04 5:47

Well, I think yes, there was especially the 70s and 80s, food culture was different. Some things were better and some things were worse than what they are now. Um, I think we have plenty of fast food now. Processed food, but we had different. And I think that what we understood about nutrition was different. I mean, I think, you know, if you're a Gen X or a millennial, perhaps especially an older millennial, you had parents who basically like, I don't think they were too worried. They were worried, like, did my child eat? Yes. Right? Uh, and and uh, you know, make sure that the kids actually could get food while they were at work. And I think that there wasn't as an awareness that maybe some of these foods were gonna maybe cause physical or psychological harm. Um, I don't think parents were sitting around saying, oh, well, I need to worry about like whole grain bread. There was a very small, much smaller amount of that awareness, I think. So, I mean, we grew up very differently with what we ate and what we thought was healthy.

SPEAKER_03 6:54

Yeah, it really is striking. And then it feels like over the last 20 years, we've really watched the scientific literature um start to turn um some of these old ideas um on their head, right? That the some of the things we thought were healthy were not, you know, we were all encouraged to have crisco oil because that's gonna be you know so much better. Right. You were like trans fat.

SPEAKER_04 7:18

And then, you know, also the uh I'm sure you remember the uh low fat phase where if you didn't have fat in something, it was great. You could go out and get pastries that had no fat in it, but were made up of like white flour and sugar. That was the predominant, you know, and and uh yes, and then you're like, wow, I wasn't eating fat. And that caused a huge amount of problems um throughout the population. So um yeah, that's that was highly unfortunate. Um now we have different trends, I'll just say, that are unfortunate.

SPEAKER_03 7:54

Oh, well, we'll have to kind of get to all that. And I and I think a lot of things kind of born from the science that you know we are gathering and really understanding more about the role of diet in nutritional health. And so when you when you look at the kind of sum total of kind of where we are now, what do you consider some of the most compelling evidence, you know, to direct us in the way forward for our most healthy consumption?

SPEAKER_04 8:19

Well, I would say some of the most compelling information has come out of heart disease. I mean, let's let's just say it heart disease, well, it's still the number one killer, but it's getting close to being eclipsed by cancer. That's partially because of the aging of the population, but it's also because as a society, we've done a really great job treating heart disease. Part of that has been great medications and being able to have those available, but another part has been diet. And so, you know, not we've done a lot of um observational studies where we've looked at the epidemiology and we saw what the patterns were that would be healthy diets for preventing and treating heart disease. And they were really strong. And then we have very large clinical trials and why very large. I'm talking to like many, many thousands of people, many studies, and it clearly showed that um having high levels of saturated fat, high levels of cholesterol, high levels of sodium, right? And also now high levels of added sugar were all bad. Yeah. I mean, you kind of get an idea of how much. So that was good too. So they could give you an idea that they're like, there's not like don't eat this. Yeah, it's like eat this much, which is actually somewhat helpful. It's really hard to tell someone like eat 30% of this. And you're like, right, how much would that on my t? I don't know. So we we had that, and it started to emerge that it wasn't any particular food, it wasn't any particular even macronutrient. So, like carbohydrates, protein, or fat are big macronutrients. It was the whole pattern that you added to have a healthy diet. And so you needed to eat, and I know it'll sound boring. This is gonna sound boring, but you needed to eat a lot of fruit, a lot of vegetables, you needed to eat whole grains, you needed to eat nuts and seeds, yeah, right? Um, you needed to eat fats that were healthy fats. So that's all the polyunsaturated fats that come from plants, and also, you know, the fats that come from things like fatty fish, like salmon, for instance, the omega-3s, but there's other ones. So that all those were very healthy, you know, a high amount of fiber across all these different foods, a lot of um legumes, so beans, you know, getting in there, and then you know, eating just a little bit of some of the other foods. So, you know, eggs, poultry, beef, lamb, but you didn't want to eat a lot of them. So it got that pattern. It didn't say you must just eat blueberries as a fruit. Yeah, it said all these different fruits are great. Um and it also said things like teas and coffees are great. So we've had a lot, a lot of different studies that confirm this. It's not like all of a sudden, and I mean just to give you an example, I know that people get into conversations about particular foods or food groups. Like I've seen eggs. People can go back and forth on the egg stuff and the really what it can comes down to is eggs are just one food in a whole diet. And you can't get too caught up on any one particular thing. You have to think about it. How does it fit in your whole pattern? If eggs are where you want to get your fat, saturated fat and your cholesterol and you love eggs, and you're not getting a lot from other places, by all means have some eggs. Yeah. But if you're already getting your saturated fat and cholesterol, like say you need to have that red meat uh a little bit all week, then probably eggs you shouldn't do. So that's the kind of thing that we've really found is very solid science um across the board. Yeah.

SPEAKER_03 12:21

I love that, Susie, because it's it's basically saying you can eat, eat food, eat food you like, but just go in a reasonable way. So when you when okay, I know what you look down and see on your plate, but when a person who eats a little bit of meat and eggs and cheese, when they look down at their plate, say it's dinner, one percentage of what they see there should be like vegetables or fruits.

SPEAKER_04 12:47

Yeah. And actually, um, I will say many different um organizations, like nonprofit or as well as government organizations across the world, say basically the same thing, which is okay. They say half of your plate should be made of fruit and vegetables. Fruits and vegetables, yeah. Any type. They can be cooked, they can be raw, but half of it. Yeah and like if you bowl, I know people are big into bowls, right? Half of your bowl can be filled with fruits and vegetables. Um and honestly, if you want like fruit at one meal and vegetable at another, that's fine. You have all fruit in your half and all vegetables. Um and they also say that like the other half, a quarter of that other half, yeah, should be whole grain. And then the other part is healthy proteins. So there's a lot of different options that could go in that other quarter. Susie, that feels so reasonable. Well, it it it is. I mean it's just that a lot of time, well, then people might say, like, well, what about my dessert? Yeah, yes. And and the answer to that is like, you know, a little bit. A little bit. Yeah. It doesn't have to be every day. And by a little bit, you know, we mean like some pieces of dark chocolate, um, you know, a half a cup of ice cream. We know how little that is. I mean, and the thing is is the amount, yeah. Um and you know, having fruit-based desserts too, is a way to really bring that in, um, and to have sweetness. Yeah. Because that's all quite that's fine. No one says don't do this. And no one says, like, if it's a birthday or a celebration, don't have celebration food, but not every day celebration.

SPEAKER_03 14:39

Yes, it's that's right. You know, so we don't need to eat cake every day, we don't need to have fried chicken or pizza every day, but once in a while it's presented to you, eat it, right?

SPEAKER_04 14:49

And enjoy it. I mean, I'm I think one of the most important things for people to understand is that food is also for enjoying. Yes. It is uh it's fine to have pleasure from food and to savor it. And you know, you're you do a lot of mindfulness work, and we talk about a savoring exercise around food. Um and there's been research too, showing when you have mindful eating. So that's literally paying attention to all your senses, right, as you eat and not doing other distracting things. But that actually causes people to fill up earlier, to enjoy their meals more, and they actually have physiological changes like a decrease in inflammation and markers of inflammation in their bodies. So, you know, part of that is really enjoying it. If you don't like what you're eating, yeah, then don't think you're gonna be uh enjoying it and being mindful, and then you might reach for something else so that you can enjoy it.

SPEAKER_03 15:49

That's such a great point. And and also going back to kind of your nutritional anthropology days, um, food is culture. Food is connecting, food is social. Food is religion.

SPEAKER_04 16:02

Yes, yeah, it's all those things, and I think that we just we have to understand that the nice thing about eating healthy dietary patterns can accommodate all of that. Yeah, you can say within my culture, within my food heritage, uh, you know, these things fit into that pattern. And there's often lovely um books out there that you can find. You can say, Well, I want to eat the way you know my particular area of the world, my particular culture, my particular religion eats, but I want to do it in a healthy way. And you can often find those types of books to help you and say, how can I make a recipe that is our tradition in a way that uses healthy fats, that uses whole grains, um, etc. So yeah.

SPEAKER_03 16:52

Yeah. You know, food is such an important piece. It's not just, you know, it's not just about survival, right? You know, it's it's not at all. Yeah. And I think that's why um having reasonable guidance is so helpful. So that's good general data about how to eat well for well-being and and health. Is there anything in particular that you think about when you think about chronic pain or symptom management, any kind of dietary uh changes or particular uh findings?

SPEAKER_04 17:22

Absolutely. Um, there is a paper that just came out in 2026 that I think is fascinating. Um, it was you it was using the UK Biobank, and I can pull up details as we need it, um, which if you don't know what the UK Biobank is, it is a large population-based study where they collected things from almost half a million people in the UK. So they did lots of measurements, but they also took things like blood. And when I think about how many people live in the UK, half a million people in the UK is a lot of their populations. It's a lot. Yes, it is. It's a lot. And they were able to give them things like Fitbits or activity monitors, and they uh did a lot of measurements of food that was very detailed because they had a better idea of things to ask than older studies that we've relied on. And they also had really good measurements of pain. So they had both acute and chronic pain. Um, and they also had widespreadness. So they could say when a person had pain on just like one area of the body versus two areas of the body versus at least three areas of the body. So they took all that information um and then they said, are there particular dietary patterns that were associated with less both acute and chronic pain? Um, then they even broke it further down and said musculoskeletal pain versus non-musculoskeletal pain, and they kicked out the people who had like end stage cancer. So I'm not talking about like metastatic pain. And um, and they looked at various dietary patterns that were, they covered things like they had one that was called a dietary inflammatory index. Um, that is exactly what you think. People developed this actually empirically, where they said what foods actually decreased levels of inflammation in the body. And then they did a number of other indices. One of them is healthy plant dietary index, differential between healthy plant-based eating versus non-healthy plant-based eating. And a one was like uh it was put together um about ecological eating, saying like planetary health, what actually when you ate gave you more planetary health, and they had a Mediterranean diet indices as well. So there was a lot. Just to let you know, this was in over 55,000 people had measures of both diet and pain. Wow. That they yeah, I mean, it's a very impressive study. We'll be glad to give people the link so that they can dive into it. And I'm gonna actually look at the abstract so since I did not write this paper, and so not everything about it is in there. Um, but when they actually looked at what was associated with musculoskeletal pain, just to start off the chronic musculoskeletal pain, and they controlled for many, many different things like smoking and exercise and sleeping and other types of chronic illnesses, um, what they found out was that um when you compared pain-free individuals to people with chronic pain, um, that the um healthy plant eating index and the eat Lancet diet score, that's the one for the dietary, um, were associated with significantly less odds of having chronic pain. Okay, but only the healthy plant diet index was linked to lower odds of having acute pain. Oh, and this was true with across um the musculoskeletal pain. Um but the pain was lower with the Mediterranean diet and the dietary inflammatory indice scores when they were non-musculoskeletal pain. Okay. So they were able to kind of pull apart and say different types of pain were more associated with different types of eating.

SPEAKER_03 21:36

Okay. So kind of breaking that out then. So for the Mediterranean diet to be most affected, it sounds like it was for people who had kind of inflammatory pain potentially. Is that what we can glean? Localized, localized in particular.

SPEAKER_04 21:54

So for inflammatory pains, like you think about arthritis, um, you're really looking Yeah, that was the the dietary inflammatory index. Okay. Um when you saw that happening. Yeah. Um, it didn't matter for acute pain, by the way. I mean, not whether whatever type it was, just the healthy, healthful plant-based diet index was the only one that decreased your lower odds of having acute pain.

SPEAKER_03 22:19

Isn't that striking? So when they say uh healthy plant-based diet, does that mean no meat, or does that just mean heavy plants? Do we well?

SPEAKER_04 22:28

I pulled it up so that we could know this because these are fairly new scales that I wouldn't, you know, I oh, so they give you a score and they give you like a point or something like that, uh, saying like this is a positive thing. So you got a positive point for whole uh plant foods, included whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea, and coffee. You got a point deducted for less healthy plant foods that includes refined grains, so like flowers, you know, fruit juices, sweet, sugar-sweetened beverages, and potatoes. Um, and then you also got a net negative score for animal foods, which include um meat, all different types of dairy, eggs, and fish.

SPEAKER_03 23:20

Okay. Great. So that makes sense. So truly, it really is that very plant-floid diet that seemed to be the most protective.

SPEAKER_04 23:28

In in the acute, yes. And for the musculoskeletal, it was both that the helpful plant-based one, but it was also this define eat lancet diet score, the one that was associated with planetary health. Uh-huh. Um, they got the highest score of once again, whole grains, yeah, tubers or starchy vegetables. So that could be like a carrot, for example, other vegetables, fruit, legumes, and nuts. Um, they said you in moderation, dairy, uh, fit food, poultry, and eggs, and then limited or avoided tirely, red meat, which is beef, lamb, and pork, added sugars, animal fats, and unsaturated fats. So they were whilst similar, not exactly the same.

SPEAKER_01 24:18

There are 86 billion neurons in the human brain. Complex networks connect these remarkable cells so we can breathe, move, think, communicate, and feel pleasure, and pain. Changes in some of these brain networks are not to underline my pain. These networks are not underlined. Stress, sadness, fear, and loneliness. And that brain networks can make your pain worse. But healthy eating, sleep, and exercise can help your brain make new connections, and so can mindfulness, joy, friendship, and love. Because this is true, the power to create a new tomorrow with less pain and a more rewarding life already resides within you.

SPEAKER_00 25:38

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SPEAKER_03 25:50

But what I'm hearing is nothing here is too far departed from what we were talking about earlier, right? It's really true.

SPEAKER_04 26:00

I mean, maybe it's saying for muscular skeletal chronic pain, we would maybe emphasize for that protein portion, more plant-based proteins than animal-based proteins. And I, you know, I would definitely say the dietary inflammatory index is a little bit different than all these for the the ones that more arthritic pain, yeah, in that it definitely has things more like seafood in it. Um it also, well, I'll just say it was validated in college students. Oh, sure. And so cheese pizzas show up as anti-inflammatory. We ate a lot of cheese pizza and beer. Oh my gosh. So, but it also has a lot of uh not foods but nutrients in it. So it's a very different index. And um, I've often wondered like if people were able to redo that with foods, if it would be a little bit clearer. Hard to say, like, eat a lot of magnesium. I mean, because magnesium is in a lot of fruits and vegetables and nuts and seeds. Do we do that and pizza? Maybe.

SPEAKER_03 27:06

Maybe, but again, it's plant forward, healthy plants, ideally. Something about you know, having an environmental awareness could, you know, that's I feel like that might be a piece of it. Perhaps you're eating things that are cage-free eggs, or you know, you're doing certain things a little high.

SPEAKER_04 27:24

I mean, honestly, you have to say, I I think it's nice that it overlaps that both we're helping the environment as well as ourselves. Hallelujah, that it isn't off the opposite. Right. That's what I say. Like, sometimes when you hear things where people are like, well, eat a lot of eggs. I'm like, well, or eat a lot of meat, I'm like, well, what is the environmental consequences of that? So thankfully, this opposite, it actually does things that are actually really good for the environment and environmental health as well as your yourself. Yeah. And right now we're just trying to figure out why these associations would happen. Yeah. And I always like to emphasize to people that we have not done the clinical trials that could actually, you know, say this is causal. Yeah. We know that people who have chronic pain, right, um, it can have a harder time making food, shopping for food, um, get comfort foods, which aren't always healthy, right? I mean, they may hurt us, but they aren't always the healthiest. And so that may be it, maybe what we call reverse causality. Um, but even if that's the case, we want to try to, because we know these foods are good, as I said, for other health conditions, right? We want to address this, you know, at a public health level to make this really easy for people to eat this way.

SPEAKER_03 28:46

Yes. And you and I've sat down and noodled through how on earth we can do a true clinical trial with food. It is such a heavy lift, having done many, many clinical trials, and just I can't figure the way. I mean, you have to provide the food, and it's very costly to do so. I mean, it's really hard to kind of conduct those types of studies.

SPEAKER_04 29:10

Well, I've conducted a number of these studies. You don't have to provide the food. Oh, I think that there has been a through now. I'm gonna say there's times when providing the food is what you should do is and is appropriate. When people um are like very ill getting them the food, yeah. Um, I think when people also are very resource limited, helping them to get the food, all very helpful. But you're right, doing that is very expensive. And is it sustainable? Right. No. I mean, if someone is on like SNAP, government assistance, and you can help them connect them to get that food, and that's going to be sustaining that, that's great. But no, what we do is we actually teach people how to um eat this way in a in as simple and as easy way as we can. Yeah. So they spend actually a very limited amount of time with a registered dietitian um to learn how to do this. And we teach them how to take the diets that they have and to swap out things that aren't really doing them a great amount of good for things that are, but have roughly the same amount of macronutrients. So they have roughly like fat, carbohydrate, and protein equivalent. Yeah. Um, we we have them swap. So maybe instead of a bag of potato chips, by the way, you can get two pieces of fruit in there or like a piece of fruit and a quarter cup of nuts. We'll give you this. So we kind of help people make those changes, um, give them recipes, give them tips like how do you do this when you're eating out, how do you do this when you're traveling? Um, and we let them know, like we give them a list. Like, if you're going to be eating this many servings of vegetables, here's a long list of vegetables to think about. Yeah, you don't have, like I said, you don't have to eat just one thing. And a lot of times, people who are used to eating this way, like they haven't, they don't know about a lot of these foods. They may say, what is this food? What is this fruit? What is this grain? I've never tried it. And we encourage them, we say, give it a try. You may not like it, that's fine, but you may love it, and your family may love it. And so we kind of try to help them, um, let them know we don't go for exotic. We don't say, you know, like you need to go to a farmer's market, you need to, you don't need to have fresh, you know, frozen in canned, we're fine. We talk how you can do this quick and easy if you want to, so that we're trying to build skills going forward to make it really easy for people. And that appears to work pretty well.

unknown 31:50

Yeah.

SPEAKER_03 31:51

So much better than other models, right? Because the goal really is how do you help the person make a long-term commitment and change their diet. And if again, if you're providing all the food, that is not sustainable.

SPEAKER_04 32:07

Yeah. Well, it isn't. And like I said, at times we you do want to do that. I just want to emphasize, but in our clinical trials, we do this and we bring in, you know, potentially the whole family, whoever is cooking, shopping, if that of our participant isn't the one doing that, we bring in that person so they're doing it with them. Um, if they want to bring other family members in to support them, we talk about their communities that might be able to support them, or how they might be able to um integrate to their communities. So all that's really important to help them sustain. And then actually, when they're in a sustaining part, when they've kind of learned, they need different things to help them keep going. Um, because we're constantly bombarded in our society with choices that are not um the good choice. We are given uh choices that you know would only be the celebratory food all the time. Yeah. And so we constantly do need to have help in that environment.

unknown 33:03

Yeah.

SPEAKER_03 33:04

And sometimes a really healthy diet can be time consuming because it takes a while to gather the food, chop everything up, prepare it from scratch, and can be expensive.

SPEAKER_04 33:15

So, you know, it can be, yeah, and part of our job is to teach people that that is not true. It doesn't have to be true. It isn't. Um I just really like to emphasize to people that you do not have to cook from scratch, you do not have to eat at home, you do not have to do these elaborate meals at all to achieve these goals. That as a matter of fact, we can teach you how to do it more quickly, maybe than what you're easily. Um, I mean, I I think of an example, and I'll I will say that I totally understand what people are talking about with alter processed foods, but I say that um it has also been detrimental the way it's defined that some people are very, very like they think like if it's frozen, it's it's processed because by the scale, it is. You a can of tomatoes is processed. I have, you know, that they get very, very um worried. And so they want to use these quick things or healthy pre-made foods. There are healthy pre-made foods teaching what they are and how to identify them is really important. Um, I remember like we worked with a mother, uh she had several kids, she didn't have a great amount of money or time. Yeah, and she's a single mother, and she thought that using frozen and canned things were not the right way to go. And she had just like given up. She just didn't have the time, like you said, to chop. Yeah, clean up, put it together. And so the team said, Oh no, you can use canned beans, you can use frozen vegetables, there's combination frozen vegetables, all sorts of things. And she said, she said, Well, wait a second, I could just buy this healthy soup and add frozen fruits and vegetables. I mean, not fruits, be an unusual soup, but that's awesome. And add a can of beans here and there, and I could have a soup and and feed my kids or make a stew that way really quick. And I, and they're like, Absolutely. And she's like, it was like a revelation. Yeah. All she was like, it took me five minutes to do everything that I thought would take me at least a half an hour to an hour to you know enhance it. And he he she said, My kids loved it, like soups with all sorts of things. I could put a whole grain instead, just throw it in there, you know, it cooks up in 15 minutes. I'm doing other things while it's cooking, it's done.

SPEAKER_03 35:45

Susie, I see you. There's gonna be people listening to this who say, Oh my god, really? Can I rise? Absolutely frozen and canned things and pre-made things.

SPEAKER_04 35:55

Absolutely. Yeah, what you have to look for is does it have a lot of salt in it? And does it have added sugar? Those are the two hidden ingredients that you need to look for. And on the label, it will say sodium. That's salt. Salt comes in a lot of different forms, but it all comes out of sodium. And you really want to look for either low or no sodium options. You can find them sometimes, but like try to make sure that for the serving, they'll give you for a whole can or a serving, like make sure that it isn't, you know, like you're looking for a serving and give a whole can. Like it's under like a thousand milligrams of sodium. Yeah. Under that, ideally better. Some some will only have like 80, like for a can of beans. That means that's the natural sodium in beans. Nothing got added to that. Um, and for added sugar, you really want to look for things, hopefully, unless it's something sweet, right? That you really want, that it has no grams or very small number of grams. Some things have natural sugars. Obviously, if they added fruit or doing a yogurt, milk has natural sugar in it, but you want it to be like under, I don't know. If it if it says four grams, five grams, six grams per serving, you are good. That's okay. Yes. But if you start seeing things that are like getting up there, to know look for a different brand. To look for a different brand.

SPEAKER_03 37:25

Yeah. It's also looking for things you can't pronounce. I mean, how concerned are you about additives and preservatives? And um, what do you think about that? I am not. Really? Talk about that. Yes.

SPEAKER_04 37:39

I think that it we're worrying about the wrong things. Yeah. Um, what so I always say this when when people say like, I'm afraid to fly, which I totally acknowledge flying can be really scary, and some people have a halt hard problem. The likelihood that you're gonna die from that, right, is much smaller than being killed by a strike of lightning, which we know is pretty rare. What we should be worried about is driving in our cars that kill between 30 and 40,000 people a year, right? If we wanted to decrease the number of people who die through transportation, we need to make cars and driving safer. Airline travel is pretty darn safe. Now, if we want to make diet and food supply safer, the additives are the airplanes of those issues. Yeah, rarely a problem. Right. Now there are people, sure. Absolutely small and unlikely. Now, compared to the much bigger issue of the amount of added sugar, the amount of lack of fiber. Yeah. Um, the lack of enough fruit and vegetables, such a small percentage of our population eats enough. I mean, we're really talking like 20 to 25 percent in the states at the top. Yeah. At the top, uh, with some and less and others that are eating enough of that and whole grains that goes down and nuts and seeds and beans. So those are those are the cars of transportation that are killing them. And I think that you know, we've been really pushed that we should worry about these additives. Do I think we still should, you know, have some eyes on that? Absolutely. And there are great groups that have their eyes on that. And thank you for that. There are the airline industry people, like making sure that those are safe. But there's so much less emphasis in you know, being pushing out that the car equivalent is not being looked at.

SPEAKER_03 39:47

So we want get those fruits, get those healthy beans, get those vegetables frozen, just get them quick.

SPEAKER_04 39:55

It doesn't matter how quick you like them. They are what you want to be eating.

SPEAKER_03 40:01

Yes. So helpful. So you've done a ton of work, and we just didn't really kind of take a small detour in the cancer world and thinking about individuals who often it's post-treatment or post-chemotherapy, they develop chronic pain and other symptoms, kind of a symptom complex. Can you talk a little bit about that work and kind of the role of nutrition and maybe lessons that we can learn from that?

SPEAKER_04 40:30

Uh, I love to. And and you're right. I mean, after people stop radiation and chemotherapy and have surgery, even though they're on long-term medications these days, um, like immunotherapies and targeted therapies, have both short and long-term toxicities that really decrease people's quality of life and can make things difficult. Um, the area that I've learned uh work the most in is fatigue, and we call it cancer fatigue. Yeah, but it often comes with pain and sleep issues and mood disorders like depression, anxiety, even though each of those are separate symptoms. I don't want people to think they're the same. Right. Um and yeah, we're talking like anywhere from like 20 to 30 percent of people who are diagnosed with cancers have those, at least one of those symptoms and possibly multiple ones, um, pretty much forever. And they don't go away. And they're not like the fatigue isn't like I'm tired and I haven't slept, sort of fatigue. It's more like I'm always tired and I have to, you know, ration what I do, sort of fatigue. Um, and the pains can be very specific to cancer. You can have hand and feet like uh neuropathies that are specific from chemotherapies or radiation. Um, and you can have joint aches and pains from certain hormonal therapies, um, particular in breast cancer patients, for instance. So, yes, um, one of the things I've looked at for that are whole food diets, because we have not spent a lot of time around diet and symptoms in cancer survivors. And we've looked mostly at weight loss, which I think is important because cancer treatments and cancer itself can cause you to gain weight, by the way. Some people who are very lose weight, other people gain weight. So it's really good to try to help maintain healthy weight. Great, but almost all the studies have been for that, or for preventing cancer before it starts. Also, really important. But um, I've looked at whether or not whole food diets can decrease the fatigue. Um, and as you know, I've looked at other interventions, but I have to say that the diet um has worked by far better than any other intervention I've looked at. By that I mean fatigue goes down more towards being normal and staying normal. Um, and other symptoms follow as well, like people are sleeping better, um, and their mood is improved if they're having issues with mood or pain. Um, so that's some of the things that I've looked at that have been very exciting, and we want to be able to do bigger studies to look at that and more different types of cancer. Um, and we've done that method of like having people switch out um less healthy for more healthy foods and trying to make it as easy as possible. And even people who are fatigued, right? So they're not they're not always super happy to get up and make food. We have helped them to be able to do it, and they've said they've found it to be actually be pretty straightforward.

SPEAKER_03 43:41

Yeah. So we're very happy about that. Yeah, no, that's super interesting that you know these these relatively modest changes can bring about some really significant change in symptoms because fatigue is a killer. Fatigue is so hard to live with. I hear this commonly from people. Who are chronic pain, people chronic pain that yeah, the pain is terrible, but the fatigue worse.

SPEAKER_04 44:07

So, yeah, it you're right. Well, it depends on the person, but you're right. There are people who really say, like, if only I had the energy to do things like exercise so that my pain could get better, right? For instance, wouldn't that be amazing? Um, or you know, to be able to even do mindfulness, like it it gets in the way. I'm like, I just fall asleep, you know, which you know that that can happen. Um, so yes, uh, and I I will say it seems like relatively minor things, but when we look at measures of like diet quality, so we have ways of measuring how nutrient dense and how many of these good patterns people are eating, like on a scale from zero to a hundred, where a hundred would be the diet is perfect. I've never met that person, but hey, that's fine. Um, and we can look and see where people start, where they start about in the middle, about 50 to 60, which is by the way, pretty good. People who already have cancer tend to already be have more awareness than the general population. Good for them. Um, but by the end of the study, you know, they're making these relatively small changes, and their diet quality is now up at 80 something. So it's a huge difference in their diet quality. They've made, you know, changes and they're like, didn't know I could even do this. So I mean, I think there's that. I will say the other area that we're beginning to get into now is uh a pain area, that chemotherapy-induced neuropathy that I talked about. Um, I'm working with a junior faculty member, he's a faculty member in nursing, and we've just looked at like what was associated, what type of foods and nutrients and quality. Um, because people are always very, like I said, they're always very keen, like which foods? And I'm like, I wish, I wish there was a food, because I'd be eating it that I could tell you, and I wish it was chocolate, but it's not. Um, what we basically found is that there were essentially no foods, no, or even food groups really that were associated. But you know what? When you put it all together, the higher diet quality was, the less likely you were to both develop these neuropathies, and they were less severe if you had them.

SPEAKER_03 46:24

Wow. So again, it's that high quality diet overall. It isn't that you eat only salmon or you eat endless amounts of vegetables. It's that it's this balance, it's looking down at your plate and seeing about 50% fruits and vegetables, 25% a healthy grain of some sort, and then 25% some form of protein, not always red meat, right? Well, right exactly.

SPEAKER_04 46:48

Yes, that you're having you're having the the plant-based proteins that yeah. And you know, once again, we haven't done a clinical trial. There are going to be many reasons for this, but that's like the next step of what we want to do to be able to look at this.

SPEAKER_03 47:05

Yeah.

SPEAKER_04 47:05

Yeah.

SPEAKER_03 47:06

This is so cool, Susie. So our time is keeping by. So let's give our listeners maybe a couple of tips about how to start. You know, let's say you have the normal kind of diet, right? You catch his catch candle, but you probably eat too much meat, you're probably eating some fried food, you're probably eating inconsistently. What do you think are some of the easiest, most actionable things we can do just to improve our diet?

SPEAKER_04 47:34

Absolutely. Well, first I say be kind to yourself. Yeah. And understand that if you, you know, you have a blowout, even if you're trying, doesn't that's not bad, but you're human and just go back to trying something again. And always give yourself grace. That's the first thing I say because it can be so quick to sabotage yourself. But to really start, I say, you know, make it simple. Choose a fruit that you like every day and choose a vegetable that you like every day, and just start there. Yeah. It's just yeah, I mean, and there's a lot, it doesn't matter what meal you do it with, it doesn't matter if you do it as a snack. You don't have to stop anything, just add that sometimes that makes a huge difference.

SPEAKER_03 48:26

Oh, that makes me so happy because you're saying I think when people think they get intimidated because, oh my god, I can't stand squash, or I can't, you know, how am I gonna eat? You know, I don't like oranges. It's just eat what you like. Eat what you like fruit.

SPEAKER_04 48:42

That's right. And I you know what? If you just like oranges and that's all you're gonna eat the fruit, go ahead and eat oranges. Yeah, I'm totally fine with that. And if the only vegetable you like is spinach, go for it. I mean, like that is fine. I also endorse if you want to experiment event, you know, as your next step and try others, um, definitely go for it. I would say that is a great first step. And I know it's pattern too, but we haven't really talked about it, but drinking water, tea, and coffee, yeah, just start to set out. I mean, there is research showing that just by drinking enough of those fluids, yeah, people actually, you know, it makes you less hungry because it's spacing your stomach. Yeah, and that helps. And also if you're not drinking enough, sometimes it's confusing to your brain and it makes it think you're hungry and you're actually just thirsty. Yeah. And so just drinking more water, teen coffee, any of those are fine, caffeinated or not. You know, it can be fizzy water without sugar, but with flavoring. All that's sometimes that's just a great way to help yourself through all this. Yeah.

SPEAKER_03 49:55

Like if no, great, great stuff. Because I do think a lot of us run around chronically dehydrated. I don't go anything anywhere. There are some people, yes, yes. So it does help.

SPEAKER_04 50:08

Yeah, and I I just sometimes I'm like, maybe if you're hungry, maybe you really are, yeah, sometimes drink drink something first, doesn't have to be a lot. See if it goes away and you're not thinking about it. And by the way, I I don't think there's anything wrong with also like diet sodas that they have been, you know, put down as well. But I'm gonna say, um, in actuality, yes, the the acidic quality of many of them is a bad thing, but overall, they actually might have good qualities, including like the um artificial sugar in them actually might be good for your microbiome. So more to come. It's never, it's like I said, it's never one story. So if you want to enjoy, you know, a diet soda, I wouldn't say that should be your whole no, no, my head is exploding as you talk here, Susie. Oh, it's amazing. But I mean, some of them are less acidic as well, like um ginger rails, root beers are less acidic. I just want to put that in there too, because I know for some people they're like, I can't do this without that. And I want to let them know that we've had a lot of myths that we create. Um, they sound great, don't they? But that's another thing, you know, instead of grabbing that sugary beverage, like a sugary coffee or tea, if you don't like your coffee or tea without sugar in it, have a diet soda or have a piece of fruit too. That can help too. So those are quick ways to start.

SPEAKER_03 51:39

Love it. That is so great, Susie. Do you have resources? I mean, you can just tell us and we can link them in the show notes. Anything any place particularly you suggest people to go?

SPEAKER_04 51:49

Yeah, I think I have at least two really great ones. Yeah. Um, one of them is the American Institute for Cancer Research or AICR, which also has um a global, which is called the World Cancer Research Fund. I can help you find these. They're they're actually merging one right now. Um, and they have great resources for both um you know professionals as well as um everyday folks for making healthy dietary changes. So they have great recipes, um, they have great ideas about you know how to make changes, small changes in your life. I really love their materials, even though it's cancer focused, it it applies across the board. Right. The other really great one is um it's a site held by Harvard School of Public Health. It's called Old Ways, which is all one word. Old Ways has once again recipes in it. And what they do is they take the the pattern that is the Mediterranean diet. So just to let you know, I know people push the Mediterranean diet. I think the Mediterranean diet is great if you're doing it in the whole food way. Yeah, but what they say is this is a pattern. It actually can apply to, you know, Spanish or Latin American food. They can apply it to food from Africa, they apply it to food from the Caribbean and say, here are the same patterns using these foods, and here are recipes that you can use. So if your, you know, your dietary tradition is, you know, from the Caribbean, you can go in there and say, hey, this is actually me eating this. Because many people tell me, like, um, my why, why Mediterranean? That's like I've heard people say that's just for some white folks. And I'm like, I get too what you're saying. This is just a pattern. It just happens, Mediterranean pattern in general has many good parts of what we're talking about, and so it shows up as being a great diet. If you like that, fabulous. But if you like other traditions or want to try them out, old ways is a great spot to get that information.

SPEAKER_03 54:09

We will definitely link, uh, we'll link our uh these in our show notes and they'll give some people opportunities to kind of try some of these neat things. I I love the idea. It's a pattern of eating, it isn't necessarily you have to hew to one particular um school of thought, like the Mediterranean diet. So as we kind of wind down here, I always ask my guests two questions. The first is was there anything that I didn't ask you that you were hoping to talk about?

SPEAKER_04 54:36

Oh wow, Afton. Well, you know, I can always talk about the ethical aspects of food, but you know, I think that's a whole nother show.

SPEAKER_03 54:46

That's a whole show. Very cool though.

SPEAKER_04 54:48

Well, another, I think another thing that really is about this whole concept of local versus local and people sitting there saying, should I eat local, even if it's not organic? Should I eat organic? I mean, all those sort of questions, which I think maybe is longer than what we have. But I don't I the quick things I want to tell people is don't worry about if it's organic or not. If you can afford and get organic, go for it. Yeah, but don't feel bad if you can't. The other thing is local impacts about one to two percent of the whole um amount of ecological impact of our food. The other 95 to 98 percent is what you eat. Really? Where it comes from, it's what you eat. And there's great data on this um from wonderful nonprofits who work very, very hard about the ecological impacts of food systems. So we have been sold a bill of goods. So eat your bananas, they have such a tiny impact of where they come from. If you like them, I just know some people say, well, I gotta eat meat because where I live, that's what can get made. No, you're having a huge ecological impact by eating that meat, whether it's local or not, whether it's raised on a pasture or not. Yes, there are small differences, but there it is. So yeah. Susie, you are a mythbuster. This has been fascinating. Well, I know, and I, you know what, I just want to tell you, I've whole held many of these myths. These are things we teach ourselves, as I said, a narrative. They sound great, but when you actually get the data, you know, and people kind of explain it, and when you think about it, it kind of blows your mind. Love it.

SPEAKER_03 56:31

Well, my dear, thank you so much. Um, I always end the show with a question. Susie Zik, what brings you joy?

SPEAKER_04 56:40

Oh my gosh, singing. Singing brings me joy, singing with other people, singing by myself, and uh, as you can see, my t-shirt, the Eurovision Song Contest, the largest song contest in the world, which has more people watching it than the FIFA soccer contest when it happened.

SPEAKER_03 56:59

Go, Eurovision, and you are a wonderful singer. I've enjoyed your performances. Can't wait to get some more. Thank you.

SPEAKER_04 57:05

No, no professional here, but uh an enjoy enjoyed amateur. Uh wonderful.

SPEAKER_03 57:11

Well, thanks again, my dear.

SPEAKER_04 57:12

Thanks for having me.

SPEAKER_03 57:14

You get that.

SPEAKER_00 57:17

If the Chronic Pain Reset Podcast series has brought you some inspiration and hope, please consider joining the community of listeners to help fund our production. Your support is important for us to keep creating content for those impacted by chronic pain. Look for the support the show link in our show notes in each episode. Today's episode was produced and edited by William Haskell. If possible by listeners like you, Son of a Books, and the team at Venue by 4L. Our music score, Just Be was produced by Bohemian Roosters. That's it for today. Join us in two weeks for another episode of Chronic Pain Reset.