Nutrition for Skin Health During Cancer Treatment

How does food impact your skin during cancer treatment? Oncology dietitian Darienne Hall shares simple, evidence-based nutrition strategies to strengthen the skin barrier, support hydration, and reduce inflammation—without supplement hype. Learn how a Mediterranean-style pattern and smart protein choices can help your skin stay resilient through treatment.

Transcript

Welcome And Expert Introduction

Raejan 0:00

This podcast is brought to you by the Ricardo Fisas Natura Bisse Foundation, produced by Lyons Creative. All the information contained in this podcast is intended only to provide general skincare guidance. The information is not a substitute for consulting with a physician or other qualified medical professional. Welcome to the Oncology Aesthetics Podcast, where we explore ways to enhance well-being, self-esteem, and resilience while navigating cancer. We bring you expert skincare tips, practical self-care strategies, and inspiring stories to help you rediscover strength, radiance, and joy. Welcome in everyone. This is Raejan, the national educator for the Ricardo Fisas Natura Bisse Foundation. Today I'm joined by Ms. Darienne Hall. Darienne, welcome to the show. Thank you. Glad to be here. Darienne, can you start off by telling us a little bit more about your role, what you do, and kind of how you walk someone through the process of their diagnosis?

What Oncology Dietitians Actually Do

Darienne 1:01

Sure. So I'm an oncology dietitian at UT Southwestern, the Simmons Cancer Center, there in here in Dallas. And it's a second career for me. So I got my master's and master master's in clinical nutrition in 2012 and my registered dietitian. And so I would note that being a dietitian is not the same as being a nutritionist. Anyone listening to this can call themselves a nutritionist and print a business card tomorrow. So, you know, if you're really looking for someone who has the education background and the code of ethics behind that, look for a dietitian. I'm also a CSO, which is a certified specialist in oncology. So we have board exams every five years we have to take to stay current in oncology. And then LD licensed dietitians. So I've got a lot of letters after my name. But what I really enjoy doing is just meeting with patients during chemotherapy to help them manage side effects with therapy. Our goal is just to keep people well nourished through treatment so they don't have any delays in treatment. I answer a lot of questions about things people have read or heard on social media, and you know, their friends and family are telling them things to take or not take and spend a lot of time reviewing supplements. There's a lot of misinformation around all of those. So really kind of just meeting patients where they're at and helping them get through this cancer journey.

Food As Comfort And Self‑Care

Raejan 2:22

Yeah, it sounds like a lot of what you do is kind of being that go-to person for what foods should I eat or avoid, what supplements should I take or avoid? Because I'm sure there's tons of stuff that people come to you with that they've pulled up on Google or TikTok or Instagram that who knows where they're getting this information from, which is I'm so glad you clarified the difference between a registered dietitian and a nutritionist, because I personally would have never known that that was the differentiation there. So thank you so much for clarifying. You're welcome. So when it comes to food, I personally am a big food person. I love to understand how it can impact somebody's skin health in particular. And of course, that's a lot of what our show is based off of is the skin aspect of going through treatment. But like with anything in life, in cancer treatment, there's so many other things that happen outside of the skin. So for me, we talk a lot about the power of touch and how much that can impact somebody on an emotional level, and of course, on a physical level, the tangible side effects that they're experiencing. Tell me a little bit about how you see food being, and really food and nutrition being sort of a form of comfort or even self-care.

Darienne 3:37

Well, I think that's one of the things I love most about my work. I'm a firm believer that food nourishes the body as well as the soul. we think of comfort food. There's a reason we call it comfort food. And for someone to provide a meal or to receive a meal, for many people, that's their love language. And so again, food is nourishing the body as well as the soul, and that provision of nutrition and care I think really is an important part of the big picture in a cancer journey. Yeah, absolutely.

Mediterranean Diet For Skin Health

Raejan 4:06

I love how you touched too on how it is comfort for the soul. It's comfort for the body as well, and I think just makes such an impact on every aspect of a person, their whole well-being, their experience in whatever portion of the journey they're going through. So, breaking it down a little bit more from food, let's talk a little bit more about the specifics of nutrients. What are some nutrients in particular that help maybe the skin stay very strong, maybe even resilient to some of the side effects that they may be experiencing?

Protein Priorities And Red Meat Limits

Processed Meats, Soy Facts, And Skin

Darienne 4:40

So, first, as an oncology dietitian, skin is not something I typically think about a whole lot, and for better or worse, during the day. And so I've spent a couple days just kind of reading more research articles and digging into the literature a little bit more about, you know, what really is the most healthy diet to support skin health. And conveniently or amazingly enough, it's really exactly the same recommendations we would have for a patient before or after a cancer diagnosis. And that's going to be that Mediterranean diet, you know, that just keeps coming up at the top of the list all the time. So more fruits and vegetables, whole grains, those beans, nuts, and seeds, lean proteins, limiting the refined carbohydrates. it really is helpful, I think, to think of your skin as kind of that protective wall around a medieval castle. Like if your body's the castle, the walls around it are that barrier that's protecting you. And so you think of the workers on the wall. You've got the workers that are building the wall, you've got others that are repairing some damage to the wall, you've got others that are defending the wall from attack. And so a Mediterranean diet is going to provide all the types of workers that your body needs to keep your wall healthy, your skin healthy. it's inevitable that age is gonna take its toll, but good maintenance can extend the life of your castle, your body, as well as the fortress around it, which is your skin. So, one of the things we look at a lot in cancer therapy that again dovetails well with skin health is looking at protein. and so the American Institute for Cancer Research is really a great go-to source if someone's wanting to look for evidence-based information in terms of what should I be eating to reduce cancer risk. And the recommendations are exactly the same before, during, and after treatment. and so if we look at kind of breaking down some different protein sources, one that we get a lot of questions about is the red meats. so that's beef, pork, and lamb. Pork is not the other white meat like those TV ads used to run if you remember those. so the recommendation on red meat is nowhere than 12 to 18 ounces per week. we don't really see an uptick in cancer risk until people start consuming above that amount. you want to be limiting kind of the grilling and the chard meats, those blackened parts of the meat, produce what we call these advanced glycation in products or ages, which are appropriately named, because not only do they increase the signs of aging, but they also can increase cancer risk, like colon cancer. So red meats, no more than 12 to 18 ounces per week. Try to limit the grilling or any of those blackened chyring with on meats. Second, processed meats. you really want to limit those as much as possible. So things like bacon, sausage, ham, pepperoni, hot dogs, lunch meat, all the things that we, you know, couple curves with me here we say. research shows that less than two ounces a day is enough for us to see an increase in colon cancer risk. Wow. So it's like one hot dog a day is going to increase colon cancer risk. And unfortunately, we're seeing colon cancer younger and younger, you know, starting to show up in people in their 30s because they grew up on lunchables, you know, those processed meats. so another question area, or area that we have a lot of questions about is soy. so wholesoy foods are not only allowed, but maybe actually beneficial. I would not have guessed that actually. Yeah, and so the advice for a long time, and I would say years ago, was for women with the history of breast cancer to avoid soy. There was concerned that these phytoestrogens would increase cancer risk because that's what they found in mice and rats. But once they started doing studies in humans, they realized that these mice and rats process these phytoestrogens very differently than humans. And there's actually studies following thousands of breast cancer survivors in the US as well as across the world, and they consistently show that women who consume soy have a better long-term outcomes. Wow. And they've also shown that young girls who consume soy in adolescence, so like if you've got teenager girls in your home, like now's the time for them to start putting soy milk in their cereal and having edamami as one of their green vegetables. because soy consumption earlier in life actually reduces breast cancer risk later in life. Wow, that is genuinely fascinating. I would not have known that. Yeah, it's a question we still get, there's still a lot of misinformation. And you'll actually find on that AIC or American Institute for Cancer research their list of foods that fight cancer. Soy is on that list. Wow. which surprises a lot of people. Yes. We kind of get this notion that I have to stay away from soy, but soy is actually probably beneficial. And then in looking through the literature, kind of to to with a focus more on skin, there's actually some research showing that soy can improve skin elasticity and hydration. So there's really no need to avoid soy if you're looking for a plant-based milk or a plant-based protein source. in as far as the cancer risk benefit versus risk, these soy isoflagones, which again, they're it's a type of plant estrogen, but it's not identical to human estrogen, and they tend to bind to what we call beta estrogen receptors, okay, which are different from the alpha estrogen receptors. So beta estrogen receptors are helpful for bone health. And so, you know, when menopause you start losing your estrogen, your risk for osteopenia or osteoporosis goes up. So soy may be beneficial in that area. and whereas the the binding to these alpha receptors is the one that correlates with cancer risk. so we're really are focused more on the soy in terms of reducing overall cancer risk by almost acting like an estrogen receptor blocker. Wow. and it's also advanced literature showing that it may improve collagen formation as well. So there's your skin tie-up.

Raejan 10:28

Yes, yeah, absolutely. That's definitely a lot of what I hear for people looking for improvement in their skin. You know, they want to help elasticity, they want to help build that collagen. And like you're talking about, it seems like there's a lot of benefit to soy that I personally never would have guessed.

Darienne 10:44

Yeah, I personally don't have a history of breast cancer, but I put soy milk in my coffee every day just because I read all these benefits and I want my bones to stay strong too.

Dairy Choices And Collagen Reality

Raejan 10:56

So then on the flip side of that, if soy has shown to have all of these benefits, are there pros or cons to dairy itself?

Darienne 11:03

so with dairy, you really want to stick with the low-fat dairy products. There is research showing that a daily serving or more of a full-fat dairy product, so think of like ice cream or a full-fat cheese cream. we suspect that these full-fat dairy products impact estrogen regulation. but we don't see that with the low-fat or fat-free dairy products. So sometimes I have ladies coming in, they're saying, oh, dairy's bad, you know, I stopped doing all my dairy. And it really is just the full-fat dairy that needs to be limited. And the low-fat dairy, we don't see that increase in risk, and that can be a good source of protein and calcium.

Raejan 11:39

Okay, great. That's good to know. That's, I mean, just so much good information in that one answer in and of itself. I feel like they were getting so much out of this. So when we're talking about, collagen, elasticity, and things like that. Are there certain types of foods that may promote that collagen build or even reduce inflammation to help support the skin barrier?

Practical Protein For Low Energy Days

Darienne 12:02

So hands down, the Mediterranean diet is recognized as the anti-inflammatory diet. Like if you're looking for an anti-inflammatory diet, it's the Mediterranean diet. as far as a collagen formation goes, you know, we see a lot of people coming in with these collagen supplements, thinking that, oh, if I eat collagen, it's gonna help my body make collagen. And eating collagen does not instruct the body to make it. So any protein, including collagen, is gonna be digested down into peptides, which are just smaller pieces of the protein, and those get digested down to the amino acids, which are just the building blocks of the protein. so the body's gonna decide what it's gonna do with those amino acids. Is it gonna make a muscle fiber? Is it gonna make an enzyme? Is it gonna make a collagen strand? But eating collagen does not instruct your body to make collagen. so most of the products you'll see on the market, if you look at the ingredients label, it'll say like bovine collagen. Some of them actually used to say bovine hide, but they've kind of that's disappeared. so basically it's cowhide. You're eating the skin of a cow. and so that's your most of your collagen peptide, you know, peptides and collagen products are coming from that. If you have a marine collagen, then that's typically made from fish scales. So it's okay to eat these if you want them. people just don't really know what they're getting. Yeah. and they're typically, I think, just a cheap source of protein that's been packaged into something more expensive. So if you like them, that's fine. but you don't have to eat collagen to improve collagen production.

Raejan 13:36

Okay. That is definitely something that I feel like gets asked about a lot, and I see a lot of people very curious about that. Like you're saying, that's supplements. So correct me if I'm wrong, but essentially having a collagen supplement is pretty much having a broken down protein.

Darienne 13:55

Correct. Yeah. So you just there just needs to be enough protein in the diet so that your body has those building blocks when it's ready to make a protein or collagen strand. And so the research I've looked at, I spent a whole day one day actually just pulling every research article I could find on collagen, and they were all comparing collagen to a placebo. So, of course, there's going to be maybe a benefit in adding a protein supplement, maybe 20 or 30 grams a day compared to a placebo. None of the studies I looked at compared collagen to, say, a whey protein powder, where you're either way you're getting that 20 or 30 extra grams of protein. And I suspect that they would come out equivalent if we were to see research like that. Most of this research is unfortunately funded by the industry. and there was actually an article that came out in May from the American Journal of Medicine, and this is their quote on a review of 23 collagen trials that they reviewed. their conclusion was there is currently no clinical evidence to support the use of collagen supplements to prevent or treat skin aging. So, again, if you just want it as a general protein supplement, that's fine, but it's not a magic fairy dust.

Raejan 15:02

Okay. So then let's talk protein, since it kind of seems like that's the end goal here, is really just making sure that you're receiving and consuming enough protein. What are some good sources of protein? Especially, let's say for somebody who might be really tired, who might be going through the side effects of going through cancer treatment, and they want to make sure they're getting enough protein intake and adequate protein intake to kind of help mitigate some of these things, what would your recommendations be to somebody who needs to increase their protein but is maybe having a hard time, you know, thinking about cooking or putting something together? How would you approach that situation?

Alcohol, Skin Sensitivity, And Risk

Darienne 15:42

so the first question I ask is Are you eating any protein at breakfast? What's a typical breakfast for you most days? if you're having protein at dinner and then you're fasting all night and then you're skipping protein at breakfast and not getting protein till lunch, that's just too long of a stretch to go without protein. Your protein needs are higher, you're gonna start cannibalizing your own lean body mass to get those those amino acids, those building blocks that your body's needing. so there needs to be a good source of protein at breakfast. That can be yogurt, that can be eggs, that can be cottage cheese, you know, whatever works for you. you know, some cultures eat fish and vegetables at breakfast, you know. So really whatever works with your food culture. protein sources that are easy. So think of keeping some tuna salad or egg salad, chicken salad, something like that. That's just in the fridge. It's easy to grab. Hummus is a great snack. peanut butter crackers, keep those, you know, in your purse when you're out and about. but there should be some protein at every meal. You want to spread that protein throughout the day and ideally include that in some of your snacks as well.

Raejan 16:51

That's honestly great tips and tricks, I think, even for somebody who's not necessarily going through cancer treatment. I would not have thought of some of those things just to kind of keep it accessible, you know, because you want something that's manageable and easy without it being, you know, going through a drive-thru every day for lunch or for breakfast to kind of make it quote unquote easier on you. So those seem like healthy alternatives, but they're manageable and they're accessible and they're things that you can just grab and go really quickly. You don't have to worry about necessarily putting in the effort and energy of cooking every single day three times a day.

Darienne 17:27

Yeah, and it's also important after treatment because there is research showing that you can a person can consume the same number of grams of protein, but if they're spreading that throughout the day, like breakfast, lunch, and dinner, as opposed to consuming that same amount of protein at just one or two meals, they're gonna maintain and preserve that lean muscle mass better if they're getting that protein throughout the day. Okay, and breakfast is typically the you know, maybe someone just having toast with their coffee. It's like put some peanut butter on their toast or some almond butter or an egg.

Fats, Omega‑3s, And Safe Supplement Use

Raejan 17:55

Yeah, okay. So again, kind of that reiteration of the age-old tale of breakfast as the most important meal of the day. I love that. So then on the flip side, we're talking a lot about foods that help promote the health of the skin, the health of the whole body. What are some foods or things that you see people consume that can maybe even make irritation or skin sensitivity worse?

Darienne 18:19

so I would say, aside from many known food sensitivities or allergies that maybe somebody has coming into treatment, I would give a reminder that alcohol is no friend to your skin. you really want to limit alcohol during treatment and then after therapy to no more than one or two servings per week. we kind of went through this phase where, oh, red wine is great, you know, it's part of that Mediterranean diet, you know, let's have some wine or two every night. but one serving of alcohol a day, which would only be five ounces of wine, is enough for us to see about a 15% increase in breast cancer risk. Wow. Two servings a day, those two glasses of wine is about a 30% increase in breast cancer risk. so alcohol is a known carcinogen, not only for breast cancer, but really for every type of cancer from the mouth all the way through the exit through your GI tract. so we would say if you don't drink, don't start. if you do hold that during treatment, your liver will thank you. It's working hard enough to clear the drugs. Yeah. and then not more than one or two servings after that. and then even for skin, alcohol can have some short-term effects. you can start to see the signs of dehydration or treating that inflammation that can worsen conditions like if someone has rosacea or eczema. it can make the skin more sensitive to the sun, as which other drugs that are in the treatment list can do as well. but then in the long term, alcohol accelerates aging and can really increase that risk of developing skin cancer as well, particularly melanoma. People, I mean, who would put those, connect those together? So, yeah, we really just recommend that less is best. it's your personal choice if someone wants to consume alcohol. the recommendation for the general population is still no more than one drink per day, but even at that level, we do see increases in cancer risk.

Antioxidants During Treatment

Raejan 20:11

Yeah, that's definitely really fascinating. And like you're saying, is kind of something that you can see as an aesthetician, you can definitely tell on the skin when someone's been drinking, or you know, even just in that short-term effect, like you're saying, you know, if someone went out and partied the night before, you can typically see the signs of it on the skin, particularly in that dehydration. So understanding it sounds like a lot of what people want to mitigate on their skin, just for overall, you know, appearances or structural impact, seems to be pretty congruent with what is healthy for the body or not healthy for the body in general.

Darienne 20:48

I mean, you can see the effects of smoking and alcohol on the skin, especially with long-term use. and I think it's important to think of the skin as kind of a a window to what's going on inside the body as well. And so if you see those visible signs of aging, advanced or accelerated aging on the outside, you know that that's what's happening on the inside as well. So the skin is really kind of a window to what's going on inside the body.

Hydration, Electrolytes, And Caffeine

Raejan 21:15

It really is. And I love earlier you were talking about it being kind of like a medieval castle, and that's kind of the two ways that I would look at the skin as more of that being my scope is first and foremost, the skin is a barrier. You know, the more you can support your skin in hydration and in resilience, especially through treatment, the more there's a reduction in the risk of infection, for example, because when the skin gets too dry or it's receiving radiation and that burn is starting to crack the skin, if there's a crack in the skin, there's an opening in the barrier. Exactly. And when the immune system is suppressed, then that increases the risk of infection. So then on the counter side of that as well, you know, people want their skin to look good. So keeping the skin healthy in turn also helps the skin to look more vibrant, feel more. Like there's a little bit more vitality to it. So I love kind of seeing the parallels of how all of this is connecting. short-term and long term. Okay, let's talk a little bit more about repair, maybe barrier function. I feel like we hear a lot about omega-3s and then things like things that we use topically as aestheticians are things like vitamin E, vitamin C. Do you see a benefit in internalizing these things, like taking supplements for omega-3s, or is it kind of more along the lines of what you were talking about with collagen, where there hasn't really been shown to have any specific benefit, but I can see where it's coming from because they're kind of building blocks of the skin.

Managing Nausea, Mouth Sores, Taste Changes

Darienne 22:43

Yeah, absolutely. So definitely there's a component for food as nutrition from whole food. supplements we typically don't recommend unless someone has a known or likely deficiency to correct. So if someone's vitamin D labs come back low, we'll recommend a supplement. If someone is not eating calcium-rich foods in the diet, a calcium supplement may be appropriate. But beyond that, there's really very limited evidence to show benefits of nutrition supplements. It's a multi-billion dollar market, but if we look at the research, it's typically in animals or in the lab, and human data is often lacking. So if again, if we think of the body of the skin as that barrier to the outside world, our skin is protecting us from infection, it's protecting from UV light, it's protecting from harmful chemicals or infection, as you mentioned. you know, we're sensing touch, we're making vitamin D. It's our waterproofing. We don't melt when we jump in the pool. and it's regulating our body temperature. You know, if it's too hot, we start sweating. If it's too cold, you start getting goosebumps. And so you can see all those things that the skin is doing. And it's it's the largest organ in our body, and I think in many ways we kind of take our skin for granted. I think I did until I started preparing for this. I kind of forgot how amazing our skin is. but the dietary fats really are important. first because you need fats in a diet to absorb those fat-soluble vitamins. So vitamins A, D, E, and K need some fat in the diet to absorb those. If you're just having skin milk and Cheerios and a banana for breakfast, there's really no fat in that, and you're not gonna absorb the vitamin D as well. and so you want to be looking mostly for those heart-healthy fats. So think of the nuts and nut butters of oils. So oils that are liquid at room temperature are going to be your heart-healthy fat. So think of coconut oil, it's solid at room temperature because it's high in saturated fat. We'd not consider that a heart healthy fat. It's maybe great for the skin. You can comment on that or not, but it's not considered a heart-healthy fat. same thing with like butter. So butter might be soft at room temperature, but you can't pour it. So if you're trying to think of healthy oils, they're gonna be liquid at room temperature. Think of olive oil and canola oil, avocado oil, all of those. and then also your hard healthy fats are going to include avocado and fatty fish like salmon. So the recommendation for breast cancer survivors is for fats to fall in the range of about 20 to 30 percent of total calories. breast cancer survivors who are consuming high-fat diets or fat above those ranges typically have poor long-term outcomes. and so we typically ask patients to stay away from a very high-fat keto-style diet. That's also pretty popular these days for weight management. but again, a high-fat diet has been shown to induce poor long-term outcomes in breast cancer survivors. And there are a lot of other side effects and reasons we don't recommend that. It's eliminating a lot of foods that we know have cancer-fighting properties. So the keto diet is not one that we would recommend. But including those omega-3s, as you mentioned, those are considered to be essential fatty acids. And what that means is they're considered essential because we don't make them. We have to consume them in our diet because our body cannot manufacture them. and so the American Heart Association recommends eating fish about twice a week. You can get adequate omega-3s from eating fish twice a week. they have strong anti-inflammatory properties. plant-based sources, if you don't eat fish, would include flaxseed or walnuts, okay, chia seeds, and a couple other things are listed with that as well. there's emerging concern, however, with this fish oil supplements, that doses over a thousand milligrams may increase the risk for apib or that atrial fibrillation and stroke, especially in people with no prior history of heart disease. so I always say with supplements, with any supplement, really, just because some is good does not always mean that more is better and more can sometimes be harmful. so the bottom line with the omega-3 is just eat fish twice a week if you like fish, especially if you got any fish like salmon. if you don't eat fish, you can add a fish oil supplement. Just keep that to no more than about a thousand milligrams a day unless you have physician supervision for that. Okay.

Raejan 27:03

I want you to say that line again just because it's reverberating in my head. Just because some is good doesn't mean that more is better.

Darienne 27:10

Exactly.

Raejan 27:11

Wow, I love that. And I feel like that's so applicable to so many things.

Darienne 27:15

Well, and like for example, during COVID, zinc was very popular because, oh, it it boosts immune function. Well, too much zinc zinc will reduce your immune function. Yes. So there is a safe upper limit. And if people, you know, are considering supplements and want to read some more about that, the NIH has a great website, it's the NIH Office of Dietary Supplements. and it will give you information on what the RDAs are for specific nutrients as well as potential risks with too much or too little, and if there's a safe upper limit, and that needs to be considered across all supplements combined. So sometimes people are coming in with three or four different supplements that may include even something as simple as vitamin D. but there's a safe upper limit, it's 4,000 IU a day. Once you start getting above that, if your blood levels are too high, even though it's a great anti-inflammatory, you know, it can protect from UV radiation with your skin. but high levels can cause other problems like calcification of the arteries and things. So again, I that's one of my favorite phrases. Just because some is good, yeah, doesn't mean that more is better.

Raejan 28:16

No, that's brilliant. And it brings me to something that, you know, we were talking about before we kind of got rolling, and something that I've heard a lot about recently is antioxidants. People taking in high level of antioxidants, but from what I hear when you're going through chemotherapy or radiation, that's actually not a good thing to be doing.

Eat The Rainbow And Helpful Resources

Darienne 28:35

Can you tell me a little bit more about that? Sure. So antioxidants protect cells from what we call free radical damage, which is what they're supposed to do. With chemo and radiation, we are creating free radical damage to go after those cancer cells. So if you're dumping in high doses of vitamin C, for example, like emergency or all these other antioxidants, they're working against the oxidative effects of chemo and radiation. So there is research showing that high supplemental doses of antioxidants may lessen the effectiveness of treatment, which we do not want. Right. but we don't worry about the levels of antioxidants that are naturally occurring in whole foods. So fruits and vegetables, those are always encouraged as part of a more plant-based diet during therapy. And nutrition always comes packaged best in whole foods. Mother Nature knows what it's doing when it puts an orange together. Like there's more in an orange than just vitamin C. And so, you know, we are a very you know, our culture wants to, you know, say, oh, well, I can take this and kind of then eat whatever I want. And it's like, no, you really, you know, vitamin C is important, but you need everything else that's in that orange too. it all works together. Giving the color and the fiber, and yeah, it's a whole foods.

Raejan 29:48

That's a brilliant way to put it, is the Whole Foods aspect of it just being so important. And I love too that, you know, you were giving such great tips and tricks on, okay, well, what if somebody doesn't have the energy or the time necessarily to sit down and cook with this beautiful, colorful palette and all of these Whole Foods? What are some alternatives for that? So I love that you're able to kind of touch base on all of those things. And I'm sure that is what is so helpful for your clients that come to see you is trying to help them find those alternatives. Okay, try as much as you can to get those Whole Foods in because of that well-roundedness. And here are some alternatives for those moments where maybe you can't necessarily have that in its totality. Which actually brings me to the hydration thing. Again, coming back to that, some is good, more might not be better. in hydration, you know, we hear a lot about things like electrolytes and salts or things that are going to increase that absorption of hydration. Do you see a benefit in that? Or is that kind of another one of those things where you don't really need to be taking in more of that? How do people stay adequately hydrated?

Closing And Listener Call‑To‑Action

Darienne 30:55

Well, I'm glad you mentioned hydration because our body's about 60 to 75% water, including the skin. so we're kind of like little flowers that wilt if we don't get enough water and then we perk back up when we're watered. So we need to stay well watered. even mild dehydration is enough for us to see an increase in fatigue, which is always a common side effect with most chemotherapies. constipation can be an issue with a lot of the anti-nausea medications, and so mild dehydration can worsen that. chemotherapy can be toxic to the kidneys and the bladder, especially with chemotherapies like cytoxin. So you need that flushing action to keep those drugs moving through your not only your body, but through your your bladder and your kidneys as well. So you mentioned the electrolytes. In general, we don't really recommend electrolyte replacement drinks, which would be like your sports drinks, unless there's a loss of electrolytes. So someone's having diarrhea or nausea and vomiting, or you know, they're out mowing the lawn and sweating for more than an hour. these drinks are typically very high in salt and sugar. Most Americans are already getting too much of both. So water is really the perfect hydrator. if someone needs a little flavor to that to make it more appealing, then it's a great idea to add maybe a little splash of juice in there. you can make your own infused waters, add some maybe cucumber and mint, or muddle some berries in there. there's a lot of flavored waters on the market now, like sparkling waters. I personally like spindrift because it's made with like a little splash of natural juice in there instead of these kind of chemical flavors that make it taste like something else. in general, you want to be drinking enough to keep your urine a light lemonade color. if the urine is completely clear, you might be drinking too much water and flushing out too many of those electrolytes. So there should be a little tint to the urine, about a light lemonade is a good gauge. if the urine's looking much darker than that, then that's a reminder to drink more. Okay. I tend to be a camel myself. I have to remind myself to practice what I preach and try to keep a water bottle with me, you know, at all times during the day. and so adding a little flavor to that can be helpful. and in addition to the urine color, you can also do what's called the skin trigger test. I don't know if you've heard of that before, where you just pinch the skin on the back of your hand and hold it. And then when you release it, you can see how long it takes for that crease to go away. And I'm probably, I just did that to myself. And it's like, yeah, it's kind of that little tint of skin is sticking up a little longer than it probably should. So I probably could use a little extra hydration at the moment.

Raejan 33:38

Well, that's a great way to look at it in tell. And to your point, too, with the hydration, we see that being something that is super duper important with the skin. We see dehydration of the skin being really almost one of the top concerns within our clientele with the skin, is it being very dry? And of course, with dryness comes a lot of discomfort within itchiness, peeling, cracking, again, that sort of skin barrier dysfunction as well. So that hydration aspect is so important. And I'm glad you mentioned that you can drink too much water, you can be overly hydrated because that is something that also needs to kind of be looked out for.

Darienne 34:20

well, and in the same vein with the supplements, herbal teas can sometimes fall into that category where there might be ingredients in an herbal tea that can interfere with a drug or have a contraindication with maybe a hormone-sensitive cancer. so make sure if you're taking any kind of herbal teas of those reviews, for example, turmeric is a common ingredient in many teas that can interfere with adriomycin and cytotoxin, which are common breast cancer chemotherapies. It can interfere with tamoxin, it can interfere with some of the aromatase inhibitors that people are on after their primary treatment. the Memorial Sloan Kettering About Herbs database is a great website if you have a question about, you know, this chamomile tea, can I take that or not? so that would be a resource we can include maybe a list of some of the resources we like to use at the end of your materials on the podcast. and you know, that's not going to replace a discussion with your pharmacist, and you should always make sure that any supplement you're taking is added to your medications list. So whenever medications change, pharmacy can run a drug interaction checker because we do see a lot of common herbal teas that have contraindications with them. and then coffee or tea, sometimes we, you know, have people come in and say, Oh, I stopped drinking coffee because I heard caffeine's dehydrating. And it's like, if you're drinking one, two, maybe even three cups of coffee a day, we would still count that as part of your daily fluid intake. If you drink 12 ounces of coffee, you're not gonna pee out 16 ounces of water. it's still going to have a hydrating effect. After that, we start to maybe worry about the effects of caffeine. But one to three cups a day, I'm not gonna worry about that. And you'll actually will find both coffee and tea on that AICR list of foods that fight cancer. coffee's shown to reduce the risk of liver cancer. So have your morning cup of Joe if you enjoy that. And don't worry that you're having something bad because there's actually a lot of health benefits and antioxidants in both coffee and tea.

Raejan 36:24

That is wonderful to know, honestly, because you do hear so many mixed things about caffeine or coffee. I'm also glad that you touched on tea as sort of a category of supplements because I feel like that's something that I wouldn't have thought to mention to a doctor. and just because, you know, it's more of like a, oh, I'm just consuming a beverage, you know, a lot of those teas, I wouldn't have necessarily thought of them as an herbal supplement. But it's great that you mentioned that because I do think it would be really important to say something about those things to your oncologist, to your doctor, to, like you said, to a pharmacist to make sure that there won't be any sort of negative counteractions or interactions between the medications that they're being put on or receiving and the things that they're just kind of consuming on a daily basis. Yeah, that's great to know.

Darienne 37:12

Yeah.

Raejan 37:13

Kind of to wrap things up a little bit, I was really just sitting here kind of thinking about more of some of these alternatives that you've talked about and how to make the nutrition aspect and these helpful tips and tricks more accessible to our listeners and to people who are going through this. One of the things that we see a lot in our clientele and that people tell us a lot about is people dealing with nausea, maybe even mouth sores or changes in taste, things that would make it really difficult to have kind of a full, well-rounded Mediterranean diet. How do you help people and support them in those situations when eating or consuming something honestly doesn't even feel good?

Darienne 37:55

Yeah, well, the first thing I would say is no food fights. a lot of times people may have been having these symptoms with the nausea, especially, or the loss of appetite. And it is very difficult to stay well-nourished. And you know, the family might be just kind of pushing food on them all the time. And we really need to allow the patient to determine what they can and can't eat in a given day. There may be up days, there may be down days. So we're really looking at the big picture here, not you know what's happening in one day. nausea is unfortunately quite common, and so in that case, those small frequent meals throughout the day and snacks, the general recommendation is to limit foods that are not gonna set well in your stomach typically anyway. So foods that are really fatty and heavy, fried, you know, greasy, spicy foods. Food smells can often trigger nausea. so if a meal needs to be prepared by someone else, perhaps, in the kitchen and or made in advance, it's where it can just be served at room temperature, so you're not getting those smells coming up in your face. It sometimes can trigger the nausea. even a drink maybe needs a lid and a straw. So if you're having even a protein shake, and maybe that smells, you know, you just had one too many protein shakes, and that smells bothering you, put it in a container with a lid in a straw. Kate Farms is one liquid meal replacement that may work if you're just not able to eat solid foods but are doing okay with with drinking, then that's a complete nutrition protein shake. and your dietitian might be able to offer you samples of that, or you can probably get them online. There are medical supply companies that can offer those typically half the price that you'll see online, so they can be much less expensive actually than protein shakes you're picking up in the grocery store, but they're a complete nutrition product. Like okay, just drink nothing but these shakes for the next 10 years and be fine from a nutrition standpoint. So on therapy, if someone's not eating well, I love to recommend these shakes, and then everyone in the patient and the family can be rest assured you're staying well nourished. with the mouth sores, soft, moist foods are gonna be much better tolerated than foods that are really hard or crunchy that can kind of scratch the lining of the mouth. It's a good idea to avoid acidic foods. So think of like citrus or lemon or lime, you know, vinegars, those are gonna be irritating if you've already got mouth sores starting to develop. a baking soda and salt water rinse, just making making that as a mouthwash, just swish and spit several times a day might be helpful. But if that's not clearing up those mouths, then make sure your provider is that it's communicated to your provider so they can give you those prescription mouthwashes if you need them. ginger gel is one over-the-counter topical product that I often recommend. It has that hyaluronic acid that I know is in a lot of skincare treatments. it kind of creates a protective barrier on those mouths and lets the skin, the mouth sores heal from underneath. So ginger gel is something that people can get over-the-counter without a prescription. for those changes in taste, we have a whole handout that's available on our website with what we call fast tips. So fast, F-A-S-S, fats, acids, salts, and sweet. and so depending on if your food is tasting cardboardy or if it's tasting metallic, you know, you can play around with some of those different flavor tips. and so if you just wanted to search for UT Southwestern Simmons Oncology Nutrition, that website will come up with all of our handouts for managing a long list of potential side effects, you know, things like dry mouth and diarrhea and constipation and the whole list of things. and that's available to the public. That's not just for patients at our cancer center. and then there's also some great tips there for survivorship and healthy eating as well. So we'll try to include that in the tips at the end of the podcast. Yes.

Raejan 41:44

Amazing. Oh my gosh, I feel like we could continue talking about this for hours. I mean, your years of expertise have definitely shown through, and I feel like there's so many topics that we could just keep going on about. But unfortunately, we we will have to wrap it up at some point. But before we do, I would love to hear from you if there's any anything that you feel like we haven't covered that seems really important for our listeners, for people who are going through this. I know that this has been such a wealth of information and so helpful for everyone involved, myself included. so I'd love to hear from you if there's anything else that you just kind of want to touch base on before we wrap up this episode.

Darienne 42:22

Yeah, so I mean, I think we covered protein pretty well. I think it's important to note that we talked about healthy fats, those heart-healthy fats. I think it's important to note on the flip side of that coin that a diet high in saturated fat and high in those simple sugars, those refined carbohydrates, can not only damage how the skin repairs itself, that collagen remodeling, it can also delay healing. So if someone's having surgery or mastectomy, you know, it can even impact the wound healing and within that process. Radiation is another thing that comes to mind with that. Yeah. and so we we we often get the comment of, oh, sugar feeds cancer, you know, I like I won't even eat a cookie anymore because it's you know, it's gonna feed my cancer. Yeah. and that's really not true. So does sugar feed cancer? Yes, but it feeds every cell in your body. There's no way that you can not eat that cookie and somehow that's gonna keep your cancer from growing. So where sugar becomes an issue is people who are consuming chronically high levels of refined carbohydrates or added sugar throughout the day have higher insulin levels. Insulin is a growth factor. We need it to survive, but too much insulin over time, because it's a growth factor, increases cancer risk. So it's not that sugar feeds cancer, it's that insulin, it's that sugar over time increases insulin output, and that can over time increase cancer risk. So our recommendations are follow with the American Heart Association, which is to limit added sugar to no more than about 100 calories a day for women. It's about six teaspoons worth or 24 grams if you're a gram counter, 150 calories for men and then we don't worry about sugar that's naturally occurring in fruits or plain you know yogurt plain dairy products. So you know sometimes people say they stopped eating fruit. Like, I'm not worried about the sugar that's in a banana, I'm worried about the sugar that's in the fruit loops. Yes, I'm not worried about the sugar that's in yogurt because if you look at the nutrition label, it's gonna have sugar in it, and that's just the lactose, which is the sugar that's naturally in yogurt the yogurts that are so sweet a five-year-old is gonna eat them because they've added you know in all that extra sugar. so fortunately the nutrition labels now include a line item for added sugar, and that's really what we're focusing on. so I think it's a great idea to get in the habit of looking at that line for added sugar and maybe comparing between brands to find, you know, which yogurt or bread or whatever you're looking at has less added sugar in it. and then if you can't remember, I mean, I'm a dietitian, I do this all day long, but yeah for most people it's like, well, how much one am I supposed to have? so a good quick trick for looking at those nutrition labels with added sugar is whatever the percent daily value it shows for women, double that number. So if the nutrition label says if I eat one serving of this food, it's gonna give me 20% of my daily value for added sugar. We would, under American Heart Association guidelines, count that as 40% of your daily value. Okay. So you can have that food. It's not that you can't have it, it's just you need to think about what am I eating throughout the day. Uh-huh. so if you like a teaspoon of sugar in your coffee in the morning, fine. Just, you know, how does that fit in with how much sugar you're having through the rest of the day? And so when we talk about added sugar, it's not just the white sugar, it can be honey, it can be maple syrup, it can, you know, be any kind of sugar that's added to an original food to add it to it. So those added sugars that are not naturally occurring. I think overall, you kind of asked like in summary, I would say if you look for a list of foods for skin health, which I did to get ready for this, everything is really covered under that umbrella for the Mediterranean diet. So we talked about the omega-3 fatty acids from you know, foods like fish and walnuts and flaxseed. We talked about those heart-healthy fats and vitamin E, which you're gonna get from those liquid oils. avocado, nuts, and seeds. We talked about antioxidants, which have those great anti-inflammatory properties as well. And so the recommendation there, and people sometimes want like a list of nutrients that they're gonna eat that they should look for. But we don't eat nutrients, we eat food. and so my focus tends to be more eat the rainbow. Are you eating something that's red and green and yellow and orange and purple? And if you're including those in your grocery cart every week, you're gonna be getting those nutrients that you need for skin health and for reducing cancer risk and for reducing risk of heart disease and diabetes and dementia. It all falls under that same umbrella for a more plant-based diet most of the time. There is nothing that I would ever say to never eat. It's always the question of how much and how often. So if it's your birthday, have a piece of birthday cake. If it's New Year's Eve, have a glass of champagne. But you shouldn't be doing that every day. So I think we, you know, again, that if you're looking for what is that Mediterranean diet, like I need kind of a plan. It's not a prescription, it really is just kind of a meal pattern. Old Ways Mediterranean, excuse me, Old Ways Mediterranean is a great online resource for more information about how do I put together a meal plan that actually kind of looks like a Mediterranean diet. eatingwell.com actually has meal plans. You can just type in, you know, look for the Mediterranean diet, and it'll come up with a meal plan for several weeks if you're looking for something like that. and the one of the reasons I like Oldways with our pagia population as well is that they adapt that Mediterranean diet to several different food cultures. So if you're eating more of an Asian diet or an African-American heritage diet, it'll give you guidelines for how you adapt that Mediterranean diet to those food cultures.

Raejan 48:27

I love all of that. I especially love how you were just talking about, you know, eating the rainbow. It kind of, to me, helps simplify it, something that doesn't seem very easy necessarily, but you can simplify it into eating the rainbow, following that Mediterranean diet. We eat foods, we don't eat nutrients. I love that. Darienne, thank you so much for all of this incredible information and for being here and willing to chat with us about all of this today. We are so thankful to have you on the episode and to our listeners, thankful to have you as well. We will see you next time. Thank you for joining us. We hope you found this information helpful. It's your reviews and feedback that helped make this podcast even better. If you enjoyed this episode, please subscribe, leave a review, and share it with someone who might benefit. Until next time, take care, stay radiant, and we'll see you soon.