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This is the second Spanish-language episode.
We are what we eat, and there’s no doubt that certain lifestyles increase the risk of developing cancer. So how does food help us reduce that risk? Where can I get help finding healthy food? And what should I be eating if I have cancer? In this episode, medical oncologist Diane Reidy-Lagunes talks with her MSK colleagues, nutritionist Karla Giboyeaux and gastroenterologist Delia Calo, about building good habits in our daily lives to reduce the risk of cancer — from grocery shopping and cooking to scheduling regular screenings.
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Learn more about the Ralph Lauren Center here.
Cancer Straight Talk from MSK is a podcast that brings together patients and experts, to have straightforward evidence-based conversations. Memorial Sloan Kettering’s Dr. Diane Reidy-Lagunes hosts, with a mission to educate and empower patients and their family members.
If you have questions, feedback, or topic ideas for upcoming episodes, please email us at: [email protected]
Episode Highlights
What are the most frequently asked questions you receive from patients regarding diet and nutrition?
1. Do I have to be vegan, or do I have to stop eating meat? The answer is no, but there are recommendations from the American Institute for Cancer Research to reduce your consumption of red meat to three servings a week, which is about 18 and 12 ounces. There is evidence that frequent and excessive consumption of red meat and sausages increases the risk of different types of diseases, including colon cancer.
2. Does sugar affect cancer directly? Sugar doesn’t directly affect cancer or cancer growth, but it does affect our weight. It is important to try to maintain a healthy weight and consuming a lot of added sugars affects that, so it is good to incorporate it into our diets in a moderate way according to our needs.
3. Is it safe to eat soy, specifically for patients who have breast cancer? The truth of the matter is that we can consume it. We don’t want to be consuming soy products day and night, but it’s a good option, especially for those people who don’t eat a lot of animal protein.
What advice can you give someone who loses their appetite due to cancer treatment?
1. Suddenly changing your diet after receiving a cancer diagnosis is not healthy because the effect of the cancer treatment plus the effect of the diet change will not be good for your weight. You can lose muscle mass, which is what you want to maintain at all costs. It’s important to look at food as medicine.
2. Try to have a meal schedule. If you can eat even a tiny bit, that’s great, just eat more often every hour. It’s important to eat small but frequent meals and try to have calories and protein in every bite. Smoothies are a great way to incorporate lots of protein and calories.
3. Cold foods are good for people experiencing nausea since they have fewer scents.
What advice can you give people regarding their gastrointestinal health?
1. People always want to know if they can take supplements, for example, probiotics. We don’t recommend it to people with cancer.
2. If you have stomach pain such as abdominal spasms, sometimes mint can help. Though if you have esophageal reflux, mint can make it worse, so you have to balance it.
3. To prevent constipation, eat foods with more lots of fiber, such as fruits and vegetables. Exercise also helps with constipation. If you still have constipation, you should go to the doctor because that is one of the early signs of colon cancer, so it is important you get an evaluation from your doctor.
4. Polyps and colon cancer don’t necessarily cause symptoms until they’re very advanced. So even if you feel healthy and have no reason to get tested, you could still have an early form of cancer.
What is a polyp and how do you find them?
A colon polyp is a tissue growth that can transform into colon cancer. Colonoscopies are the preventive method we use to detect and remove polyps before they start growing. It prevents you from having cancer growth. We are now recommending colonoscopies at 45 years old. They changed the age from age 50 to 45 and it’s for everyone, women, and men of all races.
How can I prevent colon polyps?
1. Eat less red meat and less processed meat.
2. Avoid consuming alcohol as much as possible.
3. If you are older, get screened often. Polyps are more common in older people, but we also find them in young people.
Why is colon cancer more prevalent in the Latino community?
The Latin American community is not accessing available preventive screenings as much as other races in the United States, and when they go for preventive screenings, they find the most advanced cancers than the cancers detected in other races. That’s a problem. We need to remind our friends and family members to get screened regularly and go to their primary care doctors for checkups.
What are affordable ways to get cancer tests or preventive screenings in New York?
The Ralph Lauren Center in Harlem offers tests to anyone who goes there. They don’t have to be residents of the community. Memorial Sloan Kettering also has the Immigrant Health and Cancer Disparities Service that launched a mobile health unit in December 2021 in New York City, which provides people with education and referrals to doctors for various cancer screenings.
How can we have a nutritional diet if we don’t have access to healthy food, or the resources for it?
At the Ralph Lauren Center, MSK’s FOOD Program is very useful, especially for patients who receive government benefits that sometimes are not enough. We help them apply to other programs that, for example, deliver food to their houses.
Seeing a nutritionist at the Ralph Lauren Center is also important because we talk about how to save money in the kitchen while still being healthy, such as reducing meat, one of the most expensive food products.
Consuming beans, fruits, and vegetables that are in season is highly recommended because things that are in season are much cheaper. The less processed the product is, the cheaper it will be.
In summary:
1. At age 45, have a colonoscopy. Cancer can be prevented.
2. Nutrition is very important, and moderation is the key.
3. Stop smoking and avoid alcohol.
4. Ask your doctor if you have symptoms, please. You deserve it.
Show transcript
Dr. Diane Reidy-Lagunes
We are what we eat. Or that's what they say. There is no doubt that certain lifestyles increase the risk of developing cancer. Nutrition plays a huge role. But how can we reduce the risk of cancer? And what happens when you have cancer? What role do diet and nutrition play? We're going to talk about this right now.
Hello, I'm Diane Reidy-Lagunes from Memorial Sloan Kettering Cancer Center and welcome to the Cancer Straight Talk podcast. We want to be a source of information so that you – whether you are a patient, partner, family, or friend – feel more prepared and supported to face this fight against cancer.
Today we are joined by nutritionist Karla Giboyeaux. She will give us an idea of what patients' most frequently asked questions about nutrition are. At MSK, we value the nutritional foods that patients put on their plates, but the most important thing is to provide them with the tools they need to lead a healthy digestive life. Dr. Delia Calo is also here with us, a gastroenterologist at MSK for almost ten years. She is going to give us information about cancers related to the digestive system. She will also talk about a topic on which she has done a lot of research: the early detection of colon cancer through preventive examinations. Delia and Karla, welcome to the program.
Dr. Delia Calo
Thank you very much.
Karla Giboyeaux
Hello. Thank you for having us.
Dr. Diane Reidy-Lagunes
Thank you for joining me. Karla, I'd like to start with you. Can you tell us the most frequently asked questions you receive from patients?
Karla Giboyeaux
Well, there are three frequently asked questions. The first is, “Do I have to be vegan, or do I have to stop eating meat?” To answer whether you have to be vegan, the answer is no, but there are recommendations from the American Institute for Cancer Research to reduce your consumption of red meat to three servings a week, which is about 18 and 12 ounces. There is evidence that frequent and excessive consumption of red meat and sausages increases the risk of different types of diseases, including colon cancer.
The second is whether sugar directly affects cancer. This is a myth that we as nutritionists discuss a lot with patients because there is so much bad information on the internet, most of it totally useless and designed to scare people with cancer. Sugar doesn't directly affect cancer or cancer growth, but it does affect our weight. It is important to try to maintain a healthy weight, and consuming a lot of added sugars affects that, so we need to incorporate it into our diets in a moderate way according to our needs. If you want to eat a cookie or dessert, do it with great pleasure. But if we want to reduce added sugars, try not to go too far and understand that sugar, because it's not a food group, is something we use to improve the taste of foods to make them better on the palate. It helps a lot of patients who have cancer, who have appetite loss, or who have changes in taste. Often, patients who are undergoing chemotherapy or radiation therapy experience changes to taste in their mouths. Food doesn't taste very good so by sweetening meals, it helps them eat better and eat more when they need to. And it's important to eat well, especially during treatment, in order to successfully cope with it.
And the third is whether it's safe to eat soy, specifically for patients who have breast cancer. Soy is something of concern because soy, on a microscopic level, has molecules called phytoestrogens, which are a little similar to the hormone estrogen, and that's why many people who have this type of breast cancer are afraid of it. But the truth of the matter is that we can consume it. We don't want to be consuming soy products day and night – that's not what we want – but it's a good option, especially for those people who don't eat a lot of animal protein. It's a good source of protein, you just have to be careful with supplements that have concentrated soy products, that's all.
Dr. Diane Reidy-Lagunes
I agree, and I always say that our patients need calories. As you say, a piece of cake is okay – you can't eat all the cake – but we also don't want patients to lose weight because they need energy. And can you tell us a little bit about, for example, a person who has cancer and is receiving treatment and may lose weight and lose their appetite? Are there other tips you can give us?
Karla Giboyeaux
Yes, of course. As you said, it's not good, for example, if a person who is not vegetarian or vegan, who just eats a regular diet, starts treatment and suddenly changes their diet. That’s not healthy because then the effects of the treatment plus the effects of the diet change will not be good for their weight, and they can lose muscle mass, which is what we want to maintain at all costs. This happens when patients have no appetite and no desire to eat anything at all, which happens because they’re nauseous from treatment and don't have any energy, which is quite normal. It's important to look at food as if it were medicine though and try to have a meal schedule. Even if you eat a little bit, that counts. The most important thing to remember is if you eat just a tiny bit, then you need to eat more often, like every hour. It's important to eat small but frequent meals and try to have calories and protein in every bite. Nutritional supplements also help. You can make smoothies and add things that have a lot of calories such as peanut butter, nuts, protein powder, fruits, quinoa, and yogurt. All those things are going to give us protein. They are going to give us calories. With a blender, it's so easy, especially if we have nausea, then cold things come in handy. Cold foods don't have a lot of scents, so it doesn’t affect nausea as much. The main thing is to think that food is a medicine, and it is something that will help us feel good.
Dr. Diane Reidy-Lagunes
Thank you very much. I completely agree. Delia, as a gastroenterologist, what kind of questions do you get asked from our patients?
Dr. Delia Calo
People always want to know if they can take supplements. They always ask about probiotics, which we don't recommend to people with cancer. For healthy people who don't have other diseases, it's smart to discuss supplements with your doctor. Sometimes people also have stomach pains, such as abdominal spasms. What can they do when they encounter pain? Sometimes mint can help, though if you have esophageal reflux, mint can make it worse, so you have to balance it. Of course, constipation is very common. There is a lot of constipation in this world and of course it causes pain. The first thing you should try to do is eat foods with more fiber or with more fruits, more vegetables. Increase the amount of garlic you have. Exercise also helps with constipation. Of course, if you still have constipation, you should go to the doctor to see what is happening because that is one of the early signs of colon cancer, so it is important you get an evaluation from your doctor.
Dr. Diane Reidy-Lagunes
Is there anything else that you have to clarify to people?
Dr. Delia Calo
Patients often say to me before I do their colonoscopy, “I'm sure you won't find anything because I feel good. I don't have any symptoms. I go to the bathroom every day. I'm only here because my doctor, my oncologist, told me to come and it took a lot of effort to come here, but I didn’t want to. I'm sure I'm okay.” But that's not always the truth, because polyps and colon cancer don't necessarily cause symptoms until it's very advanced.
Dr. Diane Reidy-Lagunes
What is a polyp?
Dr. Delia Calo
A colon polyp is a tissue growth that can transform into colon cancer. Undergoing a preventive exam can lower your risk of developing colorectal cancer because we can remove the polyps before they start to change. It prevents you from having cancer growth. So it's one reason to get a colonoscopy. We are now recommending colonoscopies at 45 years old. They changed the age from age of 50 to 45 and it's for everyone, women and men of all races.
Dr. Diane Reidy-Lagunes
We repeat: if we remove a polyp, cancer can be prevented.
Dr. Delia Calo
Exactly.
Dr. Diane Reidy-Lagunes
That’s super important. Just like you, I have a lot of patients who don't really want to do a colonoscopy or say it's too difficult. Are there other types of prevention methods you can recommend?
Dr. Delia Calo
There are other tests that can't prevent cancer, but they can help find cancer that isn't very advanced. There are fecal tests we can do and chemicals that look for hemoglobin in feces. Looking for molecular changes can tell us if polyps are advanced. A colonoscopy is the best though, but if you absolutely can't do it, do one of the others to try to detect what you may have.
Dr. Diane Reidy-Lagunes
What causes polyps and what can patients do to prevent them?
Dr. Delia Calo
There are things that we can change, one of them being our diet. Eat less red meat, as we said, less processed meat. Alcohol too. It was thought that a little alcohol once a week was fine, but the best thing is not to drink anything at all. We all try to do our best though. Nobody is perfect. And of course, our age. Polyps are more common in people who have advanced age, but we also find it in young people.
Dr. Diane Reidy-Lagunes
Yes, that's super important because your research focuses on early detection of colon cancer. You’ve also found that the numbers appear higher in the Latino community. Can you tell us about that?
Dr. Delia Calo
The Latin American community is not accessing available preventive screenings as much as other races in the United States. And when they go for preventive screenings, they find the most advanced cancers than the cancers detected in other races. That's a problem. Of course, we need to try to help with education and healthcare access for all. Here in New York, we have a lot of doctors, a lot of hospitals, where a colonoscopy is easy to get. There are other places in the United States where that is harder. Remember that it is important to go to your primary care doctor and try to improve your health as much as possible.
Dr. Diane Reidy-Lagunes
And Delia, what are other affordable ways to get tests or preventive screenings, for example, in New York?
Dr. Delia Calo
MSK has a center, the Ralph Lauren Center in Harlem, that offers tests to anyone who goes there. They don’t have to be residents of the community. It also has the Immigrant Health and Cancer Disparities Service that launched a mobile health unit in December 2021 in New York City, which provides people with education and referrals to doctors for various cancer screenings. We are trying to inform and educate people so that everyone takes care of themselves and stays in good health.
Dr. Diane Reidy-Lagunes
There are many cases in which patients do not have the means to access healthy food. Let's listen to Rosa Sanabria, who has been fighting cancer for more than 20 years. Rosa has been on the MSK Food Program and shares her experience before and during the pandemic:
Rosa Sanabria
When I started using the hospital’s services, it was a great help, because in other hospitals they hadn't paid much attention to me. There were no interpreters. But this was like getting the best thing that could ever happen to me. During the pandemic, they gave us the great benefit of bringing food to the house. They gave us vegetables, rice, pasta, milk, and many cleaning utensils.
Dr. Diane Reidy-Lagunes
Karla, you have helped many patients like Rosa who face this problem. What are other ways to have a nutritional diet?
Karla Giboyeaux
Yes and I'm glad that Rosa has found utility in MSK's Food Program. It's very useful here at the Ralph Lauren Center, especially for patients who receive government benefits, but sometimes it's not enough. We help them apply to other programs that, for example, deliver food to their houses. These programs are for patients who have specific conditions, so seeing the nutritionist is good because we can help you request those services. Another thing is that during my visits we talk a lot about how to save money in the kitchen while still being healthy, such as reducing meat, one of the most expensive food products. So it's a two-for-one. We save money and are healthier. Consuming beans, fruits and vegetables that are in season is also highly recommended, because things that are in season are much cheaper. The less processed a product is, the cheaper it will be. And we also have a program at the Ralph Lauren Center called Cooking With Karla. It's in English, but we offer the recipes in Spanish as well, and it's something you can enroll in. You can get the information on the MSK website.
Dr. Diane Reidy-Lagunes
Karla and Delia, you two speak Spanish. What is the importance of connecting with your patients in their native language about something as important as nutrition?
Karla Giboyeaux
Well, for me it's very important because as a Puerto Rican, if I were a patient, I would like to connect with someone who is from my own culture. So it's very, very important. Patients feel more comfortable, they feel more confident, and they open up more and tell us more things that are happening to them. And that's good because that way we can help them much better. Right, Delia?
Dr. Delia Calo
Yes, it's true. They are so proud, so, “Oh, thank you!” They're always thanking me. I didn't do anything, but they feel so. They feel so comfortable. It's like a family. “Where are you from?” And we have a conversation. It feels like they can rest and that's the truth. They tell you more because it doesn’t take as much effort to tell you, and they know that you are listening, and you know that you understand. It's almost like meeting an old friend because we have something in common, a language and a culture. I think these are my favorite patients because I have so much fun talking to them.
Dr. Diane Reidy-Lagunes
Thank you both for being here with me.
Karla Giboyeaux
You're welcome.
Dr. Delia Calo
Thanks, Diane.
Dr. Diane Reidy-Lagunes
To all our listeners, I'm going to give you a summary of what we talked about today:
1) To the Latino community, please at age 45, have a colonoscopy. Cancer can be prevented.
2) Nutrition is very important, and moderation is the key.
3) Stop smoking and avoid alcohol.
4) Ask your doctor if you have symptoms, please. You deserve it.
Thank you for listening to Memorial Sloan Kettering's Cancer Straight Talk podcast. For more information, or to send us any questions you may have, visit us at mskcc.org/podcast. Help others find this helpful resource by commenting on this podcast on Apple Podcasts or wherever you listen to your podcasts. These episodes are for you, but they are not intended to be a medical substitute. Remember to consult your doctor with any questions you may have about medical conditions. I'm Dr. Diane Reidy-Lagunes. Onward and upward.
