Qué comer después del diagnóstico de cáncer de mama (seno)

​​Dr. Marisa Weiss: Hello everyone. I'm Dr. Marisa Weiss. As Lisa just said, we're so happy you're here with us today. A very important webinar. So many of you are interested because managing food choices after a breast cancer diagnosis can feel especially challenging. It's that one area that you can make immediate changes that can help you get healthier.

You may be hearing conflicting advice, though, dealing with side effects that can change your appetite or how foods taste, navigating weight ups and downs, or wondering whether what you eat really makes a difference. It's a lot on top of everything else going on in your life. As a breast cancer survivor myself, I understand the struggles. This webinar is a supportive judgment-free space to talk about nourishment and to have your questions answered. It's not about perfect eating or rigid rules. We want to offer practical guidance to help you fuel your body and mind in ways that feel doable and sustainable whether you're newly diagnosed, in active treatment, finished treatment, living well, or navigating metastatic breast cancer. 

Our experts will break down what healthy eating really means, how to get balanced meals on even low-energy days, and which foods taste good and may help ease side effects. We'll also share tips to boost your protein intake and other healthy eating ideas you can start using today. Most of all, this webinar is about empowering you with the knowledge that you can improve your own life without feeling pressure or guilt. Think of it as a work in progress.

First, I want to take a moment to acknowledge our generous sponsor, AstraZeneca. Thank you so much for making this event possible. 

We're fortunate to have three incredible speakers with us today. Elizabeth Heiskell is a chef, bestselling cookbook author, longtime TODAY Show food contributor, and founder of one of the South's top catering companies. She's known for her warm southern hospitality and practical joy-filled approach to cooking. She has built a national following across television, social media, and live events. A breast cancer survivor and passionate advocate for early detection, Elizabeth brings authenticity, resilience, and heart to every stage, whether she's sharing a recipe or her own story.

Amy Bragagnini is a registered dietitian and board certified specialist in oncology nutrition. She works at Trinity Health Lacks Cancer Center in Grand Rapids, Michigan. Amy is a media spokesperson for the Academy of Nutrition and Dietetics. She's also a consultant at the Women's+ Health Collective, where her work includes guiding women at the intersection of nutrition and issues like menopause, fertility, mood changes, and food sensitivities.

Erica Salehi is a clinical research registered dietitian who has spent the past decade helping people with cancer, particularly breast cancer, at Memorial Sloan Kettering Cancer Center. Right now, she's focused on learning and further developing her skills, earning her PhD at the Yale School of Public Health. Her research examines how nutrition quality before, during, and after cancer treatment can improve energy balance, quality of life, and survival outcomes for people with breast and endometrial cancers. Thank you all so much for being here today with us.

Before we get started, I'd like to review the basic food groups that will be referenced throughout today's webinar. A healthy diet includes a mix of foods from five main food groups: fruits and vegetables, whole grains, protein foods, dairy, and fats. 

Fruits and vegetables are a big focus because they provide different types of fiber and a full range of nutrients, including vitamins like vitamin C, A, and K, as well as folate, minerals like magnesium and calcium, and protein like lentils, beans, and nuts. Most spices also of different colors are plant-based as well. 

Whole grains like oatmeal, brown rice, whole grain bread give you fiber, vitamins, and minerals that refined grains just don't.

And then there are the protein foods, including meat, fish, poultry, chicken, beans, nuts, soy, which provide protein as well as essential vitamins like B12, and help maintain strength and energy. 

Then we have our dairy products like milk, cheese, cottage cheese, or fortified milk alternatives like almond and soy milk, which can provide protein as well as calcium and vitamin D for our bone health. 

And finally, the healthy fats from foods like fish, nuts, seeds, and plants, which support many different ways that our body and our mind function. And there's still room for our favorite foods too. And we'll talk about all of this shortly. 

Now, it's my honor to introduce celebrated chef, cookbook author, and breast cancer survivor herself, Elizabeth Heiskell. Elizabeth, it's wonderful to see you again.

Elizabeth Heiskell: Oh my Lord, thank you.

Dr. Marisa Weiss: Absolutely. We'd love to hear your story. I know that, I remember back in 2023 actually, you were diagnosed with breast cancer and you actually found the lump yourself. Tell us about what happened and how your life was impacted.

Elizabeth Heiskell: So it was just one of those things. I was in the best shape of my life. My career was exactly where I wanted it to be. Breast cancer was not on my radar. It was no more on my radar than the man in the moon, honestly. And we were at a football game. Actually, we were watching a baseball game at a restaurant that I love more than anything. I went and I just scratched just like this. And I felt something. It was large and it was big enough that I thought, oh gosh, that's got to be a fatty tumor. I mean, we're talking big.

And so I went to the bathroom. I had my friend go in with me. And I was like, "Michelle, just come look at this. Come see what this is." And she felt it. And she said, "Elizabeth, I don't even have to feel it. I can see it."

Dr. Marisa Weiss: Wow.

Elizabeth Heiskell: And I said, "Well, I'm sure it's probably just one of those fatty tumors. I have them all over. It's not a big deal." So I ended up calling my gynecologist, who happens to be a wonderful friend. And we went in Monday morning, and immediately she started asking questions and wanting to review my mammograms. And she said, "When's the last time you had one?" And I said, "Oh my gosh. I mean eight months ago, I'm sure." And so she said, "Okay, that's wonderful news." So she went back, she said, "I'm going to go check the film, and I'll be right back." So she came back, and she had this really terrible look on her face, and she said, "Elizabeth, it hadn't been eight months. It's been two years since you had a mammogram."

Dr. Marisa Weiss: Time can slip by.

Elizabeth Heiskell: And I think that's one of the most important things, is time does slip by. And we had COVID, and all of these things.

Dr. Marisa Weiss: Everything. 

Elizabeth Heiskell: And so very quickly she gave me a quick plan. I was going to go, I was going to have a biopsy, I was going to get an ultrasound, all these things that I was going to do. And then we were going to wait for the results.

And I just kept thinking it was a fatty tumor. Honestly, I still just did not believe it, even though everyone around me was talking in hushed tones, and everybody was looking really worried when I would come in a room. And I was on my way to Memphis to meet with, Goldbelly was interested in selling my cakes.

Dr. Marisa Weiss: Wow.

Elizabeth Heiskell: I know. And I was thrilled. And I was on my way to Memphis to meet with them. And I got a call from the doctor, and he said, "Elizabeth, you have invasive ductal carcinoma." I didn't really know what invasive, I knew what invasive means, but I didn't know what ductal really meant. But honey, I knew exactly what carcinoma meant. And so we turned the car around and headed back to Oxford. And that started the journey. I always tell people, I think the hardest part, or one of the hardest parts of cancer, was the first time that I had to tell someone that I had cancer. When I had to come home and look at my husband and say, "Luke, I have breast cancer." But that's how we started.

Dr. Marisa Weiss: God. When you get that call. That call. Everyone remembers when they get that call, right?

Elizabeth Heiskell: Oh. It's just, it's earth-shattering.

Dr. Marisa Weiss: Earth-shattering.

Elizabeth Heiskell: And it's such a shock and it's such a trauma. And it's a trauma that you carry with you because then you don't trust anything. If I can get breast cancer, well then what else can happen to me? I can get hit by a bus tomorrow. Just sort of that sense of security that we have walking around in this life is shattered.

Dr. Marisa Weiss: Right. How'd you find the strength through food, given that you're a chef, after your own diagnosis? Did you change your approach?

Elizabeth Heiskell: I'm going to tell you, the thing that I found such control. I was searching for control because I felt like cancer had taken control of everything, and I no longer had control. The doctors had control, the treatment had control, where I was going to get, everything was so controlled now, and this was something that I could control. I felt like I could do something about my health. I could do something about the cancer that made me feel better. I could control what I put in my mouth. I could control going to the grocery store.

And just that little bit, that sense of sort of getting Elizabeth back, and that control through food, it really helped to build me back up. We don't know about chemo. We can't administer that. We can't administer all of these other things. There are just so many things that are coming at you. But I can damn sure control what goes in my mouth. And that's where I really found a lot of strength.

Dr. Marisa Weiss: Well, that's great. And what advice do you have for anyone listening who wants to eat homemade healthy meals but lacks the time, the energy, or the cooking experience, the skills that you have?

Elizabeth Heiskell: Yeah. And I'm going to tell you, I'm going to be completely honest on this. There were days that I couldn't do anything. I couldn't cook anything. I was doing good just to get some crackers down. So please don't think that I was in here ripping up gourmet meals.

But I did find that the simplest food really worked for me. So I really focused on eating seasonally. Because when the vegetables are extremely fresh, they taste so much better and you don't have to do anything to them. You keep it super, super simple. So mine happened to be in summertime. And so I relied on a lot of really fresh vegetables, fresh meats that were from farms close by. And I just would roast them in the oven. I mean, there were nights that just a sweet potato was all I could get down, but it was okay.

And I think that's the thing is that you have to give yourself grace. But food to me is one of the most comforting things. It takes you back to a time and a place like nothing else, because it uses all of your senses. So you hear it cooking, you smell it, you see it, you taste it. There was a meatloaf that my mom used to make. And right when I got diagnosed, I made that meatloaf, mashed potatoes, and Le Sueur peas, even though they were not healthy and they were certainly not on that little diagram that you gave of all the healthy foods. But they comforted me, and they really brought me so much joy at a time when I really, really needed it.

Dr. Marisa Weiss: Wow. And it's like really food is medicine.

Elizabeth Heiskell: It is.

Dr. Marisa Weiss: Sure.

Elizabeth Heiskell: It's medicine not only for our bodies, but also for our spirit and our emotional health, I feel.

Dr. Marisa Weiss: Yeah, absolutely. And it really fuels our body and mind, as you were saying, and can help us find the joy, the connection, and the comfort that you have. And coming from your platform as a chef and a breast cancer survivor, we're so excited about learning from you. And I'm going to hand it over to you now, Elizabeth, because I really want to learn from you and see what I can take home for my own life and for those people I have the pleasure of taking care of. And for all those people at Breastcancer.org that lean on us at the organization, we want to make sure that we learn as much as we can from you tonight.

Elizabeth Heiskell: Wonderful.

Dr. Marisa Weiss: Thank you.

Elizabeth Heiskell: Well, I cannot thank you enough, Dr. Weiss. Just having this opportunity, it's just meant the absolute world to me. And so what we're going to do now is I want to introduce you to two registered dietitians that have literally made their lives about helping people with cancer. And they do this through food and through nutrition. They have so much wisdom that they're going to share with us. Amy and Erica, welcome. We are so grateful to have you here today.

Amy Bragagnini: Thank you.

Erica Salehi: Thanks for having us.

Amy Bragagnini: Thank you so much.

Elizabeth Heiskell: Amy, I'm going to start with you. So we saw the diagram of all of the different foods that are healthy eating, but what does that really mean?

Amy Bragagnini: Yeah, I like that you did that in quotes actually, because if you ask 100 people, you're probably going to get 100 different answers.

Elizabeth Heiskell: Thank you.

Amy Bragagnini: So healthy, in and of itself, is basically just consuming variable foods that will support the overall health of your body. They'll support all your body's systems. What I find that can be tricky with the word healthy is a lot of people, at least in my institution or maybe even broader, they want me to list out foods for them that are unhealthy, foods that they need to stay away from and foods that are considered healthy.

And I think in that realm, you can find nourishment in really any food. Granted, and what I try to talk to my patients about, it's more of the day-to-day dietary patterns that we're taking in that will support your health. Taking one moment to have, say, chocolate. Chocolate, for a lot of people, might not be healthy, but it's certainly healthy for my soul. So I really do think that I try to help people's mindsets when it comes to choosing more nutrient-dense foods. And just because of your example as well, a lot of people going through treatment, they want to eat healthy, but sometimes the treatments themselves make balanced eating trickier. So nourishment is kind of the thing to focus on at that point.

Elizabeth Heiskell: Yes. Erica, and let me ask you this, when you think of a healthy plate, let's just say, what does that look like? We've had so many different, the building blocks, and this is exactly the food pyramids, and all these things, and now it's healthy plates. Can you kind of tell us what that means exactly?

Erica Salehi: Yeah, it can be confusing. Now there's an upside-down pyramid.

Elizabeth Heiskell: Exactly.

Erica Salehi: But a balanced plate can look different for everyone depending on your dietary preferences, your taste preferences, what you're going through, your intolerances. For cancer survivors, a good framework that we like to start with is encouraging a whole food, plant-forward diet. And the reason for that is because plant-based foods are rich in fiber and phytonutrients, and those are substances you can only get from plants. And they reduce inflammation, they support your body's immune system, and they can ultimately help reduce your risk of cancer recurrence.

So when you're thinking about your plate, a good framework to start with is to think about two-thirds of your plate being vegetables, fruits, whole grains, or beans and legumes, and then aiming for one-third or less of your plate to be from animal protein. Ideally lean proteins, things like poultry, seafood, eggs, if you do eat red meat, trying to limit it to maybe once or twice a week.

And then, of course, having variety is really key. So variety in the fruits and vegetables that you have throughout the week. And one way that I like to describe that is to eat the rainbow, and think about all the different colors in a rainbow and how can you incorporate all of those colors throughout your week. So red, yellow, blue, green, purple. That'll really ensure that you're getting all the vitamins and the phytonutrients that your body needs.

Elizabeth Heiskell: That's amazing. So would that be the same thing if you're a pre-diabetic, or maybe if you have diabetes and you have cancer, is that sort of the same model for you? I mean, is that still great advice?

Erica Salehi: Yeah. I think when someone presents with diabetes, I might reframe a little bit to shift focus onto the type of carbohydrate that you're having. So just thinking a little bit more about proportions. And the first thing that I'll typically tackle is what are you having to drink besides water? Because there's a lot of hidden sugar in sodas and juices. And it's not to say that you can't ever have those, but they can really make a big difference in your blood sugar. So for someone that's diabetic, I first talk about that.

In terms of food, you really want to think about filling your plate with non-starchy vegetables. So those are things like broccoli and asparagus and cauliflower, carrots. Those vegetables are especially rich in fiber, and they help stabilize your blood sugar and they reduce cancer risk. So it's a twofold benefit. And then thinking about lean proteins, especially with diabetes, because we want to protect your heart health. So when you can opt for chicken or seafood, that's a bit more ideal than some of the higher saturated fat meats in pork and beef.

And then also in terms of the type of carbohydrate, complex carbohydrates are often more ideal. So if you do want something like a whole grain on your plate, thinking of things like quinoa or brown rice or starchy vegetables like a serving of sweet potatoes or squash. Those are also better than something like a piece of white bread. And so people with diabetes respond to carbohydrates differently. So if you do have it, it's good to really work with someone one-on-one. And if you track your blood sugar, you can kind of trial and error your way through.

Elizabeth Heiskell: Yes. So Amy, Erica mentioned protein, and this is something that, I don't know if it's just me and what I'm dealing with with my Instagram or social media or all that, that's all I get is protein. I mean, it is protein this, it is protein that. These people, I've never seen people working so hard to get protein in their diet. I mean, it looks like they're getting like 10,000 grams. I have no idea what is going on with all of this. So can you please help us? And then there's the thing of protein powders and protein drinks and protein shakes. And I saw protein water the other day. And so please kind of help us with this.

Amy Bragagnini: Yeah, it's definitely a new buzzword these days in every arena you go in. A lot of my patients at the Women's+ Health Collective, they're perimenopausal and menopausal. So they're looking to get more protein to help with their metabolism. Obviously in my oncology world, people do need enough protein.

So just to break it down, protein is a macronutrient that we need. It's really having its day in the sun right now. And it's important for the growth and repair of our tissues and our fluid balance and just basically helping just our body grow as it needs to. Truth be told, we're all likely getting enough, unless you are falling under a specific situation, like you are undergoing treatment for cancer or you have other various diseases that might require you to increase your protein intake. But I think this is very similar to the '80s, if you'll remember, where fat was the worst thing.

Elizabeth Heiskell: Oh, God.

Amy Bragagnini: Everything was fat-free. And I fell for it. I was a kid then. And so, well, actually, not so much of a kid, to be honest. But it's one of those buzzwords that it's almost a health halo at this point. When you look at labels of things, or even just the packaging of different products, if it says high protein, people sometimes automatically think, well, that's healthy for me. Protein cupcakes are not necessarily the most nutrient-dense food. Not that I would say not have them, but we need to kind of step back and see the big picture.

When I educate my patients though, I try to remind them of whole food sources of protein, like lean meats and like eggs, dairy products, especially plant forward products or foods, nuts and seeds and beans and whole grains. They're definitely important. But I don't always think that people really need to go way overboard. And really the thing that I wouldn't want them to do is go online to maybe any random source and plug in their numbers to figure out how much actual protein they need a day. There are some reputable sites out there, but there's a lot that are not. So always, shameful plug, reach out to a registered dietitian to be able to figure out exactly how much you need for where you are in your life.

Elizabeth Heiskell: But let's say that you're struggling. You're in chemo or maybe the radiation is making you sick, you don't feel good, you have absolutely no energy. Would a protein powder be something that someone may want to use? And if so, do you have any that you recommend, any of those, like an Ensure or one of those drinks, that maybe you could sort of supplement with?

Amy Bragagnini: Yeah, I definitely do. It's an excellent point. There are lots of instances in people's lives, especially like you mentioned, going through treatment, that can make consuming enough protein in adequate amounts difficult. So usually when I find people are struggling with their appetite in general or just getting enough nutrition overall, I find that drinking tends to go a little bit easier for people than sitting down with a plate and eating. So finding a protein modular or a protein supplement can be a good idea.

The only downfall is that there are so many different types out there. When patients will say, "Well, I didn't know which one you wanted me to get. I didn't know if I should do the high protein or the plus or the max." So really in general, again, a dietitian can help guide you with that. But protein supplementation can be really beneficial. Finding a drinkable kind of a method to deliver it. I will say taste is, a lot of the time, the downfall. A lot of people don't like gritty chalky taste. So it's all about finding ones you like, and then maybe having some assistance with how you can incorporate it into various recipes for a good, well-balanced drink.

Elizabeth Heiskell: Perfect. That helps. You have no idea how much that helps. Erica, we also are hearing a lot about ultra-processed foods. Can you sort of give us a little bit of guidance on exactly what that is? I mean, what do we need to know? How can we avoid them? Do we need to avoid them?

Erica Salehi: Yeah, confusion on this topic is totally warranted. Researchers are actually still trying to figure out the best way to identify and classify these foods, but for right now, the way that we recognize them, and currently in research and in practice, is they're usually high in saturated fat and added sugar and sodium and calories, and they often contain ingredients that you wouldn't find in your kitchen. So things like high fructose corn syrup or color additives and emulsifiers.

But the part that's confusing for people is that some ultra-processed foods can still offer some health benefits. So things like fermented foods can often be a great way to boost your gut microbiome. And I like to use the example of whole grain bread products and processed meats. So whole wheat breads and whole grain cereals are a great source of dietary fiber, which is cancer protective, but these are actually usually classified as ultra-processed. It's actually hard to find one that's not in the supermarkets. And ultra-processed meats, which we know increased risk of cancer, are in the same category.

So all that to say, the best thing to do is not get too stressed about whether something is ultra-processed or not right now, and focus on the nutritional content of your food. So avoiding fast foods and some of those common processed foods that are really high in added sugar, like chips and cookies and processed baked goods, those are usually high in sodium and saturated fat.

And don't hesitate to look at the nutrition fact label when you're shopping and just take a glance. One measure I like to encourage my patients to think about is, with added sugar, that's on most nutrition fact labels, and you want to get 30 grams or less ideally in a day of added sugar. So those are just ways to kind of identify maybe aspects of ultra-processed foods. But again, really focusing on the overall pattern, making vegetables and fruits and whole grains a priority over some of these more processed foods.

Elizabeth Heiskell: Perfect. And you mentioned fiber when you were talking about the processed foods. So again, it's sort of like the protein. I'm hearing a lot about fiber. I'm seeing fiber gummies. I'm seeing fiber additives that you can add to your coffee. I mean, it just seems like it's everywhere. So I'm going to ask a couple of questions with this. How much fiber do we need? And what do you think is one of the best types of fiber? I mean, what do we need to be looking for? Where can we find this fiber?

Amy Bragagnini: Yeah, well, just like protein is one of the big buzzwords lately, I kind of wish fiber was out there more. I know it's there. But fiber I want to scream from the rooftop. When I was younger, I just did not really think about how important it was. But as we've been doing our research on just how important our gut health is to just about every part of our body, when it comes to hormonal balance, when it comes to digestion, when it comes to sleep, when it comes to adipose tissue, everything really revolves around our gut. So we want to treat our gut well. And the way to do that is by consuming enough fiber.

So there's two main types of fiber. You've got your soluble fiber and your insoluble fiber. Soluble fiber dissolves in water, and it's a super important type of fiber in order to help moderate and lower blood glucose levels, reduce cholesterol levels. Insoluble fiber does not dissolve in water, but it can add bulk to our stools. So getting a good balance of soluble and insoluble fiber is really important.

And just like Erica mentioned, when it comes to the label of nutrition labels, that's another area that I always want people to go to. Like her example about the whole grain breads, a lot of breads might say whole grain, but hopefully they're staying true to that. But always checking the label to see how much dietary fiber is in a product is a really good idea. Fiber is something that can help keep us regular, and it really just improves our overall satiety. It helps us feel fuller longer, which is really important as well.

So how much do we need? What I always tell people is the Academy of Nutrition and Dietetics recommends that we get anywhere from 25 to 38 grams of fiber a day. Now, when I say that to my patients, I always say, "Let's take a step back and let's figure out about how much you're eating already." Because my patients really want to do good and they want an A on their report card. And so when they hear 25, and they're only eating 10, they shoot for the stars, and they really try to meet what they need and sometimes that can lead to a lot of GI distress. So working with a dietitian can help them incrementally increase the amount of fiber by choosing whole foods and increasing that intake.

Elizabeth Heiskell: Okay, that's perfect. Thank you. So obviously, we're here for people that have been diagnosed with breast cancer. And Erica, you know this treatment, or a lot of the treatments, can cause nausea, weakness. And there were times, like I mentioned in the beginning, that I could not eat. I just could not do it. Do you have any advice for what we can do when eating does feel impossible? I know Amy mentioned, or we talked about the protein shakes and drinking things instead of actually eating a plate. And so maybe, I think that was great advice, do you have anything else that you might want to mention?

Erica Salehi: Yeah, definitely. It's different for everyone. But this can be challenging because it can be hard for people to even identify or describe nausea, especially when it's low-level nausea. And I really try to help people recognize that low-level nausea as soon as possible so that they're able to get ahead of it and take their anti-nausea medications before nausea gets worse. So nausea doesn't necessarily mean I'm going to throw up. That's usually pretty bad nausea, and hopefully we're managing it before it gets to that point. It could just be feeling kind of queasy, or I can't even think about food, that feeling.

So the anti-nausea medications, I know that's not a food, but they're really helpful in helping you get to the food that we want you to have. So trying to take that as prescribed. Especially when you're thinking about the timing of your meals, have your meals when your medication is going to be most effective. Also, nausea typically worsens on an empty stomach. So even if you don't feel hungry, sort of having small frequent intake of bland and easy to digest foods is the way to go when nausea is bad. So a lot of times things like dry salty foods like pretzels or crackers or toast, even ginger chews sometimes are helpful.

And also, of course, hydration. So even some tricks like having ice chips or popsicles or Jell-O or Italian ice, just to get that hydration. And then sometimes even the temperature of the room that you're in, the ventilation in the room can make a difference. If the smell of food bothers you, making sure that you're trying to avoid the exposure to that food odor as much as you can. Maybe have someone else cook for you or cook outside on the grill. And then avoiding really greasy or high fat foods and highly seasoned foods sometimes can make a big difference.

With liquids, it's best to have them between meals rather than during meals, just because it can really fill up your belly and it can make you feel even more nauseated when there's so much in your stomach. Then I did just want to throw out that the Fred Hutch Cancer Center has some good ways that you can search by the symptom you're having. So if you're experiencing nausea, you can search for recipes that are helpful during that time. And it's called cookforyourlife.org.

Elizabeth Heiskell: Oh, that's perfect. Well, I'm sure they'll link that for everyone that's listening because that sounds like an incredible resource. Amy, one of the things that when I was going through chemo, my mouth, it felt like this, I don't know, everything just tasted metallic, and things just tasted off. Do you have maybe any advice for that?

Amy Bragagnini: Yeah. I've been doing this for 25 years, and it's always the side effect that I feel really bad about because I know everyone has her own taste perceptions. And when it comes to what tastes or textures they're used to or that are pleasing, and when things are off, it's very hard to kind of say, well, doing this will go good for you or this won't.

So what I try to do is just take a broad approach of, okay, so what exactly are you experiencing? You mentioned metallic. So first thing that people can do, and most people scoff at it, but trying to use either plastic or bamboo silverware, staying away from canned products, so you're not introducing another level of metal in there. Across the board, as long as someone doesn't have any mouth sores or any difficulty with the sores in their throat, using lemon or lime or citrus flavorings can be really beneficial to maybe cut through some of that. There's always the addition of a little olive oil or a fat that might also help.

But I think across the board it's really just experimenting. So most of my patients will say, "I feel like I'm chewing on cardboard." Or I don't know, they say a lot of things, so chewing on whatever. So really then what I tell them to do is, and it might sound nuts, but open your refrigerator, look in your condiment section of your refrigerator and just do a taste test. Pretend you're on a game show. And just see if you can get any flavors from the various condiments in your refrigerator. Sometimes people will be able to detect maybe a raspberry vinaigrette where they wouldn't be able to detect a ranch dressing. So finding any kind of flavor profile that might be beneficial or work for them. And then I usually say put it on everything. 

Changing the temperature of what kinds of things you're normally eating might be beneficial. And it's also important too, whenever any of my patients have said my mouth tastes foul, make sure you're having a healthcare provider take a peek in your mouth just to make sure you haven't developed any thrush.

Elizabeth Heiskell: Oh yeah, very good point. Erica, are there supplements that we could use, vitamin supplements, to sort of help during this time? Or do you see that sometimes they'll even make things worse with constipation or diarrhea? I mean, is there an answer for that?

Erica Salehi: Yeah. Supplement wise, I always like to defer to the oncologist for those questions. A lot of times for diarrhea, they might recommend like psyllium husk, which is Metamucil or Imodium. And then with constipation, it's a little bit more challenging. But there are things we can do with food. So with diarrhea, a lot of times it's small frequent meals with stool thickening foods. So you've probably heard of the BRAT diet, but you can go more in depth in that too. Yeah, like banana, peanut butter, unsweetened applesauce, oats, potatoes, white rice or bread products, and non-fattening plain yogurt. And I know that goes against what we've talked about a little bit earlier, but sometimes you just need to get through and get through these symptoms. And so eating something is better than nothing.

Elizabeth Heiskell: Truer words have never been spoken, Erica. And I think that's one, I think I'm hoping that the people that are struggling with this right now realize that though. I mean something's better than nothing. And at this point, you just got to get through it. And so whatever you have to do, give yourself grace. 

Amy, are there foods that could help with the energy level because if you are feeling that bad, or maybe that could even help with your joint pain or your fingernails that are getting so brittle. Could we find answers for those in certain foods?

Amy Bragagnini: Yes, definitely following, I don't want to say diet, but definitely having an eating pattern that involves more nutrient-dense foods. We've all kind of said it. But trying to choose foods that have a lot of vitamins and minerals that are whole foods. And trying to eat smaller, more frequent meals. Sometimes little amounts of energy in will deliver a little bit of energy out all throughout the day.

I find that a lot of my patients do struggle with inflammation. And another kind of buzzword we've been hearing a lot about lately is an anti-inflammatory diet, and consuming foods that are less inflammatory. And what I always want, again, kind of similar to how I mentioned it earlier, but reminding people that nutrient-dense foods really in general are already going to supply your body with a good balance of nutrients. There aren't necessarily any one specific food that I would say, if you eat this food, then you are going to get it inflamed, unless someone does have a food allergy or food sensitivity or another digestive issue.

But generally, if you can consume a dietary pattern, that consumes a good balance, especially of a lot of different fruits and vegetables. The American Institute for Cancer Research also mentioned that taking in things like coffee and tea, squash, carrots, 100% tart cherry juice, things with omega-3 fatty acids like salmon or flaxseed, those are all very good examples of, they have anti-inflammatory properties. When it comes to brittle nails, we just want to make sure you're getting enough protein. Also, foods that are rich in biotin and zinc, so things like kale and nuts and avocados. And also make sure you have excellent hydration, which is another important thing for all your body's systems.

Elizabeth Heiskell: Perfect. And Erica, would you say that there are certain supplements maybe that could help, or foods, that could help with sleep? That was something that I had, and I feel like most people do with cancer, not only are you up because you're terrified and worried, but then also a lot of the treatments they give you, you're on a lot of steroids and different things like that. And it can be extremely difficult to sleep.

Erica Salehi: Yeah. In terms of timing, I would say trying to refrain from eating too close to bedtime. Give your body time to digest before you lay down. Some people have indigestion and that can also keep you up. So two-ish hours, at least, before bedtime to space your dinner and when you lay down is helpful.

If you do need a snack, this is maybe more anecdotal, there's some evidence, but it's not super strong, that a glass of milk, if you can tolerate dairy, or a whole wheat toast or a small bowl of oatmeal, might help a little bit. And then of course, there's foods to avoid like caffeine, even six hours before bedtime can still bother some people. It depends on your tolerance.

And then everyone's different, but having high-fat foods or spicy foods, even at dinnertime, can sometimes disrupt sleep. And then of course, limiting added sugar, especially before bed. Limiting alcohol. There's really no such thing as a nightcap unfortunately. So yeah, then talk to your oncologist about supplements to see if melatonin or other things like that might be an option.

Elizabeth Heiskell: And Erica, I'll just stay with you on this, when we're thinking about shopping for healthy foods, I know there are a lot of people that don't have amazing groceries, a Whole Foods on the corner, just like I can tell you I don't. I live in the middle of Mississippi, and we're very limited in what we can get. How important is organic, and especially farmer's markets obviously in the summer are amazing for finding fruits and vegetables, but in the wintertime, which is where we are right now, it can be difficult. Do you have any advice for this?

Erica Salehi: Yeah. First off, with organic, we don't have enough evidence right now to say that organic foods offer more protection against cancer. So don't feel bad if you can't afford organic or you don't have access to it. It's a personal choice, and we need to see more data before we can really say whether or not there's any sort of protective effect.

And then in terms of planning out your week, I always say the best thing you can do for your nutrition and your wallet is to plan ahead, make a shopping list before you go to the market so you know what you need to get. And always try to buy produce that's in season. It usually costs less and it tastes better. If there's something you need that is not in season, oftentimes the frozen version might be cheaper. There's nothing wrong with frozen fruits and vegetables. They have just as many nutrients. Just watch out if there's added sugar or things like that, and you can check the label for that.

And then a lot of times if you don't have the energy to prepare meals, people sometimes opt for meal delivery options. So I know Mom's Meals has medically tailored meals, and they offer reduced or no cost meals to certain populations. So that could be something to look into.

Elizabeth Heiskell: Oh, that's amazing. Amy, do you have anything to add to that? Maybe any just low-effort sort of cooking tips, ways that we can cook during this time that would be, not this huge gourmet meal, but just something to sustain us.

Amy Bragagnini: Yeah. Definitely utilizing, a lot of people are afraid of the freezer aisle because they've gotten the message that maybe that might not be the best for us, but certainly frozen fruits and vegetables, rotisserie chicken, canned beans. There's so many different things that are at our disposal. And like Erica said, and I agree, I say planning and preparation, I mean, I say it almost every day. Making sure you're thinking ahead. Knowing the times that you're going to receive chemotherapy and maybe knowing that afterwards you're not going to have the energy to cook. So batch cooking, doing sheet pan.

The other thing that I'll say is a lot of times people will tell me that friends, family, churches want to prepare food for them. And so many times they will tell me they throw away a lot of the food that's given to them just because they didn't like it or it didn't sit well. And I'm a big proponent of, if people are going to be really nice and offer that generosity, you can also offer them a gift by saying I don't like this, I don't like these foods. Can you make me something like this? Many people will say, that's not my jam. If they're going to do it for me, I'll just take what I can get. But if you know yourself well enough to know that you're going to have a salty metallic taste afterwards, then you can kind of dictate what you request.

Elizabeth Heiskell: Amy, you took the words right out of my mouth, because I finally got to that point where I would say, "Listen, I'm not trying to be rude, and I certainly am not trying to be picky, and I am so unbelievably grateful, but you probably don't know this, but when you're going through chemo, these are some of the things that I'm dealing with. Anything bland. No spice." And I said, "If that's a problem, listen, don't worry about it. But I did want to let you know if I have an option."

And obviously planning ahead and meal prepping when you do feel good, that little short window where you do feel good, and putting it in the freezer, that made all the difference for me. Making potato soup, making sweet potato soup, making all these things, and then having them ready to pull out. 

We've got some great questions from our fabulous audience. And one of them that they want to know: what is your favorite healthy snack, and I want to hear from both of you all, that you could either buy or maybe something that you could make?

Amy Bragagnini: Do you want me to go? Okay, I'll go first.

Elizabeth Heiskell: Oh yeah, that's fine. I'm sorry, Amy, you go first.

Amy Bragagnini:

No, that's good. I have been really obsessed, as I'm getting up in years, with getting a little bit more soy in my diet. And edamame in the air fryer is like my new jam. It's my new favorite snack. I just love it. It's easy. I just buy frozen edamame and let them thaw. And for me, I like the crunch, I like the savory nature of it, and they're really, really delicious. So I've been eating a lot of that lately.

Elizabeth Heiskell: Okay. Erica, I promise I'm going to get right there with you, but we did also have a question from our audience about if you are estrogen-positive breast cancer, should you avoid things like edamame and soy? Does that matter?

Amy Bragagnini: It's a great question. I hear that all the time. And the answer's no. I know that there's a lot of speculation that because soy, estrogen, has a chemical structure similar to... Let me just make sure I said that right. Because soy has a chemical structure similar to estrogen, maybe there's a fear that this soy or eating soy might fuel their cancer. And actually what we found through a lot of research is soy is completely safe and might actually be a protective nature against cancer, even development. So I'm always encouraging my patients to get more soy.

A lot of the women that I work with getting breast cancer treatment are looking for good protein options. They're looking to support their bone health. They might be dealing with not-so-fun hot flashes during certain types of treatment, as I know. So getting a little bit more soy from whole sources — so tofu, tempeh, doing miso, doing edamame — is super important.

Elizabeth Heiskell: Okay, that's amazing. All right, Erica, so I want to hear what your favorite snacks are, and even if it's something that you have to buy at the store or something that you like to make.

Erica Salehi: Yeah, lately I've been on white bean hummus. I found a recipe online and I can share it, but I'll drizzle it with extra virgin olive oil and a little sumac, and then I'll dip whatever I have in the fridge. So cucumbers, peppers, carrots. And that's just easy right now while I'm in school too because it holds up well all week.

Elizabeth Heiskell: Yeah, and it's great. That's one of those bland foods that still has a ton of nutrients. You've got fiber in the beans, but you can add as much or as little garlic or lemon or tahini as you want. So that's a great one. 

Someone was asking, we always hear that, well, we hear that sugar sort of feeds cancer. It's just like it is the absolute worst. We need to stay away from it in all shapes or form. Is that true? And/or are sugars from fruits, are those okay? Or is it even true that sugar is the big bad wolf and we should avoid it at all costs during our treatment and even after?

Erica Salehi: Yeah. Yeah. All the cells in our bodies need glucose, which is a form of sugar, for growth and for energy. And so cancer cells also need glucose to grow. But we can't direct where sugar goes after we eat it. And there's really no evidence that tumor cells are given more sugar than other cells in our body. So the important message is that we need to nourish our bodies.

And then that said, if you can limit added sugar, that's important because high sugar foods are high in calories, and they often lead to excess body fat. And excess body fat does have an increased risk for cancer. So indirectly with the weight question, we always want, as much as you can, to strive for maintaining a healthy weight. And part of that is reducing sugar, but that doesn't mean that you can't enjoy an occasional cookie or treat, and that won't cause your cancer to grow.

Elizabeth Heiskell: Perfect. Thank you. That makes me feel so much better. Because I'm telling you, I ate a lot of chocolate cake during this time. 

Amy, so tell me, if someone is interested in finding or getting a registered dietitian to help guide them through this time and even after, is it covered from insurance? Can you also help with weight gain, weight loss? Can you kind of just let us know about that?

Amy Bragagnini: Yeah, I might be biased, but I really do feel like dietitians can do it all. No, I mean really in general, dietitians have a role in just about every phase of our life and especially, especially during cancer treatment. And so first and foremost, no matter where you are in your life cycle, if you have questions about nutrition or you're looking to help lower risk of certain chronic diseases, seeking out a registered dietitian is important. So you can go to the Academy of Nutrition and Dietetics' website, eatright.org, and find a nutrition professional.

The second thing I tell people to do is call their insurance company and just ask the questions about what is covered and if they have registered dietitian benefits. I find that, given my practice in oncology, I don't bill for my services, but maybe other places might. And so it's always important to ask, will I be getting a bill, and how might I get this visit covered? Because it's definitely worth it. And sometimes it's just a matter of what the diagnosis is in the end. And you can let the healthcare providers worry about that.

So yeah, so I think contacting your insurance company just to see, but a lot of insurance companies will definitely, they will cover a certain amount of registered dietitian visits. And it gets a little trickier with Medicaid and Medicare, or Medicare only, but that being said is there's always room for discussion with the healthcare team.

Elizabeth Heiskell: Amazing. Ladies, I cannot even tell you. I mean, I just wish that when I was first diagnosed that I had this webinar because you all have answered so many questions that kept me up at night. I mean, just your expert advice is priceless, and I know that you all have reached so many people today and helped countless people solve a lot of issues that they're having. So I cannot thank you enough on behalf of all the people that are watching. Thank you. Thank you. Thank you. 

So now what we're going to do, we're going to bring Dr. Weiss back, and we're going to let her talk about certain foods to eat, maybe not to eat, and then share some tips from Breastcancer.org community members.

Dr. Marisa Weiss: Thank you so much, Elizabeth, for leading that important conversation with Amy and Erica. There was so much to learn. I took a lot of notes while I was answering people's questions in this—

Elizabeth Heiskell: So did I. I was sitting here taking notes as well.

Dr. Marisa Weiss: And the great thing about nutrition is that you can try things and see if you like them and make more of them, buy more of them, ask where you can get them, and there's all kinds of varieties of things. So it's an ongoing fun experiment, generally speaking.

I want to reiterate that when fatigue hits, because fatigue is one of those most common side effects of treatment and the experience of going through breast cancer. And when you're dealing with that side effect, eating can feel like one more exhausting task. So the goal is to make food as easy and light as possible while providing you with the energy and nutrients that you need. And when life gets complicated, simplify. Your energy drops and you need to simplify. In general, you want to only do what you need to do or want to do. And that's the guide I used for myself when I went through breast cancer 15 years ago and literally every day since then, because nutrition is something you have to do every day. It's a lot of work.

One helpful strategy is to cook in bulk on the days you feel a little bit better. Or if someone's coming over and you have to be social, or you can be social together and have that person do some of the chopping and the washing of vegetables, the stuff that takes energy that's not so much fun. If you're already cooking, you can make extra and freeze it in single portions. I'm a jar collector. I love storing things and heating things up in glass, like glass jars. I especially like, and I specifically buy foods in wide mouth jars that are easy to clean, to fill up, and they store more volume of food for freezing and reheating.

Or you can use the Bisphenol A, called BPA, free plastic bags and reheat it in glass. I usually take it out of those. Or if you take it out of the freezer and it's a liquid in a bag, it's sometimes hard to wait long enough to defrost it, or you can just cut it out or wait for it to defrost, or put it just water, warm water heats it up. And I take it out and put it in a ceramic bowl or a plate.

Another tip is to eat more when your energy is highest. For a lot of people, that's earlier in the day. So if dinner feels like too much for you, it's okay to make breakfast or your lunch your main meal. I do that. My husband, he comes home really late, and I often have dinner on the table just because I want to knock it out. And it's not hard for me to make it, and I often just reheat or repurpose leftovers. But I usually have eaten beforehand just so that I follow the rules that Erica and Amy suggested. Just that I want to protect my sleep. I don't want to eat just before I lie down.

Snacking can be easier than sitting down to a big plate of food. Things like yogurt, cheese, fruit, nuts, hummus, or cut-up vegetables. When you're feeling strong and good or someone comes over that you want to put them to work, put some cut-up fruits, vegetables, celery, carrots sticks, that kind of thing in the refrigerator so that when you do want a snack, it's easy for you to grab and to eat it. And bring it with you if you're packing your lunch. And this can really make the effort of getting nutrition easier, less overwhelming. 

And if a full balanced meal isn't happening for you, that's okay. Something healthy is always better than nothing. Some people like multiple small meals rather than three meals a day. That way you can alternate what you need, like protein for breakfast, or vegetables for lunch, and fruit closer to dinner time rather than loading your plate with things you're not in the mood for at a particular time.

And remember what you're drinking. It's important to drink plenty of water and to consume foods that are rich in water, like broth or cantaloupe, grapefruit, strawberries, watermelon, cucumbers, spinach, soups, and more. You can jazz up your water with sparkling flavored waters. I had to get serious with myself about reducing alcohol use or consumption. So I love the Spindrift flavored seltzer. I put it in a wine glass, little mint, little lime on it. Wow, feels like a cocktail. But everyone has your own preferences, so think about what works for you. I also have to avoid caffeine. So I choose fluids and foods that don't contain that. I love chocolate, but it's going to happen earlier in the day.

The standard guidance for fluids is eight cups of water per day, particularly those that contain electrolytes. That's all the vitamins, minerals, and stuff that add to what you're drinking and make it fill you up more and can replace what you're missing. If you're sweating a lot or you've got diarrhea or things like that, or you have vomiting, you want to make sure that every sip that you take has something in it of value to you, like broth that has protein in it, as well as vitamins, minerals, and water.

If you're losing fluids in these ways, make sure to drink the beverages that contain those nutrients. Like I said, there's the broth like vegetable, chicken, beef broth, either bouillon cubes, even easier, coconut water or other low sugar juices and some Gatorade types that can help replace what you're missing. Staying hydrated is incredibly important at all times, but especially when you're going through treatment for cancer. If you can't hold down food or can't hold down what you're drinking, let your oncologist know. Even if you go in and get some hydration, like get extra fluids when you go in for your chemo or a few days after, if you just can't hold things down, you'll feel a lot better.

You've heard a lot about how much protein is popular today to hold on to our muscle, our motor, which is like our powerhouse, it's our furnace. It keeps us energetic and it keeps us strong, and it makes us less likely to fall. And it helps us consume and burn the calories that we bring into our body. But if you are down and out, you've been laid out by surgery, anesthesia, you're recovering, those muscles can shrink pretty quickly. And especially if you're tired, try to get enough protein as well as calories to maintain that strength and muscle mass.

If you've lost weight quickly, you lose not just fat, but you also lose muscle. So really want to make sure that when it comes to protein, think about adding it to the foods you already like. Like you can toss beans or lean meat, fish, or tofu into soups or pasta or casseroles. You can put cheese on top of things that gives it flavor. It's like a spice that also has protein in it. You can look into protein powders. Ask your doctor if you need a recommendation. Believe it or not, adding chocolate protein powder in my morning coffee actually tastes pretty good. And I only use decaf coffee because that caffeine, even in morning coffee, can interfere with your sleep way later in the day at night. And sleep is queen for you and for me for sure.

Keeping easy protein options on hand can also help, like hard-boiled eggs. They can last a long time in the fridge. Yogurt, peanut butter, nuts, or cottage cheese all take very little effort. Throw them in. You can throw them into a lot of what you're eating. It can add fullness, richness, flavor, protein. And turning snacks into something more filling, like fruit with peanut butter or vegetables with yogurt dip or hummus, can make a big difference.

The big takeaway is this: eating doesn't have to be perfect or complicated. Simple choices still help support your energy and strength, and that's what truly counts. It's a work in progress. We're not expecting you or me or any of us to be perfect at this. 

I want to recap some of the top recommendations for fueling your body. Proteins like seafood, chicken, eggs, beans, cottage cheese, tofu. Tofu, by the way, is just a curd of soy milk. Eating sauteed or air-fried or toasted chicken rather than oil-fried chicken. It gives you the protein without all the heavy fats. Legumes, it's a big word, like beans, lentils, and peas, have a lot of protein in them and can fill you up and give you fiber, which is really important. Just like whole grains like oats, brown rice, and quinoa are sources of energy. They have protein in them and they’re also a major source of fiber, which helps your gut maintain the microbiome, cuts back on inflammation, really important.

Nuts, including pistachio, almonds, and walnuts, give you protein. Healthy oils also help your gut microbiome. Seeds, like hemp seeds and pumpkin seeds, give you protein, fiber. They're satisfying, give you energy. Leafy greens like spinach, kale, collard greens, et cetera, contain all kinds of nutrients. Protein, a little bit of protein in there, but also vitamins. Calcium. Calcium is a mineral. It's best to get your calcium through your food rather than a supplement. So leafy greens and dairy products and fortified milks, even like plant-based milks, are really good sources of calcium. You can have those leafy greens raw or cooked or steamed.

There are fruits like apples, berries, and avocados, which have a lot of fiber in them. Also, avocados obviously have a lot of healthy fats. They're filling. They're delicious. Vegetables like broccoli, Brussels sprouts, and sweet potatoes can help give you the nutrients that you need, the fiber that you need. In terms of fats, like extra virgin olive oil, really delicious. You could add sesame oil, for a little flavor, that's good too. Flax and chia seeds add protein and fiber and can give you a crunch to make your food more delicious. You can put those things into overnight oats with ground flaxseeds or chia seeds, which can absorb some of the moisture and make it more like a pudding and more like a treat.

And for cooking healthy food with a range of great flavors, try the spices of different colors from the rainbow, like I was saying, like curry yellow, the red paprika, the red color, leafy green basil. I'm big on pesto. I make a ton of it in the summer so I can have it through the year. You can make a pesto with parsley, even with cilantro, with olive oil and nuts. I make mine with cheese, some people don't. You can add it at the end on top. Delicious. There's mint, parsley, cilantro, as I said, paprika, turmeric, black pepper, delicious. Even particularly when it's freshly ground. Treat yourself, get a mortar and pestle, and you'll see how much more flavorful the fresh pepper is rather than the store-bought ground pepper. But some pepper is better than no pepper, so whatever's easiest.

I also want to mention that social connection is so important, and sharing food can bring you together with loved ones. People ask you, "You want to go out for coffee?" Or, "You want to go out for tea?" Or, "You want to share a meal?" With people close to you, catch up on things so you can feel connected and listened to and supported.

Now, as a reminder of what to try to limit in your diet. Avoiding those high calorie foods and drinks, making you crash after the sugar high. Those drinks make your blood sugar go up like this, and then they crash down, and that's when you can feel exhausted and just strung out. Not good. Not feeling good. When it comes to drinks, be careful when you go to those Starbucks or places like that where they have these mucho mocha, matcha, cappalatcha, all those funny names, like cream and sugar. Also be careful of high calorie dips and chips. Pretzels have a lot of calories without the nutrients.

You want to avoid the added sugars. Really try to stick to what Amy and Erica mentioned, like less than 30 grams a day, 10 teaspoons of sugar a day, less if possible. And I'm not just talking about added sugars, but look at how much sugar is in what you're eating. Look at those labels. Get used to that. Start reading them. And oh my goodness, I went to Trader Joe's and bought the protein pancakes. Yum, yum, yum. But then I looked on the label, and I saw there's actually a lot of sugar in there. So I started making my own protein pancakes, not that hard. Not sweet, but satisfying because I smashed the bananas in there, gives it some flavor and a little sweetness. That's enough. 

You can actually adjust, if you're a sweet toothed person, or you're going through chemo and you're seeking comfort foods with a lot of sugar in them, you can start to get in the habit of consuming foods with less sugar and being satisfied, but it does take some adjustments. You want to avoid those sugar filled drinks. Try the flavored seltzers. They're yummy, delicious, very little sugar. Alcohol. Sadly, alcohol is converted to sugar. And all those mixers you put in with the alcohol, like even tonic water sounds simple, it's got a lot of sugar in it.

You want to avoid the full fat dairy products like whole milk or even ice cream and things like that, and try something else that's not quite as high in calories. Actually, there's a great recipe I have that someone gave me. Take grapefruit slices, and shave some ice on it, and dribble a little bit of olive oil on that, and a little bit of honey. Yum, yum, yum. No fat really, and really very little sugar. And it's delicious. Really refreshing.

You want to avoid saturated fats like coconut oil. Sorry about that. Trans fat, same thing. Stick margarine, which has a lot of trans fat in it. Fried foods and salt. Like fried foods, like you might love a french fry, but I can promise you, you can make a delicious potato, especially one that's a sweet potato, by, you can boil it first, smash it, and roast it with a little bit of green herbs and a little bit of salt. Delicious. And you can put in the oven a little longer at a high heat to make it crunchy or air fry it, and it's just as gratifying as fried foods. Avoiding a lot of extra salt, especially it comes in our diet through lunch meats and things like that. Bacon, nah, those aren't good things to eat. Avoid those.

And then of course we have the tips from our Breastcancer.org community. Before we end, here are these amazing tips from members of our community. And this is, please go to the community and you will learn so much from each other. I want to highlight a few. Like number two, if you are tired and standing up in front of the stove is a pain, use a high stool or a chair. Or if you're chopping a lot of vegetables, put the cutting board lower down so you can use the weight of your arm and your body against it. That's especially true if you're feeling tired.

Or you have that neuropathy, like you've got numbness, tingling, pain in your feet and your hands. Maybe chopping is not what you want to be doing right now. A lot of stores do have pre-chopped things. Or if people want to ask, want to offer to do something for you, you could say, could you peel and cut a whole pound or two or three pounds of carrots for me? Then you can roast them when they're peeled and cut at an angle like three cuts per carrot. Yum, yum, yum. When you roast them at a high heat, like 375 or 400, the natural sugar from the carrot will caramelize and come out. You could put other things on them, like a butternut squash and things like that.

Number five, look at number five, the tip from our community. Ask help at the grocery store. That's why people are there to help you. Many times employees can assist with helping you shop or load your car. Or you could have groceries delivered. And if the smell of the grocery store is an issue or you're nervous about catching germs in indoor public places, go to an outside farmer's market if it's available to you. Or wear a mask in the grocery store.

And lastly, look into a meal delivery service or check if you qualify for Meals on Wheels, which will reduce the burden of buying and cooking food. You don't have to be end-of-life to get Meals on Wheels. There are a lot of communities where the township actually provides resources for Meals on Wheels. I remember my mother, who had breast cancer, got Meals on Wheels when she was recovering from her surgery. She was surprised that she qualified for it, even though she was otherwise healthy. And the food was actually quite good.

We have a lot of nutrition resources for you at Breastcancer.org. We'll send you links to articles and podcast episodes. And you can find more now by going to Breastcancer.org/nutrition . We'll also be continuing the nutrition conversation with an Instagram Live in March. Look out for details in your email. 

And if you missed our webinar on starting exercise , I recommend watching it. It's never too late to begin and benefit from regularly moving your body. And then if you can just, not just the everyday up and down the stairs or taking the stairs instead of an elevator, especially walking down the stairs instead of taking an elevator, with a little bit of an effort, you can help your bones stay healthy. And we're going to email you a link to the video. For those of you who've come on and signed up for this webinar, we're going to send you a link for the exercise video as well as to the nutrition video.

And remember, there is no one right way to eat after a breast cancer diagnosis. And your needs may change from day to day, month to month. And that's to be expected and it's okay.

So as we can learn from today's webinar, food is not about perfection. It's a tool that can support your strength, your energy, your quality of life. And I hope that food can bring you comfort and joy. It does for me, but it does take work. Recently, you may have heard me share earlier, I became board-certified in both lifestyle medicine and obesity medicine. Both focus a lot on nutrition, because I believe wholeheartedly that a healthy overall lifestyle can significantly improve our overall health and well-being, including how we feel today, and to increase our sense of optimism about the future. And it also, by my training in this way, I can engage with experts in nutrition like Amy, Erica, and our chef Elizabeth. 

I want to help my patients and you all find the health and happiness that you deserve. Getting to and sticking to a healthy weight, physical activity, nutrition, getting a good night's sleep, having social meaning and connections are the best recipe for long-term health and happiness.

I know it's not always easy, but I also know that you can do it. You start with one step, get to know it, learn a few things, feel good about it, and then you can take another step. And you just take it one day at a time. The team at Breastcancer.org is here to support you all along the way. 

I want to thank you all for spending this time with us. Take care of yourself, and try a lot of the tips that you suggested to each other and also from our experts.