Healthy Eating During Breast Cancer Treatment

Jamie DePolo: Hello, thanks for listening. If you've been diagnosed with breast cancer, eating nutritious food and maintaining a healthy weight is an important part of your treatment plan. What you eat can affect your recovery from treatment, your energy levels, and how severe some side effects may be. 

Our guest is Amy Bragagnini, a registered dietitian who is a certified specialist in oncology nutrition, as well as media spokesperson for the Academy of Nutrition and Dietetics. She is currently a dietitian at the Mercy Health Lacks Cancer Center in Grand Rapids, Michigan. Amy is going to help us wade through some of the conflicting diet advice out there and offer her expert insights on how to make your diet as healthy as it can be. Amy, welcome to the podcast. 

Amy Bragagnini: Thank you so much for having me. 

Jamie DePolo: Great. So, I'm going to start with a real general question because I'm not sure everybody knows this. To you, what is healthy eating? I mean, I know some people think it's got to be real strict or you can never have one potato chip, but I'm looking to you for your expert opinion. 

Amy Bragagnini: Well, so the first word that always comes to my mind when I think of healthy eating is simply “balanced.” I try to remind my patients that there's not any one perfect diet out there. Anyone that feels like they could make some improvements to their diet or make improvements in what they're eating, I think it's important to just start with self-care and with good intention. To take time to do some research, to meet with a registered dietician, if possible, and also, then be realistic about kind of how you're currently eating, again being kind to yourself. And then start to investigate some ways to slowly, maybe implement small changes over time. 

Jamie DePolo: Okay. Thanks, so the other thing that comes to mind whenever I think about nutrition is the stories that we see pretty much every month, every week, maybe sometimes every other day, about this food, oh, we found that it prevents cancer, or oh, no, people who drank milk when they were kids have a higher risk of cancer. And me personally, I'm always just slightly skeptical of those studies because a lot of times they're relying on people who are now in their 40s, 50s, 60s, remembering what they ate and how much of it they ate when they were kids. Or it's just a very small sample size. So how do you talk to your patients about all this? If they come in with like, oh, I need to eat five bananas a day now because, there was just that story about resistant fiber preventing cancer. So how, how do we, how do we handle all this? 

Amy Bragagnini: Everything you said is so accurate. Sometimes I don't even like to turn on the TV and watch the news because I think, oh my goodness, I'm going to have to field this tomorrow. 

But you know, the first thing I tell my patients is don't panic. It's very easy to see the headline of a news story and start to be very fearful that we've done something wrong or we're eating wrong foods. You know, and then like you said, remind patients that there are so many different types of studies, some based on what we're supposed to remember. I can't remember what I ate yesterday, but I have to remember and recall all of my different food intake. Also, some sample sizes for the study, if the study only had 90 people. You know, we have to make sure that, you know, people understand that there's so many different types of research studies out there. Some are animal based, some studies happen in the lab. So not everything that you see in the media is applicable to everyone's day-to-day life and intake. 

Jamie DePolo: Okay. Now, I know there are some foods that are better than others, especially for people who've been diagnosed with cancer and breast cancer in particular. So could you talk a little bit about those? 

Amy Bragagnini: Yes. Definitely. Well, speaking of studies, any time we see a study that has to do with fruits or vegetables, a lot of times those studies just are harping the benefits of the fruits and the vegetables. So that's usually where I start with all my patients, is just remembering that fruits and vegetables are two of the most important parts of our day-to-day diet, specifically to breast cancer. The more fruits and vegetables women can get, the lower risk of breast cancer. 

Another really important word, again, is balance. Is figuring out what your day-to-day looks like and trying to fill your plate mostly with vegetables and then having a little bit of lean protein. Really helping patients remember that carbs are not the bad guy. You know, many times we see different diets that come out that are completely carb free or we start to use carb as an evil word. You know, it's definitely finding the right amounts to put into your diet that will give you energy, will promote healing, and will just also taste good. 

And that's another thing people forget is, food and So, eating should be fun and we should enjoy it. And truthfully, going on a very strict, not so fun, I guess, diet that eliminates a lot of the delicious foods out there, it's not sustainable and people won't be able to stick with the diet very long. 

So again, finding the right fit for the right amounts of nutrients. Again, fruits, vegetables, adequate protein, and then complex carbohydrates and healthy fat. 

Jamie DePolo: Okay, and I want to ask you one question a little bit deeper about carbs, because as you said, they're not the bad guy. But sometimes I feel like a lot of the processed foods, which my understanding is probably shouldn't be a very large part of a healthy diet, those tend to be very carby, and I'm wondering if that's kind of where that sort of demonization comes from. Because if you think about like, I don't know, cheese puffs and potato chips and you know, all the things that are in their salty wonderfulness, but they're not, there's not a lot of nutrition in those and they're super processed, and goodness only knows what kind of fat and other things they have in them. So do you think maybe that's where part of it came from?

Amy Bragagnini: So, yeah. I think in today's society, many times we demonize carbohydrates, and it's very important for someone to remember that not all carbohydrates are created equal. So, a lot of the foods that you mentioned are in fact simple carbohydrates. We digest them very quickly in our body and they spike our blood sugar level, which we really don't want to consume a lot of. Plus, a lot of the foods you mentioned are affordable, they're on the cheap side, and they're super processed, like you said with a lot of different preservatives and additives. And so those foods tend to, again, spike our blood sugar and that's something that we want to kind of control in that we want to consume foods, if we're going to eat carbohydrates, having them be complex, meaning they contain fiber, they contain some protein, they'll digest more slowly in our body and give us energy for lots longer.

Another big hot topic point these days when it comes to cancer is sugar. You know, when speaking of carbohydrates, an example of a simple carbohydrate would be sugar, and many processed foods contain a lot of added sugar. And I think that's where also people get a little confused where they think, well, I, can't have any carbohydrates. And that's not, that's not it. You know, we need healthy carbohydrates. What we do want to limit is the amount of added sugar in our diets. So things like cookies, candy, cake. Again, not eliminate, just limit, okay? We want to be able to have the balance be eating those kinds of food as a treat, not a normal, you know, maybe three times a day thing. 

And the best way I tell my patients to know if something they're eating does have added sugar is to simply look at the label. It's so nice now that all food labels have listed on -- or most food labels have listed on them -- the amount of added sugar, so we can kind of be able to figure out, all right, either product comparison or you know, just kind of know that we should really reduce the amount that we're taking in specifically added sugar. 

Jamie DePolo: Okay, and just in case somebody is wondering, could you give us a couple examples of good complex carbohydrates, like things that we should be eating?

Amy Bragagnini: Yeah. That's an excellent question. So, complex carbohydrates can be found in things like quinoa, any kind of a grain like whole-wheat pasta, whole-grain breads and brown rice, those are all examples. Cereals, the best way to know if your cereal is a complex carbohydrate would be to simply again turn and look at the label. And if it has usually over three grams of dietary fiber or more, and some protein, we would consider that a complex carbohydrate. Also, things like vegetables, most, you know, most vegetables are considered complex carbohydrates. They've got fiber in them. So eating, if you're going to eat a potato, keep the skin on. That's where the fiber comes in. 

Jamie DePolo: Okay. Perfect. Thank you. Now, I do want to focus a little bit, too, on people who are in treatment, because a lot of times what they normally eat doesn't taste good to them, or they develop food aversions, especially people going through chemo, so how do you talk to your patients? Are there foods that you, say, would recommend for somebody going through a specific treatment like chemotherapy? 

Amy Bragagnini: Yes. Generally, the first thing I'll do is investigate what type of cancer someone has, say, breast cancer, and then I'll do some research into what exact chemotherapy regimen they're having. Meaning, is it every week? Is it every three weeks? And by that, I'll kind of get a better idea of kind of what symptoms the patient might experience, so from there, I can definitely make a tailored suggestion, food suggestion for the patient. 

So, for example, somebody undergoing certain types of chemotherapy for breast cancer, it's very important that on the day of chemotherapy, that someone has something in their stomach in the morning. Having some amount of breakfast is going to be a good way to start the whole process. 

And usually, chemotherapy days are longer days. So then I educate my patients to bring healthy snacks and lunches with them to make sure that they can eat during treatment. Many patients are surprised by this, and I have a lot that show up and haven't had anything to eat. And they think, well, if I don't eat, I won't get sick, and a lot of times many people do get queasy when they have an empty belly. So eating something in the morning, eating smaller, more frequent meals. 

Someone that's undergoing chemotherapy needs adequate amounts of protein. And specifically I encourage lean protein. So leaner meats, dairy products, beans, nuts, whole grain products are all great sources of protein. I do encourage that patients limit, when it comes to meat, eating too much red meat and too much overly processed meat. Just not the best, healthiest sources of protein. 

Another really good reminder for people is to stay hydrated. You'd be surprised the amount of people I ask, you know, how much water do you drink during the day, and they just laugh. They're like, I don't know, I might have one bottle. So, I am…I’m a walking truth to water intake. I was just not a great water drinker for the longest time. And I found that when I was given a really good container that kept ice cold all day, if I keep it by me, I will consume three, four, or five of these because it's a habit now. So, we're trying to educate on forming new habits, and water drinking can definitely be one of them. 

And then, just like anything, you know, to go back to your question, eating plenty of fruits and vegetables. There's a really good study that came out -- the Women Healthy Eating and Living Study -- and it found that carotenoids, the healthy vitamins and minerals that are found in fruits and vegetables that are more on the orange color, so think sweet potatoes, carrots, winter squash. Women that were undergoing breast cancer treatment, the people that ate the highest amount of the carotenoids and the fruits and vegetables that I mentioned, had a 43% reduction in new breast cancer incidents. 

So, getting back to, you know, the question of yes, sometimes specific recommendations on various fruits and vegetables for the type of cancer that's being treated is a good education topic too. 

Jamie DePolo: Okay. I'm curious, someone told me once, and I don't know if this was based on research or not, but that recommended, as you said, eating a small meal before going into a chemotherapy infusion. But this person's rationale was it helps, it can help prevent food aversion. So, you've got something in your stomach already, so when you come out from chemo and you're maybe not feeling so great and then you try and eat something, you may kind of develop a distaste for it because you're already feeling bad. Have you ever heard about that or is that just sort of a saying?

Amy Bragagnini: No. It's really not. I've definitely heard that. A lot of anecdotal research just from patients telling me what they've been through and definitely some research in studies. That I found many of my patients, that if they get chemo, say, on a Monday, and they feel pretty good on Monday, they feel pretty good on Tuesday, and by Wednesday, Thursday, they're not feeling very good. Sometimes it can be helpful to avoid eating their favorite foods on the days that they know they're not going to feel very well because, as you mentioned, food aversion. 

People that have ever gotten sick on something, maybe it's you just had the flu and you didn't know it and you end up having a bad time with it. It's really hard to go back and eat some of those foods. And so, you know, somebody that has a decent, you know, amount of food in their stomach, maybe then on the days they're not feeling very good, they can go easy and just go light. 

I always kind of tell patients that, you know, we don't really know how this treatment is going to affect you. Everybody is a little different, so to be on the safe side, if you have, you know, a period of time within your treatment regimen that you're not feeling very good, don't push it. Don't try to eat, you know, big amounts of food. Just kind of remember if you've ever had the flu, what maybe your mom gave you or what you usually eat to kind of get you by. So for me, it's just chicken broth, saltine crackers, you know, and a, and a light soda, just for the carbonation. Some people it's jell-O, you know, so everybody is a little different, but taking it easy during those times can definitely help you get through those hard times and then go back to kind of eating your favorite food. 

Jamie DePolo: Oh, yeah. I could tell you mine. It's flat Vernor’s and saltine crackers. 

Amy Bragagnini: Yes. Yes. 

Jamie DePolo: That's what my mom always gave me. 

Amy Bragagnini: Exactly. Isn't it weird that even as an adult I remember that. And I don't get sick very often, but when I do, it's always, it's always the chicken broth and the couch. 

Jamie DePolo: That’s funny. I do, I have a question about water, too. I drink a lot of water, but I also enjoy carbonated water, seltzer. And I have been told by different people that that's not as good as drinking plain water. What's your take on that? Have you heard that? 

Amy Bragagnini: You know, there's always going to be something that…you know, so it's…if it, you know, if I have a patient drinking regular soda, then if they switch to diet, then they'll have people say, well, you shouldn't be drinking the diet soda because of all the artificial sugar, and that's bad. But the regular soda had a ton of sugar in it, and that's not great either. 

So, my point is I would need to see more definitive research why carbonated water isn't, you know, great. I would say, though, that, you know, water is the absolute best. Hands down. If somebody had, told me that, which one should I drink? I would say regular water, but if I have a person that is, just can't stand water and is only going to drink carbonated water or nothing. Drink the carbonated water and feel good about it, right? You know, just to make sure that the carbonated water doesn't have a lot of added sugar. 

Jamie DePolo: Okay. Okay. Thanks, so now I want to talk a little bit about side effects, because that also is a huge issue for many people being treated for breast cancer, and I haven't seen a lot of research on side effects and nutrition. I'm assuming it can help, especially like when you're recovering from surgery where you're just flat out knocked out. But I'm also wondering like those side effects from the hormonal therapies like the aromatase inhibitors and tamoxifen are also a huge problem for a lot of women. So I don't know, are there any ways to eat that can help with any of those things?

Amy Bragagnini: Oh, absolutely. Yeah. I mean, we kind of already talked a little bit about, you know, my message of showing up to chemo with something in your stomach. You know, many different types of chemotherapy can create nausea within someone. And the nausea can be from various different things, so it's important for the health care team to figure out, is the nausea related to the chemo? Is the nausea related to the person being really scared in the car going to chemo, and did that trigger nausea? Because that's certainly a thing. Is the person’s nausea related to, you know, not eating? I mean, it's…there's so many different things. Also, is the person taking the anti-nausea medication correctly and as prescribed? So, getting down to the point of what's causing nausea. 

But definitely certain foods can help. I think that having something in your stomach, eating every couple hours can help. Certainly, I advise patients when they are not feeling maybe the greatest to stay right away from the kitchen. To not smell a lot of the smells of food cooking because that can sometimes trigger nausea. To not panic. You'd be surprised at the amount of well-meaning spouses that are, you know, you have to eat because, you know, you know…just because they're scared, which I completely understand. However, if the person is pretty not feeling like eating, then forcing too much food on them is not going to be a good thing, and that's going to create some nausea too. 

There's also some natural things that might help, in addition to medication, help with nausea. Ginger is certainly one that people have told me helps them. Whether it's a ginger-flavored soda or ginger candy chews, a lot of people really say that that helps. 

I think many people have tried different methods of maybe more homoeopathic. So maybe acupuncture, maybe nausea bands, or you know, meditation. There's a lot of different things. But the one of the most important thing is trying to make sure you have something in your belly every couple hours and to take your medication as prescribed and then to listen to your body. 

Jamie DePolo: Okay, and I guess I do want to sort of ask about the hormonal therapy side effects, so like tamoxifen, aromatase inhibitors. I know some of the big ones, at least for tamoxifen, are hot flashes. And for the aromatase inhibitors, it's joint pain. Now I haven't seen any research on nutrition and joint pain, but I have talked to people and anecdotally they've said, well, whenever I have a drink, I get a hot flash. So if I don't drink alcohol, I'm much better off. Are there specific foods that you've either heard about or seen research on that can either help or bring on hot flashes like that?

Amy Bragagnini: So, you’re right. Definitely alcohol can be something that can trigger a hot flash for people. People are very different when it comes to what might trigger something. I've read caffeine might be something that might bring on a hot flash. Definitely maybe eating a diet that is more heavily processed, higher in sugar, not as high in fresh fruits and vegetables and healthy, lean proteins. 

There is some, there are some studies out there that talk about the potential for soy or soy foods to maybe help with hot flashes. And this is always a topic that I will get into specifically even with breast cancer patients because there's a lot of fear when it comes to soy consumption with many breast cancers. So, many types of breast cancer are estrogen receptor positive, you know, meaning that estrogen is feeding the cancer. And because soy has a chemical compound structure very similar to estrogen, it's fair to say, well, if it's similar to estrogen, and the estrogen is not good in my body, why the heck would I eat soy? 

But they've done a ton of research on this, and they have found, many different research organizations have found, that consuming whole soy foods can be okay during any kind of cancer treatment, whether you have cancer, whether you don't have cancer, whether you have estrogen receptor-positive breast cancer. And the recommendations are up to two servings a day of whole soy, so tofu, tempeh, miso soup. And again, anecdotally, then I've had some patients that say that soy can help manage their hot flashes too. 

I think adequate sleep can also be helpful. Getting some good physical activity. It's kind of a balance. 

Jamie DePolo: Okay. Yeah, that's the only thing I've really read that or seen studies on, rather, that can help with the joint pain from the aromatase inhibitors, is exercise. Like, I haven't seen any dietary studies on that. I don't know if you have or not. 

Amy Bragagnini: There's one thing that comes to mind that I did read, and it was tart cherry juice. They talk a lot about, well, antioxidants in higher amounts and how…not specifically antioxidants in higher amounts, but specific different types of, say, fruits or vegetables, like tart cherry juice, like up to four ounces a day, I read a study, that really helped with joint pain. Again, going back to our original conversation about studies, I would probably want to see a lot of research to, you know, recommend anything like that. 

But somebody with a lot of joint pain might benefit from maybe looking at the amount of omega-3 fatty acids in their diets. Following kind of a more Mediterranean eating style where your diet is filled with healthy fruits, vegetables, fish, monounsaturated fats from like olive oil and nuts. That can sometimes, you know, decrease inflammation in our bodies and maybe help with a little bit of joint pain. And again, the omega-3s are pretty good. 

So, you know, I think that it's probably not just one thing. It's probably, again, a balance of, like you said, physical activity and trying to eat healthy. 

Jamie DePolo: Okay. Great. This study to me was interesting, and it was done in 2020. And it was researchers from Virginia, so George Mason University and Virginia Commonwealth University, and they found that most people who were diagnosed with cancer thought they ate a healthy diet, but then when they actually analyzed their diets, their diets were not great. 

So, I guess what I'm wondering, if any people are listening out there and they think, well, I eat pretty healthy. Do they really, and how could they…I mean, I don't want to, I don't want to criticize anybody, but how could they maybe start to think about it, like, okay, I'm not sure now. What should I…what are some things maybe they should look at or consider? 

Amy Bragagnini: Well, the very first thing I would recommend is to see if they can see a registered dietician. I know that sounds like I've said it a million times, but the dietician can certainly sit with them and kind of analyze what they have been eating and offer some good advice. 

The next thing I will say is, as a dietitian, whenever I sit with a patient and we are going over what they're eating, they're already feeling, probably even if they think they're eating healthy, sometimes just seeing a dietitian can, I don't know, make people feel like they're not doing enough or their diets aren't good enough. And so the, so my role is to make sure that they know that, again, there's no perfect diet out there, and so what I try to do first and foremost to build rapport with people, is to point out what they are doing well. I think that can be really important for someone to know that they, you know, they don't have the world’s most terrible diet, but they're taking in a couple servings of vegetables a day, or you know, definitely we all have room for improvement. But I think starting with the positive, especially again for someone that maybe isn't, is finding out that they're not eating very good, instead of kind of yelling at yourself, just say, all right, there's some room for growth here, right? 

The next thing I think that's very important if you are on the path to how could I improve my diet, is to, again, obtain science-based research. So not only a registered dietitian, there's really good sites that you can go to, Breastcancer.org being one of them. Oncologynutrition.org or Eatright.org is the Academy for Nutrition and Dietetics. The American Cancer Society has a lot of really good handouts and very user-friendly information on their website, too. 

And then as I mentioned, as far as starting on the journey of making change. I always remind people Rome wasn't built in a day. So take a breath and say, all right, I know that this pesky dietitian wants me to eat five to seven-plus servings of fruits and vegetables a day, but I know I'm only eating two. This pesky dietician is not going to tell someone to shoot up to seven over night because it's not sustainable. It's not going to…it's not going to last. 

So, what I try to do is help people take a breath and just start to make one small change at a time. And that's where, again, a dietitian can help find out what those goals could be, what is going to be the most easily-reached goal. Because I know that whenever I set a goal for myself and I reach it, it really ignites momentum, you know, within me to continue on.

So, you know, I think that is important as far as looking at eating as a one day at a time, and there's no perfect day, and if you “splurge” a little, that doesn't mean you're eating bad or good. I never say foods are bad or they're good. I try to say, you know, unless someone does have an allergy to peanuts, okay, peanuts are not good for that person. I can definitively say those are bad. As far as, you know, some people that eat a pretty healthy balanced diet and want a cookie or two occasionally. I don't…I think that's why they probably eat a healthy, balanced diet, because they have realistic thoughts about, you know, what the foods that they really find pleasure in and then they allow themselves to have that occasionally, and then that allows them to kind of stick with, you know, their usual healthy eating. 

And another point, I guess I want to make too, is sometimes I do have people that come in saying, well, I know don't eat very good, but I take all of these supplements, and these supplements are the key. And so again, I start with saying, well, you know, good for you for taking interest in your own health. And then I just try to remind them that supplements do not, they do not replace the absolute beautiful benefit of eating whole natural foods in a balanced way. 

There are some times that, absolutely, a certain supplement is going to be maybe needed if someone is running low in certain areas. Or women especially could probably use some extra calcium and vitamin D. It's very person-specific though. But again, reminding people that supplements are not going to replace a good, healthy balanced diet. 

And to then also remember that sometimes, especially in the cancer world, the oncologists really are, especially the radiation oncologists, don't want patients taking high doses of antioxidants or mega dosing anything. They really want them to kind of scale back and again, try to obtain their nutrients from whole foods. 

Jamie DePolo: Right. Oh, thank you for that because we haven't talked about it yet, but I know that's so important. And even, you know, you said radiation, but also certain chemotherapy medicines, supplements can interact with that. There are certain things you shouldn't take before you're having surgery, so it's just, it's so important for people to talk to their doctors and…about what they're taking. 

Amy Bragagnini: Yes. I think that is…I'm glad you said that, because that's…a lot of people underreport what they're on. And when I meet with them, they'll say, well, I've got this and this and this, and I say, well, that's not in your chart. And it's really important for all the medical team to know specifically what you're taking in case there's an interaction, which there can be with the different types of chemotherapy agents out there, especially from an herbal standpoint. Some herbs are absolutely not recommended. 

And then just to let you know, I try to use the anecdote that unless we have really good scientific, you know, information on why a certain thing is needed, then I would worry, if it was my own body, about taking too much. That might maybe interfere in some way with the chemotherapy working as effectively as it could. So, what our job as practitioners are to figure out, you know, what, you know, what is maybe needed and what might do harm, and then try to educate on that. 

Jamie DePolo: Okay. Thanks for that. Yeah. I think sometimes people think, well, it's not really a supplement, it doesn't come in a pill. It's this natural herb that I'm just using as a tincture or something, and they don't really think of it as a supplement. So that's…I guess we all need to do some education on that. 

But finally, to wrap up, I know you've talked about seeing a registered dietitian a couple times. So if somebody wants to do that, how do they go about it? How do they find someone? And I guess I'm wondering now, given that COVID sort of opened the door and made telemedicine, you know, a little more standard, does that open the door then, too, for people who maybe live in an area that don't have easy access to go in and see a registered dietitian or you know, it's just too far away? So, how do you recommend somebody go about doing that? 

Amy Bragagnini: Yes. That's a great question. So, the first thing I would recommend is have the patient contact his or her insurance agent, just to see what kind of potential coverage there is. I checked with our clinical financial consultant on this question just to make sure I was answering it right. And he said Amy, there are so many different insurance plans and everything out there that you know the best thing to do is just call. I know that some major insurance companies will cover a certain amount of registered dietitian visits a year, so it's definitely worth a call. 

And then, you know, the second thing specific to cancer, is if you are in a cancer center undergoing treatment, ask. Ask if there's a registered dietician available. And then make sure when you go to schedule, maybe, an appointment with the dietitian, find out if the dietitian bills for his or her services. And then from there, you need to find out, well, okay, I need to check with my insurance, just to see…again, if you already know you have coverage then this should not be a problem. 

Now, in my cancer center and I know many cancer centers, we have registered dietitians available to see patients and we do not bill for our services, which I'm very happy about. Because it really does create a lot of ease and a lot less fear for people that don't know if they can afford getting extra bills. If you aren't undergoing treatment for cancer, then you have a really good opportunity to go to the Eatright.org website, the Academy’s, and right up in the corner is a Find a Nutrition Expert tab. And you can click on it, and I think you just put in your zip code and it can kind of show you all the dietitians in your area that might be available. 

And then from there, it's just kind of figuring out the best way to be seen. I love the telehealth option. I've had such good…in my consulting work on the side, I've had such great pleasure from patients not having to, especially people with kids, people that live far away, and it's just very nice to be able to talk to people and see them and still provide really good advice that you don't necessarily have to be in person.

Jamie DePolo: Oh, yeah. That's great. That's great. And I'm wondering too, on the Eatright.org site, could somebody search specifically for somebody like you who is certified in oncology or is that something different? 

Amy Bragagnini: Well, I believe that they can. Oncologynutrition.org might also have a find an expert tab, but again, I know that if you, if you are in a cancer center, in most of the cancer centers in the United States, there are there are registered dietitians. So if you're searching for cancer and you're part of a cancer care team, then you probably have access. 

But from another standpoint, you know, I do think that when you are on your search engine, whether…if you're not finding what you're needing from Eatright.org, you could always type in, you know, in the search engine the word “registered dietician local,” and that, in case someone isn't on the Academy’s website, they might be, you might be able to bring them up that way.

Also, I think word of mouth is also a very good thing. A lot of people have seen dietitians these days or have known somebody, but again, I think the Eatright.org is the best place to start. 

Jamie DePolo: Okay. Amy, thank you so much. This has been so helpful. I am so grateful for all your insights and I could talk about nutrition all day, but we probably should not do that. So, thank you so much and we'll have to talk again in the future. 

Amy Bragagnini: Thank you so much for your time. I really enjoyed myself.