Latest / Rad Chat / E221: Gina Giebner - Gastrointestinal Dietary Advice for People Living with and Beyond Cancer
Transcript
- Jo McNamara Rad Chat Host (00:00) Hello everyone and welcome to Rad Chat, founded by me, Jo McNamara. Naman Julka-Anderson (00:04) And me, Naman Julka-Anderson. Rad Chat is a forward-thinking global knowledge hub where healthcare professionals can advance their expertise in therapeutic radiography and oncology. Unlike traditional academic resources, we blend real-world experience, expert insights, best practice, and patient perspectives. Jo McNamara Rad Chat Host (00:21) We make advanced knowledge engaging and accessible, supporting continuous learning and professional development without compromising patient care or your personal time by providing insights into both technical skills and career development, helping you to progress confidently in your field and shape your professional future. Naman Julka-Anderson (00:38) Just to let you know, our episodes may contain sensitive and difficult topics that you might find distressing or triggering. Please consider checking out another episode. Jo McNamara (00:47) So this is part of the Education and Workforce Development series where we're going to be hearing from Gina Giebner, a cancer dietitian with 20 years plus of specialist GI experience and a current NHS oncology caseload. And she helps people optimise nutrition before, during and after treatment. So welcome Gina. Gina Giebner (01:08) Yes, so thank you. Jo McNamara (01:09) So for anyone listening who doesn't know who you are, can you just introduce yourself and give us a little bit about your kind of professional background if you can. Gina Giebner (01:18) So my name's Gina. I'm a dietitian and as you said, I've been working for over 20 years. I currently work in Glasgow for the Beatson West of Scotland Cancer Centre as I used to be their late effects dietitian, however that service is unfortunately closed. But I'm still there seeing people depending on a few different things. I get different referrals for a variety number of cancer patients. I also work freelance. I've worked all over the country, different jobs in Oxford was where I was from, Kent. I started my cancer dietitian first Macmillan funded post in Yeovil. And I've also worked abroad in Australia and also a really interesting job on a small island called Santa Helena Island in the middle of the Atlantic, which was a really interesting job. And I currently live at the moment in Scotland in the Scottish borders and do a lot of remote work. Naman Julka-Anderson (02:17) Amazing, been everywhere. You've probably seen a lot Gina Giebner (02:18) you Naman Julka-Anderson (02:19) of practice change across time as well in different places across the world. What made you choose Gina Giebner (02:23) Definitely. Naman Julka-Anderson (02:24) dietetics in the first place? Gina Giebner (02:25) I always felt like I wanted to work for the NHS and I like to talk to people and I've always been interested in food. I enjoy my food and I like foods from all around the world. So combining that plus also I'm not really one, apart from hand holding, I'm not really one to get my hands dirty. I thought dietetics might be the best option for the NHS and it's been a great job, I really enjoy it. Jo McNamara (02:58) For anyone listening, Gina, who's maybe heard the term dietitian before, but also hears the term nutritionist, give us a bit of a rundown. What was the difference between the two and why potentially would cancer patients want to see a dietitian? Gina Giebner (03:14) Really interesting question, yeah. So there are different training pathways. Nutritionists tend to work with more healthy population and sort of general healthy eating and population health potentially in industry. And dietitians can work, are registered professionals. I you do get registered nutritionists as well and unregistered nutritionists. The dieticians are registered professionals and we have a code of conduct and we have to abide by sort of scientific evidence based as much as possible. And we work with people who are ill with medical conditions such as cancer. And in my background, I did a physiology degree prior to doing dietetics. And in dietetics, we learn a lot more about physiology and illness and combining nutrition and health with illness to improve outcomes and disease. So we're all registered professionals as opposed to maybe, like I said, some nutritionists are registered, but there are a lot of nutritionists out there who aren't registered and might not be giving the best, most scientific evidence-based information, which might not be safe. I suppose that's where you can trust. can definitely trust the dietitian because we're registered and we would we have to we're part of the HCPC and we're audited and have to be make sure. Naman Julka-Anderson (04:42) How did you kind of go into the GI side of things? Do you, when you kind of qualify as a dietitian, do you focus on different things or does it vary across training across the country? Gina Giebner (04:51) I was really lucky. I did my training in Glasgow, which I think is one of the best places in the world to be a dietitian, partly because there are quite a lot of poor dietary habits in Glasgow and health outcomes are quite poor. There are high levels of poverty and it was really interesting to see the different diets that there are in Glasgow and also as a student struggling with money myself, trying to see what food I could buy locally and then compared to where I was in Newcastle as a physiology student, it was a lot cheaper. So Glasgow is a great place to do dietetics and then my training practical training was in London in Tooting St George's which was fantastic because there's a whole host of different cultures there and it was a big London hospital. I went into GI because I did a rotation in St Thomas's Hospital and part of that was gastroenterology and oncology but actually my first job, my very first job was in intensive care. So I started off in intensive care and then I went into nutrition support and gastro. From there, I then went into the community, believe it or not. I did some home tube feeding and learning disabilities. And it was then I started to get an interest in oncology. And from there, I got a Macmillan job and combined everything together, all those jobs that I'd had, ultimately to do oncology because I've had an experience of gastro, I really keen to do the GI component of oncology. Jo McNamara (06:58) For anyone listening, Gina, who maybe doesn't know lot about the cancer pathway, does every cancer patient have a dietitian and at what stage should they be referred to one if they need one? Gina Giebner (07:10) Unfortunately not everybody has access to a dietitian and maybe not everybody needs one if they're reasonably well nourished with that before treatment and during treatment and after treatment but there are certain cancers where we know that there may be a problem and also in an ideal world, everyone would want to chat to a dietitian and see a dietitian, perhaps answer those questions that worry them, dispel myths, talk about prehab, which is really important for everybody. But a lot of that prehab advice, if it's more general, can be given by somebody else or directed on websites, webinars. But if somebody is underweight or they might have a procedure drawing their treatment that puts them at risk. For example, head, neck cancer patients, that's not my area of expertise, but I do know that a lot of head and neck cancer patients will need extensive support and they know they might need some tube feeding drawing their treatment. And so seeing a dietitian as early as possible is really important for them. Naman Julka-Anderson (08:20) For anyone who's diagnosed with cancer, are the main, I suppose, or universal things they should focus on around nutrition before treatment starts? Gina Giebner (08:28) So it's a little bit like training for exercise, for a marathon, for example, you going through treatment, you want your body to be in optimal, optimal state as possible. And that's part of what we call prehab, which is getting yourself your body optimised for what's ahead. And that will include getting your mind in the right place if possible, which is really difficult, obviously, when you have these diagnosis, exercising being as doing any sort of small movements in towards getting a bit fitter exercise wise can be helpful. And then nutrition as well, try and optimise your body. So we know that things like vitamin D, getting your vitamin D level as good as it can be is really important for your outcomes. Trying to make sure that you eat as varied a diet and get your diet as healthy as it can be. Same as the general advice we give to everybody else, you know, including fruit and vegetables, protein, carbs and healthy oils. So just trying to get your diet in a little bit of as best order as you can, depending on your taste and also if you're cancer. Because if you have a problem with swallowing, you might not be able to meet those general guidelines. So you have to sort of adapt it to the individual. Where I'd hope if there was someone struggling, they might get access to a dietitian in an ideal world. Jo McNamara (09:51) Is there anything from a GI cancer perspective that you would advise that's maybe different to other cancer site specific patients? Gina Giebner (09:59) Not necessarily. I suppose if they've got a blockage or they've got symptoms as a result of their GI condition, for example pancreatic cancer, they may not be digesting their foods very well, losing a lot of weight because they're not absorbing their full nutritional component. So they may need additional support in the form of some medication like digestive enzymes if they've got pancreatic cancer or adapting the consistency of the diet if they've got esophageal cancer to prevent blockages. They may only be tolerating liquids so they might need special liquid feeds, liquid supplements to meet their needs. They may need to adapt the fibre in the diet if they're at risk of a bowel obstruction, for example. So there's a whole host of different things that might need to be adapted if someone's got a GI condition. Naman Julka-Anderson (10:59) How do you help people from different dietary backgrounds or cultures? Because it must be quite challenging to try and find the right balance and nutritionally as well. Gina Giebner (11:09) Yeah, it can be difficult. For example, somebody's vegan and you know, they might have be at risk of a bowel obstruction. And so that's really, that's really difficult. And that's where, a dietitian and also someone from different cultures, a dietitian will come in to look at, you know, work with that patient as an individual and adapt their diet based on what would be best for them and according to their needs. So we would work out what the protein, calories, vitamin and minerals that they would need to help get them through treatment, keep them well, prevent any problems like anemia, which is obviously one of the things that can cause poorer outcomes if someone's having a surgery or any type of treatment. We would want to look at making sure that that diet is meeting their nutritional needs based on their likes and their cultural beliefs. So luckily, I I'm quite lucky. I've been around the world, I've traveled a lot, worked abroad and had to experience in London, working with lots of different cultures. So I feel reasonably confident and I'd hope that any dietitian would also have expanded their knowledge about different diets. But if I didn't know, I would have reached out to my colleagues and learned very quickly or pass on to different dietitian who might have that experience if I felt I couldn't give it. Jo McNamara (12:40) It's great to hear you talking about personalisation because I suppose sometimes it's easy as healthcare professionals to refer to personalised care but it can be really challenging can't it, actually delivering it when potentially you know some of the manufactured feeds and things like that aren't necessarily suited to people. So I can imagine it can be quite challenging from that perspective. Gina Giebner (13:06) Yeah, and a lot of people don't like the manufactured products. So again, that comes, we come back to the dietitian to try and work with that patient. I hear quite often, a lot of, working in freelance as well as the NHS, a lot of people come to me and say, I've been told by the dietitian to add cream to... to add lots of unhealthy foods to my diet and that doesn't really go well with my ethos. I'm worried about Jo McNamara (13:38) Yeah. Gina Giebner (13:39) high cholesterol, heart disease. This can't be healthy, eating all these foods. And then I have to explain what the dietitian would have said to you. That's because you're losing weight. But how about we look at perhaps using nut butters, which might be more acceptable or... extra virgin olive oil instead of cream. that you're sort of making some swaps that are maybe more acceptable to that person. I mean, I suppose that might not be a dietitian, they may have been given a standard leaflet that says have cream, Jo McNamara (14:11) Yeah. Gina Giebner (14:12) have lots of sugar. And that worries people. They've heard online that sugar feeds cancer, which... Jo McNamara (14:19) Yeah, I was gonna follow up with that because I was talking to Naman earlier on this week about how I saw a clickbait Instagram post about Steven Bartlett's podcast saying, why a dietician's giving advice about, increasing sugar and sugar causes, cancers to thrive. Come on, Gina, as a dietitian, Gina Giebner (14:41) You Jo McNamara (14:41) what do our patients and healthcare professionals need to know about sugar and cancer? Gina Giebner (14:47) Yeah, the myth is that sugar feeds cancer. But it's, you every single thing that we eat apart from fats gets converted to sugar. And every cell in our body needs sugar as energy if, and cancer needs sugar, but if we don't give energy in the, if we starve our body from starve the cancer from sugar, we're going to starve our body from sugar and what will happen is we'll break down muscle and we'll lose body weight and become weaker and weaker if we starve ourselves. So we can't not have sugar in our diet and so the sugar feeds cancer is a myth, it's been going around for a long time. One thing that is important really I suppose in the cancer prevention field is there is evidence about weight about maybe having huge amounts of sugar perhaps if you're drinking a liter of full fat full sugar coca cola and lots of sweets and a really really high sugar diet that might compromise your overall nutrition and put on a lot of weight that that might be a risk factor but if you're you've got cancer then and you're having a bit of sugar from a bit of chocolate or ice cream or something like that, that's really not going to be a problem at all. Naman Julka-Anderson (16:16) I think that's a difficulty. Just thinking back to when I was a baby radiographer, if there's any basic advice we give our head and neck patients, for example, it'd be, it's only temporary that you're having all of these unsavoury Gina Giebner (16:27) Yeah. Naman Julka-Anderson (16:27) things that you wouldn't normally have, but it's to help get you through the treatment. But then that still isn't always helpful for patients to hear because obviously sometimes patients can be PEG or RIG fed for years after head and neck cancer. It doesn't Gina Giebner (16:38) Yeah. Naman Julka-Anderson (16:39) mean that things are going to improve very quickly. It's quite difficult, I suppose, to have that balance. Gina Giebner (16:44) Yeah, and sometimes I tell people, patients that are really quite underweight and they're not really, they haven't got an appetite, they can't manage much. Often the sugary foods are the least heavy on the system and they're the easiest to digest quickly. And if someone's underweight, they go into fasting very quickly, so their body hasn't got that store of carbs that we normally have. So if they're fasting for longer than a couple of hours and they're safe because their body mass index is only 16 for example, they're going to metabolise their muscle really quickly. So in fact having a steady steady supply of sugar through the day is one of things I tell those people to do just to keep their blood sugars up, stop that fasting from happening, to preserve their muscle mass is a really good, sugar can be a really good tool to try and prevent muscle loss. Obviously, you still want to try and encourage proteins and things as well through the day, but just having that background of sugar for someone who's low weight is again that marathon runner. need sugar, the sugar of the carbs to maintain their exercise. So it can be really good tool for dieticians, not something to be afraid of. Jo McNamara (18:10) And then there are any kind of tips and tricks that you would maybe talk to patients about in terms of kind of managing the side effects of treatment, but utilising nutrition. Gina Giebner (18:20) Yeah, some side effects like nausea, for example, it can actually be your body's hungry. So trying to eat as soon as you get up, something bland, a little bit like, I always tell people, it's a little bit like sickness and pregnancy. So as soon as someone wakes up in the morning, they have a need for energy and their blood sugar might drop and that might cause a sudden nausea if somebody's, know, their body's really hungry. So I always tell people, you use the nutrition, have something right by your bed, be that a juice or be it a few crackers or a couple of ginger biscuits. Ginger's old fashioned remedy for nausea. It works for some, but for some people on chemo, they don't like people to recommend it because they hear it so often and they're really feeling sick. Timing your medication around your meal time, so anti-sickness half an hour before you eat or loperamide half an hour before you eat if you've got diarrhoea with food, especially if you have a stoma trying to pair your food with your medication can be quite a good tool. Dry mouth, for example, one... tip as I always tell people go Mexican and put lots of lime on everything if you've not got a sore mouth that can really stimulate the saliva and there's tips like what to do with your mouth care as far as trying to make sure you're not getting problems with dry mouth and sore mouth so changing the types of foods you eat so that you're not going to get stung. And one of the tips I tell people is if they've got a sore mouth or they've got gastritis and lots of reflux, I tell people think about having an ulcer in your mouth or a cut on your finger. Any food that's going to sting that ulcer would likely sting your mouth or your oesophagus or stomach if that's inflamed. So if someone's got mucositis, so avoiding citrus, really hot things. Spicy things, really salty things might be a problem for somebody if they've got soreness. And so I find that analogy of an ulcer in the mouth works quite well and people can imagine, yeah, I wouldn't eat a lemon if I've got an ulcer. Naman Julka-Anderson (20:56) I suppose taste changes as well happens quite a lot from chemotherapy. How do you recommend things for that? Because I know some people can go really sweet one week and then the next week they prefer bitter or more salty things. It's so difficult and it swings around quite a lot. Gina Giebner (21:10) It usually depends on the type of taste changes that they may have. So if they're tasting a certain thing like metallic, they might not want so much meat, they might prefer sweet things. If their mouth is like cardboard, it might be having things to try and stimulate the saliva like the citrus or keeping things soft and moist. Sometimes people fatigued so much and the taste changes are so bad that they have no appetite so I just say look just try and eat things that you're going to get down quickly so having a cottage pie or something with gravy on that's sloppy you're more likely to eat a bit more of that than if you were going to have a baguette that you have to chew and you might just have a couple of what couple of chews and spit it out and not try anymore whereas you're having a apple crumble and custard you might get that all down. So it's adapting not just for taste but maybe the texture and the ease of eating that can be beneficial. Jo McNamara (22:23) When we hear the term dietitian outside of oncology, we typically think of someone who might support someone to lose weight. And obviously that is quite the reverse when it comes to oncology. But I actually have experienced it with friends and family and patients that I've supported that they've actually kind of been quite proud of the fact that they're losing weight during treatment because they haven't been able to ordinarily. What advice and support would you give those people who are like, well, actually, this is the only side effect I'm feeling happy about from treatment. But there is there is some long term consequences as a result of that, isn't there, Gina? Gina Giebner (23:05) Yeah, so you're more likely to get more side effects and perhaps you might have more treatment breaks if you're losing weight, losing muscle weight. It's usually muscle weight that gets lost and we become more weak. And also there could be micronutrient deficiencies if you've been losing a lot of weight because you're not eating very much. And that would then potentially cause problems more the longer term. If you, as far as you finish the treatment, you end up malnourished afterwards or weaker, you can't exercise, you can't maybe get back to work, it might affect your mental health because you're fatigued, you're more likely to pick up maybe infections and colds, things like that. If you're having surgery, then the outcome can be worse. If you're what we call sarcopenic, which is where you lose muscle over fat proportion benefits of good nutrition and try not to lose too much weight and exercise through treatment can't be, it's just really important, it's really important both of those. Naman Julka-Anderson (24:14) I've got a question around detoxing and fasting, lots of different myths and things like that that come up anyway around dietitians and what to expect. Some people I know have come across patients who wanted to do sort of fasting during chemotherapy and then after chemotherapy finishes the detox, there's a lot going around on Instagram or TikTok with videos around detoxing post-chemo. What are your thoughts around all of this? Gina Giebner (24:40) So the detoxing I'll take first is again a myth. Our bodies are really good at doing that itself naturally. Our kidneys and our liver do a really good job of detoxing our body. We don't need to go on anything special or do anything special for that. just generally, you need to just get back to a healthy eating. mean the Mediterranean diet is the sort of go-to healthy eating diet. Obviously that needs to be adapted to different cultures. I'm in Scotland and I very much try and encourage people to choose local produce like mackerel and salmon and rapeseed oil and things like that and lots of colourful fruit and vegetables. So getting back to a normal healthier diet for you after treatment or whatever diet is best for your symptoms is going to be the best thing detox diets, there's no evidence that they do anything. They may make your symptoms worse, they may make you weaker because they might not have enough protein or micronutrients in and they might upset your gut because there might be a lot of fruit and vegetables and really concentrated and upset you because they're not possibly whole foods. With regard to the fasting, there have been some interesting studies done on mainly breast cancer and ovarian cancers showing some benefits through treatment but there's small studies so we don't really have enough information on them yet. Intermittent fasting for people who want to lose weight there again there's studies showing that could be beneficial so they're saying it doesn't make any difference and during treatment I don't tend to recommend it because it can interfere with good nutrition it can cause, it can for some people make them more unwell. And most of the people I would see are probably, it might be a risk for them to potentially fast when they're, when I would be saying, actually, you want to have a bedtime snack and something as soon as you wake up to minimise the fasting so that you're not going to metabolise your muscle. So it's again, really individual. If somebody's really well, and they're eating well and their weight is stable and they want to give it a go and they discussed it with their team then I'm sure that's fine to do but just making it keeping a track on on on on your weight and your overall health and making sure you get everything in it's a bit like I suppose the other thing is that there's a lot of people on the new weight loss jabs as well and it's reduces the appetite and people on treatment on those as well. I would also, the same advice I give to people who are on those jabs who aren't on treatment, who don't have cancer, because I see other people apart from cancer, that I would say you need to get the good stuff in. You can't just not eat because that's going to make you really ill. If you don't get fibre in, don't get calcium in, you don't get protein in, you're going to run into other troubles later on. We know that we need fibre to protect our bowel health, to make good bacteria in our bowel. So in the longer term, if people aren't having enough fibre, protein, enough calcium for our bones, then there could be a different problem later on. Jo McNamara (28:30) So Gina, you've specialised in GI late effects. Tell us a little bit about what patients typically experience and what dietetic advice and support you'd give them. Gina Giebner (28:40) So late effects, late GI effects can be anything from bloating, excess gas, most frequently it's diarrhoea, urgency, leaking, incomplete evacuation, cramping, sometimes constipation, and a whole host of things can go on in the body following treatment that can cause these symptoms. Unfortunately, there isn't really access to specialist services for everybody across the country. Some pockets across the UK, mostly in England, there are specialist services to help people with late effects from cancer treatment. And it's important to have access to these services because a lot of these symptoms are caused by actual... changes or changes to our structure and function of our body. For example, we can have problems with our pancreas after radiotherapy or even during some treatments, we can have problems with our pancreas or from our bile acid system, which can cause diarrhoea. and we can actually treat these with diet and with medication if we get the right diagnosis. I'm really passionate about it because I've been working in this area now for probably about 10 or so years, I can't really remember. I started doing it in Somerset where they have a really good service down there and now I'm in Scotland and unfortunately there's no services in Scotland. So when you see somebody come to you with diarrhoea that they've had for many years after their pelvic radiation and you can see them with a doctor and we organise some tests to see if they've got any of these conditions. They're diagnosed with possibly one or two of these conditions and you treat them with medication and dietary support, might even just be dietary support. Then a couple of weeks later... they come back to you and they say, I can't believe it, I'm living my, I'm not, my bowels are normal again. I had one lady who had cervical cancer who, I think she was in her late thirties. And she said, said to me after seeing myself and the doctor and getting her on treatment, she said, I went for a holiday for the first time since my cancer diagnosis. And I was able to wear a bikini and feel confident without being toilet-tied for the first time. And that sort of dramatic change from somebody who was going to the toilet overnight, having accidents when they were out, to then feel confident to wear a bikini is quite dramatic. So that's why I feel so passionate about late effects. Naman Julka-Anderson (31:41) Yeah, it's an amazing success story to share, thank you. Any of the people you've supported living with secondary cancers? I wonder how that is affected when they're already struggling with some of the late effects of their primary treatment and then they're diagnosed with further metastases or having further treatment. Gina Giebner (31:55) Yeah, they're already struggling with the symptoms and they want to make sure they're fit enough and well enough for the next treatment, mean, obviously everything all depends on the individual and what they can do and what they're able to do. And if somebody is, you know, more, more palliative or, you know, at the end of the life then you might change some of the advice that you give. If somebody's on lots of medication, say for example, they're on 20 Creon tablets a day, they still may choose to take them because they know it controls their diarrhoea, but they may choose not to because they fed up of having all those tablets all the time. They may switch to loperamide just to calm things down, it's really something that we adapt the medication and the diet would be adapted based on that individual and what they're going through at the time. And if somebody's having an active secondary treatment, then we would obviously still try and control the symptoms, but look at how we can best support them during their next treatment. Jo McNamara (33:04) And what about supplements, Gina? Should cancer patients be taking supplements and which ones? Because there are a lot on the market now, aren't there? As someone going through perimenopause, I think every time I open up a magazine or social media, I'm being sold collagen or creatine or magnesium. And that's me going through menopause, let alone someone who potentially is a cancer patient already not feeling great and starting to think much more about their health overall. Gina Giebner (33:35) As a general rule, would say people don't need supplements during their treatment unless they're not eating very well or have a vitamin deficiency or are already prescribed, say for example calcium and vitamin D for bone health or on vitamin B12 injections or tablets because they're having them for medical known reasons they probably don't need to take a general A to Z or any super strong supplements or the only one caveat of that is vitamin D, but we can still overdo vitamin D. We can have toxic effects from high doses of vitamin D. So it's best just to take a standard dose, is about 400 to 800 international units, unless you get a blood test which shows you need more then nobody needs any extra vitamins. If you do take any and are really keen to take any, it's really important to tell your oncology team about it. There are lot of interactions with some supplements and treatment regimes, so it's really important to get that checked. Jo McNamara (34:59) So we're going to move into some quick fire round questions, Gina. So a bit different, but I thought this would be a fun way to hopefully clear up additional myths that we've heard about. So let's start with one about you. What food do you wish you ate more of or got the opportunity to eat more of? Gina Giebner (35:19) I'm a big fan of eggs. I can't lie. I don't think I can be vegetarian because of eggs alone. I just love eggs. Yeah, that. Jo McNamara (35:28) I love eggs. It's a running joke in my family at how many eggs we go through and it's largely Gina Giebner (35:33) You Jo McNamara (35:34) due to me so yeah I'm absolutely with you on that one. What one food do you wish more people ate? Gina Giebner (35:46) Yoghurt. Jo McNamara (35:47) Okay, good, brilliant. One cancer nutrition myth you'd love to ban forever. I think I can guess this one. Gina Giebner (35:57) Sugar feeds cancer. Jo McNamara (35:59) Perfect. What one supplement do you think a lot of people waste their money on? Gina Giebner (36:09) Hard one I'd probably say tumeric Jo McNamara (36:16) Okay, perfect. One thing people should prioritise when their appetite is poor. Gina Giebner (36:23) Protein. Jo McNamara (36:23) And that leads on to this next one. Protein or calories? Which one do you think wins for someone who's losing weight? Gina Giebner (36:30) Calories but then protein converts to calories so yeah but calories Jo McNamara (36:35) either or. Gina Giebner (36:36) calories generally it's but yeah both both are important but protein converts Jo McNamara (36:42) Yeah. Gina Giebner (36:43) to calories eventually. Jo McNamara (36:46) Smoothies, nutritional powerhouse or overrated? Gina Giebner (36:51) I'd say they're overrated personally but some people Jo McNamara (36:54) Okay? Gina Giebner (36:54) if somebody's only managing liquids they can be a powerhouse for them. Jo McNamara (36:59) Brilliant. What's the biggest mistake you see people making with nutrition during their cancer treatment? Gina Giebner (37:06) Googling and going online and listening to social media influencers that you know, we know that only about 2 % is correct. So that's probably the biggest mistake. Jo McNamara (37:17) That's a shocking statistic, isn't it? Gina Giebner (37:20) Hmm. Jo McNamara (37:21) If you could change one thing about nutrition and how it's incorporated into cancer care and the patient pathways, what would it be? Gina Giebner (37:30) It should be incorporated right at the start on diagnosis and prehab. The prehab should be embedded. No being scared of we shouldn't talk about it to somebody who's just got a diagnosis. People are keen to know and it should be embedded right from the start throughout. Jo McNamara (37:52) And the last one is about friends and family. What is the one thing that you would say to them who's maybe supporting someone that's going through a cancer diagnosis? Because food is so sociable, isn't it? It's something that isn't just about eating. It's about the kind of social interactions and socialising with friends. So what advice would you give to them potentially? Gina Giebner (38:15) Try and keep things normal. There may be times when people don't want to eat. Try not to put too much pressure on them because that can be hard and it can make things difficult in the family. just, yeah, still go out if you can. Try and keep things as normal as possible. Buy things perhaps that you know that they like and try if someone's got a poor appetite perhaps don't think about them having a normal meal perhaps go to more buffet style eating, put food in the middle of the table rather than on their plate because they might be overwhelmed by a big meal. Jo McNamara (38:56) Amazing advice. Is there anything that you'd like our listeners take away from this episode Gina? Gina Giebner (39:10) Really that nutrition is super important. It makes us feel good inside and out. We are what we eat is the phrase, isn't it? And I know personally, if I don't eat very well for a few weeks, then it does affect my mood, not just my body, my mood. Yeah, don't, and I suppose the other thing really important is don't avoid things that you like. If you enjoy eating certain things like ice cream or chocolates and that makes you feel good, that feel good factor has a real benefit on our mental health. You don't have to go totally strict and there's no such thing as a diet. It's about healthy eating and keeping yourself well, depending on what you're going through. Jo McNamara (40:04) Amazing advice. well thank you so much to our guest Gina for talking about diet nutrition for people living with and beyond cancer. Thank you all for listening to Rad Chat with myself Jo McNamara and Naman Julka-Anderson. Thank you very much. Gina Giebner (40:17) Thank you. Jo McNamara Rad Chat Host (40:18) So what do you do now? Well you can use this episode as part of our free continual professional development accredited content which offers flexible learning that fits your busy schedule. Just check out the show notes for the reflective questions, links to literature and resources and link to the completed form to receive your accredited certificate. Naman Julka-Anderson (40:38) Stay up to date with the latest radiotherapy and oncology advancements by liking and following us on social media and hitting subscribe wherever you get your podcasts. Jo McNamara Rad Chat Host (40:48) Please do join our supportive community designed by professionals who understand the unique challenges of working within radiotherapy and oncology. Follow us across all of our social media channels and make sure to check out our website www.radchat.co.uk. Together we're actively working to improve our profession and make a lasting positive impact on cancer care. 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