**Disclaimer: The information in this podcast should not be construed as medical advice. Please consult with your health care provider regarding your medical decisions and treatment. Any listed resources are not intended to be endorsements.**
In the podcast, Peggy welcomes Sue Hill, a registered dietitian at Henry Ford Health Cancer in Detroit, to discuss food safety and nutrition for post-transplant patients. Sue emphasizes the importance of following guidelines by the Academy of Nutrition and Dietetics to prevent foodborne illnesses, as transplant patients have suppressed immune systems. She provides detailed advice on safe food handling, stressing the need to keep hot foods hot and cold foods cold, and the importance of storing foods at correct temperatures to prevent bacterial growth.
Sue advises on meat handling, recommending thawing meat in the refrigerator and cooking it thoroughly, especially for transplant patients. She underscores the necessity of properly handling and cooking eggs, as well as ensuring fresh fruits and vegetables are cleaned correctly. A specific tip is to use a vinegar-water solution for cleaning produce. For post-transplant patients, Sue suggests avoiding pre-cut fruits and vegetables from stores and opting for whole, washable, and peelable items instead.
The conversation also covers the handling of cooked meals by friends or family, where Sue recommends preparing food in the patient’s kitchen when possible to ensure safe food practices. She also discusses the importance of maintaining proper food temperatures during transportation and reheating.
Regarding vitamins, minerals, and probiotics, Sue advises consulting with healthcare teams before adding supplements, as they monitor patients for specific needs. She highlights the value of natural food sources like Greek yogurt for probiotics.
Sue also touches on hydration, suggesting safe water sources and recommending products like Pedialyte for electrolytes. For sugar intake, she clarifies misconceptions, advocating for healthier carbohydrate choices and warning against simple sugars. Additionally, Sue advises against alcohol consumption post-transplant due to its impact on the liver, which is already burdened by medications and chemotherapy.
Lastly, Sue offers tips for managing low appetite and fatigue days, suggesting simple, familiar foods and staying hydrated. She encourages patients to inform their healthcare team if sluggishness persists. Sue concludes with a positive note on the progress in post-transplant patient care and outcomes.
FDA Safe Food Handling Guidelines: https://www.fda.gov/food/buy-store-serve-safe-food/safe-food-handling
Bananatrol Plus Prebiotic:https://www.trybanatrol.com/
Other Resources:
National Bone Marrow Transplant Link - (800) LINK-BMT, or (800) 546-5268.
nbmtLINK Website: https://www.nbmtlink.org/
nbmtLINK Facebook Page: https://www.facebook.com/nbmtLINK
nbmtLINK YouTube Page can be found by clicking here.
Thank you to our sponsors. This season is supported by a healthcare contribution from Sanofi https://www.sanofi.com/
Peggy: Welcome, everyone. Today, we have Sue Hill, a registered dietitian at Henry Ford Health Cancer in Detroit. She's a part of the supportive oncology services department. She is going to share with us today best tips and practices regarding food, nutrition, safety precautions, and so much more for people that are just getting home, and for loved ones really. They're the ones preparing the food usually. This is going to be a wonderful episode. As we all know, getting home post-transplant is overwhelming, and good nutrition and hydration are key. Pull up a chair and let's dig in. Hi, Sue. Thanks for being with us today.
Sue Hill: Hi, Peggy. Thank you for having me. I appreciate this.
Peggy: Let's start with reviewing the guidelines recommended by the Academy of Nutrition and Dietetics post-transplant.
Sue: These guidelines are what you need to follow following any kind of a transplant, but we're going to talk specifically about stem cell transplant today. Why is it important to follow these guidelines? It's because you are going to be at a higher risk for developing foodborne illness after your transplant because your immune system is going to be suppressed. We're trying to recreate that immune system basically. We need to be careful. Normally our bodies can take care of little bacteria and stuff that enter when we're normally healthy. Maybe you ate something that was a little off, but your body took care of it and that's cool. After a transplant, that's not the case.
That's why we need to be a little bit more vigilant about being careful about not only how food is prepared and cooked, but how it's handled, what the proper temperatures are. Then we've got some other information we're going to talk about throughout the rest of our time together. Just overall, I can't stress this enough. It's just really important that we follow safe food-handling technique. Everybody should be doing this no matter if you're a transplant patient or not. This is just what I like to call kitchen common sense type of things.
Peggy: I like that.
Sue: Basically, you want to keep your hot foods hot and your cold foods cold. What does that mean? That means that food that needs to be kept cold needs to be kept at the proper cold temperature. If it's meant to be refrigerated, it should be kept below 40 degrees. Anything that's hot should be kept above 140 degrees. Now, why do I say 40 and 140 degrees? That is what we call the danger zone when it comes to bacteria that can be growing in food is between 40 degrees and 140 degrees. That's where bacteria like to grow. That's why we say hot foods hot, cold foods cold.
Now, the other thing that's really important is also making sure that once the food is prepared or the groceries are brought into the house, get the cold stuff in the refrigerator as soon as possible. If you've prepared something that's hot, you get it to the table, you eat it, and then we have to deal with leftovers. We're going to be talking about that in just a little bit. Again, we want to keep that food out of that danger zone, which is the temperatures between 40 and 140 degrees.
Peggy: Terrific.
Sue: One of the things I talk a lot with patients is handling meats because a lot of time meat is where you are going to have the biggest chance for developing a foodborne illness in many cases. First of all, if you have meat that is frozen, you want to make sure it's thawed appropriately. When I was a kid, my mom would say, "Hey, we're going to have chicken for dinner. Can you go down to the freezer and get a package of chicken out?" It would sit on the counter all day long. It didn't matter if it was January, if it was July. That's just the way it was. I've lived to tell the stories, but that's not the case that we want to stress with our post-transplant patients.
We need to make sure that when you do pull something out of the freezer that you want to thaw it appropriately. How is that? You can put it in the refrigerator to thaw, like we just had Thanksgiving. There's all kinds of stuff about, "Well, how do I deal with my frozen turkey? There's a lot of stuff written about should we put it in the refrigerator and let it thaw for four days? Should I have it under running cold water or all the other stuff? The important thing is that you use the proper technique. The best, the safest one is to thaw it in the refrigerator.
If you're going to have chicken for dinner tonight and you're pulling it out of the freezer this morning, that's not going to be thawed out adequately by tonight. You have to do a little bit of thinking ahead. What if that's the case? You can do it under what they call running cold water. That has to be running water. You have to keep changing the water to make sure that we're keeping it at the proper temperature. You can use a microwave to thaw stuff out, but sometimes that can be iffy.
Peggy: I agree. There's hot spots and colds.
Peggy: That always makes me a little nervous.
Sue: Exactly. Then it also, you get some cook spots as well too. It's just nasty and stuff, so you just want to be careful about that.
Peggy: Sue, I wanted to say, I think our moms read the same playbook because I think I was eating chicken that was on the counter all day as well. I live to tell the story too.
Sue: Yes. We don't do that nowadays, that's for darn sure. I think we know better now, but God bless our moms. Anyways, so we're going to thaw it properly. If you buy the meat fresh from a meat counter at a butcher shop or at your local grocery store, just make sure you're keeping that meat at the proper temperature as you're transporting it home. Usually not a big issue when it's cold outside, but definitely during the warmer summer months, depending on if you're going to make other stops on your way home from the grocery store and stuff, that's really important.
Bring an insulated bag with you to the store. If you're not doing the shopping, but that the caregiver is, make sure they know this as well too, to try to keep that meat at the most optimal temperature for keeping it safe. Now we've got meat that's ready to cook. What do we do? We want to make sure we cook it to the proper temperature. What is that? You can go on the USDA website and they will list different temperature ranges for when food should be cooked, when it's considered cooked. I'd like to tell patients that usually chicken and pork, nobody wants to get sick from those. We all cook it to the proper temperature, but everybody's got a different opinion as to when beef is done.
The temperature can be anywhere from like for example, a steak, you can still have your piece mooing basically, or it can be shoe leather, and everybody's got a different opinion. It's just really important that the meat is not pink on the inside. It has to be cooked all the way through. No medium rare steaks or rare steaks. It has to be done. The other thing is ground meat. It doesn't matter if you're a transplant patient or not. Ground meat needs to be cooked all the way through because there is so much surface area of that meat that's exposed to oxygen when you grind meat, that there can be a lot of potential for bacteria to be growing in there. That's really important as well too.
Peggy: Sue, would you go as far as to say maybe folks just getting home post-transplant just easier to avoid some of those things for a short amount of time? As you're saying all this, I'm thinking, sounds like a lot of work. Maybe it would just be easier not to eat that ground beef for a few months.
Sue: Not necessarily. No, I think if you just follow the guidelines, like I said, I call this kitchen common sense. This is stuff that we should be doing anyways. If you weren't doing these practices before, then yes, it might be a little bit of extra work for you. Overall, this is stuff we should be doing anyway. Okay. Thank you. The other protein food that I want to address real quickly is eggs. Again, everybody's got a different opinion as to when their egg is cooked.
We really need to make sure that yolk and that white is not runny. If you're going to have a fried egg, sorry, it's got to be well done. It can't be over easy. It can't be where you can dip your toast in it to get that lovely, yummy yolk and stuff like that. Can't do that because that's actually where a lot of bacteria in eggs is in the yolk. Make sure that the yolk and the white are cooked. No really wet scrambled eggs either, you got to be careful about that.
Peggy: Oh, good to know. Thank you.
Sue: Overall, like I said, when it comes to the other foods that are in the diet, because I talk a lot about food safety and protein-type foods, but we're going to talk a little bit about some of the fruits and vegetables as well too. I think that's a big confusing point because depending on where you're having your transplant at, what the team says, some say, "Well, I can't have any fresh fruits or vegetables." Other ones are like, "Oh, the doctor says I can have whatever I want." Let's just deal with that topic for just a minute.
Peggy: Sure.
Sue: Yes, you can have raw fruits and vegetables. Again, they just need to be cleaned properly. They need to be handled properly. Again, it starts in the grocery store. When you're purchasing fresh fruits and vegetables or your loved one is, make sure they're looking at it and make sure there's no bruises, make sure there's no mold that's visible, no soft spots if you're, feeling like a tomato or something like that. Again, those are areas that can be potential for bacteria. Then once you get those home, it's just important that you clean them well.
I have a little vinegar and water solution that I tell my patients about. You mix up, it's one part white vinegar to five parts water. You mix that up in a bowl and you put the things that you want to eat raw, like you put your strawberries in there. You could put your lettuce in there, and things like that, and let it soak for about 10 minutes. Then you take it out and you just rinse it in regular water, and boom, it's good to go. You'd be surprised what actually might be coming out of some of those berries and things like that. That is okay. You can eat those things. You just got to make sure everything was handled properly and cleaned properly before they're consumed.
Peggy: What is the ratio, Sue, on how much vinegar to, let's say,
a bowl of water.
Sue: It's one part vinegar to five parts water. If you were going to do a big bowl of fruits and vegetables, you want to do all at once, you'd put a cup of vinegar to five cups of water.
Peggy: Great.
Sue: Like I said, soak it for about 10 minutes and then rinse it off. It's not just you just don't throw it in there and then swish it around and go. No, it's got to soak in there to make sure that we're getting whatever potentially could be there out of there. The other thing too, is just to be careful if there's anything that can be washed and peeled like melons or oranges or bananas or stuff, those still need to be washed before you peel them. Avoid any pre-cut fruits and vegetables at the grocery store because you don't know how well they cleaned those melons or whatever it is that they're selling pre-cut. Get a good old vegetable brush, scrub the outside real good, and then peel or cut into whatever it is that you're going to eat raw.
Peggy: Terrific. I love all this. I'm learning a lot that I'm going to start doing in the kitchen.
Sue: Like I said, you'd be surprised.
Peggy: I've been making some mistakes, I think. Sue, let's talk about well-meaning friends who want to cook a meal. I'm one of those people. I love to cook and I sign right up and I'm realizing I need probably need to be a little more careful. People are just getting home and getting settled. I think a lot of what you just covered, of course, that's what friends should be doing. Is there anything else, any other warnings you'd like to include?
Sue: I would say that first of all, if you do have somebody who wants to help, and I think that's wonderful that you have support, see if they could possibly come over and prepare this in your own kitchen so that you can know exactly how the food was handled before it was prepared. If it's not a possibility, then your friends and family have to know how important it is that they follow these guidelines.
The dietician, either before you were admitted for your transplant or before your discharge from the hospital after your transplant, should give you a list of these guidelines. If need be, make a couple of copies so that if somebody is offering to do these things, they have to know that this is how the food needs to be handled and proper temperatures, et cetera, in order to bring foods over to the home.
Again, transportation, it depends on the time of the year. If it's something that's fresh out of the oven and you got a 20, 25-minute drive from your friend's house to your house, that food needs to be wrapped in an insulated bag and wrapped up really good. Then it needs to be probably reheated a little bit in the microwave before you have it. Cooking thermometers. A good digital cooking thermometer is something very helpful to have on hand to make sure that things are at the proper temperature.
If you are going to microwave something, make sure that you're stirring it partway through the reheating process because you don't want any hot and cold spots in there. Again, that's important. If it's something that's meant to be kept cold, again, an insulated bag to try to keep things cold. Try to put those little freezer blocks, those blue ice things, type of things, have those in the bag to try to keep that at the proper temperature.
Peggy: Terrific. Great advice. Let's talk about vitamins and minerals. This comes up a lot in our programming, and even probiotics. What are your thoughts on all of this, Sue?
Sue: The thing about vitamins and minerals is your healthcare team will be monitoring your blood work. Many times, especially you may have experienced this during chemotherapy, that you might need some extra potassium or a little bit of extra magnesium, or something.
The healthcare team is looking at your blood work and is making decisions on what extra stuff you need. A lot of people are like, "Well, maybe you're anemic, so maybe you need some extra iron." I always tell patients, don't start adding some of these extra vitamins and minerals and other things until you talk to the healthcare team about it. Again, the team is monitoring you for various deficiencies that could potentially be there.
The other thing about the probiotic, I think there's a lot of good foods that actually have probiotics in them. Again, we got to make sure that the food was handled properly before you eat them. Talk to the team about actually taking an actual probiotic. Just because you go to the store and you're like, "Oh, this is a good probiotic," we don't really know. The thing about probiotics and vitamins and minerals and stuff is that they're not regulated by any agency. We can't guarantee the safety of how things were produced in certain factories or other facilities and stuff. That would be something, again, I would talk to your healthcare team about to see what they want you to do and what they feel you need to do.
Eating some good old Greek yogurt is an awesome probiotic. It's a really good source of probiotic, a good source of protein as well too. I would definitely recommend some of that, and maybe even some good old sourdough bread is another good one too.
Peggy: That's good to know. Sue, I just thought of something I wanted to ask you. Even for someone maybe that's struggling to put weight on, and I know that GVHD sometimes can leave people just famished and they just can't seem to gain weight. How do you feel about Ensure and those supplemental drinks?
Sue: I would talk with the dietician on the team because some patients, especially if they have GVHD of the gut and they're having terrible diarrhea, sometimes though some of those drinks can actually make the diarrhea worse. You want to be careful about that. There are guidelines that the dietician can help you out with when it comes to dealing with diarrhea from a food perspective. There are other products on the market as well too that actually can help with some of that diarrhea that a dietician can recommend.
There's something called Bananatrol Plus. Basically it's a prebiotic, it's banana flakes, and it can actually be used for when people are experiencing diarrhea from chemotherapy, from different medications that because diarrhea. Patients who have C. diff can use this as well too. What it does is it actually helps to thicken up the stools a little bit. The prebiotic helps to feed some of those beneficial bacteria in the gut, not the bad ones, but the good ones, to try to help with that reabsorption of the fluid.
Again, those would be things to talk to the dietician, the transplant team about and see. I prefer, if it's possible, to not have to use so much things like Imodium, and things like that, or as much as what they might have to use it if we can try some other food type of things.
Peggy: Well, thank you. That leads us right into hydration. What do you recommend to your patients regarding trying to stay as hydrated as possible?
Sue: With hydration, it's important to make sure that the source of hydration is a safe source. Depending on where you live and your water source, you got to make sure that the water is safe. Most city water should be okay, but if you're worried, have your water tested. Definitely, if you live anywhere where you have well water, that should be tested before your transplant to make sure that well water is clean. If there's any question, you can always boil the water for about 15 minutes, and when we talk about boil, we're just not talking a simmer. We're talking like a good old heavy boil where those bubbles are popping on that water and stuff like that, for about 15 minutes. That should make the water safe to drink.
I also sometimes recommend some of the things like Pedialyte or Gatorade for some of the extra electrolytes. I'll be honest with you, I tend to go more towards Pedialyte than I do Gatorade. The reason being is that Pedialyte comes, there's one that actually I found it at the Walgreens and it was the Walgreens brand of Pedialyte, but it was clear, it didn't have any flavor to it, and it didn't have any colors to it. It's something that could be added to your own, like a little bit of cranberry juice or a little bit of apple juice or something like that, but for a little bit of extra electrolyte support. It didn't have any sweeteners of any kind in there, be it natural sweeteners or artificial sweeteners.
Again, there can be problems with both of those. There are some foods that actually are higher in water amounts, for example, watermelon and things like that, you can be consuming and you're able to get some of your hydration that way as well too. Start the first part of the day, don't wait to start drinking your fluid as well too. I think a lot of people think, "Well, I'll drink it a little bit later on, drink a little bit later on." Start it first thing in the morning. If you feel overwhelmed by having a big jug of water next to you--
My colleague and I were talking about that this morning and about her grandmother and her mom's trying to get her grandma to drink, drink, drink, and puts this big glass of water, and grandma won't drink it. If she puts her a little bit of water, like about six ounces of water in a glass next to her, she'll sip on that. Then when she gets down with that, mom adds a little bit more water and that's a way for her to get a little bit more fluid in there. Sometimes when you have too big of a container of something or too much food on the plate or something, it's so overwhelming that you're just like, "I can't even look at this." Sometimes you got to just do smaller things.
Peggy: Oh, that's a great idea. I think we all could drink more water and just trying to trick your brain and find ways to make that happen is so important. This has been just so terrific. Let's talk about sugar, Sue. It really gets a bad rap, doesn't it?
Sue: Sure does.
Peggy: What do you think about sugar?
Sue: The thing about sugar is, actually, I have a document in front of me that's 11 pages. It's from the oncology nutrition practice group of the Academy of Nutrition and Dietetics all about sugar and cancer because there's lots of misinformation out there about it. Sugar is basically, there's different types of sugars or different carbohydrates. Let's put it that way. Some are better for us than others. Some people will say, "Well, sugar feeds cancer."
I'd like to let people know right up front that cancer is very primal and it wants to survive and it's going to take whatever you have in your body to try to make itself live. It's not going to say, "oh, there's sugar I'm going to just going to eat that and I'm not going to go after anything else." That's not true. That's important number one. Like I said, the quality of those sugars are important. Ideally, we don't want you consuming a lot of what we call simple sugars like candy, like regular pop, pies and cookies, and stuff like that as a large part of the diet. A little bit is okay. The other carbohydrates though are really important because your body is trying to repair the bone marrow and it needs nutrients in order to do that. We don't want to starve the body, and so everybody's like, "Well, I'm going to get enough protein and that should do fine."
No protein is not meant to be an energy source. It's actually meant to help with cell repair, muscle maintenance, and things like that. In order for your body to allow your protein to be able to do that, you need carbohydrate. There's your fruits, your vegetables, your beans, your whole grains like your oatmeal and barley, and things like that. Those are all the healthier carbohydrates to include in the daily diet. They're healthier because a lot of times they're higher in fiber. If they're higher in fiber, they break down slower than some of the simple carbohydrates because everything in your body has to be converted into glucose.
Your brain basically runs on glucose so glucose is a simple sugar. The longer it takes the body to break down that sugar the less of an insulin response the body has towards how much sugar is there, which actually can help decrease the amount of inflammation. It's a big long process there but that's basically in simple terms. Choosing the better carbohydrates is what we recommend. We don't want you totally to avoid all carbohydrate at all.
Peggy: This is great and very informative. I appreciate it. Let's dig in next about cocktails, a glass of wine. Is it off limits? What do you think? Occasional?
Sue: I would say for right now I have to give you guys some bad news. I would say stay away from alcohol at least for the first three months after the transplant and even longer for certain patients because some of the medications that you may be on are cleared through the liver. The chemotherapy that a lot of patients have gone through before their transplant has been cleared through the liver. The liver is having a lot of work to do, and guess what also gets cleared through the liver? Alcohol. We don't want to stress the liver more than what we absolutely need to, and alcohol will definitely do that.
I would say no to even a beer or wine, or anything like that, until you talk to your health care team to see what their thoughts are. Usually, the health care team has a pharmacist on it. The pharmacist can be very helpful in answering some of those questions about what medications am I on that could be making my liver work harder and I shouldn't be taking any alcohol.
The holidays are coming up and a lot of people, they want to celebrate with family. There's a lot of recipes out there for something called a mocktail. M-O-C-K, tail. You can drink and mix things together like ginger ale and cranberry juice. My friend used to call that a Cape Codder, but a mixed drink like that. There's sparkling waters that you can have other things mixed with it that are non-alcoholic. You can enjoy something a little out of the ordinary but still, it'd be no alcohol. No, I'm just going to have to say no to the alcohol.
Peggy: We understand and we appreciate your opinion. I know when I was pregnant, I would make myself a club soda with a splash of cranberry and lots of lime. I would almost feel like I was having a drink.
Sue: Exactly.
Peggy: Sue, we have covered a lot today. Any tips for the really tough days, maybe the really extra sluggish days, the fatigue coupled with just not having a great appetite? Anything you want to add about that in your experience with patients?
Sue: Yes, you're definitely going to have your up and down days. In fact, you might have a couple of good days and you're like "Wow, I'm on the upswing," and then you do have a down day and you're like, "What the heck happened here?" I think you need to take advantage, first of all, of the good days and make sure you're eating and drinking as well as you can. On those down days, this is where simple foods can come into play. It doesn't have to be anything that's too extraordinary. I tell you, when I worked inpatient in our oncology floor here at Henry Ford, patients were having down days.
The stuff that they liked were simple things like a can of Campbell's chicken noodle soup. We would have homemade chicken noodle soup the kitchen would make it and it was actually pretty good. They're like, "No, I want Campbell's," because they know what to expect with the Campbell's. Just make sure if you are going to have that Campbell's that you clean off the top of that can real good before you open it up, FYI. That's a food safety tip there.
Peggy: Good point.
Sue: Simple things like scrambled egg and toast, even patients just thought a bowl of mashed potatoes and gravy sounded good to them. I think that's the important thing. On those down days, keep it simple. Toast with peanut butter on it. Again, if you're feeling sluggish, evaluate why am I feeling sluggish? Maybe I haven't enough fluids because a lot of times we just talked about hydration. A lot of times that can be the reason is that maybe even not getting enough of their hydration in.
If it continues though for more than like a day or two, make sure you let your stem cell team know what's going on. Again, like we do here at Henry Ford, sometimes the patients just have to come in and get a bag of IV fluid and it perks them right up. Like I said, take a look and see like what have I not been doing that maybe has contributed to this when it comes to food and drinking. If you can't identify something, just let the team know. Especially if you're right out of transplant, those are the days that you just don't know what's going on.
I know that the transplant team they want to know if you're having problems because if it's something that they can address in the clinic early, like I said, with a little bit of IV fluids or something, they would prefer that rather than having to stick you back in the hospital that's for sure.
Peggy: Absolutely. Sue, thank you so much. We really enjoyed having you on the show today and I know that this information is going to be so helpful to so many.
Sue: I appreciate you allowing me to share this knowledge and I just want to say that I've been working in cancer now for almost 25 years. Things have really come a long way when it comes to how patients are doing after their transplants. Still a rough go but it's great to see how well patients are doing, so just want to share that little amount of encouragement that I really am pleased to see the progress.
Peggy: That's so encouraging and I think someone with your experience, you've seen it since many years ago and to see the progress and the success. We know that more and more people are getting transplanted and it's life-saving, so thank you.
Sue: Absolutely I'm going to say I get to see patients in their one-year anniversary after their transplant, and it's one of the easiest visits I do because they're like, "Everything's fine. Yes, I'm eating this. I'm doing this. I'm fine, I'm back to work," and all this other stuff, so it's awesome. It's nice to see.
Peggy: Thank you for those encouraging words. I'm sure they'll be appreciated by many.
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