CANCER AND FOOD CAN BE A COMPLEX COMBINATION. Nutritional guidelines may differ depending on the type and stage of cancer: Some patients need high-calorie diets, some require lots of protein, while weight management may be a priority for others. Meanwhile, the disease and its treatments can affect palates, appetites and even the ability to swallow.
Enter the field of culinary medicine, which emerged as a medical school elective nearly 20 years ago and recognizes that food and cooking can play important roles in treating and preventing disease. Culinary medicine covers not only nutritional recommendations, but also practical application, guiding patients through methods of cooking that can prepare simple meals capable of appealing to their preferences while meeting their nutritional goals.
Christine Zoumas, the director of the Healing Foods Program at Moores Cancer Center in San Diego, prefers another term for the field. “I like to call it culinary translation,” says Zoumas, a registered dietitian. “We’re translating dietary prescriptions into kind of a language and a routine that will fit into individuals’ lives.” Over the past decade, several cancer centers across the U.S. have installed demonstration kitchens, where registered dietitians guide patients and caregivers through the preparation of meals that are recommended before, during or after their treatment. These classes blend the medical and culinary sciences.
“The cooking demos are a great opportunity for patients and caregivers to get connected with registered dietitians to get individualized recommendations,” says Tracy de Leon, a registered dietitian at MD Anderson Cancer Center in San Antonio. “When a patient is going through chemotherapy or radiation or surgery, their needs change, and nutrition is such a huge aspect of their treatment course.”
At cancer centers that have incorporated cooking demonstrations into their supportive oncology programs, nutritional education becomes an interactive experience. The hands-on approach doesn’t just improve dietary habits. It also fosters confidence, and maybe even a little fun. “There is a traditional way of patient education, and it’s one person teaching the other person, and then we assume the other person will go and do what they learn. There’s a huge gap within that,” Zoumas says. “I think sometimes people need to be empowered. They have to take that information, understand it, and translate it into their lives in their kitchens. If you come to a class, you get the opportunity to learn the why—the reinforcement of nutrition education—then you get to see it done … and you’re thinking, ‘Well, that’s pretty easy.’ And then you get to taste it, and now that’s the motivation.”
Whatever term used—culinary medicine or culinary translation—the field is based on evidence and research. A report issued in 2018 by the American Institute for Cancer Research (AICR) and the World Cancer Research Fund states that nutrition can affect the prevention and treatment of cancer and patient survival. Yet only 34% of cancer survivors meet AICR’s recommendations for fruit and vegetable consumption, 31% for fiber, and 47% for red meat intake.
A study published October 2020 in Nutrients sought to find out whether nutritional interventions improve food choices in cancer survivors, just as smoking interventions in recent decades have encouraged 87% of cancer survivors to meet the recommendations for smoking, which call for current smokers to quit smoking and nonsmokers not to begin. If so, the researchers were interested to know which style of intervention is most effective.
The authors compared teaching cooking skills and nutritional information to cancer survivors via in-person classes and cooking demonstrations against self-guided learning via printed information. The intervention group attended eight weeks of a course entitled Coping with Cancer in the Kitchen while the control group received printed materials. Both groups received recipes and information from registered dietitians based on AICR materials.
After 15 weeks, members of both groups answered surveys about how the programs affected their habits, skills and confidence in preparing the recommended diet. The group that attended the in-person classes and demonstrations had greater improvements to their nutritional knowledge, as well as the skills and confidence to adopt a diet suggested for cancer survivors. This group also perceived fewer barriers to introducing more fruit, vegetables and whole grains to their diet. The study did not evaluate the effectiveness of virtual cooking demonstrations, which many cancer centers shifted to during the COVID-19 pandemic, although the authors believe their findings warrant additional research into that area.
Developing cooking demonstrations for cancer survivors is more complicated than the usual demonstrations found on TV shows, due to the differing nutritional needs of each person in the class. In Zoumas’ demonstrations, she begins by teaching a base recipe. Then, she offers ways to alter it based on the needs of the individual: perhaps adding high-calorie or high-protein ingredients, perhaps introducing a new flavor to appeal to varying palates.
Cooking demos in cancer centers aren’t meant to make someone a whiz in the kitchen; they’re designed to make patients feel confident in the knowledge and skills needed to improve their health through nutrition—even, and perhaps especially, when the meals they’re preparing are simple.
“I usually tell people that you can do a lot with smoothies,” de Leon says. “People often don’t realize the types of ingredients that you can put into a smoothie or shake. Maybe this person needs high calories and high protein, so how can we pack it in? You discover some tips and tricks, and soon people are coming up with their own ideas, and it becomes a ripple effect for what we can do for that one patient.”
At Moores Cancer Center, Zoumas is looking into the prospect of creating cooking demonstrations to help particular populations who share specific food challenges. Their first target group will be people with head and neck cancer dealing with swallowing problems, a condition called dysphagia. They’re developing liquid and pureed recipes that address patients’ nutritional needs while fulfilling what they enjoy eating. If they’re on a pureed diet but love chicken and potatoes, she’ll teach them how to eat what they enjoy in a way that works with their treatment and is easy to prepare. “My goal is when they leave our class, they know exactly how to be healthy and how to take our recipes and concepts and take them into their lives,” Zoumas says.
Zoumas and de Leon encourage all survivors to talk with their care team and a registered dietitian to learn how their nutritional needs evolve before, during and after treatment. That information will help them get the most out of cooking demonstrations. They also encourage survivors to start incrementally, adding one serving of fruit or vegetables a day, or finding a new whole grain that they enjoy. The goal is to take small steps over time to adopt a positive habit, rather than overhauling their diet all at once.
“So many people come to me and they blame themselves for their diagnosis. They think it must’ve been due to this or that, something they did. The other half come to me puzzled because they put so much effort into their health and it failed them … people need to be relieved of blame,” Zoumas says. “Let’s all relieve the stress of everyone has to be perfect.”
Information from a registered dietitian will break through a lot of the suggestions found online that aren’t based on scientific evidence. De Leon finds that many patients are relieved to learn that the absolutes they may have read about—cutting out all sugar or all carbohydrates, for example—are rarely relevant to them. “Some of the biggest myths are about cutting out all sugars or carbs or fats,” de Leon says. “Every person is different, depending on what that patient needs to take care of themselves. But we don’t want to be too restrictive if we don’t have to.”
And even though tastes can change during treatment, survivors shouldn’t feel discouraged, but instead lean into the changes. “Rediscover your tastes,” de Leon says. “Make a list of what you like and build off of that list. And as you get connected to the right resources, bring that list to [your dietitian], and they can offer you individual recommendations.”
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