Transcript of Part 2 of “Why Diet and Nutrition Are So Important for Bladder Cancer Patients with Dr. Jill Hamilton-Reeves”

July 7, 2021

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Voice Over:

This is Bladder Cancer Matters, the podcast for bladder cancer patients, caregivers, advocates, and medical and research professionals. It’s brought to you by the Bladder Cancer Advocacy Network, otherwise known as BCAN. BCAN works to increase public awareness about bladder cancer, advances bladder cancer research, and provides educational and support services for bladder cancer patients and their loved ones. To learn more, please visit bcan.org.

Rick Bangs:

We’re back with episode two of three of how diet and nutrition help bladder cancer patients before, during and after bladder cancer treatment with Dr. Jill Hamilton-Reeves.

So, let’s talk about immunotherapy, a lot of bladder cancer patients are getting immunotherapy today. Do you have any guidance for them that would either increase the effectiveness of their immunotherapy or make the side effects more tolerable?

Dr. Jill Hamilton-Reeves:

Yeah, great question. I’m so glad that you put this one in here and it’s exciting that we have immunotherapy for bladder cancer now. So this is not an area that I have personally done research. My level of expertise is reading the literature. There are some interesting things that as a scientific community we’re looking at. One of them is how intricately involved our gut and our immune system, they’re really, really involved with one another. And so, there’s some data where people are looking at ways that we can increase the diversity of the microbiome.

Dr. Jill Hamilton-Reeves:

And so, for your listeners, we have lots of healthy bacteria, maybe even some that it’s not quite so healthy, but we have lots of bacteria that live in our gut and they help us synthesize some vitamins like vitamin K, and they also help with energy production locally for the intestine. They help sometimes with mood and cognitive abilities, and they help kind of get signals to the immune system, the gut to the brain and to the immune system is an intricate one. And if you think about it, it makes a lot of sense. If you eat something that’s going to make you sick, your body needs to know right away so it can fight it. So, there’s a lot of sensors within the gut. And then the bacteria kind of help with that.

Dr. Jill Hamilton-Reeves:

The idea is that the more diverse your bacteria are, the healthier that you’ll likely be. And so, there’s some interesting kind of preliminary data suggesting that people that have a lot of diversity to their microbiome tend to do a little better with Anti-PD-1 therapy or other immunotherapies. And so, then the next logical question is, well, how do I have a diverse gut then? And it’s usually somewhat diet related. And the things that have shown lots of things that you eat can change the gut bacteria. Also exercise can change your gut bacteria. But the ones that seem to be major drivers are a high fiber diet, and the fibers that are a little more fermentable. So, eating legumes and fruits and vegetables and whole grains can help with that microbiome. And then, oh, by the way, they also have lots of vitamins and minerals and other good stuff in them that make you overall healthier. So it’s kind of a no losing kind of situation to eat those things during immunotherapy.

Dr. Jill Hamilton-Reeves:

Some people naturally will ask about probiotics, which is basically like taking a pill that has the bacteria in it already. Way back when I was doing, my very first research project ever in graduate school was a probiotic study. And I swore off of them because it was so confusing. And then here I am, I actually have some microbiome stuff too. You never say never. Eat my words every time. The probiotics, there’s some conflicting results, so I wouldn’t say that that’s going to be your silver bullet. If your health care provider does recommend them, I wouldn’t press against it because there are some, there’s some data coming out of different species and strains, or if they know the flora of your gut, they might be trying to help correct it a bit. So that could be a route that people might take.

Dr. Jill Hamilton-Reeves:

And then again, thinking about the brain running a body budget for energy, mounting an immune response takes a ton of energy. And so, I’m not saying that you need to stuff yourself with food, but again, it’s not the time to be lazy about eating. Plan ahead. You likely won’t have a ton of side effects unless you’re one of the unlucky that had some of the immune-related adverse effects. But just stay on top of your eating, keep your weight consistent, and eat regular meals. And like I said, if you focus on some of those really nutrient dense foods like fruits and vegetables and legumes and whole grains, I think you’re improving your odds the best that you can.

Rick Bangs:

You would want somebody to discuss probiotics or other supplements with their doctor, right, especially as they’re getting treatment.

Dr. Jill Hamilton-Reeves:

Yes, absolutely. Yeah.

Rick Bangs:

Okay, fascinating. So let’s talk about the group of muscle invasive patients who are going to face radical cystectomy. You know from the data and I know from personal experience that this is really a major surgery, it’s impacting the urinary bowel and sexual function. Is there anything these patients should do nutritionally before they have surgery, and how do fitness and nutrition before surgery play into the results from the surgery including any complications?

Dr. Jill Hamilton-Reeves:

Yeah, great question. So I think hearing a bit about your story, if the listeners haven’t heard it, would be super helpful, because I was told what to expect from my urology colleague, Dr. Holzbeierlein. And that’s kind of what got me involved in this field to begin with, is he went through and he just read case by case. So I didn’t meet these humans face to face, I just heard about these cases that technically went really well, and yet, the patient really didn’t do well afterwards, and they lost a ton of weight. And it wasn’t really, I asked him at the time, I was like, have you tried feeding these people around the time of surgery? I think we’re going to get to that with the next question. Have the listeners already heard or could you tell them a bit about what you experienced?

Rick Bangs:

Sure. So very briefly, I was diagnosed in 2006, so it’s a little bit of a different time period. There’s some things we do today that weren’t done then. I specifically asked about things that I should do to get ready for surgery. And one of the things I was told was to do walking or exercise to kind of make sure that I was building up some level of muscle because, sadly, I was told that when I wouldn’t be eating, muscle was going to be depleted before fat, which didn’t seem like it was a good thing. You’d certainly want the fat to go before the muscle, but apparently, the way the body consumes or gets its energy, that’s what happens. I don’t think I could eat for at least three or four days.

Dr. Jill Hamilton-Reeves:

You couldn’t eat and they didn’t clear you to eat?

Rick Bangs:

They didn’t clear me.

Dr. Jill Hamilton-Reeves:

Yeah, that was typical back then.

Rick Bangs:

They didn’t clear me for three or four days. And I believe if I recall that by the time I had checked out of the hospital now, by that time, I was eating a little bit. I think I’d lost like 18 pounds.

Dr. Jill Hamilton-Reeves:

So your story is very similar to kind of what I heard is the typical situation that my urologist kind of walked through with me in 2012. So, how great that they explained that fitness would be helpful, that’s awesome that they set that expectation. I don’t think everybody else had that expectation at that time. So, kudos to your team for mentioning that.

Dr. Jill Hamilton-Reeves:

I did want to touch on the muscle before fat thing. So, people that have been in my medical school classes I teach the first year medical students. We talk about this issue of starvation, and essentially the body is very wasteful of muscle the first 24 to 48 hours. And then it gets smart and it realizes, ooh, we are really going to get into trouble if we keep blowing through muscle like this. And so then it will switch over to using a little bit more fat. However, when people are trying to heal and they are running low on the building blocks of protein, amino acids, which we know from the work that I’m doing that there’s some amino acids that get extremely depleted with the surgery, it needs to get those amino acids from somewhere, and we don’t have a storage form of protein in the body other than our muscle.

Dr. Jill Hamilton-Reeves:

So if you’re not eating, if you are healthy, normally, it would be 24 to 48 hours of wasting away your muscle, but then your body would kind of slow that down. But the problem is, you just went through getting yourself totally cut open and rearranged, and your body needed protein to rebuild. And it was prioritizing that healing over your muscle mass. And so, that’s why there’s such that extreme drop off right after the surgery, and that’s not uncommon. The part where you talk about not eating for three to five days, that kind of goes into our next question, so maybe I’ll let you kind of take that away, and then I can kind of continue from there, unless you have comments or questions.

Rick Bangs:

No. I just never felt it was fair that muscle would go before fat. It just didn’t seem right.

Dr. Jill Hamilton-Reeves:

It isn’t.

Rick Bangs:

We’ve kind of hinted this or kind of explicitly stated that it’s a different world now than it was when I had my radical cystectomy, and there are these new surgical procedures, and thank goodness there are, that reduce some of the challenges that I might have had with digestion and recovery. So what’s changed?

Dr. Jill Hamilton-Reeves:

So, there is a whole pathway that surgeons are following now that, we use the acronym ERAS, which stands for enhanced recovery after surgery. And it was a brilliant coming together of supportive services and surgeons to realize like, hey, if we worked a pathway together, we might be able to get patients in and out of surgery in much better shape. And so, all of these different health care professionals sat down and talked about, okay, these are my priorities, these are the things I know my patients need. And then they basically kind of bundled that together and got a working group going, and now there’s even an international ERAS society that I really enjoy going to those meetings because they’re so multidisciplinary, and it’s just a very clear mission to help patients do better through these big surgeries.

Rick Bangs:

And that’s all the time we have for segment 2 of how diet and nutrition help bladder cancer patients before, during and after treatment with Dr. Jill Hamilton-Reeves.  Be sure to tune in for segment 3 coming soon.

Voice over:

Thank you for listening to Bladder Cancer Matters, a podcast by the Bladder Cancer Advocacy Network, or BCAN. BCAN works to increase public awareness about bladder cancer, advanced bladder cancer research, and provide educational and support services for bladder cancer patients. For more information about this podcast and additional information about bladder cancer, please visit bcan.org.