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Nutrition can play a significant role in recovering from cancer: An Interview with Oncology Dietitian Natalie Ledesma, MS, RD, CSO

Nutrition can play a significant role in recovering from cancer, but the challenges in realizing that potential are many. At issue are scientific complexity and potential credibility issues – the terrain within the body and the terrain without.

Oncology dietitian Natalie Ledesma, MS, RD, CSO, recently discussed the importance of building trust, credibility, and unity with patients. This is important in many contexts, from the initial education to the day-to-day work.

Education

Initial educational choices are about giving oneself the educational foundation and also about establishing credibility. There are many pathways that a nutrition professional can take, and many that will work at least some of the time, in some settings.

Ledesma knew she wasn't a traditionalist. She knew she wanted to push the envelope. But one can have a conventional background and still push the envelope. Ledesma pursued the Registered Dietitian pathway. Some nutrition professionals who take alternative paths are very knowledgeable, she notes, but it can be a challenge for them to establish themselves within the healthcare community. With her RD background, she's more likely to be trusted than if someone without the background were pushing the envelope.

Ledesma has a master’s degree, but this, and the dietetic internship that followed, were just steps along the way. It takes a strong science background to understand the metabolic pathways that a particular cancer uses. Despite burgeoning knowledge, there is much to learn about why a treatment might work for one person but not another. Ledesma is a Board Certified Specialist in Oncology Nutrition as well as an RD. She continues to read journal articles. She continues to seek out new knowledge and research. She doesn't think "Okay, now I have it," even after 19 years of study-- something she stresses that practitioners can do whatever their educational background.

Ledesma is a member of Dietitians in Integrative and Functional Medicine, a practice group of the Academy of Nutrition and Dietetics. The group is 4,000 strong.

Entering the Field

Having a credential doesn’t automatically translate into having a large role in the treatment process. Some physicians are more open to integrative nutrition than others. There was a point early in her career where Ledesma needed to prove herself as a knowledgeable practitioner – and do so repeatedly– in order to provide care. She found herself working with physicians who were very research-based and, like her, wanted to expand their knowledge base. Nutrition, though, was not their area of expertise. At the beginning she needed to cite a lot of research.

There came a point where her professional judgment was trusted and she could get more quickly to the business of patient care. There came a point where she was also seeing referrals.

Dietitians who are working in team settings typically do need to win over physicians. Some nutritionists, Ledesma realizes, face greater challenges than she did. It’s not all a matter of geography. The process of establishing oneself depends on the individual physician. One can find nutrition-savvy doctors in small towns. One can run into issues, still, in San Francisco. Ledesma notes that once a dietitian builds trust with one physician on a team, things get easier.

While Ledesma supports including more food knowledge in the medical school curriculum, she believes it is far more important how open physicians are to complementary approaches than how knowledgeable they themselves are.

In the Field

Ledesma continues to integrate science and people skills in her day-to-day work with patients at Smith Integrative Oncology. It is important to have very detailed information about a patient's physical status. Blood sugar, inflammation, nutritional status: It’s all in a day’s work. Ledesma works to place abnormal markers within context. While one may sometimes need to “bandaid” a deficiency of some sort, it's important to seek out the underlying pattern.

It is also important to assess a patient's emotional status and level of overwhelm. Cancer patients go through a sort of “mini medical school”, Ledesma notes, and they do so at a time when they are reeling from the diagnosis itself.

Ledesma’s clients are, by and large, people who already know the basics about nutrition. They know to choose broccoli over Pop Tarts. Some are trying to do too much. They will need to scale back on the number of supplements if they're feeling nauseous.

If someone did not have healthy habits prior to cancer diagnosis, Ledesma may need to focus on only one or two goals at the onset. Again, this is so as not to overwhelm: this time on an emotional level, not a physical one. After trust is established, more can be added.

How often does Ledesma wish to see a client? This depends on their needs. At the beginning, visits may be scheduled every week or two. If the initial battle is won, appointments may eventually decrease to once or twice a year. Sometimes Ledesma touches base with clients through electronic means. This can help them keep costs down. Flexibility is crucial, she says.

Cancer isn't something that one fights one time and then forgets. It is important to maintain that healthy body terrain, but client motivation tends to ebb and wane. Ledesma, who has an undergraduate degree in psychology, notes that motivational interviewing can be useful. This is a counseling technique used to keep people focused on their own goals.

An oncology nutritionist knows a lot about biological pathways – but doesn’t reduce people to them.