Your Brain On... Chemotherapy

Welcome to Your Brain On, the podcast where we explore the neuroscience of everything. I'm Dr. Aisha Sherzai. Today we're talking about chemotherapy and the brain. If you or someone you love has gone through cancer treatment, you may have heard the term chemo brain. It's a phrase used to describe the memory lapses, slow thinking, and mental fog that so many patients experience during or after treatment. And for years, it was brushed off, called anecdotal or explained away as stress. But today we know better. The brain is affected by cancer, by chemotherapy, and by everything that surrounds it. The fear, the inflammation, the disruption of certain hormones, sleep, identity, and so much more. This episode is about understanding what's really going on in the brain during cancer treatment, what the science actually tells us, and where it still falls short. And most importantly, how people can get better. Let's start with what we know and what we don't. Studies suggest that about 75% of people undergoing chemotherapy experience some form of cognitive dysfunction. For about a third, those changes last beyond treatment, sometimes for months or even years. What does that actually look like? It looks like slower processing, difficulty concentrating, having word finding difficulties, trouble with multitasking, or having difficulty with short-term memory. A lot of people describe it as feeling like they're moving through mud, mentally foggy, emotionally flat, and cognitively blunted. The term chemo brain suggests that chemotherapy is the sole cause, but the truth is it's more complicated than that. Cancer-related cognitive impairment, or CRCI, is likely multifactorial, which means that there are so many factors involved. Inflammation from the cancer itself, Plus, the impact of surgery, the anesthesia, the radiation, the hormonal changes for the kinds of cancers that impact the endocrine system all play a major role. Chronic stress in itself can impact the hippocampus and the prefrontal cortex. Sleep is often disrupted, whether it's because of the chemotherapy itself or the pain related with cancer. Other factors that play a role are nutrition, exercise and movement, emotional health, etc. And yes, there are some studies that have shown structural changes in the brain during chemotherapy. We actually have evidence that the gray matter volume decreases, especially in certain regions that are tied to memory and attention. But let's be clear, these findings are often quite modest. Imaging data is limited by sample size, which basically means that it hasn't been tested in a lot of people. The design is variable and the follow-up period is very short. So we don't have tremendous amount of information in this field and we can't say with a high degree of confidence that the brain shrinks during chemotherapy. What is more consistent across the literature is functional change and how the different parts of the brain communicate, especially under cognitive load. What all of this tells us is this, the brain is adapting under pressure. It's not necessarily damaged, but a more appropriate way to describe it is it's coping. It's responding to systemic stress. And we know from longitudinal studies that many of these changes resolve with time. So neuroplasticity is a real phenomenon and so is recovery. Earlier this month, Dean spoke with Dr. Liz Oriordan, a breast cancer surgeon, a speaker, and an author. And she's also someone who's lived through breast cancer not once, but three times. As both a doctor and a patient, she brings a perspective that bridges clinical knowledge with deep human insight. And she's used this experience to educate, advocate, and connect with people around the world. She's fantastic. In 2024, she was awarded the Humanitarian Award from Future Dreams Charity for her work in breast cancer awareness and patient care. Liz's voice matters, not just because of what she's been through, but because of what she's built from it. I would love for you to tell us about your journey. Yeah, sure. So for anyone listening who doesn't know me, I was a consultant breast surgeon in the UK. I'd spent 20 years training to be the best breast surgeon I could. I found a lump in my breast. I'd had a couple of cysts before. I never checked them regularly. And I think most people, if we're honest, don't check ourselves for cancer because we think it's never going to happen. And my mammogram was normal. I had an ultrasound scan and that showed a large cancer. And in that minute, I knew far more than normal patients. I knew I need chemotherapy. I knew I need a mastectomy. I had a good idea what my chance of making it to 10 years was because it's my job to know this and it's like something in my brain just switched off I'm in denial this isn't happening to me it's happening to someone else and that's how I process through treatment I had the full works chemotherapy mastectomy all my nodes out I had radiotherapy I was put on hormone blockers and it took me about a year to recover from all of that and go back to work but sadly about two years later in 2018 I had a local recurrence on my chest wall and the side effects of the treatment for that meant that I couldn't operate anymore. I was forced to resign at the age of 43. And I had no job, I had no hobbies, I had no status, I didn't know who I was, I'm still grieving for so much I'd lost. And I had a second recurrence a couple of years ago. And losing everything makes you realise who you are, and what defines you and what your real purpose is. And mine is to help people and small animals and birds. And I kind of just found new ways to keep doing that by talking, by writing, by doing podcasts, by doing explainer videos. And it's just led to this volunteer doctor for the internet, but it is so rewarding. Absolutely. I mean, I think I've done research all my life. I worked at NIH and all these incredible institutions, and I'm right now executive director of clinical research at Charles Drew in UCLA. And I'll be honest, I recognize the moment we're in in history and communicating science becomes almost more important than the science. Yeah. So I did a PhD in molecular oncology and you get very good at writing sentences that have 200 words. That's what your professor wants. And when I had cancer, I started writing for media. I realized I've got to change my tone completely. I'm not trained to write for the average general public. They say the general reading age is like seven or nine years. And I had to learn really quickly how to explain concepts. And I was talking about radiotherapy and a friend said, what's radiotherapy? It's like, oh, the stuff I think is obvious is still medical jargon to other people. And I've learned to use things like oranges and lemons and fine ways of helping people explain it. Because I think we've all got the attention span of a gnat. And most people are terrible at understanding statistics. We hear the relative risk, the scary headline risk. But actually, to take the time to explain what it means to them just takes that risk away. But it's not sexy and it doesn't sell newspapers. And that simplification is not dumbing down. I hate that concept. It's not like looking down at the population. It's about being cognizant about the emotional and the conceptual elements of the conversation and how it can get connected to a thousand, 10,000, 50,000 people. And you do it so well. You're absolutely amazing. Having said that, this is a very common condition. Cancer is common. Chemotherapy is common. Yet conversations about it are lacking. For example, in African-American communities here, colon cancer and others are lower frequency, but death rates are higher. People are afraid to get evaluated. Physicians are not good at communicating, and so they make them even more afraid. That is what your job is, and hopefully ours as well, to take away that fear. Yeah, we know there are cultures in the world that don't talk about cancer. It's shameful to have it. We're scared of it. And I think by me being a doctor saying, I didn't know this, and I didn't know that, and this is what it's really like. Based on the people that talk to me, I can give a relatively honest opinion of what it's like for most people. And the first thing my women would ask when they came to see me and I said, you've got breast cancer, is am I going to lose my hair? And I knew a little about the side effects of chemo. I knew you lost your hair. I didn't realize it was all the hair on your body. Brazilian and leg wax, here you come. I knew you'd feel a bit sick. But that was about my limit because I'm not an oncologist. I didn't realize that chemo brain, as we call it, is real and can be permanent. I think they say it causes about 10% brain damage. And then when you get the menopause, it's hard to know what's confounding it. But my cognitive function changed. I used to do cryptic crosswords and anagrams and solving really quickly. Now I can't see an anagram and I can't do mental arithmetic and I still get nominal aphasia. I'll call my phone a potato and I know it's not a potato, but I can't find the word. And that's really real. And it's hard if you've got a high pressure job and suddenly your brain doesn't work. It's just, it's miserable. And I had quite a mild dose of chemo. I had it in a day and I was home. But people who had chemotherapy for bone cancers and leukemias, they're in hospital for two or three days. It's really intense. But you can't remember it six months later. It's remarkable. I mean, one of the leading hypotheses for chemo brain is inflammation. There are many different paths, cytokines, crossing the blood brain barrier. Can you walk us through the current scientific theories about why chemo brain happens? Again, at this point, I think it's mostly theories. They haven't been fully validated, although we have some incredible tools now. We can even, with using PET scan and ligands, look at neuroinflammation, which to me is so cool because I think a major driver of health in general is inflammation. And if we can follow it at that molecular level with ligands, it's just remarkable, especially in the brain. But at this point, it's theories. So I would love to hear what your thoughts are. I can't remember ever actually seeing someone who said, this is why it happens. To me, I feel because chemo attacks every cell that's growing and dividing, the brain doesn't divide very quickly. so it takes a while for that damage to occur and it may not come back because the brain may not duplicate or regrow those nerves that were damaged because of the chemotherapy that could be one action we know inflammation is a real problem everywhere and again it's what drugs can get through that blood brain barrier and we give chemotherapy to treat some brain metastases it was really interesting to see exactly what damage are we doing and I know we use the cold capping to stop the blood going to the scalp but I love to know if cold capping reduces the inflammation in the brain Yeah We use cold capping for MS. Yeah. It's not pleasant. You have an ice cream headache for about four hours. I didn't realize it would happen. Yeah. And it was only when a friend came and said, right, when you get chemo, your brain's going to go, you won't be able to do this. And I was like, what? nobody told me. I didn't realize how big an impact it is. Yeah. And the fMRI studies show that the prefrontal cortex especially is affected, which is executive function and some attention as well. Did you notice anything specific to that extent as far as your executive function and problem solving and attention? Yeah. So I went back to work after about six months. And by that time, I got used to the side effects of the menopause because that can change how your brain functions. I can't have HRT. But as a breast surgeon, I'd be used to seeing 10 people in the clinic, one after the other, then I'd sit down, I'd write all the notes. I couldn't remember the patient I'd just seen. I could not remember the things that I used to do. I would have to write everything down. I couldn't rely on my brain to remember two or three things. I could not multitask anymore. And you don't understand why. And you try and train your brain to get better. But I now learn I need to write everything down. And I need to be, I sound like an idiot when someone says this, I'm not going to remember that. Can you write it down and email it to me? because my brain doesn't work like that anymore. And it's really hard. I still do a lot of Sudoku puzzles and things just to try and keep the brain active. And I think there has been some improvement. I think you just notice it in the first six months to a year when you go back to work and the brain is still recovering. Because they say it takes you a year to recover from chemo and it ages you biologically by 10 years. So your brain isn't working as well as it would. And that's something to remember as well. We did a meta-analysis on cognitive activities in general in MCI patients, which is pre-dementia, right? And what we saw was, yeah, things like Sudoku and all of those are great. They work. Even old fashioned games work. But the more effective thing is real life activities like art and music and dance and classes and volunteering and these kind of things. They are multi-domain, multiple areas of brain. And also there's an emotional component to it. So what do we do that's real life challenging? So when I stopped being a surgeon, I needed to use my hands. So I knit and I crochet and I sew and I make my own clothes. I play the piano. And you're right, it's those things. Your brain is having to do several things at once. You get the pleasure, there's a purpose to it. And I think that has really, really helped. Is there any evidence to show that having chemo brings forward the onset of dementia and Alzheimer's? There isn't a strong, I mean, the way we look at data, which is very anti-social media. So in social media, there's a paper that's done on 30 people and then it's like, oh. Oh, don't go there. And I tell them, you know that 400 papers showed results in mice when it came to Alzheimer's and none of them translated to humans. There isn't actually strong evidence that chemotherapy leads to dementia. There's enough data because this is not a rare disease, right? 7 million Americans, 55 million worldwide. So we will have to still keep looking at it. But the nature of risk is if you create some risk, that's going to just lower the threshold a bit. But then other things can take over. You know, that's the nature of it. So for you, maybe the risk of chemotherapy, but then you started doing piano and started doing all of this. And we know that cognitive activity is that much more powerful. Yeah, I think going back to trials, I think we almost need to educate the general public, even pre-bunk at school age to say, this is how a trial should be done. And we go into it assuming that it's not going to work. And you just want to prove that it's not going to work. And if it does, that's great. But the guys with their supplements creating trials to cure this, they want it to work. They're paying it for it to work. That is the outcome they are hoping for. It's a completely different setup. And I think if we could help them understand how proper science should be done and how you can't cherry pick the data and not tell people about that little bit at the bottom. Because they say it takes a thousand percent more time to debunk, to contradict nonsense. Yeah. Because you have to go and prove and find the papers and do it. They just have to say, hey, bananas cause cancer. Yeah. Yeah. So I get people, I've had five emails today saying, hey, I've got five myths. Can you debunk? Have you got three days? Could you pay me to do that, please? Yeah. It's really hard. It is. And because we're not rage bait angry, we're not trying to get the clicks and the views. It's not sexy. It's not exciting. You don't cut through the noise. No, but you know what? One of the things I say is I wish that in schools I would replace algebra with statistics and epidemiology. Yes. I mean, if people learn statistics and the nature of statistics and then epidemiologically how it's translated to populations, the world will be different. Exactly. And how to spot BS online. Yes, yes. Critical thinking. So let's talk about this chemotherapy part of it. People should know that cognition is going to be affected. Yeah. And that's not the end of this story, but that's a part of this story. It is. And I think if you're carrying on working through chemotherapy, because many people do, there are many different types of chemotherapy regimens. You need to let your employers know that you might not be able to do things as quickly or think as clearly. You may need to step down what you're doing because a lot of people can't afford to not work during chemo and they go into their job and it's suddenly my brain isn't working. What do I do? So being able to tell the important people that you might not be as quick as you used to be, it's really clear. Absolutely. The other thing I think is important for people to know that this might not be just chemotherapy. So women are disproportionately affected with chemo brain. And part of that is because at the age that they come to this disease, which is cancer, it's also the same age as menopause. A great friend of ours, Dr. Moscone, who's a brilliant, brilliant scientist working on women's brain health and menopause. menopause we know is going to affect the brain especially as we're beginning to learn more and more so that's another element and the third element is stress we know that a stress itself shrinks the hippocampus so you have to figure out that it might not be just chemotherapy it might be stress to address stress it might be lack of sleep so address sleep it might be menopause i get very worried when we kind of talk about the brain changes and the menopause and dementia because i think we don't have all the evidence yet we don't know for definite because dementia mainly happens in women as they get older is it really the menopause or is it the same thing that's happening in men so i've had a cancer that's sensitive to estrogen like 80 of the women with breast cancer it's sensitive to estrogen that means to stop it coming back we reduce your estrogen levels to lower than a menopausal woman and you cannot have hrt i think chemo is multifactorial plus you've got the stress of oh my god i've got cancer and my cancer could come back it's having to drag yourself back for the second and the third and the fourth cycle when you know how crap you're going to feel. So much involved. Absolutely. When it comes to the misinformation, recently a person with a large following came up with a video that says that when women go through menopause, the brain is actually eating itself. Oh, I know. It's nonsense. And then Aisha put out a video saying this is absolute nonsense. Where is the data? On the side of preparation, about 90% of cancer survivors say they were unprepared for the mental health and cognitive effects of the treatment. If you could rewrite the pre-chemo briefing every patient gets, what would you add about brain health, memory, and mental resilience? How would you have them prepare? So there's me as a doctor speaking, telling you what I would make sure is on that leaflet. But me as a patient would say, I probably wouldn't read it because I go home in a mess and I wouldn't look. And you get a long, long list of all the side effects. And it's like, you're made infertile. It could kill you. You could get clots in your lungs. You could get an infection that could kill you you could lose your nails you can lose your hair it's a long long list of just unpleasantness telling patients chemo can affect how you think clearly and how you remember and during your bad chemo weeks you won't be able to concentrate on anything and that's normal and give them things to look at so maybe just i love jigsaws you can put in a couple of pieces of a jigsaw and think that's a win i've achieved something today when i can't watch a rerun of friends and then tell them when chemo is finished your brain will start to improve giving them advice and telling them this can happen. And then always getting the chemo nurses because they spend time with you every cycle. You know, they're checking about all the side effects. Maybe we need to say, how's your brain function? Now, we can't change it. We can't make it better, but it may be useful to know. That's absolutely makes sense. The real fact is that recognizing that cognitive recovery is not just about getting back to normal. I would say there is no normal after cancer. We all talk about the new normal and nothing is normal. It's the new different. It's a new stage in your life. And you may never be able to think as clearly as you did. And do you think that this new state given that you've been through cancer and have survived is a richer state? I think it depends. My life is happier and stronger now than I was 10 years ago. I've been forced to change. I've been forced to realize what's important. It's the memories that you make and find new ways of living and being. And actually there is life outside of work. I've been forced to change and become a completely different person. Pre-chemo Liz would not have talked about her sex life online or stood on stage in front of 2000 people or written five books. My latest book is called The Cancer Roadmap And it came about when I debunked a video on Instagram by two vegan influencers who said a podcast guest told them mushrooms could cure cancer. And the publishers came to me and said, there is so much misinformation in women's health. Would you write a book about cancer? And I thought, OK, I can do that. From my experience, I think if cancer is the end of your world and for a young woman with metastatic cancer and two kids, it is the end of the world. They kind of go into a they don't look after themselves. That stress builds, the anxiety, the depression builds. They don't eat well. they don't exercise, they don't sleep, and that fear becomes all-consuming. And they tend not to do as well. But if you can find, not a positive, but find something different to distract you, well, okay, this has happened. And it took me two years to get to this space. I can't change it. Stop fighting the fact that you might be dead in three years and say, well, okay, what can I do today? And trying to find new ways to find the joy to occupy yourself. It can be a gift. It can open so many doors if you're ready to accept them. But not everybody is lucky. Not everybody feels as I did. I think it's really, really personal. So when you see people like me going, hey, life is wonderful. I'm very aware that I need to show the tough days. The days when I'm crying and I'm miserable and I'm scared because it's a rollercoaster. Hopefully you'll spend more time on the up than you do on the low. This was a fantastic conversation. I love how she described the mental fog, but also the emotional flattening that is experienced during chemotherapy and cancer, that shift in self-perception. the moment when your brain is no longer feeling like yours. And I'm really glad that she also talked about what helped, the routines, the structure, the letting go of guilt, all of that is incredibly important And also she highlighted the shift from trying to bounce back to learning how to move forward fully and differently Listening to her struck me how little we talk about this part of the recovery the cognitive piece of it and the emotional reintegration part of it the identity shift Which brings us to our next guest. Nicole Andrews is an oncology dietician who works with patients in the thick of it, during treatment, after treatment, and in the in-between. Her work is about rebuilding not just physical strength, but cognitive clarity and emotional grounding through food, through education, and through dismantling the fear-based culture that surrounds cancer recovery and nutrition specifically. She's doing an amazing job with her patients. She and I spoke about how nutrition, exercise, and cognitive healing intersect. She also discussed what she sees in her practice and how we can support people not to just survive, but to feel like themselves again. Here's our conversation. It's such a pleasure speaking with you. Public health has moved to social media, which is a good thing, and it can also be a very dangerous thing. And you're a registered dietitian. You have such a huge responsibility and there's a lot of misinformation in the field of nutrition. Let's talk about how you respond to someone who basically says, eat this food. It could be something like broccoli or let's say a kind of a supplement. And it's going to make you feel better if you're going through cancer, either reverse your cancer or prevent cancer. Like what is your general conversation to people when it comes to the idea of nutrition and cancer? Yeah. Okay. First of all, thank you so much for having me on. And yeah, when it comes to a cancer diagnosis, it's really important that we're sharing the right information to cancer survivors, which they don't get, which is because social media, while it has amazing people like you and myself, especially, you know, me talking about nutrition for cancer survivors, it has a lot of misinformation. There's so many things that really are hard on them and go wrong for them with nutrition when it's the wrong information. So it can cause a lot of complications. Now you get the right nutrition support, that's definitely what I do on my social media, it can turn everything around. They can feel like themselves. They can nourish and protect their bodies or brain health and all that. But it can be challenging because cancer survivors, they may not be experts in figuring out who's the right person or not to listen to or who's right or wrong about nutrition. So I think it's really important just first off, people who are credentialed like you and I, who have worked in an area in a space that we have experience with for many years. When somebody's like, hey, this one food. So that's not how it works. There's never one diet, one food, one supplement that you would miss. That's just not true. Our bodies are complex. And when it comes to nutrition, your body needs carbs, protein, and fat every day, four years, forever. There's not one magical food. So it's going to be clickbait if they're like, hey, this one supplement, hey, this one food, hey, this one veggie, that's going to be clickbait. Now, if they're saying, hey, I love this food. For example, like me as a cancer dietician, I love raspberries personally, but also they just pack in so much nutrition in just one cup. So I might talk about how raspberries are great, but it is not a superfood. There's no one food, one diet that is going to magically make cancer disappear or that's going to magically make it so cancer never comes back. Now there's eating patterns that we can do, and there's a lot of amazing foods we can add in that will make a huge impact. But that's one thing we've got to look out for. There's never this one magical thing when it comes to health or nutrition and cancer. It's a collection of things and it's simplifying those and making it realistic and easy for them to implement. That's how they get results. When they say one thing, one supplement, red flag, I'd run the other way. I really appreciate you saying that. I think one thing that gives me solace is that this kind of language is it's applicable for cancer survivors, but it's also applicable for all other health related issues as well. Well, thank goodness the same dietary pattern that is good for heart health is good for brain health, is good for GI health, is good for reproductive health. So there's not a lot of huge differences in the dietary pattern. And as a scientist, I study different dietary patterns. And I'm glad that we've shifted from recommending a particular nutrient or a particular supplement to telling when it comes to general public health messaging. It's telling people to eat a variety of different things in a form of a dietary pattern. What does that dietary pattern look like for cancer survivors? Yeah. So really what we're looking at is mostly plant-based. You could go vegan or vegetarian if you want, but that's a personal choice. When it truly comes to reducing risk of cancer, there's only two foods you really want to eliminate that have been tied in with strong human data to increase cancer risk. One would be alcohol, and then two would be processed meats. And those will include like your pre-cooked meats or like heavily processed. So like bacon, sausages, deli meats, things like that. Those are going to increase risk of colorectal cancer specifically. And then the alcohol is going to increase risk of seven different cancers. Some of those colon cancer, liver, mouth, throat. So those are the only two. So when everyone comes in hot with, oh, no diet Coke or, oh, no gluten or, oh, sugar, they are just not, it's not true. It's really important for everyone to know that foods are studied all the time and scientists are releasing updates. Scientists are looking at, for example, zero calorie sweeteners. Those have been looked over for decades and decades. So there's no hidden thing like hiding and scientists aren't hiding anything either. They're actually doing a great job of figuring out what really increases cancer risk or decreases. So we don't have to go vegan or vegetarian, but we do need to add in more plant foods. So if you want to reduce risk of cancer, you have to think about what happens. How does cancer come about? Comes from a damaged cell, damaged DNA. So what can you do with food to help those cells basically be protected or repair that DNA? You eat more plant foods because plants contain certain vitamins and minerals, antioxidants and phytochemicals that either guard and protect your cells from being damaged or maybe they're damaged because our cells do get damaged daily just from being a person. But those certain plant foods will repair it. So like when you eat an orange or a strawberry, whatever your favorite food is, maybe you love apples. You're eating that. It's going around protecting or repairing your cells. And it's pretty amazing, pretty beautiful. I do want to point out plant foods include fruits and veggies, beans, legumes, nuts, seeds, and then whole grains. A lot of people are demonizing grains unless you have celiac disease. You can have grains and you should. So those foods are going to help you to reduce risk of cancer. Now, in addition to that, to nourish your body through cancer treatment and beyond, it's okay to have lean dairy. It's okay to have lean proteins. We want to choose more of those heart-healthy fats that are going to be lower in saturated fat, more of those mono and polyunsaturated fats. It's okay to have sugar in moderation. No one is saying to have a high sugar diet, but to have a cookie or go on an ice cream date or have a little sweetener in your holiday coffee or birthday cake, these things are normal and they're not gonna make your cancer grow. And if you pull them out, it's not gonna make your cancer vanish. So when it comes to really reducing cancer risk, it's okay to have the sugar in there, but it's not supposed to be your whole diet. A lot of your diet is supposed to be those plant foods and lean proteins. So that's how I'd eat to reduce my risk of cancer. And that's what I say on my social media, but that's also really what I tell my clients, whether they're during or after cancer treatment. I love it. Thank you so much for sharing that. That's exactly what the evidence shows for other conditions as well. There's a lot of misinformation surrounding the concept of eating organic versus inorganic and the whole GMO issue as well. In the realm of neurology, we know that exposure to pesticides, like people who actually have an occupational hazard that work in the field and they're exposed to these chemicals, could potentially have a higher risk of developing Parkinson's disease. But beyond that, we really don't have any evidence of conventionally grown fruits and vegetables increase the risk of any brain diseases per se. And I know that in the realm of cancer, there's a lot of misinformation around that. What are your thoughts about that? And how do you talk to your patients and clients about it? Yeah. So you don't need to buy organic. And that's one thing or any type of organic food. That's one thing cancer survivors are told. And a lot of them will share with me, like, this is really a big part of my budget now. Or they're skipping out. Like, maybe they would have picked up some blueberries, which would totally reduce their cancer risk and support their gut health, which is huge, but they weren't organic. So they feel like they can't, or the organic blueberries are $8. And they feel like, again, like that's such a huge part of their budget. So it's really important to look at talking with farmers and food scientists and looking at all this. So organics is not going to reduce your risk of cancer better. Conventional blueberries, when it comes to the nutrient profile, it's going to be exactly the same for organic or conventional. Same with frozen, okay? And this is good news because then we can go out and have more fruits and veggies, which is what will help you reduce cancer risk. When we look at pesticides, they're both going to be at safe levels. They're going to use different type of farming patterns, but they're both going to be safe. It's really just a lot of marketing. It's a different way of farming if not nutrient superior. When it comes to GMOs, we've got to say thank you to the scientists and farmers because what they've done with GMOs is they changed around crops that are more drought tolerant or may even need less. pesticides. They're looking at foods to make them in a way that's easier to grow so we can enjoy them and afford them. So there's not really a lot of GMOs. And I think what's really important for cancer survivors and everyone to understand is they'll even label things because people are so afraid of GMOs having a non-GMO, but they won't even have a counterpart. So for example, like oranges or raspberries will be labeled non-GMO, but there are no GMOs that are oranges or raspberries. So there's so much fear mongering. These companies are now putting all these things on products that we don't even need to have. GMOs are safe. You do not need to buy organic. I just need you to have more fruits and veggies and know that pesticide residual on either of them is so low. First of all, they both use pesticides, but if you want to reach this safe limit of maybe like spinach today, you'd have to eat 800 bags of spinach and nobody's doing that. So it's just so important to know it's not going to cause you any harm. It's at very safe levels. It's watched so close. It's reported on so close. And that if you really want to reduce your risk of cancer, I need you having more fruits and veggies that fit in your budget and that you want to eat. Beautiful. And all of the observational studies that have showed the association between consumption of foods like fruits and vegetables, whole grains, legumes, nuts and seeds, all the wonderful foods that could potentially make us healthy, they were tested on conventionally grown vegetables and fruits. They were not the organic type. So we actually have decades of data showing that when you follow that dietary pattern of eating conventionally grown produce you actually feel better and you healthier So thank you so much for elaborating on that I love to pick your brain on your approach as a registered dietitian with your patients who are going through chemotherapy specifically and some of their complaints. Because I'm a neurologist, I always get consultations about quote-unquote brain fog because it's not an ICD-9 code, but essentially the cognitive impairment that some people experience going through chemotherapy. And that requires a lot of neurological workup. We want to make sure that we get some imaging and do some memory testing, so on and so forth. And I always send my patients to a registered dietitian. Tell us for our lovely audience here, what does that entail? How do you work with someone who comes in with, say, for example, fatigue or low energy when they're going through chemotherapy? What are some of the things that they need to be aware of as far as nutrition is concerned? Yeah. So there's a few different things that we can kind of look at right away. So first off, please note that you can't blame yourself for that low energy or brain fog, that a lot of different cancer survivors are getting it with different modalities. Maybe some are even on chemo. It's just a diagnosis, the cancer being present. But I want to encourage everyone that it will get better. And there are things that you can do. And that as you go through cancer treatment or go through from having a diagnosis to getting your clean scans, your body's going to be healing. I've worked with dozens, I mean hundreds of cancer survivors where the brain fog, it gets better. The energy, it comes back. It just takes some time. So you have to remember that for brain fog, it's so important that you're nourishing your brain with those brain foods. And one of those is carbohydrates. So carbohydrates are going to land any fruits, grains, all dairy except for cheese. We cannot take out the carbs. Your brain needs that. Other healthier fat choices are also going to really support brain health. So choosing anti-inflammatory fats like flaxseed, walnuts, those are going to really nourish your brain. So that's one thing to keep in mind is we don't want to be taking out all the fats and taking out all the carbs. Another thing for your brain health is the decision fatigue. There's so many things going through your mind. So many things to cancer survivor. Your treatments, your appointments, your future, coping, talking to your family. I mean, whoa. Not only may you be physically tired because what's going on with the treatments and cancer present, but now you have this mental load. So really working on reducing that mental load, which can be very challenging. But you have to have support. like your physician, like your dietician, your family. All right, so getting that decision fatigue down and exercise. Exercise is so important to improve circulation, have better treatment outcomes, but to just really take care of your organs so much, including your brain. So the exercise is what's gonna be so important. And I wanna make sure it's clear. I'm not saying go to the gym every day for two hours. I'm talking about like just walking around the block. I had one client, she couldn't even walk to her mailbox and back. And we made small goals. And these are like behavior change goals. you start walking to your mailbox when you get that down then you do a loop around your mailbox then you get that down then you're walking a mile so with exercise we need to incorporate it back in as a cancer survivor to support your brain health to improve your energy truly it's hard because cancer survivors are like i'm so tired so i'm not going to go exercise and i'm like but if you exercise you're going to feel less tired but the thing is though we're not asking you to do two hours we're asking you just to start and accountability that's what i do inside my programs that hold you accountable. And it doesn't mean that you can't rest, but that's no longer the recommendation when it comes to really improving energy, helping with your brain health. You don't want to go through cancer treatments and always be resting. You really want to continue to move and exercise. I'll even have cancer survivors build some muscle during treatments. It's possible. But I think I want you to know it's not doing everything. If you're not exercising at all, and you're listening to us right now, and you're thinking, okay, I guess tomorrow I'll go out and run five miles. You know, that's not what we're saying. We want you to walk 10 minutes. And if that goes good, let's build on that. So for brain health, it's adding back in the carbs, it's exercising, it's getting a support system to reduce your mental load. Those are the main things. I just see so often cancer survivors cutting out carbs and grains. And that's just something we got to bring back. Beautifully stated. Yeah, I know carbohydrates and specifically glucose is the most important fuel for brain cells. And it really disturbs me to hear, you know, some of these influencers suggesting people start something like the ketogenic diet during cancer therapy or chemotherapy. That just messes up so many things, their energy levels, their calorie intake. And of course, like you said, the fuel for their brain. So I really appreciate that you said carbohydrates. Get them back. Yeah. Keto is not, we don't want to be doing that. Please don't do the keto diet. That's a fad. Absolutely. I have tremendous love and respect for registered dietitian. I'm not just saying that because you're in front of me, but I truly feel that this is your field. You've been trained to do that. Tell us why people need to ask their physicians to speak with a registered dietitian because a lot of even oncologists at some centers, they might not be aware that there is an RD that can speak with their patients about how to eat during their chemotherapy and live a vital life, a cognitively vibrant life. Why is it important for people to ask to speak with a registered dietitian or get a consultation with them? This is why I do what I do. So it is imperative that as soon as you're diagnosed with cancer, even before that, to reach out to a dietitian to make sure you're hitting all the right nutrients to feel your best. Because the whole goal, first off, your cancer center may or may not have a dietitian. So in order for you to have the best treatment outcomes based on all the literature, reduce severity of side effects, improve that brain fog, keep your energy up, preserve lean body mass, meaning hold on to that muscle during treatment, comes from nutrition. Your dietitian will be able to help you or me as your dietitian with the proper nutrition. You do not want to wait until you start losing weight or you start not feeling so great because it's harder to get back those certain nutrients you're missing or that energy back when you've waited. So really, if you want to attend all treatments at full doses, which is exactly what we want because that's how you're going to get clean scans, you want to make sure to be very proactive about nutrition. The goal is not, I'm just going to wing it or eat whatever until I feel bad. Because once you start feeling bad, based on those side effects, it can be hard to regain that energy or that muscle. The goal is you're eating well enough, enough calories and protein, because it's very possible that you are hypermetabolic, meaning you're burning so many more calories just from cancer being present. Your protein sometimes can even double because your body, when you have cancer present and cancer treatment, plus just your day-to-day body running, you need tons of protein. So when you get all these things ahead, you feel like yourself, you don't have a severe side effect, and you can go through cancer treatments and actually feel pretty good. That should be the normal, and it can be with the right nutrition. I don't believe that you're diagnosed with cancer, you're going through treatment, it's all doom and gloom. If you get the right nutrition in, you can get to your treatments and still feel like you and still do your life around those treatments. So yeah, that's just nutrition makes the biggest impact of you just feeling like yourself and attending all treatments. And then I think the other part of it is that the fear. So a very large percentage of cancer survivors actually, they go through cancer treatment, have so many food fears that it creates disordered eating. And that's completely not fair and unexpected by so many survivors. When you talk to me as your dietician, we clear that up so you don't fear the sugars. You don't fear the gluten. You don't have these unnecessary food fears because that's not fair either. And that can linger even after treatments are done. So it's getting ahead of all the fear-monging information out there. So you have a healthy, happy relationship with food as well. I'm grateful for Nicole for that conversation. If you've been through cancer treatment and you're struggling to focus, to remember, or to feel like yourself again, I hope you heard something today that felt true or validating or useful. Chemo brain is real, but it's not forever. And it's not just chemo. It's everything your brain has been carrying from inflammatory changes to insomnia to the trauma of survival during cancer. The science is still evolving. Of course, we need better studies, more inclusive data, and longer follow-up. But what we already know is this, the brain is adaptable, neuroplasticity is possible, and it does respond to support, to physical, emotional, nutritional, and cognitive support. Whether it's Liz finding her footing again after feeling lost or Nicole guiding patients towards nourishment without fear. These stories remind us that recovery isn't linear, but it is very likely. If you're someone experiencing chemo brain, here's a summary of what you need to know. First and foremost, make sure you speak with your physician about it. It may be a condition that is reversible with some blood tests. Ask about checking your vitamin B12, vitamin D, thyroid functions, iron levels, anything that could be adding to the cognitive load. These are all testable and in some cases treatable. Engage in any kind of gentle movement, whether it's walking or just gently moving, tai chi, yoga, pilates, anything that improves your blood flow and supports brain plasticity. Good nutrition is incredibly important and if you have the resources, see if you can get a conversation going with a registered dietician to help you create a program during this important time. But generally speaking, try to consume complex carbohydrates, omega-3 fatty acids, colorful fruits and vegetables that fuel the brain and make sure that it gives it the nutrients it needs at the time of stress. Getting a consistent sleep is very important and if you have insomnia or other sleep issues, please speak with your physician or even a sleep specialist to see what other things you can do to get a good night's sleep. It helps with your memory and the repair process tremendously. Managing stress is so important and you can do that with therapy or mindfulness exercises and it protects the different parts of the brain and improves your focus and attention. And just as important is self-compassion, forgiving yourself, giving yourself some slack during this difficult time. Chemo brain is not a failure. It's your brain doing its best under extreme stress. So you need to be kind to it. We're grateful for our speakers for spending their time and experiences with us. This has been your brain on chemotherapy and I have been your host, Dr. Aisha Sherzai. Thank you so much for listening and I hope that you enjoyed this episode as much as we did. пло