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Cancer Nutrition Consortium

Dr. Joel Epstein: “If You Want to Be Interesting – Be Interested”

April 15, 2018

If you subscribe to Dale Carnegie’s aphorism, then Joel Epstein is one of the more interesting people you’re likely to meet. Epstein – whose full title is Joel B. Epstein, DMD, MSD, FRCD(C), FDS RCSE – is, among many other things, a member of the Medical-Dental staff at Cedars-Sinai Medical Center in Los Angeles and a consulting staff member at the City of Hope in Duarte, CA.


While his CV and his multiple degrees are impressive, Epstein has never been motivated by following a pre-ordained career path. Instead, he’s followed his interests and created his own area of specialty. Those interests have led him from Canada to the U.S. and back (with a fellowship from the Royal College of Surgeons in Edinburgh, Scotland thrown in for good measure), and from dentistry to oncology to taste and nutrition science. Along the way, he’s published more than 750 publications.

“I always had difficulty choosing between medicine and dentistry,” Epstein says. “I’m still in the middle.”

PASSIONATELY CURIOUS
While treating oncology patients at Cedars-Sinai and City of Hope, Epstein became interested in finding ways to address a problem faced by most cancer patients during and after treatment: chemotherapy and radiation therapy change taste perception, often radically. Now Epstein is teaming up with the Cancer Nutrition Consortium (CNC) on a new study designed to much more precisely identify and measure the physiological aspects of taste that undergo change during cancer treatment. The study’s goal, Epstein says, is to help nutrition scientists come up with new solutions that will enable cancer patients during and after therapy to enjoy food and get the nutrition they need.

ACCOUNTING FOR TASTE
It’s an area that has been explored for decades, but most studies to date have relied on relatively general and subjective patient questionnaires about taste, which is extremely difficult to quantify.

“Taste is much more complex than we thought,” Epstein says. While it’s generally supposed that there are four or five main taste categories – sweet, sour, bitter, salty and, acknowledged more recently, umami or savory – there’s surprisingly little definitive scientific detail on the exact mechanisms of taste in oncology.

A NEW APPROACH
Epstein’s CNC study will combine a highly-detailed interview process with new methods of chemosensory testing designed to reveal an unprecedented level of detail about the individual elements of taste – and the factors that enhance or negate them. One method recently developed by one of Epstein’s collaborators in the study, Temple University biologist Gregory Smutzer: polymer- based “taste strips” that can be applied to specific sets of taste buds, dissolving on the tongue and releasing targeted taste molecules that pinpoint taste sensitivity and recognition levels.

MOLECULAR ENGINEERING
“It will help us be better at designing products,” Epstein says, allowing food scientists to optimize foods to appeal to patients undergoing specific treatment types and stages of cancer. In addition, he says, “There are a lot of these things we can do through molecular management, like blocking specific taste receptors” through pharmaceutical treatments that adapt patients’ chemoreceptors to counter-act biological changes caused by therapy.

“Many of our treatments damage patients’ salivary glands and other things that contribute to the sensation of taste,” Epstein says. “It’s deeply interesting to be learning exactly how radiation and chemotherapy affect those things.”

And while his cancer patients at Cedars-Sinai, where he makes his rounds, have benefited from his curiosity and expertise for years, soon Epstein’s unique combination of interests could end up significantly improving the daily lives of cancer patients around the world.

Read more on Dr. Epstein and his work with the CNC.