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Optimizing nutrition after breast cancer treatment

Patients should maintain a healthy weight to help ward off recurrence, studies show

By Mindy Athas, Special to The Baltimore Sun

10:43 AM EDT, September 30, 2011

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Many cancer patients end treatment underweight. Post-treatment breast cancer patients, however, often end up overweight. This can sometimes be attributed to medications such as steroids or chemotherapy. Or the patient is overweight to begin with. Losing this weight is a worthy goal as overweight and obese patients have an increased risk for cancer recurrence, studies say, as well as chronic diseases such as heart disease and diabetes.

Find your Body Mass Index, a measure of your weight in kilograms divided by your height in meters squared. If your BMI is normal, check your waist circumference, which highlights abdominal fat, another independent risk factor. If your BMI is greater than 25 and/or your waist circumference is greater than 35 inches (for women), it suggests a need to lower your weight and/or your body fat percentage.

Some studies suggest healthy weight maintenance as the most important goal for breast cancer survivors. Greater stores of adipose tissue (fat cells) and larger fat cell size may increase circulating estrogen in the body, which can stimulate growth of breast tissue. Abdominal fat is also of more concern than fat on the lower body. Aim to shrink your fat cells as best you can with diet and health care provider-approved exercise.

Where to cut back

Start reducing your intake of these foods. Choosing these items less often, substituting healthier versions and cutting back on portion sizes, will help you eat less.

• The World Cancer Research Fund has recently released new information supporting the potential link between intake of red (beef, lamb) and processed meat (bacon, hot dogs) with cancer risk. Hedge your bets and limit intake of these foods, especially nitrite or nitrate-containing meats. Processed foods may be cured, salted, smoked or otherwise preserved chemically. In fact, dietitian Mary Flynn advocates for a plant-based olive oil diet in her book "The Pink Ribbon Diet: A Revolutionary New Weight Loss Plan to Lower Your Breast Cancer Risk."

• Saturated and trans-fats should be avoided. Look for "partially" or "fully hydrogenated oils" on food labels and put those items back on the shelf. Even if the front of the label boasts "No Trans Fat Per Serving," read the fine print on the ingredients. Also limit foods with long ingredient lists. To help decipher the confusing terms, consider a useful phone application such as Chemical Cuisine by the Center for Science in the Public Interest. For basic fat deciphering: http://www.mayoclinic.com/health/fat/NU00262.

•Simple sugars are not just bad for the teeth. Sugar in all its simple forms (sucrose, glucose, fructose, corn syrup) can wreak havoc on the rest of your body too. Carbohydrates convert to glucose in the body for fuel. The more complex the carbohydrate, the slower it will break down, gradually raising blood sugar levels. Simple carbohydrates spike blood glucose levels. Excess blood glucose acts like a bad traffic jam: clogging the blood and impeding flow. The resulting elevated blood insulin may be linked to cancer, diabetes and other inflammatory conditions. Having simple sugars during, rather than between a meal (one with fat, protein and fiber), may buffer this effect. Either way, cut back on added sugars (desserts, candy, soda, sweet drinks) and natural sugars (juice and dried fruit).

• Although moderate alcohol intake is associated with lower cardiovascular risk factors, this benefit may not apply to younger women. Additionally, alcohol may lower folate levels and raise circulating estrogen levels, both of which could increase recurrence risk. Study results are mixed, so limiting alcohol intake may be prudent. Taking folic acid supplements is not warranted, however, so breast cancer survivors should strive to eat more foods naturally rich in folate.

Focus on these foods

•Make an effort to eat a variety of foods and seek locally grown, in-season items. Drink more water and eat at least 25 grams per day of fiber.

•Antioxidants protect cells from damage. Aim for whole foods, not pills. Pick plant foods (fruits, vegetables, grains, nuts), tea (black, green, white), cocoa (dark chocolate), true soy foods (tofu, soymilk, edamame), mushrooms, and olive oil. Watch portions on the high-calorie items. Soy food evidence is mixed, so limit servings to three per day.

•The leaves, stalks, roots, fruits and nuts of plants make them nutrition powerhouses. Add vegetables, fresh herbs and fruits to every meal and snack. Force them into breakfast, tuck them into lunch and make them the center of your dinner plate. If nothing else, make these your go-to items all day long. In this case, more is definitely better.

•Add whole grains and beans to your diet daily. Whole grains are less processed, hearty-textured and filling. Try quinoa, barley, brown rice, millet, oats, amaranth, rye, buckwheat and popcorn. Read food labels for those with the most fiber and the least ingredients. Find breads, cereals and crackers with more than 3 grams of fiber per serving. Watch the portion sizes: Calories do count and it's easy to over-eat tasty grains, which can lead to weight gain.

•Substitute olive oil for your butter and corn oil. Use peanut and other nut or seed butters instead of margarine, but watch the portions. Try avocado on sandwiches, and hummus or guacamole rather than cream-based dips. Omega-3 fatty acids, polyunsaturated fats found in fatty fish, oil and nuts are anti-inflammatory superstars. Add these to your diet daily by means of canned or frozen wild salmon, arctic char and sablefish, canola oil, flaxseeds, walnuts, omega-3-enriched eggs, and fish oil capsules from trusted sources. Be mindful of eating fish contaminated with chemicals or high in mercury. For a safe fish list phone app go to montereybayaquarium.org.

Wrap up

Diet and nutrition are key players in the post-treatment game, but remember to nurture yourself in other ways. Get plenty of rest, sleep in a dark room and have a bedtime routine.

Make sure to get regular physical activity, at least 15 minutes daily, is the newest minimum or aim for four days per week of some exercise.

Also try to avoid chemicals, including smoke, and educate yourself about what's in your environment that can raise cancer recurrence risk.

Every day try to laugh: Find joy in the simple things and spend time in nature. Explore meditation, relaxation therapy, massage, acupuncture, Reiki and guided imagery.

Mindy Athas, RD, CSO, LDN, and outpatient dietitian and nutritionist for the University of Maryland Greenebaum Cancer Center, is a contributor to The Baltimore Sun's fitness blog Exercists (baltimoresun.com/exercists).