Four Things You Should Know about Getting Back to Healthier Living After Breast Cancer Treatment
by Laurie M. Hatch, MS, RD, CSO
Like so many other breast cancer survivors, Charlene marked her calendar with “One Year of Survivorship” after her recent mammogram and checkup with her oncologist. She celebrated as her oncologist shared with her that she had “no evidence of disease.” Her doctor explained her survivorship care plan, reviewed again how the anti-hormonal drug she was taking works to reduce estrogen levels, and gave her a referral for a bone density test. Charlene was so excited about her good news she forgot to ask the questions she’d prepared about getting back to healthier living after treatment.
Once she left the appointment, questions about what to eat, creeping weight gain, bone thinning caused by her anti-hormonal medication, and her desire to return to exercise kept bubbling up. Plus, she was hounded daily with advice from friends, family, coworkers, and social media about what to eat to fight cancer, the complications of exercise after cancer treatment, and how to lose weight. She didn’t know what or who to believe. Although she was fully in survivor mode, Charlene was still scared and anxious for answers to her questions.
For Charlene and the 250,000 other women who are diagnosed with breast cancer each year, questions about their post-cancer health often go unanswered or – worse – are met with flawed guidance. Additionally, many breast cancer survivors approach developing a healthier lifestyle after cancer as a total renovation when just a little touch-up is more than enough.
No single food or food group fights cancer. However, adopting a plant-based, anti-inflammatory eating style is using food as medicine in its purest sense.
After more than 20 years as a dietitian and as a breast cancer survivor myself, I recognize the significance of getting answers to these questions. I also understand the desire to use a hammer to rebuild health when a feather to nudge the way toward healthier living is more than enough. Here, I want to address four of the most common healthy lifestyle concerns people have after being treated for breast cancer.
What should I eat to help me avoid a recurrence of breast cancer?
Charlene, from the example above, knew her diet was lacking. She had heard about the anti-inflammatory diet, but details about what it entailed were hard to pin down. The anti-inflammatory diet is not actually a diet but rather a collection of eating patterns that embrace
- Eating plant-based meals with fewer animal proteins
- Reducing refined sugars and grains
- Emphasizing fruits and vegetables
- Balancing the types of oils you use
- Limiting or avoiding alcohol
No single food or food group fights cancer. However, adopting a plant-based, anti-inflammatory eating style (like the Mediterranean diet) is using food as medicine in its purest sense. Eating a variety of fruits and vegetables, healthy fats, fewer sugars and processed refined grains, as well as more plant proteins and limited or no alcohol adds up to a solid approach to better health and potentially lower risk of cancer recurrence.
If you have no physical limitations or side effects that are keeping you from becoming active and you have the all-clear from your doctor, try a gradual increase in lower-level movement, like walking, gardening, cleaning house, dancing, or water walking.
I know I need to lose weight, but I become overwhelmed thinking about it. What can I do?
After treatment ended, Charlene got a wakeup call: she had gained ten pounds over the last year, and she was already overweight before her diagnosis. She had read that being overweight may increase her risk for additional cancers and other weight-related diseases. Also, with an estrogen-positive breast cancer, extra weight can put survivors like her at higher risk for a recurrence.
Many breast cancer survivors feel overwhelmed about weight gain after treatment and don’t know where to begin. Setting a small goal is often what is needed to give you a jumpstart toward healthy weight loss. What’s more, recent research suggests that a modest weight loss of six to ten percent of your total body weight effectively lowers your risk for cancer recurrence, as well as other diseases. With a plant-based eating plan and a commitment to making small, measurable, realistic food choice changes and adding more movement to your daily routine, this amount of weight loss is attainable for most people. However, before beginning a weight loss plan, breast cancer survivors need to have fully recuperated from treatment and must first check with their doctor.
My doctor told me that I’m likely to experience bone loss while taking my anti-hormonal medication, but I don’t know which foods have calcium in them or if I need a calcium supplement. Can you help?
After her bone density test, Charlene’s doctor let her know she had a slight loss of bone density, but nothing to worry about for now. Still, her mind drifted to what to do to prevent further bone loss since her doctor explained to her that she would be taking an anti-hormonal drug for years.
Women ages 51 to 70 should aim to get the recommended 1200 milligrams of calcium each day. That is roughly three daily servings of dairy foods. As a breast cancer survivor, you must pay careful attention to your bone health, particularly if you are taking an aromatase inhibitor, which is an anti-hormonal medication. Sounds simple, but many women don’t get three daily servings of calcium-containing foods, especially when trying to reduce calories.
To meet calcium requirements for bone health, try to aim for two servings of a dairy-containing drink or calcium-fortified orange juice for 600 milligrams, and then count your well-balanced plant-based diet as another 300 milligrams. This adds up to 900 milligrams of calcium daily. That means you only need another 300 milligrams each day to meet the recommended 1200 milligrams. This can come from food or from a supplement. However, you should check with your doctor before you add a calcium supplement, as taking a supplement if you do not need to take one is not recommended.
I have fallen behind on my exercise routine over the last few years, and I don’t know how to get started again safely. Do you have any tips?
Charlene let her gym membership lapse during cancer treatment. Besides, she often feels too tired to go to the gym anyway. And she’s not alone. Side effects like fatigue, numbness in feet and hands, shoulder and arm tightness, and lymphedema are common hurdles that prevent many women with breast cancer from leading a more active lifestyle.
A safe place to begin when it comes to increasing your physical activity is to get a doctor’s referral to a physical therapist or cancer exercise trainer. These professionals are familiar with the issues cancer survivors face in getting back to exercise safely after surgery, chemotherapy, or radiation. A cancer exercise trainer has specialized knowledge about how cancer treatments and their side effects, like lymphedema and neuropathy, increase risks for injuries and other challenges. They will work with you to create an individualized physical movement plan that is tailored to your lingering side effects and specific challenges. Moreover, professional guidance is critical if you have neuropathy (numbness) in your feet or hands or other physical challenges that make movement difficult.
As a breast cancer survivor, you must pay careful attention to your bone health, particularly if you are taking an aromatase inhibitor, which is an anti-hormonal medication.
If you have no physical limitations or side effects that are keeping you from becoming active and you have the all-clear from your doctor, try a gradual increase in lower-level movement, like walking, gardening, cleaning house, dancing, or water walking. Start with short bouts of activity (like five to ten minutes) up to three times a day until you are able to handle the recommended 150 minutes of physical activity each week. From there, you can gradually add resistance exercises to help build muscle mass and bone density.
Even just a little exercise is far better than nothing, and research shows that exercise plays a significant role in supporting the health of cancer survivors. With side effects, some breast cancer survivors struggle to find physical activities that are safe and comfortable. The key is to find something you enjoy – or at least can tolerate – and stick with it.
A Final Word
Women like Charlene want to know what they can do to thrive as survivors. Maybe you see yourself in her story. Research shows that a healthful, plant-based diet plus increased physical activity adds up to a powerful one-two punch against cancer. Together, healthy food and safe exercise are strong medicine!
Laurie Hatch is a registered dietitian who has been working with people treated for cancer for nearly two decades. She is also the owner of Food Is Medicine RD (foodismedicinerd.com). As both a cancer dietitian and breast cancer survivor, she has written a textbook and journal, In the Pink: A Breast Cancer Survivor’s Guide to a Healthier Life, which will be released this year. Her passion is enhancing the lives of other survivors by introducing them to using food as medicine, reaching a healthier weight, and moving more and sitting less. She lives with her husband in Denver, CO. You can find her on Facebook, @lauriehatch, and Instagram, @foodismedicinerd_cancer.
ACTION! For personalized guidance, find a registered dietitian in your area. A nutrition professional can deliver the answers to your most pressing food and nutrition questions, create a plan designed just for your survivorship years, and set you up for greater success. You can search for registered dietitians near you at eatright.org/find-a-nutrition-expert.
This article was published in Coping® with Cancer magazine, Fall 2023.