Metastatic breast cancer and diet: eating well after diagnosis

It can be overwhelming to face a metastatic breast cancer diagnosis. The good news is that it doesn’t have to be complicated to figure out a healthy diet that helps you feel good.

When Brenda Levin of Philadelphia was diagnosed with metastatic (stage IV) breast cancer in 2017 at age 40, she read every article she could find about the effect of diet on cancer.

She wanted to make sense of how she, someone who followed a healthy diet and lifestyle, could end up with breast cancer. More important, she wanted to know what diet she should follow to keep the breast cancer from growing.

As a trained practitioner of acupuncture, Chinese herbal medicine, integrative nutrition, and shiatsu massage, Brenda thought she was prepared for whatever life threw at her. But her diagnosis made her rethink what she learned, particularly about food. Should she swear off sugar? Avoid alcohol and caffeine? Never eat her favorite treats again?

“I was at a healthy weight with a healthy diet,” says Brenda. “I have always exercised. … Plus, I have always focused on getting ample amounts of vegetables, protein, a good balance of carbohydrates, some fruits, and healthy fats into my daily food regimen.”

Brenda’s research showed her two important things. First, she had done nothing wrong to get cancer. Second, there are no magical foods that make cancer disappear. Since then, she has focused on eating a variety of fresh foods, cooking with healthy oils (examples: olive and canola oils) and allowing herself an occasional glass of wine or ice cream.

“I tell myself not to overthink or stress about anything,” she says. “If I am going to eat a chocolate croissant, I am going to enjoy every morsel of it, stress-free.”

There is no perfect diet

Some people might find it reassuring to be handed a special cancer diet: a firm list of what foods to eat and not eat after a cancer diagnosis. But nutritionists say there is no such thing as a fool-proof, cancer-busting diet, despite many popular claims that people with cancer should absolutely avoid refined sugar, alcohol, and other “forbidden foods” that frequently pop up in a Google search.

Instead, nutritionists advocate for a well-balanced diet rich in vegetables and fruits that satisfy the senses and serve up healthy nutrients. That approach can also help avoid excessive weight gain, which research has linked to certain kinds of cancer.

“While there are absolutely so many things you can do with your everyday diet to help support your immune system and help support your body, we want to get away from the mindset that there is one prescriptive diet that everyone should follow,” says Stacy Kennedy, MPH, RD, LDN, CSO, co-founder and director of nutrition at Wellness Guides Personalized Nutrition & Fitness Coaching, in Boston.

Ms. Kennedy likes the dietary recommendations for cancer prevention and survivorship outlined by the American Institute for Cancer Research, which call for “a diet rich in whole grains, vegetables, fruits, and beans.” The AICR also offers information about specific foods that may help reduce the risk of many cancers, as well as foods to restrict. She generally advises people to follow a Mediterranean-style diet, which features a lot of plant-based foods (fruits and vegetables), whole grains (such as whole wheat, quinoa, and oatmeal), legumes (such as peas, beans, lentils, and chickpeas) and nuts.

What About Soy?

The question of soy often comes up in relation to breast cancer. Some people worry because soy contains substances that make it similar to the hormone estrogen, and estrogen encourages some breast cancers to grow. But there are research findings that suggest soy may be protective for the body.

“According to research, eating natural foods that have soy is perfectly healthy and does not carry a risk,” Ms. Kennedy says. Tofu is one example. Others are soybeans or soy nuts, soymilk, and edamame (immature soybeans). Until more research is conducted, she advises against eating or drinking products with concentrated soy or soy protein isolates (heavily processed soy), which can be found in protein powders and some protein bars or meat-free products such as meatless burgers, vegetarian chicken, or “meat alternative.” Read product ingredient lists carefully to see if they contain soy protein isolate, Ms. Kennedy says.

Learning to Balance Your Plate

People with cancer are often motivated to make dietary changes, but Ms. Kennedy says it’s important to stay balanced.

“You don’t always have to eat salads and grilled fish,” she says. “In real life, you are going to a barbecue or a graduation party or the beach and at times you’re going to eat foods that appear to be ‘off plan.’ In reality, that’s what healthy eating and balance is all about: trying to keep nutrition in the big picture of your overall wellness.”

Gwen Ryan, 58, of Gloucester, Massachusetts, was first diagnosed with early-stage breast cancer in 2014 and now has metastatic breast cancer.

“Like most people, I was bombarded with information from well-meaning friends and I also surfed the internet on what to eat and what not to eat,” Gwen says. “I remember one day thinking, ‘I can’t eat anything.’”

She was grateful when a social worker at Dana-Farber Cancer Institute in Boston, where she gets her medical care, told her about a new program designed to promote weight loss and healthier eating. At the first session, the instructor made it clear that “there is no ‘No List.’”

“I learned what a healthy plate should look like. One half should be colorful vegetables; the other half was split between a deck of cards worth of protein, healthy grains and carbs, and a little fat,” she says.

She said the program, which included using a Fitbit activity tracker and a food tracking app, dispelled the myth that sugar equals cancer. It instead urged moderation and mindfulness in choosing and eating food. She learned to stop eating when she felt full.

“I learned that if you are going to have the ice cream, make sure you really enjoy it. Check in with yourself after a few bites to be sure you still enjoy it. If not, put it down or share,” Gwen says. Since starting the program, she has lost 40 pounds. She’s not sure that losing weight and improving her diet will change the course of her breast cancer, but she feels more upbeat and has energy to go to the gym.

“Now I’m not living scan to scan, but I’m living between scans,” she says.

Research on diet and cancer can be hard to interpret because of the way studies are designed. Often, they are observational, which means they look at health outcomes in large populations as they take place. This is different than studies of new medicines, which are carefully controlled and compare one treatment to another. The result is that researchers can’t establish a direct cause and effect with cancer and diet, but they can see patterns called associations. Associations that emerge from research can make a convincing case for following some key principles.

Abby Wetzel, MS, RD, LDN, a dietitian at Abramson Cancer Center in Philadelphia, says she urges people with breast cancer to make food choices that mirror the Mediterranean diet because research suggests it can help “reduce your risk of cancer occurrence or recurrence.”

Ms. Wetzel counsels people to include protein with every meal, whether fish, chicken, nut butters, beans, or legumes. She steers them away from white starches, including sugary box cakes, cookies, white pasta, and white bread. Cutting back on processed sugar can help prevent insulin swings and may limit inflammation in the body, which research has linked to cancer.

“A lot of research shows that it is sugar’s relationship to higher insulin levels and related growth factors that may influence cancer cell growth the most,” Ms. Wetzel says. “Many types of cancer cells have plenty of insulin receptors, making them respond more than normal cells to insulin’s ability to promote growth.”

A rule of thumb is to make your plate as colorful as possible. More colorful foods and fewer white foods mean eating less sugar

“It is important to choose the correct carbohydrate foods, such as vegetables and fruit, to add more nutritional value to your overall diet,” Ms. Wetzel says. “The more color you add to your meals, the better you are going to feel.”

Eat Better to Feel Better

Lynne Richmond, 55, a public relations professional in Washington, D.C., met with a nutritional counselor after she was diagnosed with stage III breast cancer 2 years ago. At first, they focused on strategies to help with chemotherapy side effects, but now that she is in what she calls “survivor mode,” her focus is on eating healthy for life.

“I didn’t think there was a magic fix. But I thought eating better could give me a better chance of survival than if I didn’t do anything,” Lynne says. The plan includes staying away from packaged foods, carbs, and sugary desserts as much as possible, and she tries to skip the alcohol, too. She likes leafy greens such as spinach and kale, and blueberries and other fruits that are high in antioxidants.

For Sheryl Greene, 51, of Roanoke, Virginia, a 2012 stage II breast cancer diagnosis led to a change in shopping habits. She reflected on what she ate, helped by nutritional counseling she received as part of her cancer care. She realized that she ate a lot of canned foods and not enough foods she prepared herself. High-fructose corn syrup, a refined sugar, was in many of her packaged food choices.

Now Sheryl shops almost entirely on the perimeter of the grocery store, where fresh foods are, and avoids the middle aisles. She also likes farmers markets and looks for food marked organic.

“There is always some study that will contradict the previous study,” says Sheryl, who works in sales. “At some point you have to just decide, ‘What is it that I am going to stick with?’”

Sheryl hasn’t gotten used to the unwanted food advice from people who know her cancer history. Some make comments about what she should and should not eat.

She prefers to view her food choices in a positive light. “I can have it, but I choose not to,” she says.

Lesley Glenn, of Central Point, Oregon, was diagnosed with metastatic breast cancer in 2013 after an earlier stage IIB diagnosis. “I have hormone receptor-positive invasive ductal carcinoma, and have been on an aromatase inhibitor for the past 3.5 years. As many of my HR+ peers can attest, one of the first signs that estrogen is being depleted from your body is the weight gain.” In one year, Lesley gained 20 pounds.

“I knew that I wanted to make a more concerted effort to fill my body with things that made me feel good. My energy and stamina became very important to me,” she says.

Lesley tried a vegan diet for 6 months. “Yes, I felt good, and lost a bunch of weight, BUT I missed the foods that I loved and that are a big part of my culture and who I am…Plus being 100% vegan was hard work, at least for me.”

These days, Lesley reports, “You could probably say that I am on the plant-based, pescatarian, Mediterranean-with-an-occasional-piece-of-bacon diet…I believe that your body will tell you what you need as you eat more consciously.”

You can read more about Lesley’s experience in her blog, To Eat or Not to Eat?

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