Nutrition and Breast Cancer
Before her breast cancer diagnosis, Kimberley Jennings, 50, of Richmond, Virginia, ate healthfully. She was diagnosed with stage II breast cancer in August 2014. She had chemotherapy, a bilateral, or double, mastectomy, more chemotherapy, targeted therapy and then radiation therapy.
“Boy, did my taste change,” says Kimberley. “I had plenty of appetite, but nothing tasted good.” Only salty and greasy foods had flavor. Potato chips and fast food were her go-to meals after treatment sessions. She gained 15 pounds.
“I was not prepared for weight gain by any means,” Kimberley says.
Why Weight Gain?
It’s not uncommon for people with breast cancer to gain weight during treatment, rather than lose it. Suzanne Dixon, MPH, MS, RD, registered dietitian and epidemiologist, says your metabolism — the processes the body uses to maintain life, including how it breaks down food for energy, maintenance and repair — can slow down, causing weight gain. And, slower metabolism and weight gain can be a direct side effect of some cancer treatments. If this is true for you, losing weight can be
Christine Zoumas, MS, RD, director of the healthy eating program at the University of California — San Diego Moores Cancer Center, says weight gain also may be a result of being less active or not active at all during treatment. Side effects like fatigue or anemia may make you feel too tired to go to the gym or carefully shop for food. Nausea, diarrhea and pain can make eating or working out difficult.
The cancer, its treatments and how you feel each day can impact what you eat. Some people overeat while in treatment, says Ms. Zoumas, out of a fear of the extreme weight loss many people associate with cancer.
It’s OK to worry about your weight while you’re dealing with cancer. But remember that your first priority should be getting the treatment you need.
“Treatment may not be the time to focus on weight loss, but if weight gain is approaching or exceeding a BMI [body mass index] of 25, your doctor or nutritionist might recommend a change in diet,” Ms. Zoumas says.
BMI is a way to measure whether a person is a healthy weight for their height. A high BMI can mean a person is carrying too much body fat. For example, a BMI of 27 is considered to be overweight, while a BMI under 18 is considered underweight. A BMI between 20 and 25 is considered a normal weight. Ms. Zoumas says many people she sees have a BMI of over 25.
Eileen Z. Fuentes, 41, of Hasbrouck Heights, New Jersey, tried many popular diets before her diagnosis. Frozen low-calorie meals and 100 calorie snack packs were standard.
“It wasn’t until I got sick that I started looking at health-supportive foods,” Eileen says. She found a book, Anticancer: A New Way of Life (Penguin Publishing Group, 2009), that inspired her. She started to follow a vegan diet.
Unlike Kimberley, Eileen experienced weight loss during treatment. Chemotherapy left her with no appetite, nosebleeds, and she often vomited. “I associated food with fear because I was throwing up so much,” Eileen says.
Finding a Healthy Diet
Ms. Dixon cautions that people can get hung up on the particulars of some diets and miss the larger point: health.
Ms. Zoumas agrees. “Somebody can look at tomato sauce and be panicked that the sugar [in it] is going to cause cancer, and they shouldn’t have the tomato sauce. The bottom line is: sugar does not cause cancer and the tomato sauce actually contains lycopene [a natural chemical], and other nutrients that may be beneficial to people with cancer.”
Your diet may be led by your treatments and the side effects you experience. For example, if you have metastatic breast cancer your diet may aim to ease vomiting, fatigue, or nausea because your treatment — and its side effects — is ongoing.
Overall, a plant-based diet is often recommended for people with cancer, as long as you are not having symptoms or side effects that make it hard to eat well and maintain a healthy weight. Being overweight or obese is common in the United States, and people with cancer face this issue, too. Many plant-based foods are lower calorie, making them ideal for people struggling with weight gain.
But if symptoms or side effects make it hard for you to eat or upset your stomach, plant foods may not be right for you. They can be tough to chew and hard to digest. Foods that are higher in calories and protein may help you meet your nutrition needs while you’re coping with treatment.
Carotenoids, the pigments in plants that make vegetables red, yellow and orange, have antioxidants and other health properties that may lower cancer risk and possibly lower risk of recurrence. Cruciferous vegetables such as kale and broccoli contain a natural chemical called glucosinolate that may have anti-cancer properties. More research is needed to know whether eating these foods helps slow tumor growth or kill a cancer cell.
Research shows, Ms. Dixon says, the type of diet a woman adopts after breast cancer appears to affect the risk of recurrence. Maintaining a healthy body weight, which often comes from eating a well-balanced diet, goes a long way toward keeping people healthy after being diagnosed with cancer.
What You Can Do
Fruits and vegetables are the foundation of a healthy, plant-based diet. Both contain fiber, vitamins and minerals.
Ms. Dixon and Ms. Zoumas recommend you avoid or limit:
- processed foods
- red and processed meat
- added sugars and fats
“I won’t sugar-coat it. It’s difficult,” Ms. Dixon says. “It’s completely normal to find it challenging… Weight management is very challenging under any circumstances, let alone when you’re going through breast cancer treatment.”
Changes in taste caused by chemotherapy can affect how water tastes to you, making dehydration possible. Stacy Kennedy, MPH, RD, CSO, LDN, senior clinical nutritionist at Dana-Farber Cancer Institute and Brigham and Women’s Hospital in Boston, suggests squeezing lemon or adding mint, basil, cucumber, melon, berries or other fruits and fresh herbs into water. This “infused water” may taste better than plain water, and can add nutrients. Soups and smoothies can help, too. Getting enough fluids can relieve constipation, fatigue and sometimes, changes in taste.
Ms. Zoumas suggests some flexibility. If one burger is going to make you happy and help keep you on an overall healthy diet, go for it. Or, you may prefer dramatic diet changes. Ms. Dixon says if it’s a shift towards a healthier diet, that’s alright, too, but making gradual changes works well for many people.
If you’re losing too much weight or finding it hard to eat, Ms. Kennedy suggests instead of eating more at each meal, try a small, well-balanced plate. She suggests using a guide like the Harvard School of Public Health’s Healthy Eating Plate.
“There are options for everyone,” Ms. Kennedy says. “You can take it anywhere: [use it] at home, dining out, at a party.”
Talk with your oncologist before dramatically changing your eating habits. He or she will be able to ensure you don’t make any changes that may make treatment harder to tolerate.
Eileen was raised on homemade Dominican meals cooked by her mother and grandmother. After diagnosis, her mother-in-law cooked for her, creating Dominican cuisine from scratch. Eileen later combined fresh ingredients like kale, turmeric and other foods with the dishes she grew up eating.
“For once, it felt like I was eating real food again,” Eileen says. “I was sleeping better. I felt better. I looked better. It was a huge transformation.”
Today, Eileen works at the Columbia University Medical Center’s Herbert Irving Comprehensive Cancer Center in New York as a clinical coordinator. Her job includes empowering those with breast and gynecologic cancers to navigate their care and improve their lifestyle. She says to achieve ideal health we should look to our ancestors. She makes it her mission to teach others how to shop for and prepare good food that takes into account their ethnic background.
Kimberley made small, gradual changes to her eating. First she stopped drinking soda, then stopped using artificial sweeteners a few months later, and so on. She encourages this slower pace to make the change less jarring.
Kimberley finished traditional chemotherapy in July 2015, but continues with targeted therapy. Targeted therapy is scheduled to end in March 2016.
While chemotherapy made healthy foods taste worse, she’s found that fresh foods are more edible since she’s been on the targeted therapy. Switching to a healthier diet does take effort though: she makes sure everything she buys has four or fewer ingredients, to make sure nothing is too highly processed.
Since making the change, Kimberley has no sugar cravings and doesn’t snack or feel fatigued. For breakfast, she has homemade yogurt, grains and fruit. For lunch, a salad with seasonal fruits, nuts, seeds and protein. Seafood and beans replace red meat. Dark chocolate may sneak in. Dinner is usually like lunch. She wants to follow this diet for the rest of her life.
“I’m back at my pre-cancer weight and feeling quite well,” she says.
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