“What We Can Learn About Breast Cancer & Diet From the Women’s Health Initiative”

* Photos originally accompanying the initial publishing of this post have been removed to honor the request of the presenters of this session. *

You would be forgiven if you think the Women’s Health Initiative (WHI) is a vehicle for women to initiate action and take good care of themselves. You would also be forgiven if you’ve never even heard of the Women’s Health Initiative.

Sitting down with a friend over a steaming cup of coffee to discuss the outcomes and nuances of WHI is not an everyday occurrence for the lay public, but it’s exactly the lay public, specifically the FEMALE portion, that the WHI works to impact.

The Women’s Health Initiative is a multi-million dollar, 20+ year national health study focusing on the prevention of heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. In older women, regardless of race and socioeconomic background, these chronic diseases are the major causes of death, disability and frailty. (1)

This robust study was one of the most definitive, far-reaching clinical trials of postmenopausal women’s health ever undertaken in the U.S., and will continue into the future to provide practical information to inform women and their physicians.

The Observational Study portion continues to examine the relationship between lifestyle, health and risk factors and specific disease outcomes, and involves tracking the medical history and health habits of 93,676 women. 

Every aspect of the study yields fascinating outcomes for improving health, yet as you may have guessed, I’m most interested in the Dietary Modification component, an evaluation of the effect of diet, specifically a low-fat, high fruit, vegetable and grain diet, on the prevention of breast and colorectal cancers and coronary heart disease.

I recently attended the Academy of Nutrition and Dietetics annual Food & Nutrition Conference (FNCE) where three dietitians knee-deep in the WHI research presented on this topic; Dr. Marian Neuhouser and Dr. Lesley Tinker from Fred Hutchinson Cancer Cancer Research Center in Seattle, WA (the WHI Clinical Coordinating Center for data collection, management, and analysis), and Dr. Linda Van Horn from Northwestern University Feinberg School of Medicine in Chicago, IL.

Because this research continues to evolve and yield new findings, it was no small undertaking to distill volumes of information into an insightful overview and actionable directives we can use NOW , but these esteemed speakers did not disappoint. Below, I share the main take-home messages:

Insight Into Why Specific Diet Protocols Don’t Yet Exist


Cancer cells are wily; able to successfully evade our immune system’s efforts to destroy them, replicate themselves many times over, invade and metastasize to other areas of the body, build new blood supply’s, and resist cell death. Determining the EXACT way that food, dietary patterns and nutrition can outsmart and confer protection against a cancer cell’s innate arsenal remains elusive – yet researchers are making progress.

Nutrition, Diet and Its Impact on Cancer Initiation


We aren’t there yet – true prevention, that is. While I dream of a world where prevention rules, until that time comes I use the term “risk reduction.” Still, findings exist that link diet and nutrition to a positive impact on the cancer disease process at several points, specifically: DNA repair, cellular proliferation, differentiation, the cell cycle and apoptosis (cell death). How does diet do that, you ask?

Per Dr. Neuhouser, who graciously responded to my email request for answers to that question (my notes were sketchy!), “These mechanisms are influenced by nutrients – primarily micronutrients – that act as co-factors of enzymes that up-regulate or down-regulate these pathways. Energy intake also plays a role, because macronutrient intake leads to insulin secretion, and hyper insulin secretion up-regulates the cell proliferation pathways.”

Here’s a translation:

Micronutrients are nutrients in food that the body needs in small amounts; vitamins and minerals, whereas macronutrients are foods required in large amounts; carbohydrate, protein, fat (and water and fiber.) Micronutrients (i.e. vitamins E, C, D, A and minerals like calcium, potassium and phosphorus) act like “helpers” (co-factors) to make other processes happen in the body, and macronutrients supply calories (making up our “energy intake”) to fuel the body. It’s the action of these micro and macronutrients – too much or too little micronutrients and/or calorie intake – in “regulating” certain pathways that help tame or spur on cancer cells in their proliferation or differentiation, support cells in their repair efforts, or encourage cell death.

Having the ability to one day share with patients/clients specific foods that turn cancer cells on or off, knowing how much to eat for targeted results, providing meal timing guidelines, and micro and macronutrient distribution for each individual’s specific breast cancer would be a game changer. Personalized nutrition protocols such as this would make a significant difference in healing, treatment outcomes, risk reduction, and dare I say, even PREVENTION!

What We DO Know

  • Being overweight or obese is linked to nearly every common cancer in both men AND women.
  • Lifestyle factors, exercise AND diet are responsible for ~30% of all cancers.
  • A better diet is associated with lower risk of cancer deaths, which held true for all women in this study EXCEPT for those who started with a body mass index (BMI)  >30.
  • There appears to be an interrelationship between pre-diabetes and diabetes as risk factors for breast cancer, with obesity a contender as the link.
  • We may see some differences in outcomes between the different types of breast cancer (there are many) and diet.
  • Women who ate a high-fat diet at the start of the study (which was reduced during the study through intervention) showed greater reduction in breast cancer risk (possibly connected to weight loss.)
  • Over the long term, postmenopausal women who followed a diet consistent with the American Cancer Society guidelines on nutrition and other healthy diet indicators (i.e. American Institute for Cancer Research) had significantly lower breast cancer risk and mortality.
  • Breast cancer takes years to develop; a healthy diet should be maintained long-term for the maximum health benefit.


Putting It Into PRACTICE

As I see it, the challenge for most women in effectively and consistently using the ACS nutrition guidelines lies in only being told WHAT to do, but not HOW to do it. Below are the “whats”, and I’ve added a few “how-tos” to help make this work for you:

6 American Cancer Society Guidelines on Nutrition

  • Eat a healthy diet, with an emphasis on plant foods. 
      • ⅔ of plate filled with vegetables.
      • Eat a vegetable and/or fruit with each meal/snack.
  • Choose foods and drinks in amounts that help you get to and maintain a healthy weight.
      • Serve meals at home on 9 inch plates; have seconds if you’re still hungry (are you REALLY?), yet refill plate only 50%.
      • Take ⅔ of restaurant meals home as leftovers.
      • Order smallest size available for beverages containing calories.
  • Limit how much processed meat and red meat you eat.
      • ≤ 18 ounces/week.
  • Eat at least 2 1/2 cups of vegetables and fruits each day.
      • Not sure how much that is? Use measuring cups to train your eye, or visualize 2 ½ fists full.
  • Choose whole grains instead of refined grain products.
      • Whole wheat pasta and flour.
      • Brown rice.
      • Quinoa, amaranth, whole grain (vs. pearled) barley, millet.
  • If you drink alcohol, limit your intake.
    • No more than 1 standard drink (defined below) per day for women or 2 per day for men:
      • 12 ounces of regular beer
      • 5 ounces of wine
      • 1.5 ounces of distilled spirits
    • A standard drink contains 14 grams of PURE alcohol (the true culprit behind the cancer connection, which has nothing to do with the VOLUME in your glass.) (2)
    • For breast cancer, there is NO safe limit for alcohol.

If you want more nutrition and breast cancer information and updates on programs and services, shoot me an email at cathy@cathyleman.com.

I’ll subscribe you to my weekly newsletter, and as a thank you, send along my “25 Ways To Strike Back At Breast Cancer.”

You can follow me here. . .

Twitter: @cathylemanrd

Facebook: https://www.facebook.com/eatwellgetstrong/

Easy. Peasy. 


  1.  “The Women’s Health Initiative” 
  2. “The National Institutes of Health | The National Institute on Alcohol Abuse and Alcoholism”


“Food & Nutrition Conference (FNCE) 2017 Snappy & Quick Recap”

100th anniversary for the academy; 20th anniversary for me!

When you celebrate a milestone anniversary, throw a bash, and 13,000 people show up?

It could end up messy, chaotic, and jumbled, or, as was the case for the Academy of Nutrition and Dietetics 100th anniversary celebration, a rousing success.

Sure, there was some grumbling – you simply can’t shuttle bus 13,000 people between McCormick Place and beyond for 3.5 days straight without long lines and extended wait times – and that was only for the women’s bathroom (a hazard of belonging to a predominantly female profession!)

But then again, some people are NEVER happy. I wasn’t one of them.

I’ve just returned from my profession’s annual food and nutrition conference and exhibition (FNCE) held October 21-24. My brain is stuffed full of new information, and my heart overflows with gratitude and love for not only what I do, but the amazing people I get to do it with; my colleagues.

I got to hang out with a group of the most dedicated healthcare professionals and caring friends I know – from literally every corner of the United States and beyond. Regardless of our individual areas of practice – sports, women’s health, pediatric or oncology nutrition – soaking up the latest nutrition science from cutting edge researchers, physicians and other professionals while sitting shoulder to shoulder with our nutrition besties literally had all of us a little giddy.

Except those complainers ;).

Below are a few highlights of the event, and in the coming weeks share blog posts that dig deeper into the four hottest presentations I attended:

  1. The Women’s Health Initiative: Two Decades of Knowledge Ready for Dissemination
  2. The Evidence: Intermittent Fasting Effects on Cardiometabolic Disease and Cancer
  3. Cancer Survivorship Lifestyle Guidelines: Time for Action
  4. Nutrigenomics: Is It Ready for Prime Time?


While I didn’t get to spend a lot of time at the exhibits, here’s what I saw trending: 

  • Foods you can eat on the run – everything seemed to be packaged to take with you.
Power Bar w/a Savory Item
  • Foods that are already prepared; just heat and eat, rip open and eat, or squeeze and eat.
Bagged and plastic bowl’d ready-to-eat salads were plentiful.

  • Bars are going NOWHERE. Whether meal replacement, snack, protein or granola – packaged food bars show no signs of slowing down.
If I have to eat a bar that I didn’t make in my kitchen – this is one of my favs!
Have to send a shout-out to this bar, created by local Glen Ellyn guys who (very) recently sold the company to Kellogg – for enough $$ to buy 10 lifetimes of bars. Company still headquartered in Chicago!
  •  An obvious focus on what’s NOT in your food vs what is, and a reminder that this product really is REAL food. Ok.

  • Superfoods, superfruits, etc. were just – everywhere.

And finally, what would a nutrition and food conference be without an actual cranberry bog. Yes, this really happened. Don the waders and boots and climb in to slosh through the bog. . .I didn’t.


“Introducing. . .Breast Cancer PREHAB.”

It was time to cry uncle.

Over the long Labor Day weekend I was not physically idle for a second (sleeping doesn’t count), and neither was my mind.

I’d been chewing on an issue that just wouldn’t leave me alone – the question of how to wrap my mind around all of the scientific information on breast cancer nutrition, fitness and lifestyle, package it up neatly, and present it to women who need it most in a timely, orderly, succinct yet engaging, ongoing message of love, support and inspiration. You’d think that would be fairly simple to accomplish, yes?

Ambitious, yes. Simple, no.

While writing my weekly blog over the last few months, sifting through topics relevant to the breast cancer community and working to develop content for my “still-in-progress-new-website”, one thing became excruciatingly clear. All of that scientific information is exciting and relevant, yet the sheer volume is enough to overwhelm, stymie forward motion, and bury me alive.

So what to do?

Well, go to the Morton Arboretum and run laps, of course. It was Saturday morning, and somewhere around the third mile I had the aha moment I’d been searching for.  


That was it. Breast cancer PREHAB.

Shortly after my diagnosis I read this exact article in CURE magazine and remember thinking, “THIS. RIGHT. HERE. This is what women need to know about and take action on. This will help them.”

I also recalled the two most common challenges shared by the 140 survivors I surveyed on breast cancer and nutrition; and they both occur at the time of diagnosis:

  1. “I want to know what I should be eating and how I should change my diet, but I don’t know who to trust. Online sources give conflicting information, and my doctor said: a) nutrition doesn’t matter, b) you can eat anything you want,             c) he/she doesn’t know enough about nutrition to help me.”
  2. “What should I eat (or not) to reduce my risk of recurrence.”

My survey asked nutrition questions only, yet in the time since gathering that feedback I’ve had multiple exchanges with members of the breast cancer community about exercise and fitness; specifically, how best to use physical activity to improve treatment outcomes and yes, that hot topic. . .reduce risk of recurrence.

So there you have the eureka moment those running endorphins churned up for me;  focusing my efforts and work on the PREHAB space, an area of breast (and other) cancer interest currently in its infancy, yet steadily gaining ground.

So What Is Breast Cancer Prehab?

The idea of prehab as a proactive approach to avoid pain and injury is a familiar concept in the world of physical therapy, not yet so much in the breast cancer world, which makes education on what prehab is, its value and benefit, and what can be gained from taking action at the time of diagnosis imperative. Breast cancer prehab isn’t so much about avoiding pain and injury, but more about building physical resilience and strength to better withstand the rigorous demands on the body (and mind) of breast cancer treatment; surgery, chemotherapy and radiation are all trauma to the body, so the concept of prehab posits that the more resilient one is going in, the better the outcome.

While “prehab” may conjure up only a physical component, nutritional counseling and education, and even psychological support have also shown to contribute to positive outcomes.

Another thing I love about breast cancer prehab is that the concepts translate far beyond the time of a diagnosis to support a reduction in risk of recurrence, survivorship, or living with metastatic breast cancer. The guidelines for prehab – education on how to uplevel nutrition and fitness to build physical resilience – apply even for women who haven’t been diagnosed as a focus on prevention.

675 women PER DAY are diagnosed with breast cancer. The collateral damage (to use a phrase coined by Dr. Susan Love) in terms of physical limitations, psychological impact, and negative outcomes on energy, stamina, immune system health and a host of other physiological issues post-treatment is colossal. The opportunity to help lessen that burden with actionable tools and services is exciting and humbling.

My blog will continue to address a wide variety of breast cancer nutrition/fitness/lifestyle topics, all supporting the idea of taking action; which I hope I’ve convinced you is especially important at that critical time of diagnosis.

Stay tuned, big things are coming!

“Even before treatment starts, you can help the healing process begin.”                                                                            – Cathy Leman, MA, RD, LD

If you’d like to learn more, these are good places to start:

  1. “Patients Do Better After Surgery If They Do Prehab First”
  2. “Cancer Prehabilitation Important Lessons From a Best Practices Model”
  3. To Boost Patient Health, Rehab Sometimes Starts Before Cancer Treatment




“Striving to Thrive In A Toxic World”

A TruGreen truck brought me to tears.

I’m not kidding.

It was April 2015, two months after completing my radiation treatments. To anyone who didn’t know about my breast cancer, nothing seemed amiss – I didn’t look or act different in any way. But inside? I was a mess.

I was really struggling, fighting tooth and nail to regain my equilibrium. One of the things that helped most (and continues to), was moving. Running, walking, dancing; it didn’t matter, really, as long as I could physically move emotion through my body.

And so, it was relief I was seeking as I headed out for a long run on a glorious spring day, only to round the corner at the end of my block and come to an abrupt halt. There it sat, parked in front of my neighbor’s house, mile-long nozzle+hose combination stretched across my path on the sidewalk, toxic chemicals spilling from its belly; the TruGreen (formerly ChemLawn – but we’re NOT fooled) truck.

Even if I hadn’t seen it, I certainly would have smelled it. That unmistakable chemical odor assaulted my nasal cavity and reached my brain in seconds, sounding the alarm, triggering the tears, and leaving me feeling terrified and utterly helpless.

Let me see if I can explain. If you’ve had breast cancer, you’ll get it – if you haven’t, I hope you can at least empathize.

After my lumpectomy and radiation treatment ended, I felt like I got to “start over”, to live the next however many years of my life I am blessed to live with a clean slate. The cancer was gone, cut and zapped from my body – and I desperately wanted to hold onto that. That treatment, combined with the prescribed five year adjuvant medication protocol helped me feel fairly confident I’d be ok.

However, from a realistic standpoint, that thinking could be considered slightly naive. No woman can ever be 100% certain she’ll remain cancer-free (hence, my “fairly confident”).

30% of women with early stage breast cancer (which I had) develop metastatic, stage IV breast cancer.

Upon learning this information, the optimistic, glass half-full Cathy whispered, “That means 70% won’t”, while the practical, go-to-the-science Cathy screamed, “That’s the reality. It’s foolish to gloss over the data – ignoring it won’t make it disappear.”

Trust me when I say, I’m not taking any chances with my health. I will do everything in my power to keep myself safe and cancer-free. Universe willing.

And that’s where the “helplessness” comes in. IN. MY. POWER. There’s so much outside of my power, including the drenching of neighboring lawns with toxic chemicals, that I hardly know where to begin even putting things inside my power.

How can I possibly avoid for the rest of my life all villains known or suspected to contribute on some level to the worldwide breast cancer epidemic? How do I avoid being held a cancer-fear hostage by every errant lawn chemical, drift of second-hand smoke from a stranger’s cigarette/cigar/vape, blast of acrid motor exhaust, gas station/lawn mower/snow blower fume, or bite of food that made contact with rogue toxins leached from plastic on the random occasions I must eat outside my own home.


The obsession of it all could quite possibly kill me before any type of cancer ever would.

But obsessed (slightly) I choose to remain. A couple of weeks ago at a Chicago street festival, I even asked a gentleman who lit a cigarette near me if he would mind smoking elsewhere to assuage my post-breast-cancer-freaked-out-by-second-hand-smoke fear.

Yes. I absolutely did that. My husband is my witness. The gentleman graciously obliged.

My “DAM. MAD. About Breast Cancer” initiative was developed to help women TAKE ACTION to thrive with, during and after a breast cancer experience, and potentially avoid it completely in the first place. Signing a contract with a chemical lawn service is an ACTION that may seem not to yield a significant impact, yet you only need to read my story above to know that’s simply untrue.

Positive actions elicit positive change. While we’ll never completely rid our environment of toxins, if we all do our small part through POSITIVE ACTIONS to reduce breast cancer risk, collectively we can’t help but make a significant positive impact on this monster.

If you’re in the northern and western Chicagoland area and interested in using safer products and services for your lawn, here are a couple of options to consider. By the way, I receive nothing for mentioning these businesses, I simply want to share helpful information! For those of you in other areas, stay tuned. . .there’s more coming soon on this topic.

Pure Prairie Organics The Leman lawn is cared for by this company. Chris Burisek, the owner of Pure Prairie Organics and a kindred spirit when it comes to supporting a safer, cleaner world would be thrilled to bring his professional lawn care services to your home. Chris is a pro who’s been making lawns safer for pets, kids, and grown-ups since 1994, not to mention, a heck of a nice guy.

Greenwise For my friends in the northern suburbs of Chicagoland.


“When GI Joe Gets Cancer.”

It’s said that age is the greatest risk factor for developing cancer, with risk increasing significantly after age 50, and half of all cancers diagnosed in people age 66 and above. (1) Currently, there is no single reason why aging bodies are more susceptible to cancer, although longer exposure to carcinogens and mutations in the genome are certainly culprits.

Since the population is aging (isn’t it always because that’s the way it works?) I don’t take issue with that, but will someone please explain to me how a fit, healthy, 25-year old, aging but not aged Army serviceman is diagnosed with testicular cancer?

Or a healthy, fit, aging but not aged 42-year old is diagnosed with pancreatic cancer?

Testicular cancer isn’t actually my area of expertise nor experience. Neither is pancreatic. But in the last 2 weeks alone, and as recently as this morning, I’ve learned of 3 new cancer diagnoses – pancreatic, breast and testicular – in people that I know, are related to people that I know, or who were referred to me for cancer nutrition education by someone that I know.

When. Does. It. Stop.


This informational slide from American Cancer Society Cancer Facts & Figures paints a not-so-pretty picture. And I wanted to share it with you.

If you think for one minute that you’re not a cancer target, I would advise you to re-think. The statistics are ridiculously alarming, and the fact that cancer diagnoses are on the rise, while a sense of urgency devoted to determining what’s causing the increase appears to be lacking, is beyond me.

While I’m grateful for continually improved treatments, pharmaceuticals, and early detection, I must stress that these are not cures, nor are they preventive. Early screening does not prevent cancer, it simply catches it – hopefully before it’s had an opportunity to do too much damage.

I know how complex cancer is, how random, how wily, how varied and virulent – but I don’t care. I want research dedicated to determining causes and outcomes that provide ways to avoid/prevent.

Is that asking too much?


Why Does Cancer Risk Increase As We Get Older?