“Why You MUST Make This a December to Remember”

 

What is it about the holiday season that sends us into frenzied, wild abandonment of the tried and true habits that keep us sane, fit, limber, focused, grounded, nourished and strong (mentally AND physically) the remaining 11 months of the year?

I honestly don’t know.

Well, that’s not entirely true. From my years in private practice I have a few ideas (with science to back me up), but I don’t know what it is that drives YOU into the space of wild abandonment.

As we welcome December, what do you say we make it one to remember by taking a different approach – a more centered, deliberate, mindful approach – in an effort to greet January with open arms rather than a laundry list of regrets.

If you’re anywhere on the breast cancer path; newly diagnosed, in treatment, in survivorship, or living with metastatic, daily decisions about the food you put into your body, the exercise you do (or don’t), the time you get yourself to bed (and up in the morning), the people you surround yourself with, the dialogue in your head, the multitude of self-care choices you make every, single minute of every, single day can take on a new urgency.

Especially during the holidays, and it doesn’t matter which one you observe – Christmas, Hanukkah, Kwanzaa or a mish-mosh of them all – the volume of self-care decisions also escalates. Successfully navigating the special holiday foods, booze, late nights, restaurant meals, and power-shopping fortified with fast-food stops and gigantic, seasonal, coffee-as-dessert drinks is enough to make you throw your hands up and simply cave to “taking care of myself takes a backseat”

There’s a litany of research suggesting the “best” approach to breast cancer and food/fitness/sleep/self-care, yet those well-intentioned recommendations can make you feel like one false move is enough to invite a new or escalated bout of breast cancer – and aren’t the holidays just riddled with landmines of false moves?

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Angst-Producing Issue #1 – “Am I eating the “right” foods?

Consider. . .You’re so afraid of eating the “wrong” things that you restrict the holiday foods you enjoy the most, only to end up bingeing when no one’s looking on candied sweet potatoes, rugelach, or sugar cookies.

The Science. . .We don’t yet have definitive guidelines on specific foods that absolutely reduce risk of breast cancer recurrence or mortality, but we do have good data to suggest that dietary PATTERNS and the synergy of nutrients are just as important as individual foods. The science supports a dietary pattern heavy on fruits, vegetables and fiber, and light on added sugars and fats. How to reconcile THAT recommendation with sugar plums and mac-n-cheese? (1)

December to Remember Approach. . .

  • Aim to reduce added sugar and fat when you bake or cook.
  • For most recipes, you can easily reduce the sugar by at least one-third (typically more) without compromising taste or texture. (2)
  • Cut back on the amount of oil used in sauteing (or substitute wine, water or broth instead) and in salad dressings. Healthy fats are important for healthy diets, but remember, “Yes, Virginia, there is a calorie connection.”
  • Combine butternut squash with a reduced amount of cheese in that mac-n-cheese dish to reduce fat AND increase fiber/veggies.

Be Kind to Yourself. . .Don’t deny yourself any special holiday foods, and kick to the curb the guilt you feel for enjoying those special foods. Guilt is a useless emotion, so give away its place at the holiday table.

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Angst-Producing Issue #2 – “Am I exercising enough and doing the “right” type of exercise?

Consider. . .You’re either heading into the holiday season de-conditioned and feeling overwhelmed (and again, guilty) about it, or already fit and looking to ratchet up your activity to counteract all of that holiday eating. You either wallow in guilt and eat to ignore how you feel about being out of shape, or kill yourself to fit in your workout even when sleep may be a better option (see #3 below).

The Science. . .We know that exercise can reduce the risk of diagnosis and recurrence, improve energy and reduce pain for advanced breast cancer, and helps everyone in managing stress, anxiety and depression. Current recommendations are for 150 minutes per week of deliberate physical activity, using a combination of cardiovascular, strength training, and flexibility and balance exercises (3, 4).

December to Remember Approach. . .

  • Schedule and prioritize your exercise; use a calendar, set a reminder, make a date with a friend/family member to “meet and move”. Scheduled gets DONE!
  • A little bit is better than none. Hard to believe, but your body responds to even the slightest increase in physical activity, so yes, doing 15 minutes at times you can’t find 30 is still beneficial.
  • Do exercise that you enjoy. This sounds old and trite, but it’s so true! If you try to do a type of exercise that you hate, you will not do it. Ever. Stop trying to trick yourself. . .it won’t work.
  • Get the exercise in consistently, but don’t forget to also pay attention to food portions and quality. You simply can’t out-run/lift/swim/dance a crappy diet (5).

Be Kind to Yourself. . .Missing a workout doesn’t mean your previous hard-won efforts evaporate. Just get right back to consistency as soon as you can. A break in a workout schedule doesn’t mean a break-up with your fitness routine. And if you’re just starting out? Start slowly, listen to your body, and keep going!

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Angst-Producing Issue #3 – “Am I sleeping enough or too much?

Consider. . .You cut back on sleep in order to bake one more batch of cookies, wrap a couple of gifts, send out a few more invitations, or fill your online cart in the wee hours of the night. It just feels so productive, doesn’t it? Not so fast, you creator of “must-be-perfect-holiday” you.

The Science. . .There is interesting research to suggest that getting less than the recommended amount of sleep (7-8 hours/night for adults) may be connected to some cancers, breast cancer included. Connection doesn’t mean causation, and the jury is still out on the definitive science here. But it is important to realize there’s something there, so adding good sleep hygiene to your arsenal of breast cancer management tools isn’t a bad idea. Not to mention, inadequate sleep can throw off appetite, hunger and satiety, which can lead to overeating and choosing foods that are less than nourishing (6, 7).

December to Remember Approach. . .

  • Establish a bedtime routine. It works for kids (if you have/had them, you made sure they followed it!), and you’re just a grown-up kid – it’ll work for you, too.
  • Take a hot bath/shower, climb into your cozy bed and read a (non-stimulating, non-backlit) book, sip herbal tea.
  • Buy yourself special holiday pajamas; they’re not only fun, they’ll signal BEDTIME in your mind when you wriggle into them at the end of a long day.
  • Set a reminder, timer or a schedule to GO TO BED. Seriously. If you disregard your body’s signals to sleep, sometimes a little extra (auditory)  nudge can help.

Be Kind to Yourself. . .Sleep is cathartic. It heals, it energizes, it restores. Why do you think sleep deprivation is considered a torture tactic?? Because, it is. Do yourself a favor and get your zzzzz’s.

Sources:

(1) Foods That Fight Cancer

(2) Is It Possible to Reduce Sugar in a Baking Recipe?

(3) Physical Activity and Cancer

(4) Exercise Can Counteract Treatment Side-effects, Improve Cardiovascular Fitness in Women with Advanced Breast Cancer

(5) Diet Tops Exercise for Cutting Weight, Cancer Risk

(6) Lack of Sleep Increases Your Risk of Some Cancers

(7) Good Sleep May Improve Breast Cancer Survival

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“Three Reasons You Have “Weight Creep” and What To Do About It!”

Although breast cancer survivors are quick to express gratitude for the life-saving treatments we receive, we can be just as quick to bemoan how those same treatments yield untold numbers of lingering physical challenges. While the type, variety, and severity of treatment aftermath varies widely from person to person, if there’s a unified grouse from women who’ve walked the breast cancer path, it has to be weight gain.

Which, by the way, I find particularly egregious.

Isn’t it enough for a woman to go through the rigor and horror of breast cancer without being plagued by the one thing that compounds not only body dissatisfaction (a major concern for many breast cancer survivors), but according to research, an increased risk for recurrence?

While there’s a dearth of scientific literature pointing directly to weight gain and body dissatisfaction in breast cancer survivors, I can share anecdotally from many women, the extra weight and its stubborn reluctance or refusal to budge is frustrating at best, maddening at worst, and depressing as hell.

You could make a strong argument for kicking weight concerns to the curb, choosing instead to focus on the glorious miracle that is surviving breast cancer and the gift of continuing to exist on this planet. Seriously, what’s a little weight gain in comparison to not being alive? Are we honestly that vain – kvetching about how our favorite “pre-breast-cancer” jeans just don’t hang the way they used to – rather than celebrating the fact that we’re even around to complain about it in the first place?

Of course not! That isn’t vanity, now is it ladies? It’s about lamenting only one of the myriad of post-breast-cancer body changes that you’re encouraged to accept as your “new normal” – and if you’re honest – not liking one, dam bit.

Don’t get me wrong, I’m not suggesting you disregard the recommendations to maintain a healthy weight if you’re already there, or lose weight if you’ve gained, but I’ve recently participated in some discussions on my breast cancer social media outlets re: weight gain, and want to dive a little deeper here. Let’s begin with the weight gain thing that you may not even know is a thing; weight creep.

I spotted this scale on a Vienna sidewalk a number of years ago. On. The. Sidewalk. for heaven’s sake.

What is “Weight Creep”?

Weight creep, which tends to happen with age, is the phenomenon where the numbers on the scale gradually increase. Each new decade we’re alive (yay!) brings body composition changes (bleh), most notably, the loss of calorie-hungry muscle and an increase in slothful body fat.  For post-menopausal women (natural or surgically/medically induced), the dramatic decrease in estrogen encourages fat gain (especially in the belly and hips) which can result in weight redistribution and changes in body shape, even when the number on the scale may not move (much). Not only that, perfectly normal age-related joint creakiness and stiffness may be exacerbated by chemo regimens or long-term, post-treatment medications like tamoxifen or aromatase inhibitors, inciting true physical discomfort even pre-menopausal breast cancer patients are known to experience. Regardless of your chronological age, when your body feels like it’s 90 years old, how physically active are you? Probably not very. If you’re moving less, yet eating the same amount of food you did when you were younger and/or more active and carrying more muscle, you begin to see just how creepy weight creep can be.

How Does Breast Cancer Treatment Cause Weight Gain?

Chemotherapy can lead to weight gain by causing the body to hold more water (edema), producing fatigue, which may lead to inactivity, triggering nausea, which can be managed by eating (even in the absence of hunger), driving both physiological and psychological food cravings, and sending women into menopause. Also, steroid medications prescribed as part of the treatment regimen can increase appetite, and with long-term use cause an increase in fatty tissue in the abdominal area. Beyond chemo, the 5-10 year tamoxifen or aromatase inhibitor medication regimen prescribed for certain breast cancers can decrease estrogen or progesterone levels, leading to a reduction in muscle, increase in body fat, and lower metabolic rates.

Although many would have you believe the “idea” of weight loss is simple – eat less/move more – the basic physiology of weight loss is extremely complex, becoming even more so when breast cancer treatment is added to the mix. For example, some research suggests that lipoprotein lipase, an enzyme critical to the efficient breakdown and use of fats from the diet may become less effective with the menopause-induced decrease in estrogen.

What to do when it feels like so much is working against your weight loss efforts? Let’s start by identifying habits that may be hurting rather than helping. Habits which, unlike your rogue hormones, you can control and change!

Three HABITS That Cause Weight Creep and What to do About Them.

  1. You decide to worry about the weight later, and later keeps getting pushed further out on your calendar:
    • You may feel you can focus only on getting through the cancer – it takes everything you have – so the weight can, well, wait. And with all the disruption, appointments, emotional upheaval, and general turmoil breast cancer brings to your life, it’s easy to put your focus and energy on whatever is screaming for immediate attention, situations that if ignored, come with consequences attached. For example, you wouldn’t intentionally skip a doctor appointment or refuse to refill your medication, nor would you make your kids miss school because you don’t feel like driving them; each would result in consequences. The thing about weight gain and consequences? Those darn consequences aren’t immediate. Sure, you may not feel great in your body or your clothes don’t fit like they used to, but you tell yourself you can live with that; you’ll get to the weight when you have more time, energy, focus, or motivation. So you skip planning your meals, refuse to listen to the voice in your head encouraging you to go for a walk, and putting together that salad you want for dinner? You just don’t feel like it. Try starting with this: plan breakfast for M, W, F, walk 20 minutes one day/week, and buy pre-bagged salad. Done!
  2. You reward or justify your workouts with food.
    • If you’re just getting back to exercise, the intensity and duration of your workout may be less than what you’ve done in the past. That doesn’t negate the benefit of the workout, but it also doesn’t warrant extra food “because I worked out today.” Did you know that it’s entirely possible to burn less than 100 calories in a single workout? For example, if you weigh ~120 pounds and walk one mile at a 20 minute/mile pace, you won’t even hit the 100 calorie mark. While there’s absolutely nothing wrong with that effort, you’re simply not burning gobs of calories; if you burn 85 but eat 250, that explains (partially) why you may gain or maintain weight even though you’re active. And by the way, if you must reward your workout efforts? Book a massage, go to a movie, get in bed early with a great book. . .anything as long as it’s a NON-FOOD reward.
  3. Planning is not your forte’.
    • One of my favorite sayings (because it’s always so darn true) is “failing to plan is planning to fail.” And when it comes to getting health-supportive, nourishing food into your house and onto your dinner plate? It couldn’t be more true. There’s no need to stress yourself out by writing a week’s worth of menus, creating elaborate meal plans, or choosing a recipe for every meal and snack, but a little planning ahead ensures you’re getting in the foods that make you feel good. Try starting with this: choose two recipes, buy the ingredients you need, and block out a couple of hours to pull them together. Store in the fridge and heat up as needed. Done!