“How Targeted Nutrition May One Day Eliminate Your Breast Cancer Risk”

Purchased this in 2007! #aheadofmytime

“Essentially, “nutrigenomics” is the study of the effects of foods and food constituents on gene expression. Identifying the effects of individual nutrients or an entire nutritional plan based on an individual’s genotype allows for a customized nutritional “prescription” targeting unique and specific health needs. | What I love about nutrigenomics is the focus on wellness and prevention rather than the treatment of disease. While nutrigenomics is not yet mainstream, consumer awareness and demand combined with robust scientific evidence (the ability to replicate studies) is moving us toward the day when a prescription for a targeted eating plan will be as common as a prescription for penicillin.”  – Cathy Leman, MA, RD, LD

Nutrigenomics [nutri-gen-O-mics] is a term that may be new to you, and why wouldn’t it be?

Unless you’re steeped in the world of nutrition (and genetics) and prevention, nutrigenomics wouldn’t necessarily be on your radar, yet it’s a fascinating area of nutrition and I’m excited to give you a quick introduction here.

My first experience with nutrigenomics was somewhere in the early 2000’s when I attended a workshop on functional nutrition. I’ll never forget how Ruth DeBusk, PhD, RD (a nutrigenomics guru, btw) shared the concept of using nutrition to “switch” certain genes off and on. I was captivated by what that could mean for the future of nutrition and disease management and prevention, and my work continues to be influenced by that idea today.

Consider this. A simple DNA cheek swab reveals breast cancer genes that could be modified with targeted dietary advice. What if that advice was simply to eat an apple every day, because nutritional constituents identified in that apple were known to reduce or eliminate that particular individual’s risk of developing breast cancer. For someone else, the same cheek swab reveals apples INCREASE the risk of developing breast cancer. Advice to skip the apple and eat the fruit(s) identified to decrease risk would be life-changing.

Can you imagine?

Essentially, nutrigenomics is the study of the effects of foods and food constituents on gene expression. Identifying the effects of individual nutrients or an entire nutritional plan based on an individual’s genotype allows for a customized nutritional “prescription” targeting unique and specific health needs.

What I love about nutrigenomics is the focus on wellness and prevention rather than the treatment of disease. While nutrigenomics is not yet mainstream, consumer awareness and demand combined with robust scientific evidence (the ability to replicate studies) is moving us toward the day when a prescription for a targeted eating plan will be as common as a prescription for penicillin.  

At the recent Academy of Nutrition and Dietetics conference, I attended “Nutrigenomics: Is It Ready for Prime Time?”, presented by Ahmed El-Sohemy, PhD, adjunct professor in the Department of Nutritional Sciences at the University of Toronto, and the Canada Research Chair in Nutrigenomics, who outlined a solid argument for why we should even “bother” to consider nutrition and genetics/genomics.

Quite simply, one nutritional protocol does not fit all.

Take caffeine, one example highlighted during the talk. Depending on an individual’s genotype (the underlying genetic information encoded in a chromosome), caffeine can have an increased, decreased, or zero effect on health outcomes. If you’re someone who experiences elevated blood pressure or heart rate when you eat or drink anything with caffeine – wouldn’t you want to know more about how to manage that?

For now, we use broad nutrition recommendations supported by research that, while effective,  aren’t always as targeted as we’d like. The idea of applying nutritional recommendations that match each person’s health needs is absolute nirvana to me. I simply can’t wait until that’s the norm in how we practice dietetics.

Until then, stay tuned for more on the topic of nutrigenomics. The implications for each of us in taking control of our health is monumental.

FYI, a couple of recommendations for further reading on this topic, both penned by Dr. DeBusk, RD:

“Genetics The Nutrition Connection”   |  “It’s Not Just Your Genes”

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Easy. Peasy. 

 

“Are We A Moderation Nation? Always, Sometimes, Rarely.”

Diet advisor: “Eat everything in moderation.”

You: “Everything?”

Diet advisor: “Yes.”

You: “What about donut holes? And miniature peanut butter cups?”

Diet advisor: “Yes. Moderation still.”

You: “My donut hole moderation runs anywhere from 1-1.5 dozen, depending on my craving, and my peanut butter cup moderation is strictly determined by the number remaining in the bag, PLUS how much stress I’ve encountered before reaching for said bag.”

Diet advisor: “I’m firing you. Rules are rules.”

You: “But if you could just be more specific, maybe I could stick with the rules. Puh-leeezze don’t fire me.”

Diet advisor: “Specifics don’t exist. You should know your own level of moderation. Still fired. And furthermore, until you get your moderation in check, don’t even THINK about calling me for help.”

___________________________

Sound familiar? Lord, I hope not – at least not as an exchange with a live person. But perhaps that’s the message you hear swirling about in the world of dieting and eating “clean”; simply find the right moderation for YOU, don’t deviate from it, and you’re good.

That’s good ‘ole moderation for ‘ya – too loose, too vague, too unhelpful.

Especially when you try to rely on moderation in situations where basic nutrition isn’t even a consideration; like stress eating. Or emotional eating. Or eating when you don’t feel well. Or eating when you’re over-hungry, over-tired, or just over-everything.

The scenario in the intro is 100% fabricated by moi. Yet, there are nuances of truth. Most people working one-on-one with me struggle with emotional or stress eating – it’s far more common than you can even imagine.

And in my breast cancer community? If you were a stress eater BEFORE your diagnosis, the behavior certainly won’t suddenly be replaced with “balanced eating habits supportive of recovery.

Ummm, no.

In fact, those stress eating behaviors are likely to ESCALATE, potentially spiraling out of control as you obsess over the “right” way to eat for your cancer.

All of which leads me to share some ideas in figuring out the whole “moderation” thing.

The red light, yellow light, green light approach to moderation and choice, aka “Stoplight Nutrition” is used most often in child nutrition, but it also resonates with adults. While I like the general concept, it can still leave too much open to interpretation, and for good reason. You can’t bog kids (or adults!) down with too much detail before you lose them.

Red Light Foods = Stop & Think!

Very little, if any, nutritional value. Tend to be high in calories, sugar and fat. Considered a treat, limit to a couple each week.

Yellow Light Foods = Slow Down!

Whole grains and lean proteins. Contain nutrients, could be moderately high in calories and fat, still important to be aware of portion size. Make up most of the diet.

Green Light Foods – Go!

Fruits, veggies, water, nonfat milk. High nutritional value, low in calories, sugar and fat. The healthiest choice, include most often.

Stoplight Nutrition is also portrayed as:

Red = Rarely (Whoa!)

Yellow = Sometimes (Slow!)

Green = Anytime (Go!)

Here’s my pared down way of using this information. Every time you make a decision about what and how much to eat, of ANY food (on its own or in combination) use these two steps:

Step I

Is the food something I would eat. . . .

  • Always
  • Sometimes
  • Rarely

You don’t even need me to give you examples here – you KNOW what goes into these categories!

Step II

Ask yourself (and be honest!):

  • Am I hungry?
    • Yes = eat.
    • No = wait.
  • What type of hungry am I?  
    • “I would eat an apple” hungry = eat.
    • “I wouldn’t eat an apple, but I would eat cake” hungry = wait.

Notice I didn’t say “Don’t eat!”, I said “Wait.” If you’re NOT truly hungry, the urge to eat will leave you, especially if you get involved doing something else. If you ARE truly hungry, you won’t get “unhungry” simply by waiting – you’ll get hungrier (it’s why that apple sounds so appealing.)

Practice, practice, practice. You’ll get really good at this, but be patient – changing hard-wired habits takes time.

P.S. This post is courtesy of a week where time scurried away, leaving me unable to do a deep dive into the remaining three topics I want to cover from FNCE . . .but, they’re on the way.

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. 

“A SWEET Guide To Help You Navigate Breast Cancer & Sugar.”

Sugar, in all its stark white, sparkling glory is an enormously popular, widely misunderstood, and hotly-debated topic in the breast cancer world.

Rarely a week passes when I don’t hear or read “Sugar feeds breast cancer” proclaimed with absolute certainty. People appear to accept this declaration as truth, yet I ask; does it really? With October host to the annual convergence of breast cancer awareness AND Halloween, I think now is the perfect time for sprinkling sweet words of wisdom to my readers about this ubiquitous ingredient we love to hate and debate.

Before we dive in, let me make one thing clear. When I write about nutrition and food, the first thing I do is hit the research. I’m a dietitian. I have a bachelor of science degree in nutrition. I will say this until the day I leave this earth – nutrition is a science, not an opinion. While everyone rightly deserves their own opinion about nutrition (and food), I’m not “everyone.” I’m a nutrition professional AND a breast cancer survivor. I have a professional obligation to write from the science, and a personal obligation to share evidence-based nutrition information that serves the breast cancer community. I take both very seriously.

That said, I asked myself what non-sugar-coated nutrition information would be most helpful for someone newly diagnosed with breast cancer, feeling frustrated and confused because she couldn’t get a straight answer about whether sugar helps or harms, and grappling with “must I completely avoid sugar to keep the cancer from growing?” or “is it even possible to eat sugar and be as healthy as I can right now?” between the time of diagnosis and start of treatment.

What would someone want to know, who perhaps doesn’t give a rats ass about the science, but did hear (somewhere) that sugar does indeed drive cancer growth? Someone who wants a definitive and reliable answer, yet because overwhelm and impatience have become forces of nature, and an inability to focus has rendered the inclination to sift through pages of (conflicting) online nutrition information as appealing and effective as herding cats, she just wants to be told what to do.

Start Here. . .

There are literally hundreds of studies and reams of information on sugar and breast cancer; there’s no way I could possibly cover it all in this single blog. I’ll continue to write about this topic, but for today, here are my goals:

  • Provide a quick “Carbohydrates 101.”
  • Give you a tiny taste of the current research/science.
  • Provide a sweet guide to help you put this information into practice.

A Little Carbohydrate Background

Carbohydrates are one of three macronutrients (protein and fat are the other two) necessary in the diet to support energy, growth, and life, and include a wide range of starches, sugars and fiber. Some sugars are NATURALLY OCCURRING, like the sugar found in fruits, vegetables, whole grains, and some dairy products. Other sugars, such as high fructose corn syrup, are produced commercially and then ADDED to foods.

“Carbohydrate” is a category that includes a wide range of starches, sugars (both naturally occurring and commercially produced), and fiber. There are many types of sugar, which are classified by chemists according to their chemical structure, i.e. monosaccharides (single, simple sugars) and disaccharides (two simple sugars joined together), and several forms of sugar, i.e. glucose, fructose and galactose, which come together to create even more forms of sugar, like the lactose in milk (glucose + galactose), and the maltose found in molasses (glucose + glucose.)

The concern for newly diagnosed and metastatic patients is that sugar “feeds” cancer, making it grow faster and uncontrollably, hastening its potential and/or further spread throughout the body. For patients undergoing treatment, there may be concern that sugar interferes with chemo and/or radiation. For women without a breast cancer diagnosis or are “NED” (no evidence of disease) post-treatment, the concern is that sugar will “cause” a cancer diagnosis or recurrence.

A (very small) Taste of The Current Research

  1. Including “naturally occurring” sugars in your diet from fruits, vegetables, whole grains and dairy (i.e. PLAIN cow’s milk versus chocolate or other “flavored” milks which have ADDED sugar) is an eating pattern you can feel comfortable about. These naturally sweet (or “savory” whole grain) foods not only provide energy-rich carbohydrates, they’re loaded with vitamins, minerals, fiber, antioxidants, and phytochemicals versus only the empty calories of most added sugars. (1)
  2. Sugar does indeed feed cancer cells, as well as ALL of your other cells. Every cell in your body uses glucose (the “broken down” form of carbohydrate) for energy. Even on a no/low carbohydrate diet, your body transforms protein and fat into usable glucose (blood sugar) to support the function of your brain (which can use ONLY carbohydrate for energy) and all your other tissues.
  3. Because cancer cells are especially “hungry and hyperactive,” they consume glucose more quickly than non-cancerous cells. With the help of a radioactive compound very SIMILAR to glucose that allows detection of the metabolic activity (hungriness and hyperness) of cancer cells, medical professionals are able to see this phenomenon during a PET (Positron Emission Tomography) scan.
  4. Cells use sugar like cars use gasoline. Normal cells use a reasonable amount of gas, but because cancer cells divide at faster rates than normal cells, they’re gas (sugar) guzzlers. (2)
  5. Compelling epidemiologic studies have shown that dietary sugar intake has a significant impact on the development of breast cancer, but the data is inconsistent and the mechanism is unclear. One proposed mechanism for how sugar impacts breast cancer is through inflammation (obesity is a strong driver of systemic inflammation.) In one study, sugar did accelerate and promote the development of breast cancer in mice fed the equivalent of the average sugar consumption by the American population – 70 pounds/person/year according to this particular study – through changes in metabolic signaling pathways and the expression and production of certain proteins linked to the inflammatory response. Takeaway: sugar DID NOT DIRECTLY cause breast cancer, rather, it exerted influence on a particular signal and pathway involved in promoting its development. (3)
  6. Another very small study, again, done on mice and only certain types of breast cancer cells in culture and for select chemo medications, indicated that sugar may interfere with the body’s response to and effectiveness of chemotherapy, calling for further investigation to achieve definite outcomes and practices for real-life applications. (4)
  7. When carbohydrates are eaten, the body increases its output of insulin to help return post-meal blood sugar levels to normal. Failure of insulin levels to return to normal after the blood sugar is cleared indicates insulin resistance and high levels of insulin remaining in the blood. Insulin resistance can result from obesity and inactivity; insulin resistance is associated with higher breast cancer recurrence risk. (5)

A SWEET Guide To Help You Navigate Sugar Challenges

  • Aim to keep your ADDED sugar intake to 10% or less of the TOTAL calories you eat daily:
    • For example, if you eat 2,000 calories per day, all the calories you eat from ADDED sugar for the entire day would equal 200 calories. Remember, that’s CALORIES not grams, there’s a difference (see below.)
  • Added sugars are found in:
    • candy, cookies, cake, pie, brownies, muffins, sweet rolls and pastry, ice cream, sorbet, gelato, sweetened beverages like juice-drinks, fruit punch, sports drinks, sweetened iced tea, bottled smoothies, soda and coffee drinks, cereals, some breads, ketchup, barbeque sauce, spaghetti and tomato sauces, flavored milks (plant-based and cow), flavored yogurt, protein and cereal bars, salad dressing, canned baked beans (this is NOT a definitive list – check your ingredient labels!)
  • 1 gram of sugar has 4 calories:
    • If a food label shows 5 grams of sugar in one serving, that food gives you 20 calories of sugar (5 grams x 4 calories.)
  • When choosing packaged foods, look at the “ingredients” label.
    • If you see any of the following terms, you’ll know there is ADDED sugar: brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, invert sugar, malt syrup, maltose, molasses, raw sugar, sucrose, trehalose, turbinado sugar.

What 200 calories/day of Added Sugar Looks Like

Breakfast

  • 1 packet instant maple and brown sugar oatmeal; 12 grams sugar (48 calories from sugar)
  • 1 cup vanilla almond milk; 13 grams sugar (52 calories from sugar)

Lunch

  • 2 tablespoons honey dijon dressing; 5 grams sugar (20 calories from sugar)
  • Mixed greens salad with 1 ounce candied walnuts and 2 tablespoons dried cranberries; 9 grams sugar + 13 grams sugar (88 calories from sugar)

Surprise! You’re already at 208 calories from sugar and your day’s not even over.

This example isn’t meant to prevent you from eating ANY added sugar, rather, to give you an idea of how added sugars can creep in without you being aware. This is an easy fix!

Fix It Like This. . .

Choose plain instant oatmeal and add 1 teaspoon honey, use plain (no-sugar-added) vanilla almond milk. Add olive oil and balsamic vinegar to your salad, raisins vs dried cranberries (raisins have natural vs. added sugar) and non-sugared, toasted walnuts.

Sources

  1. “Does Sugar Feed Cancer?” 
  2. “Does Sugar Feed Cancer? It’s Not That Simple.”
  3. “Dietary sugar induces tumorigenesis in mammary gland partially through 12 lipoxygenase pathway”
  4. “Modification of dietary sugar on the chemotherapeutic potential in breast cancer”
  5. “Obesity, Insulin Resistance and Insulin”

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.”

And you can follow me here:

Twitter: @cathylemanrd

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

Easy. Peasy. 

“29 Foods to Help You Manage Breast Cancer Stress”

Stress is insidious.

It weasels in even when you think you have a handle on it, wreaking havoc on your sleeping patterns, waking hours productivity, and at the cellular and hormonal level, your body’s immune system and regenerative ability.

There’s all sorts of stress to contend with on a daily basis; traffic stress, late-for-work stress, forgot-our-anniversary-now-you’re-really-mad-at-me stress. It can be endless.

Every person copes with stress in their own way, and we all perceive stress differently. For example, that thing stressing out your best friend may not raise even a blip on your stress radar, and vice versa. But the thing guaranteed to trigger a massive stress response in anyone?

Hearing “It is breast cancer.”

It’s an experience I can only describe as feeling like your brain is stuffed into a box in a separate room, completely detached from your body, yet still trying desperately to keep up with and process the information being relayed.

So what actually DOES happen to your body when you’re exposed to the complex phenomenon of stress? Your body’s wondrous physiology behaves in a fairly coordinated manner by activating something called a “stress response,” a series of reactions involving hormones, behavioral changes, and alterations in the functioning of your autonomic system (the mechanism by which body processes like breathing and heart rate work without conscious effort.)

Back to that concept of coping mechanisms, one very good (universal) solution for managing breast cancer stress, is to eat a stress fighting diet. Not, mind you, a macaroni-and-cheese-at-every-meal kind of stress fighting diet – that’s more of a stress numbing diet – and perfect fodder for another blog post.

The diet I’m talking about is one that confers powerful stress reducing benefits that: improve brain functioning, prop up your immune system, lower blood pressure, promote optimal circulation, reduce free radicals and other toxins, minimize cortisol and adrenaline levels, the stress chemicals that trigger our fight or flight response.

Yes, food can do all of that.

“Now, more than ever, eating nutrient-dense food to support your body’s ability to handle stress at the cellular level is essential for your overall well-being. Not only that, eating for stress reduction and management helps reduce recurrence risk and revs up your energy levels.” – Cathy Leman, MA, RD, LD

Here’s a list of 29 foods that get into your cells and do the good work!

Happy eating. . .

  • Vitamin C fruits and veggies
    • Green and red peppers, potatoes, oranges, grapefruit, strawberries, tomatoes, kiwi, cauliflower, cabbage, onions
  • Vitamin E foods
    • Dry roasted sunflower seeds, almonds, spinach, safflower oil, wheat germ, green leafy vegetables
  • Polyphenolic foods
    • Chocolate, tea, coffee
  • Complex carbohydrate foods
    • Barley, rye, oats, whole wheat
  • Omega 3 foods
    • Walnuts, ground flax seeds, fatty fish, chia seeds, canola oil

Want more breast cancer nutrition, fitness and lifestyle inspiration and information that you can’t get here? Go to www.cathyleman.com and subscribe to my newsletter!

“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.  

PREHAB.

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