After Breast Cancer: Challenges of Creating a “New Normal”

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I was delighted to deliver the keynote presentation and lead an interactive session at an event that aimed to raise awareness about diet and lifestyle among breast cancer survivors. The event was focused on some of the unique challenges that breast cancer survivors face when it comes to changing eating habits following their cancer diagnosis.

We explored the different aspects of this diet dilemma propagated by headline hype and mixed messaging.

Challenge #1: What’s the Focus?

People who have been diagnosed with breast cancer have diverse nutrition issues—both during and after cancer treatment. The recommendations provided by AICR to reduce cancer risk can provide an excellent framework, but the recommendations may not be appropriate for someone temporarily struggling with eating.

Breast cancer survivors often face increased risk of heart disease due to the side effects of some cancer treatments and other risk factors like high blood pressure and diabetes. This means it is important to focus on eating habits that are both cancer and heart-protective.

Here are some of the foods for which there are too many contradictory messages floating around. Let us handle them one by one.

● Sugar – A diet loaded with high-sugar foods and drinks is not healthful, and studies show it makes maintaining a healthy weight more difficult. But fear that any amount of sugar, even from a piece of nutrient-rich fruit, would fuel cancer growth is not supported by research. A more practical approach that is supported by research would be to: avoid concentrated sources of sugar and big portions. Choosing fiber-rich foods and sources of protein and healthful fat can slow the rise of blood sugar after meals and reduce insulin surges.

● Dairy – Claims that milk and other dairy products contain estrogen that could promote growth of estrogen-sensitive cancers make these foods seem risky. However, overall research suggests that levels of estrogen in milk, especially low-fat or nonfat milk, are too low to have any negative effects among women. Based on Continuous Update Project (CUP) analysis, the most recent AICR Expert Report found evidence was too limited to support any conclusion about dairy products and breast cancer. If anything, the report cited some evidence indicating potential to reduce risk.

● Soy – Hearing isoflavone compounds found in soy called “phytoestrogens”, avoiding soyfoods might seem an appropriate precaution. However, research now shows that earlier studies in which soy isoflavones promoted growth of estrogen receptor-positive (ER+) breast cancer in mice involved much higher blood levels than would result from humans consuming soyfoods. Observational studies link moderate soy consumption with lower breast cancer risk in Asia (where soy foods are commonly consumed throughout life) and consistently show no increased risk for survivors of even ER-positive breast cancer who consume soyfoods. Among women 12 months or more after diagnosis, soyfoods are linked with fewer deaths from all causes, possibly reflecting a heart health benefit.

● Weight and Weight Gain effects are worth considering as one part of eating habit choices for breast cancer survivors. Combined effects of treatment and other factors may lead some women to gain an unhealthy amount of body fat. This can make heart risks like high blood pressure and type 2 diabetes worse, and excess body fat moreover associated with deaths from all causes among breast cancer survivors. Weight gain of more than a few pounds is notable even for women with a weight classified as normal based on body mass index (BMI).

On the other hand, weight loss is not always good. Especially during acute treatment, some people may struggle with eating and have an unhealthy weight loss that includes loss of muscle and other lean body tissue that can be associated with negative outcomes.

Challenge #2: Creating a “New Normal” Lifestyle

Behavior science research has provided plenty of information that helps create long-term healthy eating habits. It would be helpful to draw on them.

● Think small – It might seem that if you want big results, you should aim for big changes. But research suggests that targeting change that is too drastic creates demands on motivation that is not sustainable. In contrast, a small change that allows you to experience success creates positive momentum.

● Watch self-talk – The way we talk to ourselves can be a powerful source of encouragement, or can alternatively perpetuate feelings of being a helpless victim of circumstances. There are many things that are not under your control as a cancer survivor. But self-talk can be a valuable ally to remind yourself that you have choices, and that progress – not perfection – is the goal for a healthy lifestyle.

● Plan for barriers – Fatigue can make preparing meals seem overwhelming. Create a list of meals you or others can pull together using healthful options to make a meal easier, like plain frozen vegetables, canned beans, and frozen or canned fish and chicken. Another barrier for some cancer survivors comes from feeling guilty about changing family meals “just for them.” But healthy can be delicious! Looking through a different lens, you can be proud to bring healthier habits to those you love and possibly without anyone even realizing you are doing it.

● Address what is behind unplanned eating – Sometimes planning nutritious meals does not address the least healthy parts of your eating habits. Urges to eat that have nothing to do with hunger can arise from boredom if you have cut back on activities, trouble sleeping, or stress-related emotions. The acronym POUR can help: Pause, Observe, Understand (skip the judgmental self-talk) and Respond by doing something to change or cope with what is behind the urge to eat. Have a list of ideas ready. Drop the rest – very negative, because this is not a time when you can trust your creativity to come up with good responses.

A Path Forward
After a breast cancer diagnosis, it is understandable to want to “get back to normal.” But it may also be a time to consider what a “new normal” might look like. Unless otherwise advised by your personal healthcare provider, the recommendations from the AICR Third Expert Report, which are based on the big picture from the strongest of today’s evidence, are ideal as a helpful blueprint for creating that new normal.

Forget the urge to do it all or do it perfectly. Pick a target that you want to tackle, start small so that you can feel the joy of success, and talk to yourself with the supportive wisdom you would use when talking to a friend.

Karen Collins

Author: Karen Collins

Karen Collins, MS, RDN, CDN, is AICR’s Nutrition Advisor. Karen is a speaker, writer and consultant who specializes in helping people make sense of nutrition news. You can follow her blog, Smart Bytes®, through her website and follow her on Twitter @KarenCollinsRD and Facebook @KarenCollinsNutrition.

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