Breast Cancer Prevention is Just a Healthy Lifestyle…
The longer I practice medicine, the more often I return to the basics. Regardless of a patient’s diagnosis, the foundations of health are always going to help someone feel better. Sleep, healthy food, moderate exercise and stress reduction are all important factors to consider in a treatment plan. Yesterday I had the pleasure of attending a brief educational event with a physician who is an expert in the field of breast cancer, Dr. Lise Alschuler. There was so much good information there that I want to pass along to you all. Because I tend to be a minimalist and a skeptic when it comes to heavy supplementation, I really appreciated how much time she spent focusing on lifestyle factors as prevention. For many disease states, including this one, lifestyle factors are far more effective than adding supplements into the diet. They are also less expensive!!
I was surprised to learn that the biggest impact of supplements and lifestyle changes was seen on the time period after you are diagnosed with breast cancer. This means survival. I think this is powerful because we often focus on breast cancer prevention, when in fact breast cancer is very common. In reality most women do not die from breast cancer. The five year survival rate for breast cancer is around 90% for all types combined. It is much higher for localized masses that have not yet spread. So the issue is not just how to prevent cancer, since cancer is a natural part of cellular division, but how do we improve outcomes so that cancer is no more than a minor lifeevent if we are diagnosed?
What You Eat
All the boring basics are statistically preventative for breast cancer. What you eat determines what type of tissues you have in your body. A Mediterranean-style diet (high in plant-based foods, high in legumes, high in unsaturated oils, low in processed foods) has been shown to reduce your risk of dying from breast cancer by 57%. You can easily move in this direction by adding more lightly cooked vegetables to your diet, and by eating one meal per week that is made up primarily of beans or lentils.
Eating highly processed food is associated with a huge increased risk in breast cancer. Processed foods are things that dissolve more easily into your bloodstream because the fiber has been removed from the food. Think about the difference between brown rice and white rice. Brown rice has more fiber, so white rice is more processed. Think about a stalk of wheat growing in a field versus white flour- the flour is more processed. So more white foods typically indicate that something is more processed. Anything containing a lot of sugar such as soda, candy, etc will also contribute to your intake of processed foods. There is a direct relationship between intake of processed food and risk of breast cancer diagnosis. You don’t have to be perfect with your diet! Beginning to back off of highly processed and sugary foods will lower your risk proportionally.
Another way to lower this risk is by increasing fiber intake. There is a clear association between HIGHER fiber intake and a LOWER risk of breast cancer. I use a lot of fiber in my practice because it is so good at supporting your body’s ability to get rid of waste. There is a ton of buzz about “toxins” and “detox” on the internet, but did you know that your body actually does an excellent job of getting rid of toxins on it’s own? It’s called your digestive system! When you take additional fiber, you are binding the waste products that your liver is dumping into your digestive system.
My favorite fiber product was just reformulated and we have it in stock. One scoop daily provides you with five grams of soluble fiber (associated with reduced risk of breast cancer) and five grams of insoluble fiber (great for digestion and helping probiotics set up camp in your gut). See the link below.
How You Move Your Body
Many of us are more sedentary right now since we are working from home. Some of us have been lucky enough to cut out the commute and are using that extra time to get out or get moving. The data on exercise and cancer prevention is clear across the board- in fact I would argue that nearly every single condition I treat in my practice is better with moderate exercise. And it’s free!
Dr. Alschuler mentioned one study demonstrating that 2-3 hours of brisk walking per week reduces your risk of dying from breast cancer by 31%. Exercise can your risk of getting diagnosed with breast cancer, and also improves outcome even if you have never exercised prior to diagnosis. 2-3 hours of walking per week really isn’t much. The more exercise, the more risk reduction we see.
One note about exercise: it is really important to vary your type of exercise, particularly as you get into menopause when your risk of breast cancer is much higher. I really start to focus on this idea with my perimenopausal patients because the things that are successful for maintaining weight when we are younger don’t always work as well when we get further into our 40s and 50s. I really like to see my middle-aged patients incorporate weights into their workouts, and to try new things. When you keep your exercise varied, your body has less of a chance to adapt metabolically and I see much better weight management. Doing the same cardio routine over and over tends to be less effective at preventing weight gain in menopause, though it is still excellent for your cardiovascular health.
One of the most frustrating things that I learned is that after menopause, gaining weight increases risk of being diagnosed with breast cancer by 25%. I find this annoying because it is really hard to prevent weight gain in menopause, when most women gain an average of five pounds. I hate to focus on weight because it can be a very frustrating aspect of menopause with no magic answer. I want my patients to feel vibrant and strong, and the good news is that often body mass mirrors these good feelings. But it does appear that gaining weight in menopause makes your risk of cancer go up, so even more reason to get out and get moving. If you are struggling to keep weight off, or if you feel like the things you are doing are no longer working for your metabolism, we can troubleshoot your routines with you. Please use this link to schedule an appointment.
How You Sleep
Similarly frustrating, many women really struggle with sleep once they go into menopause. It is probably the most common menopausal complaint after hot flashes. Sleep is essential for so many bodily functions that this is one of the first things I like to see improve when women transition into menopause. We all know that it can make or break your mood, energy, and metabolism. But now we are seeing that a lack of sleep can also increase your risk of breast cancer.
Dr. Alschuler mentioned a study that looked at the time spent asleep. Less than 6 hours of sleep nightly for postmenopausal women was associated with a 98% increase in risk for breast cancer. (This doesn’t mean your risk is then 98% it means basically that you are twice as likely as someone sleeping more than 8 hours per night to be diagnosed with breast cancer. Sometimes these numbers get confusing.) This makes me want to make everyone’s sleep perfect! It’s a tall order but here are some of my favorite tools to get the job done:
For falling asleep: I love melatonin and Sleep Blend. For staying asleep I love Cortisol Manager, SleepBlend, and AlphaGaba Pm.
If you like to drink alcohol, don’t shoot the messenger. I am a drinker not a judger, but like many women who are middle-aged I find that alcohol disrupts my sleep and my mood more and more as I get older. The research is very clear that alcohol intake contributes tremendously to your risk of breast cancer. Go get a mason jar or a measuring cup and fill it to the four ounce mark. This isconsidered ONE SERVING of wine or beer. Two to five drinks per day (basically one large glass of wine, or 8 ounces) increases risk of breast cancer by 40%. One drink per day (real drink, four ounces) only increases your risk by 6%, so if you are truly a casual one-a-day drinker, there isn’t reason to stop unless it disrupts your sleep.
One of the first things we try when a woman who likes to drink isn’t sleeping well in menopause is to aim for three days per week drinking alcohol, but try to go four days per week without. Often the result is that a person can clearly see how she feels on alcohol and off of it. The goal is not to eliminate everything pleasurable in life, but to find out how much you actually need to enjoy it. Many of us are overindulging these days due to lockdown boredom. This is a good time to reevaluate our relationship with alcohol and how it serves us.
Supplements for Prevention
To be honest there are very few that I would include here, because the risk reduction is so low for most items that it isn’t really worth it to buy and take every day for years on end. As stated above, dialing in your stress, exercise, sleep, and diet will really go much further for prevention.
Vitamin D3 is the main exception. D3levels are very clearly associated with breast cancer. High vitamin D status, which means levels over 60ng/mL is associated with an 82% reduced risk of breast cancer. Conversely, low Vitamin D status under 20ng/dL is associated with a larger tumor size at diagnosis and an increased risk of death once diagnosed. I don’t know why, for the love of all things healthy and holy, insurance will not cover Vitamin D testing for average people, but I still feel it is worth it to assess this in all patients. I do so much work with mental health and I also see that low Vitamin D status can really worsen outcomes for my patients with depression, so why not get it checked and get it up?
Breast cancer prevention appears to go hand-in-hand with a healthy lifestyle. While new and interesting supplements come and go, there is no pill that is a substitute for good sleep, moderate exercise and a healthy, nutrient-rich diet.