Nutrition, Exercise and Healthy Living

Your body will undergo many changes and stresses during your treatment and recovery period. Leading a healthy lifestyle and knowing what to expect will help make your journey easier.

Wellness and exercise

There’s a lot we don’t know about breast cancer, but mounting evidence suggests that exercise may reduce the risk of cancer reoccurring and make a real difference in survival.

Exercise can be a special tool at your disposal to empower you. Exercise enhances well being and makes you feel good. It is a tonic for the mind and body and can help you avoid or reverse weight gain. Even moderate amounts of regular exercise – a half-hour walk every day or a few laps in the pool – can make a difference to your physical and emotional health.
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Exercise tips

  • Exercise for at least two, but preferably four, hours a week. You can start with 20 minutes of walking, biking, swimming or using a treadmill. These are continuous movement aerobic exercises that improve mood, reduce hot flashes, prevent constipation, improve cardiovascular fitness and promote sleep.
  • Carry a water bottle when exercising and drink plenty of water. Wear comfortable shoes, and be aware of posture and breathing. Start slowly and gradually build up your duration and intensity.
  • Consult with your doctor before starting vigorous
  • exercise regimens if you are undergoing chemotherapy, have just had breast surgery, or have swelling of the surgery side.

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Nutrition

Good nutrition is a vital part of cancer treatment. Healthy eating can improve your strength and energy levels, increase tolerance of side effects, help to maintain a healthy weight, decrease risk of infection, and promote healing. Eating the right foods before, during and after treatment is important for recovery. Be aware that your treatment plan may affect your appetite.

Basic dietary guidelines

  • Eat less fat: A low-fat diet is a safe, proactive step you can take to improve your health. Avoid saturated fats, polyunsaturated and hydrogenated oils, and transfats. Choose monounsaturated fats, like olive oil and canola oil. Decrease your intake of meat, and emphasize lean poultry and wild salmon, which is rich in omega-3 fatty acids. Dairy products should be non-fat with no hormones added.
  • Control caloric intake: Fat-free does not mean calorie free. Decrease your intake of refined carbohydrates, such as candy, cakes, juices and sodas. Your scale is the best indicator of whether you are eating too many or too few calories.
  • Eat fiber rich foods: Eat 25-35 grams a day of fiber from whole grains, oats, wheat, barley, rye, beans and/or legumes. Look for cereal that contains more than five grams per serving of fiber. Increase your fiber intake slowly to prevent bloating.
  • Eat fruit and vegetables: Strive to eat a wide variety of five fruits and five vegetables per day, especially broccoli, cabbage and cauliflower. These foods are rich in antioxidants and phytochemicals, which may help strengthen your immune system.
  • Eat adequate protein during treatment: Protein is the building block of your cells and vital for the repair of healthy tissue damaged during treatment. Excellent protein sources include non-fat and hormone-free dairy products, skinless poultry and fish. Balance is the key. While soy foods are high in protein, it is recommended that women with breast cancer limit their intake to about one serving a day. If you use protein powder, choose a non-soy source such as whey protein.

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Water and health

Drinking enough water is essential to health. Eight to ten glasses of water a day is recommended for keeping the body well-hydrated and for preventing constipation. You must drink more water to replace the water you lose if you exercise, sweat, have hot flashes, night sweats, a fever, diarrhea or vomiting. Check your urine color. If you are drinking enough water, it should be a pale yellow and not a concentrated dark yellow.

Good fluids to keep you hydrated include water, herbal tea, non-fat milk and diluted fruit juices. Coffee, black tea, chocolate, high fat foods and caffeinated soda can cause you to become dehydrated. Drink alcohol in very limited amounts, if at all. Moderate drinking is one to two alcoholic drinks per week.
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Menopause

  • Most women who are 40 years or older will stop their menstrual periods while on chemotherapy. Only five to 25 percent will resume regular menstrual periods after finishing treatment.
  • Approximately 40 percent of women younger than 40 will stop their menstrual periods while on chemotherapy. About half will resume their regular cycles after finishing treatment.
  • The symptoms of treatment-induced or medical
    menopause are the same as natural menopause. However, they may be more severe since treatment-induced menopause comes on very quickly. This is particularly true for younger women.
  • Common menopause symptoms include:
    • Irregular periods
    • Hot flashes, a sign that the ovaries are no longer producing enough estrogen
    • Problems with your vagina or bladder as tissues in these areas become thinner and drier
    • Lack of interest in sex
    • Fatigue and sleep problems
    • Memory issues and other problems, such as depression, mood swings and irritability
    • Weight gain
  • There are a variety of non-hormonal approaches available to treat menopause symptoms, including:
    • For relief of hot flashes, avoid alcohol and caffeine. Wear layered cotton clothing. Try splashing cool water on your wrists. Some women find that Vitamin E eases hot flashes.
    • Try drinking warm milk, chamomile tea or teas that contain valerian at bedtime to help you sleep better.
    • Eat a well-balanced diet low in fat and high in fiber. Adding flaxseed, tofu and miso may provide additional relief, as they are dietary sources of estrogen. These are called phytoestrogens, and their safety should be discussed with your physician. Try different relaxation techniques – such as visualization, deep breathing, massage or acupuncture – to help deal with irritability, stress or anxiety.
    • Water soluble lubricants can help relieve vaginal dryness.
    • Drink lots of water, wear cotton underwear, and urinate frequently to prevent bladder infections. Kegel exercises will also improve your bladder control.
  • Consult your health care provider before taking any additional medications or supplements and to discuss appropriate treatments for you.

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Osteoporosis

Osteoporosis is a condition common among postmenopausal women and is characterized by a decrease in bone mass and density. This causes the bones to become more fragile and increases the risk of hip and other fractures. Estrogen has a protective effect on bone; however, women produce less estrogen after menopause. Reduced levels of the hormone can trigger bone loss.

Women who have been treated for breast cancer may also be at increased risk for osteoporosis for several reasons:

  • Loss of ovarian function due to surgery or chemotherapy will cause estrogen levels to drop.
  • Chemotherapy may cause bone loss.
  • Breast cancer itself may actually stimulate the production of osteoclasts, cells in the body that break down bone.
Osteoporosis risk factors
  • Family history of the disease
  • Being postmenopausal or having had early menopause
  • Abnormal absence of menstrual periods
  • Prolonged use of certain medications, such as glucocorticoids
  • Low calcium intake
  • Lack of physical activity
  • Smoking
  • Excessive alcohol intake
Management strategies
  • Nutrition: a well-balanced diet rich in calcium and vitamin D is important. Talk to your doctor about calcium supplements and whether you need them to meet your daily calcium requirement.
  • Exercise: the best exercises for your bones are weight-bearing exercises that force you to work against gravity, such as walking, stair-climbing and dancing.
  • Smoking and alcohol: smoking is bad for bones, as well as the heart and lungs. Smokers may actually absorb less calcium from their diets. Alcohol can also negatively affect bone health. People who drink heavily are more prone to bone loss and fracture.
  • Bone density testing: bone mineral density (BMD) tests measure bone density in various sites of the body. These tests can detect osteoporosis before a fracture occurs. They can also predict your chance of having a fracture in the future.
  • Medication: there is no cure for osteoporosis. However, medications are available for the prevention and treatment of the disease.
For more information, contact the National Institutes of Health, Osteoporosis and Related Bone Diseases National Resource Center at 1-800-624-BONE or OsteoInfo@osteo.org.
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Follow-up Care

  • It is very important to go to all scheduled follow-up appointments once your treatment is complete. Your doctor will perform a physical exam, ask you about any problems or symptoms, and order laboratory or imaging tests as needed.
  • You should never hesitate to tell your doctor about any symptoms or side effects you have, especially those that concern you.
  • Your follow-up appointments will probably be scheduled for every four to six months in the beginning. The longer you are cancer free, the fewer appointments you need. After five years of being cancer free, you will probably see your doctor only once a year.
  • You will need yearly mammograms on the noncancerous breast and the cancerous breast if it was treated by lumpectomy.
  • You should have yearly pelvic examinations if you are taking Tamoxifen due to the increased risk of uterine cancer.
  • You should consider testing your bone density if you are taking an aromatase inhibitor, since it blocks estrogen in the bones.
  • Blood tumor markers, liver function tests, bone scans and chest x-rays are usually not needed unless your symptoms or a physical exam suggest something unusual.

The information in this section is not meant to replace the individual attention, advice, and treatment plan of your oncologist and medical team.
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