A cancer experience is the definitive existential crisis. It shakes us out of a comfortable fog of illusion, which allows us to maintain a more-or-less intellectual perspective on life’s endpoint. It plunks us down in a harsh landscape that offers an all-too-close and personal view of the possibly sooner, not later reality of our physical death.
So when the rigors of cancer treatment have been endured and are behind us, and we are back in the land of the living, it’s understandable to just want to put the whole painful, terrifying experience in the past and get back to “normal life.” As David Servan-Schreiber, M.D., Ph.D. relates about his own post-cancer stance in his book, AntiCancer, “Like most people who have had a first alert with cancer and who have pulled through, I chose to treat my illness like a bout of pneumonia or a broken bone.” But ask a breast cancer survivor if she’d prefer a past history of a wrist fracture or cancer, she doesn’t need to think twice about the answer. As Servan-Schreiber goes on to say, “I had never considered that if I’d had a cancer… I needed to take charge of myself to limit the risk of relapse.”
Unlike acute illness or physical trauma, a breast cancer diagnosis casts a long and threatening shadow into the future. This shadow is the risk of recurrence and no matter how we may try to repress or ignore it, it is always with us. The risk of recurrence and the fear that it brings can be lessened by focusing the light of our awareness and intention on actively creating wellness in our bodies, minds, and spirits. As Lise Alschuler, N.D. and Karolyn Gazella note in their inspiring book, The Definitive Guide to Thriving After Cancer, “In an ironic twist of truth, this illness – and the fear that it evokes – can teach us how to embrace life, to meet it head on, and to live with vitality. The experience of confronting cancer can teach us how to reduce the risk of it returning. It can be a bridge to deeper and greater health.”
It’s not a coincidence that the same factors that prevent breast cancer also promote breast health and reduce the risk of cancer recurrence. It’s encouraging that these anticancer strategies are neither exotic nor are they difficult to implement, with a little knowledge, a commitment to healthy change, and a bit of persistence. They also happen to be in alignment with current health recommendations for the prevention of many chronic diseases. Thus, the same action plan that helps to protect against breast cancer recurrence is also a plan for wellness and vitality throughout our lives.
For breast cancer survivors, hormonal balance and a lifestyle that promotes it is paramount. The anti-inflammation and immune system-modulating hormone cortisol, the blood sugar regulating hormone insulin, sex hormones, and hormone-like compounds in the environment (so-called endocrine disruptors) must all be factored into a post-cancer plan for breast health.
Fit vs. Fat
Maintaining a healthy weight is one of the most broadly supportive strategies for breast health. Obesity has been associated with increased overall cancer risk but specifically with increased risk of breast cancer and breast cancer recurrence. This may have to do with negative factors associated with being overweight such as: increased levels of insulin and insulin-like growth factor 1 (IGF-1) (both are associated with increased breast cancer risk), higher levels of more dangerous, cancer-promoting forms of estrogen (such as 16-alpha-hydroxyestrone), and the estrogen-producing effects of fat cells.
Other possible factors influencing this obesity-breast cancer association may have to do with what tends to be undersupplied by a lifestyle associated with excess weight such as the antioxidant-rich and hormone-balancing benefits of a diet rich in fiber, colorful vegetables and fruits, and the immune-supportive, stress hormone-modulating, anti-inflammatory effects of regular exercise. A 2014 study found that breast cancer survivors were more likely to gain weight in the first five years after treatment than cancer-free women. Focusing on attaining and maintaining a healthy weight is especially important to offset this tendency.
Too often, the prospect of getting fit and making the positive lifestyle changes that come with it are perceived as an overwhelming and complex undertaking, such that inertia takes over and we remain stuck in our unhealthy habits, feeling powerless to move ahead. Habits come to exist because they are comfortable to us, and we equate healthy change with deprivation, self-denial, and discomfort. But authentic transformation is not about dramatic change, nor is a restrictive “boot camp” mentality. Positive change is about enrichment – taking small steps that generate vitality, wellbeing, and peace of mind and spirit. The “side effects” of these steps include lower body fat, improved sex hormone, stress hormone and insulin balance, reduced inflammation, and a stronger immune system. All of these factors protect against breast cancer recurrence and improve the quality of our lives. Some measures to a healthier lifestyle include:
1) Eat More Plants:
A plant-based diet emphasizes vegetables, fruits, beans, nuts, seeds, whole grains, and healthy oils (such as olive oil). As a result, it is lower in animal sources of protein (meat/ fowl/ fish) and saturated fat than the usual western diet, and contains minimal amounts of processed or refined sugars and flour products. An easy way to move toward this way of eating is to start by spending more time shopping at your local farmer’s market, or in the produce section of your grocery or health food store. Choose appealing, colorful fruits and veggies to bring home and prepare (organic choices, as much as possible, are especially important for breast health). Salads, soups, and smoothies are easy and tasty ways of slanting meals toward the plant kingdom. Toss some beans on a green salad, snack on a few pecans or almonds between meals, have lentils as a side dish with your roast chicken, have an entirely plant-based meal a couple of times a week. Don’t forget the mushrooms! Mushrooms, in addition to their immune-strengthening benefits, have been shown to inhibit processes associated with breast cancer development. If you need inspiration and support for making healthy cooking a delicious habit, use some of the many available cookbooks and online sources (see resources).
A Side Note On Plant-based Diets:
One of the best reasons to include more of the plant kingdom in your diet is that in doing so, you are not only feeding yourself, you’re also providing nourishment for a whole micro-universe of microbes in your digestive tract. They eat what we eat and it’s no coincidence that a plant-based diet supports healthy populations of beneficial probiotic organisms. Thanks to emerging research displaying the importance to human health of the micro-biome (the trillions of microbes in the human digestive tract and their genetic material), significant connections are being identified for breast health and the health of the digestive tract. Just a few of the ways that digestive health influences breast health:
- The presence of probiotics (healthy bacteria) in the digestive tract has been shown to “prime” the immune system, to empower it throughout the body. In fact, the majority of immune activity takes place in the digestive tract, through an arm of the immune system called the GALT (gut associated lymphatic tissue) or MALT (mucosal associated lymphatic tissue). This speaks to the central role in immune regulation played by the gastrointestinal tract.
- A well functioning digestive tract allows us to obtain optimal nutrition from the food we eat. Yes, “we are what we eat” but as importantly, we are what we digest and what we absorb. The best diet cannot provide optimal nourishment if food is not broken down properly or is not absorbed well.
- The balance of bacteria, yeasts, and other microorganisms in the digestive tract influences our health for better or worse. For example, elevated levels of the enzyme beta-glucuronidase, which are associated with bacterial imbalance, have been shown to increase the risk for breast and other hormonal cancers. It does this by reactivating hormones and toxins that have been neutralized and released into the small intestine, whereupon they are reabsorbed into the blood stream to exert their toxic effect on tissues once again.
2) Move Your Body:
If you’re like the man who said, “Whenever I feel the need to exercise, I lie down until it goes away,” then, may I have your attention, please? Research shows that exercise has particular benefits for breast cancer survivors. There is ample evidence for improvement with regular exercise in many of the biomarkers associated with breast cancer. The level of exercise sufficient to confer protection may be less than you’d think: a 2011 study at the Yale School of Public Health looked at 4,463 women diagnosed with invasive breast cancer and found that those who exercised for the equivalent of three hours per week by fast walking (that’s 30 minutes, six days a week) had significantly lower mortality from breast cancer and other causes than inactive women. So find a walking buddy (human or canine), a dance, yoga, or Pilate’s class, a swimming pool – find a form of movement you enjoy – and get into the healthy habit of exercise.
3) Cultivate Inner Peace:
Cortisol, a hormone secreted by the adrenal glands, helps us to maintain equilibrium in the face of stress. When cortisol stays elevated for extended periods, however, it has negative effects on the body and mind. Immune function is suppressed, and sleep quality and neurotransmitter balance are impaired, affecting our natural rhythms of rest, recovery, positive mood and energy.
The interconnections between mind, body, and spirit have been a focus of attention in the cancer research community in recent years, leading to the awareness that states of serenity, a sense of life purpose, interconnectedness with others, and balanced optimism play important roles in cancer prevention and survival. There are many ways to access the calm and peace within: connecting with a spiritual community in alignment with your beliefs, going on retreat, walking in nature, mindfulness and meditation practices, performing acts of service. If the inner life has not beckoned you in the past, let your cancer experience serve as an invitation to strengthen your connection with the infinitely rich and profoundly reassuring world within and beyond yourself.
4) Clean Up Your Act:
Pesticides and food additives, household cleaning products, cooking and food storage practices, personal care products from perfume to sunscreen can expose us to chemicals with estrogen-like effects, the so-called endocrine disruptors. Resources such as the non-profit, Environmental Working Group (www.ewg.org) provide guides to “detoxifying” your personal environment. Making the shift to “greener” choices reduces the burden of estrogen and estrogen-mimics in the body and their potential for cancer-promoting harm.
5) Supplemental Allies:
Although healthy lifestyle steps are essential elements of a breast health plan, supplements can also play a strong supporting role, supplying nutrients depleted by cancer treatment and augmenting cancer-protective body functions. Basics could include an activated B-Complex vitamin, a high-potency multiple vitamin and mineral supplement, a molecularly distilled, sustainably sourced and triglyceride-bound Omega-3 marine oil, a probiotic formula which uses clinically effective strains and whose potency is guaranteed through the time of expiration, and vitamin D (monitor your serum levels through testing at least twice a year).
Additional supplements for consideration that have encouraging scientific support for preventing breast cancer recurrence include:
- SGS: Sulforaphane glucosinylate is a compound found in members of the brassica family of vegetables (broccoli, Brussels sprouts, cabbage, cauliflower, bok choy and others). It is concentrated in young broccoli sprouts and has been studied for more than two decades for its anticancer effects. A recently published study performed at the University of Michigan on cultures of human breast cancer cells found that sulforaphane targeted and killed breast cancer stem cells, a small number of cells within tumors, which drive the growth and spread of cancer. Because tumor stem cells permit cancers to recur after treatment and metastasize, and because they are so small in number (approximately one cell in a million is a stem cell), the effectiveness of sulforaphane in finding them, reducing their number, and their ability to create new tumors without affecting healthy cells, is a truly groundbreaking finding. SGS supplements have been available several years; high quality products are standardized to provide about 50 mg. of SGS per capsule from 500 mg. of broccoli sprouts and/or seed. Of course, you can also grow your own sprouts from organic seeds and enjoy an ounce or two a day on salads or as a snack.
- Curcumin: Like SGS, the anticancer benefits of this deep golden-hued component of the spice turmeric, found in curry, have been researched for decades. Curcumin has also been receiving recent attention for the ability to target and kill breast cancer stem cells. Since bioavailability (its ability to be absorbed by the body) has been an issue, time-released and water-dispersible formulations are options.
- EGCG: Epigallocatechin gallate, is a polyphenol compound found in high amounts in green tea. Studies supporting its protective benefit for breast cancer recurrence have evaluated the effects of green tea as a beverage, but organically sourced, highly concentrated supplements are an alternative, particularly if you’re not a fan of the taste.
To Survive, Or Thrive?
In their excellent “Five to Thrive” multimedia initiative, Alschuler and Gazella (both cancer survivors and “thrivers”) have shifted the focus of life after cancer from mere survivorship to a more proactive goal of thriving, of creating an internal environment that is not just resistant to recurrence, but is nourished and empowered on every level for the healthiest life possible.
The Five to Thrive Plan is based on the large and ever-increasing body of evidence that the direction of movement along the continuum from health to cancer (and back to health) is strongly influenced by specific aspects of body system function. Alschuler and Gazella provide a five-point plan for balancing these functional states, cite the scientific basis for each strategy, and supply simple, concrete action steps for implementation, with coaching tips for moral support. Their book, online magazine, website, and radio program serve as a comprehensive source of ongoing, up-to-date, expert guidance for moving from survivor to thriver.
Are You Cured? Or Are You Healed?
Naturopathic medicine has long made a distinction between the concept of cure and that of healing. Cure implies that the problem at hand has been dealt with and the level of health enjoyed previous to diagnosis has been regained. In contrast, to be healed means that the limitations and imbalances that promoted illness have been resolved and the person is healthier than they were before. I have also come to believe that healing requires us to participate in this process in a way not necessarily required by the experience of cure. Authentic healing acknowledges and honors the many facets of healing, empowers us to positively influence our experience of life’s journey, and affirms our innate ability to align with the power of healing within us all. Healing makes us whole.
Resources:
Anticancer: A New Way of Life, by David Servan-Schreiber, M.D., Ph.D.
The Definitive Guide to Thriving After Cancer, by Lise N. Alschuler, N.D., F.A.B.N.O., and Karolyn A. Gazella
Clean, Green & Lean, by Walter Crinnion, N.D.
Crazy Sexy Kitchen: 150 Plant-Empowered Recipes to Ignite a Mouthwatering Revolution,by Kris Carr
The China Study Cookbook: Over 120 Whole Food, Plant-Based Recipes, by LeAnne Campbell and Steven Campbell
Forks Over Knives The Cookbook: Over 300 Recipes for Plant-Based Eating All Through the Year,by Del Sroufe and Isa Chandra Moskowitz
Food As Medicine, by James Gordon, M.D.
www.ewg.org and their new report, “Rethinking Carcinogens,” for consumer guides to a less toxic life
www.getsomeheadspace.org for download of a fun, user-friendly mobile app for learning and practicing mindfulness meditation
Debra Gibson, N.D. practices naturopathic family medicine in her Ridgefield, Connecticut office. She can be reached at (203) 431-4443 or at [email protected]. Her blog is www.debragibsonnd.com.