As if going through cancer treatment isn't tough enough, can it actually make you fatter? In this episode, we look at the science behind breast cancer treatment, chemotherapy, and their effect on body fat.

Sometimes understanding a situation can make dealing with it a lot easier. You'll also hear about three steps you can take to manage your weight after breast cancer treatment and some straight talk about what that really means.

Resources: 

Energy Balance and Metabolism after Cancer Treatment

An observational study to examine changes in metabolic syndrome components in patients with breast cancer receiving neoadjuvant or adjuvant chemotherapy

Premature ovarian failure and body composition changes with adjuvant chemotherapy for breast cancer

Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer

Read Full Transcript below:

Welcome to the breast cancer recovery coach, I am Laura Lummer, and today's show is Cancer Treatment, and Body Fat Are the odds stacked against you?

This is a subject that is near and dear to my heart and one that I know is a frustration for many women after breast cancer treatment. Today we'll look at what the science tells us about weight gain during and after breast cancer treatment as well as what we can do to keep it in check.

Before I get into that, I want to give a huge thank you to all of you who listen and subscribe to the breast cancer recovery coach, and I have some exciting news that I want to share with you. This week I received an email from a big fan of the show, letting me know that the Breast Cancer Recovery Coach was chosen as the number one breast cancer podcast by women.com a website that describes their mission as being devoted to supporting and promoting women who are creating wonderful and beautiful things.

Thank you MaryJo for Making me aware of this honor and thanks to all of you who listen and reach out to me and take the time to leave positive reviews and ratings for this show you all make this podcast true labor of love for me and I'm honored to be here and humbled by this awesome acknowledgment.

Ok, are you one of the many women, I included who was shocked to find out that you could and probably would gain weight while you were being treated for breast cancer and going through Chemotherapy? We're told that things would go back to normal when your treatment ended but they didn't, and they still haven't? Have you found yourself in tears in front of a physician who says things like, just eat less and exercise more or, one of my personal favorites, well air isn't making your body bigger? 

Ugh! Just thinking about this makes me want to start dropping F-bombs but I'll get kicked off of I heart radio if I do so let me just say… don't ask doctors for nutrition advice...ask for a referral to a dietician or seek out a nutritionist who will actually listen to what you have experienced and ask about what you've tried so far and then work to understand your unique needs and actually help you. 

I would like to dedicate this show to my former primary care physician who told me he had never heard of anyone gaining weight during Chemotherapy.

Well, there was a study published in the Journal of Clinical Oncology in 1990 where 646 women with node-positive breast cancer were followed as they underwent Chemotherapy or chemo hormonal therapy or were only observed and did not receive treatment. What they found was that the premenopausal women who received adjuvant Chemotherapy gained the most weight-averaging 5.9 kg or 13lbs), whereas the postmenopausal women who received adjuvant Chemotherapy gained an average of 3.6 ~8lbs. 

They concluded that, in comparison with node-positive breast cancer patients who did not receive Chemotherapy, and I quote "adjuvant chemotherapy is associated with greater weight gain in node-positive, postmenopausal breast cancer patients; the amount of weight gain appears greater for premenopausal than postmenopausal women..."

You might be wondering why weight gain is more significant in premenopausal women? You're not alone. Many scientists and physicians wonder about this and there seem to be a lot of factors involved. 

In the journal Menopause in 2011 a study was published that looked at chemotherapy-induced ovarian failure or CIOF.

What these researchers observed was (70%) of the women developed CIOF from chemotherapy treatments but that all of the women had significant weight gain after 12 months and this weight gain was due to fat in the trunk and legs but not lean mass.

However, the women who developed CIOF gained an average of 1.8 kg or just about 4 lbs. of fat in the torso while they lost an average of 0.6 kg or a little over an lb. of lean body mass in the same area and this loss of total body lean mass was directly correlated with the decrease in bone density.

The Women who did not lose ovarian function gained an average of 0.9 kg or almost 2 lbs. of fat in their torso but didn't have any significant change in their lean mass.

Here's the kicker, even though both groups gained body fat both groups also had a decrease in energy intake, which means they were eating less.

https://www.ncbi.nlm.nih.gov/pubmed/21814159

 the journal Cancer Epidemiology, Biomarkers & Prevention published a study in 2015 

Women who were diagnosed with breast cancer in the 5 years before they filled out the baseline questionnaire gained an average of 3.81 pounds more than women who hadn't been diagnosed.

Women who were diagnosed with estrogen receptor-negative breast cancer in the 5 years before they completed the baseline questionnaire gained an average of 7.26 pounds more than women who hadn't been diagnosed.

Women who were treated with chemotherapy (with or without hormonal therapy) in the 5 years before they filled out the baseline questionnaire were more than twice as likely to gain at least 11 pounds compared to women who hadn't been diagnosed.

Women who took a statin while receiving Chemotherapy gained about 10 pounds more compared to non-diagnosed women who took a statin, as well as diagnosed and non-diagnosed women who didn't take a statin.

Finally, in 2005 the Journal of Clinical Oncology published the results of the Health, Eating, Activity, and Lifestyle (HEAL) Study,  where 514 women with stage 0-IIIA breast cancer were followed for the first 3 years of their diagnosis and they were monitored for weight and body fat changes. Of the 514 women, 68% gained weight, and 74% gained body fat. The weight changes ranged from 4-10 pounds and the body fat from 2.1 to 3.9%.
https://www.ncbi.nlm.nih.gov/pubmed/2199619

For those who gained fat but didn't gain weight, that's because they lost lean mass or muscle and bone weight while gaining body fat.

I could go on and on about these studies because there are a lot of them out there. But I really wanted to call your attention to them because I want to reassure you that you are not alone. You are not crazy and if you say you're really watching your food intake and you're consistently active, but people don't believe you because you're not losing weight...I believe you. 

So, let's talk about what we can do after breast cancer treatment, Chemotherapy, or the continued intake of aromatase inhibitors which can also have a big impact on weight gain. 

Something that I commonly hear from women is that I don't eat any differently than I did before and I'm still gaining weight. If you are in this camp it may seem super frustrating but as a personal trainer, it makes perfect sense to me. 

First of all, a common side effect of Chemotherapy is cachexia which is wasting of the body tissues. This is what most of us expected to experience when we went into Chemotherapy and what many cancer patients still do go through. Although cachexia can include body fat, it has a big impact on lean body tissue, like a muscle. 

So, if you went through several months or longer of cancer treatment, you were probably less active because you felt like crap, if you had Chemotherapy you probably lost muscle mass which burns more calories than fat. You may have also experienced Chemotherapy-induced Ovarian Failure which means you were put into menopause because of your treatment. 

This can cause a rapid accumulation of body fat in part because of an enzyme that sits on the surface of cells whose job is to pull the fat out of the bloodstream and into the cell.

It's called Lipoprotein lipase or LPL and guess what suppresses its an activity...estrogen. So, if you were premenopausal before breast cancer treatment and then quickly thrown into menopause, one school of thought is that the sudden decrease in estrogen makes LPLs job a lot easier when it comes to pulling fat into fat cells and storing it there.

Now, put all or some of these effects of treatment together and you end up with a slower metabolism and if you're postmenopausal or on hormone suppressing therapies there are even more dynamics at play. In this situation, if you're eating the same way you always ate, you are going to gain weight because your body isn't using as many calories as it used to AND it may not be using them as efficiently as it used to because of all the changes it's been through, potential inflammation (that's a whole other show) and because of prescription drugs that you may need to take.

This doesn't mean you can't lose weight it just means that you may have to try a lot harder and be a lot more consistent to see results.

Step number one...clean up your diet. I know...you hear this all the time but seriously...clean up your diet. Take all the money you don't spend at Starbucks and put it in a jar for the new cute jeans you're going to need. The number one easiest way to clean up your diet is to STOP buying crap! I cannot tell you how often I hear women struggle with late-night snacking or come home late at night junk food binges and I say stop bringing it home...I mean seriously, you're doing this to yourself so own it. You can't eat a bag of chips while you're watching the bachelor if you don't have a bag of chips in the house. This comment is closely followed by, but my husband likes them or my kids like them and guess what...they don't need them either.

If you are going to partake in a food indulgence...which I am a big fan of doing...make it yourself. Take the time to bake something from scratch with or for your family. Then at least you know what's really in it and because it takes effort, you won't do it as frequently and it will be so much more enjoyable when you do.

As cancer survivors, we have to remember that cancer LOVES sugar and cancer cells according to the Warburg theory can not only survive despite fluctuations in oxygen levels, which would cause other cells to die,  but they become "addicted" to glucose. (blood sugar)

So, make your indulgences moderate and worth it.

Step two...strength train. You must rebuild that lean body mass muscle! I know there are a lot of women who just said or thought oh I don't want to get big or look like a man.

Know that I'm rolling my eyes right now. Building muscle to the point where you look like a bodybuilder or a fitness professional takes a lot of work. It requires regular heavy, intense lifting and strict diet protocols. Trust me; if you're not focused on trying to build muscle, you don't ever have to worry about looking like a man or a bodybuilder. I'm just talking about enough muscle to lift your amazon boxes off the porch or pick yourself up off the floor. Enough muscle to boost your metabolism and support you in burning more calories and attaining a healthy weight that makes you feel good and reduces your risk of having a cancer recurrence.

I know there are a lot of young survivors out there, but 95% of breast cancer is diagnosed in women 40 or older, and at this age, you are in or coming into what Ayurveda refers to as the Vata Stage of life—typically beginning at 50.

This is a time where the body itself begins to slow in its natural ability to recover and restore it's a time where physically we begin to experience atrophy, dryness, roughness, and stiffness. 

So, we have to be intentional in maintaining the strength and mobility of our bodies. You can begin and train for an exceptionally long time with just the strength of your body. Exercises like squats, pushups, pull-ups, yoga, and many others that can be done without weight are excellent ways to build lean body mass. I love using the TRX because you can take it anywhere, use it at home, in the park, lots of gyms have them now, and it gives you a lot of range from beginner to advanced exercises. You can find videos of me showing several exercises on my YouTube channel and my website.

Step 3. Be patient with yourself. Try to focus on the journey of creating a healthy lifestyle and not the face of that damn scale. Besides, it's not your weight that matters, it's your body composition, just like the example I gave earlier of women in the study who did not gain weight but did gain body fat. The important thing is to increase lean body mass, muscle, and more bone density and lose body fat. 

PLEASE don't think fat turns into muscle or muscle becomes fat, that like saying fingernails turn into eyeballs. It's not the same tissue, and that does not happen. So, don't give it any thought. I worked with a woman once who had never exercised in her life because she believed that muscle turned into fat, so it was better never to exercise at all because if she stopped, her muscles would become fat. 

If you think this way, please email me so that I can clarify things for you and get your body moving!

If this is all overwhelming and confusing for you, find a professional that you trust, and that listens to your unique needs. Your health and safety are worth the cost of working with someone who knows what they're doing and understands the complications of your situation.

So, March is national nutrition month, and nutrition is one of my FAVORITE topics. Thus, the next episode of the Breast cancer recovery coach is going to be looking at what happens when we bring two popular nutrition plans together to fight cancer and obesity.

You're going to want to hear that one.

If you have questions or comments or something you would like to add to today's show, please find me on Facebook Laura Lummer or Instagram The breast cancer recovery coach and share your thoughts with our thriving community of breast cancer survivors and me. 

I love hearing from you, and I look forward to talking with you again in two weeks until then...move your body and let your lifestyle be your medicine.

RESULTS

The study included 46 premenopausal and 40 postmenopausal women. All individual MetS components and overall MetS score were statistically significantly increased (p<0.01) after Chemotherapy. Bodyweight, percent body fat, fat mass, lipids, glucose metabolism, and inflammation were also statistically significantly increased (p<0.01).

Eighty-six women with early-stage (I-III) breast cancer who were free from clinically diagnosed MetS (defined as three out of five components of MetS) were prospectively tested for the presence of the five components of MetS within one week before initiating and after completing (neo) adjuvant Chemotherapy. The five components of MetS measured were waist circumference, blood pressure, and fasting levels of blood glucose, triglycerides, and high-density lipoprotein cholesterol.