Re: Breast cancer, and seeking advice
 

Another reason those steroids may be worth avoiding. You know..besides the fact that they might interfere with the treatment.
The metformin file keeps-a-building. It being a caloric restriction mimetic seems to fit right into what you are seeking. If you really want to know if the carbs and sugar you do consume are keeping you from ketosis, there are keto strips available at Walgreens in the diabetic supply area. If metabolism and insulin sensitivity is askew, you might be surprised what it takes diet-wise to avoid contributing to the issue. Glycemic index of some fruits can be surprising. If you have Stevia and unsweetened baking chocolate, you can make an extremely low carb chocolate fix with a microwave. Just made some using stevia and Ghirardelli 100% cocoa chips and a bit of peanut butter.
You mentioned previously avoiding green tea because of caffeine. There are plenty of decaf green teas and decaf green tea supplements like Capsibiol: decaf green tea combined with synergizing capsaicin...another supplement thought to regulate metabolism.
I'd be wary of testosterone supplementation since there seems to be some suggestion of androgen receptors in breast cancer.
Glutamine seems to be a supplement offered to cancer patients to offset muscle wasting.
Again, there is suggestion that weight resistance training may help in metabolic matters more than cardio. Jumping rope for a half hour straight seems like a lot...especially on a hard surface (back,joints). Some feel too much excercise can actually trigger inflammation and reduce immune system functioning. (Yes..I can hear the couch potatoes cheering)

Re: Breast cancer, and seeking advice
 

Alaska Angel, you said:
My impression is that this could be why HR positives eventually recur.

Do you believe that all Her2+ eventually occur?

Re: Breast cancer, and seeking advice
 

Hi Marcia,

Thanks for posting the links. I did not know about this specific study but I am glad to see it, and to see more research into endocrinology as the basis or influence for many diseases. I too led a very energetic lifestyle prior to dx, and I think that helped a lot even though my physical endurance and body composition has been changed by treatment.

The endocrinologist I saw was specifically aware of the issue of muscle fatigue. I am glad I was able to make the initial connection with the endocrinologist, with the recognition of the importance of endocrine analysis and the support of both my PCP and the RD.

A.A.

Recurrence and ER status
 

Barbara, I don't claim to know. My personal impression is no. One wonders what brings about recurrence after such long periods of time. I probably should have more specifically said "why recurrence happens years later for those HR positives who do recur". I think they manage to hang in there ,but gradually can lose ground in terms of weight gain because they are handicapped by limited muscle proportion and because even small interruptions result in faster and greater weight gain than in people who have not been treated with chemotherapy, radiation, etc. From what I see, recurrence for them has a much slower progression once it happens, and that offers them the possibility of better and better treatments as more and more is learned.

A.A.

Re: Breast cancer, and seeking advice
 

AA,

Here is a timely study on the subject of exercise and weight gain in aging women from the current issue of JAMA:

http://jama.ama-assn.org/cgi/content...ct/303/12/1173

Physical Activity and Weight Gain Prevention

I-Min Lee, MBBS, ScD; Luc Djoussé, MD, DSc; Howard D. Sesso, ScD; Lu Wang, MD, PhD; Julie E. Buring, ScD

Context The amount of physical activity needed to prevent long-term weight gain is unclear. In 2008, federal guidelines recommended at least 150 minutes per week (7.5 metabolic equivalent [MET] hours per week) of moderate-intensity activity for "substantial health benefits."

Objective To examine the association of different amounts of physical activity with long-term weight changes among women consuming a usual diet.

Design, Setting, and Participants A prospective cohort study involving 34 079 healthy US women (mean age, 54.2 years) from 1992-2007. At baseline and months 36, 72, 96, 120, 144, and 156, women reported their physical activity and body weight. Women were classified as expending less than 7.5, 7.5 to less than 21, and 21 or more MET hours per week of activity at each time. Repeated-measures regression prospectively examined physical activity and weight change over intervals averaging 3 years.

Main Outcome Measure Change in weight.

Results Women gained a mean of 2.6 kg throughout the study. A multivariate analysis comparing women expending 21 or more MET hours per week with those expending from 7.5 to less than 21 MET hours per week showed that the latter group gained a mean (SD) 0.11 kg (0.04 kg; P = .003) over a mean interval of 3 years, and those expending less than 7.5 MET hours per week gained 0.12 kg (0.04; P = .002). There was a significant interaction with body mass index (BMI), such that there was an inverse dose-response relation between activity levels and weight gain among women with a BMI of less than 25 (P for trend < .001) but no relation among women with a BMI from 25 to 29.9 (P for trend = .56) or with a BMI of 30.0 or higher (P for trend = .50). A total of 4540 women (13.3%) with a BMI lower than 25 at study start successfully maintained their weight by gaining less than 2.3 kg throughout. Their mean activity level over the study was 21.5 MET hours per week (~ 60 minutes a day of moderate-intensity activity).

Conclusions Among women consuming a usual diet, physical activity was associated with less weight gain only among women whose BMI was lower than 25. Women successful in maintaining normal weight and gaining fewer than 2.3 kg over 13 years averaged approximately 60 minutes a day of moderate-intensity activity throughout the study.

Author Affiliations: Division of Preventive Medicine (Drs Lee, Sesso, Wang, and Buring) and Aging (Drs Djoussé, Sesso, and Buring), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School; Department of Epidemiology, Harvard School of Public Health (Drs Lee and Buring); Department of Ambulatory Care and Prevention, Harvard Medical School (Dr Buring), and Massachusetts Veterans Epidemiology and Research Information Center, Boston Veterans Affairs Healthcare System (Dr Djoussé) Boston, Massachusetts.

Hopeful

Re: Breast cancer, and seeking advice
 

Hello Angel! Just wondering how things are going for you. Awhile back, I called "Spring!" too early and got yelled at for it, but it seems to me that right now that if spring isn't there, that it's right around the corner and that you can get out and move around a little more and work that body. I know you and Pinkgirl live near each other. Maybe you can get together and do some salmon fishing or kayaking together.

Re: Breast cancer, and seeking advice
 

Hi Bill,

I don't think this year was the best year to try predicting the weather just about anywhere on the planet, Bill, including my little corner of it!

I learned that some assumptions that are commonly made about weight loss aren't true for menopausal women. I learned from my mistake, but by real life measuring. I learned that increasing total calories moderately not only did not work for me, but it put weight that took me years of effort to lose, back on again in just over a year.

With the steady long wet winter I haven't dropped what I had gained by last fall. I have stayed on a restricted diet with 1/2 hour a day of exercise and that kept me from putting on any more weight, which matches unfortunately rather well the results of the study that Hopeful posted. It isn't very rewarding to be hungry so constantly and exercise daily and and still not lose weight.

In the meantime...
For me at least there seems to be some importance to the balance of hormones that is related to the proportion of fats consumed in the diet, and possibly to exercise. Over and over I've had the same odd connection pop up, sort of a very slight Atkin's diet effect (but not anywhere near as high in fats or as low in carbs), where I'm eating a restricted calorie diet and by just slightly increasing the proportion of fat in the diet but still eating some bread and fruits and things like oatmeal, suddenly I've lost a measurable amount of weight without exercising more. Sometimes I wish I could be like a mouse in a study where everything is controlled and measured for a while, and have one factor at a time changed.

Rich's comment is all too true. While I don't have any other chronic conditions except breast cancer and a stubborn disposition, my joints can't take anywhere near the pounding that they could a few years ago, and with less muscle mass, genuine fatigue sets in sooner even with variations of the types of exercise.

Still plugging away,

A.A.

Looking for ideas, suggestions
 

This week I will be aboard a 30 foot sailboat for several days in somewhat cold weather, and not on land.... I have to come up with some way to do the same amount of exercise that I get from walking 3 MPH every day 7 days a week, or else I have to figure out how to reduce my calories from 1,000 calories a day to compensate for the lack of exercise. What do those of you who use ellipticals and who can only eat 1,000 calories a day if you do your full workout do when you are aboard for several days in somewhat cold weather?

Thanks,

A.A.

Re: Breast cancer, and seeking advice
 

AA,
Having lived aboard for a number of years I know your space will be limited,however there are a few things youcando.
Weights (canned vegetables,juices), therapy (resistance) bands and perhaps an audio tape of a mat pilates workout that can be done on the cabin sole. Between the three , raising lowering sails and just keeping your equilibrium on a moving vessel you should be able to stay fit,

Bon voyage!
Marcia

Off and sailing
 

Sounds good and salty! I can do the exercising either before breakfast while the boat isn't moving and the captain is sleeping so that he won't step on me, or else while he relaxes after dinner. I have measured out the foods precisely so that I can't eat more than 1,000 calories a day, and will weigh in when I get back!

A.A.

Re: Breast cancer, and seeking advice
 

Sounds like a fun trip! Would love to know more about the trip and the OVCA early detection trial you are enrolled in..PM me! (P.S. your caloric needs will be higher in colder weather and your internal leveling system is constantly adjusting muscles all over your body to compensate for the motion of the boat through the water...quite a workout in and of itself ;))
Marcia

Re: Breast cancer, and seeking advice
 

Here's an exercise you can do anywhere anytime:

http://www.nsshu.com/front/bin/ptlis...ategory=336045

Click on the characters 'below' number 4 and you will see the demonstration film of the doctor and his patient.

It's basically just standing naturally with legs open to the shoulder width and swing both arms to shoulder height back and forth. On the 5th time, bend your knees while swinging your arms. Be sure to have your fingers open straight while swinging.

The skinny gentleman in the center of the film is a neurosurgeon in Taiwan. He changed his life style and started paying attention to diet and exercise when he was diagnosed with stage III colon cancer 5, 6 years ago.

Have a great trip!

Re: Breast cancer, and seeking advice
 

AA, sounds like a fun trip. I have an idea about the burning calories on your 30 ft boat. I presume this trip will be somewhere in Alaska, and from my memories of our family trip there, it will be mighty cold!! I would imagine just trying to stay warm in the Alaskan climate will burn tons of calories!!

Figuring out alternatives
 

Hi!

Sunshine probably seems pretty ordinary for summer in most places, but here just having an entire week of it was totally delightful. It was cold enough that we wore long pants and fleece jackets even in the sunshine but it felt terrific to enjoy the blue skies day after day with only a few clouds to make the sunrises and sunsets even better. I enjoyed the trip, stuck to my diet, did as much exercise as possible, and had a very good time even though I gained 2 pounds. The most exercise was during 3 hours of very choppy seas, just trying to keep on course and keep my balance. We came back with a nice supply of fresh coho for the freezer and a barbecue! I'm back to daily walking and resistance exercises. I am planning a trip south, with an appointment to see the endocrinologist, as well as have a lab draw and annual TVUS for the ovarian cancer detection clinical trial I have been in for 4 years now.
Thanks for your help!

Alaskaangel

Re: Breast cancer, and seeking advice
 

Hi Lizm100,

I just wanted to post a link about a study that explains the importance of reducing carbs in particular because of its focus on the importance of carbs for certain populations of overweight people, those who have developed insulin resistance.

I think your observation about carbs was correct for me. I have gradually eliminated most foods from my diet that contain any significant amount of carbs because I believe it makes a difference. But the insulin resistance now is so great for me that even that consistent sacrifice is not enough, even when combined with an hour of brisk walking 3 miles per day plus weight resistance exercise, and a caloric limit of around 1,000 calories of low-carb diet per day.

In my personal effort to reach proper weight for me I have made a point of making changes that could be done by the greatest number of overweight breast cancer patients -- which means, no fancy exercise machines and no expensive personal trainers, as well as sticking to exercise that can be done by humans who have to work an 8-hour day as well as handle other ordinary demands. The use of inexpensive weights, Therabands, exercise balls, walking, bicycles, skates, music, etc. all fit that profile and are useful.

However, my metabolism has gradually continued to slow down more and more and now what would have produced weight loss when I initially completed treatment at age 51 is not enough, and even the slightest break from any of it produces significant weight gain, with no weight loss at all despite hours and hours of going hungry and loss of extensive time used for exercise.

http://www.medicalnewstoday.com/articles/192317.php

However, I think this is what is gradually happening to me despite the consistent low-carb, low-fat diet and exercise:

http://www.medicalnewstoday.com/articles/200489.php

"We hope to identify when a person becomes pre-diabetic, before they go on to develop diabetes."

I think I am pre-diabetic. My lab results clearly prove that I am eating a primarily vegetarian, low-carb, low-fat diet. I am getting absolutely consistent significant daily exercise. But the steadily slowing of metabolism with chemopause over the 8 years since diagnosis is resulting in a situation where the insulin resistance is greater and greater and there is no flexibility to drop more calories or add more exercise (or both) on a consistent basis without damage to the joints and support frame.

Primarily I want to point out that I think you are right about carb sensitivity, and why carbs are key for some of us, even though eventually reducing carbs and increasing exercise may not be sufficient.

Thanks

AlaskaAngel

Re: Breast cancer, and seeking advice
 

Just want to add on to the bit above. I have encountered info that metformin reduces Her2. Might be a good option for you for multiple reasons.

Re: Breast cancer, and seeking advice
 

Hi Rich,

Yes, I know. I still do not understand why, when I asked the endocrinologist for a low dose of metformin last year, he didn't go for it and just give me the Rx for it. I think maybe he was distracted at the time by the issues of loss of libido and the reduced effectiveness of the Estring that was resulting in dyspareunia. I was rather annoyed when he suggested just having a tummy tuck... yes, that might provide some better self-image, and it might even reduce the amount of aromatase produced to a minor degree, but I'm interested in all-around weight loss for survival primarily, with appearance being secondary. I will be seeing the endocrinologist again soon and taking a copy of my August annual physical exam done by my NP here (with copy of the exorbitantly expensive labs). I want to try to pin down what the scientific basis is for the calorie recommendation obtained with the MedGem testing and why it was so far off the mark for me. My suspicion is that it is designed to work for the general population but may be actually detrimental for someone who is insulin-resistant or someone who has metabolic syndrome. It is a mystery to me.

In terms of metformin, I would like to have a better comprehension of just how it actually works. If it doesn't "speed up" the metabolism (? does it?) then what does it do, that apparently in addition reduces risk.

A.A.

metformin
 

I'm not sure how metformin reduces the risk....

http://www.medicalnewstoday.com/articles/109698.php

"Metformin has a novel mechanism of action. There have been a number of papers published recently that describe its action through activation of the AMP kinase pathway, which is a cellular energy sensor of the cells and potentially important pathway for the development of cancer," said Jiralerspong.

"The other interesting aspect is that Metformin works by decreasing the amount of insulin- resistance in diabetics and insulin seems to be a growth factor for cancer," said Gonzalez-Angulo.

Re: Breast cancer, and seeking advice
 

Yes...the two functions you mention are considered desirable.

AMPK, the metabolic syndrome and cancer


Reducing recurrence

More on metformin HERE

My 2010 visit with endocrinologist
 

I've seen both the endocrinologist and the OB-GYN. It is always strange to spend so much time and effort making such things happen from my end, only to actually have a max of 15 minutes with them for any examination and discussion. It takes 3 full days of travel by truck and ferries for me just to get there!

Still, I did manage to get an Rx for metformin this time. I also was given the reason I hadn't been given a prescription for it last time I saw the endocrinologist. I hope to try the metformin to see if there is any (and how much) truth behind the reason I was given.

The endocrinologist said that my lab tests last February showed (and still show) that I am not diabetic and I am not insulin-resistant. According to the endocrinologist, those who don't fit into either category do not benefit from use of metformin. I have been given the Rx on the outside chance that I am possibly marginally one or the other (not enough to be detected by the lab tests), to see if the drug helps.

I asked whether the endocrinologist was aware that there are a now quite a few clinical trials that are attempting to determine whether cancer patients who are taking metformin show better statistics than those who aren't. As usual, the professional endocrinologist responded that he was not. There simply is not enough communication happening between Cancerland and the endocrinologic experts with the knowledge to help deal with what is essentially an endocrine disease. They are excluded from the initial analysis and decision-making process of how to treat the disease -- they are not included in our treatment recommendation panels, the "tumor boards".

UNDERSTATEMENT: We need endocrinologists and dietitians who are given equal representation in our decision-making process for the recommendation of treatment of cancer patients.

These trials for the use of metformin by cancer patients are being run because diabetics who happen to be on metformin were showing better statistics than those patients who were not on metformin. Given that the endocrinologist believes that metformin doesn't work for those who are not diabetic or insulin resistant, the trials might end up just showing that people like me simply don't benefit from taking it -- and that only those with diabetes or insulin resistance do benefit from taking metformin.

I'm not a scientist but in reading some of the discussion about the basis for the metformin trials, it sounds to me like there is more to it than that, and it might apply to some subsets of bc like HER2, but not to other subsets.

The question is, if my metabolism is neither diabetic nor insulin-resistant, and I am not experiencing all of the key symptoms of either metabolic syndrome or PCOS, what then is resulting in consistent slow weight gain for me regardless of disciplined dieting and exercise? If I am none of the above, what am I? Should there be another, new category of metabolically disabled patients for those like me that hasn't yet been created, to help those like me?

From what I can tell, postmenopausal breast cancer patients are sort of metabolic lepers. We are told to diet and exercise, but never given any clear diagnosis or reason other than that we are now "postmenopausal" and thus our "metabolism has slowed down". We are not given clear targets for diet or exercise. I have been fumbling around trying to figure out what amount of diet and what amount of exercise are needed for me to be able to consistently lose weight.

As I become more and more postmenopausal, I have become more and more metabolically disabled. Most disturbingly, the experts I have sought help from are not working as an integrated group to help me with this. Cancerland is still focused almost entirely on the initial treatment, leaving the patient (me) to stumble along on my own in trying to avoid recurrence -- as if recurrence is far less important than initial treatment. To me, this is precisely WHY there continues to be the belief that once one recurs one will not become permanently NED. The only therapy that is clear (and only for those who happen to be HR+) is the stern recommendation for the use of an aromatase inhibitor. Aromatase inhibitors are oncology's somewhat dubious "answer" to the problem of greater fat accumulation in our society of overweight people and in particular, postmenopausal metabolic disability. A far better answer is to get rid of the fat, period.

The answer to the question "what am I, if I am not insulin resistant or diabetic and do not have metabolic syndrome?" was not provided to me. I may decide not to start the metformin until I am back home where my schedule and diet and exercise are a little easier to control and maintain, and because getting a prescription that is started in the Lower 48 then transferred to Alaska may be difficult. But the prescription is at least a chance to get out of the dead end where I've been, consistently exercising and dieting and still slowly gaining weight and increasing my risk of recurrence.

I do have to say that I think it is extremely short-sighted to encourage hormone receptor positive stage I breast cancer patients aged 50+, who are generally at low risk, to go through all the expense and ugliness of treatment only to end up fighting inevitable weight gain that is directly due to chemopause long before a recurrence would occur without "throwing the book at it". Being both HR+ and HER2+ with access to trastuzumab as an early stage breast cancer patient may be a golden opportunity that is being wasted. These are the patients who were not included in the trastuzumab trials. It is quite possible that these patients might do better with trastuzumab alone, and that they may be actually throwing away a chance to liver longer. than those who do standard treatment.

Additional support link:

The majority of breast cancer patients are over 50 at time of diagnosis and are postmenopausal. Since weight gain is a risk factor and the majority of patients gain weight with treatment, one has to consider whether those who are least at risk (early stage breast cancer) will end up cancelling out the benefit they receive from doing chemotherapy because of the added risk they then have due to the weight gain that comes with doing chemotherapy. This is especially true because most breast cancer patients are over 50 at time of diagnosis, and more of them are postmenopausal.

http://www.newswise.com/articles/met...nopausal-women

AlaskaAngel