Breast cancer survivorship is a journey that extends beyond treatment, and diet plays a crucial role in long-term health and well-being. This article provides a detailed overview of dietary recommendations for breast cancer survivors, incorporating the latest research and expert opinions to empower individuals to make informed choices.
The Importance of Diet and Nutrition After Breast Cancer
Diet and nutrition are key aspects of good health for everyone. But for people living with cancer, it can mean healthier years ahead. Making the change to a balanced diet and healthy lifestyle isn't always easy, especially when breaking lifelong habits, but slow and consistent changes can help.
"Cancer is a teachable moment and an opportunity to work with cancer patients when it comes to nutrition," says Dawn Mussallem, D.O., a Mayo Clinic general internal medicine physician and cancer survivorship specialist. "I find that living a healthy lifestyle focused on nutrition and physical activity during and after a cancer diagnosis can be empowering and give patients control over their disease. It can also improve cancer outcomes, reduce the risk of secondary cancers, and improve quality of life during and after cancer."
For cancer survivors, the same diet recommended for cancer prevention is advised: a low-fat, whole-food, plant-predominant diet rich in colorful vegetables and fruits, whole grains, beans, and nuts. This dietary pattern is essential for optimal health and is good for prevention, treatment, and reversal of some chronic diseases, not just cancer.
Weight Management: A Cornerstone of Survivorship
Maintaining a Healthy Weight
Women who are overweight or obese (and those who gain weight) after a breast cancer diagnosis have worse survival than those who are lean. Reaching and staying at a healthy body weight is one of the most important things you can do for your general health. Being overweight and having too much body fat is linked to an increased risk for some diseases, including certain types of cancer, type 2 diabetes, high blood pressure, and heart disease.
Read also: The Hoxsey Diet
People who have gone through menopause and are overweight or obese have a higher risk for breast cancer. Research suggests that gaining a lot of weight during or after breast cancer treatment can increase both your risk of breast cancer returning and your risk for getting other cancers.
Body Mass Index (BMI)
BMI is a measure of your body weight based on your height. It’s one way to assess body weight. A healthy BMI for most adults is between 18.5 and 24.9. BMI doesn’t measure how much muscle you have compared to how much extra fat is on your body, so it shouldn’t be the only marker for overall wellness. However, it can be a useful tool to look at health and disease risk.
Managing Weight Gain After Diagnosis and Treatment
People often gain weight after their breast cancer diagnosis and treatment. If you’ve gained weight, it can be hard to lose it. Because of this, it’s important to try to stay at a healthy weight during your treatment.
Choose a balanced diet. Always put food on a plate so you know how much you are eating. Drink 8 (8-ounce) glasses of liquids per day. Don’t drink more than 1 cup of fruit juice per day. You don’t have to change your diet all at once. You can set 1 or 2 goals each week. If you have setbacks, you can learn from them. Small changes add up to big results over time.
Balancing Your Plate
The balance of foods on your plate is important when trying to eat healthily. No more than one-third of your plate should be animal protein. If you eat red meat, such as beef, pork, and lamb, try to eat it only once or twice a week. You can also replace animal protein with plant proteins, such as beans, nuts, and tofu.
Read also: Walnut Keto Guide
Your meal might not always look exactly like the plate shown here. You could have a cup of lentil and vegetable soup and a small apple, and you’d still get similar nutrients and have a balanced meal. You might also eat more vegetables at lunch and dinner than at breakfast. The most important things are to have a mostly plant-based diet and control your portions for all meals.
Managing Portion Sizes
A portion size is the amount of food you’re choosing to eat. A serving size is a standard amount of food and can sometimes represent the recommended amount of food. It’s important to think about serving sizes when figuring out how much to eat. Portion sizes of bottled, packaged, and restaurant foods and drinks have gotten larger over the years. Use measuring cups and spoons to measure your portions.
Keeping a Food Diary
Tracking what you eat and drink with a written food diary helps you be more aware of your choices. It can improve your thought process and awareness of what, when, and why you eat. For example, you might find you eat too much late at night when you’re more tired than hungry. You might notice that you have certain snacks because you’re stressed or bored. If you keep a food diary, you may be more likely to reach your nutrition and body weight goals. Keeping a food diary can also help you make better choices about the foods that you eat. Your clinical dietitian nutritionist can help you use your food diary to meet your nutrition goals.
To keep a good food diary, write down what you eat right after you eat it, including the portion size. Be as detailed as you can. For example, you can write that you ate “1 cup of bran flakes and ½ cup low-fat milk.” You can also include how you were feeling when you ate. Many people find writing a food diary by hand with a pen and a small notebook works best. Other people use a smartphone app or the “Notes” section of their smartphone.
Emphasizing Plant-Based Foods
The Power of Vegetables and Fruits
Eat at least 2½-3 cups of vegetables and 1½-2 cups of fruit every day. Eat a variety of vegetables and fruits. Vegetables (including beans) and fruits are full of vitamins, minerals, fiber, and other substances that may help prevent cancer. Eating vegetables and fruits may also control weight, since they are low in calories, high in fiber, and have lots of water.
Read also: Weight Loss with Low-FODMAP
A variety of fruits and vegetables benefit people who have had cancer. "When it comes to creating a plant-based diet, it's different for each individual and family," says Dr. Mussallem. "Some people may want to eat 100% plants.
Berries: A Daily Dose of Goodness
"I give this as homework to all my patients: Have a half-cup to one cup of berries, not just twice a week, but every day. They're rich in fiber, antioxidants such as vitamin C, and phytochemicals, and they're enjoyable," says Dr. Mussallem. "The Nurse's Health Study findings showed that breast cancer survivors who had two servings of berries per week demonstrated a 25% improved breast cancer-specific survival," adds Dr. Mussallem. When fresh berries are not easy to find or they are not cost-effective, Dr. Mussallem recommends frozen berries.
Whole Grains: A Foundation for Health
Whole grains keep all parts of the original grain, so they have more fiber and nutrients than refined (or processed) grains. These include things such as whole wheat, brown or wild rice, oats, and corn. Studies show that eating whole grains might lower the risk of colorectal cancer.
Grains are an important part of a healthy diet. Whole grains contain three parts: the bran, germ and endosperm, which are rich in nutrients. When grains are refined to make products such as white bread, white pasta and white rice, some of these parts are removed - along with their nutrients.
Fiber: An Essential Nutrient
Dietary fiber is found in plant foods such as beans, whole grains, fruits, vegetables, nuts, and seeds. Eating these foods may help prevent excess body weight, which can lower the risk of cancer. Studies of fiber supplements like psyllium fiber and wheat bran fiber haven’t been shown to reduce colon polyps.
Most people should eat at least 25 to 35 grams of fiber per day. You can do this by eating about 2½ cups of vegetables or legumes, 2 cups of fruit, and 3 servings of whole grains every day. To eat 3 servings of whole grains, you could have 1½ cups of whole-grain cereal, oats, whole-wheat pasta, millet, quinoa, brown rice, or other cooked whole grains or 3 slices of whole-wheat bread.
Increasing the amount of fiber in your diet over a short period of time can cause gas and bloating. Add sources of fiber to your diet slowly and drink lots of water. This will help your body get used to the change. High-fiber foods usually have at least 3 grams of fiber per serving. Vegetables, fruits, beans, and whole grains are usually high in fiber. They also have many vitamins and minerals. Whole grains include the entire grain seed. They’re better for you than refined grains. Read the labels on your foods to find those that are high in fiber. Labels that list the word “whole” or “whole grain” before the first ingredient are good fiber sources. For example, look for “whole wheat flour” as the first ingredient in bread, not just “wheat flour.”
Healthy Fats: Choosing Wisely
Eat “good” fats (polyunsaturated and monounsaturated fats). It’s healthy and necessary to include some fat in your diet. There are different types of fat. Some are healthier than others.
For most people, it’s better to avoid eating too many calories and choose healthier types of fats instead of avoiding them completely. Monounsaturated and polyunsaturated fats are healthier for you. They’re found mostly in plant foods, fish, and other seafood.
Limiting or Avoiding Detrimental Foods and Beverages
Red and Processed Meats: A Carcinogenic Concern
Limit or avoid red meat and processed meat, such as beef, bacon and sausage. Processed meat has been cured, smoked, salted, or fermented to improve or preserve flavor. Examples include bacon, sausage, hot dogs, and deli meats. Evidence that red and processed meats increase cancer risk has existed for decades, and many health organizations recommend limiting or avoiding these foods.
"Processed meats are a Group 1 carcinogen. They are in the same class as cigarettes. When it comes to carcinogens, I don't think it is appropriate for me to counsel my patients toward moderation," says Dr. Mussallem. "Evidence suggests that red meat is a probable carcinogen, so it is best to limit red meat as much as possible. Red meat includes beef, pork and lamb.
In 2015, the International Agency for Research on Cancer (IARC) classified processed meat as “carcinogenic [cancer-causing] to humans” (Group 1) and red meat as “probably carcinogenic to humans” (Group 2A), based on evidence that they increase the risk for colorectal cancer. It isn’t known if there is a safe level of red or processed meat to eat. Because of this, the ACS recommends eating more protein from fish, poultry, and beans instead of red meat.
Sugar-Sweetened Beverages: Empty Calories
Limit or avoid sugar-sweetened beverages. Added sugars and other high-calorie sweeteners (such as high-fructose corn syrup) are often used in sugar-sweetened beverages and energy-dense foods (for example, traditional “fast food” or ultra-processed foods (or UPFs). The health impact of UPFs (also called highly processed foods) is an area of increasing concern. These highly processed foods are usually high in fat, sugar, refined grains, and salt. Studies have linked them to health problems, including weight gain. More research is needed to understand the impact on cancer risk.
The trouble with fruit juice and other highly processed drinks is that they are low in nutritional value and high in concentrated, sugary calories. "When it comes to juices, you're stripping away some of the most vital benefits of fruit, and that's the fiber. Eat the whole fruit. Don't waste your money on the juice," says Dr. Mussallem. The same can be said for soda and other sugary sports drinks, which can contribute to obesity and excess weight.
Alcohol: A Known Risk Factor
Avoid alcohol. Research shows a link between drinking alcohol and an increased risk for breast cancer. Women who drink more than 1 serving of alcohol per day on average are at an increased risk of breast cancer. The type of alcoholic drink doesn’t matter. The risk increases with the more alcohol you drink. If you drink, do it in moderation and try to save it for special occasions.
"Alcohol is also a carcinogen. The best recommendation we can give to patients for cancer prevention, or following a cancer diagnosis, is to just avoid it. There isn't a health benefit when it comes to alcohol consumption," says Dr. Mussallem. "The more you drink, the more risk there is. Patients will ask, 'How much is reasonable if I'm going to have a little bit of alcohol socially?' What is important is that we talk to our patients about standard drink sizes," she says. "Patients are shocked when I share that 5 ounces of wine equals one drink, and 12 ounces of a regular beer or 1.5 ounces of an 80-proof liquor would be equivalent to one standard drink.
Saturated Fats: Moderation is Key
Saturated fats are fats that are solid at room temperature. They are found in butter; lard; fat-containing milk, yogurt and cheese; and meats, and they should be consumed in moderation. "The Women's Health Initiative study, after a 19.6-year follow-up, showed that a low-fat diet helped to reduce breast cancer mortality," says Dr. Mussallem. "When saturated fat is reduced in men with prostate cancer, there's a reduced risk of recurrence. The Physicians Health Study investigated dietary patterns after a prostate cancer diagnosis.
Added Sugars: A Source of Empty Calories
Sugars are naturally found in many foods, such as fresh fruit and milk. It’s okay to eat naturally occurring sugars in moderate portions. Some foods (such as soft drinks, fruit drinks, snacks, and sweets) have added sugars (sugars that aren’t found naturally). Foods and drinks with added sugars can add too many calories to your diet. Over time, this can make you overweight or obese. They can also cause issues with your blood sugar and insulin (a hormone that helps control your blood sugar levels). Insulin issues can include chronic hyperglycemia (high blood sugar), hyperinsulinemia (having too much insulin in your blood), and insulin resistance. These conditions may increase your risk for getting breast cancer and some other types of cancer. The World Health Organization (WHO) recommends having no more than 25 grams (6 teaspoons) of added sugar per day. Read food labels to find out how much added sugar a food or drink has.
Grams and % Daily Value are now required for added sugars. Less sugar is better. Ingredients are listed in descending (decreasing) order. This means that the product has more of the ingredients that are listed first and less of those listed last. Make sure sugar isn’t one of the first few ingredients on the list. Food labels list added sugars in many ways. If you have other health concerns, such as diabetes, prediabetes, insulin resistance, or obesity, talk with your clinical dietitian nutritionist.
Salt and Sodium: Be Mindful of Intake
Eating foods with a lot of salt can raise your blood pressure and increase your risk for stroke, heart failure, and kidney disease. Most people should eat less than 2,300 mg of sodium (about 1 teaspoon of salt) per day. Fresh food that isn’t processed is usually lower in sodium. Read food labels to find out the amount of sodium in the product.
Fast Food and Ultraprocessed Foods: Limit Consumption
Fast food and ultraprocessed foods are tempting - for both their convenience and taste. A processed food is any food that has been changed from its natural form. Some foods, such as sliced carrots, are minimally processed, while others, like potato chips, are highly processed. Many ultraprocessed foods lack fiber and vitamins and are high in unhealthy saturated fats, starches and sugars. When possible, try to stick with foods that are less processed. Most - if not all - of these drinks offer no nutritional benefit, meaning they provide nothing but extra calories and sugar.
Soy and Breast Cancer: Separating Fact from Fiction
About soy foods Some breast cancer cells use estrogen and other hormones to grow. Because of this, many people have questions about soy foods and breast cancer. Soy foods naturally contain plant compounds called isoflavones (i-so-FLAY-vones). Isoflavones are similar to the estrogen that’s made in our body, but they work differently. Eating soy foods (sometimes called phytoestrogens) won’t increase how much estrogen your body makes. Research shows that eating whole soy foods won’t increase your risk of getting breast cancer. If you have breast cancer or have had it in the past, eating soy foods won’t make your cancer worse or increase your risk for cancer recurrence (when your cancer comes back). Some research shows that eating soy foods may offer health benefits. This is still being researched. It’s usually better to choose whole soy foods over very highly processed soy foods and ingredients. Whole soy foods contain important nutrients such as protein, iron, and calcium. These ingredients are safe for most people and won’t increase your cancer risk. Some research shows that very high amounts of isoflavones may not be safe. It’s important to eat whole soy foods that may offer health benefits and not soy products in a supplement, powder, or pill form. Soy products marketed as dietary supplements may have health risks.
Supplements: Proceed with Caution
A recent survey reported that over 70% of cancer survivors take dietary supplements. But dietary supplements aren't recommended for cancer prevention or in the cancer survivorship setting. "There are a lot of false claims out there. Cancer patients are a good target for this $32-billion industry. There are multiple studies that show that some supplements can actually cause harm," says Dr. Mussallem.
There are many dietary supplements you can take if needed. They come in many forms, such as pills, liquids, and powders. The healthiest and best way to get nutrients is from food. Most people can get the nutrients they need from a balanced, mostly plant-based diet. However, some people may need to get some nutrients with supplements. Ask your healthcare provider or clinical dietitian nutritionist for more information if you think you might need to take supplements.
Remember the following precautions (safety measures) with dietary supplements. It’s important for your entire healthcare team to know about any supplements you’re taking. This includes vitamins, minerals, herbs, botanicals, and other supplements.
While dietary supplements can provide some benefit, they also have risks. Dietary supplements are not regulated the same way as medicines are. Eating a diet rich in vegetables, fruits, and other plant foods may lower cancer risk, but there’s little consistent evidence that dietary supplements do the same. Some high-dose supplements containing nutrients such as beta-carotene and vitamins A and E may actually increase the risk of some cancers. Vegetables and fruits contain many different compounds that probably work together to have healthful effects. Some supplements claim to provide the same nutrition as vegetables and fruits, but they usually contain only a small fraction of what whole foods provide. Food is the best source of vitamins, minerals, and other important food components.
Organic Foods: A Personal Choice
When the United States Department of Agriculture (USDA) labels a food “organic,” it means that farms and facilities have grown or produced the food according to certain rules. Organic animal products must be made from animals that aren’t given growth hormones or antibiotics (substances given to animals to make them grow faster or treat disease). These animals must be given organic food. There are some benefits to choosing organic foods, and for some people it’s an important personal choice. However, there isn’t enough research to show that it’s better for your health to eat organic foods. Eating more of them won’t lower your risk for cancer. Some organic foods may be more expensive or harder to find compared with other foods. It’s important to remember that you should always eat lots of different fruits and vegetables.
Eating Well During Breast Cancer Treatment
There are many types of treatment for breast cancer. It’s important to eat well during your treatment.
If you’re getting chemotherapy, you’re at an increased risk for getting an infection or foodborne illness. This is because chemotherapy treatment can lower the number of white blood cells in your body. These cells fight bacteria (germs) and keep your immune system strong. Avoid foods that aren’t prepared.
Practical Tips for Planning a Healthy Diet
Planning a Healthy Diet
The guidelines below can help you plan a healthy diet. Eat mindfully. Avoid snacking. Eat your meals at set times during the day. Limit how much alcohol you drink. Eat a wide variety of vegetables and fruits. Limit total and added sugars.
Understanding Food Labels
Reading and understanding food labels can help you make healthy food and drink choices.
The Mediterranean Diet: A Promising Approach
Many studies have focused on the Mediterranean diet, a pattern of eating that emphasizes whole, minimally processed foods.
Starting Small and Staying Consistent
If you are new to your survivorship journey, making these changes to your diet can feel overwhelming, but Dr. Mussallem recommends starting small and staying consistent. "As a cancer survivor, I get excited when I make my own healthy plant-based meals and when I work with patients," says Dr. Mussallem. "It's exciting to be able to feed and nurture the body. And patients feel better while on a whole-food, plant-predominant diet. Remember that cancer survivorship is a marathon - not a sprint. Start small and stay consistent before overhauling your entire diet. Make one or two improvements (for instance, more servings of vegetables, fewer alcoholic drinks) and commit to those for several weeks before moving on to your next goal.