THIS IS VERY MUCH A WORK IN PROGRESS. LAST EDITED AND UPDATED 23 OCTOBER.
Cancer free since my breast cancer diagnosis in June 2022 and bilateral mastectomy in July 2022 (all described in the category “A bump in the road” on this site).
Also, my Dexa scans, always better than average, and with the most recent one showing no change even after taking hormone blockers (notorious for causing osteoporosis) for three years, many are asking me what I do, and don’t do, to “preserve” my bones.
On the other hand, I still follow a couple of groups about this subject on Facebook, and talk to a few former and current breast cancer patients.
The subject of nutrition and exercise invariably comes up, and to my surprise, many say – defiantly, almost proudly – “I haven’t changed a thing since my diagnosis”. To me, that is like saying – I’ll be damned if am going to do ANYTHING myself in order to avoid or delay recurrence.
That is of course a choice, but I don’t understand it. If I am ever diagnosed with cancer again, I want to be able to say that I did (almost) everything I could in order to avoid or delay it. And I was even lucky enough not to need neither chemotherapy nor radiation. I would have thought that if you have been through months or even years of that level of hell and come out the other side alive, you would be interested in trying to not have that happen again.
Also, to continue a lifestyle which was probably a contributory factor to the kind of shitshow you have been through, without making any changes to it at all, seems to me to be asking for trouble, and almost begs the question – why did you even go through all that?
There is also the small matter of the hormone blockers which most women have to take and which have so many side effects – joint issues, osteoporosis and many, many others, which in itself necessitates a diet and lifestyle that strengthens bones.
And in the case of breast cancer, and certainly the kind of hormone positive breast cancer that I had, there is now a lot of scientific evidence that lifestyle plays a role. In fact, around the time of my surgery, I heard several times that there are five known culprits: 1. Alcohol, 2. Stress, 3. Alcohol, 4. Obesity, and 5. Alcohol – always said a little bit “tongue-in-cheek” of course.
The redwine I have always loved and had my fair share of over the decades, does not taste quite as good …….. More about that later.
So which changes have I made?
Before anyone who actually reads this give up, eyes glazed over, or feeling that this is all much too complicated and disruptive and time-consuming, I have to say that with time and daily routines, all of this becomes second nature and you will no longer need lists of dos and don’ts.
While I do spend a lot of time keeping up with the latest research, I do not clutter up my already limited brain capacity with the scientific explanations of why some things are healthy and some not – I just make a mental note of what I should be eating on a daily or weekly basis, and what I should avoid. All this information is readily available and is to a large extent common knowledge and common sense. I am just trying to put in one post what I have found watching hundreds of videos.
When it comes to diet and exercise, it is more about consistency. Where earlier, in terms of healthy living, I might have been 10 percent consistent, I am now 98 percent consistent. If that makes any sense.
By the way, the term “everything in moderation”, which I hear and read over and over again, drives me crazy. We do not know the origin or context of that idiom, except it is ancient and thus from a time when life was very different from today, but we do know that cancer knows no moderation. When it comes to nutrition, if it is going to keep the doctor away, consistency is key. And the same goes for exercise.
And what is the worst that can happen by living an anti-cancer lifestyle as consistently as you can (except some people will call you fanatic, and I guess there is some truth in that – cancer respects nothing less :-))?
It is the same lifestyle that will hopefully keep most other diseases at bay – for example diabetes and many cardiovascular issues. It is also – supposedly – so-called “anti-ageing”, since it is for the most part all about anti-inflammatory, and keeping your immune system in top form which might contribute to staying as disease free, independent and mobile as possible for as long as possible.
Not to mention the mets that all of us might have, knowingly or unknowingly – risking feeding them with what we now know about for example refined white sugar and how lethal it is, not just in terms of cancer prevention – what is the point of that?
In the case of hormone positive breast cancer, the considerations you have to make on a daily, if not hourly basis, are two-pronged – if not more.
First of all, you have to learn which foods might prevent cancer, and which foods are considered carcinogenic.
And then there is the hormone blockers you have to take, or will be advised to take, and choose to take, and therein lies most of the issues you will have for at least five years – for many another five, and then perhaps another five – depending on your age. (My gynecologist says that at my age (coming up to 73) they will not prescribe those hormone blockers longer than five years, so in my case, that is until September 2027. Whether I will then be advised to start on another type of anti-cancer medication – I somehow don’t think so but I have not asked – taking one year at a time.
By many called the evil pill, they have more potential side effects than any other medication I have ever heard of. I do hear of some women who do not really have any of them, but for the majority, it is basically like ageing on steroids, potentially affecting every organ and other part of your body, and again, your age at the time you start taking them (before, during, or after menopause?) has a lot to do with it. I am certainly grateful that – estrogen-wise – at nearly 70, I was already like a dried-up old prune when I started taking them.
Three of the major side effects are arthritis, obesity, or at least making weight management a daily uphill battle, and osteoporosis. (I am not even going to mention the kidney-, liver-, heart- and whatever else problems that may arise, not so much because I am in denial about those as because since trying to protect all those organs is in any case inherent in the kind of nutrition and exercise regime that will be described below, and quite frankly too exhausting and frightening to contemplate on a daily basis).
Personally, (like I think the majority of women who take these blockers) I do suffer from aching joints and stiffness – not to mention brainfog, but how much of that is due to my age and how much is because of the medication, I obviously can’t say. Exercise helps, and saying “oi-oi-oi” inwardly whenever I get up from having sat still for too long, helps :-). And I have to believe that the anti-inflammatory diet I am sticking to most of the time is also a mitigating factor.
As for osteoporosis, I have been blessed with “good bones”. The results of the dexa scans I have ever had, including the one I had when I started taking the pills, were always excellent, and the result of the one I had just recently after taking hormone blockers for three years, was unchanged in comparison. Which is actually quite amazing, when you think of it, and if I do say so myself, and I am very grateful for that, while doing everything I can to keep it that way. I do not worship “Big Pharma” the way most people do, and I do not want to take any additional medication necessitated by the hormone blockers.
(Just to specify the remark about “Big Pharma”: I know they do a lot of good, investing in research and producing in many cases life-saving medicines, but when some of them pretend to have patient well-being at heart, that is pure hypocrisy. They have a whole other list of priorities. I am especially disappointed that they keep the chemo myth alive just because that is where they earn the big bucks. Again – I do realise that some that money goes towards valuable research, and there may be types of cancer where chemotherapy is effective, but the number of breast cancer patients I hear about whose lives are ruined for six months or longer and then they end up finding that it had no effect on their tumour, and even that they developed new tumours despite the chemotherapy is breathtaking).
Since it is by now a tried and tested weight management strategy, especially for the over-60s, and for many absolutely essential in order to keep their weight down, I do intermittent fasting on most days and eat some time between 10.00 and 11.00, and again some time between 17.00 and 18.00, though if I eat out with others, that is of course not possible. I got used to that really quickly and find it liberating and time-saving to only have to think of two meals a day. Those two meals are time-consuming enough since so many vegetables have to be prepared and consumed.
Starting with what I do NOT eat/drink: Although I do make exceptions (and usually regret it immediately afterwards) if circumstances more or less force me to, because I am with other people, or very hungry, and there is no other choice, there are foods that, in theory, I don’t eat:
Conventionally grown or produced products.
Empty calories since I need all the natural nutrition I can get without putting on weight, so:
Anything containing refined, white wheat flour (and that is actually most of the things on offer in most cafés) – it is simply empty calories with no nutritional value whatsover, and on top of that, it is often bleached. For example, there should be a law against industrially manufactured “toast bread”.
Anything containing trans-fats (think industrially manufactured bisquits, croissants, ice cream etc. the origin of which is uncertain).
Anything deep-fried. Usually in the wrong kind of oil, and in addition not changed after each use, thus becoming more and more carcinogenic by the minute.
Dairy made from cow milk. Having always believed that cow milk is only for humans up to the age of about two (if at all), and I have never been one to drink a lot of milk (cheese is another matter but mostly from goats or sheep). And I have the Dexa scan results to prove me right :-). In fact, the radiologist who reviews them always reiterates: no cow milk dairy and no calcium supplements. The latter tend to end up in the blood (where we definitely do not want it), and not in the bones. Regarding the need to eat calcium-rich food, however, and also at least one daily ferment, he (the radiologist) highly approves of my love of a certain goat milk yoghurt (Andechser Ziegenyoghurt – available in most ecological supermarkets).
Processed meat (and yes, this goes for both industrially produced bacon, ham and sausages as well as “artisanally”, “hand-crafted” ham, sausage and other “charcuterie” although the former category is of course much more harmful than the other.
Anything with refined white sugar in it. Although again, if I am with other people, and there is a cake or dessert, otherwise of good quality, on offer, I will eat, enjoy – and regret :-). I know – no point in regrets – just revert back to the healthy habits as soon as possible.
More generally: all processed foods. And that is really simple. Just buy fresh, real, everything that does not come with a list of ingredients, and is preferably not hermetically wrapped. Needless to say, everything should be bio-/ecological. In that regard, I am lucky to have several conventional supermarkets which have a lot of ecology available, as well as several purely bio-/ecological supermarkets within walking distance, most notably LPG Mehringdamm with an amazing selection of ecolological fruit, vegetables, meat, cheese and a good choice of everything else. Including the best display of ecological wines I have so far seen in Berlin.
Which brings me to the subject of alcohol, briefly mentioned earlier in this post. Since my surgery, more information is surfacing about the many negative health effects of alcohol. You have to be blind and deaf in order not to have realised by now that ANY amount of alcohol is really bad for you. And yet, the cocktail culture, which I have never understood, is gaining ground – what is that about? Alcohol mixed with soda or juice or whatever – It does not get more unhealthy than that.
I had probably had more than my fair share of alcohol (beer, wine, whisky) by the time I turned fourty, and yet I continued for another couple of decades, in complete denial of the health risks. Not so any longer (ultimately, combined with a couple of other factors such as stress during the last few years before retirement, it probably cost me my boobs). I have always particularly loved wine, and still do, but I do not feel like drinking it very often, and when I do, I do enjoy some really good wine, but it is rare, and it has to be worth the calories and the health risk.
As it happens, I know a couple of fellow foodies here in Berlin, with whom I occasionally eat in so-called “high-end” restaurants with a set menu AND wine-pairing. I do hugely enjoy those dinners, and have made it a rule to have no regrets afterwards. Those are my treats, a kind of reward for my otherwise rigorous diet and exercise regime.
So just to be clear: Wine (really good wine, and maximum once a month) is the ONLY form of alcohol I drink now, and I think everybody, regardless of medical history, but especially over 60 with hopes of staying healthy for another couple of decades or three, should consider the same – certainly ditching the strong stuff, and probably also beer.
By the way, I have not mentioned soft drinks, or sodas, or whatever people call them, the reason being that I do not understand how they even exist, let alone why grown people drink them. I have always felt like that about them, and probably had my last coke or fanta as a teenager. The diet versions are probably even more unhealthy than the conventional ones.
And fruit juice. Should be banned. Pure sugar and water with the “solids” removed. (Smoothies, on the other hand, are OK since everyting is preserved, in fact often the peel, pips etc, which would often be discarded when eating whole fruit and vegetables are left in when making a smoothie, and as long as sugar has not been added).
So what DO I eat/drink?
Daily (or almost):
Hot beverages: Since it is being touted as the healthiest teas in the world, it will come as no surprise that I drink Matcha (real Matcha – not the awful sugary stuff from David Rio that many cafés serve which if it does not contain sugar, it contains maltodextrin which is possibly even worse) as ell as Pu-erh tea.
Whatever you do, buy real tea, and not in teabags, unless you check what they are made of. Most conventional teabags release billions of micro- and nanoplatiscs into the tea when submerged in hot water.
I start the day with a big glass of water with a bit of cinnamon and dried ginger and a tablespoon apple cider vinegar. Then a cup of matcha mixed with half a teaspoon of moringa powder – cold in summer, hot in winter.
During the day, I have (actually must have since I am quite addicted :-)) at least one cup of good coffee. I am lucky enough to have a café in the ground floor of my building, where Melek makes some of Berlin’s best coffee. Failing that, “Bei Schicksals” down the road comes close (and they also serve real Matcha). More about Bei Schicksals later. And luckily, a cup or two of coffee daily is healthy. Other than that, lots of water, sometimes herb teas and/or home made bone broth.
Whilst I do not eat red meat (deemed carcinogenic by WHO, AND bad for the environment/climate change) unless it is served to beyond my own control :-), and except on rare occasions when I crave a lamb curry. I try to eat vegetarian much of the time, and vegan some of the time, except my GP is not impressed with my protein levels and is encouraging me to eat poultry and fish, which is no problem for me – I love both, so salmon from Deutsche See Manufaktur at least once a week, and a can or two per week of sardines WITH the skin and bones (for calcium) – BPA-free, and for sustainability, a Marine Stewardship Council (MSC) logo. I order these: https://fontainefood.de/sardinen-mit-haut-graeten-bio-olivenoel. The rest in the way of chicken or duck when I eat out, and at the time of writing (October), I am looking forward to “goose-leg season”.
Grains, at least one of the following: quinoa, amaranth, oats, buckwheat, millet, rye, rice (black, brown, red – never white, unless I have to, and in that case preferably basmati, sice it has at least a tiny amount of nutritional value, unlike most white rice).
Nuts and seeds: A tablespoon or two of chia (pre-soaked) and/or flaxseed (freshly ground), alternating sometimes with hemp seeds, at least one kind each day, sometimes two, sometimes all thee. About 30 g mixed nuts (almonds, walnuts, brazil nuts, pistacio – preferably soaked overnight). Also sesame seeds for their significant amounts of calcium, so I usually eat them in the form of great dollops of tahini which is almost always the base of my salad dressing.
Legumes: Personally, I mostly eat black chickpeas, red kidney beans, green and red lentils …. but in terms of legumes anything goes and should form an important part of everybody’s diet. I eat one of the above, combined with one of the earlier mentioned grains) at least once daily. On those occasions where I want to bring an uncomplicated packed lunch instead of having to resort to sandwiches bought along the way, I keep a stack of chickpea flour pancakes in the freezer, sometimes with that flour mixed with millet or buckwheat and with as much chopped vegetable (broccoli, red bell pepper, red onion, ……. as well as spices, to grab and thaw in the rucksack).
Cabbage, tonnes of it, spring cabbage and white cabbage in summer, red in winter. Cauliflower and Brussels sprouts only occasionally when I come across interesting recipes.
Leafy greens, lots of them.
Red bell peppers, red onion, garlic (if and when eating a couple of cloves of raw garlic is inconvenient, for one reason or the other, I eat black, a.k.a. fermented, garlic – I love it and eat it like candy.
Tomatoes: I recently read or heard that for weight management, it is a good idea to eat a tomato about an hour before each main meal. I really can’t remember whether that is because it blocks something, or starts a process of something else, but I do remember deciding that it can’t hurt. We all ought to eat many more vegetables than we think, so what is the worst that can happen by adding a couple of tomatoes to the daily regime?
Oranges, lemons (but not grapefruit which for some reason is counterindicated in case of breast cancer).
A tip if for one reason or the other you do not want to eat too much fruit (blood sugar levels, weight management) but worry about getting enough vitamin C: Amla, an Indian gooseberry, is reportedly the most C-vitamin rich food in the world, and not only that, unlike most C-vitamin, it can be cut, grated, cooked, whatever, without losing the C-vitamin content. It is available in powder form. I find the flavour absolutely disgusting, but I add it to savoury dishes such as curries and don’t really notice it.
Prunes – 4-6 daily – for the boron (bone health).
Berries – mostly blueberries and the even healthier aronia.
Cacao (the real, pure stuff – not the sugar-laced garbage that there is so much of everywhere). And by the way: the sweeping statement that “chocolate is healthy” is nonsense. CACAO (pure, and good quality) is healthy. But if you must eat chocolate, make sure it is at least 80% cacao, and with a sugar content no higher than 10%.
It is also important to eat some kind of ferment at least once daily – sauerkraut, kimchi, yoghurt (see above about goat yoghurt), tempeh, balsamic or other vinegar, feta, ………
Nutritional yeast (for vitamin B12 which in case of breast cancer is counter indicated as a supplement but OK to take by adding nutritional yeast to savoury food (it adds a slightly cheesy flavour).
Weekly, at least once:
Avocado. Yes, avocado. I do know that it is terribly politically incorrect, since it is one of the world’s most unsustainable foods to produce, store, and distribute, but based on what I read about their nutritional value, and that they may even have anti-cancer properties, I allow myself at least one, preferably two (and sometimes even three) avocadoes each week.
Sweet potato (preferably purple, but if unavailable, red/orange will do).
Tofu
Tempeh
Aubergine, carrots, leeks, in fact everything on offer in the ecological supermarkets and the bio-sections of the conventional supermarkets.
Seaweed (dried – sprinkled in salads and/or in curries).
Eggs. Hmmm. Really? The jury seems to be out though apparently they are more and more back in favour, even after breast cancer. So I do eat them. Especially the omelet with spinach which they serve in “Bei Schicksal” down the road where they also serve a very nice lentil soup. Together, as brunch, that is often my treat after an early walk. And one of these days I will pluck up the courage to ask them where the eggs come from, but right now, that omelette is so good that I don’t want to hear the answer :-).
On the subject of “Bei Schicksal”, they also make their sandwiches with gluten-free bread on demand (and the contents of the sandwiches is by and large healthy – not much processed meat there).
To be continued ……..
Supplements
As advised, generally as well as by the radiologist evaluating my annual Dexa scans, I take Vitamin D3. As also advised, I do not take calcium supplements, BUT we are also advised to take electrolytes, and the best brand I have been able to find, from Raab, contains calcium as well as magnesium and a few other minerals for synthesis. Most other electrolyte brands – extremely stupidly – contain sugar or artificial sweeteners in this insane growing trend of sweetening everything “because that is what people like” – I hope the insulin manufacturers are grateful and laughing all the way to the bank. I get the above, sugar and sweetener free, in Alnatura, but as far as I know, the pharmacies also sell it.
Because experience shows that my joints like me better when I take them than when I don’t, I also take glucosamine and MSM. That does not really have anything to do with the theme of this article as such, but I have of course verfified whether that is advisable for women who have or had breast cancer.
And finally, whenever I have put on a kilo or two, which happens when I eat like normal people, and with Letrozol it is extremely difficult to lose that weight again, I take Berberine and find that that helps in keeping blood sugar down and, with time, lose that weight again.
And to all those who claim they do not know the difference between supplements and medicines (????? yes, that actually happens, scarily often): Please stay ignorant or google it, but do not ask me that question again. I really can’t stand hearing it.