Mediterranean Diet Helps Breast Cancer Survivors with Weight Goals

Managing weight after breast cancer treatment is important for outcomes

By Michelle Qaqundah, ND, FABNO

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Reference

Braakhuis A, Campion P, Bishop K. The effects of dietary nutrition education on weight and health biomarkers in breast cancer survivors. Med Sci (Basel). 2017;5(2):12.

Objective

To determine the effects of dietary changes on weight, waist circumference, BMI, blood lipid profiles, and glucose profiles in breast cancer survivors

Design

Six-month, 3-arm, parallel randomized control trial with baseline testing and post-intervention testing

Participants

Fifty postmenopausal women aged ≥50 years from Auckland, New Zealand, previously diagnosed and treated for stage 1, 2, or 3 breast cancer; all women included in the study had a BMI >25 and had completed treatment (chemotherapy and surgery) at least 3 months and less than 3 years (including hormone therapy) prior to study start. Participants were excluded if they were on anti-inflammatory medications, drank more than 2 alcoholic beverages per day, smoked tobacco, or had poorly controlled diabetes mellitus. Women of any ethnicity were eligible to participate.

Intervention

Participants were randomly assigned to 1 of 3 arms:

Arm 1: Mediterranean diet

Arm 2: Healthy, low-fat diet

Arm 3: No treatment (control)

Arms 1 and 2 received 6 group nutrition and lifestyle education sessions once a month with 6 summary newsletters.

Study Parameters Assessed

Body weight, BMI, waist circumference, complete lipid profile, hemoglobin A1c (HbA1c), adherence to Mediterranean eating pattern (using PREDIMED questionnaire), quality of life score (functional assessment of cancer therapy-breast [FACT-B] questionnaire), group education attendance, and 3-day food diary (completed once during intervention period)

Primary Outcome Measures

Change in body weight, BMI, and waist circumference

Key Findings

Participants who followed the Mediterranean Diet had significantly greater weight loss (-1.61 kg), decreased BMI (-1.02), and reduced waist circumference (-1.40 cm). These parameters were also improved in the group who followed a low-fat diet, but to a lesser extent (-1.35 kg weight loss, -0.56 BMI, -1.31 cm waist circumference). The control arm gained weight (+1.10 kg) and had an increase in BMI (+0.58) and waist circumference (+1.94).

Practice Implications

Obesity and overweight status are associated with an increased risk of developing breast cancer1 and poorer prognosis for breast cancer survivors.2 Mechanisms related to obesity that are thought to influence the progression of breast cancer include increased levels of circulating insulin and insulin-like growth factor, sex hormones, and cytokines released from adipose tissue.3 In this study and in others,4 breast cancer survivors tend to gain weight during and after cancer treatment. Targeted treatment strategies such as improved diet and physical exercise benefit our patients directly, by improving markers related to cancer progression, and indirectly, by decreasing weight.

This study compared 2 dietary interventions to a control no-treatment arm and found marked improvement in weight, BMI, and waist circumference in the Mediterranean diet arm, and some improvement in the healthy low-fat arm. Other studies have observed a similar trend of improved weight loss and waist circumference with the Mediterranean diet vs low-fat diet,5,6 but the Mediterranean diet is more than just an effective diet for weight loss in this population.

The Mediterranean diet is a great option for breast cancer survivors. It focuses on vegetables, fruits, legumes, whole grains, fish, and extra virgin olive oil (EVOO), ingredients that we know are important for their health. Furthermore, it is a colorful diet, rich in phytochemicals that include antioxidants, anti-inflammatories, and polyphenols. The Mediterranean diet has been shown to decrease markers related to metabolic syndrome (high-sensitivity C-reactive protein [hs-CRP], interleukin [IL]-7, IL-18, and insulin resistance),7 which is associated with increased cancer incidence and cancer-related mortality, and markers related to inflammation8 and lipid oxidation.9 It has also been shown to decrease incidence of breast cancer10 and decrease breast cancer recurrence.11

What is the take-home message? Breast cancer survivors need your help to maintain or lose weight after cancer treatment. Without any intervention, a trend toward weight gain has been observed, which worsens their prognosis. Choosing a diet rich in phytochemicals gives them additional benefit through various mechanisms, and the Mediterranean diet is a well-documented good option. Dietary counseling was found to be effective in this study; however, other studies have found improved compliance when patients had hands-on experience such as cooking classes.12 Unrelated to this study, let us not forget the additional importance of physical exercise for weight loss and breast cancer survivorship!

About the Author

Michelle Qaqundah, ND, FABNO, is a naturopathic oncology specialist and Italian-trained chef, currently practicing in Lucca, Italy. She is the founder of Mediterranean Life Wellness Retreats, which offer participants the opportunity to learn how to cook the Mediterranean diet with her while enjoying Tuscan excursions. Qaqundah is the past director of naturopathic medicine at Cancer Treatment Centers of America and the past president of the Oncology Association of Naturopathic Physicians.

References

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  2. Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010;123(3):627-635.
  3. Renehan AG, Zwahlen M, Egger M. Adiposity and cancer risk: new mechanistic insights from epidemiology. Nat Rev Cancer. 2015;15(8):484-498.
  4. Alacacioglu A, Kebapcilar L, Gokgoz Z, et al. Leptin, insulin and body composition changes during adjuvant taxane based chemotherapy in patients with breast cancer, preliminary study. Indian J Cancer. 2016;53(1):39-42.
  5. Estruch R, Martínez-González MA, Corella D, et al. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016;4(8):666-676.
  6. Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359(3):229-241.
  7. Esposito K, Marfella R, Ciotola M, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004;292(12):1440-1446.
  8. Neale EP, Batterham MJ, Tapsell LC. Consumption of a healthy dietary pattern results in significant reductions in C-reactive protein levels in adults: a meta-analysis. Nutr Res. 2016;36(5):391-401.
  9. Fitó M, Guxens M, Corella D, et al. Effect of a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial. Arch Intern Med. 2007;167(11):1195-1203.
  10. Toledo E, Salas-Salvadó J, Donat-Vargas C, et al. Mediterranean diet and invasive breast cancer risk among women at high cardiovascular risk in the PREDIMED Trial: a randomized clinical trial. JAMA Intern Med. 2015;175(11):1752-1760.
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