Exercise may lower a woman’s risk for breast cancer. Guidelines recommend people get about 150 minutes of moderate exercise a week. Although more research is needed to confirm the underlying mechanisms driving the protective benefits of exercise,  exercise is an easy way to encourage good health overall. Scientists from the University of Minnesota in St. Paul conducted a study of 391 inactive, healthy, premenopausal women whom they split into two groups. They found that the 179 women in the intervention group, who received 30 minutes of moderate-to-vigorous exercise five times a week for over 16 weeks, showed changes in their estrogen metabolism that could explain the anti-cancer benefits of working out.“Ours is the first study to show that aerobic exercise influences the way our bodies break down estrogens to produce more of the ‘good’ metabolites that lower breast cancer risk,” said Mindy Kurzer, a professor in the Department of Food Science and Nutrition at the University of Minnesota in a statement.

The study, appears in Cancer Epidemiology.  There was a  25% increase in the metabolite ratio 2-OHE1/16-alpha-OHE1, which has been linked to a lower breast cancer risk. More 2-OHE1 and less 16-alpha-OHE1 have been associated with a lower risk since 16-alpha-OHE1 is thought to encourage cancer cell growth. These changes were not seen in the control group of women who did not exercise over the study period. The findings give cancer researchers more insight into how exercise interacts with estrogen to reduce cancer risk. This is especially important since estrogen is a large contributing factor in breast cancer development.

Researchers at  University of North Carolina studied more than 3,000 women between the ages 20 to 98: 1,504 women with breast cancer and 1,555 women without the disease who were participating in the Long Island Breast Cancer Study Project. They found that women who did any exercise at all had a 6% lower risk of breast cancer than sedentary women. However, women who had children and exercised about 10 to 19 hours each week either during their reproductive years or after menopause experienced a much greater benefit, with a 30% lower risk of breast cancer compared to women who exercised less or were inactive.

Kale and other green leafy vegetables are nutrient-rich and good additions to any diet.

Preparation time: 10 minutes.   My type of recipe

Serves four as a side dish.

Ingredients

• 2 bunches of kale,* cleaned and coarsely chopped into 1- to 2-inch pieces
• ½ cup water
• ½ teaspoon cumin
• ¼ teaspoon cayenne pepper (dried, powdered, red pepper)
• ¼ cup raisins or dried cranberries
• ¼ cup chopped walnuts

*You can substitute other greens, such as chard, collard greens, or mustard greens, if you like.

Instructions

• Clean and coarsely chop kale.
• Place water, chopped kale, cumin, and cayenne pepper into a large pot over medium-high heat.
• Heat for about 4 minutes, stirring often, until kale is wilted.
• Reduce heat to low, drain water, and return kale to pot.
• Add raisins or dried cranberries and walnuts.
• Stir over low heat for about 1 minute, until heated throughout.
• Serve immediately and enjoy!

Per serving: 125 calories; 15 grams of carbohydrates; 5 grams of protein; 5 grams of fat; 2.5 grams of fiber; 408 milligrams of potassium

“More and more patients are coming to their doctors and asking for nutritional recommendations before and after treatment, but there is really no standard direction to send them,” said Dr. Champ. “So we started looking at sources where people may go to see what information they were digesting.”

There were discrepancies. Half the information presented or linked to on NCCN sites contradicted the other half.

Half promoted a low-fat, high-carbohydrate diet, and half promoted weight maintenance during treatment, endorsing a 1:1 ratio of carbohydrate to fat. Of the four external sites that provided nutrition guidelines, half favored a low-fat, high-carbohydrate diet, and half favored high-caloric intake to maintain weight. What’s more, the information is not always cancer-site specific, more general recommendations for all cancers are noted. And the weight maintenance recommendations are really less for survivorship and more about not losing weight during treatment, Dr. Champ said.

But depending on cancer type and stage, one might expect different weight changes attributed to these concerns. For instance, recommendations for patients with locally advanced head and neck cancer may diverge dramatically from nutritional recommendations appropriate for patients with localized breast or prostate cancer.

Studies show that the majority of women gain weight during adjuvant treatment for breast cancer, and prospective trials have shown a similar detriment in survival outcomes in obese men during prostate cancer treatment. Promoting low-fat, high-protein diets may cause patients to turn to a high-carbohydrate diet and compound any other weight issues.

It is likely that recommendations favoring calorie-dense diets and therefore weight maintenance are in response to previous findings on weight and cancer. Weight loss during cancer treatment has been associated with a detrimental impact on quality of life, poorer treatment outcomes, and decreased survival time.

Such contradictory information may cause problems for some patients. The lack of data and consistency in recommendations could drastically alter a patient’s dietary habits during treatment depending on which site they access.Many centers, even high-quality institutions such as those reviewed in this study, do not even offer recommendations, and the external referenced websites advocate a variety of nutritional approaches that are inconsistent with each other and NCCN member websites.

“These findings demonstrate an urgent need for consistent, evidence-based nutritional guidelines for patients, and potentially for additional research in this domain,” said Dr. Champ.

A protein associated with conditions of metabolic imbalance, such as diabetes and obesity, may play a role in the development of aggressive forms of breast cancer, according to new findings by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, and their colleagues. Metabolic imbalance is often caused by elevated carbohydrate intake, which can lead to over-activating a molecule called C-terminal binding protein (CtBP). This over-activation, in turn, can increase the risk of breast cancer. Results of their work appeared in Nature Communications, Feb. 5, 2013.

“Modifying diet and maintaining a healthy diet, combined with developing pharmacological ways of lessening CtBP activity, may one day lead to a way to break the link between cancer and obesity,” said Kevin Gardner, M.D., Ph.D., head of NCI’s Transcription Regulation Section, Genetics Branch.

It has been known, primarily through population based studies, that there is a strong link between obesity and cancer. More research is needed and is being done.

Vitamin D slows the progression of cells from premalignant to malignant states, keeping their proliferation in check

A team of researchers at McGill University have discovered a molecular basis for the potential cancer preventive effects of vitamin D. The team, led by McGill professors John White and David Goltzman, of the Faculty of Medicine’s Department of Physiology, discovered that the active form of vitamin D acts by several mechanisms to inhibit both the production and function of the protein cMYC. cMYC drives cell division and is active at elevated levels in more than half of all cancers. Their results are published in the latest edition of Proceedings of the National Academy of Sciences.

Although vitamin D can be obtained from limited dietary sources and directly from exposure to the sun during the spring and summer months, the combination of poor dietary intake and sun avoidance has created vitamin D deficiency or insufficiency in large proportions of many populations worldwide. It is known that vitamin D has a wide range of physiological effects and that correlations exist between insufficient amounts of vitamin D and an increased incidence of a number of cancers. These correlations are particularly strong for cancers of the digestive tract, including colon cancer, and certain forms of leukemia.

“For years, my lab has been dedicated to studying the molecular mechanisms of vitamin D in human cancer cells, particularly its role in stopping their proliferation,” said Prof. White. “We discovered that vitamin D controls both the rate of production and the degradation of cMYC. More importantly, we found that vitamin D strongly stimulates the production of a natural antagonist of cMYC called MXD1, essentially shutting down cMYC function”.

The team also applied vitamin D to the skin of mice and observed a drop in the level of cMYC and found evidence of a decrease in its function. Moreover, other mice, which lacked the specific receptor for vitamin D, were found to have strongly elevated levels of cMYC in a number of tissues including skin and the lining of the colon.

“Taken together, our results show that vitamin D puts the brakes on cMYC function, suggesting that it may slow the progression of cells from premalignant to malignant states and keep their proliferation in check. We hope that our research will encourage people to maintain adequate vitamin D supplementation and will stimulate the development of large, well-controlled cancer chemoprevention trials to test the effects of adequate supplementation,” said Dr. White

Throughout the treatment and recovery process, cancer patients can use nutrition and exercise to strengthen their body and manage their side effects. Proper fuel and physical activity can help patients maintain a healthy weight and muscle mass, counteract fatigue and release anxiety.

Patients generally need to increase their calorie and protein intake to meet the increased energy demands of cancer recovery. Fruits, vegetables, whole grains and lean proteins should make up most of a patient’s diet. These foods are packed with the vitamins and minerals that can stimulate natural healing processes.

Certain foods can also help control treatment-induced side effects. For example, high-fiber foods like beans and raw vegetables can correct constipation, while low-fiber foods like white bread and eggs can help counteract diarrhea. Juicing can deliver high amounts of nutrients and focusing on plant-based meals can boost the immune system.

Physical exercise can also help cancer patients with certain conditions. Light to moderate cardio can help patients maintain heart and lung health, while strength training prevents excessive loss of muscle mass. Patients can also use exercise to boost their appetite, beat fatigue and even diffuse anxiety.

While most cancer patients can reap these benefits during recovery, there are certain precautions they must take when changing their exercise or nutrition habits. Surgery is one major contraindication for strenuous exercise routines, but patients can work closely with their medical team to design an exercise and nutrition program that works for their situation.

Creating an Exercise Routine After Surgery

Most curative cancer surgeries require a recovery time of six to eight weeks. During this time, patients should focus on resting and eating well rather than working out. However, after this period is over and the body has had time to heal, patients can re-introduce exercise back into their life.

The following tips can help make it a safe and smooth experience:

• Start with small weights or short times and gradually increase them as you become stronger.
• Stop moving if you become dizzy or breathless, or experience abnormal pain.
• Choose gentle exercises like yoga or walking in favor of more strenuous sports.
• Consider exercise classes designed specifically for cancer patients.
• Aim for roughly 150 minutes of activity once you are strong enough, which is in accordance with the American Cancer Society’s guidelines.

Before launching your post-surgical exercise routine, be sure to discuss your plans with your oncologist and your surgeon. Never begin or make changes to your exercise plans before obtaining clearance from your doctor. Applying the above nutrition and exercise tips and guidance from your doctor will help you to safely enjoy the benefits of exercise and nutrition as you heal.

Author bio: Faith Franz researches and writes about health-related issues for The Mesothelioma Center. One of her focuses is living with cancer.

A cancer diagnosis can be extremely difficult to deal with physically and mentally.  New medical advances are enabling more people to fight this disease successfully. But there are still side effects of the surgery and treatments even though there has been much advancement.  One of the side effects from cancer can be lymphedema.

The circulatory system is made up of arteries and veins and the lymphatic system.  The lymphatic system relies on movement of muscles to circulate the lymph fluid throughout the body.  Our blood-circulatory system uses the heart to move fluid around.  You can think of the lymphatic system as a road system.  When one or more roads are blocked due to lymph node removal, the system does not flow smoothly.  The “traffic congestion” can cause swelling.  This protein rich fluid collects when the lymphatic system can not pump it back to the heart.

Lymphedema is swelling (edema) of a body part and is a disorder of the lymphatic system. Too much lymph fluid can accumulate in an area of the body that has been damaged. When lymph nodes are removed or radiated there can be damage to the lymphatic system.  Lymph movement or drainage can change causing swelling. Fibrosis of the axilla due to surgery or radiation can cause lymphatic obstruction.  Symptoms include a feeling of tightness, leathery skin texture, and heaviness.

The more lymph nodes removed the greater the chance of developing lymphedema. Even if you have had a few lymph nodes removed, you should still understand the lymphedema precautions.  For example, if you had a sentinel node biopsy your risk is 5 -7%.  It is important to monitor for lymphedema since it is always easier to treat it when caught early.  It can happen right after surgery or years afterwards.

One of the most important things that you can do to decrease your risk of lymphedema is to keep your weight at a good level.  The individuals whom I have worked with who had lymphedema, typically see a marked reduction of swelling  in conjunction with weight loss. Proper nutritional is important and decrease salt.

Exercise is very important for lymphedema control. It is important to perform range of motion stretches and techniques to improve venous drainage. Start by elevating the affected area above heart level. Strength training is not only safe- it might help. You must proceed slowly under the guidance of a physical therapist or cancer exercise specialist. It is important to learn the right exercises for your particular situation, and how to do them properly and with good form.

Dr. Schmitz, as a follow up from her 2009 study, stresses the importance of starting slowly and using proper form with a well trained certified professional. Her study demonstrates the importance of exercise after cancer and doing it safely with slow progressive improvement in order to decrease risk of lymphedema. Begin resistance exercise as soon as you receive medical clearance.  More information on exercise and lymphedema can be found in the next installment.

A compression garment or sleeve, which supports the muscle and helps bring the lymphatic fluid to the heart, can be worn while exercising and at other times. Get advice from a lymphedema specialist as to when you need to wear a sleeve.

There are things that one should do to decrease the chance of developing lymphedema.  Try to avoid extreme temperatures, avoiding sunburns.  Also there should be nothing on your body that is too tight, which can restrict lymph circulation.  Examples of this would be taking blood pressure on the affected arm, carrying a heavy bag on your arm, or wearing tight clothing and jewelry.

Check regularly for infections and call your doctor immediately if this occurs. Insect stings, scratches, skin punctures, and bites can cause infections. Wash the affected area frequently and avoid cracks in the skin through moisturizing.  Your lymphedema specialist can recommend more precautions.

A goal of understanding lymphedema is to prevent it from developing into a bigger problem. There are 3 classifications.  In stage 1 there is pitting which may be reduced with arm elevation.  In stage 2 it does not reverse and fibrosis occurs and  Stage 3 is elephantiasis in very extreme cases. Your lymphedema specialist will teach you Complex Decongestive Therapy consisting of skin care, manual lymph drainage, and exercise.  If you meet with your lymphedema specialist at the first signs of swelling, pitting, redness, heaviness, etc. lymphedema can be kept under control.

Topics to be covered include:

1. What is osteoporosis and osteopenia?

2. Who is at risk and why is it increasing?

3. Effects of osteoporosis

4. Protecting your bones through exercise

a.  Why  exercise improves bones

b.  How to start a strength training program

c.  Which exercises increase bone density

d.  The exercise that should be avoided and potentially cause fractures

5. Balance and preventing falls

6. Posture and body mechanics

7.  Guidelines for daily life activities to prevent fractures

Osteoporosis means porous bone and is a disease that weakens the bones.It is a serious health issue with 44 million people at risk for this debilitating disease.   Bone density decreases and the bones become fraglie and break easily. The disease can cause the bone to fracture or break easily.  The most common sites for breaks are the hips, spine and wrist, although it can cause a break in any bone. A broken hip or spine usually require a hospital stay or surgery so they are of particular concern.  It can lead to permanent pain, disability,or death.

Our bodies are always braking down bone and replacing it with new bone. In the reabsoption stage, the old bone is broken down and in the formation stage, new bone is built. It is constantly being renewed throughout our lives.  As we age the replacement process slows down.  Bone is a living issue which has little spaces which get larger as we lose bone density. To make matters worse, the outside of the bone thins as well.  Calcium and phosphate are essential for bone formation.  If you do not get enough calcium or your body does not absorb enough calcium, it will hurt bone production.

Bone loss occurs in everyone as we get older. Bone forming cells begin to slow down which causes bone to be lost at a faster pace then it is formed. Osteoporosis occurs as a result of an acceleration of this process which is called primary osteoporosis. Secondary osteoporosis is caused by some medications and disease processes. Half of the women and men older than age 70 may have this disease.  It may occur in older people and women after menopause. The leading causes of osteoporosis are a decrease in estrogen in women at menopause and a drop of testosterone in men.

It is a silent disease because it progresses without symptoms.There are no symptoms in the very early stages.  Most people do not know that they have it until a bone breaks. It can be from a fall or something as slight as a bear hug. A sneeze or sudden movement can be enought o break a bone in someone with severe osteoporosis.  Later in the disease you can notice kyphosis or a stooped posture.  A dowager’s hump becomes appearant. There can be neck or back pain due to fractures or bone tenderness. Loss of height can occur even up to 5 or 6 inches.

Reduced bone density can be seen on a DEXA scan.  Your clients over 50 have this routinely done to test bone mineral density.  A score of –1 to –2.5 standard deviations indicates osteopenia which indicates the beginning of osteoporosis.  A standard deviation of more than- 2.5 is considered osteoposrosis .  This number is called a t score which compares bone density to a 25 year old.  This test focus on the lower spine and hip. Many times osteoporosis begins in middle age as hormone levels change or at an older age associated with a vitamin D deficiency

Who is at risk?There are risk factors-some are controllable and some are not.

Women are at higher risk than men. They have smaller bones and  there may be issues which increase risk such as: late menarche, amenorrhea, and hysterectomy at young age. Older people are at risk as there bones get thinner.  Osteoporosis seems to run in families and those that have had a fracture after 50 are considered to be at higher danger. Caucasions and Asians are at higher risk as are smokers and and alcohol use ,being thin, doing little exercise, and a diet without sufficient vitamin D and calcium.  Other risk factors: rhumatoid arthtitis, type 1 daibetes, anorexia, premature menapause, asthma,muliple sclerosis, lupus,some antacids,cancer treatments,and thyroid,gastrointestinal, blood and renal disorders.

Why is osteoporosis increasing?

A very large percentage of your cleints over 50 probably have osteopenia or osteoporosis.

I have been noticing along with other fitness professionals that a larger percentage of our clients have this disease. Some of that increase can be attributed an increase in testing at age 50.  Lack of physical activiy and poor diet is increasing the prevalance of osteoporosis. A small percentage of us  have jobs that involve physical activity and most people have sedentary lifestyles.Osteoporosois is increasing for many of the same reasons as the increase in our obesity problem.

There are medications which help control this disease but there can be side effects.  The best advice that you can give your clients is to have them participate in weight bearing exercise and follow a bone healthy diet. Our goal is to keep the bones dense; strength training not only increases mucsle mass it also can stimulate the bone. We want to increase the muscle mass so there is more of it pulling on the bone. The specific exercises that are necessary for bone health and guidelines for daily life activity to prevent factures will be covered in part two. As a fitness professional you can play an invaluable role in the bone health of your clients by noticing the early signs of osteoporosis and teaching them how to manage this disease through exercise, diet, and healthy lifestyle.