Chemo Brain And How To Treat It

My brain is back.

It’s like the sun coming out after a week of rain. Except it’s been raining for over two years. The return of my full cognitive function hasn’t been as sudden as a change in the weather, but the impact on my mood has been as dramatic.

It’s like discovering I’ve been living in just one room and that my home has three storeys. It’s like discovering I’ve been driving around in first gear and my car has five gears. With hindsight, I realise how badly my cognitive functioning was effected by treatment, although living through it I probably wasn’t cognisant of how impaired I really was (and this might be one of the few benefits of chemo brain).

I know this condition has a huge impact on the quality of life of so many survivors, so I thought I’d share my best advice for recovery.

First of all, understand that as far as researchers have been able to determine, it’s not exclusively caused by chemotherapy. While we all call it ‘chemo brain’ or ‘chemo fog’ the correct description is ‘mild cognitive impairment following cancer treatment’.

The causes haven’t been clearly identified but it’s a real condition, and it can be picked up with imaging technology. In one study, breast cancer survivors not only required a larger area of their brain to respond to a question, they used more energy to do so. In another, the resting metabolic rate of the brain was slower.

So the first bit of good news is you’re not imagining things. That inability to remember your phone number, the name on the tip of your tongue or the misspoken phrase are all manifestations of ‘chemo brain’. So is a general feeling of fogginess, mental sluggishness and difficulty learning anything new.

Coping with it usually involves implementing the kind of strategies they give people with early dementia; keep lists; use a calendar and a notebook; have one spot where you always put the things you lose regularly. All of this helps but what we really want is an effective way to hasten our recovery.

The really good news is that recovery is not only possible, most people find it relatively easy to achieve.

Apart from physical damage caused by treatment, chemo brain might also be caused by a range of other factors. The main suspect is anxiety, which can cause cognitive impairment all on its own. Hands up anyone that managed to get through cancer without feeling anxious. Depression is also a common after effect of treatment and yes, it’s also characterised by brain fog. If you suspect you’ve got ongoing issues with either anxiety or depression it’s important to discuss this with your doctor.

Vitamin D deficiency could also play a part because most of us had to avoid the sunshine for several months due to either chemotherapy or radiation. If you didn’t take your vitamin D supplements and treatment just got you out of the habit of sitting in the sun then an improvement could be as close as eating breakfast outside every day. Special note here to avoid supplements with calcium in them because they’ve been shown to be a health risk and to favour sun over supplements when you can because the type of vitamin D your body manufactures in response to sunlight is more beneficial.

If you’re experiencing serious mental impairment it’s also worth asking your doctor to give you a simple cognitive test to rule out dementia or any other illness that might be impacting your cognitive function. Don’t just assume it’s a result of treatment.

Having discussed chemo brain with a number of survivors there’s now been several that have overcome their problems by dealing with anxiety, depression or vitamin D deficiency so consider those first. Once you’ve ruled out other causes there’s still plenty you can do to reclaim your brain.

Here’s my top six recommendations for treating chemo brain. Many of these are things we should all be doing to improve our health and boost our immune system so adding them into your daily routine should bring a whole lot of benefits.

Please treat this list as a menu rather than a prescription. Choose what appeals to you and try it for a few months before you rule it out. And please share any other ideas you have about this condition.

  1. Fasting (aka The Fast Diet or 5:2 calorie restricted eating)
    What it is: an eating strategy where you limit your calories to 500 on two days each week.
    Why it might help: Fasting triggers autophagy, the body’s natural mechanism for cleaning up dead and damaged cells. Even people that haven’t been through cancer treatment regularly report improved mental clarity when they adopt this way of eating.
    My experience: My cognitive function had been improving over time since I finished treatment but my biggest step forward coincided with switching to this way of eating. Of course it’s possible that this shift was coincidental so I’d be very interested to hear from anyone else that tries 5:2 or some other fasting regime and notices a brain boost. There are lots of good reasons for cancer survivors to consider fasting in any case.
  2. Yoga (Seriously, what isn’t yoga good for?)
    What it is: an ancient practice that links physical exercise with breathing and mindfulness
    Why it might help: Research shows that yoga has a profound effect on our physiology, including our cognitive function and our ability to deal with anxiety. Some of the benefits are undoubtedly associated with the increase of oxygen to the brain but yoga has such significant benefits over other forms of exercise that it’s clear they’re only scratching the surface of what’s going on inside us when we practice it.
    My experience: I’ve written before about the profound impact yoga has had on my ability to deal with treatment and my recovery. The benefits have ranged from helping me to deal with anxiety and pain to preventing nausea. Yoga helped me to restore my energy when treatment drained it and played a big part in my recovery from surgery thanks to my physical strength and flexibility.
    If you don’t find yoga appealing then exercise will also help you to recover your brain. I just don’t think it will achieve this as quickly or as well as yoga.
  3. Mindfulness
    What it is: a practice of focusing on the present moment and doing one thing at a time. Some people use meditation to learn mindfulness and others learn it by just focusing on whatever they are doing right now.
    I use both. Mindfulness for me includes listening to recorded meditations on my iPod and paying close attention to whatever I’m doing during the day. Even the washing up can be a meditation.
    Why it might help: Mindfulness trains your brain to still the ‘monkey mind’ that jumps from one thing to another. It also helps to reduce anxiety which might be a major contributor to cognitive impairment.
    My experience: Mindfulness has helped me to stay calm and to be present. My mind functions better when it’s calm.
  4. What you put in your mouth
    What it is: Attention to good nutrition, good hydration and avoiding those things you know aren’t good for you.
    Why it might help: Food and water are fuel for our bodies and the functioning of our bodies is directly linked to the quality of that fuel. We know that children show huge cognitive improvement when their diet is improved and that it also has an impact on mood and behaviour. Recent research into the addition of fresh vegetables into the diets of older people also demonstrated improved cognitive function. We are what we eat.Water is also critical to healthy brains. I noticed in hospital that my low blood pressure was immediately remedied by drinking a glass of water and our brains rely upon a good blood supply to function.

    Avoiding those things we know are unhealthy, including alcohol, highly processed food and high sugar food will also have an impact on our brains. People with allergies and food sensitivities will know that a small change in diet can mean a big improvement in health.

    My experience: My diet was pretty good before I was diagnosed. It’s even better now. I’ve significantly reduced all of those things I know are unhealthy while still allowing for the occasional treat. We predominantly eat organic food and I cook from scratch. I’ve cut right back on gluten after I noticed (thanks to The Fast Diet) that it made me tired and bloated. I still need to work on drinking enough water every day but I’ve improved on that score too. It comes as no surprise to me that the better I eat, the better I feel.

  5. Iodine Supplements
    Regular followers will know that I’d rather get my nutrition from food than supplements but based on my own research and an examination of my diet I determined that there was a possibility that I was iodine deficient. I don’t eat a lot of fish and while dairy used to be a good source of iodine, changes in farming practices mean it’s no longer used. The clearing of the fog has coincided with the introduction of iodine into my diet so it’s worth considering. Please let me know if you have similar results. As always, I strongly recommend you discuss any supplementation with your medical team, particularly if you’re in active treatment.
  6. Sleep
    Sleep is the great healer. When I was in treatment it was common for me to sleep in excess of ten hours a day. As my health has improved my need for sleep has declined but I still regularly get eight hours. Sleep is such an important part of recovery that I’m dedicating all of my next blog post to it.

Here are some other things you might like to try:

  1. Learning a language or a musical instrument
    If you’ve read any of the recent research into neural plasticity you’ll already know about this one. It’s long been thought that the only time when the brain was ‘plastic’ and able to create new neural pathways was during early childhood. Now it’s clear that we can keep building new connections in our brain for the whole of our lives. The quickest and most effective way to do this is to learn something new. Languages and music are particularly good, but learning anything new will help. A number of people have told me they’re finding ‘luminosity’ (a web site that charges you a monthly fee to play ‘brain training’ games) very helpful. You could also try puzzle books or free online puzzle sites.
  2. Get creative
    Creative pursuits are good for your brain and your mood. Pick something you really enjoy and dedicate a bit more time to it. It might be gardening or scrapbooking or making furniture out of scrap wood. It really doesn’t matter what you choose as long as it gets you making lots of happy choices. There’s a huge surge in the popularity of colouring in books for adults at the moment. I wish these had been around when I had chemo. They’re very relaxing and great fun, combining creativity with mindfulness.
  3. Take a holiday
    A break from your usual routine can be good for your brain. It doesn’t need to be expensive or involve air travel. It might just be a weekend visiting a good friend. The aim here is to find something restful and calming. If the thought of packing a bag and going anywhere makes you anxious then stay home.
  4. Have a cuddle
    Not that anyone needs an excuse, but cuddles are good for your brain. They increase oxytocin levels and this helps you to feel calmer and happier. You can cuddle a person or a pet. You can cuddle a partner a friend or a child.
  5. Have a massage
    It’s a combination of cuddling, mindfulness and increasing oxygenation. It’s the triple whammy of treatments when it comes to helping you restore cognitive function. You can also credit it with reducing anxiety, giving you a break from your routine and helping you to feel good about your body. There are now massage therapists that specialise in treating people going through or recovering from cancer treatment, so look up ‘oncology massage’ and treat this as a necessary part of your recovery (rather than an occasional treat).

Finally, don’t give up. There’s no upper limit to how well we can be. Recovery from chemo brain is certainly possible and most of the things that help us to achieve it are things we should probably be doing anyway.

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One Year Post Mastectomy

Fanfare please!

It’s been one year since my bilateral mastectomy.

It seems like an appropriate time to post an update on my recovery and to reflect on what’s helped, what’s hindered and what needs to happen during the next year.

There will be photos, so if you’re squeamish about scars then best skip this one.

The short version; I feel great. Lately I’ve actually been feeling well, really well, for the first time since my surgery. I’m amazed by the body’s ability to heal and surprised at how long it’s taking.

If you’d asked me just after surgery how long I thought my recovery would take I would have guessed three months or so. Even one whole year later there’s still a little way to go before my body is done.

This is important.

There have been times during the last year when I’ve thought, ‘Is this as good as it gets?’ It seems to me that healing will happen for a while and then there will be a plateau where nothing much changes. I’ve come to think of these plateaus as the body taking a rest from the hard work of healing.

The whole experience has been an opportunity for me to take a hard look at my life and my habits. I suspect there are people whose recovery is passive. They wait and hope, trusting that whatever medical treatment they received will do all the work for them.

It’s been my long experience that recovery from anything needs to be active. We can support or hinder our recovery with some very simple choices, like what we put in our bodies, how much sleep we get and how much stress we’re prepared to tolerate.

I’ve been actively participating in my recovery.

I’ve cared for my skin, particularly the site of my surgery, by using a body oil after my shower. I’ve also taken care of lymphatic drainage from my left side by using gentle massage throughout the day. This area has had a lot of damage following three surgeries and radiation. While I haven’t had any signs of lymphodema, I see regular lymph drainage as an important preventative measure. I’ll be doing this for the rest of my life.

I’ve lost weight using The Fast Diet. My doctor recommended this because there are statistics showing that excess weight can contribute to breast cancer risk. Fasting also triggers autophagy, the body’s natural mechanism for cleaning up dead and damaged cells. Anyone whose experienced triple negative breast cancer knows that we don’t have any of the new ‘wonder drugs’ available to us. Fasting seems like the best thing I can do to prevent recurrence. I’ll be doing this for the rest of my life.

Yoga has probably made the single greatest contribution to my recovery. I do at least one class a week (two when my husband joins me) and I practice at home every day. When I wake up in the morning I get dressed in my yoga gear. I have coffee and check my messages and daily schedule and then it’s straight into yoga before breakfast. I’m able to do things with my body that I couldn’t do before I was diagnosed. Of course the point of yoga is not to twist your body into increasingly difficult poses. Yoga is about integrating the mind, the body, the spirit and the breath. Yoga has helped me to love my post-cancer body and to feel strong and flexible, mentally and physically. I’ll be doing this for the rest of my life.

Massage has also been a big part of my recovery. I found a local massage therapist with specialist oncology training. As well as regularly helping me to move back into my own body she’s gently massaged my surgery site and this has greatly assisted in settling all of the nerve pain and helping me to regain sensation in that part of my body. It’s also deeply relaxing.

I was eating fairly well before diagnosis and treatment has been an opportunity to review what goes on my plate. We’re shifting towards more and more vegetarian meals. I rarely eat gluten any more and I feel better for it. I’m naturally eating less food thanks to The Fast Diet and the impact on my appetite. We’ve adopted the SLOW principles as much as possible; Seasonal, Local, Organic, Wholefoods.

I’m eating much less sugar and finding that I can’t eat anything really sweet anymore. I suspect this is because fasting has killed off the gut bacteria that trick my brain into wanting more sugar. The recent discoveries in relation to the gut biome continue to fascinate me. I’m sure we’re only just beginning to understand how important this work is for our future health. It’s certainly a strong motivator to avoid processed foods with all their additives and preservatives that prevent bacterial growth.

Thanks to a couple of visits with a psychologist with ACT (Acceptance Commitment Therapy) training and Russ Harris’s books on the subject, I’m now very clear about what’s important to me, what I value and what I want my life to stand for. To celebrate my one year anniversary I’ve enrolled in a permaculture course. There are those that would argue I don’t need this training because I’ve been practicing permaculture all of my adult life.

My friend Cecilia challenged me to ‘become a world famous permaculture teacher’ which is what motivated me to finally enrol. She’s clever. I don’t really need to become famous (nor do I want to) but I really do want to teach the skills I’ve been practicing for so many years. Permaculture is simply the best way to be human and the map for the survival of our species.

One of my favourite quotes has always been ‘Be the change you want in the world’. When I was a teenager I looked at a photograph of the planet from space showing all of the lights of civilisation and spontaneously thought ‘human cancer’. I was distressed by the damage we were doing to the planet and a sense of helplessness. For me, permaculture holds the key to healing humanity’s cancerous impact on the planet. It’s probably going to keep me well too.

So here’s my latest photos.

As you can see, I’ve come a long way since surgery.

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My chest has gone from being almost completely numb to almost completely recovering sensation. I still have numbness along the scar lines and there’s an area of nerve damage above my original surgery scar (that’s the little arc high on my left side). Nerve damage feels like electricity under the skin. It’s continued to improve with massage and I’m hopeful that it will eventually disappear.

My chest still feels a little tight, as if I’ve got a large sticking plaster on it, but this has improved and I believe it will also vanish in time. For most of last year I felt like I was wearing an undersized bra (how ironic) and the tightness extended all the way across my back. That’s resolved now and I only have my chest to deal with. Yoga and massage both help with this.

I still need to remember to keep my shoulders back and to hold my body up. My doctor tells me it’s common for mastectomy patients to develop a stooped back and rounded shoulders. I suspect this is a combination of relieving that sensation of tightness and, perhaps, embarrassment at having no breasts. I regularly roll my shoulders up and back, particularly when I’m at the computer.

My neck has taken a while to adjust to the absence of two F cup breasts. Removing close to two kilos of weight left my neck and shoulders in a state of shock and once again, yoga and massage have helped. A friend showed me this neat trick; point your index finger at the sky; now bring your finger so it touches your chin and the tip of your nose; push back until you feel your neck is back in alignment. You can also push your head back firmly into a pillow when you’re in bed, or the head rest when you’re in a car. This simple exercise has had more impact on my neck pain than anything else.

As for the other side effects from treatment, I’ve also seen big improvement. I rarely experience any peripheral neuropathy in my feet. I still wake with sore hands but they warm up quickly. I need to be careful with any activity where I hold my hand in the same position for any length of time, such as drawing or sewing. My hands tends to cramp up and become painful. I haven’t given up on my body’s ability to regrow nerves. While one doctor told me I’d probably be stuck with whatever I had at twelve months post chemo, another said it can take six years for nerves to regrow. I’ve already had improvement since my twelve month mark so I’m going with option B.

I have a mild hum in my ears. This is probably also chemo related nerve damage but it could just be age. My Mum has age related hearing loss. It’s important to remember that not everything going on with our bodies is related to treatment. I don’t have that awful metallic taste in my mouth any more and I think this is also a form of peripheral neuropathy. Food tastes wonderful again, particularly straight after fasting.

I wonder to what extent the fasting has promoted healing. The science indicates that it should make a difference. In early days, I certainly noticed more rapid healing following a fast. I’ve observed that if I have any kind of skin blemish it’s usually completely healed after fast day.

As you can see from the photos, the radiation damage to my skin has greatly improved. As well as the circulatory benefits of massage, I think the regular application of rose hip oil has made a huge difference.

As you’ve probably already guessed, my mental state is great. People recovering from mastectomy are, not surprisingly, at high risk of depression. I’m very grateful that the care I’ve received and the work that I’ve done have helped me to avoid that particular complication. In many ways, depression is a worse disease than cancer and certainly at least as deadly. I think avoiding depression has involved a combination of things but particularly the information about ACT, practicing ACT and the benefits of yoga.

The most significant contribution to my state of mind has been the love and support I’ve received from so many people. Special mention must go to my beautiful husband who has continued to love and cherish me through all of this. I’m still beautiful to him. It’s an enormous advantage to have someone like that in my life and I grieve for those women that go through this on their own, or whose partners leave them during treatment.

I no longer experience ‘chemo brain’. I feel as mentally alert as I ever did. I’m also calmer, happier and less stressed than at any other time in my life.

I’m now taking stock and asking ‘What else can I do to continue with my recovery and to improve my health?’ I’ll also be doing this for the rest of my life. I believe that there is no upper limit to how well I can be. To put it another way, no matter how well recovered our bodies seems to be, there is always more we can do to improve our health.

Thanks to everyone that’s been following the blog and the accompanying Facebook page. Special thanks to those that have taken the time to let me know that something they’ve read has helped them with their own recovery. You’re the reason I keep writing.

Go well. Live well. My best wishes for your continuing recovery.

Don’t Say Don’t And Ban The Bullies

Sometimes there’s a confluence, an influx of information that all seems to resonate. I’ve had one of those weeks.

It started with this thought:

What if, the next time you went to see your doctor, they told you that no matter what you did you would never weigh less than you do today? What if your doctor said you had some rare metabolic condition, so it was possible for you to gain weight but not to lose it. Ever. You could become fitter and better toned through exercise. You could improve your health and the appearance of your skin, hair and eyes with diet, but you could never, ever lose weight.

What would change?

My thinking around this issue started with last week’s post about The Fast Diet. While I’ve had great success with it, I think the key to sticking with it started before I read the book. I decided to love my body exactly as it was. I decided to abandon negative self-talk and criticism and to focus on what I loved about my body. At the time I was dealing with an extra six kilos as a consequence of treatment. Contrary to popular belief, cancer treatment doesn’t make everyone thin! I was also carrying the same ten kilos that I gained during my pregnancy over twenty years ago.

I can remember what triggered my shift in attitude. I saw photographs of myself from a night out with my family. I thought, “Oh no! Look how fat I am!” I had gone out feeling great and thinking I looked stylish and when I looked at these images all I could see was a huge, middle aged fat lady in a sequinned top. I cried. Then my daughter said, “Oh Mum! Please stop being so hard on yourself. Your body is fighting cancer! That’s enough for now. You can worry about your weight later.”

My daughter is very wise. This isn’t the first time she’s shifted my thinking. I realised that I’d been indulging in the worst kind of bullying. I had been speaking to myself in a way that I would never, ever speak to someone else.

I stopped beating myself up. I started noticing what I liked about my body. What I liked most of all was how aggressively my body pushed back against the cancer. During chemotherapy my doctor was amazed by my blood work. During radiation my skin held up under the onslaught and my mind pushed back against the overwhelming sense that I was now a commodity to be farmed, like a sack of potatoes on a conveyor belt. (The barcode they gave me at the clinic didn’t help.)

I kept up my yoga all through treatment and noticed the difference in my energy levels when ever I would spend time on my mat. Slowly, slowly as I recovered from treatment I found a new strength and flexibility. My yoga teacher, Emma, reminds me to “be in the body you have today” and to recognise that the body I am in tomorrow will be a different body. This was a powerful message to me when I was dealing with the long term side effects of chemotherapy, radiation and surgical removal of both breasts.

This week, Emma and I had a coffee together and she remarked on how far I’d come. I was told I’d have permanently compromised range of movement in my arms. I don’t. I was told that the arthritis they picked up in my bone scans would mean a life-long requirement for daily pain relief. It doesn’t. Lately I’m noticing how well I’m feeling.

People sometimes comment on how well I coped with the mastectomy. I suppose I just accepted it. I grieved. And then I moved on. It is what it is. I don’t look in the mirror and wish I had breasts. I look in the mirror and think about how amazing it is that I’m still alive. I think about all that my body has been through and how amazing it is that, in spite of all that, the body wants to heal. We are all programmed for good health. I will never have breasts again by my body has done everything possible to work around this massive surgery.

This week I’ve been reading articles about climate change and how, if we want people to understand that crisis, we need to talk about the kind of future we could have in a positive way. Scare tactics just send people in the opposite direction. Nobody wants to bullied or terrified.

I’ve also read an article about the sub-conscious mind and an author’s theory that it can’t understand a negative statement. His theory, essentially, is that when you say “don’t eat chocolate!” your subconscious hears “Eat chocolate!”. His cure for insomnia is to stop saying “I can’t sleep” and to start saying “When I go to bed tonight I’m going to have a deep and restful sleep” because your subconscious will agree with either statement. So if you say “I can’t sleep” your subconscious says, “Okay.”

It’s an interesting theory. Perhaps it’s even simpler. Perhaps it’s just that we all respond the same way to negativity, bullying and catastrophising. We push back.

When I made the decision to love my body exactly the way it is, it naturally followed that I wanted to feed my body well. I wanted to make sure I ate healthy food, avoided alcohol and looked for ways to maximise my chances of living a long and healthy life. I didn’t start The Fast Diet to lose weight or because I was ashamed of the way I looked. I started it because I was convinced by the research that it would help me to prevent cancer.

I’ve always considered myself a work in progress. Over the years I’ve broken bad habits (even that language is interesting), I’ve improved my mind, I’ve become more tolerant and compassionate and I’ve come to feel more and more comfortable in my own skin. Looking back, I can see that change usually happened because an idea was compelling, a truth was apparent or because someone close to me kindly and gently invited me to change. My failures have all included attempts at bullying, either internally or externally.

Nobody likes to give a bully what they want, even when they are the bully.

So I’m heading off to a yoga retreat for some self-nurturing and some time with one of the wisest people I know. We’ll eat healthy food, stretch and breathe and delight in our bodies and return home refreshed and recharged.

It seems to me that being positive has a much deeper meaning than the way it is commonly understood. If we’re going to achieve any lasting change we need to frame it in a positive way. “I will eat nourishing food” is far more powerful than “I won’t eat sugar”. “I will devote some time each day to being physically fitter” is far more powerful than “I will lose weight.” It’s a lot more enjoyable to achieve something than to avoid it.

So back to my original proposition. What if your doctor told you that you could never lose weight? I think the answer for most of us is that we would accept the diagnosis and start focusing on what we COULD do. We’d eat well and enjoy our food without self-recrimination. We’d abandon self-bullying diets and adopt the kind of eating pattern that included a few treats while emphasising sound nutrition. We’d exercise for the pleasure of it, enjoying it for its own sake without jumping on the scales to see if we’d dropped weight.

This is just a thought exercise but a lot of us have already had some practice. My breasts aren’t growing back. I have chosen not to have reconstruction, but those that have chosen it tell me that they still need to accept that their bodies will not be the same. We know that if we’re going to overcome what cancer has done to us, then acceptance and loving the body we have right now is part of it.

So this is my invitation to love your amazing, wonderful body. Think about all of the extraordinary things your body achieves every single day. Listen to the way you talk to yourself and apply this simple test; if you said that out loud to someone else, how would they respond?

My Top 13 Surprising Things About The Fast Diet

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Regular readers will know that I’ve been following The Fast Diet for some time now. Here’s the original post I wrote about it back in January.

https://positive3neg.wordpress.com/2015/01/19/is-there-a-fast-way-to-reduce-cancer-risk/

I’m all for people feeling comfortable in their own skin, whatever their size, and I think the whole diet industry conveniently ignores the data that says it’s your fitness that makes the most difference to your overall longevity, not your weight. I have friends that easily fit a size 14-16 who are very fit and healthy.

The problem for those of us with a high risk of breast cancer is that being overweight HAS been conclusively linked to higher risk. Maintaining a healthy weight is one of the best things we can do for our bodies. For those of us in the triple negative category it’s one of the best preventative steps we can take. There are no preventative medications available to us.

The trouble is that most diets are so misery-inducing you’d rather just eat what you want, be happy and carry the weight. I used to feel that way. I was never seriously overweight but I was carrying about 16 kilos more than I needed. Like most people I’d go through that cycle of deciding to diet, watching the weight creep off and then deciding that if I had to live that way I would rather be dead. (Of course I wouldn’t REALLY rather be dead! I smile now at how frequently I used to use that expression without really understanding what I was saying.)

Enter The Fast Diet. It’s based on good science, it’s become popular all over the planet, and it’s helped me to lose all of the weight I want and to keep it off. I thought it was time to give you all an update on the really surprising things about this way of eating.

I tried to limit this to ten things but I couldn’t.

So here’s the my top 13 surprising things about The Fast Diet:

1. It’s easy
Every other diet I’ve ever been on has been hard work. I’d be measuring portions or counting points or keeping diaries or craving ‘forbidden’ foods for months and months. I’d feel deprived and resentful. There are no banned foods on The Fast Diet and you only count calories on two days each week. The rest of the time you just eat a healthy diet with the occasional treat. Truth be told the first two weeks were hard work, but only on the two fast days. By week three it was just my new normal.

2. I can eat pizza!
I love pizza. I love melted cheese and crunchy pizza bases and everything that goes with it. I don’t want pizza every night but every so often I really want pizza. No problem. I’ve bought it. I’ve eaten it. I’ve still lost weight. We also love to eat out at fine dining restaurants and cheap, cheerful cafes. No problem. I can see why they call this ‘the foodies diet’. I have still eaten a healthy diet most days of the week but its so wonderful to enjoy good food without worrying about my weight.

3. I can’t eat pizza!
Well, I can, but I can’t finish it. One of the surprising things about this diet is that my appetite has been reduced on all seven days of the week. I’m just not as hungry as I used to be. I don’t know if this is because fasting teaches you that hunger is not life-threatening (and I suspect there’s some part of our lizard brain that makes us panic when we’re hungry), or because our stomach gets smaller and feels fuller with less food. I used to devour a medium sized pizza without a second thought. Now I really want to stop at half that amount. The great thing is that this is a choice. I’m full and I don’t want any more. It’s not because someone else is telling me I can’t have it. Bliss.

4. I don’t crave sugar or bread or biscuits….
I’m one of those people that used to get huge carbohydrate cravings. There’s been some recent research into the gut biome that’s discovered a bacteria that thrives on sugar. It can signal our brains and trick us into thinking we’re hungry, and that, in particular, we are hungry for the food it needs to survive. I suspect fasting either kills or reduces this bacteria. In any case, I no longer get cravings and I actually find myself not wanting sweet things. I know, right! I can walk past a packet of Tim Tams without a second thought. It’s a miracle!

5. I have more energy on fast days
I had expected to feel a bit lethargic on fast days and I’ve been really surprised by how energetic I feel. Once again, the first couple of weeks were hard work and I did feel weary. I had a headache and even some low level anxiety. But it passed. Now I find I have so much energy on a fast day that I need to plan to go to the gym or do some heavy work in the garden, or I’ll have trouble getting to sleep.

6. I need to drink a lot more water on fast days
I’m pretty sure the headaches in the first couple of weeks were at least partly due to dehydration. I also suspect that those sugar-eating bacteria were ramping up the chemicals as the fasting killed them off. I’ve realised that we get a good portion of our hydration from the food we eat, so on fast days I need to drink a lot more water. It’s also a great way to deal with hunger.

7. Hunger has an upper limit 
I thought that fasting would mean getting progressively hungrier as the day went on. I’m surprised to find that my hunger hits a peak at around 10.00am and then just hovers there for most of the day. I have a bit of a spike around 3.00pm to 4.00pm and if that’s really bad I’ll eat an apple and deduct those calories from my evening meal. Most of the time a drink of water and something to distract me will see the hunger pass really quickly.

8. There is no failure
If you’ve ever ‘been on a diet’ then you’ve also been off a diet. They’re notorious for making us feel like we’ve failed. I think the key to a lot of weight loss programs is that they get the credit for all the weight you lose and you get the blame for all the weight you don’t. The Fast Diet means eating normally for five days a week and just restricting your calories for two (or some other combination; see below). Unless you’re prone to binging or your diet is always unhealthy then I really think you can just eat normally for five days a week. Your appetite will naturally reduce over time. The best thing for me is that if I ‘come off’ the diet today I can just start my fast again tomorrow. And there’s always next week. I tend to bank fast days if I know I’m going to lunch with friends on a day when I’d usually fast but you can just as easily move the fast to one day later.

9. It’s really flexible
Once you understand the basic principles of fasting you can adapt it to suit what works best for you. My mum has lost a lot of weight just by eating her breakfast later each day and making sure she has nothing after her dinner. By narrowing the window of time during which she eats she’s effectively fasting each night. I’ve sometimes done two days in a row because the research on the anti-cancer benefits has focused on this type of fasting. Some people prefer to eat most of their calories in the morning and some prefer to eat them at night. Some split them into two meals. The surprising thing is how flexible this style of eating can be and how easily you can adapt it to what works best for you.

10. Fasting helps you learn what your body wants
When you’ve spent a day fasting you really notice how your body reacts to whatever you eat next. I’ve noticed that rice makes me bloated and that too much onion gives me heartburn. Because my hunger has been significantly reduced, I’m paying a lot more attention to making sure the food I do eat is nutritious. I’m back in touch with my body. It’s a good feeling.

11. Fasting has unexpected benefits
My eyes look bright and my hair is thick and shiny. Usually when you’re my age and you lose a lot of weight you expect it to age your face, but my skin looks great and I haven’t gone all wrinkly. I suspect this is because fasting triggers autophagy, the body’s ability to clean up dead and damaged cells. I’ve noticed that cuts and blemishes heal faster on fast days. I also noticed big steps forward in the healing of my mastectomy scars. It’s likely that fasting is also helping my body to kill off any potentially cancerous cells. It would be worth doing for that alone, even if I didn’t lose weight. This style of eating is also slightly contagious. Apart from my mum’s weight loss, my husband has also dropped an easy ten kilos, reducing his hereditary risk of heart attack.

12. I can eat this way for the rest of my life
The single biggest factor that has caused me to come off a diet in the past was the overwhelming sense of misery I felt, even if I lost weight. I once achieved the same weight I am now through Weight Watchers and then sustained it long enough to become a lifetime member. I was resentful of matchbox-sized serves of cheese and palm-sized serves of meat. I spent hours each day calculating points and feeling deprived when I couldn’t eat what I wanted and stay within my limits. I felt cheated by the realisation that the more weight I lost the less points I’d have so the less food I’d be allowed to eat. What’s surprised me about fasting is that I have easily lost weight without feeling deprived and I’ve kept it off. Some days I get to lunch time and realise I haven’t eaten yet. Incredible! I’m much more aware of the difference between thirst and hunger and I’m much more inclined to eat just enough rather than over eating. These are all of the things that Weight Watchers was trying to achieve but without the misery and constant feelings of deprivation.

13. I am really, really happy
I think some of this has to do with conquering sugar cravings without even trying and the beneficial effects that has on my blood sugar. I also suspect that not having nasty little bacteria messing with my brain helps and I am overjoyed to be at my target weight. But mostly this is about finally breaking out of that cycle of self-bullying, deprivation, anxiety and misery that is traditional dieting. I love food. I love eating good food. I don’t want to spend the rest of my life feeling anxious about what I put in my mouth. I don’t want to look in the mirror and insult myself for not being ‘strong enough’ or ‘committed enough’. The biggest surprise for me has been the way this form of eating has given me a great relationship with food and eating. I’ve lost 16 kilos and I’ve kept it off easily. I’m naturally choosing healthier foods because that’s what I feel like eating.

Oh, and did I mention that I’m also reducing my risk of cancer?

 

 

 

 

Six Months Post Mastectomy

WARNING: This post contains photos of my mastectomy scars. Skip this one if you’re likely to find that upsetting.

It’s the eighth of February today. That’s six months since my mastectomy.

Anniversaries take on a new significance when you’ve had triple negative breast cancer because our highest risk of recurrence is within the first three years. By the end of five years our risk has dropped to the same as everyone that’s never had breast cancer. It’s one of the few consolations for having a form of breast cancer that’s typically described as ‘more aggressive and with a worse prognosis than other breast cancers’.

I thought you might like to know how I’m travelling.

In a word, brilliantly!

My wounds are almost (but not quite) fully healed. I’ve been surprised by how long it takes. There’s a period of rapid healing immediately after surgery, as I expected, but then there is also a long, slow healing where the scar tissue gradually loosens up and improves in both appearance and sensitivity.

I still get strange electrical pings from time to time, but nowhere near as often as I used to. The tightness around my chest had greatly improved, particularly across my back. Following surgery I had a strange stabbing pain in the centre of my back when my bra fastening used to be. If I rolled my shoulders forward it was worse. That’s completely gone now. So is the mysterious stabbing pain on the outside of my upper arm near the shoulder. My surgeon, Kylie, described both as ‘referred pain’ and I’m happy to be over it.

How to describe the sensation across my chest? I think if you took something like a clay mask,  spread it over your chest and let it dry you’d be approximating the sensation. It’s a little tight, but not painful. Kylie warned me that my chest would get tighter over time and then it would ease. I’m at the happy end of the easing process with hopefully a little way to go.

As the skin has loosened away from the muscle it’s become more comfortable. You can see from the photos that there’s now a little bit of a droopy bit, particularly on the right hand side. I joke with my husband that my breasts are growing back. Actually, it’s a good thing because I now look less like a mastectomy patient and more like a naturally flat chested woman. I’m doing some hand weights to build up my pectoral muscles and to give me a bit more of a natural shape.

Having said that, I’m now completely comfortable with my flat chest. I’ve had a lot of fun replacing most of my old wardrobe. My two favourite ‘looks’ are a beautifully patterned cotton shirt over a singlet with long pants, or one of those box shaped dresses that sits just above the knee. I didn’t feel comfortable wearing shorter skirts before my surgery but now I enjoy putting my ‘yoga legs’ (as Graham calls them) on display. I’m accessorising with beautiful scarves and long necklaces which now sit beautifully thanks to my dolphin chest.

The only pain I have is from arthritis in my hips and shoulders (which I would have had anyway) and the peripheral neuropathy in my hands. They are very sore when I first wake up but improve quickly with my morning yoga.

My recent followup appointment was with my radiation oncologist, Andrew. He reminded me that I shouldn’t give up on the peripheral neuropathy and that sometimes nerves take a very long time to regrow. He suggests waiting a decade before calling it quits. This is great news because Rachel, my oncologist, has warned me that whatever I had twelve months after chemotherapy I would probably be stuck with for the rest of my life. It’s not really a big deal either way. I can still type, obviously, and last week I finally returned to playing my cello.

It’s made me very happy to discover that in spite of the numbness in my fingers, the need to completely reposition my instrument and the poor playing that results from two years without practice, I can still read music and make a beautiful sound. The challenge now is to return to daily practice. Like so many things, the cello requires a regular small investment in order to reap returns.

Andrew and Rachel are in agreement about what we thought was recurrence. It’s likely that this was actually DCIS left behind after the first surgery rather than new cancer. Why does this matter? Well, there’s a huge difference between a bit of old cancer still growing away and a whole new outbreak of the disease, particularly in terms of my long term survival odds. Although I was initially shocked at the possibility that my surgeon had made a mistake I now consider it to be serendipity, a happy accident.

You see, what we know, thanks to Kylie’s ‘mistake’, is that the cancer I used to have was resistant to chemotherapy and radiation therapy. It is almost certain that I would have needed a mastectomy at some point. Having it when I did meant the tissue removed was free of cancer and that greatly contributes to my future survival. You don’t get better margins than ‘no sign of cancer in this tissue’. If Kylie had removed a bit more tissue in the first surgery I would still have potentially lethal breasts with no guarantee that we would have caught the recurrence before it had spread to vital organs. Everything has turned out for the best.

I know Kylie still beats herself up over leaving the clip and some of the tumour bed behind. I’m glad I’m not a doctor. They are human like the rest of us and that means that, sooner or later, they will make a mistake. It’s unavoidable. A world where it’s safe for them to acknowledge that and talk about it is a safer one for all of us. It’s not a metaphor when people say that doctors often bury their mistakes!

It’s an interesting thing to come face to face with your own mortality. Last night I lay in bed thinking about a new blog called ‘We are all dying’ or ‘live like you’re dying’ because I now believe that when you really understand this, all the way to your temporary bones, life becomes richer, more precious, more meaningful………if you let it!

It still sneaks up on me at odd moments. My husband and I will be watching something on the television and laughing or joking about it. I’ll suddenly feel overwhelmed by my love for him and all he’s done and been since I was diagnosed. One day we will both be gone. That makes being here so much more beautiful.

When we’re intimate I sometimes weep with the wave of emotion that floods me. He touches these scars as if they were precious. You’ll notice that the photos are the right way around for this post because I finally felt okay about asking him to photograph them rather than using a mirror and taking them myself. The photos still shock me. From this side of the scars it’s easy to forget. Graham has just adapted to incorporate this new version of my body. He’s so grateful that I survived. He loves me.

My daughter returned from Europe and we have two precious weeks before she returns to university. I want to follow her around and embrace her randomly. I am so proud of her. She could have walked away from her studies without anyone criticising her because, after all, her mother had cancer. But she stuck it out. Her marks dropped but she still managed to pass two of the hardest subjects of her degree. Because the last eighteen months for me have been about surviving I haven’t been able to support her as I would like to have done. Now I can.

Her physical and emotional health have suffered. She’s working on being well. It’s been a shock to her to contemplate a world without me in it and it shows. I wonder if she’s realised that, like me, she is also temporary. Maybe that’s not a concept you need to come to terms with in your twenties although I know from the many young breast cancer survivors I have met that there are plenty who do. I pray for a cure. I pray for a future where she doesn’t have to fear my genetic inheritance.

My six month anniversary present was news from the Mayo clinic in the USA. They think they might have a vaccine that prevents the recurrence of triple negative breast cancer. I want to put fifteen exclamation marks on that. I still cry with joy when I watch this:

http://www.usatoday.com/story/news/nation/2015/02/03/mayo-clinic-triple-negative-breast-cancer-drug-trial/22785941/

It’s too soon to call this a cure. They’re just starting trials and the trials may yet prove that the treatment doesn’t work, but hope is like rain in the dessert when you’ve had cancer.

So, as always, here’s the photos. This is what my body looks like after six months of healing and taking very good care of myself.

P1070195 P1070196
P1070194As you can see, the puckering to the left hand side is much better and I’m reasonably confident that this is going to keep improving. I’m seeing a massage therapist that specialises in oncology at least once a fortnight and sometimes more often than that. I highly recommend it. I’m also brushing my torso with my hands each night to help promote lymphatic drainage. The lymph system sits just under the skin so you really just pat yourself like you would a cat, with long strokes down the body. I can feel the lymph moving when I do this. It’s a mild tingling sensation. I’m hoping this helps me to avoid lymphedema, a common complication of cancer treatment.

The skin on the left hand side is also much better. This skin was damaged by radiation therapy and that’s why you can see such a marked difference between the two sides. You can also see the arc of a scar from my original breast conserving surgery above my mastectomy scar. I’ve been using macadamia or hemp oil, perfumed with essential oils, after my shower and that’s helped.

The question I get asked most often is “Will you be having reconstruction?”.  My answer is still “No”. I am very happy with my decision to do the best thing for my health and have the least amount of surgery possible. Even with all of the weight I’ve lost I still have a little bit of a belly. I’m very happy to have it sitting where it has always sat rather than having it surgically relocated to my chest, with all of the risks, pain and recovery time that would have involved. Just the thought of more than ten hours under anaesthetic was reason enough to avoid it but I’m also happy about not having any more scaring than was medically necessary.

Everyone makes their own decisions on reconstruction and, if you’ve decided to have it, then I sincerely hope you are as happy with your choice as I am with mine.

I’m still not inclined to wear ‘foobs’ (fake boobs). I don’t think there’s anything about my appearance that need ‘enhancing’. Of course, I’m also the kind of person whose happy with my prematurely grey hair, my glasses over contact lenses and my habit of saving makeup for very special occasions. There are some clothes that I know would look better with a bit of a mound. Perhaps, in time, I might have a look at something to go under evening wear but so far, so good.

Emotionally I’m feeling great. Thanks to Russ Harris and the ACT skills I’ve been practicing I now have an effective method for dealing with fear of recurrence. Losing 14 kilos since surgery (and only two of that was actually cut off me) has made me very happy but it’s really The Fast Diet that’s been a major contributor to my emotional well being. I am now in a healthy weight range because of a method that’s sustainable for the rest of my life. I can still enjoy great restaurants and the occasional take away without fear or guilt. The evidence on the benefits of this way of eating and the implications for those of us seeking to avoid cancer continue to mount. I am certain that I am doing the right thing for myself, my body and my family.

I know it’s still possible that the cancer could come back. Cancer is like that. But I don’t dwell on it. I enjoy my life. No, it’s more than that. I CHERISH my life, because I finally understand how precious it is.

Is There a Fast Way to Reduce Cancer Risk?

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Here’s a quick quiz. How many of the following statements do you think are true?
1. Fasting is bad for you.
2. If you don’t eat regularly you’ll get low blood sugar and feel tired
3. You can’t exercise if you’re fasting.
4. You must eat breakfast to ‘kick start’ your metabolism.
5. Losing weight is simple a case of energy in, energy out; reduce the amount of food you eat and increase the amount of exercise you do and you are guaranteed to lose weight.
6. Fasting will promote binge eating.
7. Fasting will promote eating disorders.
8. Going hungry will make it difficult for you to concentrate.
9. You can’t sleep if you’re hungry.
10. Weight gain is unavoidable with age.
11. Losing weight means giving up food you love.
12. Over weight people are just making excuses because they are greedy.

For me, cancer has been a lesson in holding my opinions lightly. So many things that I was sure of have been flipped. The most recent example is fasting.

I can remember a friend trying to convince me of the benefits of fasting over ten years ago. I dismissed her arguments and ‘new age nonsense’ and put fasting in the same basket as alkaline and ketogenic diets. I’m a skeptic. I need evidence.

Then a couple of months ago when we were channel surfing I found a story on the Sunday Night program about intermittent fasting. It included an interview with Dr Michael Mosely who made a documentary for the BBC a couple of years back following his investigation of fasting. With Mimi Spencer, he wrote a book about what he discovered. Here’s a link with a pretty good description:

http://www.booktopia.com.au/the-fast-diet-mimi-spencer/prod9781780721675.html?source=pla&gclid=CjwKEAjwtIShBRD08fKD1OWSik4SJAAuKLovgENgBkfcr5B9jRV2vQjPVCEN_BsMJA6t1GlDkSfwohoCn1vw_wcB

I gained about ten kilos during chemotherapy and at the time it was a source of distress. My beautiful daughter reminded me that my body was fighting cancer and that I shouldn’t worry about extra weight. She was right. I stopped obsessing about it.

I also got back into my daily yoga habit. You can’t downward dog on a full stomach so postponing breakfast became normal. I usually eat what I call my ‘super porridge’ around 10.30am. I’ve also been tired so I’ve been eating dinner around 6.30pm and going to bed early. Without planning to I’ve been creating a much longer gap between my last meal and my first meal. Two things have happened. The weight that I gained during chemotherapy has gradually disappeared  (not counting the two kilos they removed from my chest!), and my appetite has reduced to the point where I rarely feel particularly hungry and I never feel ravenous.

Without intending to, I’ve been adopting one of the behaviours that research now tells us can permanently reduce weight and improve health. I’ve created a ‘fasting window’.

It occurred to me that I was naturally thin when I was younger. My weight problems came during pregnancy when I was told I MUST eat breakfast. Up until then it was my habit to have coffee in the morning and not to eat until lunch. While I was breastfeeding there was also the breakfast mantra. Now it seems the experts were wrong. Or perhaps more accurately, the advice was incomplete.

If you’re a ‘breakfast person’ then you should eat it. If you’re not then you shouldn’t feel guilty about skipping it. And regardless of your age or your weight, it seems that fasting is good for most people.

What’s most appealing to me about this way of eating is the rigorous science behind it. Most diets work for some people for some of the time until, almost inevitably, they regain the weight they lost (and then some). This diet involves a permanent change in eating behaviour that most people find relatively easy and sustainable. You won’t just lose your saddle bags and your muffin top. You’ll also drop the fat that’s around your major organs and this weight loss has all kinds of health benefits, including a reduction in your risk of developing diabetes.

Eating this way gives my body time to repair itself. When we eat our body manufactures new cells. When we fast for long enough it triggers our ‘repair mode’ and the body not only draws on our fat stores for fuel, it also cleans up damaged and unwanted cells. You can imagine what exciting news this is for anyone prone to cancer. My damaged cells can kill me.

We now know that most of us have cells with the potential to become cancer circulating our bodies all of the time. Yes, when I say ‘most of us’ I mean potentially any human on the planet and not just those of us with a history of this disease. In order for these damaged cells to become tumours they need to trick the body into providing them with a blood supply.

Of course, most of these cells get killed off by the body as part of our normal process of cell rejuvenation. Now it seems that intermittent fasting boosts this process. That means that changing the way we eat could have huge benefits for cancer patients.

Fasting also increases our white blood cell count and boosts our immune system. It helps to reduce insulin type growth factor, which is important because high levels have been shown to correlate with a higher risk of cancer. Here’s an article summarising some recent research:

http://news.nationalpost.com/2014/06/05/fasting-for-three-days-renews-entire-immune-system-protects-cancer-patients-remarkable-new-study-finds/

After checking the research I am convinced that intermittent fasting has the potential to reduce my risk of recurrence. My husband was also keen to try a 5:2 diet to lose the extra kilos that he’s put on during the last year so about six weeks ago we both started limiting our calories for two days a week.

We chose Tuesdays and Thursdays as our ‘fast days’. You can choose two consecutive days but most people find this harder than breaking them up. On fast days, Graham likes to have breakfast which is usually some kind of vegetarian omelette. I prefer to save my 500 calories for one meal at dinner time. I’ve found that it’s easier to not eat at all during the day. I love that this way of eating is so flexible and that you can adjust it to suit your preferences.

Dinner on fast days is a big pile of low starch vegetables (leave out the potatoes and corn) topped with a small serve of protein. We often have fish because it’s low in calories and I don’t eat enough of it. We’ve also had eggs, tofu, organic chicken and grass fed organic lamb or beef.

Graham gets 600 calories by virtue of his gender which means that once he’s had breakfast I’ve got plenty of room to make us both a delicious dinner.

So how are we going?

Well, a girlfriend came to visit me this weekend to take me out to my favourite restaurant as a late birthday treat. I sat enjoying the view out the window of the ocean and tucked into my goats cheese tart with duck breast followed by a giant pork chop with heaps of vegetables and thought “This has got to be the best diet EVER!”

When my daughter turned 21 I finally admitted to myself that the in spite of all the dieting and exercising I was just going to have to live with ten extra kilos for the rest of my life. I did, once, manage to get back within my BMI by attending weekly Weight Watchers meetings and obsessively measuring and counting everything but I was so miserable that it was unsustainable. What a great business model they have; any loss is their credit and any gain is your fault!

My daughter has a similar metabolism. I’ve seen her eat like a bird and train like an athlete only to be distressed by the lack of any movement on the scales.

The thing I love the most about The Fast Diet is that it has finally exploded the whole ‘energy in-energy out’ myth of dieting. Ask anyone whose battled their weight long term or any honest personal trainer and they will tell you that it’s just not that simple. Traditional dieting ultimately makes people fatter.

What’s worse than the lack of results on the scale are the thin people that spout “You just need to eat less and exercise more!” as if you weren’t already doing that. The implication that you are just being untruthful about your vigilance is offensive and demoralising. You give up. You eat a bar of chocolate. You may as well, because people assume you are anyway.

So you can imagine my excitement when (drum roll please) the scales showed my pre-pregnancy weight! I’m so happy I’ve become evangelical. We are not ‘big boned’. We do not have ‘a slow metabolism’. We are not weak, lazy, self delusional or greedy.

The first couple of weeks of fasting required some commitment and a bit of effort but it was much easier than I expected it to be. Yes, I was hungry. So what. Every diet I’ve ever tried required me to feel hungry but I was required to feel it every bloody day! Two days a week? No problem!

What makes it really easy to get through fast days is this phrase: “I’ll eat that tomorrow.”

You see, the wonderful thing about The Fast Diet is that you don’t count or restrict anything on your other days. Yes, you read that correctly. No calorie counting. No portion control. No using matchboxes or your palm to measure serving sizes of the food you love. The authors recommend that you eat a healthy diet most of the time which is high in vegetables, includes some fruit and good quality protein but you can also include occasional serves of the foods that are usually forbidden.

I’m thinner than I’ve been in twenty two years and I did it while eating pizza, French cheeses, gourmet dinners, decadent desserts and the occasional hand full of potato chips. On the recommendation of the authors via their Facebook page we suspended fasting over Christmas, both gained a couple of kilos and then lost them when we fasted the following week. You can see why they call this ‘The Foodies Diet’.

I have other reasons for eating well most of the time. I know that good quality whole foods can contribute to my health and reduce my risk of occurrence. I also know that eating well affects my mood, my energy and my appearance. But The Fast Diet means that I can finally enjoy food again without any guilt. I can have an evening out at a beautiful restaurant and not use kilojoules or fat content as a criteria for menu choices. For someone like me who loves fine dining this is close to miraculous.

Apart from the weight loss I think this way of eating helps to educate your subconscious; hunger is not going to kill me.  Like other people on this diet, I find that hunger does not increase throughout my fast days. It comes in waves. It peaks and subsides and it’s no worse at the end of the day than it was in the morning. It’s about as uncomfortable as a small stone stuck in the bottom of your shoe. Mildly annoying. Not more than that.

This is not a starve and binge strategy. Although I expected to be hungry the day after a fast day I actually stuck to my usual routine of a late breakfast. I have found that I am just not as hungry as I used to be and that I naturally eat less. Although I had no hesitation in ordering a pork chop for lunch I chose not to eat all of it and I passed on dessert. On purpose. My choice.

I’ve also lost my sweet tooth, perhaps because fasting has starved the sugar-eating bacteria in my gut. (Another recent Catalyst program explained that this bacteria can signal our brain to crave more sugar.) The research confirms that people don’t overeat after a fast day. That’s part of why this strategy works so well.

For the first few weeks, fast days were a challenge. I avoided anywhere that sold or stored food (including my kitchen) and kept myself busy doing things I enjoyed. I slept late and went to bed early in order to shorten the day. I felt occasionally ravenous but then I would distract myself with something, have a nice big drink of water and the feeling would pass. It reminded me of giving up smoking.

Now to my surprise I actually enjoy fast days. Apart from being seriously impressed with the results (12 kilos gone and counting) I find I have plenty of energy, I think clearly and I don’t ever suffer from ‘low blood sugar’ fatigue, which, it turns out, is just one more dieting myth that this research has exploded. Think about it. You go to bed every night and go without food for seven or eight or nine hours. You can usually add in the couple of hours you didn’t eat before you went to bed. Do you wake up feeling light headed because of low blood sugar? Ironic that this diet might be the way to avoid diabetes.

Some of the recent research is showing that athletes actually perform better if they fast before competition. The guy that wrote the book on ‘carb loading’ is now apologising and advocating a different approach. It makes sense that as an animal reliant upon hunting to provide our food, fasting would trigger improved athletic performance.

I’ve only got another two or three kilos to go and then I’ll cut down to one fast day a week for the rest of my life. It’s clear that this is one way I can actively help my body to avoid cancer in the future.

If you’re interested, here’s a great article by Michael Mosely:

http://www.independent.ie/life/health-wellbeing/the-fast-way-to-lose-weight-live-healthily-and-fight-ageing-30600623.html

5:2 is not the only way to fast. Some people find it easier to limit their eating to an eight hour window each day. This is usually referred to as the 8:16 diet. You might, for example, have your first meal of the day at 11.00am and your last meal at 7.00pm. Eating this way gives your body a fasting window where it can switch to repair mode. The biggest difference with 8:16 is that you need to eat this way every day (some people take one day off a week) for the rest of your life. It’s a personal choice whether you prefer 5:2.

There’s also the option of doing a three day continuous fast every month. If you prefer this, you need to be aware that this is a serious fast and not just the calorie restriction you get on the 5:2 diet. Most people doing a three day fast have only water or herbal tea. Some have clear soup or broth. I know people that combine a monthly fast with some kind of spiritual practice such as a retreat, meditation, yoga or prayer. It’s about a lot more than diet for them, but a spiritual aspect is not a requirement. I think the most difficult thing about three day fasting is fitting it into your life. Few of us can walk away from our lives for three days every month and trying to maintain an extreme fast while friends, family and co-workers are enjoying meals would be difficult.

I’ll probably do a three day fast a couple of times a year for the health benefits.

Regardless of which model you choose, fasting is good for you.

I’ll add my usual caution here. If you’re currently having treatment then discuss any diet changes with your doctor and please, do your own research. If you’re having chemotherapy then it’s worth googling ‘chemotherapy and fasting’. There is evidence that fasting might help to make chemotherapy less toxic to the body and more effective. Ironically, the chronic nausea and loss of appetite could be part of the reason chemotherapy works at all.

If you sent me a message saying you had just been diagnosed and asking my advice then part of my response would include a recommendation that you fast for three days. If I could go back in time that’s what I would do. It’s possible that fasting might just help our bodies to fight active cancer.

This is a fascinating area of research and one I’ll be keeping an eye on.

So here’s a short list of the ideas I’ve now consigned to the rubbish bin:

1. Fasting is bad for you.
2. If you don’t eat regularly you’ll get low blood sugar and feel tired
3. You can’t exercise if you’re fasting.
4. You must eat breakfast to ‘kick start’ your metabolism.
5. Losing weight is simple a case of energy in, energy out; reduce the amount of food you eat and increase the amount of exercise you do and you are guaranteed to lose weight.
6. Fasting will promote binge eating.
7. Fasting will promote eating disorders.
8. Going hungry will make it difficult for you to concentrate.
9. You can’t sleep if you’re hungry.
10. Weight gain is unavoidable with age.
11. Losing weight means giving up food you love.
12. Over weight people are just making excuses because they are greedy.

All of these are WRONG. Imagine my delighted surprise!

 

Here, Try My Shoes.

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This blog contains a lot of advice about coping with the treatment for cancer and living well after treatment. I often think that offering people advice is a bit like offering them your shoes. Someone tells you they need to walk from here to there (and sometimes they don’t even do that) and you say, “Here, try my shoes.” The problem is obvious. There’s a fair chance that my shoes won’t fit you. Even if they fit you, they might not be comfortable. Advice is a bit like that too.

When I consider whether or not to take someone’s advice it’s like deciding to try on their shoes. This is not a simple decision. From my perspective there are some shoes I know will never be comfortable. I am not, for example, going to try leech therapy to prevent cancer.

There are some shoes that look like they’ll fit me but don’t. For me this happened with radiation therapy. I did my research, heard all about the statistics, endured the embarrassment of having my breasts exposed to strangers day after day and the discomfort of skin damage and then my cancer came back anyway. Conclusion? The radiation did not ‘mop up’ any potentially cancerous cells as promised and I now have permanently weakened tissue and the risks that come with radiation treatment, including future heart trouble, leukaemia, and aggressive mutations to the cancer I’ve already had. Of course the cancer would almost certainly have come back without the radiation and then I would have kicked myself for not having it.

There are some shoes that look like I won’t like them but turn out to be brilliant. Recently I saw a television program about fasting and the research into its benefits. I’m someone whose previously dismissed fasting as too extreme, too radical and too much stress on my body. I was wrong. It turns out that fasting can trigger your body to clean up damaged cells and to improve your production of T cells, critical for a healthy immune system. This is important news for anyone trying to avoid cancer. Research has shown that all of us have potentially cancerous cells circulating the body all of the time. In those of us that develop tumour based cancer these cells have managed to trick the body into providing a blood supply so that the cells can multiply into tumours. Something that helps the body to clean up damaged cells is highly likely to help prevent the recurrence of cancer. I’m excited.

Most importantly, research into fasting has shown that it reduces the PKA Enzyme. Higher than average levels of this enzyme are present in people with cancer and it’s been linked to cell progression and tumour formation. As a side benefit, it’s also linked to ageing (not that I care any more, ever again, how old I look!).

Last week I fasted for two days. There’s a popular diet around at them moment that’s variously called ‘The Fast Diet’ or ‘The 5:2 diet” and the program I saw included an interview with Michael Mosely, one of the people that developed this concept. I really think they should call it a ‘calorie reduction’ diet rather than fasting, because it involves eating 500 calories on two days each week. That’s not the same thing as fasting. I tried 5:2 but for me it was more difficult than just eating nothing for two days. Eating something made me mildly obsessive about what I could include in my 500 calories. Eating nothing gave me a complete break from eating, preparing and thinking about food.

Over the course of the two days I drank plenty of water. On the first day I had two black coffees in the morning but I left these out on the second day. As a consequence I had a mild ‘where’s my caffeine’ headache on day two but otherwise I felt fine. I kept myself busy and distracted. I thought a lot less about food than I expected and while I did have moments of feeling like I wanted to eat I found they passed quickly if I just turned my attention to something else. In my mind, it sounded like this:

“Hmm. I feel like something to eat. Maybe an apple or some peanut butter on toast. Oh wait. I’m fasting. I’ll have a drink of water and find something to keep me busy.”

Interestingly, my hunger did not increase over the course of the two days. I did not become ravenous or distressed about the lack of food. It seemed that once my hunger reached it’s very mild peak it just stayed there and only invaded my thoughts intermittently. I was surprised at how easy I found it to go without food.

The proponents of fasting claim that it improves our cognitive function. They speculate that our ancestors, during times of hunger, would have needed to be more creative problem solvers to find food and so the absence of food improves our thinking. I managed to figure out a complex problem with a broken sliding door, to remove the door, repair it and replace it so there might be something in that.

I was hoping that fasting might have had an impact on my pain levels. I’ve still got nerve pain, particularly in my hands, as a consequence of chemotherapy. I’ve also got lower back pain, possibly from degenerative arthritis in my SI joint or another hang over from chemotherapy. Fasting didn’t seem to make much difference but I remembered my TENS machine and found it made a huge difference to my lower back pain. More creative problem solving, perhaps.

The most noticeable impact was on the duration and severity of my hot flushes. Chemotherapy induced menopause. Post surgically my hot flushes have ramped up again. I don’t find them particularly distressing because I certainly prefer them to menstruating and they mostly just involve the same feeling I get when I walk into summer sunshine. There’s a bit of a glow across the forehead and a down-to-the-bones warmth but I don’t have the panic that affects some women. For the whole two days of fasting I had two very mild events instead of six or so much stronger ones. Conclusion: If you struggle with hot flushes it might be worth trying a short fast. Of course, what works for me might not work for you. These are my shoes.

Meanwhile Graham’s trying the 5:2 diet and loving it.

If you’re interested in 5:2 there’s more information here:

http://thefastdiet.co.uk

Here’s a couple of interesting articles about fasting, one of them with good research references:

http://www.collective-evolution.com/2014/06/22/scientists-discover-that-fasting-triggers-stem-cell-regeneration-fights-cancer/

https://news.usc.edu/63669/fasting-triggers-stem-cell-regeneration-of-damaged-old-immune-system/

You might also like to google for more research into fasting.

If you’re about to start chemotherapy then you might want to talk to your doctor about fasting. Here’s just one of the pieces of research showing the potential for fasting either prior to or after chemotherapy to reduce some of the unwanted side effects. It’s also possible that fasting might improve the efficacy of chemotherapy which of course means that it might not, but so far it appears not to have any negative impact on chemotherapy and would, on that basis, be worth trying, particularly for those people plagued by extreme nausea.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815756/

But back to footwear. Sometimes, particularly in relation to cancer, I find myself being invited to wear the shoes of someone that’s losing their fight. I can understand anyone’s desire to share information and advice in the hope of helping other people. It’s the reason I blog. I also think the first rule of taking advice is to consider the situation of the person offering it. I would not, for example, take investment advice from someone that doesn’t invest, or health advice from someone who is unhealthy.

There’s a number of popular cancer related sources, including Facebook pages, blogs, web sites and web magazines that include some often radical advice from people with cancer. I’m sure it’s well meaning but when the author is advocating expensive and radical treatments that have failed to cure their cancer I’m going to be skeptical.

I’ve had quite a few people recommend Anna Kitson’s site at http://savingana.com

She also has a Facebook page.

Anna is now a regular contributor to Mamma Mia where she’s promoted as someone writing about what it’s like to die from stage four breast cancer.

Her site offers several pairs of very expensive and unusual looking shoes. Her recommendations include travelling to clinics (Kliniks) in Germany for treatment, taking expensive supplements, using hypothermia, sticking to a ketogenic diet, taking cannabis oil and considering some of the more radical alternative treatments. It’s possible that this advice is the reason she’s still alive eleven years after her diagnosis. Sadly, it’s also possible that none of it has made any difference to her health, although it’s surely had an impact on her bank balance.

It’s reasonable that she want you to walk a mile in her shoes, but keep in mind where those feet are headed.

I don’t have an easy formula for determining which advice to take and which to reject. ‘Trust your instincts’ is popular but terrible advice in my opinion. My instincts have often led me down darkened alleys to be beaten up by foreseeable consequences. I have distressingly seen ‘instincts’ cause people to reject mainstream medicine and to die cursing the alternative medicine practitioners. I’ve also seen some (but only a few) cases where rejecting mainstream medicine and implementing alternative methods resulted in a return to good health. The trouble with advising people to trust their instincts is that it invariably comes from people who, with the wisdom of hindsight, made a good choice. They seem to conveniently forget all of those times when their instincts helped them to make really bad decisions.

‘Trust science’ is also problematic because while I continue to be a fan of the double blind trial I keep three things in mind; firstly, a lot of research is funded by vested interests and there is a long history of this kind of influence having an impact on the integrity of any research; secondly, funding for research is limited and the ways that subjects are selected for research are often arbitrary which means a lot of potentially promising and beneficial treatments may not have research to support them; and thirdly, science is always evolving and changing which is both wonderful and frustrating. There’s no doubt that elements of the best possible cancer treatment you can get today will be obsolete at some time in the future, in some cases within a year.

Recently I’ve been researching diets in the hope of finding the best possible eating plan for avoiding recurrence. It’s interesting how many ‘sacred cows’ are being barbecued by the evidence. Low fat diets are bad for you, eggs will not raise your cholesterol and even lard (yes lard!) and butter might be new health foods!

When we look back at medical practices of a century ago, or even a decade ago, we can find much to criticise. This will be just as true of ‘modern medicine’ in a decades time, or with the wisdom that will come from a century of improvement. We don’t yet have a cure for cancer. A lot of the best available treatment comes with serious risks and side effects. Would you like bare feet or stilettoes to cross that fire pit?

I’ll keep learning and researching and sharing what I find. It’s likely that I’ll change shoes several times over the next year or so as I figure out what works for me. My aim is to prevent my cancer coming back. All advice comes with this caveat: We won’t know if any of my advice is worth taking for at least five years. It’s also worth remembering that we are all different and complex. What works for me might not work for you.

And as a final caution, I’m always very suspicious of anyone trying to sell me their shoes. It’s relatively easy to set up an impressive looking web site with what appears to be ‘scientific research’ and to market some new wonder product to cancer patients. There are possibly some well meaning people that are over-enthusiastic about something that shows potential and there are definitely plenty of people prepared to exploit anyone desperate for any hope of a cure. It’s always useful to ask ‘Who gains if I take this advice?’ particularly when large sums of money are involved.

Ultimately I’ll resort to gathering my own evidence, being open to what seems instinctively to be counter-intuitive, being prepared to learn and to change my mind and recognising that at some point, failing to make a decision could have worse consequences than choosing any of the reasonable options available to me.

So please, if you’d like to do so, try my shoes. But feel free to take them off again if they’re the least bit uncomfortable, and feel free to reject them completely if you can tell just by looking at them that they’re not for you.