I wrote this back in July of 2016. That was when I had just started gaining weight from the Tamoxifen.
Here’s a mind-bender: Being overweight often has nothing to do with calories or exercise. For a huge number of us, the problem is instead about misfiring hormones. Research is still catching up with this paradigm shift, which has yet to be comprehensively studied. You already know about some weight-affecting hormone issues, like thyroid and insulin imbalances. But other, more subtle ones could also be keeping you from the body you want.
Think of leptin as the hormone that says, “Darling, put down the fork.” Under normal circumstances, it’s released from your fat cells and travels in the blood to your brain, where it signals that you’re full. But leptin’s noble cause has been impeded by our consumption of a type of sugar called fructose, found in fruit and processed foods alike. When you eat small amounts of fructose, you’re OK. But if you eat more than the recommended 5 daily servings of fruit (which in recent decades has been bred to contain more fructose than it used to) plus processed foods with added sugar, your liver can’t deal with the fructose fast enough to use it as fuel. Instead, your body starts converting it into fats, sending them off into the bloodstream as triglycerides and depositing them in the liver and elsewhere in your belly. As more fructose is converted to fat, your levels of leptin increase (because fat produces leptin). And when you have too much of any hormone circulating in your system, your body becomes resistant to its message. With leptin, that means your brain starts to miss the signal that you’re full. You continue to eat, and you keep gaining weight.
The so-called stress hormone cortisol can create all kinds of trouble for women who want to shed weight. When cortisol rises, it encourages the conversion of blood sugar into fat for long-term storage. Hoarding body fat in this way was a useful survival adaptation for our ancestors when they faced stressful famines. Not so much today. Obviously, reducing stress in your life will help rein in this fat-storing hormone, but there’s another very common source of the problem: daily coffee, which elevates cortisol dramatically, causing your body to hoard fat when you least need to.
Although estrogen is responsible for making women uniquely women, it’s also the hormone that can be the most troublesome in the fat department. At normal levels, estrogen helps keep you lean by goosing the production of insulin, a hormone that manages blood sugar. When estrogen gets thrown off, though, it turns you into a weight-gain machine.
Here’s how: When you eat, your blood sugar rises. Like a bodyguard, insulin lowers it by escorting glucose into three different places in your body. When insulin is in good working form—not too high and not too low—it sends a small amount of glucose to your liver, a large amount to your muscles to use as fuel, and little to none to fat storage. When you’re healthy and in good shape, your pancreas produces exactly the right amount of insulin to have your blood sugar softly rise and fall within a narrow range (fasting levels of 70 to 85 mg/dl). But when your estrogen levels climb, the cells that produce insulin become strained, and you can become insulin resistant. That’s when insulin starts to usher less glucose to the liver and muscles, raising the levels of sugar in your bloodstream and ultimately storing the glucose as fat. Your fat tissue can expand by as much as four times to accommodate the storage of glucose.
Many people gain weight when they are treated with chemotherapy and steroids. Your extra weight may hang around and increase after chemotherapy if you also take hormonal therapy (tamoxifen or an aromatase inhibitor). If your body shifts into menopause because of chemotherapy, there’s a tendency to gain weight. If you are taking Hormone Blockers such as Anastrozole also throw you into menopause.
This weight gain may be because of the enzyme lipoprotein lipase (LPL), which is controlled by insulin.
LPL sits on the surface of cells and pulls fat out of the bloodstream and into the cell. If LPL is on a muscle cell, it pulls fat into the cell where it’s used for fuel. If LPL is on a fat cell, it pulls fat into the cell and makes it fatter.
It’s important to know that the hormone estrogen suppresses LPL activity on fat cells. This could be one reason why some women gain weight after menopause or after breast cancer treatment that dramatically decreases estrogen levels. With less estrogen in the body, LPL can pull fat into fat cells and store it there.
The shock of a diagnosis, the disruption of your life, getting through and beyond surgery and radiation, the strain of relationships at home and at work, financial stress, and less physical activity all may contribute to weight gain. During chemo, extra fluids and steroids together with less physical activity and a yearning for sweets all combine to cause weight gain. And like many people, you may be certain that taking a hormonal therapy medication makes you gain weight and makes it nearly impossible to lose weight.
Losing weight becomes much harder as we grow older, but it can still be done with careful diet changes and exercise. Be nice to yourself; don’t punish yourself.
There are lots of good reasons to maintain a healthy weight. You’ll feel stronger, have more energy, and boost your self-esteem. Also, research has shown that being overweight can increase the risk of the cancer coming back. Some studies have shown that women who were overweight at diagnosis had about a one-third increased risk of the cancer coming back. (For example, the risk could go from 6% to 8%, because one-third of 6 is 2.) Other studies showed more than a five-fold (5 times) risk increase (for example, the risk might go from 6% to 31%).
Do you need to count calories?
Many people believe that if you eat fewer calories than you burn each day, you’ll lose weight, and if you eat the same number of calories that you’ll burn, you’ll maintain a healthy weight. This plan works for many people, but not all.
If you’re counting calories, it’s important to think about what you’re eating. Say Jane eats 1,200 calories a day of cake, cookies and white bread. She’s probably not going to lose any weight. Betty eats 1,200 calories a day of fresh vegetables and fruit and lean protein. She’s probably going to lose some weight and get a lot more nutrients from her food. Counting calories is only part of the weight loss equation.
And counting calories is only one way to lose weight. Because the hormone insulin plays a major role in how your body uses and stores fat, some research suggests that eating foods that keep insulin levels steady throughout the day — lean meat and fish, poultry, vegetables, and fruit rather than foods like sugar, candy, white bread and crackers — can help you maintain a healthy weight.
The first thing to do if you want to lose weight is to talk to your doctors and a registered dietitian about a safe and sensible plan designed specifically for you and your needs. Your doctors may want you to wait until you have completely recovered from treatment or any other health issues you may have.
These steps can help you lose weight after treatment:
•Assess Your Weight
•Create a Healthy Eating Plan That Includes Exercise
•Make Healthy Food Choices and Lose Weight
Next time you go in to see your Oncologist…ask if they have a dietician in the office…if so, make an appointment.