Oh Letrozole, how long the road has been with you.  This little drug has changed the game for those of us who have had estrogen positive breast cancer. 18% reduction in risk of death and longer progression free survival (56.4 months) in women with HR+ metastatic breast cancer.  This deserves a shout out to all the researchers that made this happen - we bow to you!  However this little 2.5mg pill does a number on your body and leaves you awake at 3 A.M.,  dripping in sweat wondering why people think breast cancer is treated, then over with. This little pill is one of the reasons we keep spiraling with side effects and can't rebound after chemo and radiation. These adverse effects are why there is very low adherence to the Letrozole protocol; only 57% continue taking this after 3 years.  The first year taking aromatase inhibitors (estrogen blockers)  is typically the hardest, for me, it meant waking up with claw feet and not being able to walk for the first few minutes of each day, to joint pain, dryness (even my eye sockets were dry) and stiffness..as in I couldn't get into child pose during my first yoga class after a month of Letrozole. My cholesterol was high for the first time in my life and I showed signs of inflammation in my lab work.  Not to mention, this drug had to be administered with a monthly injection of Zoladex (blocks your ovaries from producing estrogen) right into your abdomen.  After AC chemo, you are forced into menopause, so I didn't even notice the typical side effects of menopause as I had other things going on...but nobody told me about letrozole claw foot...or the god forsaken dry eyes!  ESSH...and then there is the 2.5mg that is handed out to all of us...regardless of our age, size or estrogen levels.  I asked SO many times about dosage and was only told that it was what was researched and if I wanted a better chance of survival, I need to take 2.5mg for 10 years.  I started digging and found a few articles on dose reduction (here) and shared my oncologist. Although the double blind trial showed that dose reduction (alternate days or 1 mg MWF or .25 MWF)  was "non-inferior" to  2.5mg daily, the side affects don't seem to reduce with dose reduction. I brought the article to my oncologist and we negotiated; she said the sample size was small and that I am not "post-menopausal" so I can't apply the logic to myself.  I said, that I was "forced post-menopausal" and felt that I could reduce at-least 1-2 days a week. We agreed that on the days I fast, I can skip my dose but she asked that I try and take it all other days. This was my solution to what my body was telling me and just a reminder to keep communication channels open with your oncologist as they often do have quality of life in mind and can work with you to figure out a plan that will help you tolerate some of these life saving meds.  My rituals to keep the adverse effects away:

  • Fasting with water every Monday and skipping my dose of letrozole

  • Yoga everyday

  • Increasing magnesium and calcium with Whole Foods 

  • Drinking an anti-inflammatory drink (recipe is here) -note this should only be used after chemo as it has turmeric in it. 

  • Reducing inflammatory type foods (refined carbs and processed food).

  • Increasing fruit intake - especially passion fruit!

  • Reduce alcohol intake - even a glass of wine will throw my body into a spin now.

  • Staying hydrated

  • Using EMLA cream 30 minutes before the Zoladex injection so that you don't feel it.

After all of these bio hacks, I am feeling pretty good and can say that the my side effects are reduced by 85%. I definitely have days where a flare up happens and I haven't checked my counts yet to see if this is working as my real indicator will be my cholesterol and sedimentation rate as they went from very low to very high with Letrozole but my estrogen has remained exactly where it should be.  

Fasting

Fasting has been a common for practice in many cultures since the beginning of humanity.  The list of benefits are long, but the main are summarized below:

 

  • Decreases inflammation

  • Improves cell recycling

  • increases resistance to Oxidative stress

  • protects your brain

  • reduces harmful protein production

  • Lowers blood pressure

  • Decreases blood sugar

  • Encourages better insulin sensitivity

  • Improves cardiovascular health

  • Promotes overall heart health

  • Supports fat loss and Ketosis

  • Boosts metabolism

  • Serves as an anti-aging agent and enhances longevity

  • Supports Healthier Collagen in Skin

  • Supports with recovery from trauma.

Looking at all of these benefits, it makes one wonder if fasting would also work during chemotherapy?  Could fasting support the chemo to destroy cancer cells while reducing side-effects of chemo (such as chemo brain, skin issues and fatigue)?  Research is showing that the answer is "Yes."  Valter Longo director of the USC longevity Institute has been studying fasting for years and has now shown that the effects of short term fasting or a low calorie fasting-like diet, plus chemotherapy supports the immune system to target and kill breast cancer cells.  If you are interested in his work click here.   A journal article that defends Valter's theory shows that fasting cycles retard growth of tumors and sensitize a range of cancer cell types to chemo. - this means a higher chance of survival.  Basically what happens is that the body's DNA goes into protective mode and normal cells get stronger and cancer cells or abnormal cells become weaker thus making them more susceptible to chemo.  The journal article link is here

 

In a journal article written in March of 2017 (here​). also shows that fasting decreases glucose levels and promotes sensitization to chemo - thus reducing cancer cells.

I started fasting 48 hours before each chemo session and usually another 24 hours after or a fasting mimicking diet right after (basically eating an avocado or Brazil nuts to coat my stomach before chemo is infused).  What I noticed is that I tend to recover faster than other patients on the same regimen.  My skin looks great, my fatigue is minimal and my tumor is almost gone after 4 AC treatments.  I also don't seem to have the chemo brain or brain fog that everyone talks about.  The one thing that I need to point out is that your body needs to be able to tolerate fasting.  You should talk to your healthcare prior to fasting to ensure you can tolerate it.  I did a few practice runs before chemo and knew I would be ok..I was a bit nervous the first infusion but all went well. I also learned that President Obama is a faster - every Sunday he fasts for his health..and look at him...clear and strategic thinker and very healthy!  

Acupuncture

Managing the side effects of the western treatment to breast cancer is exhausting.  Each round of chemo brings a new obstacle to overcome and you are forever learning how to manage the responses of your body.

Acupuncture has saved me twice - the first time I had a persistent headache that would not go away along with slight brain fog.  I had one treatment and left headache free and my brain was clear of fog.  After round 3, I had nausea that stayed with me for 10 days.  One treatment of acupuncture and the nausea was gone.

Acupuncture is the insertion of very fine needles into strategic points (called meridian points) to manipulate the flow of energy or qi.  

In the USA a licensed acupuncturist must pass a national exam to obtain a certification by the National Certification for Acupuncture and Oriental Medicine.  After this exam, each state has different requirements for licensing which include clinical training hours, ethics and clean needle technique.  Note that going to a trained acupuncturist vs. a medical practitioner using needles for pain relief is a VERY different experience.  I highly recommend going to a NCCAOM certified Traditional Chinese Medical Practioner if you want the holistic approach.  To access a list of partitioners, click here

 

For Breast Cancer, acupuncture can be an adjunct therapy with chemotherapy and radiation as well as recovery from surgical procedures.  It can support with the following:

  • Nausea

  • Brain Fog

  • Neuropathy (and prevention of neuropathy)

  • Immune System Support

  • Headaches

  • Mouth Issues - soreness of tongue and heat issues (mouth sores)

  • Stress (this is HUGE as if you are stressed your western treatments can be ineffective)

  • Appetite 

  • Pain

  • Fatigue

At Mayo, acupunture is recommended for side effects and is also available at Mayo Clinic.  There are numerous clinical trials available for breast cancer patients..so ask as you may benefit from this wonderful medicine free of charge!  One article that I found interesting this week is related to joint pain and acupuncture.  The link is here.