estrogen and body fat and anti-hormonal treatment

PiscesMoon

i'm just putting down my thoughts here but would love feedback. 

whether or not i take an pharma or natural anti-estrogen medication, my question still seems not to satisfactorily answered.  i have a lot of body fat.  my BMI would indicate that i'm clinically obese.  i've lost 140 pounds in the last 3 years but still have a way to go.  it's my understanding that estrogen is stored in body fat.  i've googled BMI and HER2 positive cancer along with anti-hormonal treatment and from what i've read it doesn't seem that women with excess body fat respond well to anti-hormonal therapy.  i suppose the only way to really know is to monitor one's blood levels.

other studies (early ones i believe) that i've seen have linked obesity and recurrence.  some even suggest that obesity can interfere with the effectiveness of any treatment.  also, the studies suggest that losing weight after being dx'd does not effect the outcome, i.e., ensuring you don't get a recurrence or mets.  i'm going by memory here as i haven't bookmarked any of the studies that i've found.

now i understand that these studies are early and, in fact, may be disproven in the next five years or so.  but i think that it's good food for thought.  it truly makes me wonder - my body fat is working against me and it seems like no matter what i do my odds are not in my favor.  taking armidex or DIM or anything else seems to be almost pointless.  losing weight seems to be a good option but in the long run doesn't seem to make my odds better, either.

i'm really kind of rambling here but can anyone see my point (i don't even think that i can)?  i have no arguement that losing weight, eating healthier, excercising, etc. is a good idea.  but i'm thinking that my body fat is like a loaded weapon just waiting to go off and set off another chain of not so fun events.

thoughts?

thanks!

~M

1Athena1

PiscesMoon, you always start such interesting threads. 

I'm afraid I don't have much concrete knowledge to add. I am generally skeptical of studies pointing out that diet and/or exercise can help against cancer - I tend to find them self-serving and misleading. However, they are not all that way, and it is known that fat can store estrogen. This is especially true of mesenteric (sp) fat - that which is around the belly.

I was on Lupron for some time last year and I have also been waging an 18-month battle both with and against Tamoxifen. Both meds piled fat onto my midsection area. I am not obese or even fat, but I have been overweight. The fatigue from both drugs has made exercising a very difficult thing. It seems as though the higher I try to climb up the mountain of wellness, the more I keep getting turned back by avalanches.

I found that when I was on both Lupron and Tamoxifen, I had incredible cravings for sweets and dairy. I wonder if it was my body's way of trying to grab some of the estrogen it had lost? There were days when I would feed on nothing but chocolate - and I am someone why can go days without tasting any. Given the belly fat I acquired, the supposed anti-cancer advantage of having my estrogen hijacked by the lupron and tamoxifen was erased, IMO. My body has changed, and I feel as though I am more prone to the accumulation of fat (estrogen).

Way to go cancer treatment!!  This is definitely the illness with no known cure.

Edited for accuracy - to say that fat can store estrogen rather than turn into it. 

LoriL

I think you are right on track with your thinking!

I was formerly morbidly obese- I lost 160 lbs 3 years ago and am now at a normal BMI. I exercise a lot and my body fat is very low. My oncologist has told me several times that keeping my body fat low is going to be one of the main things that I can do to prevent a recurrence. In fact, we just had this conversation when I saw him this past Thursday. I was telling him how since starting tamoxifen a year ago, I have noticed a drastic change in my cravings and snacking in the evening. As a result, I have gained back 10 lbs. That might not seem like a lot to the average person, but to a formerly obese person it is just devasting and causing a lot of stress. It goes much "deeper" than how I look physically even though that is driving me crazy, too, as none of my pants fit!

My oncologist said that there is a lot of new research that suggests increased body fat to be a factor in recurrence. After talking about all of this, he told me that my chance of recurrence was very low anyway because of the size of tumor, location, etc. And, if I continued to gain weight, the little benefit that I might receive from the tamoxifen would possibly be negated by the weight gain. He also said that my being stressed over all of this wasn't good for me, either, as the emotional turmoil would be putting me at higher risk for recurrence, too. So, long story short, he wants to try me off of the tamoxifen and see if my cravings subside and weight drops back down. I eat good, exercise, and take a number of supplements that may be beneficial as well. So, I feel comfortable with this plan.

There is no doubt in my mind that my obesity may have played a role in my developing the cancer in the first place. The way I look at it, it's just a fact, and it is not "blaming" obese people for their cancer. It's just saying that it is a factor. I don't think that you being heavy makes taking other things like arimidex or DIM "pointless" like you said, but I think you are right on in your thinking that losing weight would definitely help you. Believe me, I know it is not easy, but the benefits of dropping the weight and body fat just can't be denied.

Best wishes to you! It sounds like you are on the right track with getting healthy. 

crazy4carrots

Athena - My understanding is that excess estrogen is stored in body fat, and not that fat can turn into estrogen.

I have a theory (and it's only MY theory, certainly not corroborated by anyone!) that when the body is deprived of estrogen, those existing fat cells "lie in wait" , waiting for estrogen, and can in fact multiply, much the same way fat cells behave when people go on diets, only to gain back more weight (and fat) after each successive diet.  It's as though those cells are saying "You're starving us and we're going to be ready the next time you go on a diet".  Remember, too, that most peri- and post-menopausal women who enter those stages naturally do expand a little in their middle.

I ran this "theory" by my onc and she actually didn't laugh at me!  She noted that nearly all of her patients on AIs have problems with belly fat and all have incredible problems (including me) trying to get rid of it.   It's the only place on my body that's bigger than it should be, and I hate it!  I've cut out so many fattening things (can't remember the last time I had ice cream), and exercise a lot, incuding all the ones that are supposed to guarantee a flat stomach, and still I have the flab.  But I do feel good and have lots of energy.  So I guess I'll just live with it (which sure beats not living at all).

As for the studies that show increased body fat to increase rate of recurrence -- it would help to know what factors have been taken into account in those studies.  There are multiple reasons why some patients recur and others don't, many for which scientists have no answers...yet.

1Athena1

Oh, man - I think you are right, Lindasa! 

misfit

Interesting topic. I never had trouble with belly fat until about 2 years before my diagnosis. Prior to that any excess weight always went to my hips and thighs. I was eating fairly well and walking every day, yet I kept struggling with my waistline. I often wonder if there was a connection to the breast cancer. I do a lot of cardio now and things seem to be getting back to normal. I guess I'm a believer as far as exercise is concerned.

My mom has had weight issues for as long as I can remember and it breaks my heart that it's so hard for some people. Good luck to those of you who are also struggling...don't give up.

Annabella58

This is a really interesting topic....however, I always had a tummy you could bounce a quarter off of, due to many years of ballet.  My BC (new) was excess estrogen, but at the time I was extemely thin, active and healthy.

I believe that from what I have read, that excess body fat can indeed store estrogen, but it can't "make" estrogen. 

That said, I've been thru an oopharectomy, so my fat that has now come to my stomach, must be the only source.

I should think that if one is moderately overweight, (and most of us over 45 are, it's a natural thing as the metabolism slows) then the tamoxifen and the arimidex can most certainly help.

It's not a leaking bucket, it's just try to reduce risk factors.  FE: I know perfectly well that a glass of wine once a week or so prob. isn't the brightest thing I can do, but I'm having one anyway.  This doesn't mean I'm drinking the whole bottle.  So, if you are moderately overweight, well, that doesn't prevent your doing some exercise to offset the estrogen.  You do not have to run a marathon or become a skinny minnie, even a 1/2 hour will help out.

don't give up....just have what you like in moderation and get some exercise. 

MariannaLaFrance

Very interesting post. I never had weight issues at all, but will say that I had a very sudden weight gain (very unusual for me) in the 2 years prior to my diagnosis. I had my 3rd baby, lost all the pregnancy weight and then some, and then suddenly my weight shot up 15 lbs-- no changes to my diet or lifestyle. I had a large tummy, and attributed most of it to having 3 kids, but couldn't figure out why it was all situated there. 

Fast forward to BC diagnosis. I've now adapted a gluten free, sugar free, dairy free diet, I'm at my high school weight again, and no longer have the stomach that I had before. I have worked hard to get to this point, but do believe that it's helping me in the fight against recurrance.

I don't think it's the only thing that will stave a recurrance off, but I sleep better (due to exercise!) knowing that I've done something in the way of potentially keeping it at bay....

I did not opt for Tamoxifen, so I don' t know what would have occurred had I taken it.... I'm just trying to do what I can sans Tamox...

Anonymous

Very interesting topic.  My understandings and personal experience with this (body fat, estrogen and estrogen blocking) is along the lines of Anniealso. When diagnosed - I was not "obese" but for sure had a few extra pounds on me - let's say a bmi of 25 or 26.  Age 44.  I made it thru treatment, stayed about the same weight, and chemo put me into menopause (onc. tests my hormone levels once a month thru chemo and now quarterly).  I am also not a great metabolizer of tamox. so I was put on Femara.  I was honestly FREAKED about possible side effects, as well as weight gain.  I am lucky to have neither, but wanted to lose weight so I started running - moderately - last may.  I  have lost close to 20 pounds which puts my bmi at 23.  I am 5 ft 10, so 20 pounds on me is about one dress size. 

 I have never been seriously overweight, but my grandmother was.  She had the most beautiful skin which my family contributed to excess estrogen.  Of course, she died at 102 and had NEVER had serious health concerns, or taken prescription meds. She was pretty much was obese to morbidly obese her entire adult life.  Go figure. 

Running is not for everyone, but my intense personal trainer neighbor told me that fast walking will do the same.  I do not run far - but run for 20-30 minutes, so maintain my heart rate etc.  I feel great.  I am happy on femara, but will be following the clinical trials on DIM. 

So, bottom line is :  body fat stores excess estrogen.  Blocking estrogen does not mean that you are doomed to be overweight.  Move more.  Moderately increase your exercise - if you walk, walk a bit faster.   Moderate diet too - I did cut back on carbs, but did not cut out completely - just get carbs from fresh fruits, veggies, and whole grain foods.  Still have a glass of wine once or twice a week - moderate!

Marianne - great job getting back to HS weight!!!  I do think that for me, a consistent fast paced exercise plan has helped me tremendously.

edited to add:  Pisces - AMAZING to lose 140 pounds in 3 years.  Keep it up!

CrunchyPoodleMama

Interesting post, and great replies! But PiscesMom, what studies said that obesity doesn't affect the risk of recurrence? I don't see how that could be, since excess fat not only stores excess estrogen, but it messes up other hormones in various different ways.

I am pre-menopausal but had gained 40 pounds in the years before my diagnosis, due to major depression. After my diagnosis last year and cleaning up my diet/lifestyle, I shed some of that, and now am on a mission to kick the rest of it to the curb through an aggressive exercise program 5 days/week (including strength training). I have NO doubt, in spite of what some study says, that this can only help stave off any recurrence, not to mention it's already helping in so many other ways (I'm happier when I'm exercising; I don't crave sweets; I sleep much better, etc.).

lago

Most middle age women tend to put on weight in their midsection which will increase after menopause. I always had a really flat, and I mean flat stomach till recently (late 40's). Granted some women would still kill for my tummy but it does stick out a little now. I expect chemopause will make it grow bigger. Now add on a drug that stops you from processing estrogen I would think your body would want you to have more fat thinking it can get estrogen from it.

This link explains it better than I can: http://www.epigee.org/menopause/weight_gain.html

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PiscesMoon I have never really had a weight problem (yet) but I have had many friends that have. Don't beat yourself up about this and don't think you are going to die tomorrow because of it. Just keep doing what you need to do to lose it gradually. You lost 140 pounds in 3 years, that's awesome! Keep it up. Not just because of breast cancer but as you know it will help with heart issues, high blood pressure, diabetes risk/or remission etc. Don't let the stats scare you. Use the information to help yourself. I know losing weight is so hard. It seems to me it's harder than quitting smoking but look you have already done so well.

Ironically I have read that premenopausal women who are thin (under 127lbs) are at higher risk for breast cancer while women post menopausal the risk increases with weight.Tomorrow they might say something else.

-------------------------------------------------

BTW I lost the 10 lbs I needed to before my surgery. It took me 7 months. It was a combination of exercise and diet (portion control was my issue. I always ate healthy just too much of it). My exercise was a combination of aerobics and strength training. The strength train book I used was this although I can't do the upper body right now because I'm only 7.5 weeks out from bmx:  http://www.amazon.com/Bottoms-Up-Joyce-Ph-D-Vedral/dp/book-citations/0446394211

BTW I looked great just before surgery but not like the women on the cover. I have just started to work out again to get to where I was 2 months ago. I assume it will take at least 1 month.

dlb823

Excellent discussion, and it made me think of a video presentation I've recently posted elsewhere that may hold another clue as to why too much fat can be an incresed risk.  It has nothing to do with estrogen, but rather putting your body into the mode where it's developing extra blood vessels: 

http://www.ted.com/talks/lang/eng/william_li.html

Be sure and watch to the end, where Dr. Li addresses obesity.     Deanna 

hymil

Awesome weight losses there girls!! I am inspired!

Very good question, i will wait to read more about this, i am a premen 49 and now two stone less than i was six months ago, BMI dropped 29+ to 25- woohoo, just doing what i can do to fight recurrence but will i benefit? anyway i feel better and i look better. and i can run a bit without collapsing, that has to be good.... I'm on a plateau now with the loss, i think it's because winter is approaching and my body says enough for now.

But just to say that, quite apart from cancer concerns, as well as the role in oestrogen production, fat also stores toxins, so when you lose weight (When, not If, ladies!!) those bad things get released into the bloodstream, so don't forget to chase them away with lots of water or good fruit juices etc to cleanse the system 

jude14

What about the people I know who got breast cancer (estrogen fed) that were not over weight and exercised and walked and worked out and still are not overweight after the breast cancer.  I have gained alot of weight since my bc and cannot seem to loose it.  Have had my estrogen levels checked in the blood test and it is so low it is unreal so i would say the AI is workinig as for keeping the estrogen down.  I always had a waist even after being menopausal but since the AI's I have nothing anymore but a round body.  I try not to stress out over any of this and feel that no matter what we do if it is meant to come back it will and if not it willnot.  You cannot outrun what is meant to be.  I have friends that by all standards should have never had bc.  I know the belly fat is not good for many reasons but it is there and for the time being going to be hard to content with so I try not to worry.  I also try not to believe every test and study that is done.  Good luck to all of you but just remember skinny healthy people get breast cancer too.......

pod1257

If you google Dr. Pamela Peek or "menopot" she gives a good explanation of how menopause and lack of hormones affects belly fat. - I am struggling as well.

Julie 

BarbaraA

Great discussion. After BC, I adopted a totally different diet: gluten free, no dairy, all organic, hormone free meats  (1-2 x week) and I went from 125 which I have been for 30 years to 108. I was not 'fat' before but had the little belly and more every where else. Now it is gone. I hope this helps but I must say that I feel great (although DH liked me with a little more padding ??).

misfit

dlb823 - thanks for posting that link!

If I understand correctly he's saying that cancer and obesity have faulty angiogenesis in common, so it's not that obesity causes cancer but that they both share this common denominator. In theory then an anti-angiogenic diet (or medication) should help with weight loss. It would be interesting to know if anyone on Avastin has found this to be the case.

PiscesMoon

obesity and hormone therapy in breast cancer:  an unfinished puzzle

http://jco.ascopubs.org/content/early/2010/06/14/JCO.2010.29.5113.full.pdf+html

intesting and quite disheartening at the same time.  if the goal is to lower estrogen and the AI's won't work as well then why not try an alertantive which may not come with as many potential side effects?  or (and this is extreme, i know) why bother with anything at all? 

PiscesMoon

annnnnnd another one:

http://www.knowbreastcancer.org/news-research/research/obesity-aromatase-inhibitor.html

lukejessesmom

I'm glad I came across this post. I just posted a similar question in the stage 4 pages. I was diagnosed Oct.08 stage 4 @ diagnosis. Finished 6 mo. chemo and have been on Femara & Lupron for 18 months. Have gained 30 lbs. and am now probably considered obese. I had a lap band procedure in April 08 because I am diabetic but had to have the saline removed when I was diagnosed. My oncologist suggested to me on Friday that I may want to consider having the band filled again to help lose this weight...for the reasons you mention about the fat storing hormones. I'm seriously thinking about it as I have responded extremely well to treatment and although I am stage 4 do not want my extra weight to cause other problems down the road, either with my diabetes or my breast cancer. Great post!

bichonlvr03

My understanding is that body fat produces estrogen.  I don't know if it stores it or not.  An example of why scientists believe fat produces estrogen is when young overweight girls start mentruating at an early age.  It is believed that their fat tissue is producing estrogen and causing early menses.

soulswithin

Just about every breast cancer patient I know were not overweight, mostly thin athletes, which makes me wonder who and where are these studies being done.

The idea is to get healthy, live a non stressful life, and don't run yourself into the ground, if you want good body karma.

I agree, in order for studies to be accurate, estrogen rates/productions, processed meats and foods, chemicals in the work force or at home, etc. You have to look at the total picture, not body wieght. Its very misleading to publish over and over the body-overweight causing cancer, and yet leave out hormonal activities in athletes who have no fat.

Nothing so far makes sense to me, it's like everyone is groping for half answers.

molly52

I am one of those "never been overweight" people - actually mostly underweight my whole life.  And I still got breast cancer.  I exercised (a lot) ate veggies, all the right stuff.  Honestly, I felt betrayed when I got BC - cause I had followed the rules.

PicesMoon - you are awesome.  You are obviously very focused and determined.  And I'm gonna say - don't let statistics and studies stop you from your goals.  Next year they will have a different study that says loosing weight before or after BC is beneficial.  So be proud of yourself and enjoy your new body.  Maybe 3 years from now they'll have a study that says women who like their body survive longer than .......

PiscesMoon

molly52 - thank you :-)  i'm kind of like a dog with a bone when it comes to certain things - i work at it and chew on it and work at it some more.  eventually i will get to the point where i am comfortable with it and then i can make a plan and move on.  :-)

thanks to everyone for your feedback and stories.  it is definately frustrating when i hear stories about thin, fit, athletic women who get bc.  this shows that 'they' still do not know a danged thing and to me it's just unacceptable.  'they' need to find the trigger to this beast so we can make it non-existant!

~M