April 2007: Weight Management During and After Breast Cancer Treatment

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Advice on getting rid of tough excess weight?

Question from Lu: Since my lumpectomy and hysterectomy, I've gained 13 pounds. I take thyroid meds because my thyroid was low and recently was put on Lipitor for high cholesterol. I can't get my weight down despite tennis, walking, running, or watching what I eat. I'm feeling discouraged. Can you give me any advice on how to get rid of this excess weight?

Answers —Cyndi Thomson, Ph.D., R.D.: First thing I would say is work with your physician about getting your thyroid medication adjusted. That's going to take some time. So if you were diagnosed with low thyroid function, that takes time. And then I would say that you may be someone who needs to link into some kind of programming or counseling or group support. If you're on your own or struggling, you may benefit from regular follow-ups and counseling. Have someone assess your energy intake, or calorie intake, against what your calorie needs are for weight control.

Melinda Irwin, Ph.D., M.P.H.: One thing you can focus on perhaps is adding in a strength or weight training program to increase your lean mass, which would maintain or increase your metabolic rate. Going through the treatment, you may have lost some bone or muscle mass, which could have caused some of the weight gain. The exercise you're doing is great, but you may want to try some different exercising like weight training.

Which weight loss program is best?

Question from Senso: What's better for breast cancer survivors—Weight Watchers, South Beach, or LA Weight Loss? Are any of them more helpful than others? Thanks.

Answer —Cyndi Thomson, Ph.D., R.D.: From my perspective as a nutrition professional, the best ones are the ones that work for you, and every woman can be different. In terms of research that's been done, the Weight Watchers program has been evaluated in breast cancer survivors. It was a small study, but it did show that women could lose weight. The other programs may be beneficial for someone as well. I think the key issue is any diet program has to also include physical activity and long-term lifelong healthy eating and activity patterns. You can't do it for six weeks and go, "Okay, I'm done."

Atkins diet okay for breast cancer survivors?

Question from Romanz: I just finished treatment and gained about 15 pounds. I want to do the Atkins diet because a friend of mine has lost so much weight on it. However, I keep hearing that red meat is dangerous for breast cancer patients. What is your take on the Atkins diet for breast cancer survivors?

Answer —Cyndi Thomson, Ph.D., R.D.: We're actually doing a study looking at a low fat versus low carbs diet in breast cancer survivors, and we made a conscious decision to adjust it and make it a modified Atkins diet because I do not feel that we want breast cancer survivors eating large amounts of saturated fat, including red meat. So you might modify the diet by choosing leaner protein sources, like fish and chicken.

Healthy way to lose ten pounds?

Question from Mary Ann: I am 42 years old and just went through seven rounds of chemo—first AC, then Taxol. I have gained around 10 lbs. throughout. I want to lose it, but in a healthy way. Please help.

Answers —Melinda Irwin, Ph.D., M.P.H.: I would say not to do anything too extreme, but make a lifestyle change. But make lifestyle changes that you can incorporate into your daily routine: adding in physical activity throughout your day, taking the stairs instead of the elevator, walking to errands instead of driving when you can. Make those conscious decisions. Purchase a pedometer so you can monitor your daily walking. 2000 steps is about 1 mile, so if you add in 500 steps a day, which is very easy to do, all of a sudden it becomes easy and you don't feel like you've made changes. If you want to get involved in a more structured form of exercise, depending on what you've been doing, you can start with walking 30 minutes 5 days per week. If you're already doing that, you can focus on increasing the intensity of your activity to burn more calories. So rather than 30 minutes of walking and burning 200 calories in that 30 minutes, say you have a treadmill and can walk on a grade, then you may burn 300 calories rather than 200. Aside from the structured workout, you've also increased your daily activities, with the end result being more calories expended throughout the day and week, which will hopefully lead to weight loss and weight maintenance. And, of course diet.

Cyndi Thomson, Ph.D., R.D.: Congratulations—you only gained 10 pounds during a stressful time. In all likelihood by doing this activity and watching portion sizes, the weight may come off.

Impossible to lose weight on tamoxifen?

Question from TLang: I gained 30 lbs. during my treatments (not from overeating) and I've been on tamoxifen just over one year. I have not lost an ounce and am very upset. I am still extremely tired. My oncologist told me that I will not be able to lose the weight while on the tamoxifen. How can this be? There has to be something! Also since this IS a side effect from the chemo, why do we not get more help from our oncologists?

Answers —Cyndi Thomson, Ph.D., R.D.: First of all, you may want to talk to your oncologist about the medication because although studies say that women do not gain appreciable weight on tamoxifen, I commonly hear this complaint. So you may want to discuss with your doctor if there are other options for medications if you really believe it's the tamoxifen that is the problem. The other thing I would say is that the best way to overcome fatigue is to get more active. That's hard in the short run, but in the long run you'll sleep better and you'll feel more rested. In your case, you may want to join a structured program or find a friend who will walk with you or help you to stay active. Understand it's going to be tough for several weeks, but just keep with it. You may be a good candidate to link up with a registered dietitian who understands cancer care at your local cancer center or hospital.

Melinda Irwin, Ph.D., M.P.H.: I would have a more in-depth talk with your oncologist about this issue and how much it's bothering you. The oncologist may not realize how important this is to you, as he/she may not have noticed the weight change. So maybe you should bring it to his/her attention and let them know.

What causes weight gain during chemo?

Question from Suze: Does chemotherapy actually cause weight gain or is weight gain during chemo caused by something else?

Answers —Melinda Irwin, Ph.D., M.P.H.: Sometimes it depends on whether the woman was pre-menopausal or post-menopausal. If you were pre-menopausal, the chemotherapy may have put you into menopause and menopause is associated with a decrease in estrogen levels, which is also associated with changes in bone density and lean mass, which could be associated with some of the weight gain. If you were post-menopausal prior to chemotherapy, then the chemotherapy could have had indirect effects with your feeling fatigued, such as nausea or depression or anxiety that would have changed certain behaviors such as diet and physical activity. If you're fatigued, you'll probably be less active. Or when some people are anxious or depressed, they may change their eating habits. That may be what's causing the weight gain.

Cyndi Thomson, Ph.D., R.D.: A lot of women turn to comfort food during chemotherapy, like mashed potatoes or macaroni and cheese, which is totally understandable. Sometimes the weight gain is related to that kind of change in food choices. I wouldn't say that chemo causes weight gain itself unless it's delivered with steroid medicines and then you could say there was a direct link. Chemotherapy causes weight gain indirectly through some of these factors that we just discussed, such as fatigue.

Association between exercise and prognosis?

Question from Wendy: Professor Irwin, emerging research, including yours, indicates that exercise may be as important to breast cancer survival as the usually prescribed hormone or chemo therapy. Yet few physicians put exercise in the same status as other "prescriptions" and do not routinely offer it as an option to women. What do you believe are the best means for changing physician attitudes and prompting insurance companies to pay for exercise programs?

Answers —Melinda Irwin, Ph.D., M.P.H.: Insurance companies probably won't reimburse exercise programs until the research is more definitive. So with current trials and future studies, hopefully the research will continue to show a strong association between physical activity and improved breast cancer prognosis. Physicians usually don't recommend something that is not necessarily reimbursable, so they tend to discuss other medications or treatment options that are reimbursable. Also, the oncologist may not be knowledgeable about what type of exercise, or what intensity and frequency, especially since the research is in its infancy in this field. Hopefully, within the next year or two there will be more research showing the causes and effects of physical activity on breast cancer. Until then, we know that physical activity is favorably associated with other diseases such as cardiovascular disease and diabetes, and therefore women who have been diagnosed with breast cancer should be recommended for physical activity because of associations with those diseases as well.

Cyndi Thomson, Ph.D., R.D.: A patient is their own best advocate. Some of the most influential people in changing health care practice are patients. Letting physicians know that this is important to you will, in the long run, have an influence.

Melinda Irwin, Ph.D., M.P.H.: Some insurance companies, I don't know which ones, are reimbursing for, say, gym memberships or renting equipment for the home. So you should call your insurance company and find out if they offer those reimbursements for those purchases.

Try losing weight during radiation treatment?

Question from Brenda: Finished chemo, heading into radiation, also started Herceptin and Arimidex. Had already gained weight before this adventure started. Is Herceptin and AI going to add to that? Feeling pretty good except for some fatigue and numbness/pain in feet. Okay to try to lose weight now?

Answers —Cyndi Thomson, Ph.D., R.D.: I think it's okay to make healthy eating choices and for you to get more physically active, but not to push a highly restrictive diet. Be sensible.

Melinda Irwin, Ph.D., M.P.H.: If you're having numbness or pain in your feet, I'd bring that up with your physician.

Chromium picolinate causes cancer?

Question from JoanneR: A weight loss center in my area recommended I use chromium picolinate to help accelerate my metabolism to aid in weight loss. I took one pill, then read up on it and was shocked to read that this product is found to cause cancer in lab rats.

Answer —Cyndi Thomson, Ph.D., R.D.: It's a hot topic for dietary supplementation right now, but the data is inconsistent. There are two things that chromium picolinate is supposed to do. One is to improve satiety, so people are less hungry, and the other is to improve glucose metabolism. Neither of these has been sufficiently explored, particularly in breast cancer survivors. Currently, I would not recommend supplementation with chromium picolinate. We need more research.

Vitamins and supplements to lose weight?

Question from Mel: What about the use of vitamins and supplements in weight loss?

Answer —Cyndi Thomson, Ph.D., R.D.: My short answer would be, if you're on a weight loss diet that is less than 1500 calories a day it would be prudent to take a multivitamin mineral supplement. But taking a supplement is not known to improve weight loss.

Good carbs vs. bad carbs: what to eat?

Question from NorthBeach: I don't understand carbs. I keep hearing that there are good carbs and bad carbs, like on the South Beach diet. How can I know what to eat?

Answer —Cyndi Thomson, Ph.D., R.D.: By good carbs and bad carbs, generally the message is to choose high fiber/whole grain carbs, not low fiber/high sugar carbohydrates. Look at your food label to check the fiber and sugar content, and select foods that are higher in fiber and low or devoid of sugar.

Definition of a healthy diet?

Question from Syd: Please define "healthy" diet. I've heard everything from eating carefully to total macrobiotic diet. Which way is the way to go?

Answers —Cyndi Thomson, Ph.D., R.D.: I would say there is no one healthy diet; it really needs to be individualized. Macrobiotic diets tend to be more restrictive and difficult to follow and may lead to nutrient deficiency. Vegetarian diets, while generally considered healthy, could also lead to deficiency of some nutrients, such as calcium, iron, or B12. The Mediterranean Diet is another healthy diet or eating plan that one could consider. Again you may want to meet with a registered dietitian to pick the best healthy diet for you. And don't forget physical activity.

Editor's Note: The Mediterranean Diet includes generous servings of fruits and vegetables as well as healthy fats such as canola oil and olive oil. The diet also includes fish, nuts, and very little red meat.

Melinda Irwin, Ph.D., M.P.H.: Make sure you eat a varied diet and monitor your daily or weekly intake and observe any patterns or cravings. Do you eat after 8 p.m.? Do you tend to eat a lot of pastas or high-salt foods, for example? But variety is probably a good way to initiate change.

Cyndi Thomson, Ph.D., R.D.: And portion control.

Which is healthier: butter or margarine?

Question from LisaBaker: I keep forgetting—what is healthier, butter or margarine? Can you explain why?

Answers —Cyndi Thomson, Ph.D., R.D.: These are great questions! When my clients ask me about butter or margarine, what I recommend is "less is better," not to use too much of either. And the variety method works well here. In my refrigerator you'll find whipped butter and Smart Balance and you'll also find olive oil, flavored oil and even nut oil, such as almond oil. Mix it up and don't eat too much of any of the above. Many margarines are high in polyunsaturated fat, which may be advisable for heart disease, but is not the best for cancer. But neither would butter be a great choice, because it's a saturated fat. We all know that trans fats that are commonly found in margarine are also problematic. So again, less is more.

Melinda Irwin, Ph.D., M.P.H.: The variety is good, too, because sometimes if you need to put a spread on bread you could try a jam or a jelly or peanut butter, but not always using butter or margarine. Change it up a bit.

Cyndi Thomson, Ph.D., R.D.: I'm a big avocado lover. I make my own butter by whipping my avocados.

Any healthy snacks that can satisfy?

Question from Steph: I'm always hungry. Are there any healthy snacks that can really fill you up?

Answers —Melinda Irwin, Ph.D., M.P.H.: Popcorn is usually good.

Cyndi Thomson, Ph.D., R.D.: I tend to push people toward raw fresh vegetables, because they can help fill you up. There's a lot of good high fiber crackers on the market now, like All Bran and Triscuit, etc. Quite honestly, a little bit of fat at the end of a snack, like maybe a teaspoon or two with the last cracker will help to satisfy you more. Or maybe some string cheese.

Melinda Irwin, Ph.D., M.P.H.: I like cottage cheese. You can get fat-free cottage cheese. That fills me up.

What are the rules of eating after 8 p.m.?

Question from Dawn: Is eating after 8 p.m. a no-no, or can you at least have fruit after 8 p.m.?

Answers —Melinda Irwin, Ph.D., M.P.H.: It depends on what time you wake up.

Cyndi Thomson, Ph.D., R.D.: Eating late at night tends to get people in trouble. If you're someone who needs a little something before bed then fruit is a good choice in small amounts.

Melinda Irwin, Ph.D., M.P.H.: This happens to me too, where I get hungry because I'm up late. If I floss and brush my teeth then I tend to not want to eat. It's kind of silly.

Cyndi Thomson, Ph.D., R.D.: Or drink lots of water.

Can diet include red wine?

Question from Patty: What about red wine?

Answers —Melinda Irwin, Ph.D., M.P.H.: I have a glass of red wine every night, usually less than a glass – 4 to 5 ounces maybe.

Cyndi Thomson, Ph.D., R.D.: I think with breast cancer survivors, if you're going to have wine, keep it a small portion and make sure your diet is adequate in folates. Folates are found in dark green, leafy vegetables as well as citrus. The study suggests that problems occur with high alcohol intake and low folates.

Editor's Note: A 2006 study found that taking folates does not reduce the risk of breast cancer. Read more about this study.

Melinda Irwin, Ph.D., M.P.H.: The other thing to remember is that alcohol has calories and sugar, so if you're trying to lose weight it may be best to have water or a lower calorie beverage.

Cyndi Thomson, Ph.D., R.D.: Or dilute your wine.

Advice to increase exercise stamina?

Question from Peggy: I am a year out of treatment. I want to start exercising again, but I feel so weak. I get winded just climbing a flight of stairs. Any advice?

Answer —Melinda Irwin, Ph.D., M.P.H.: First, the fact that you're just starting to think of an exercise program is great. That's usually the hardest step. Climbing a flight of stairs is considered a vigorous activity—that's why you're getting winded. So focus on a more moderate activity, or even lighter intensity programs, such as instruction programs or Pilates or yoga, which will maybe make you feel overall less winded. Add in some walking, even if it's just 10 minutes a day. Then you can do 10 minutes out a couple times a day. Then maybe that 10 minutes turns into 15 minutes.

Red meat, processed meat linked to cancer?

Question from Justine: I saw a news report yesterday that red meat and processed meat are linked to breast cancer. How much red meat is bad, and what is processed meat exactly?

Answer —Cyndi Thomson, Ph.D., R.D.: Processed meat in this study was defined as bacon, ham, corned beef, lunch meat, sausage, liver pate, salami, and even meat pizza. And, finally, SPAM. Although the report suggests that processed meat and meat in general increases the risk of breast cancer, it was mostly the post-menopausal women that were at risk. And certainly, processed meat and meat in general is a major of source of saturated fat, which has been linked to breast cancer in other studies but not consistently, though. The Women's Health Initiative, where post-menopausal women were placed on a low-fat diet, which would restrict meat, suggested that this diet did not reduce breast cancer risk in post-menopausal women. However, among the women who started out with the highest fat in their diet, reducing fat did help to reduce the risk of breast cancer.

What does it mean when body is in stress?

Question from Mary: I really watch what I eat, exercise and have gone to physical therapy and MLD (Manual Lymph Drainage) therapy previously. I have even upped thyroid meds, but am still unable to lose weight. If anything, I've gained and a recent cardio work-up said my body is in stress. What does this mean? Weight bearing exercises exacerbate the lymphedema and I take Mobic for inflammation, but still seem to be swelling not only in the arm, but legs and ankles as well.

Answers —Melinda Irwin, Ph.D., M.P.H.: Perhaps your exercise program is a little too intense. Research has shown that strength training does not increase lymphedema. Perhaps you should focus more on an aerobic type of program—stationary bicycling or walking.

Cyndi Thomson, Ph.D., R.D.: I would suggest that you not just think of body weight as the only measure of your health. Maybe have the body composition (body fat and lean mass) evaluated as another indicator of your health. Or the area around your waist, thighs, and hips as other indicators that you're getting your body in better shape. Unfortunately, there's no good therapy for lymphedema, but you should discuss this with your doctor as some women have done well with massage therapy. You can learn more about lymphedema at the breastcancer.org website.

Editor’s note: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Mobic (chemical name: meloxicam) can cause swelling. If you are taking an NSAID and you have swelling, see your doctor.

Melinda Irwin, Ph.D., M.P.H.: Also consider trying yoga and Pilates—it's a not as intensive strength training.

Long-term effect of a low-carb diet?

Question from Liu: What is the long-term effect of a low-carb diet?

Answer —Cyndi Thomson, Ph.D., R.D.: One concern has been the possibility of an decrease in liver function that shows itself as an elevation in liver function tests. If it's a very low-carb diet and people remain in ketosis, which is a rapid breakdown of fat, people can get headaches and weakness. However, many people do tolerate a low-carbohydrate diet very well and even long term, as long as it's not extreme. If you're interested in trying a low-carbohydrate diet, be sure to work with your health care provider so that these potential side effects can be monitored.

Different nutrition plans for different cancers?

Question from Pat: Is there research to show that women with hormone-negative cancer should follow a different nutritional plan than women with hormone positive cancer?

Answers —Cyndi Thomson, Ph.D., R.D.: This is a good one. In December's Journal of the National Cancer Institute there was a publication summarizing the results of the Women's Intervention Nutrition Study that included over 2,500 breast cancer survivors. The findings of that study showed that women with estrogen receptor-negative breast cancer had a significant increase in survival from breast cancer. So if you have an ER-negative breast tumor, the current study suggests that you should be on a low-fat diet. This protective benefit of a low-fat diet was not seen in women with ER-positive breast cancer, possibly because we have medications that are highly effective in improving prognoses for estrogen receptor-positive breast cancer. Breast cancer survivors should also be aware of another large diet study among breast cancer survivors, the Women's Healthy Eating and Living Study, which was a plant-based or high vegetable diet—low-fat and high fiber. The results of that study should be out by the end of 2007. That study is out of UC San Diego.

Melinda Irwin, Ph.D., M.P.H.: The California Teachers Study also showed that physical activity was more protective against developing breast cancer among ER-negative women.

Can Actonel cause weight gain?

Question from Svite-4: I have been on tamoxifen for three years and Actonel for 2 years. The first year I lost 20 lbs. but now I have gained them back. My diet is low fat and low carbs. Could the Actonel be causing the weight gain?

Answers —Cyndi Thomson, Ph.D., R.D.: Again, it's highly variable. Please discuss this with your doctor.

Melinda Irwin, Ph.D., M.P.H.: It also may depend on your age. If you're in your young 50s and were going through menopause either after or during the tamoxifen and prior to the Actonel, that could have caused some of the weight gain.

Adjust vitamin doses according to age, health?

Question from Lydia: Many of us who are dealing with breast cancer are older women, and I've been reading that things like Vitamin D should be taken in higher doses by those of us over 50. Is it advisable to adjust doses for age, as well as health status?

Answers —Cyndi Thomson, Ph.D., R.D.: Most nutrients requirements do have some adjustment for age and Vitamin D is an area of very active research in cancer. In fact, a scientific meeting to discuss the role of Vitamin D in cancer is being held at the National Institute of Health in early May.

Melinda Irwin, Ph.D., M.P.H.: Older women have a loss of bone mass about 1 percent per year. You should be having a DEXA scan to monitor your bone mineral density, and if you're taking a hormone therapy, then Vitamin D may be beneficial.

Cyndi Thomson, Ph.D., R.D.: The other thing is, depending on where you live in the country, you may be at greater risk. Certainly, people living in the northern states and people with darker pigmentation are at greater risk for inadequate Vitamin D.

Thoughts on sugar substitutes?

Question from Terrolyn:  Do you have a position on sugar substitutes such as Splenda? I'm on Weight Watchers Flex Points program and have lost 32 pounds in 1 year. But, to maintain a feeling of satisfaction, I like to put Splenda on my cereal, make fresh lemonade with it, and treat myself to an occasional dessert using it.

Answers —Melinda Irwin, Ph.D., M.P.H.: Congratulations!

Cyndi Thomson, Ph.D., R.D.: That's a great plan—moderation without excess. I think you can get into a discussion of which is better. I would say my personal favorite is Splenda based on the fact you can use less to get flavor. Regardless, if you're going to use a sugar substitute, you want to consume in small amounts as you are doing.

Exercise's effect on biomarkers?

Question from SuesMom: Dr. Irwin, I saw that you've published on the effect of exercise on breast cancer biomarkers and the influence of physical activity on obesity. How much exercise is recommended to influence the effect on biomarkers, and what does that mean?

Answer —Melinda Irwin, Ph.D., M.P.H.: A biomarker, or biological marker, is a surrogate marker of breast cancer risk or prognosis. So in studies where we can't follow women or we don't have enough time to follow them until some have a recurrence, we'll look at biomarkers that are related to recurrence, for example. Some biomarkers are body fat, estrogen, and insulin. So what we do is look at the effect of exercise on these biomarkers and if we see a favorable change, for example in insulin and we know insulin is highly related to recurrence and death, then we can assume exercise may be as well. Research is ongoing to answer the question about how much exercise is enough. Currently, the recommended amount is 30 minutes, 5 days per week of moderate intensity physical activity, such as brisk walking. However, if you're currently doing that, increasing the intensity or duration is recommended.

Importance of color in fruit and vegetables?

Question from Juicyfruit: Could you talk about the recommendation I've read that suggests eating lots of different colors of fruits and veggies? What is it about colors that's important, or is it something else?

Answer —Cyndi Thomson, Ph.D., R.D.: The colors or the pigments in vegetables and fruits reflect certain phytochemicals and these are biologically active compounds that promote health. For example, some are antioxidents, some reduce inflammatory response, some may modify insulin levels, etc. So when you get a variety of color you get a variety of phytochemicals and a variety of health-protective activities in your body.

Most powerful foods to prevent recurrence?

Question from Donna Still: I am halfway through chemo and have been reading about diet and recurrence of breast cancer. What are the most powerful foods to help avoid recurrence?

Answers —Cyndi Thomson, Ph.D., R.D.: We don't know the answer to that question. The WINS study suggested that low-fat eating is one important dietary factor. Certainly, most clinicians will recommend a diet high in vegetables and to some extent fruits. Avoidance of saturated fats and trans fats is also advised, and eating foods rich in Omega-3 fatty acids, such as cold water fish, may also be helpful. But more research is needed to provide more definitive answers.

Melinda Irwin, Ph.D., M.P.H.: During treatment, if you're not exercising currently you could start a light or moderate exercise program. If you have been exercising prior to treatment, maintain that program as best as you can to avoid any potential weight gain and to maintain your lean body mass, which may decrease as a result of therapy.

Effects of Arimidex on weight management?

Question from MarjorieS: My question concerns the effects of Arimidex on weight management. Even though my weight has not varied drastically, I feel that my muscle tone, especially in my abdominal area, is of concern. Chemo put me into menopause and Arimidex depleted my estrogen supply further. Am I imagining these changes or are they, in fact, to be expected? What can I do to address this?

Answer —Melinda Irwin, Ph.D., M.P.H.: A lot of women on Arimidex and similar hormones report joint pain and decreased muscle tone. Therefore, a strength and aerobic exercise program would really be beneficial.

Can people lose weight by walking?

Question from Patty: Do you think people can lose weight walking? What about a weighted vest? I have been doing some research on this.

Answer —Melinda Irwin, Ph.D., M.P.H.: Definitely, people can lose weight walking. In a study I published a couple of years ago in JAMA, while we showed modest weight loss with exercise—about 3 pounds over a year—we showed up to 10 percent loss in abdominal body fat. So sometimes your walking program may not lead to a change on the scale, but a change in your belt loop or waist size.

Suggestions for additions to program?

Question from Noodles: I'm already exercising (mostly treadmill at home), and have upped my duration and intensity without much effect. Would adding a different type of exercise be a help? What might I be able to do at home?

Answers —Melinda Irwin, Ph.D., M.P.H.: Yes, sure it never hurts to add a different type of exercise. You can try going outside and walking. Sometimes on a treadmill if you do a manual setting where it's the same pace throughout, your body adapts relatively quickly. By changing your program to, say, walking outside, your pace will vary every couple of minutes, which may stimulate your cardiovascular system and your metabolism. You can also add in stretching or a yoga program. There are videos that you can purchase, or on your cable network there are different shows. You can also do a lightweight training program in your house.

Cyndi Thomson, Ph.D., R.D.: The other thing I tell people is to play with their kids and pets. If you don't have kids or pets, maybe you can wrestle with your husband.

Melinda Irwin, Ph.D., M.P.H.: Yardwork and gardening.

Cyndi Thomson, Ph.D., R.D.: Get a jump rope. Some people can't physically do that, but some people really like it because it brings back memories. Or balance balls, especially if you're watching TV.

Does treatment affect metabolism?

Question from TDC: I gained about 40 lbs during/after my chemo and radiation treatments. I have also been on Lupron and tamoxifen. I have had a very hard time losing the weight. Is it possible that my metabolism is messed up?

Answer —Cyndi Thomson, Ph.D., R.D.: It definitely is. I think the key here, as we mentioned before, is to try and get some physical activity that will help to build muscle and it will increase the metabolic rate. One thing I would suggest (I'm doing a study now) is green tea. A lot of women are drinking green tea because they're trying to increase their metabolism so they can lose weight. It looks as though you would have to have very frequent and high intake of caffeinated green tea in order to see any effect. And even then, the effect is likely to be small. So women relying on green tea as their sole method to lose weight are probably not going to be successful. It may be that adding green tea to exercise and other diet changes will be good, but we don't know.

Does exercise bring on hot flashes?

Question from PainterSue: I am going through premature menopause from the chemo. Now, it seems like exercise brings on hot flashes! Is there anything I can do?

Answers —Melinda Irwin, Ph.D., M.P.H.: It could be that if you're new to exercising that one of the adaptations to exercise is to sweat sooner, which is a good thing because then you're dissipating the heat from around your heart to your skin. So the sweating that you have because of exercising may make you think you're having a hot flash.

Cyndi Thomson, Ph.D., R.D.: You could try using a big fan.