Hydration Refresher

What if I told you that you may need to take in more salt this week? It’s going to be another hot one so today I’m talking about ways to optimize your hydration level so you can feel your best.  Optimal hydration can improve your treatment side effects, mood, physical performance and weight balance.  Your fluid and electrolyte needs are unique.  Learn about electrolytes and water goals in cancer care below.

There’s more to hydration than drinking 8 cups of water a day.  Understanding how much you need to drink and whether it can be helpful to supplement with electrolytes is a key topic in cancer care. 

Many of my clients have significantly decreased their processed food intake as well as eating out less often through working together.  That means a major drop in salt and sodium intake which is usually a really good thing, but on these hot days you may not be getting enough sodium for optimal hydration.

Why is sodium important?  Your body has the ability to absorb fluid in two main ways: passively and actively.  To actively absorb water, sodium and glucose (sugar) are needed.  When this is activated you can hydrate more completely which is important if you are struggling with dehydration or active outside in this hot weather.  

How do you know if you are dehydrated?  Cancer treatment is a risk factor for dehydration.  That’s why you get IV fluid during chemo.  A buildup of medications and chemo increases therapy side effects, so you want to be hydrated enough to flush them out effectively.  Mucositis, nausea, vomiting and diarrhea impact fluid intake and output but replacing these fluids can be challenging.   Also, inflammation from radiation treatment increases fluid requirements because extra fluid is used to protect and soothe the treated tissue.  If you are significantly dehydrated, on exam, your blood pressure may be low.  It can also show up as high sodium (Na) or high creatinine in your blood work.

Beyond treatment, dehydration can worsen lingering side effects like peripheral neuropathy, lymphedema, brain fog, fatigue, and decreased mental wellbeing.  Other risk factors for dehydration include being a “salty sweater”, not having strong thirst signals, advanced age and following a low carbohydrate diet.

If you are mildly dehydrated, just 2% below your optimal level, you may notice having more difficulty paying attention and feeling calm.  I’ve also seen dehydration contributing to the 3pm sticky spot of cravings and tiredness.

The best way to monitor your hydration level throughout the day is by paying attention to your urine colour.  You’ll notice in the morning urine is a dark yellow because you haven’t been drinking much through the night typically, and your body is repairing, recovering and creating waste.  You should notice your urine getting paler through the morning as you rehydrate.  The kidneys are most active for the first half of your awake hours.   Support their job of getting rid of that waste by starting your day with non-caffeinated fluid and continue to take in fluids every 1-2 hours.  A light straw colour is an indication of good hydration.  If your urine is clear it can mean you’re not absorbing the fluid you’re drinking efficiently.  This is a time where electrolytes can give you a boost.

Urine Colour Hydration Scale

Electrolytes can increase your body’s ability to absorb fluid from your diet as well as get that fluid into the cells so they can perform optimally.  The key ones are sodium and potassium but you may also see magnesium and calcium in some electrolyte and rehydration products.  These are all nutrients we can get in adequate amounts from a personalized diet.  But there are situations where supplementing with electrolytes can make a big difference.  During treatment, if you are having a hard time drinking water or you are struggling with GI (gastrointestinal/digestive) side effects including vomiting, diarrhea, high ostomy output, constipation or dry mouth/mucositis, fluid replacement is vital. Oral rehydration solutions used in severe dehydration contain about 600 mg of sodium per 250mL.   For day to day dehydration caused by long activities outdoors or mild/intermittent GI side effects, look for a product or recipe that has at least 300 mg of sodium per cup.  You will probably only need 1-3 cups to optimize your water absorption.  Potassium, magnesium and calcium supplementation need to be discussed with your health care provider.  Cancer can have a big effect your intake of food sources of these electrolytes as well as blood levels and requirements.  Supplementing too much with any of these can make side effects worse and possibly result in hospitalization.

What about sugar?  Zero calorie electrolyte products are everywhere.  To be a true rehydration drink sugar or glucose is needed.  Think of these more as a way to boost your fluid intake by giving your water taste.  A little bit of sodium can increase thirst and therefore increase your overall fluid intake through the day but it won’t be enough to replace high losses.  Speak to your health care team to understand what your requirements are based on your unique situation.

Is 8 cups of water a day really the goal? I’ve seen 8 cups of water a day recommended all over the place.  That’s a very general recommendation but often a reasonable target for most people.  However, for optimal results it's best to calculate your fluid needs based on your age, weight, body composition, daily environment and activity patterns. I usually find people's needs are higher than 8 cups.  

Here are some ways to take action and improve your hydration level this week:

• Start the day fresh with a clear glass of water

• Find a water bottle you love and carry it with you

• Put a visual reminder to have a drink in the place you spend most of your day

• Measurements on a water bottle can help you track your progress and get you closer to your goal

• Water isn’t the only fluid: herbal tea, 1-2 cups of coffee, sparkling water, milk, nutritional supplements, soup and yogurt count!

• Add flavour to keep things interesting: try a slice of lemon or lime, True Lemon crystals, dilute juice 1:5, low calorie electrolyte powders such as Nuun if appropriate for your individualized needs.

• Keep a pitcher of water with a known volume in the fridge, infuse it with chopped fruit or herbal tea if desired.

Rose Sun Tea

Rose petals contain polyphenols that have anti-inflammatory activity.  It may aid in reducing mucositis pain as well as chemo-induced nausea and vomiting.

Enjoy this slightly sweetened tea chilled on a sunny day.

Ingredients 

¼ cup of dried organic rose petals

2-4 tsp of honey, to taste

1.5 L of water

Instructions

In a glass or BPA free pitcher, add dried rose petals, honey, then water.

Cover and place the pitcher in a sunny spot for 4-6 hours. Stir halfway.

Refrigerate or pour over ice through a tea strainer to enjoy!

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Homemade-Aid

Make your own sports drink to take with you on an activity lasting more than 2 hours outside such as hiking, golfing, gardening, Dragon Boating or biking

Ingredients

½ cup juice such a grape, cherry, cranberry (if struggling with constipation try apple or pear, if struggling with mouth sensitivity try peach or pear nectar)

3½ cups water

½ tsp salt

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DIY Oral Rehydration Solution

To replace high losses, an oral rehydration solution may be recommended.  To make your own, use this recipe.

Ingredients

3/8 tsp salt (sodium chloride)

¼ tsp Windsor Salt Free® (potassium chloride)

½ tsp baking soda (sodium bicarbonate)

2 tbsp + 2 tsp sugar

Add tap water to make 1 liter

Tips to Reduce Treatment Related Weight Gain

Worried about weight gain and breast cancer? Studies have shown a link between body weight and breast cancer risk. Many women experience weight changes after a breast cancer diagnosis. In my previous post I talked about some of the reasons why. Here are a few simple things you can do right now to boost your body during treatment and reduce treatment-related weight gain.

Women have a variety of different treatment plans depending on the individual and type of breast cancer (ER, PR, HER2 negative or positive, tumor stage stage, genetics, medical conditions, risk factors, etc.). The tips here are general enough for most, however, it is important to discuss your individual concerns with your healthcare provider. There are many benefits to working with a specialized dietitian through cancer treatment. You likely have nutrition services available through your cancer center. Look at your patient directory or speak to your nurse or oncologist. Savour Nutrition offers virtual nutrition support through 1:1 counseling and coaching from Calgary, Canada. I spent the first decade of my dietetics career at Cancer Control Calgary. My practice now focuses on providing continuous care from diagnosis through healing. In this space I can help people feel more clear, confident and in control of their diet while improving treatment outcomes, reducing side effects and recovering from treatment damage so cancer survivors can live a vibrant, empowered life. If you have questions about working with me, reach out through this contact form and tell me about where you are in your journey and where you need guidance.

Weight Gain and Breast Cancer Treatment

Gaining weight through breast cancer treatment can be distressing. It adds to the body dissatisfaction so many women feel after being diagnosed. Often, your body feels completely different than it did before and it can be confusing and overwhelming to put your energy into losing weight.

If you are still going through treatment, either surgery, radiation, chemotherapy or hormone therapy there are some strategies and tools to nourish your body in a way that maintains muscle mass, balanced intake and reduces stress.

Fuel For Repair.

Cancer treatments damage healthy tissues as well as cancerous ones. Your body needs important nutrients to repair this damage to your skin tissue and on a deeper level, your immune system (and all its many, many parts). Trying to get enough of the best foods can be limited by side effects like mouth soreness, taste changes and food aversions. If side effects are making eating challenging, you may need more support. But right now you can start focusing on high protein foods throughout the day.

Getting enough protein can greatly reduce muscle loss and help maintain a balanced body weight. Protein is the single most important nutrient for cell repair. Start including a high protein food like eggs, greek/skyr yogurt, nuts/seeds and their butters, meat including fish, bivalves, chicken, pork and beef, high protein plants such as beans, legumes, soy, sea vegetables and whole grains.

Here is the trick: include a high protein food at each meal and snack.

When my clients start including 1-2 protein choices every time they eat they stabilize their weight, improve their energy levels and often their blood counts. The best protein foods for you are the ones you enjoy. This can look different for everyone. Certain diet restrictions can make it more difficult to achieve your protein target (which is calculated using weight, height, nutrition status and treatment plan).

Balance Your Intake.

Meal schedules hit a rocky patch during treatment. Frequent appointments, wait times, fasting protocols, decreased food availability, food confusion and stress can disrupt regular meal times and force you to eat in foreign settings, making choices that you might not usually make at home. You might be skipping meals then finding yourself ravenously hungry, then going for the first option you have. Which might not always be a nutritious one. You need more nutrition during treatment than before your diagnosis so it’s important to think about how you can accommodate this increased need. Planning ahead for treatment schedules takes the pressure off so you can savour good, nutritious foods when you need them.

Bringing balanced snacks with you to appointments. I always suggest keeping a bag of trail mix in your car and bag. Get my recipe below. UHT milk bottles/boxes, high protein snack bars and meal replacements can also be kept in a bag in the car for nutrition emergencies.

Have a packed lunch on full treatment days. Bring small amounts of a variety of foods because you might not find everything enticing when you go to eat it. Include 3-4 high protein foods, some fruit, veg, dips, a couple of different textures, your favorite food, a treat or “just because” food and some fluids.

The trick that works for most people is to eat a smaller amount but more frequently so you’re not overwhelmed by side effects or meal portions and you can offer your body nutritious foods throughout the day.

Get help with family meals. Many of my clients are the ones responsible for meal planning, preparation and shopping but they don’t have the same time or energy for it during treatment. Make a plan to delegate these tasks. Family and friends can make some of your favorite recipes, bonus points if they can be portioned and frozen for a later day. Finding healthy meal delivery services or ready-prepared dishes can support balanced choices and meals at home.

Reduce Food Stress.

How many times have people given you unsolicited advice about your diet? How many times have you wondered before you put something on your plate whether or not it was safe? Feeling unsure about your food choices can be debilitating. Some of the advice out there is downright dangerous. If you’ve been drastically changing since diagnosis, your diet it's probably contributing more stress than good. Everyone means well; the purpose is to help you through treatment. Start doing that right now by taking a deep breath into your belly and exhaling some of the tension in your stomach. Set your mind at ease, knowing you can make healthful choices without going over the deep end. Your diet does not need to be perfect to be nourishing. And you don’t need to restrict and deprive yourself to cure the cancer.

Brenda had always thought she ate pretty well. Sure, she didn’t really like kale but she figured she was doing the right things. It was rattling to hear she had breast cancer. She started to question all she thought she knew about how to be healthy. “Maybe I should only be eating salads and cut out animal products.” Her husband would often find her in the glow of the refrigerator, stalled and fretting over what was safe to eat. “Shouldn’t I be eating all the superfoods that can cure cancer? I don’t even know what to make for dinner!” she worried. Through our time together she found relief and realized she and her support system were capable of making good meals that Brenda could eat during treatment. Adding nutritious foods to her day to fortify her body so she could focus on healing.

Knowing what to focus on and creating a plan to help you meet your nutrition needs through treatment will help by providing consistent, nourishing foods your body uses to stay strong. When you get enough protein, avoid skipping meals and decrease the stress of food choices you hold on to muscle mass and boost your body’s natural recovery systems.

If you are looking for support, send me a direct email at Erin@savournutrition.com

Savour Nutrition is launching a small group cohort program for women diagnosed with breast cancer wanting to nourish their body and heal their relationship with food. With the best food combinations for you, the right nutrients and powerful strategies you can start feeling better and recognize your best self.

Join the waitlist for more information!

Satisfying Trail Mix Recipe

Store-bought trail mix can be high in calories and sugar. Making your own trail mix let’s you add the most nutritious combinations of nuts, seeds and fruits. Adding a low calorie crunch choice makes the mix even more satisfying while lowering the amount of fat per serving and increasing the fibre!

Satisfaction Formula:

1⁄3 low calorie crunch

1⁄3 protein rich nuts & seeds

1⁄3 sweet dried fruits and chocolate.

1⁄3 cup serving provides about 8g protein, 4g fibre (may vary depending on ingredient combination)

Low Calorie Crunch options

● Whole grain cereal (Shreddies, Chex, Cheerios)

● Whole grain crispy cracker/snack (Crispy Minis Rice Cracker, popcorn, mini triscuits)

● Dry Roasted Beans, Lentils or Legumes (roasted chickpeas or lentils, soy nuts or dry

roasted edamame) *bonus these are also high in protein

Nuts and Seeds

Using at least two types of nut and seed adds interest and texture. Listed from highest to

lowest protein content: pumpkin seeds, peanuts, almond, pistachio, sunflower seed, cashew,

walnut.

*Pumpkin seeds, peanuts and cashews are great sources of Zinc which helps skin healing after surgery and boosts the immune system during chemotherapy.

Dried Fruits and Chocolate

Add some sweetness with dark chocolate chips and/or dried fruit.

Dried or freeze dried blueberries, freeze dried strawberries, dried cherries, dried cranberries, raisins and dried apple are lower sugar, higher fibre, and nutrient dense options.

Tropical fruits like pineapple, banana and mango have much more sugar than fibre. They can be balanced by being in combination with dark chocolate chips and/or dried berries.

→ Next post will be about where to begin with treatment related weight gain.

Worried About Weight Gain After Breast Cancer Treatment?

As an outpatient cancer dietitian I would often get referrals from Oncologists to see women for weight loss during breast cancer treatment. “Not appropriate!” I’d think, putting it to the bottom of the consult pile. My primary role was helping with side effects and reducing weight loss in people being treated for cancer. Treatment is a stressful time, with a plethora of side effects that can benefit from nutrition support. Weight loss can be difficult at the best of times, so addressing it during treatment did not seem like something I could treat in a one hour session. But MOST women going through breast cancer treatment gain at least 5lbs and usually don’t return to their pre-treatment weight. Now, I work with many women who are dissatisfied with their weight after treatment. They are often getting pressure from their doctor to lose weight to reduce the risk of recurrence, feeling uncomfortable in their body and dealing with food fears and cravings. Unfortunately, this can bring up a lot of guilt and confusion during a time when they’re trying to figure out how to recover and shift back into “normal”. They may start scrolling through diet posts again, trying to figure out what’s the best new weight loss method, only to lose, fail and rebound sinking deeper into post treatment depression, fatigue and brain fog. Why you’ve gained weight after treatment is also the key to how to balance your weight and shift into a body you feel better in.

In this series I’ll be showing you the reasons for weight gain after a breast cancer diagnosis, tools and strategies to limit treatment weight gain and supportive ways to balance your weight after treatment.

Weight Changes Through Diagnosis.

The heartbreaking diagnosis of Breast Cancer can immediately change the relationship you have with your body. For some, they go numb, not listening or feeling into the body’s cues and messages. For others they dig into confusion, guilt or denial. The relationship you have with your body will also affect your relationship with food and appetite. Some women start to shift their body weight through the difficult weeks of appointments and treatment plans. Skipping meals, over eating comfort foods, receiving food and gifts from loved ones or becoming increasingly concerned about what foods are safe to eat can be major influencers of weight change.

What Surgery Takes and Leaves Behind.

Many women describe an increased appetite when they get home after surgery. Why? Because their body is asking for extra nutrition for healing! But many women aren’t eating enough of the best foods or enough of the most important nutrient. Pair that with decreased movement for a few weeks and they quickly lose muscle. Now that body composition has shifted, weight gain becomes increasingly likely.

Cathy felt “puffy” after surgery, IV fluids and constipation made her feel bloated. She was relieved to be home but too exhausted to get back to the kitchen. She and her family ate meals provided by friends and family as well as convenience foods and relied more heavily on eating out. Cathy didn’t have much of an appetite but everyone around her encouraged her to eat, appealing to her sweet tooth and love of home baked treats. When she was seen at the cancer center a few months later she was shocked to see how much weight she had gained. Then the guilt and confusion set in.

Hormone Therapy Does Not Cause Weight Gain.

Maybe Tamoxifen isn’t supposed to cause weight gain, but it’s still one of the main concerns when women start taking it. Of course many women see changes in their body through menopause, so it’s unrealistic to think hormone therapy is not affecting weight and body composition. The horrors of hot flashes, sleepless nights and rampant cravings leave women feeling like they deserve a medal, or at least a treat, for going through all this!

When Sandra talked to her doctor about her weight and concerns about Tamoxifen she was disputed by her doctor saying “Tamoxifen doesn’t cause weight gain.” Confused, she was told to just eat less and move more. Sandra felt dismissed, her concerns weren’t heard or validated and now she felt like she brought this on herself. She struggled all year, denying the changes her body was going through.

Radiation Increases the Burn.

If you weren’t eating the right foods for healing after surgery, radiation can continue to burn through muscle mass. Not to mention the daily appointments, throwing off healthy routines and eating habits. Fatigue and brain fog can really set in during this time, often lasting months beyond when radiation finishes.

“Ringing the Bell” was not the end of the cancer battle for Megan. She struggled as she tried to return to work. She doubted her abilities and skills as she questioned who she really was after the treatment. She sure didn’t feel like herself! Spending longer days at the office trying to keep up, she came home exhausted and completely tapped out each day. Dinner was the easiest foods she could get in but it didn’t refuel her for the next day. Until we built a meal framework that provided her body with the energy and nutrition it deeply needed. Her energy levels improved dramatically, giving her the strength she needed to make intentional choices to rebuild her body and lifestyle after treatment.

Aren’t I Supposed to Lose Weight During Chemo?

Most people think of nausea and poor appetite when they imagine chemotherapy. Fortunately, modern anti-nausea medication schedules have drastically improved treatment-related nausea. But appetite can still be far from normal. Dexamethasone is a common anti-nausea that can increase appetite and fat, fuelling food cravings and high blood sugars.

Chemo side effects can make eating tough. Alternating diarrhea and constipation. Taste and smell changes. Mouth tenderness. Fatigue. Pain. They can all affect your interest in food and leave you questioning, “What can I actually eat?!” This is also the time where I see massive changes in body composition. Severe weight loss can delay treatment and add months to the recovery period. Some get lost as they go deeper and deeper into the chemo fog, making it hard to orientate to a healthier way of being.

Judy felt terrible during chemotherapy. Her appetite was off, she couldn’t sleep and she missed the comforts of her regular routines. Although she was concerned about gaining weight, she was just eating what she could and doing the best she could during treatment. It felt like everyone around her had a food tip. Don’t eat sugar. Don’t eat meat. Have you tried gluten-free? Asparagus can cure cancer! A month after her final chemo cycle she felt she should be switching into “normal” mode but she didn’t feel normal. Her appearance totally changed when she lost her hair, her body was unrecognizable when she looked down and she had gained 35lbs. She wondered if she should be cutting back on calories, even though her meal portions were already much smaller than before treatment. Cravings for high calorie, processed foods were stronger and more frequent than she had ever experienced before. She wanted to be working out again but spent most afternoons on the couch fighting sleep. As we worked together she realized that she didn’t need less food, she needed more nutritionally dense foods to boost her body during its recovery phase. Weeks later she was seeing a full scalp of baby hairs sprouting and noticing she had more energy in the day. She started building back supportive routines while being kind and compassionate to herself. Once again she was able to find a sense of control in her lifestyle choices as we worked with her current state to get her into the recovery zone.

As you take on these layers and layers of difficulties through treatment it adds to the weight of your life, and your body. You didn’t just “gain 20lbs after treatment”. What your body needs is not severe restriction but compassionate support to recover and heal. I work with women through coaching packages to take them from their confused and distressed state into a space of improved energy, motivation and self-confidence. A space where they can heal and find love for their body and themselves.

If this has been your experience through breast cancer treatment and you are looking for support, send me a direct email at Erin@savournutrition.com

Savour Nutrition is launching a small group cohort program for women diagnosed with breast cancer wanting to nourish their body and heal their relationship with food. With the best foods for you, the right supplements and powerful strategies you can start feeling better and investing in your best self.

Join the waitlist for more information!

→ Next post will be about strategies you can use during treatment to minimize weight gain.