All about feeding your brain after a breast cancer diagnosis

Chemo brain is a lingering side effect of great concern to people experiencing breast cancer. This effect is especially distressing for women who were able to accomplish many tasks at once before medical treatments. Are there foods you can feed your brain to speed up recovery?


It's described as mental fog, from taking longer to finish tasks at work, forgetting names, or not being able to answer the phone while cooking. Often referred to as chemo brain or chemo fog, the actual term is chemotherapy-induced cognitive impairment (CICI). But that may be too specific, as many patients also experience a drop in cognition after radiation, immunotherapy, and hormonal therapies.


A MIND plate of foods to keep brain young
An example of a Mind Plate for brain health

Chemo brain is experienced by as many as 75% of all cancer patients. For those experiencing breast cancer, 12–82% are reported to have this frustrating side effect. Chemotherapy treatment with Doxorubicin (DOX), used commonly in breast cancer treatments, can often cause chemo brain.


Younger breast cancer thrivers report significant memory problems but recover faster than older patients (older patients may start chemo with memory deficits as well). Chemo brain usually disappears within 6-9 months after treatment is completed, and for some, may linger for years. But time is the greatest healer.


It's important to report your symptoms to your medical team, because the only way we know about chemo brain is through patient-reported symptoms. These can range from mild to severe. Age, lifestyle and even genetics, can influence the severity of chemo brain and how long it takes to recover. Cognitive function is also greatly affected by lack of activity, stress, menopause, sleep disruption, nutrition, pain, aromatase inhibitors, and medications for nausea and pain.


How to Feed your Brain

Recovering from chemo brain health is influenced by six types of support:

  1. Physical activity support

  2. Stress support

  3. Sleep support

  4. Social support

  5. Medications and supplements support

  6. Food and nutrition support

Let's go through each one of these types of support for brain health after diagnosis and then dive deeper into actionable strategies surrounding food and nutrition.


Physical activity support

Being active is incredibly beneficial for physical and mental fitness, to de-stress, improve sleep, as well as keep your heart, lungs, and muscles healthy. It reduces recurrence for breast cancer, and helps reduce joint pain on aromatase inhibitors.


It's never too late to start physical activity if you are able. Patients often reduce their activity during treatments and become more sedentary. But in a nationwide study, physical activity prior to and during chemotherapy showed immediate better cognitive function and 6 months after completing treatments. This means being active can even reduce the effects of chemo brain before it starts.


A study was done in women who were an average of 53 years old with stage I-IIIC breast cancer. Patients who met minimum National Physical Activity guidelines prior to and during chemotherapy had better cognitive scores over time.


National guidelines include at least 150 to 300 minutes of moderate-intensity aerobic activity, such as brisk walking or fast dancing weekly. They also recommend muscle-strengthening activity, from lifting weights to push-ups, for 2 days a week; and balance training.


Aerobic exercise, also known as “cardio” or “endurance” exercise, helps to get your heart rate up and your muscles warm. Examples of aerobic exercises include biking, swimming, running, and climbing stairs. This type of exercise benefits your brain because it helps to preserve existing brain cells and also promotes the growth of new ones.


Another type of exercise is strength or “resistance” training such as pushing or pulling weights or other heavy objects (like groceries). This is known to help build and maintain strong bones. Strength training also helps your brain by enhancing your concentration and improving your decision-making skills.


Stress support

All patients with breast cancer experience stress. Stress is how the body and brain react to a threat or demand (or “stressor”). These reactions are often called “fight or flight.” They include increased heart rate and breathing and a heightened sense of focus. All of these physiological reactions are initiated by the brain when it detects the threat.


Once the threat is gone, the stress response relaxes and your body and brain can regain their normal (“low/no stress”) balance. However, sometimes that stress lingers on for days, weeks, and months (or longer) and becomes long-term or “chronic” stress. It’s this chronic stress that can negatively impact your brain. Chronic stress can effectively shrink the part of your brain responsible for memory and learning (your “prefrontal cortex”) and can increase the part of your brain that is receptive to stress (your “amygdala”).


While stress shouldn't be eliminated entirely, you can learn effective techniques to better manage it and preserve your brain health. One very practical—but often difficult—strategy is to “just say no” to things you don’t actually have to do. Turning down unnecessary opportunities to take on more responsibility may help reduce the amount of stress you feel. Allow yourself more time to complete tasks while effects persist.


Another strategy to reduce stress is to focus on the specific problem at hand in the present moment. This can help you see the current situation more clearly and make better decisions, to avoid turning it into an unmanageably large issue or perceiving the situation to be more difficult than it has to be.

Finally, calming the mind through meditation or guided imagery can help reduce the feelings of stress by refocusing your attention on something positive and soothing. Try Tibetan sound meditation or Qigong. The inevitable stress of a cancer diagnosis and having cancer can itself affect memory, so mindfulness-based relaxation techniques are often recommended. Take a deep breath when trying to remember a word or a name, and tell yourself it's OK to take more time.


Stress-reducing activities include new experiences such as traveling, activating all the senses such as walking in nature, spirituality and other “environmental enrichment.” Computer-based programs for brain-training may also be effective for patients with breast cancer. These enhance the plasticity of the brain, and enable it to regenerate and recover.


Sleep support

Sleep is hard during cancer treatments. Getting your 7-9 hours of restorative sleep each night may seem like a dream, but it helps your mood and ability to manage stress. Sleep also allows you to have the energy to do what you need to do to maintain and improve your well-being.


Eliminating toxic waste in the brain is a process that only happens during sleep. Practice sleep hygiene by avoiding coffee, chocolate, soda, and alcohol before bedtime.


One of the most important things you can do to get enough sleep is to foster a regular sleep schedule. By going to bed and waking up at about the same time every day—including weekends and when you’re traveling—you “train” your body and brain to get on a healthy sleep schedule.


Another strategy to help you get more sleep is to create a relaxing bedtime routine. That routine can start an hour (or more) before you need to sleep and can include things like dimming lights, putting your screens away (no more TV, internet, or smart phones), listening to soothing music or reading a spiritual book, journaling, or having a warm relaxing bath.


Whatever helps you get your sleep is going to also help your brain.


Social support

Staying connected to a network of people you care about can help reduce stress, improve mood, and help to feel more supported in life. Your social network can include your spouse and/or partner, immediate and extended family members, friends, or others in your community.


You can socialize informally or spontaneously (like walking or chatting with a neighbor) or you can join organized activities like hobby groups, sports teams, or volunteering opportunities. The brain benefits of socializing even extend beyond people to pets. Studies show that pets can help you feel calm, improve your health, and enhance your social life, all of which can benefit your brain.

Letting people know you're struggling with memory will enable them to be more patient and even laugh with you when you call your child by your pet's name!


Medications, supplements and other support

Occupational therapy can help you with strategies for cognitive rehabilitation. Still, depending on your personal health situation, you may be advised to take medications or supplements.


Medications can be important to reducing your risks for serious conditions and slowing down the progression of diseases. Some of the medical conditions that are linked to deteriorating brain health include high blood pressure and diabetes. These can increase your risks of cognitive decline (reduced memory and ability to think). Medications may also include antidepressants, and stimulants.


Probiotics supplements show a significant link to avoiding chemo brain entirely and improved cognitive function — possibly by changing the gut microbial numbers and variety. Omega-3 supplements reduce inflammation, among other benefits. Nootropics (mind-change from the Greek) include ginseng, pine, and gingko biloba. However, many herbal and vitamin/mineral supplements interact with chemotherapy and other medications.


If your doctor is recommending medications or your registered dietitian nutritionist is recommending supplements, be sure to take them as directed and go for routine monitoring or testing as required.


The Mind Diet book
The Mind Diet includes whole grains

Nutrition support: Feeding your brain

There are several foods and nutrients that promote a healthy brain. University researchers developed the MIND diet to emphasize foods that are rich in antioxidants and critical brain nutrients such as vitamins and other plant-based phytochemicals.

It was developed specifically for optimal brain function, is easier to adhere to long-term, and shows remarkable benefits even if you don't follow it perfectly. In fact, many foods can still be enjoyed in small servings.


The foods that make up the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet can lower the risk of Alzheimer's disease by more than half, and studies show that the diet delays aging of the brain by 7.5 years. The MIND diet emphasizes brain health by bolstering fruit and vegetable intake.


The top 10 brain-friendly foods on the MIND Diet are the following:

  • fish

  • all vegetables

  • green, leafy vegetables

  • whole grains (any grain with a good amount of fiber)

  • spices, chocolate, coffee, tea

  • nuts

  • beans

  • berries

  • olive oil

  • wine (except for cancer survivors)

The five foods to avoid or limit are the following:

  • Butter and stick margarine

  • full-fat cheese

  • fried foods

  • red meat

  • pastries and sweets

Let’s go through a few of the key foods and nutrients to boost your brain health.


Omega-3 fatty acids

Omega-3 fatty acids are a group of essential fats that promote heart and brain health. Some of the best sources of omega-3s are fatty fish such as salmon, herring, and sardines. The MIND diet recommends at least one serving of fish each week. If you don’t love fish, omega-3s are also found in nuts and seeds such as flax, chia, walnuts, and soy.

More plants

Plants contain more than vitamins and minerals, they’re also a source of fiber and antioxidant phytochemicals. Some of the top plants for brain health are deeply-colored fruits and vegetables like berries, leafy greens, and broccoli. The MIND diet recommends vegetables every day, at least six servings of greens each week, and at least two servings of berries each week. Grapes and grape juice contain the benefits of resveratrol without the toxicity of alcohol.

Spices and chocolate

Spices and dark chocolate contain antioxidants called flavonoids. These compounds can help improve blood flow to the brain and reduce inflammation. These can be found in high amounts in turmeric, cinnamon, ginger, and dark and unsweetened chocolate.

Coffee and teas

Did you know that coffee can help to improve your memory ? Up to three cups of black coffee per day is recommended. When it comes to teas, black and green teas contain antioxidants for brain health.

Whole grains

Whole grains like oats and quinoa are rich in brain-healthy B-vitamins and fiber, making them an important part of the MIND diet. B-vitamins are essential so that the brain can create energy, repair DNA, maintain the proper structure of neurons (nerve/brain cells), and create essential neurochemicals for optimal function. B-vitamins also act as antioxidants to reduce the harmful effects of free radicals that can damage brain cells (or any cells).

Vitamin D

Vitamin D is also known as the “sunshine” vitamin because your skin makes it when it’s exposed to the sun. Low levels of vitamin D are associated with increased risks for brain disorders such as Alzheimer’s. You can increase your vitamin D levels by going in the sun for 5-15 minutes three times a week. You may need slightly more time if you have darker skin or live in a more northern latitude. Try not to get too much sun without sunscreen as it can increase your risk for skin cancer. Vitamin D supplements are also widely available. Talk to your registered dietitian nutritionist to find the right one for you.

Limit red meat

Consuming too many foods high in saturated fats is linked with an increased risk for heart disease and Alzheimer’s disease. For cancer prevention, no more than 18 ounces of red meat per week is recommended. Try limiting your red meat, butter, and dairy whenever you can and consider substituting with beans, lentils, and soy.


Bottom line

There are many things you can do to bolster your brain health after diagnosis. They include a number of healthy habits such as being active, reducing stress, getting enough sleep, socializing with others (or with pets), and following recommendations for medications and supplements. When it comes to food and nutrition for brain health, try to get enough omega-3s, more plants, spices and chocolate, coffee and tea, and vitamin D. Limit the amount of red meat you consume.


Need a plan to help you embed these six supports to feed your brain in your day-to-day life? Book an appointment with Tamar today to see if my service can help you. https://www.tamarrothenbergrd.com/services


References


https://ascopubs.org/doi/abs/10.1200/JCO.20.03514


Association of cognitive impairment and breast cancer survivorship on quality of life in younger breast cancer survivors

Von Ah D;Crouch AD;Monahan PO;Stump TE;Unverzagt FW;Storey S;Cohee AA;Cella D;Champion VL;

https://pubmed.ncbi.nlm.nih.gov/34173970/


Cognitive Function and Chemo Brain from cancer treatment: City of Hope

https://www.cityofhope.org/patients/living-with-cancer/dealing-with-cancer-side-effects/cognitive-function


How Does Stress Affect the Brain: What is Stress: TUW

https://www.tuw.edu/health/how-stress-affects-the-brain/


Physical Activity May Lessen the Effects of Chemobrain

January 20 et al.

https://www.cancer.gov/news-events/cancer-currents-blog/2021/physical-activity-cognitive-function


www.pnas.org

https://www.pnas.org/doi/full/10.1073/pnas.1112599109


Prevalence of cognitive impairment and change in patients with ... - Wiley Online Library

https://onlinelibrary.wiley.com/doi/10.1002/pon.5623


Probiotic supplement attenuates chemotherapy-related cognitive impairment in patients with breast cancer: a randomised, double-blind, and placebo-controlled trial

Juan et al.

https://www.sciencedirect.com/science/article/abs/pii/S0959804921012168


https://pubmed.ncbi.nlm.nih.gov/34173970/


Suffering from "chemo brain"? There's hope and many things you can do

Jorg Dietrich

https://www.health.harvard.edu/blog/suffering-from-chemo-brain-theres-hope-and-many-things-you-can-do-2019112018403


Therapies for cognitive impairment in breast cancer... : Medicine

College

https://journals.lww.com/md-journal/fulltext/2020/05080/therapies_for_cognitive_impairment_in_breast.58.aspx


What Is Chemo Brain?

https://www.cedars-sinai.org/blog/chemo-brain.html


What is the MIND diet? Food Insight. https://foodinsight.org/what-is-the-mind-diet/

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