Living Healthy to Maintain Breast and Bone Health

[00:00:00] Adam Walker: This program is supported by Amgen. Amgen strives to serve patients by transforming the promise of science and biotechnology into therapies for patients with serious illnesses, learn

From Susan G Komen. This is. A podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.

Dr. Jennifer Ligibel is an associate professor of medicine at Harvard Medical School and Senior Physician at the Dana Farber Cancer Institute. She’s also the director for the Leonard P Zicam center for integrative therapies and healthy living and the director of the center for faculty wellbeing at Dana Farber cancer center. She joins us today to discuss the impact of lifestyle factors, such as physical activity and nutrition on breast and bone health and how the decisions that we make may affect our long-term health and quality of life.

Dr. Ligibel, welcome to the show.

[00:01:04] Dr. Jennifer Ligibel: Thank you so happy to be here.

[00:01:06] Adam Walker: Well, this is just such an important conversation. So I appreciate you taking the time. To start off, can you tell our listeners about your research focused on the impact of lifestyle factors on breast cancer risk and outcomes?

[00:01:18] Dr. Jennifer Ligibel: Sure. Absolutely. So my work really focuses on how exercise, nutrition, and especially obesity are related to a woman’s risk of developing breast cancer.

And for women who’ve been diagnosed with the disease, how these factors are related to outcomes like cancer recurrence and even survival. So we have a lot of evidence that comes from observations or sort of studying populations and we see that women who exercise more regularly, women whose weight is in a healthy range, and women who eat a diet that’s healthier uh, seem to have lower risk of developing breast cancer.

There’s also evidence that the same factors are related to lower risks of recurrence and lower risks of cancer related mortality. There’s also a lot of research that shows that exercising more during your treatment, for example, helps to prevent side effects of cancer treatment, helps to keep people feeling better through their therapy.

So the research that we’ve done is really to try to take that evidence and go a step further to see if a woman isn’t exercising after being diagnosed or if her weight isn’t a heavier range. If you can help her change those things and see if that will actually have an impact on their risk of her cancer coming back.

We just finished enrolling patients in a very large study called the breast cancer weight loss trial, which is partially funded by the Komen Foundation, that is looking at whether a weight loss program, exercising more, consuming fewer calories, improving the healthiness of the diet after breast cancer diagnosis will actually reduce the risk of a woman’s cancer coming back.

And so we enrolled 3,200 women from across the United States and Canada and we’ve been studying the effect of a two year weight loss program on cancer outcomes. We’re really excited to be trying to look at not only are there connections between these factors and the risk of developing cancer or the risk of having a worse journey from cancer, but also looking at whether these are things we can change by helping women exercise more, change their diets, and lose weight.

Wow. I mean,

[00:03:40] Adam Walker: I never thought about any of that stuff, so that’s pretty amazing. And I guess that’s why you do research because maybe we haven’t thought about it before. So, so talk to me just, I mentioned this in the intro, but I want to make sure we cover it. How are breast health and bone health related?

[00:03:55] Dr. Jennifer Ligibel: That’s a great question.

You know, breast cancer and bone health are really important issues for women. Um, and they both tend to be issues that become increasingly important as women age and especially as women go through menopause. Bone loss after menopause is something that affects an enormous number of women um in the United States, around the world.

And although you may kind of look at this and say, you know, breast cancer and bone health seem to be sort of different orders of magnitude, the number of women who break their hip and lose their functional status, or who become really disabled because they’re losing their bone density and they develop fractures or they lose height.

Uh, it’s really important issue to keep women healthy as they get older. There are some common risk factors for breast cancer and poor bone health. Um, the exercise that we do, the foods we eat impact both of those things. There’s a lot of other things that affect both breast cancer risk and bone health as well that aren’t as related.

And I think both of them have a strong genetic component. They’re not necessarily the same genetic risks, uh, but they’re both, they’re both medical conditions that are influenced not only by what you do, but by your genes as well.

[00:05:20] Adam Walker: Hmm. And so you mentioned that exercise can help support better bone health and potential better breast health as well. Um, how does physical activity play that role in preventing osteoporosis and breast cancer? And is there anything specific that our listeners should be focusing on?

[00:05:37] Dr. Jennifer Ligibel: So one thing I will say is that we do have really high level evidence that shows that exercise, especially weight bearing exercise, where you’re getting your muscles and your bones to move against weight is incredibly important for maintaining bone health.

This evidence actually comes from randomized trials where you take women that aren’t doing this kind of exercise and you started them on a program and you see their bones get better. So that’s about the strongest kind of evidence that we, that we can develop. And so we know that that type of exercise is critical for keeping bones strong.

And that’s why the US Surgeon General and other groups that put together guidelines uh, for the health of the population recommend that both men and women, not only engage in aerobic exercise, which we think of as being really important for heart health, but also do at least two episodes of strength training or resistance exercise every week.

Now it doesn’t mean you have to go to the gym and lift heavy weights, big weightlifters on TV, but even doing exercise with bands, resistance bands to kind of put more resistance that your muscles are working against or using soup cans or milk jugs or things like that. But it’s really important that your muscles are moving and that they’re moving weight and that will help keep your bones stronger.

[00:07:00] Adam Walker: Yeah, I’m really glad you said that. Because when, when we first started talking about exercise in this conversation, I immediately went to aerobin exercise, like walking, biking, running like those types of things. It never really occurred to me the, the critical factor of, of actually lifting weights and, and, and having that resistance against your muscles to strengthen your bones and the other parts of your body.

So I really appreciate you making that differentiation there. Um, so, so let’s get into nutrition for a second as well. Why is consuming a diet sufficient with vitamin D and calcium so critical to bone health? And is there a connection between vitamin D and breast cancer?

[00:07:38] Dr. Jennifer Ligibel: Absolutely. So, um, vitamin D and calcium are sort of the building blocks that your body needs to keep your bones healthy and strong. And one of the things that happens is that women, as they get older, their bodies don’t absorb and use calcium in particular as well. Um, and so it’s why it’s really important to make sure that your diet has plenty of calcium.

Your body actually absorbs calcium better from food than it does from supplements. Um, and there’s been a lot of controversy about calcium supplements and kidney stones and things like that. So I always encourage my patients to really look at their diets and see how much calcium they can get from food sources because your body just uses it better and you’re less likely to end up with complications like kidney stones.

Vitamin D is pretty fascinating and I think that we are really just at the beginning of our understanding about how vitamin D is important for so many different things in our bodies. We know that vitamin D is really critical to bone health. But one of the tricky things about vitamin D is that it comes from different places and food is one of those places. Um, but the sun is also an important place that vitamin D comes from. And I live in Boston and I will say that, sadly, we don’t get as much sunshine as many parts of the country, especially in the winter months.

And so the proportion of women in the Northeast, especially that are vitamin D deficient is pretty high and we know that has an impact on your ability, your body’s ability to keep your bones strong. There’s also some evidence that vitamin D levels may be linked to breast cancer risk. But this studies so far that have tried to give people supplements of vitamin D to see if that will prevent breast cancer have really not shown a whole lot of benefit.

Some people say that well, they haven’t gone high enough with the vitamin D supplementation, but I think there’s still a lot that we don’t know there. But I would definitely say that making sure that you have enough vitamin D and I recommend to my patients in the Northeast, especially, during the winter that a supplement of a thousand or 2000 units of vitamin D per day is something that is helpful for their general bone health.

Um, many primary care doctors will also check vitamin D levels, because if you’re really low, you need a different program to try to get the level back up to a healthy place.

[00:09:58] Adam Walker: Okay. That’s also great to know. Again, things that I would not have thought about prior to this conversation. So, so that’s really helpful. So, so talk to me about healthy weight. How, how has a healthy weight related to breast cancer? And what’s the relation between the healthy weight and bone health?

[00:10:15] Dr. Jennifer Ligibel: So we know that um, excess adiposity, sort of fatty tissue um, is a risk factor for developing breast cancer after menopause. And there have been, honestly, hundreds of studies that have looked at the relationship between body mass index or body composition and breast cancer risk and have really convincingly shown that higher levels of adiposity, especially when people’s body mass index crosses into the obese range, is associated with a higher risk of developing breast cancer after menopause.

We also know from studies that look at women who have had bariatric surgery, compared to women who’ve not that, when a woman goes through bariatric surgery procedure, her risk of developing breast cancer is significantly lower than women who are of the same body mass index, the same age, kind of matching a lot of factors that don’t have bariatric surgery.

And in fact, in many of those studies, the risk is about 50% lower. So not a randomized trial. It’s hard to randomize people to have such a big surgery, but really, really provocative evidence that weight might be a modifiable risk factor for developing breast cancer. And then we also know that women whose weight is higher when they’re diagnosed are at a higher risk of having their cancer come back and that’s really the whole point of our study. To see, again, like the bariatric surgery, if you change weight, can that change risk? And so we’re really excited to get the results of those studies over the next couple of years.

The relationship between body mass index and bone is a little more complicated because if you think about the fact that when you put more resistance on your bone, it helps keep it stronger. Sometimes in fact, when women have more body weight, their bones are actually a bit stronger. But the caveat to that is sometimes women will have more fat and less muscle and muscle is really important for keeping your bones strong.

So it’s why it’s important to exercise and do that type of weight-bearing exercise regardless of what your body mass index is.

[00:12:28] Adam Walker: Okay. That’s great to know. So we’ve talked about nutrition. We’ve talked about exercise. We’ve talked about healthy body weight. Let’s talk about sleep and stress management for a second. Why are these important parts to a healthy lifestyle?

[00:12:45] Dr. Jennifer Ligibel: It’s a good question and these are both areas where there’s still an awful lot that we don’t know. But we know that there are close relationships between sleep and weight. When people are heavier, their sleep is disrupted. But even more, we find that people who don’t have good sleep, tend to eat different foods.

They’re at higher risk of developing obesity, and you can end up in sort of a vicious cycle, um, and that can affect your breast cancer risk. There’s not as much evidence for bone. Um, but there is absolutely evidence that paying attention to getting good sleep, um, is really, really important to your general health, to your cardiovascular health, and probably to your breast cancer health.

[00:13:28] Adam Walker: Hmm. Yeah. I mean, it seems like it would, it has an effect on kind of everything in a lot of ways. So I appreciate you sharing that. And so as a part of an overall healthy living strategy, can you talk a little bit more about the importance of screening?

[00:13:42] Dr. Jennifer Ligibel: Absolutely. Absolutely. So both breast cancer and osteoporosis have screening tests that are recommended, um, especially as women get older and these are important things to make sure you’re working with your primary care physician about when you should be having breast cancer screening and what type of screening.

Sometimes the, whether you have mammogram, which is recommended for everybody, or you need enhanced screening, things like an MRI, depend on your family history. Some of the other factors, uh, risk factors that you may have. Um, it’s the same for osteoporosis screening. We recommend something called dual, I’m just going to call it DEXA.

Uh it’s the same for us osteoporosis. We recommend a test called a DEXA, which is a special x-ray that can show doctors how dense your bones are, how, how strong they are um, in your hip, in, in your back and spine, which are places where you tend to be at most risk of osteoporosis. And again, the recommendations for how often you need that test, and when you need, it are going to depend a little bit on your age, on your family history, on other medications that you might be taking.

So it’s really important to ask your doctor about your screening and when you should start and how often you should be having these tests. It’s really important. I think over these last years of the pandemic, a lot of people have fallen off of their screening. They haven’t had their mammograms every year. Um, they’ve kind of lost track of when their last bone density was and so it’s really important to follow up with your primary care physician about screening.

[00:15:20] Adam Walker: That’s so, so important. My last question, help us. This is such a broad topic and a lot of times people just have no idea where to start. So I would love for you to just share some practical tips. What are some things that our listeners can implement today to start making an impact in their overall health?

[00:15:40] Dr. Jennifer Ligibel: I think move more, sit less is probably one of the most important things that you can do for your general health, your bone health, your breast cancer health.

We all know that our lifestyles are, unfortunately, increasingly spent sitting in front of a computer, in a car. As much as you can, make sure that you’re getting up and moving, build active activities into your life every day. I think that’s probably the most important place for people to start. And you can start slow, you know, don’t start by signing up for a marathon, you know, walk around the block, find a group of friends that you can go for a walk with.

Being outside is one of the things that we can do that it has been safe over these years. And I know it’s not easy for everyone. And there are circumstances where people don’t have access to safe places. But I think that, you know, this is something that trying to find, whether it’s outside in your neighborhood or going to an indoor space, um, finding a place where you can move is probably the most important thing that people can do.

[00:16:48] Adam Walker: That’s right. That’s so important. Just take a moment, get up, set an alarm and as a reminder to stand up and move around and take a walk and get outside a little bit. Well, Dr. Ligibel, thank you so much for your time today. Thank you for all of the wisdom that you’ve shared with us and, uh, thanks for joining us on the show.

[00:17:05] Dr. Jennifer Ligibel: Absolutely. Thank you so much.

[00:17:11] Adam Walker: This program is supported by Amgen Amgen strives to serve patients by transforming the promise of science and biotechnology into therapies for patients with serious illnesses, learn

Thanks for listening to real pink, a weekly podcast by Susan G Komen for more episodes, visit real for more on breast cancer. Visit Make sure to check out at Susan G Komen on social media. I’m your host, Adam, you can find me on Twitter at AGA Walker or my blog, Adam J