Abstract
Sleep disturbances overthrow breast cancer patients’ eating behavior, aggravating sarcopenic obesity causes like insulin, leptin and dopamine resistance, thus increasing recurrence and mortality risks. Seeking fat loss solutions for sarcopenic obesity in ER+ breast cancer patients with sleep disturbances, we randomized 50 – of which 16 were depressive – to follow a high protein diet (D) or the diet and sleep journal interventions (D+SJ). Patients ate only when hungry foods naturally high in protein, calcium, omega-3, pre- and probiotics, and were asked to write a daily food journal. Half of the patients were asked to write a 7-day Kalionka Institute type sleep journal – containing questions about the time it took them to fall asleep, number of awakenings during the night, how much they slept, how much they stayed in bed, and self-perceived sleep quality. After writing the sleep journal, we asked patients to follow set sleeping and wake up hours calculated based on their SJ answers, and to not sleep during the day. After 8 weeks we remeasured body composition with a multi-frequency bioelectrical impedance scale. 8 patients from the D+SJ group asked to leave the study, 5 being depressive. D group lost 2.31±2.86% body fat (p=0.001), and 0.76±1.16% visceral fat (p=0.001); with no fat loss difference between patients with or without depression. Depressive patients did not obtain statistically significance for weight loss. D+SJ group improved sleep quality and lost 2.16±2.35% body fat (p=0.002), and 0.86±1.24% visceral fat (p=0.005). Depressive patients didn’t obtain statistically significant results neither for fat, nor for weight loss – maybe because of the overtiring effect of the SJ intervention. So, both D and D+SJ interventions improve breast cancer patients’ body composition despite sleep disturbances, but only non-depressive patients also lose weight. And SJ intervention improves sleep quality in patients without depression, decreasing weight regain risk.
Highlights
Breast cancer patients who gain weight during treatment have higher risks of all causes mortality, oncology specific mortality and recurrence (1)
This study is part of a series of studies aimed to find a preventive solution for sarcopenic obesity during breast cancer treatment
A high protein diet based on foods naturally high in proteins, omega-3 fatty acids, calcium, proand prebiotics can improve body composition by increasing insulin and leptin sensitivity, and it can assist in breast cancer recurrence prevention through a moderate intake of glucose
Summary
Breast cancer patients who gain weight during treatment have higher risks of all causes mortality, oncology specific mortality and recurrence (1). Appetite is triggered by ghrelin acting on the same NPY and AgRP secreting neurons within hypothalamic arcuate nucleus, but ghrelin is mainly secreted by oxyntic gastric cells when the stomach is empty, which may or may not coincide with the blood sugar being low enough to generate physical hunger When they don’t coincide, and patients decide to eat in response to ghrelin instead of to a blood sugar level lowered enough to generate physical hunger, muscle’s insulin sensitivity decreases (13). Respecting satiety is essential for increasing back the insulin sensitivity, but insulin resistant overweight and obese patients with sleep disturbances have a lowered ability to perceive it due to leptin resistance (because insulin stimulates leptin secretion by the already higher body fat percentage), and dopamine resistance (because they use eating to feel better emotionally). When stress becomes chronic and feel they can’t fight it anymore, they re-enter into the β-endorphins/cortisol loop – loop that can lead to emotional eating, and to depression
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