Lately I’ve been speaking with people who are having a hard time dealing with anxiety, so I thought it would be worthwhile to dive deeper into grounding methods.
For me, hands down, strong neutral physical sensations (with “neutral” being the operative term here) are by far the best ways to pull my head out of swirling thoughts and get back to where I am now on the Earth.
Buttocks and feet are great focal points for drawing attention away from rapid breathing or heartrate.
Currently, I’m focusing on touch points: those places on your body where you are making contact with any surface. This is highly effective because it is well-suited for any situation. You don’t necessarily need to be in a particular position, nor do you need a quiet space. So if you’re in the middle of an exam, sitting in your boss’ office, standing at a podium or walking down the hallway of a hospital, this grounding method can shift you back to the present moment.
The idea is to focus on the sensation of pressure. My suggestion would be to bring your attention to whereever on your body you can sense that contact with a surface, giving preference to places further from areas that might be reinforcing anxiety, such as the chest region and a rapidly beating heart. So, hands, feet and buttocks would be good candidates. If you’re walking, then pay attention to the change in pressure of your steps as you put your foot down and lift it again.
Feel into these body parts, sensing how the pressure feels against them. You can also bring in sensations such as tingling and temperature. Like an investigator, experiencing these sensations as if for the first time, get curious about their quality. If needed, squeeze the muscles, but then make sure to relax them too, so that you’re not clenching. Then see if you notice a difference in sensation.
Try it right now. Go ahead, I’ll wait…
You don’t need a special place to practice grounding yourself. Where you are right now is perfect.
Did you try it? And did you feel anything? The type of sensation doesn’t matter here. The main goal is to get out of your head, which may be in overdrive. Paying attention to what your body is doing RIGHT NOW helps move you away from thoughts of dread and gives you a handle on your reactions.
Important: as with all calming techniques, this takes practice. It is not a one-time thing that you try, nor is it a pill that you pop and everything settles down. The more you practice this, especially when you’re in a peaceful surroundings, the better you will get at shifting your focus during times of anxiety. Just as with a formal meditation practice, it is consistency that will improve your focus and thereby your abilities.
The added benefit to practice is that you will realize you *can* do it, that it *does* work, and you will build confidence in yourself that you can handle it. So in an anxious moment, you’ll be able to say, “I got this” and bring yourself to a more manageable place.
I am always looking for ways to illustrate the complexity of emotions associated with having cancer, or caring for someone who does, as a means of relating it to people without this experience.
An immersive video game called That Dragon, Cancer does this by telling the story of a young child with the disease, in this case, a brain cancer called Atypical Teratoid Rhabdoid Tumor (AT/RT). The game explores the fear, hope, helplessness and fight that we go through when confronting so much uncertainty.
To be clear, this is not a video game in the usual sense, it’s a narrative with mini-game elements, sometimes lighthearted, sometimes dark. We follow the journey of a family as they navigate the rollercoaster of cancer diagnosis, doctor appointments and treatments. Those of us who have been on this path can relate to the tsunami of emotions and information, all rolled up into one overwhelming ball. The game does a good job of representing these feelings.
If you’re interested in experiencing this game with a blind playthrough, this is where you should stop reading. For more information on That Dragon, Cancer, visit the official website here.
WARNING/SPOILER: Because this is a true story, the developer Ryan Green (Numinous Games), along with his wife Amy, could not control the outcome; the game was created to honor the memory of their young son, Joel, by chronicling his battle with terminal childhood cancer.
Little Joel underwent a staggering number of treatments for his brain tumors.
Be aware that there are very distressing parts to this game. Just as cancer patients fight for meaning and claw for hope, so does this family. If you are not in the right frame of mind for this, or are at a painful part of your cancer journey, it might be best to skip this game. When the game originally came out in 2016, it left well-known YouTubers in tears. Everyone can relate to loss; Ryan and Amy made this even more powerful by documenting their son’s journey in recordings made during his treatments. Therefore, when you hear the distressed cries of a young child in misery, those are Joel’s actual cries, and they are heartbreaking. But hearing his delighted giggles helps ease the pain.
It is all very raw and real.
Even in the distress, we experience joy in the life Joel lived.
Losing hope, or clinging to it in the face of insumountable odds, is documented here. The Green family hopes for a big miracle, with Ryan and Amy each heading towards the outcome in different ways: Amy is adamant that Joel will be healed while Ryan is riddled with doubt. There is a very strong Christian influence in this gamethat reflects the Green’s religious beliefs, with many references to God, Jesus and saving grace through prayer, so those whose beliefs differ may find this element foreign and possibly irritating, and they should decide whether it is appropriate for them. Nonetheless, the game is beautifully done with moments that will make you smile in between tearful episodes and there is value in experiencing it.
Those who expect a movie-style, “deus ex machina” happy ending may be left empty and unsatisfied, but I found the end to be uplifting, inviting in the acceptance of inevitability.
The game also honors the memories of other cancer patients in imaginative ways.
I’ve now played That Dragon, Cancer three times through. The emotions that it evokes are very familiar and I found this game cathartic and validating. As the Green family discovers, if someone succumbs to cancer, it does not mean that their faith was not strong enough. If there’s one thing I’ve learned about this disease, it is that cancer is not picky, it doesn’t care about your desires and it doesn’t play by the rules.
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From the developer, Numinous Games: “An immersive narrative videogame that retells Joel Green’s 4-year fight against cancer through about two hours of poetic, imaginative gameplay that explores faith, hope and love.” $9.99 on Steam.
If you’re new to mindfulness meditation, you might have found it difficult to hold focus on your breath. But the reality is that you don’t need to be a beginner to struggle with this. There are some days that the mind refuses to be still and even a long-time meditator will find themselves carried away by thoughts.
In an effort to help keep my head here and now, I started paying attention to how it was that I lost focus. For me, it happens during the lull between breaths.
The breath remains the main focus.
What is that lull? Well, there’s a very short, almost imperceptible pause between my inhale and exhale. I’m okay during that time because I can focus on the sensations in my chest and belly. That’s not the pause that gives me problems.
It’s after the exhale that I experience a longer pause before the next breath begins, especially if my breaths are slower and deeper, because my body doesn’t require another breath right away. And that’s when I’m more likely to “see something shiny” and my mind wanders off.
But I found that by focusing on my hands during this pause, I could keep my random thoughts at bay.
If you’re having focus issues and would like to try this, all you need to do is consider your focus as cyclic. First, with the inhale and exhale, focus on the breath sensation–choose wherever you feel the air movement most distinctly, such as the rising & falling of your chest, the rushing of air in and out of your nostrils, or similar. It will be different from person to person.
Next, during the pause between your breaths, turn your focus to the sensations in your hands and fingers. There may be some tingling or throbbing, or perhaps nothing discernable. That’s okay. Just see if there’s anything there that you can feel.
Then, when your next inhale begins, pay attention to the breath again.
The main point of this exercise is to stay present during those times that the mind is very active.
It may sound like you’re jumping from one body part to another, but in reality the transition is very smooth. The focus on the hands gives you a place to go until the next breath returns, all the while keeping you present.
When I first tried this, I thought I was “cheating” because I wasn’t staying with the breath. And I had to remind myself that the purpose of this wasn’t to earn a gold star for being the best “focus-on-only-the-breath” meditator. It was to stay with whatever was happening “now”.
Allowing a slight change in focus when my mind is active keeps me present. Staying present calms me more effectively. And that helps me return to the meditation cushion day after day after day.
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There is beauty in the stillness that we experience between breaths. This dual focus practice isn’t meant to pull us away from that. Rather, it gives us a focus for those days when the mind is active and easily distracted, and appreciating that stillness is not available to us.
Some time back I posted sleep researcher Dr. Matt Kelly’s TED Talk on sleep, which I highly recommend. Now, the American Academy of Sleep Medicine (AASM) has issued a position paper which states unequivocally that “sleep is essential to health”.
As noted in the position paper, “Healthy sleep is important for cognitive functioning, mood, mental health, and cardiovascular, cerebrovascular, and metabolic health.” Anyone who has suffered through the daylight savings time change – that would be most of us – can tell you that even missing out on a single hour of sleep can leave you feeling off for a few days.
Sleeplessness is too often an occurence for too many of us.
And many of us have likely had the experience of sacrificing sleep for school or work projects, adjusting to newborns, or other similar temporary situations, not to mention the occasional middle-of-the-night stress session.
But sleep disruption on a chronic scale has far-reaching repercussions, and has been “associated with an increased risk of mortality and contributes to both the individual risk and societal burden associated with several medical epidemics, including cardiovascular disease, diabetes, obesity, and cancer.”
In particular, shift work has been associated with an increased risk of cancer, due to the persistent disruption of the body’s biological clock, as reported in a recent CDC blog post based on reviews by the National Toxicology Program and the International Agency for Research on Cancer. Data came from both breast and prostate cancer surveys. [The CDC post does outline what shift workers can do to protect themselves.]
While the studies may be confusing, good sleep hygiene is always important.
According to the AASM position paper, the consensus among different sleep-related organizations is that adults require at least 7 hours of sleep regularly, with the range being 7-9 hours. While this seems straightforward, one meta-analysis (Lu et al., 2017, Biomed Res Int) of 10 studies suggested that sleeping excessive amounts (over 9 hours) was linked to an increased risk of estrogen-positive (but not estrogen-negative) breast cancer for women. At the same time, Xiao et al. (2016, Sleep Med) found that short sleep duration was associated with triple-negative (but not estrogen-positive) breast cancer in black women as compared to white women, suggesting racial disparities in the data, so further research is needed.
Confusing? Yes, this is clearly an area that calls for more study. Some clarification came recently from the publication of the “Million Woman Study”. This was an extensive prospective multi-year study of women in the UK that, you guessed it, found no association between breast cancer and sleep of any duration (Wong et al., 2021, Sleep). Nonetheless, the authors did note some shortcomings of the study, so this question is likely to be revisited.
Take home message? Conflicting studies aside, everyone would agree that good sleep hygiene (see CDC recommendations) is important no matter what your cancer risk. With our lives running 24/7 and sleep schedules constantly being disrupted, we should take a clue from the animals who settle down as the evening begins, like clockwork. We might have advanced as a civilization, but we can’t get past the reality that when it’s dark out, it’s time to hit the sack.
I didn’t think I needed a video game to help me mediate.
In the description for “Playne” (on the Steam platform), the developer states that the game is designed to help you establish a meditation habit. While, I thought it would be uninteresting for someone who already had a solid habit, the reviews of the game were very positive and the concept seemed inviting, so I decided to give it a try.
After a week of meditation, saplings have emerged.
I had no idea that it would have such an impact on the quality of my meditation. While I often listen to ambiances (such as through the “MyNoise” app and website) and use guided meditations (“Calm”, “Insight Timer”) or similar auditory cues (“Unwind”), what I didn’t have was a visual representation of my meditation practice as it progresses over time. “Playne” supplies that.
“Playne” has three modes: Story, Sandbox and Evolve. This post is about the Story mode, as that’s the one most people start out with and the one I’m currently working on. Sandbox allows to you build your own meditation spaces and Evolve can only be unlocked after 100 days of meditation (I’m still in the 50s).
You have a small selection of meditations to choose from with the emphasis being on learning to sit with yourself.
The game starts out on a semi-barren island with only a tiny flame in a campfire, a stone lantern, several rocks and Sensei Fox to keep you company. There are both guided and unguided meditations to choose from and as you meditate everyday, the fire grows taller and seedlings sprout and grow. With consistency, you unlock different story chapters, which wise Fox relates, gain the ability to change the weather, and most importantly, grow the island into a beautiful meditation retreat. All it takes is patience.
There is a breath bubble to guide your breathing if you wish, and also a ring that serves as a countdown timer. Both can be turned off if they are distracting or unnecessary.
You are given the ability to chose the length and type of your meditation. In addition, you can regulate inhales and exhales (the length of which you can designate) with a breath bubble, keep track of your meditation time with a minute-ring, enable a journaling option (known as “thought pages”, which you can either keep or burn in the fire if preferred), and mark each instance that you become aware that your mind has wandered (as I enthusiastically wrote about here). There are different places on the island to meditate, and as you accumulate more days, you not only get more weather options to chose from, but also access to elements such as birds, fireflies, Aurora Borealis and butterflies. These are quite lovely and make your “Playne” even more inviting.
Be forewarned that there is the temptation to mark your progress and count achievements. I understand why, from the viewpoint of a game, this is necessary but it does go against the concept of mindfulness. On the other hand, I’m really looking forward to flowers and butterflies!
Now for the potential downside: As much as I enjoy all the offerings, there are a few parts of the game that seem antithetical to mindfulness meditation. The game keeps track of “effort”, you gain “achievements” and note your “progress”. As do other meditation apps/games, “Playne” maintains a record of your streak, and depending on your settings, if you don’t log in to meditate with “Playne” on a given day, you run the risk of having the flame in the campfire go out. While I know that this is done to encourage daily meditation, it is also somewhat problematic, as the whole idea of mindfulness is non-striving. I feel that too much emphasis on achievement in the context of a meditation practice goes against being mindful of the present.
Over 50 days into this, my Playne has grown significantly.
Being of a naturally competitive nature, I was reluctant to turn my practice into one where I would be clinging to achievements. Nonetheless, there are enough positives to this game, and it has benefited my practice so much, that I have been learning to let go. That in itself is a significant improvement!
Yes, it’s unlikely that I will risk breaking my streak, but that’s pressure I can live with.
Reservations aside, I am really impressed with the game. I will write about the Sandbox and Evolve modes when I get to them, and post more images as my “Playne” grows. Additionally, there is a virtual reality (VR) option that I am looking forward to playing with. For anyone starting out with meditation, “Playne” offers a solid platform from which to develop and maintain a consistent meditation habit.
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In addition to “Playne”, I am also using other mindfulness media on a regular basis (my favorite ones are here). That makes for a lot of checking in with electronics, unfortunately. I’ve gotten to the point where I meditate about a half-hour to an hour-plus every day. While it’s a priority in my life, there are days that it’s a struggle to find time for it all. Introducing “Playne” has added to this, and the last thing I need more of in my life is stress.
Sometimes I combine “Playne” with other apps to take advantage of the “Playne” ambiance while doing my favorite guided meditations. More recently, however, I’ve also used “Playne” as a way to emphasize unguided meditation, and that has allowed my meditation practice to mature and expand beyond the confines of a computer program and into the rest of my day. That is one of the greatest benefits of this program and the main reason why I have found it so valuable.
Looks like visiting a cardiologist after stopping aromatase inhibitors for breast cancer was a good idea after all.
The letrozole (aromatase inhibitor) that I’d been taking has been associated with cardiovascular effects, and since I was feeling progressively worse from the medication, I wanted to make sure that everything checked out okay.
With the improvement in surivorship comes an increase in the diseases that come about from cancer treatments. The longer people live, the more long-term effects take their toll.
It seems like the American Heart Association (AHA) agrees with my concerns. An April 26, 2021 statement by the AHA underscored the complicated picture of cancer treatments, in this case hormonal therapies for breast and prostate cancer. As stated in the article by Okwuosa et al. (2021) published in Circulation: Genomic and Precision Medicine, “As patients with hormone-dependent cancers continue to live longer, CVD [cardiovascular disease] has emerged as a leading cause of mortality and morbidity among survivors of these cancers.”
Ironically, breast and prostate cancers are some of the most common cancers in women and men, in addition to having some of the most effective treatments. The number is of breast and prostate cancer survivors is growing. Part of the success of treatment is expressly due to the development of hormonal therapies for long-term (5-10 year) use. At the same time, the increase in CVD problems is a result of this success, because as cancer survivors age they experience greater amounts of age-related cardiovascular events than do non-cancer surivors.
So, what do you do when the treatment that’s increasing your chances of beating cancer may also be increasing your chances of a cardiovascular event? Isn’t that one of the many problems with cancer? If your treatment works well, then that opens the door to having it work “too enthusiastically”, possibly with long-lasting negative effects.
It still comes down to healthy behaviors.
The AHA statement paper cited here stresses the importance of communicating with your oncological team about CVD risk factors and possibly requesting a referral to a cardiologist, having appropriate tests conducted (ECG/EKG, echocardiogram), and–in my opinion the most important thing the survivors themselves can do–modify lifestyle (diet, exercise, smoking cessation, etc.) to maximize your chances of a cardiovascular event-free survivorship.
While it may be frustrating to think of entering into an “out of the frying pan, into the fire” scenario with a potential leapfrog from cancer to CVD, nothing is written in stone. You can make an effort to protect yourself and avoid being a statistic. Focusing on healthy living will benefit you in many ways and is guaranteed to improve your life, no matter what your risks.
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Link to the AHA statement: Okwuosa et al. (2021) Impact of Hormonal Therapies for Treatment of Hormone-Dependent Cancers (Breast and Prostate) on the Cardiovascular System: Effects and Modifications: A Scientific Statement From the American Heart Association. Circ Genom Precis Med, DOI: 10.1161/HCG.0000000000000082
Note: this is another grounding technique, by which I mean a way to retain focus on what is happening in the “now” rather than getting lost in memories of the past, which we cannot change, or succumbing to fears about what may happen in the future. It’s not a woo-woo magical technique. It’s merely being mindful about what is currently taking place so that you can respond appropriately and maintain your composure.
During acute stress, we need to bring ourselves back to the present quickly. By doing so, we are able to clear our heads of the “what-ifs” and “you shouldas” that cloud our thoughts at those times.
But what’s the fastest way to do that? For me, it’s definitely focusing on the fingertips. Each fingertip has approximately 3,000 nerve endings, more than any other part of the body (except the most intimate). When you touch something, all those nerves start firing.
You can take advantage of this sensitivity to ground yourself.
Channel Benedict Cumberbatch’s Sherlock and put your fingertips together.
This is what I do: I “steeple” my fingers (thumb against thumb, index finger against index finger, etc.) as if I were Star Trek‘s Mr. Spock contemplating a complex situation. The fingertip pressure immediately commands attention from my fearful mind in the same way that a boss displaying that hand gesture would command an employee’s attention. Taking deeper breaths, I rub my fingertips against each other in a circular motion. The movement enables the nerve endings on the fingertips to keep firing as the sensation continues. Or I can bounce my fingertips off each other, or keep them together but flex the fingers to create a pulsing motion.
Closing my eyes accentuates the emphasis on sensation and makes maintaining focus on it easier.
Yes, this seems so simple, but it’s also quite effective. By placing our focus on the fingertips, we take our attention away from more reactive parts of the body like the chest area, where the heart might be beating fast and ribcage expanding and contracting with rapid breathing. Feeling into those areas might only serve to reinforce the heightened emotions that we’re experiencing.
The hands lie further away from that commotion, and that distance between the chest and our fingertip sensations enables us, if even for a short while, to get some perspective. Think of it as the anxiety not being “in your face”.
We can use body sensations as anchors to help stabilize us through anxious times.
Sometimes, when I close my eyes, all I “see” is that sensation of fingertip to fingertip, as if it’s the only thing that exists. I can play with this, imagining that I’m holding something between my hands, and that the sensation I feel is actually the feeling of that object against my fingers. It can be a pane of glass or even a beach ball. It all depends on what my brain is willing to accept at the moment. It’s a relaxing mental exercise.
As with many things related to mindfulness, it’s helpful to practice this fingertip pose when we’re in a relaxed and meditative state to connect the sensation to a feeling of calm, enabling it to serve as an anchor when our emotional seas are rough. The more we practice, the stronger that association, and the more effective the grounding response when we use this technique in the midst of anxiety.
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Fun fact: body language experts consider steepled fingers to be an expression of confidence. That might be the little boost you need when you’re navigating a stressful event!
I’ve written before about being an imperfect meditator. There are days when the narrative running through my head is never-ending and refuses to be silenced.
However, I found something that helps while I was playing a meditation game called “Playne” (about which I’ll write in the future). One aspect of this game is that it allows you to mark the occurrence of a thought by clicking the mouse button.
As soon as you realize you’re not focused on your breath, you click the button, and the program makes a pleasant little noise.
The concept is similar to that of a meditation bell except you decide when the “bell” sounds.
As simple as this sounds, it has made a huge difference in my meditation practice. Not only does it help me recognize when I’ve drifted away, but that little sound is very effective at bringing me back to the breath. Instead of gradually floating back to breath awareness, I immediately wake up into the present moment.
It’s as if the sound plants a sonic flag at the point where realization hits and that speeds my return.
This is not unlike a meditation bell that sounds at regular intervals and invites you back into focus. However, the benefit from the sound in my meditation game comes from teaching self-awareness and presence, because I ring it when I myself identify the thought. In mindfulness meditation, we are taught to note the thought inside our head, but in my opinion, the sound helps it “stick”.
Over the past weeks, I’ve become quicker in releasing the thoughts and returning to the breath. The more I practice, the stronger the habit of regaining focus quickly becomes.
While it’s not feasible for me to hold all my meditation sessions within the confines of a game, I’ve found that there are other means of marking my thoughts. Clicking a retractable pen works similarly to the sound in “Playne”. The “click” is just enough to bring attention to itself without being disruptive
Something as simple as the clicking sound of a retractable pen can serve the purpose of noting a thought an d bringing you back to the breath.
Other gadgets that can work? Anything that delivers a distinct sonic note. Tapping a hard surface with the edge of a coin would serve the purpose. Or a hand tally counter that one might use to count people coming through an entrance. A quick search of phone apps reveals a number of tally counter apps if you don’t have access to the handheld mechanical device.
But it’s important to remember that the point of this is not to get obsessed about how many thoughts you had during a particular meditation. What you want is a little sound, like a gentle beep or click, to make you more aware of the thought.
Next time you are finding it hard to focus on your breath, grab a pen, a coin, open an app on your phone…even snapping your fingers may serve as your thought marker. It may be that little extra something that helps you back to the present all that more quickly.
I’m still experiencing weird sleep disruptions. Many nights I’ll be up for an extended time during the wee hours of the morning.
This isn’t conducive to being bright and alert during the day, so I’m devising a game plan for limiting the length of these nighttime interruptions.
My newest strategy is a variant of a counting practice that I heard over the radio years ago, and it goes like this:
Imagine a clean whiteboard. In one hand you’re holding a dry-erase marker in your favorite color, in the other a cloth or eraser.
Your imaginary nighttime whiteboard won’t have a reflection like mine, but you get the idea. The numbers are familiar but you might need to think a bit about how to form them in reverse.
Write “100” in large numbers, but do it backwards so it looks like a mirror image. Channel your inner da Vinci. 🙂
Your board may be brighter and the numbers more perfect than mine. Perhaps you’ll choose a different color. All that matters is that you focus on forming the numbers in reverse.
Then erase the number and write “99”, again reversed. Erase it again.
Keep counting down. Don’t rush. Think about how your hand should move to scribe the backwards numbers. Breathe deeply. When you erase, erase carefully and completely.
As you count down, don’t breeze past the erasure. Make sure you allow your imagination to clean off all markings of the previous numbers before you start writing the next ones.
You probably won’t get to zero. The first two nights I did this, I didn’t make it past 80. It doesn’t always work so well, but when it does, it’s soothing and sleep-inducing.
Why does it put you to sleep? First, you’re not doing anything very complex and therefore this shouldn’t be putting you into a greater state of wakefulness; in fact, counting down is kind of boring. You’re giving your full focus to this task so there are fewer opportunities for intrusive thoughts to interrupt. If they do, return your focus to the numbers. Do this each time your mind wanders. And while the task is easy enough, it does require you to pause and consider how to move your hand, since you’re doing the opposite of what you usually do to write a number.
The counting task requires enough attention that you shift your focus away from thoughts that may be keeping you up, but is gentle enough to lull you into a calmer state that helps bring on sleep.
If imagining a whiteboard doesn’t work for you in the middle of the night, there are other counting variations that would work as well:
Starting from 100, simply count backwards by threes (no imaginary writing required). If 100 seems too optimistically small a number from which to start, use 300 or even 1000. If counting down by threes seems too complex, try twos. Go slow.
Really good at addition? Try calculating the Fibonacci Sequence, a series of numbers where the next number is the sum of the two preceeding it. Start from zero, add one and then keep going: 0, 1, 1, 2, 3, 5, 8, 13, 21, 34… unfortunately, this can get out of control quickly (I usually lose track somewhere in the three-digit numbers). But intrepid math fans might be able to get far enough to refocus themselves to the present and enter a calmer state.
Does the idea of math cause you stress? Then just count your breaths, start from 100 and going backwards, slowing down the breathing as you go, imagining the numbers count down with each inhale. This works particularly well if you focus on releasing all your muscles with each exhale.
A specific strategy may not work every time, but the overall idea is the same: something that requires a little brain focus with minimal excitation or strain (so that you can lazily shift your focus and keep your mind gently occupied). Do not rush through these; the magic lies in the process. There is nothing to achieve here. You’re simply boring yourself to sleep.
Try any of these the next time you find yourself awake with a racing mind and let me know how it goes.
IMPORTANT: Please discuss the information below with your oncological and nutritional team prior to making changes to your diet!They will be able to provide you with the proper guidelines for your situation.
One common area of contention within the context of hormone-positive breast cancer is the effect of soy consumption on cancer risk. There has been some back-and-forth on this topic, and “to soy or not to soy?” is a frequently-heard question coming from newly-diagnosed cancer patients.
It was a concern for me. I became vegetarian at age 18 and consumed a soy-heavy diet until my mid-40s, at which point, partly spooked by warnings about soy, I backed off. As recent research shows, I needn’t have.
For a little background, the main concern for breast cancer patients is the presence of phytoestrogens in soy, known as isoflavones, and how they function in the human body. They have a mild estrogenic effect, which is why many women use them in supplement form to ameliorate the uncomfortable effects of menopause. In that sense, they are acting like estrogen, although it’s important to stress that they are not estrogen.
Soy (here, both tofu and edamame) is a staple in Asian and vegetarian cuisines, and is the only plant-based protein that is a complete protein.
But given this similarity to estrogen, does soy increase the risk of breast cancer and breast cancer recurrence? In short, studies show that if you grew up eating soy and eat it daily, as is the case in many Asian countries where soy products are dietary staples, soy has a significant protective effective against breast cancer. Results of these studies have been inconclusive in Western populations, however this seems to be due to differences in diet: not only do Westerners eat considerably less soy compared to Asians, they also don’t eat it throughout all stages of their lives.
Is there a difference in how these diverse cultures handle isoflavones? It appears that a major isoflavone-derived metabolite, equol, has well-documented antioxidant and estrogen-like actions and seems to be associated with numerous positive outcomes, but only about 30-50% of the human population has the gut microbiota to derive it from the diet. There is a need for more research on how this conversion takes place and under what conditions.
But most importantly, as stated by the American Institute for Cancer Research, “Population studies don’t link soy consumption with an increased risk of any cancer.” While the childhood and adolescent consumption of soy is what seems to offer the most long-term benefits, for those who increased their intake at a later age or don’t eat it regularly, the current view is that even if eating soy doesn’t significantly reduce your risk of cancer, there is no definitive evidence that it will make your risk worse.
For me, that means that I will continue using soy as an important protein source in my diet.
Take note:
As with other foods, unprocessed and minimally-processed soy is still the healthiest option.
Overdoing anything is not good, so don’t overload on overly processed soy supplements in the hopes of preventing cancer development and/or recurrence — particularly if you’re postmenopausal and not a life-long soy eater. Having said that, there is ample room for minimally-processed soy foods (tofu, edamame, tempeh, miso) in a healthy plant-based diet, and that will definitely benefit you.
No single thing will prevent cancer 100%, so you’d be well-served to consider your lifestyle as a whole. As a matter of fact, Zhang et al. (2017, Cancer) noted that “[w]omen who consumed high levels of dietary isoflavone were more likely to be Asian Americans, young, premenopausal, physically active, more educated, not overweight or obese, never smokers, and drank either no alcohol or <7 drinks per week.” [Emphasis mine.] That means protection came not only from soy; the women were also engaging in other behaviors associated with a lower risk of breast cancer. Bottom line, lifestyle matters!
Finally, this is only a brief summary of what I found. Soy is a topic that I’ll be keeping my eye on and will report back as newer studies are published.
In the meantime, here are three excellent reader-friendly websites for more information:
References for this post (all articles are available online free of charge):
Baglia ML, Zheng W, Li H, Yang G, Gao J, Gao Y-T, Shu X-O (2016) The association of soy food consumption with the risk of subtype of breast cancers defined by hormone receptor and HER2 status. Int J Cancer. 139: 742–748. https://doi.org/10.1002/ijc.30117
Lee SA, Shu XO, Li H, Yang G, Cai H, Wen W, Ji BT, Gao J, Gao YT, Zheng W (2009) Adolescent and adult soy food intake and breast cancer risk: results from the Shanghai Women’s Health Study. Am J Clin Nutr. 89: 1920-1926. https://doi.org/10.3945/ajcn.2008.27361
Mayo B, Vázquez L, Flórez AB (2019) Equol: A bacterial metabolite from the daidzein isoflavone and its presumed beneficial health effects. Nutrients. 11: 2231. https://doi.org/10.3390/nu11092231
Messina M, Rogero MM, Fisberg M, Waitzberg D (2017) Health impact of childhood and adolescent soy consumption. Nutr Rev. 75: 500–515. https://doi.org/10.1093/nutrit/nux016
Nagata C (2010) Factors to consider in the association between soy isoflavone intake and breast cancer risk. J Epidemiol. 20: 83-89. https://doi.org/10.2188/jea.je20090181
WuAH, Yu MC, Tseng C-C, Pike MC (2008) Epidemiology of soy exposures and breast cancer risk. Br J Cancer. 98: 9-14. https://doi.org/10.1038/sj.bjc.6604145
Zhang FF, Haslam DE, Terry MB, Knight JA, Andrulis IL, Daly MB, Buys SS, John EM (2017) Dietary isoflavone intake and all‐cause mortality in breast cancer survivors: The Breast Cancer Family Registry. Cancer. 123: 2070-2079. https://doi.org/10.1002/cncr.30615
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When I asked my oncologist about soy, he shrugged and said, “Yes, it’s true that soy foods contain plant estrogens…but you’re not a plant.”
Frantic Shanti 