Yoga and Nutrition

New research on obesity and breast cancer

A study presented this week at the 2014 American Society of Clinical Oncology (ASCO) Annual Meeting suggests that in younger women with early stage estrogen-receptor positive (ER+) breast cancer, obesity is associated with poorer outcomes. The research comes from a review of 70 clinical drug trials enrolling 80,000 women. It further supports an increasing body of data suggesting worse overall outcomes related to breast cancer for women who are overweight or obese compared with women who stay at a healthy weight.

About two-thirds of all breast cancers are hormone receptor positive, meaning estrogen and/or progesterone fuel their growth. Fat cells help make and store hormones including estrogen. Therefore, carrying excess fat tissue may increase breast cancer risk by increasing the body’s exposure to circulating estrogen. Previous research has shown overweight and obesity increase risk for breast cancer development in post-menopausal women, as does weight gain in adulthood. In fact, women who gained 60 pounds after the age of 18 had twice the risk of post-menopausal breast cancer versus women who maintained their same weight. To date, however, negative effects of overweight and obesity with regard to breast cancer were demonstrated only in older women, not pre-menopausal women with ovarian function.

Preventing excess weight gain in the first place is the best way to reduce risk for certain cancers and many other illnesses. It isn’t clear yet whether weight loss in adulthood reduces risk of cancer diagnosis or mortality. However, we do know that even a modest sustained weight loss (5%-10%) in people who are overweight or obese decreases risks for heart disease and diabetes. Given the potential relationships between these types of systemic and metabolic diseases and cancer growth, it is certainly possible that weight reduction could have even more benefits than those we already know.

Many risk factors for breast cancer, such as family history, are not modifiable. The good news is, avoiding excess weight gain – both for women at risk for breast cancer and those already diagnosed with breast cancer – is largely controllable. The following points are helpful in weight reduction and management over time:

  • Choose a mostly plant-based diet with a variety of whole foods.
  • Limit processed foods and fast foods.
  • Decrease added and refined sugars.
  • Monitor portion sizes.
  • Eat mindfully and pay attention to physical hunger and satiety cues.
  • Eat meals more slowly.
  • Keep a written food diary.
  • Engage the support of friends and family.
  • Exercise for at least 30 minutes most days of the week.
  • Get enough sleep.

Concerns Over Cans and BPA

BPA, or bisphenol A, is an industrial chemical used in polycarbonate plastics and epoxy resins that has come under scrutiny for potential harmful health effects. Developed as a synthetic estrogen in the 1890's and granted "GRAS" (generally recognized as safe) status by the FDA in 1963, it is widely present in both food packaging, such as aluminum can linings, and nonfood materials, such as medical devices, paper receipts, and printer toner. Six million tons are produced yearly. Concern about BPA lies in its possible action as an endocrine disruptor. This is a category of chemicals that can alter normal hormone-dependent physiology. Small amounts of BPA leach from containers into the foods and beverages that they hold, especially when those contents are acidic, high in fat, or heated (like canned tomatoes, Chef Boyardee, and warmed baby formula, respectively).

It's hard to avoid BPA. In fact, the CDC has documented its presence in the urine in 93% of Americans older than 6 years of age. [1] Less clear are the actual health effects of BPA exposure. Up until recently, research consisted mostly of lab animal and in vitro studies. In the past year, however, the number of epidemiologic studies exploring the effects of BPA exposure in humans has doubled. A recent review of this literature supports associations between BPA exposure with decreased fertility, altered male sexual function, childhood neurobehavioral problems and asthma, cardiovascular disease, and type 2 diabetes. [2]  

Significant questions remain. Does adult BPA exposure matter, or is childhood and fetal exposure what's critical? Since BPA has a short 6-hour half-life in humans, how can we determine longer term exposure? Without the type of controlled studies that would be obviously unethical, particularly during pregnancy and over large swaths of time, is it possible to assess causation versus correlation? How do we quantify and define "low dose" exposure?  [3] Some researchers say the "low doses" associated with toxicities are still much greater than humans are exposed to in practical terms, whereas others believe "low doses" may be more harmful than higher amounts and that dose-response isn't demonstrable. [4]

As consumer awareness and demand grow, BPA-free food packaging is increasing. Alternative can linings, such as polyester coatings, have been developed, but their safety is not certain, either. One promising technology is oleoresins, which are made from natural plant sources, but they can be used only with non-acidic foods. 

Some brands have eliminated BPA from all or some of their cans. Amy's Kitchen has eliminated BPA in all cans. Eden Foods canned beans are BPA-free. Whole Foods states that 27% of their canned goods are BPA-free, but don't specify which. They do report that they will no longer accept new canned products that contain BPA.

Glass jars and Tetra-paks (boxes) are a viable option, particularly for acidic foods. Eden Foods offers crushed tomatoes in glass jars, Bionaturae makes tomato paste in glass jars, and Pomi makes chopped tomatoes in Tetra-paks. Many brands of tomato sauces are available in jars, and Hunts now sells tomato sauce boxes.

Broths and soups are widely available in Tetrapaks. Pacific Natural and Imagine Foods make many options from potato quinoa spinach soup to chicken stock to vegetarian pho base.

If you do use canned foods, rinsing the food well with running water may decrease ingestion of BPA.

Of course, the surest way to minimize dietary BPA intake would be to avoid all packaged foods. More realistically, work toward limiting canned goods and choosing more fresh, frozen, or dried foods. If you have more fresh vegetables than you know what to do with (including broccoli, green beans, cauliflower, zucchini), steam them lightly and then freeze them in glass jars. Dried beans can be prepared in large batches and frozen for future use. Look for pre-cooked frozen beans such as lentils, garbanzos, and soy beans. Frozen vegetables and fruits are wonderful alternatives to fresh, are just as nutrient-rich, and contain less sodium and added sugar than canned. As for canned soda… well, do you really need another reason to avoid it? 

Cans aside, lessen BPA exposure by using glass or ceramic instead of plastic in the microwave, keeping plastic water bottles away from extremes of temperature (eg, the dishwasher) and direct prolonged sunlight, and replacing plastic containers that become cracked or chipped. 

As always, consider the big picture. If your workday lunch options are a quick greens salad with canned artichokes and beans—or fried chicken and Doritos—the choice should still be obvious. Minimize BPA cans where you can, but use your own judgment in making sound, healthy choices. 


1. Calafat A, Ye X, Wong L, Reidy J, Needham L. Exposure of the US population to bisphenol A and 4-tertiary-octylphenol: 2003-2004. Environ Health Perspect 2008;116:39-44.

2. Rochester JR. Bisphenol A and human health: A review of the literature. Reprod Toxicol 2013;42:132-55.

3. Teeguarden J, Hanson-Drury S. A systematic review of Bisphenol A “low dose” studies in the context of human exposure: A case for establishing standards for reporting “low dose” effects of chemicals. Food Chem Toxicol 2013;62:935-48.

4. The National Workgroup for Safe Markets. No silver lining: an investigation into bisphenol A in canned foods, 2010.


Vegan chocolate cheesecake with coconut cream glaze

This non-dairy chocolate cheesecake has a thick, creamy, pudding-like texture, and isn't cloyingly sweet. Though unlike a traditional cheesecake in many ways, it's baked similarly: at medium-low heat for an hour, then left in the oven with heat off for another hour. Admittedly, it takes some time to prepare, but the actual steps are very simple and the clean-up is easy -- important when you have a barely-there kitchen. For my celiac friends: use gluten-free cookies or cereal for the crust, and this recipe will fit your bill.



For the crust:
2 cups crushed graham crackers, other cookies, or cereal (I used a combination of Ezekiel Almond Sprouted Whole Grain cereal and Barbara's oatmeal Snackimals cookies)
3 Tbs + 1 Tbs butter replacement spread, such as Earth Balance, melted

For the filling:
1 pound silken tofu, drained
1 pound tofu cream cheese (I used Daiya brand)
1 1/4 cups vegan chocolate chips, melted and cooled
1 1/4 cups sugar
3/4 cup cocoa powder
2 Tbs agave
1 Tbs vanilla
1 Tbs corn starch
1/4 tsp salt

For the coconut cream glaze:
1 can coconut cream
2 tsp vanilla
2 Tbs confectioners sugar


1) Preheat oven to 350 degrees F.
2) Grease 9" round springform cake pan with 1 Tbs butter spread. Combine crushed cookies and/or cereal with 3 Tbs melted butter spread. Press mixture into the base of pan and set aside.
3) Mix tofu and cream cheese in food processor until smooth.
4) Add remainder of filling ingredients and process until smooth.
5) Pour filling into cake pan over crust. Tap pan firmly against countertop to remove air bubbles.
6) Bake for 60 minutes. Turn off heat, and keep cake in oven for another 60 minutes. The cake will be wobbly inside and shiny outside. Remove and cool at room temperature, then cover loosely and refrigerate overnight (or for at least 10 hours) to set. At the same time, place can of coconut cream in refrigerator.
7) When ready to serve cake, make coconut cream glaze: Scoop solid part of coconut cream and a small amount of remaining liquid out of can. Using a hand mixer or stand mixer, whip coconut with powdered sugar and vanilla for 3-4 minutes or until smooth and thick. Drizzle coconut cream glaze over cake slices immediately before serving.

Cake and extra coconut cream glaze may be stored in the refrigerator for 4 days. 



Nutrition during cancer treatment

A broad subject up there, yes. So many angles to consider. Here's a brief piece I wrote for Coping With Cancer magazine that looks at eating well during cancer treatment, including managing side effects, staying hydrated, and preventing undesired body weight changes. As always, I'd love to hear your thoughts, too.


Check out Meals to Heal

Meals to Heal is an innovative company in NYC that offers home delivery of fresh, customized meals for people living with cancer. They recently interviewed me about the benefits of oncology nutrition education and counseling (here). If you think you or someone you know could benefit from their services, check them out at or follow them on Twitter @meals2heal. Happy and healthy eating to all!