Fueling for the long run

I asked my medical oncologist today if this first cycle of chemotherapy could be looked at as a baseline — would it be repeatable over the next five rounds or should I expect something different each time? I was delighted when she said this should be the pattern and my experience should be similar each cycle. With the exception of two days of bone pain, and some general tiredness, I haven’t been bothered by a lot of the usual side effects.

I’m hoping my intentional approach to nutrition is one of the reasons this hasn’t been a challenge. So far, my regular diet has served me well, with an increased focus on additional protein and lower fat.

Like surgery recovery, during chemotherapy your body needs calories — and a significant amount of protein — to combat infection, provide energy throughout the day, and heal between infusion cycles. Because I haven’t dealt with nausea or loss of appetite, I haven’t shifted my eating habits that much. Instead, I’ve been adding denser carbs, higher protein, and nutritious snacks.

A typical meal plan looks something like this:

• Morning: Coffee with a scoop of vanilla whey protein powder
• Breakfast: Greek yogurt with banana, mixed fruit and low carb muesli
• Snack: Celery with hummus
• Lunch: Soup garnished with Greek yogurt and salsa
• Snack: Homemade protein bar
• Dinner: Turkey meatballs, basmati rice, spinach, mushrooms and onions
• Snack: Slice of multigrain bread with peanut butter

I’m normally bad at drinking enough water, but chemotherapy gives me a good reason to focus. It’s dehydrating by default, and you want to flush the drugs from your system as quickly as possible after infusion. You don’t want them sitting in your kidneys with the potential to create damage. I aim for two litres of water per day as a minimum — and my Sodastream is getting a workout because the only way I drink water consistently is if it has some fizz.

All that said, during the first week of my infusion cycle, I lost almost five pounds in as many days. I don’t know yet if that’s part of a pattern, or if I was simply dehydrated. I’ve since rebounded to my stable weight by Day 15, so have fingers crossed it was a temporary effect.

A lot of the literature around nutrition and cancer is focussed on the debate about sugar, managing loss of appetite, and food choices that minimize the effects of nausea. A second priority is hydration, especially if nausea and vomiting are symptoms you’re actively managing during chemotherapy. I get it. But it doesn’t answer my questions around the quality of calories I eat, or the balance of macros that might serve me best during treatment. I want to fuel my body to manage this onslaught as best it can, but there are few guidelines to reference beyond the basics of the Canada Food Guide.

One of the clearest outlines I’ve found is published by Johns Hopkins. It’s a plain language version of why plant-based proteins, healthy fats and carbs are good choices through chemotherapy — “they offer the highest levels of vitamins and minerals.” Standford Medicine offers some equally practical guidelines about what to eat, and how to eat, during active treatment — especially on chemo infusion days.

I’m working on spreading out my food into smaller meals throughout the day versus three main meals with snacks. I struggle especially first thing in the morning since breakfast has never been my favorite meal. It’s the reason I add protein powder to my coffee — it both staves off hunger by creating a sense of fullness, and gives my body some dense protein to work with until my brain is ready to tackle food.

Yes to long runs

The best news from meeting with my medical oncologist is that my weekend long runs are likely to stay in the mix. With the caveat to listen to my body, she said, “I’ll never say ‘No’ to physical activity that makes you feel good.” And she agreed that emerging research supports the benefit of excercise through treatment.

I’m still working on rebuilding my base post-surgery and have started to mix in progression runs to dial down paces from an easy jog. Tonight, that got me to a 13:30 min/mile pace over the last block of my run. Still not fast, but slowly, my legs are starting to remember what it feels like to run for 30 minutes, instead of breaking it up into run/walk intervals.

Everyone says that your experience of chemeotherapy is unique. Like surgery, it’s proving to be nothing like what I expected. I’m pleasantly surprised to find myself able to maintain a 10-15 mile/week base right now.

And I’m looking forward to a long run on the mountain this holiday weekend.