Does Letrozole Cause Weight Gain?

Weight gain is one of the many potential side effects of Letrozole, an Aromatase Inhibitor. In fact, “Will Letrozole make me gain weight?” is one of the most common questions asked in SBC’s weekly support groups. Not every person taking Letrozole gains weight; everyone's body responds differently to endocrine therapies. However, in today’s post, we are going to look at the most common factors associated with weight changes and provide some recommendations for combating the unwanted cushioning some develop as a result of this estrogen depletion.

Join our mailing list and never miss out on great content!

Why Do Some People Gain Weight from Breast Cancer Treatment?

A large percentage of people report weight gain after a breast cancer diagnosis and treatment [1]. Explanations for the weight change can be attributed to lifestyle changes that normally come with a breast cancer diagnosis. For example, you may feel more fatigued and therefore reduce your level of physical activity. If you are on steroids, you may notice the feeling of being hungry more often. Increasing calories can also be associated with coping as you deal with the stresses of a breast cancer diagnosis [2].

Chemotherapy and Weight Gain

Weight changes can also occur in younger women who are premenopausal during chemotherapy. The Women’s Healthy Eating and Living (WHEL) study [3] indicates that 65% of people treated with chemotherapy were more likely to put on a few extra pounds [3]. On average, women report gaining 2-5kg (approximately 4-11 lbs). However, that is not the time to worry about weight gain or to start a new diet plan. Remember, you are going through cancer treatment, and it is a time to be kind to yourself!

How Does Endocrine Therapy Lead to Weight Gain?

Chances are, if your cancer is hormone receptor positive, meaning that the cells have either estrogen or progesterone receptors, you will most likely be advised to take endocrine therapy as part of your longer-term treatment plan. Endocrine therapy, also known as hormonal therapy, reduces estrogen levels or blocks the estrogen receptor. In some cases, your oncologist will advise you to take Tamoxifen, or one of the Aromatase Inhibitors (Anastrozole, Exemestane, Letrozole).

The goal of hormonal therapy is to reduce the chances of the breast cancer returning or progressing. However, looking into the quality of life and survivorship/thrivership, you should also be cognizant of the impact estrogen depletion has on overall health. These aromatase inhibitors can cause osteoporosis, increase cardiovascular events, and lead to diabetes [4].

It's easy to associate weight gain with being less active, one’s metabolism slowing down with age, or making poor dietary choices. Regardless, there seems to be a consensus that those diagnosed with breast cancer who utilize endocrine therapies tend to gain weight, even when they are exercising and making conscious, healthy nutritional choices.

How Does Letrozole Affect Lipid Metabolism?

One factor that is seldom discussed (and more research is certainly warranted) is the role that Letrozole has on lipid metabolism. While some trials and research have investigated the impact aromatase inhibitors have on the lipid profile, conclusive results have been elusive [5]. What we do understand is that aromatase inhibitors can have an adverse effect on blood levels. For example, increasing total cholesterol, meaning LDL levels (the “bad” cholesterol) and HDL (the “good” cholesterol), can lead to increased risk of cardiovascular disease [6].

Additionally, the enzyme lipoprotein lipase (LPL), which is controlled by insulin, pulls fat out of the bloodstream and into the cell. If this enzyme is in a muscle cell, it will turn the fat into energy. When the enzyme is sitting in a fat cell, it will pull fat into the cell and make it fatter [7]. Estrogen suppresses LDL, and with lower levels of estrogen in the body, this could be a reason some women gain weight during menopause or as part of breast cancer treatment.

How to Combat Weight Gain During Breast Cancer Treatment

As noted, several factors affect weight gain while undergoing chemotherapy or hormonal therapies. Some of these biological side effects are out of one’s control. However, there are actions you can take to maintain a healthy weight, including diet and activity level. Below are some of our favorite recommendations:

• Choose foods that are unprocessed and nutrient-dense

• Eat a diet low in added sugar

• Limit (or avoid) alcohol

• Increase fruits, vegetables, and whole grains

• Find an enjoyable activity that enables you to move your body daily (walking, light weights, swimming, etc.)

This list is not comprehensive and you can feel free to choose. It is important to start with realistic and achievable goals. We are in this for the long haul!

Dietary Recommendations for Fighting Cancer Treatment-related Weight Gain

Fruits and vegetables are known to contain phytochemicals packed with antioxidants and nutrients, meaning they are rich in vitamins and minerals relative to their caloric content. Consider some of the following options:

• Whole grains: unprocessed foods that are high in complex carbohydrates, fiber, and nutrients, such as wheat, rye, oats, rice, bulgur, and barley.

• Green leafy vegetables: include spinach, Swiss chard, beet greens, lettuce, and romaine.

• Cruciferous vegetables: include broccoli, turnips, brussels sprouts, cauliflower, bok choy, kale, and mustard greens.

• Umbelliferous vegetables: include celery, parsley, fennel, carrots, and parsnips.

• Solanaceous vegetables: nightshades like eggplant and tomatoes.

• Cucurbitaceous vegetables: gourd family, including squash, pumpkin, cucumbers, and watermelon.

Understanding how your body responds to cancer treatment is complex. You have been through a lot! What worked for your body pre-cancer may no longer be suitable during treatment. If you are struggling with weight gain because of breast cancer treatment or hormonal therapies, speak to your oncologist about your concerns. Ask for a referral to a nutritionist. Get confirmation on what an ideal exercise plan should look like for you!

Cancer takes a toll on everyone, but continue to love yourself and your body; nurture it with compassion, movement, and wholesome food, and it will love you back in spades.

---

References

[1] Raghavendra, A., Sinha, A. K., Valle-Goffin, J., Shen, Y., Tripathy, D., & Barcenas, C. H. (2018). Determinants of Weight Gain During Adjuvant Endocrine Therapy and Association of Such Weight Gain With Recurrence in Long-term Breast Cancer Survivors. Clinical breast cancer, 18(1), e7–e13. https://doi.org/10.1016/j.clbc.2017.11.006 [2] Gu, K., Chen, X., Zheng, Y., Chen, Z., Zheng, W., Lu, W., & Shu, X. O. (2010). Weight change patterns among breast cancer survivors: results from the Shanghai breast cancer survival study. Cancer causes & control : CCC, 21(4), 621–629. https://doi.org/10.1007/s10552-009-9491-z [3] Lauby-Secretan, B., Scoccianti, C., Loomis, D., Grosse, Y., Bianchini, F., Straif, K., & International Agency for Research on Cancer Handbook Working Group (2016). Body Fatness and Cancer--Viewpoint of the IARC Working Group. The New England journal of medicine, 375(8), 794–798. https://doi.org/10.1056/NEJMsr1606602 [4] Buch, K., Gunmalm, V., Andersson, M., Schwarz, P., & Brøns, C. (2019). Effect of chemotherapy and aromatase inhibitors in the adjuvant treatment of breast cancer on glucose and insulin metabolism-A systematic review. Cancer medicine, 8(1), 238–245. https://doi.org/10.1002/cam4.1911 [5] Boutas, I., Pergialiotis, V., Salakos, N., Agrogiannis, G., Konstantopoulos, P., Korou, L. M., Kalampokas, T., Gregoriou, O., Creatsas, G., & Perrea, D. (2015). The impact of Anastrazole and Letrozole on the metabolic profile in an experimental animal model. Scientific reports, 5, 17493. https://doi.org/10.1038/srep17493 [6] Zidan, J., Chetver, L., Hussein, O., & Zucker, M. (2010). Effect of letrozole on plasma lipids, triglycerides, and estradiol in postmenopausal women with metastatic breast cancer. The oncologist, 15(11), 1159–1163. https://doi.org/10.1634/theoncologist.2009-0222