Letrozole (Femara) and anastrozole (Arimidex) are aromatase inhibitors used to treat some types of hormone receptor-positive breast cancer. They both work by lowering estrogen levels in the body. Letrozole and anastrozole tablets can be taken with or without food.

If you’ve wondered what foods to avoid when taking anastrozole or letrozole, the answer usually isn’t a strict list of foods. Still, some foods and drinks may affect side effects, other treatments you’re taking, or your overall breast cancer care. Here are three foods and drinks to discuss with your cancer care team.

1. Grapefruit With Some Combination Treatments

Grapefruit isn’t known to interact directly with letrozole or anastrozole, but it can interact with some other breast cancer drugs used alongside them. For example, grapefruit products should be avoided with some CDK4/6 inhibitors because they can raise medication levels in your blood and increase the risk of side effects.

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If you take another cancer medication along with letrozole or anastrozole, check whether it interacts with grapefruit. Your pharmacist or oncology care team can tell you whether grapefruit or grapefruit juice is safe with your treatment plan.

3. Alcoholic Beverages During Treatment

There isn’t one alcohol rule that applies to everyone taking letrozole or anastrozole. The National Cancer Institute advises people receiving cancer treatment to ask their healthcare team whether drinking alcohol is safe with their specific treatment.

You may want to avoid or limit alcohol if it seems to worsen your side effects. Letrozole and anastrozole can cause side effects such as hot flashes, dizziness, fatigue, and sleep problems.

Alcohol is also linked to a higher risk of several cancers, including breast cancer. If you drink, ask your cancer care team what amount, if any, is safe for you based on your treatment plan and health history.

Additional Factors To Keep in Mind

Talk openly with your healthcare provider about your diet, supplements, and any foods or drinks you’re thinking about avoiding. Nutrition needs during cancer treatment can vary, and a registered dietitian can help you manage eating problems and get enough protein and calories.

You May Need To Switch Medications

If you’re experiencing unpleasant side effects, your doctor may be able to switch you to another treatment.

“I was miserable on letrozole with pain and insomnia. My oncologist switched it to anastrozole, and I’m much better. They are very similar meds, but he says one of the meds might be easier for some people,” a MyBCTeam member said.

Your Body Might Need Time To Adjust

Other MyBCTeam members found that their bodies needed time to adjust.

“I found that letrozole side effects evolve over time,” another member wrote. “I’ve been on it for 2.5 years, and at the four- to six-month mark, I think my body finally adjusted, and the side effects didn’t bother me so much. I do exercise and stretch daily, which helps.”

Regular exercise can help reduce bone loss and lower the risk of fractures in people with osteoporosis. Ask your cancer care team what types of movement are safe for you.

A Healthy, Balanced Diet Is Key

No matter where you are in your breast cancer journey, try to follow a healthy eating pattern when you can. If you don’t have nutrition-related problems, the American Cancer Society recommends a healthy eating pattern for cancer survivors.

This eating pattern includes vegetables, fruits, whole grains, and healthy sources of protein. You can also ask your care team whether any advice about foods to avoid with estrogen receptor-positive breast cancer applies to you.

Drink enough fluids to stay hydrated, especially if treatment side effects make it hard to eat or drink normally. If you’re unsure how much fluid you need, ask your healthcare team for guidance.

Don’t assume that drinking extra water changes how your body processes letrozole or anastrozole. The letrozole label describes how the body breaks down the medication and removes it through urine. The anastrozole label also describes how the body breaks down and removes the medication.

If you’re having trouble planning healthy meals, a registered dietitian nutritionist can help. Ask your doctor for a referral, or call your health insurance company to find providers in your network.