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Supplement Savvy for Cancer: Breast Health

By Jill Place, MA, RD

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More women get Breast Cancer than almost any other type of cancer. Risk factors for Breast Cancer might include:

Family history Early onset of menstruation
History of benign breast conditions High-fat, high-sugar, low fruit-and-vegetable diet
Weight gain near menopause, obesity, and excess body fat Lack of exercise
Insulin resistance Exposure to environmental estrogens like hormones in food
History of oral contraceptive and HRT use Smoking
Radiation exposure  

It seems that the more women are exposed to the female hormone estrogen the more they might be at risk for breast cancer. Estrogen levels can increase in breast tissue as you get older. In one study, estrogen levels were 10 to 50 times higher in the breast tissue than in the blood of postmenopausal women. If you're overweight or over fat you may also be insulin resistant, which means that your body doesn't use the hormone, insulin, well. Insulin resistance makes it difficult for you to lose weight. Insulin resistance also makes your body fatter. If you have extra body fat, you may also make more of an enzyme called aromatase. Aromatase increases the level of circulating estrogen in your body. As a matter of fact, many of the medications like tamoxifen that reduce further risk of Breast Cancer are aromatase inhibitors.

The way estrogen is metabolized in your body may also be a factor in whether you get Breast Cancer. There are three pathways by which estrogen can be metabolized in your body. They have long, complicated names, so let's just call them the 2-OH, 4-OH, and the 16-OH pathways. 2-OH is called the "good estrogen" because if your estrogen is metabolized down that road it seems to prevent cancer. 4-OH and 16-OH seem to be cancer-causing pathways. In one study, women who developed Breast Cancer had lots of 16-OH and very little 2-OH.

Fortunately, there are lifestyle changes and certain nutrients found in food and supplements that may help decrease circulating levels of estrogen and help metabolize this estrogen down the "good estrogen" pathway. These lifestyle changes and nutrients may decrease the risk of further breast cancer by 33 to 50 percent.

First, let's look at some lifestyle changes that may help prevent Breast Cancer.

LIFESTYLE CHANGES

Breast Cancer occurs 6 to 10 times more often in the United States than in Asia and Africa. Our Western lifestyle may possibly be the culprit. Since the low-fat food craze is now on the wane, we're back to eating about 40% of our calories from fat. We eat about 20 pounds of white sugar a year. We eat less than two servings of fruits and vegetables a day. We eat about 11 grams of fiber a day. And about 25% of us or less are exercising on a consistent basis. Let's face it, we're just not a tofu-eating, broccoli-loving, green tea-drinking, salmon-eating, salad-loving, 10 K-running culture.

In order to decrease your risk of Breast Cancer, it might be a good idea if you:

Eat a very low-fat diet with about 15 to 20% of your calories from fat.

Increase fiber-containing foods like whole grains, beans, fruits, and vegetables to 20 to 35 grams a day.

Eat nine-plus servings of fruits and vegetables a day.

Eat more cruciferous and carotenoid vegetables and fruits like carrots and broccoli.

Cut commercially raised red meat and poultry out of your diet. These cows and chickens are treated with hormones to plump them up. If you're still eating meat, buy organic beef and poultry at the Health Food Store.

Consider a higher-protein diet and possible nutritional supplement support if you're insulin resistant.

Exercise regularly.

Here are some nutritional supplements that may also help:

INDOLE-3-CARBINOL

The breast-healing properties of Indole-3-carbinol (I3C) were recognized as far back as Roman times. I3C is mostly found in cruciferous vegetables such as cabbage, broccoli, Brussels sprouts, cauliflower, and kale. I3C has been shown to increase 2-OH, the "good estrogen". I3C may also stop the oxidation of fats. In this way, I3C acts as an antioxidant. I3C also regulates liver detoxification enzymes. Because of this, I3C can regulate the metabolism of cancer-causing substances. I3C seems to be protective against breast, prostate, colon, liver, lung, tongue, and endometrial cancers.

What to Watch Out For . . .

Since there's no long-term safety data on this supplement, pregnant women and nursing mothers should avoid I3C. If you have cancer, you should also talk to your doctor before using I3C. Because the actions of I3C need stomach acid to work, antacids, B2 blockers, and proton pump inhibitors may inactivate I3C. Some sources say that I3C may work with tamoxifen to protect against further breast cancer. But I3C may also compete with tamoxifen and make it less effective. There's no research to prove this, however. But it might be wise to steer clear of I3C during tamoxifen treatment.

METHYLATION NUTRIENTS

Methylation is a process by which chemical methyl groups are connected to your DNA. Methylation is important because it is a process that repairs and stabilizes DNA. Methylation is also important because cancer cells seem to have a lower level of methylation than normal cells. Methlyation also helps make more of the 2-OH "good estrogen" and makes "bad estrogens" like 16-OH less active. Nutrients such as Vitamin B6, Folate, Vitamin B12, Zinc, a form of Betaine called Trimethylglycine Anhydrous, Choline, and Intrinsic Factor, a substance that helps your body use Vitamin B12, may help in the methylation process.

What to Watch Out For . . .

B6 shouldn't be taken by pregnant women and nursing mothers in doses greater than 20 mg. If you're taking levodopa without carbidopa or amiodarone, you shouldn't take more than 5 mg. Neuropathy, nausea, vomiting, and abdominal pain may occur with high doses. Drugs like carbamazepine, cycloserine, ethionamide, hydralazine, isoniazid, oral contraceptives, penicillamine, and valproic acid decrease B6 levels and may lead to deficiency. B6 may affect the absorption of phenytoin, phenelzine, phenobarbital, and theophylline.

Folate shouldn't be taken in high doses if you have anemia. Drugs such as anticonvulsants, cholestyramine, colestipol, colchicine, NSAIDS, phenytoin, and sulfasalazine may reduce absorption. Folate may enhance the actions of fluoxetine, lithium, lometrexol and Vitamins B6 and B12. Folate can counteract high homocysteine levels sometimes seen with metformin. Folate can also reduce the side effects of methotrexate.

B12 shouldn't be used by pregnant women and nursing mothers in doses greater than 12 mcg, and those with anemia because of a Folate deficiency shouldn't use more than 10 mcg. Drug such as cholestyramine, colchicine, colestipol, metformin, nitrous oxide, para-aminosalicylic acid, and proton pump inhibitors like omeprazole decrease B12 absorption. Calcium, Folate, and Vitamin B6 enhance absorption. Hydroxycobalamin should be used instead of cyanocobalamin for those whose have Leber's optic atrophy.

Zinc in higher doses may cause digestive disturbances and may suppress your immune system. Drugs such as bisphosphonates, quinolones, penicillamine, and tetracycline may decrease absorption. Many supplements decrease absorption, such as Calcium, Copper, Inositol, Iron, and Phosphates and food components such as caffeine, oxalates, phytates, and tea. Cysteine, Histidine, and N-acetylcysteine may enhance absorption.

Choline and Betaine are generally well tolerated.

GREEN TEA EXTRACTS

Green tea has been a popular beverage in China and Japan for centuries. And green tea may be one of the reasons why these countries have the least amount of certain cancers, such as breast and prostate cancers, in the world. The most active ingredient in green tea appears to be Epigallocatechin-3-gallate (EGCG), which might have an anti-cancer effect against breast, prostate, ovarian, colon, pancreatic skin, lung, and liver cancer, and others. In China, esophageal cancer risk was reduced 60% with the consumption of two to three cups of green tea a day.

EGCG has been shown to be a more potent antioxidant than Vitamin C. EGCG also kills tumor cells without killing normal cells. Green tea helps the liver to get rid of cancer-causing substances more rapidly. Green tea also enhances the actions of cancer drugs such as doxorubicin and may increase concentrations in cancer cells and not in normal cells. It would be great if you drank a lot of green tea. And don't worry about the caffeine! The caffeine in green tea doesn't act like a stimulant like the caffeine in coffee. The caffeine in green tea might also have a favorable effect upon breast health. If you don't drink green tea, a supplement appears to be a good bet.

What to Watch Out for . . .

There's no long-term safety data on this supplement, so pregnant and nursing women might best avoid it. Green tea may also decrease blood clotting, so it's not a good idea for hemophiliacs and those taking wayfarin or aspirin. It's also not a good idea to take green tea before and after surgery.

SOY AND THE SOY CONTROVERSY

At first glance, soy appears to be a great idea for those with Breast Cancer. Soy isoflavones, especially genistein, appear to have antioxidant activity. They also have been associated with the reduced risk of breast, lung, and prostate cancers and leukemia. Soy is widely used in countries like Japan and China that have the lowest incidence of Breast Cancer in the world.

Genistein is the most studied of the isoflavones and appears to prevent cancer. Genistein may help kill cancer cells and stop the growth of blood vessels that feed tumors. Genistein may also inhibit aromatase activity and may lower circulating estrogen levels. Many human studies have shown that soy also reduces hot flashes and other annoying menopausal symptoms. Many women also take soy to decrease symptoms of hormonal medications such as tamoxifen.

But there's a big controversy to soy or not to soy for those with estrogen receptor-positive Breast Cancer. If you're taking tamoxifen of any other hormonal treatments you're estrogen receptor-positive. These medications can't work if you're not. Estrogen receptors are proteins that bind to estrogen and allow it to be used in your body. If you have a lot of estrogen receptors you may have a lot of circulating estrogen too. Soy has weak estrogen activity. It also binds to estrogen receptors. Your body may not be able to tell soy from estrogen. In this way, soy may trick your body into increasing circulating estrogen levels. For this reason, soy isn't recommended for those with positive estrogen receptors.

So you might want to exercise caution with soy foods if you have estrogen receptor-positive Breast Cancer. One to three servings of whole soy foods like tofu, tempeh, edamame (fresh soybeans), soy milk, and miso is probably okay. But you especially might want to steer clear of soy supplements and soy protein powders that have concentrated amounts of soy isoflavones until further research says it's okay to use them.

CHASTEBERRY OR CHASTE TREE

Chasteberry is an herb whose use was first recorded by Hippocrates in the 4th century BC. Chasteberry.
may inhibit the secretion of prolactin , which stimulates the growth of mammary glands. There's some research that excess prolactin may be a risk factor for Breast Cancer. Chasteberry's influence on prolactin and two other female hormones, luteinizing hormone and follicle-stimulating hormone, may also help reduce
the menopause-like symptoms of hormonal drugs like tamoxifen.

What To Watch Out For . . .

Pregnant and nursing women shouldn't use Chasteberry. There are few drug interactions, but dopamine receptor antagonists can diminish its effectiveness. Rashes are a rare side effect. Because Chasteberry has an effect upon progesterone synthesis, it may not be appropriate for women who have strongly progesterone receptor-positive breast cancer.

BLACK COHOSH

Black Cohosh has been used since early Native American times. It may help PMS and menopausal symptoms. Black Cohosh is the active ingredient in Remifemin®, one of the most famous herbal preparations sold today.

There's been some confusion, however, about the way Black Cohosh works. Some scientists consider it a phytoestrogen. Others say it doesn't work like estrogen. There's some evidence that Black Cohosh may act like estrogen in some tissues but not in others. With all this confusion, Black Cohosh may not be a good choice to decrease menopausal symptoms from hormonal drugs like tamoxifen after breast cancer treatment. Especially since studies haven't shown that it reduces symptoms with these drugs.

What to Watch Out For . . .

Since there have been no large-scale studies on this herb, its hard to know how safe it is if you've had Breast Cancer. It's especially not safe for those with estrogen receptor-positive Breast Cancer as it many work like estrogen and increase levels in your body. Also, there's no evidence that Black Cohosh can be used like estrogen to prevent osteoporosis or heart disease. Pregnant women shouldn't take Black Cohosh. Black Cohosh can make drugs for high blood pressure more potent, so avoid its use if you're taking them.

ESTROBALANCE

EstroBalance™ is a medical food drink mix made by Metagenics. Medical foods are powdered high-quality vegetarian combinations of food components, vitamins, minerals, and other nutritive substances that are formulated to provide nutrition support for the whole body while also targeting certain diseases or conditions. EstroBalance provides nutritional support for women's hormone cycles. Originally formulated for premenopausal women with symptoms of hormone imbalance, it may also be ideal for those who have had breast cancer and are on hormonals such as tamoxifen. EstroBalance has nutrients such as non-soy isoflavones and defatted flaxseed meal that may help balance estrogen metabolism.

The ingredients in EstroBalance are geared to reduce circulating estrogen levels by sending estrogen to be metabolized down the "good estrogen" pathway. EstroBalance might also provide the nutrition support to reduce hormonal side effects such as hot flashes, mood swings, and weight gain.

The diet that comes with this product is meant to improve general estrogen metabolism. If you're still menstruating and are experiencing symptoms of hormone imbalance such as PMS, irregular cycles, fibroid breast cysts, or heavy bleeding, you might want to follow the diet more closely. Or you might want to consider the diet as a general healthier alternative and use one or two daily servings of EstroBalance as a snack or meal replacer if you've had Breast Cancer and want to reduce the menopause-like side effects from hormonals.

What to Watch Out For . . .

This product may not be suitable for pregnant or nursing women, children, or those with celiac disease. It hasn't been tested for interactions with birth control pills. EstroBalance contains plant pigments that may stain clothing and surfaces.

© Copyright 2002 Jill Place, MA, RDTo Top of Page

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