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The Functional Medicine Approach to Breast Cancer Prevention

Breast cancer is a health issue that most women will think or worry about at some point in their lives. One of the reasons is because we hear so much about breast cancer these days: in the media; through fundraising organizations; and from family and friends facing the diagnosis. Another is because it has become much too common. Perhaps you, or someone close to you, are a breast cancer survivor.

October is Breast Cancer Awareness Month, and we want to honor and support all women by highlighting our Functional Medicine approach to the prevention of breast cancer, whether the focus is on primary prevention, or prevention of recurrence. 

Because research shows that how you metabolize estrogen can increase your risk, we focus on supporting estrogen detoxification, a process that happens primarily in the liver.

HOW MUCH ESTROGEN DO YOU HAVE?

Many women believe that after menopause they aren’t making estrogen anymore.

This is not true. 

Before menopause, estrogen is produced in several places in the body, including the ovaries, adrenal glands, and produced from testosterone by the enzyme aromatase in fat cells. After your ovaries have been removed or you have gone through menopause, estrogen is still being produced, in low but measurable amounts, by these other tissues. 

You might wonder: since we all have estrogen, why do some women, and not others, end up with breast cancer? 

Well, it turns out that all estrogens are not the same, and these differences are influenced by genetics and the environment.

When estrogen is processed for elimination, the hormones are sent to the liver where they are metabolized, a process also called detoxification. During the estrogen detox process, you can end up with “bad” estrogens or “good” estrogens. The bad ones are considered “toxic” because they are very strong stimulators of estrogen receptors (causing more cell proliferation), and they can damage DNA, as opposed to the “good” estrogen metabolites that are weaker estrogens and not harmful to cells. Of course, the “good” estrogens are preferable!

Although our genetics influence how easily we make the good and bad estrogens, it turns out (no big surprise!) that food and other lifestyle factors have an enormous effect on the kinds of metabolites the liver will make. Influencing your estrogen detox pathways in a good way is what we focus on for breast cancer prevention at Blum Center for Health.

IMPROVE YOUR RATIO OF GOOD:BAD ESTROGENS

Our first step to help you reduce your cancer risk is to increase your good estrogens, and decrease the bad. 

Top 4 Ways to Reduce Your Breast Cancer Risk 

  • Eat lots of food that supports estrogen elimination and detoxification pathways, including:
    1. Lots of antioxidants and cruciferous vegetables like kale, broccoli and cauliflower
    2. Fiber from fruits and vegetables helps you excrete estrogens via the gut.
    3. Soybean that is organic and non-gmo, and in its whole form, like edamame or tofu. Or, fermented soy like tempeh or miso. Soy has a very gentle and positive effect on estrogen receptors and is actually good for most women.
    4. Ground flax seeds:  can block the conversion of testosterone to estrogen, thus lowering your levels.
  1. Consider taking the supplement Di-indolylmethane, or DIM, or it’s more powerful cousin, Sulforaphane, which are basically the active component extracted from cruciferous vegetables. This can improve the good:bad estrogen ratio with the goal of decreasing your risk of breast cancer. We also recommend it to reduce symptoms of too much estrogen, such as fibrocystic breasts, uterine fibroids or heavy painful periods. This condition is called estrogen dominance.
  2.  If you want to know more about your personal risk, genetic testing can be done to evaluate your probability for making bad estrogens, and urine testing can be done to assess your current ratio of good:bad estrogens. With these test results, we can determine how to use food, supplements and mind-body practices to increase good estrogen levels and lower bad ones. These tests are available from our Functional Medicine nutritionist or practitioners.
  3. Lower your total toxin load.  In addition to targeted support for detoxing and eliminating estrogens, keeping your general toxin load and exposure low is very important because environmental toxins like herbicides and pesticides can push your estrogens down the “bad” pathways. We recommend cleaning up your exposures, and supporting your liver with a general detox program. How to do this?  Read on!   

HOW TO REDUCE YOUR ENVIRONMENTAL EXPOSURES AND LOWER TOXIN LOAD

We always recommend doing a simple Liver Support Detox program in the spring and fall to help keep these toxins from building up in the body and causing problems. Check out our do-it-yourself 14-Day Whole Life Detox to get startedAdd a bottle of Broccoprotect (sulforaphane) if you are concerned about your estrogens and you’re all set.  

And if you are confused about what to do?  Make an appointment with our health coach, Melissa Rapoport! She will help you form a plan to reduce your toxic load and bring balance back to your body. Either call 914-652-7800 to set up an in-person appointment, or go to CoachMe to set up a video or phone appointment. 

Want to learn more about detoxification? Check out these detox blog posts.

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How to Manage Cancer Treatment Side Effects with a “Whole-Person” Plan

By Pamela Yee, MD

Breast cancer patients often see me to reduce a variety of treatment side effects. Side effects during chemotherapy. Side effects from radiation. Side effects from being on long term estrogen suppression, such as Tamoxifen or Femara.

For some women, estrogen suppression, and the assumption that they are going to hit menopause like a wrecking ball, induces more fear than either chemotherapy or radiation. One day you’re living with a certain level of hormones and the next day the cord is cut. It’s easy to start imagining what it means to suddenly live without the hormones that define womanhood.

Some of the side effects of estrogen blockers are much like those in menopause: night sweats, hot flashes, vaginal dryness, insomnia, mood changes on the spectrum of irritability up to depression. Additionally, the Aromatase Inhibitors, like Femara, can cause muscle or joint pain and stiffness. In my practice, this is actually one of the most limiting side effects and a cause for some to stop their treatment.

Good News: There’s Another Way

Treatment of the muscle and join pain associated with Aromatase Inhibitors does not have to come in the form of more pharmaceuticals like non-steroidal anti-inflammatory agents (NSAIDS), such as ibuprofen and naproxen, which are very disruptive to the gastrointestinal system.

For years I’ve been advising my patients to employ techniques like acupuncture and exercise to treat side effects. Now there is research to back up my approach.

A study recently published in the Obesity Journal (1) demonstrates that exercise — both resistance training and aerobic — mitigates the side effects of Aromatase Inhibitors. How much training did it take? Weight training twice a week and 150 minutes of moderate aerobic exercise. Not only were side effects reduced but patients had a positive change in body composition. This is very exciting news and shows how even a small amount of exercise can have a big impact.

In many prior studies looking at the role of exercise in breast cancer patients, exercise has shown to increase survive and weight gain has been been associated with increased mortality.

Exercise has always been an important part of my treatment strategy with patients with breast cancer. The data clearly reinforces my approach as I continue to support my patients in helping them prioritize exercise in their treatment plan to increase their lifespan, improve their quality of life, and prevent recurrence.

About Dr. Yee

Pamela Yee, MD is an Integrative and Functional Medicine Physician at Blum Digital, LLC in Rye Brook, NY.   Dr. Yee has a special interest in integrative cancer care and creates highly personalized treatment plans for each of her patients. She lives in Nyack NY where she and her husband manage their own organic micro-farm.

CLICK HERE to learn more about Dr. Yee

Reference:

(1) Thomas, G. A., Cartmel, B., Harrigan, M., Fiellin, M., Capozza, S., Zhou, Y., Er-colano, E., Gross, C. P., Hershman, D., Ligibel, J., Schmitz, K., Li, F.-Y., Sanft, T. and Irwin, M. L. (2016), The effect of exercise on body composition and bone mineral den-sity in breast cancer survivors taking aromatase inhibitors. Obesity. doi:10.1002/oby.21729