Whole-Food Guide for Breast Cancer Survivors (21 page)

Breast Thermography: Visually Evaluating Estrogen’s Effects on the Breasts

Blood and urine tests can provide information regarding estrogen that is circulating throughout the body, but the question remains as to how much actually ends up in the breast tissue. The amounts are certainly not the same; in fact, the concentration of estrogen in the breasts may be ten to fifty times the concentration in the bloodstream (Jefcoate et al. 2000).

Breast thermography offers a solution to this problem by providing an indirect way to visualize the effects of estrogen on the breasts. While it does not measure estrogen per se, a thermography exam can identify the type of blood vessel patterns that estrogen would commonly produce. Excessive levels of estrogen in the breast would normally produce a vascular pattern that is different from a breast with normal estrogen levels. If you are taking birth control pills or undergoing hormone-replacement therapy, a thermogram can be especially valuable to you to determine whether or not the estrogen you are taking is harming your breasts and increasing your cancer risk.

Guidelines for Managing Your Estrogen Load

Because an overabundance of the wrong kinds of estrogens can place a burden of risk on your body, consider making it a top priority to lighten your estrogen load. Here are our suggestions for doing just that.

Avoid Xenoestrogens

To beat this drum one last time, it is truly essential to be aware of estrogenic compounds (known also as xenoestrogens) in the environment, which are having a greater and greater impact on not only breast cancer rates but also all other cancer rates. In particular, avoid conventional meats and dairy products; pesticide-laden produce (see ewg.org/foodnews /summary/ for a list of the “dirty dozen” fruits and vegetables); plastic items, especially heated or frozen plastic containers and those made with BPA; and personal care products with ingredients you don’t immediately recognize. In
Hormone Deception
, Lindsey Berkson (2000) discusses the effective use of low-heat saunas (which induce sweating) to help remove xenoestrogens. Also, curcumin—a powerful phytonutrient in the spice turmeric—is currently the subject of multiple studies, with preliminary research suggesting that it may also be effective for this purpose.

Maintain a Healthy Estrogen-Progesterone Balance

Maintaining a healthy estrogen-progesterone balance is easier said than done. Many women have had wonderful results from using bioidentical progesterone creams or capsules,
not to be confused with progestins
, which are pharmaceutical progesterone-type drugs shown to
increase
breast cancer risk (Bluming and Tavris 2009). While the labels of many products on the market claim that they are progesterone creams, our view is that hormone balance is too critical to be left to chance. Therefore, we believe it’s imperative that you work with an integrative practitioner to measure your progesterone levels so you can add just the right amount of bioidentical progesterone to maintain a healthy hormone balance.

Keep in mind that birth control pills only add to your body’s estrogen load, making this balance even more difficult to attain.

STRESS IS A PROGESTERONE BUSTER

Progesterone is the major precursor of important corticosteroid hormones (aldosterone and cortisol) made in the adrenal cortex. When progesterone is sidelined into producing cortisol, the hormone that helps us deal with physical and emotional stress, there’s less progesterone available for other uses, such as balancing estrogen.

In this way, the fast-paced, demanding lifestyle of the twenty-first century can deprive the body of its natural progesterone, which already declines dramatically after menopause under any circumstances. Premenopausally, stress may also affect your ability to ovulate, restricting or shutting down the production of progesterone entirely.

Exercise Helps Reduce Estrogen Levels

The results of over two dozen epidemiologic studies on exercise and estrogen levels show us that women who exercise regularly have a reduced risk of developing breast cancer (see, for example, Campbell and McTiernan 2007). Moreover, a 2002 study (Chlebowski, Aiello, and McTiernan) assessed the
direct
effect of exercise on estrogen levels and found that women who exercised and lost more than 2 percent of their initial body fat had a 14 percent decrease in estradiol levels. Is it the loss of body fat or the exercise itself that reduced estrogen levels in this study of postmenopausal women? The results don’t tell us, but we do know that both a healthy weight and healthy estrogen levels are essential to managing breast-cancer risk. If exercise can accomplish one or both of these goals, we’re in good shape!

Think Before You Drink

Steering clear of excess alcohol intake is important, because the same liver enzymes that break down alcohol are also used to clear estrogen. What’s more, excess alcohol consumption is linked to higher estrogen levels (Seitz and Maurer 2007).

Reweighting Your Estrogen Ratios

An Eating for Health food plan, with its emphasis on fresh fruits and vegetables, will provide an excellent start for helping you to eliminate unhealthy estrogens (16α-hydroxyestrone and 4-hydroxyestrone) while raising levels of healthy estrogens (estriol and 2-hydroxyestrone). You’ll want to pay particular attention to the foods and nutrients that follow.

CRUCIFEROUS HEROES

Cruciferous vegetables, those belonging to the
Brassica
genus, are the quickest route to shifting your estrogen balance toward the favorable 2-hydroxyestrone estrogens. The power of this vegetable group has been demonstrated both in the lab (Pledgie-Tracy, Sobolewski, and Davidson 2007) and in population studies (Kim and Park 2009). Known for encouraging healthy liver detoxification and for shifting more estrone toward the “good” 2-hydroxyestrone pathway, this family includes broccoli and its sprouts, cauliflower, cabbage (red, white, and napa cabbage, as well as bok choy), Brussels sprouts, arugula, collards, kale, daikon radish, kohlrabi, rutabaga, turnip, and watercress.

Note that excessive consumption of raw vegetables in this group can cause thyroid trouble for some people; we suggest that you lightly steam these veggies and eat them raw only as an occasional treat.

FIBER

Fiber is another key factor in the successful secretion of estrogens. In the absence of fiber to bind to, estrogen metabolites run the risk of being reabsorbed by the body. That’s why eating a diet that is low in fiber, having a history of chronic constipation, or both are associated with excess estrogen. What’s more, soluble fiber—found in fruits, vegetables, nuts, seeds, and legumes—is fermented in the colon to create healthful flora. Fiber also breaks down into a unique fatty acid known as
n-butyrate
, which is believed to have anticancer properties (McIntyre, Gibson, and Young 1993).

LIGNANS

As you will recall from chapter 9, another reason to enjoy flaxseeds on a regular basis is that they contain high amounts of lignans, phytochemicals that, when acted on by healthful intestinal microbes, are transformed into the protective compounds enterolactone and enterodiol. These compounds may redirect estrogen metabolism toward a healthy ratio of 2-hydroxyestrone to 16α-hydroxyestrone (McCann et al. 2004). Flaxseeds have also been shown to raise levels of SHBG (Hyman 2007), reducing the amount of free estrogen available to act on breast tissue.

Other good sources of lignans are sesame seeds, whole grains, and olives.

FERMENTED FOODS

We’ve talked quite a bit about the brilliant contributions that beneficial organisms can make to your health and to your cancer defense team. But where do you find these profoundly benevolent bacteria? Fermented foods, overflowing with microflora, are a fabulous addition to your diet. If you’re new to fermented foods, a good place to start would be organic yogurt. Keep in mind that the carb content of yogurt is normally lower than that of nonfermented dairy products, because the lactose (milk sugar) is digested by friendly bacteria as part of the fermentation process.

Perhaps you’d enjoy trying kombucha (fermented tea), amazake (fermented rice drink), or kefir (fermented milk). What about homemade sauerkraut (see the recipe in appendix B) or kimchi? They all contain copious amounts of cooperative microflora, which, as you know by now, we consider to be one of the keys to the kingdom of good health!

FERMENTED SOY

Because fermented foods provide beneficial bacteria, we also recommend the consumption of moderate amounts of fermented, organic soy products, such as natto, miso, and tempeh. Although soy has a long and controversial history, its phytochemicals genistein and daidzein have been credited with helping to alter the 2:16 estrogen ratio, while the fermentation process helps to deactivate potentially troublesome goitrogens (substances that induce goiter formation). Soy falls into the category we call
phytoestrogens
, compounds that are estrogen-like, but actually compete with estrogen for territory on a cell’s surface. This ability to bind to cell receptors
instead
of estrogen serves to prevent human estrogens and xenoestrogens (environmental estrogens) from attaching to cells and promoting growth (Tempfer et. al. 2007).

We do
not
believe that
processed
soy has this same positive effect. One study (Allred et. al. 2004), in fact, looked at the specific effect of soy processing and its impact on breast cancer. Animals with breast cancer were fed soy from various sources—from unprocessed soy foods to highly processed soy protein isolates—all containing the same amount of genistein. When all was said and done, the highly processed soy appeared to
promote
cancer growth. For this reason, we recommend against processed soy products, such as soy burgers, soy franks, soy ice cream, soy protein bars, and so on.

EVE HAD IT RIGHT

Some scholars contend that it was a pomegranate, not an apple, that tempted Eve in the biblical Garden of Eden. While we’ll never know for sure, we do know that eating pomegranates or drinking pomegranate juice may help prevent and slow the growth of ER+ breast cancer. A group of phytochemicals called
ellagitannins
, found plentifully in pomegranates, was shown to inhibit the growth of estrogen-responsive breast cancer in laboratory tests. The researchers (Adams et al. 2010) believe that it’s the ellagitannins in pomegranates that work as natural
aromatase
inhibitors; aromatase is a key enzyme the body uses to make estrogen, particularly after menopause. Further studies will be needed to confirm this effect; meanwhile, we know that eating pomegranates and pomegranate products can help keep breast cancer at bay via several other possible mechanisms (see chapter 3).

NUTRIENTS

High-quality, targeted supplements can also go a long way in helping you achieve the goal of maintaining a health-enhancing balance of estrogens in your body. The following are some of our favorites, although it is always best to work with a qualified nutrition professional or other holistic health care practitioner to create just the right balance for
you
.

Calcium d-glucarate.
Calcium d-glucarate, a natural substance found in apples, oranges, broccoli, spinach, and Brussels sprouts, helps the liver with its job of detoxifying estrogens via a process known as glucuronidation. Calcium d-glucarate also helps inhibit the glucuronidase enzyme mentioned earlier, which in turn facilitates the elimination of estrogens. A typical dosage is 500 milligrams per day. Note that the mineral magnesium is the cofactor that helps this whole process run smoothly. Green, leafy vegetables; legumes; nuts; seeds; and whole grains are good sources of magnesium. Remember that when flour is refined and processed, the magnesium-rich germ and bran are removed.

I3C or DIM.
Indole-3-carbinol, known by its close friends as I3C, is one of the key phytonutrients in cruciferous vegetables that gives them their estrogen-modulating effect. Eating broccoli sprouts, cauliflower, and other crucifers releases I3C, but you can also take it as a supplement for preventive therapy. Diindolylmethane, or DIM, a metabolite of I3C created when I3C mixes with juices in the stomach, is also used as a supplement for prevention. Both compounds are believed to work by promoting the formation of the healthful estrogen 2-hydroxyestrone.

Methylation boosters.
Methylation
is one of the biochemical pathways used by the liver to detoxify estrogens and other compounds, specifically raising 2-hydroxyestrone levels and lowering harmful 4-hydroxyestrone levels. For this reason and because there is a growing consensus that deficient methylation is a major contributor to not just cancer but also many major degenerative diseases, we want to do all we can to support healthy methylation. Cruciferous vegetables, the ultimate dietary multitaskers, help this process along, as do foods high in vitamins B6, B12, and folate. You’ll get abundant amounts of these nutrients by Eating for Health and taking a high-quality foundational multinutrient.

Please note, however, that after age fifty, it becomes more difficult to absorb vitamin B12 through the gut, and deficiency is common. Your doctor can check your B12 status using simple blood tests. Some women can enhance B12 levels through oral supplementation, while others need regular B12 injections.

To get a rough idea of how well you are methylating, your doctor can check the
homocysteine
level in your blood, because elevated serum homocysteine is a classic sign of a methylation defect. Try the previous suggestions and retest. If your homocysteine remains stubbornly high (above 10 micromoles per liter), you’ll want to consider adding other known methylation-enhancing nutrients like
trimethylglycine (
TMG), choline, or
S-adenosylmethionine
(SAMe).