As we wrap up October, I have finally had a chance to reflect on breast cancer awareness. While I wish I was able to say I haven’t known anyone with breast cancer, unfortunately it’s not the case. In addition to my patients, it’s sad that I have seemingly lost count on the number of people I know who have had or passed away from this horrible disease.
This year in particular had its devastating impact on our family when my aunt lost her battle with breast cancer. The loss of my father’s remaining sibling rattled our whole family. Just writing this brings tears to my eyes.
From a personal perspective, this disease has been crushing.
But as a Functional Medicine Doctor, I want to do all I can to make an impact in the battle against this enemy.
So… I want to get to the down and dirty about the functional medicine approach to breast cancer. I am going to dive deeper than the commonly known risks for breast cancer:
- getting older (over 55 years of age)
- being a woman
- race (Caucasian woman have a slightly higer risk)
- having a family history
- having a personal history of breast cancer
- certain genes (BRCA1 and 2 to name the most common)
- having dense breast tissues
- have benign breast conditions like fibrocystic changes,
- being sedentary
- obesity or being overweight
- having more than 2 alcoholic drinks a day
- exposure to DES (an estrogen like drug given to pregnant women from 1940-1970 to prevent miscarriage)
- Getting your period before the age of 12
- Going into menopause after the age of 55
- Being on oral contraceptives
- Never having had a baby or having your first baby after the age of 30
I am going to focus on prevention methods that, unfortunately, you’ve likely NEVER heard in your doctor’s office.
In the above list the last five risk factors all have to do with estrogen. If you get your period early or go into menopause late, you have a long time you are exposed to estrogen which puts you at higher risk. Because of this, I am going to focus this article on estrogen: how it’s produced, how it’s transported in the body, how it’s broken down through detoxification, and what affects its elimination. Keep in mind estrogen is a necessary hormone for both men and women but keeping it at healthy levels is what is important.
Don’t worry though, I am going to stick with the basics so this will NOT be a full blown medical lecture on hormone production
WHAT INCREASES THE PRODUCTION OF ESTROGEN?
Whether you are a man or woman, you produce estrogen. An enzyme called aromatase converts testosterone to estrogen.
Things which increase the activity of aromatase will ALSO increase the production of estrogen. What are some things that stimulate aromatase’s activity?
- Inflammation, specifically Prostaglandin E2 (look for my future post on what causes inflammation)
- High insulin
- Chemicals in our environment which can act like estrogen in the body aka xenoestrogens (think BPA in your plastic bottles)
So what can you do about it?
Modulating your stress, for one. While no one can entirely control the amount of stress they are subjected, we can control how we react. Personally, I use the inner balance app by heart math I am actually using it now to remind me to breathe when I am working! Ten minutes, twice per day will help control your response to stress by teaching you to turn on your parasympathetic nervous system, thereby calming you down.
Controlling your weight and insulin levels by eating low glycemic load load foods aka low carb like berries, leafy greens, and avoiding refine processed foods like pastries and bread.
Do not use personal grooming products containing parabens, phalates, or BPA (to name a few). I like using Environmental Working Group's Skin Deep site to determine whether a product is safe for use. And do not heat food in plastic containers or drink water out of plastic water bottles to further minimize BPA expsure. Did you know that the lids of to go coffee cups are made of BPA? Take the lid off that cup when you are getting a cuppa to go. Lastly, forgo the receipt when you are out shopping as many cash register receipts are laden with BPA.
You can also decrease the production of aromatase by utilizing natural substances that as natural blockers to the enzyme such as:
- Flax seed: 2 TBSP/per day
- Fiber: eat your 7-10 servings of fruits and veggies per day
- Green tea 2 cups per day
TRANSPORTATION OF ESTROGEN
Estrogen is shuttled throughout the body by a protein called SHBG (sex hormone binding globulin). The more SHBG, the less free circulating estrogen there is to create a problem, and vice versa. So what decreases SHBG?:
- Higher insulin levels
How can one support the transport of estrogen?
- Low fat vegetarian diet
On the flip side, SHBG is decreased by a low fat vegetarian diet. By low fat, I am referring to bad fats like trans fats, which should be avoided 100%. The caveat I tell my vegetarians is to ensure adequate protein, adequate good fats (i.e. avocado, olives, and coconut oil), as well as ensure adequate B12, CoQ-10, carnitine, and zinc intake, as these are often deficient in vegetarians.
DETOXIFICATION OF ESTROGEN
Estrogen is broken down by the process of detoxification. In its simplest explanation, all medicine you ingest and or hormones you produce are broken down via detoxification.
There are two steps or phases:
Step 1 (or phase 1) breaks the chemical or hormone into a more active metabolite and requires B vitamins, Vitamin A, C, D and E, folate, milk thistle, Calcium, and glutathione (that’s a lot of co-factors!).
Step 2 (or phase 2) requires the addition of a molecule to make this active metabolite hydrophilic, or water loving, so you can pee, poop, or sweat it out! For that to happen, you need amino acids and glutathione. Amino acids are building blocks of protein. So if you are not getting enough protein from your diet, you will not be able to excrete all the active metabolites made by phase 1, and will likely feel sick.
Side note: this is why I don’t recommend juice fasting that is not supported by protein in those who have thigh toxic burdens or loads. If you do a juice fast alone and have a high toxic load, you will quickly be making active metabolites but won't have the amino acids to clear these metabolites and likely feel very sick. Furthermore, if you don’t make enough stomach acid, a condition known as hypochlorhydria, you will not be able to break down protein either.
So what supports detoxification of estrogen?
- B Vitamins
- Vitamins A, C, D, E
- Milk thistle
- Amino acids
Examples of FOODS which support detoxification:
- Artichoke: 6 oz. of whole
- Pomegranate juice 6 oz.
What inhibits detoxification?
- Deficiencies in the above vitamins
- A genetic mutation in the COMT gene
- A genetic mutation in the CYP1B1 gene
Now here is what most doctors won’t tell you: mutations in your genes (also known as SNP’s or single nucleotide polymorphisms) can decrease your ability to break down estrogen. Without getting too technical, both the COMT gene and CYP1B1 gene aid in the detoxification or breakdown of estrogen. If these genes are mutated (and actually expressing) you will break down estrogen at a slower rate.
Additionally estrogen is broken down into 3 metabolites: 2-hydroxy, 4 hydroxy and 16 hydroxy estrogen; with 2 hydroxy being the good estrogen and 4 hydroxy being the bad estrogen. You can actually measure these metabolites in the urine. And this is something to consider especially for those at high risk for breast cancer and for those patients who choose Bio-identical hormone replacement. (BHRT)
I recommend genetic testing for the above SNP’s and checking urine metabolites when appropriate .
ELIMINATION OF ESTROGEN: A SPECIAL CONSIDERATION
The 2nd phase of detoxification primes the estrogen metabolite to be eliminated as discussed above. However, if you have an imbalance in your microbiome (the bacteria what reside in your gut and are normally beneficial), some of these bacteria can produce an enzyme called beta glucoronidase.
Beta-glucoronidase cleaves or cuts off the molecule making that estrogen metabolite hydrophilic therefore not allowing it to be excreted. The way to correct this is to bind the beta-glucoronidase with calcium D glucarate while you restore balance in the microbiome and decrease its production.
Beta-glucoronidase can be measured in specialty stool tests. In order to support healthy metabolism of estrogen, the level of this enzyme must be kept in check. Recently, I saw a patient who had elevated levels of beta-glucoronidase on stool testing, which helped partly explain his gynecomastia (aka “man boobs”).
Remember you guys, women are not the only ones negatively affected by excess estrogen.
Here are some recommendations to restore balance in the microbiome and lower beta-glucoronidase:
- Prebiotics or foods high in prebiotics
- Probiotics or foods high in probiotics
- Managing stress
- Limiting alcohol consumption
- Eating foods high in calcium D-glucarate
- Supplemental calcium D-glucarate
Eating foods high in prebiotics like raw Jerusalem artichoke, raw chicory root, raw garlic, and onions, or foods high in probiotics like kimchi and sauerkraut, miso, kefir, and kombucha can help repopulate your gut microbiome with beneficial bacteria.
Eating a diet high in vegetables and eliminating processed foods and sugar can restore a healthy microbiome in as little as two weeks. Eating a diet rich in omega-3 fatty acids can also restore a healthy microbiome in as little as 7 days.
Foods high in calcium D-glucarate include: cruciferous vegetables like broccoli, cabbage, and brussel sprouts. Oranges, grapefruit, apples, spinach, carrots, potatoes, lettuce, bean sprouts, and grapes also contain calcium D-glucarate. Sometimes giving calcium D-glucarate in a supplemental form is necessary and/or taking a supplement with the active components of cruciferous vegetables like I3C or DIM is necessary as well.
In summary, it is critical to know where you may be getting exposure to excess estrogens, whether you can breakdown and eliminate the estrogen, and whether you have a genetic predisposition to not being able to break down and clear excess estrogen from your body.
So exercise, get enough sleep, eat your veggies, be mindful of stress, and drink alcohol in moderation. Know your risk and talk to your practitioner to see if SNP testing or estrogen metabolite testing is right for you.
This sounds just like most other wellness prescription, right? And that’s because these same lifestyle changes help protect against a whole host of diseases.
But now you know why each of these are important for breast cancer prevention, so I hope you can use these to either help yourself or a loved one decrease the risk of developing this disease.
Have any of you heard of beta-glucoronidase? Or has your doctor ever told you about COMT or CYP1B1 SNP’s?
In loving memory of Milica Grujic 8/16/45-2/19/16.