Breast Cancer -- Real Prevention

By James LaValle, R.Ph, ND, CCN

October was Breast Cancer Prevention month, and as always, fund raising and education initiatives were everywhere. There are many advances in our understanding of how breast cancer develops, yet out of all the articles I saw in the mainstream media, none of them explained the most important factors influencing breast health.

Most breast cancer is the type that is called hormone sensitive. That means it is cancer that forms in response to estrogen. It is usually implied that it is solely a matter of having too much estrogen (and/or other compounds that have estrogen-like structure) in the body. However if you dig deeper, you learn that it is not so much the estrogen itself, but how it is being metabolized in the body and whether it is balanced by adequate progesterone that are the primary problems.^1-2

Estrogen/Progesterone Balance
The balance between estrogen and progesterone is very important for breast health and is almost never mentioned in popular literature on hormone sensitive breast cancer. There is a big misunderstanding among some people in the medical community that progesterone increases breast cancer risk. This was due to studies that found that synthetic progestins formerly used in women on hormone replacement therapy did increase breast cancer risk. However, further study has clarified that natural progesterones do not.³

Natural (bio-identical) progesterone actually reduces the production of certain growth factors, and increases a process called apoptosis (cell death) in proliferating breast cells. Several studies have shown that women with progesterone deficiency have anywhere from 4 to 6 times the risk of developing breast cancer.⁴

Estrogen Metabolism
As estrogen breaks down in the body from the primary estrogen in the body, estradiol, it can convert to a form called 2OH estrone, the good metabolite, or to 16OH and 4OH estrones, forms that cause tissue proliferation. 16OH contributes to endometriosis for instance, the over-proliferation of uterine lining tissue that causes painful menstrual cramps and can reduce a woman's ability to conceive. These metabolites also increase the risk of breast cancer. On the other hand, women with a higher 2OH to 16OH ratio have a 40% less chance of developing breast cancer.

There is a second step in the breakdown of estrogen called methylation. This step takes 4OH and makes it less active in tissues and actually makes a form of estrone (called 2-methoxyestrone) which inhibits breast cancer. So if your methylation pathways are purring along wonderfully you can break estrogen down into beneficial metabolites. Key nutrients to support methylation are the B vitamins, folate, B6 and B12, and dietary sulfur (found in onions, garlic, cabbage family vegetables and in foods like whey and eggs).

The final step for estrogen breakdown is glucuronidation, a metabolic process in which the different estrogens bind with glucuronic acid in the liver and from there get excreted in the GI tract. At least that's what should happen. Magnesium is needed for glucuronic acid to bind with estrogen. If you aren't taking in enough, the estrogen will not be bound and will just continue circulating in the body.

Gut flora also influences glucuronidation. Pathogenic (harmful) bacteria in the intestines can cause estrogen to get uncoupled from the glucuronic acid. So instead of being carried out of the body, the estrogen re-enters circulation, and the woman will accumulate too much in her system. This pathogenic bacteria called beta-glucuronidase is associated with increased cancer risk.

Diets high in fiber and beneficial flora reduce beta-glucuronidase levels, and so promote good estrogen metabolism. A form of calcium called D-glucarate inhibits beta-glucuronidase and so is also a very helpful nutrient.

There are a couple of substances in foods that help healthy estrogen metabolism and have significant and strong evidence of being cancer protective. (See Laura's article for more information on that.) This is where most of the articles in popular women's magazines focus -- eating a diet that is high in these cancer protective substances; and while it is important to eat this way, unless you measure your estrogen metabolites with urine or saliva testing, you have no way of knowing if your diet is directing your metabolism to more of the healthy and fewer of the bad estrogen metabolites. (My new e-book explains estrogen testing in detail. Look for The Keys to Healthy Aging: Making Hormone Replacement Work for You.)

Other Influences: Thyroid and Insulin
The other two influences on breast cancer you rarely read anything about are thyroid health and high insulin levels. Laura's article discusses the diet and insulin connection to breast health, but medicine has known for some time that women with breast cancer have a higher than average degree of thyroid problems, including autoimmune thyroid disease and hypothyroidism.

We know now that any disease of autoimmunity raises cancer risk.⁵ Since it is known that people with autoimmunity have a suppression of natural killer cells, the cells that can fight and overcome cancer cells, this shouldn't be surprising. You may think that autoimmune thyroiditis and hypothyroidism are not that common, but they in fact are second only to diabetes as the most common endocrine disorders -- and they occur in anywhere from 10 to 30% of the population.^6-7

To really get proactive against breast cancer, all women can and should get tested for the following:

• Estradiol, estrone, progesterone, and estrogen metabolites.
• Low thyroid and thyroid antibodies if you have any reason to suspect your thyroid is under-active.
• Post-prandial glucose and insulin levels to ensure you are not developing insulin resistance.

Once you have an accurate reading on these vital hormone levels, an appropriate supplementation and dietary plan can be applied as needed.

References

1. Kabat GC, et al. Epidemiology. 2006;17(1):80-8.
2. Adly L, et al. Int J Cancer. 2006;119(10):2402-7.
3. Campagnoll D, et al. J of Steroid Biochem and Mol Biol. 97(5): 441-450.
4. Oldenburg H, et al. Critical Reviews in Oncology/Hematology. 200763(2);125-149.
5. Landgren O. J Natl Cancer Inst. 2006 Sep 20;98(18):1321-30; and Eur J Gastroenterol Hepatol. 2000:12: 645-48.
6. Maruchi N, et al. Mayo Clin Proc. 1976;51: 263-5.
7. E-medicine from webMD. Hashimoto Thyroiditis, May 30, 2006.

[Ed. Note: James LaValle is the founding Director of the LaValle Metabolic Institute, one of the largest integrative medicine practices in the country. Dr. LaValle is the author of the bestselling book Cracking the Metabolic Code: 9 Keys to Optimal Health and is the Executive Editor of THB's The Healing Prescription. To learn more, click here.]

Cutting Edge Fitness: Organizing Your Training Session For Injury Prevention By Carlo Alvarez

We are all trying to get more out of our workouts, but one of the things we don't want is to sustain an injury. Like anything else we do in life, organization is key. An organized plan for your workout sessions will provide a more consistent and effective workout, but more importantly, will also help prevent injury.

The American Academy of Orthopaedic Surgeons recommends doing a proper warm up, cool down, and stretching exercises to reduce your chances of injury while trying to become fit.¹ I also highly recommend working with a certified fitness trainer who can help you design a program with all of these components and who can make sure you are using good form when executing exercises.

First, you and your trainer should determine how much time you have available and identify your priorities (what you want out of your training). From there, exercises that are going to help you achieve your specific goals are chosen.

It becomes easier to outline a simple training session once you have determined time available, priority components, and what exercises to utilize.

The 3-Part Plan
Most workouts are divided into 3 parts: Pre-Workout, Main Session, and Post-Workout. Each part is important for the development of the whole body, and when properly designed, will not only help you achieve your fitness goals, but will incorporate injury prevention exercises. The following overview will give you guideline on how I design a 60-minute training session for clients, and could be used to help you work with a trainer to organize well-planned sessions.

The Pre-Workout -- 10 Minutes

Activation. These drills help with the activation of the central nervous system and allow the muscles to fire and wake up prior to activity. We utilize exercises that stimulate the lower back, lower and upper abdominals, upper shoulders, and hips.

Torso Training. A strong mid-section is the link between the upper and lower body. This has become a crucial part of a training session due to the current research and the benefits that it provides to the total development of the body.

Mobility Drills. Our mobility drills are designed to mobilize the torso and hips through range of motion exercises that include hurdles, tubing, medicine balls, and standard/mini barbells.

The Main Session -- 45 Minutes

Our goal is to train the entire body during each session. The specific routines will vary based on your individual goals and your existing strengths and weaknesses. We incorporate both bi-lateral and uni-lateral exercises that will stimulate the whole body, with the goal being to increase work capacity without sacrificing technical efficiency of exercises. These training sessions are done in an up-tempo fashion that stimulates multiple muscles and helps accelerate post-exercise metabolism.

The Post Workout -- 5 Minutes

The post workout may not take much time but is extremely important.

Joint Integrity. Joint integrity exercises are used to strengthen the small stabilizing muscles of the most injury-prone areas. We focus on the ankles, knees, hips, elbows, and shoulders. These are usually small in movement, but a high number of reps are done.

Static Flexibility. Stretching should be done post-workout since the muscles are warmest after training. A static post workout stretch has been shown to bring muscle to resting length and allow the body to relax. We usually do stretches for the low back, hamstrings, quads, shoulders, chest, and neck.

There are many ways to organize your training session, but this framework incorporates exercises for all the elements of fitness, not just weight management and muscle strength/toning, but proper warm up/activation, and development of core strength, joint integrity, and overall flexibility. By following this plan, it will not only help prevent exercise-induced injuries, but will reduce the likelihood of injuries that can occur in everyday activities.

Reference

1. http://orthoinfo.aaos.org/topic.cfm?topic=a00310.

[Ed. note: Carlo X. Alvarez is a noted authority in the customized fitness and sports performance field. He is recognized for his integrated and systematic approach to training, based on a foundation of safe and proven methodology that has direct and measurable benefits to performance.]

Healthy Nutrition: Eating a Breast Cancer Preventive Diet By Laura LaValle, RD, LD

If you have read any breast cancer prevention articles over the last month, you probably saw several articles on making sure your diet includes plenty of omega-3 fats as well as high antioxidant-containing foods like berries, colorful vegetables, beans/legumes, and green tea -- all to help your body keep damage from free radicals to a minimum. This is all good advice, but it does not adequately address the other side of the equation -- avoiding foods that promote inflammation in the body.

Prevent Insulin Resistance
Not controlling your intake of refined sugars, white breads, pastas, soft drinks and fast foods can lead to insulin resistance, which is a known contributor of inflammation and oxidative stress in the body¹. Inflammation caused by poor dietary habits not only greatly increases risk of type 2 diabetes and heart disease, but also increases risk of cancer, including breast cancer.²

Several large human studies have found that diet plays a large role in increasing inflammation and the risk of type 2 diabetes -- and that leads to an increased risk of cancer. The worst diets appear to be those high in fructose-sweetened soft drinks, refined grains, diet soft drinks, and processed meat and low in red wine, coffee, cruciferous vegetables, and colored vegetables.

One study found that insulin resistance even without the women being diabetic significantly increased breast cancer risk -- and this effect was even independent of body weight or body fat distribution.³ Another study of 60,000 women followed over 20 years found that being insulin resistant not only increased breast cancer risk, but increased the risk of being diagnosed with more advanced stages of cancer.⁴

So clearly, controlling insulin resistance is one of the most powerful ways we can reduce our breast cancer risk. For most people, this will mean eating diets that limit high glycemic index and high glycemic load foods.

Increase Levels of Protective Estrogen
As my husband Jim wrote, cabbage family vegetables which are high in sulfur compounds improve methylation in the body that helps prevent the buildup of unhealthy estrogen metabolites called 16OH. In addition to that, broccoli in particular, contains two substances, diindolyl methane (DIM) and indole-3-carbinol (I3C) that help the liver make enzymes that neutralize 16OH production.^5-6

However, to achieve levels that significantly impact 16OH production, it's necessary to take it in a concentrated supplement form. Several clinical trials have demonstrated the ability of a DIM supplement to significantly increase the ratio of good to bad estrogen metabolites in as little as four weeks.^7-8

Decrease Levels of Harmful Estrogen
Phytoestrogens are substances in plants that in effect, block bad estrogen metabolites from being able to exert their harmful effects. Phytoestrogens are found in many plant foods; soybeans, peas, beans, and pomegranates are foods that are particularly high in beneficial phytoestrogens. (Soybeans are a two-edged sword however, because with excessive intake they can inhibit thyroid hormone synthesis.)

Plant lignans are a type of dietary fiber found in high amounts in flaxseeds. Lignans increase something called sex hormone binding globulin, which can bind to estrogens and carry them out of the body. They also reduce levels of beta-glucuronidase, the pathogenic intestinal bacteria that prevents harmful estrogen metabolites from being eliminated. Regular inclusion of lignan-containing ground flaxseeds or flaxseed oils may help prevent breast cancer by aiding the body's elimination of excessive estrogen.

And finally, reducing your exposure to environmental estrogens (xenoestrogens) is important because they may trigger tissue proliferation much like excessive natural estrogens.⁹ Many pesticides are xenoestrogens, and this is the reason we recommend eating organically raised foods as much as possible. Phthalates in plastics are also xenoestrogenic, so avoid eating or drinking out of plastic containers or microwaving with plastic wraps.

References

1. Sies H, Stahl W, Sevanian A. J Nutr. 2005;135(5):969-72.
2. Schulze MB, et al. Am J Clin Nutr. 2005;82(3):675-84; quiz 714-5.
3. Bruning P et al. International J of Cancer 52 (4): 511-16.
4. Cust A, et al. J Breast Cancer Res and Treatment, July 2008.
5. Bradlow HL et al. Ann NY Acad Sci. 1996;768:180-200.
6. Bell MC, et al. Gynecol Oncol. 2000;78(2):123-129.
7. Dalessandri KM, et al. Journal of Nutrition and Cancer. 2004;50(2):161-7.
8. Wang Z, et al. Mol Cancer Ther. 2008 Feb;7(2):341-9.
9. Watson C, et al. Steroids. Feb. 2007; 72(2):124-134.

[Ed. Note: Laura B. LaValle, RD, LD is presently the director of dietetics nutrition at LaValle Metabolic Institute (formerly part of Living Longer Institute). She offers personal nutritional counseling at LMI for clients who need help with their diet in relation to illness or disease. Laura also provides educational services in the areas of health promotion, wellness, and disease prevention. To learn more, click here]

Healthy Recipes: Baked Butternut Squash with Pecans and Thyme By Laura LaValle, RD, LD

It's peak season for the sweet nutty flavor of butternut squash. This easy to prepare Thanksgiving favorite is perfect for both holiday entertaining and simple weeknight meals. When purchasing, look for gourds with a hard, thick rind and no signs of decay.

Serves: 4
Time to Table: 1 hour

Healing Nutrient Spotlight
Excellent source of vitamin A, vitamin C, manganese
Good source of thiamin, magnesium, copper

Ingredients*

1 small to medium butternut squash
1/4 cup water
1/2 cup raw pecans, chopped
1 T. organic butter
2 tsp. fresh thyme
sea salt, to taste

*Select organic ingredients for optimal nutrition.

Preparation

Halve squash, scoop out the seeds, and place cut side down in shallow pan. Add 1/4 cup water. Bake at 350° for 30 to 45 minutes until squash is tender when pierced with a fork. Turn squash over in pan, season with salt and place butter and nuts inside each half. Season with thyme. Bake for an additional 15 minutes. Cut each half crosswise to make four servings.

Nutrition
165 calories, 13 g total fat, 3 g saturated fat, 6 g monounsaturated fat, 3 g polyunsaturated fat, 8 mg cholesterol, 14 g carbohydrate, 2 g protein, 3 g sugar, 1 g fiber, 8100 IU vitamin A, 1.3 mg niacin, .2 mg thiamin, .5 mg pantothenic acid, .2 mg vitamin B-6, 25 mcg folate, 18 mg vitamin C, 60 mg calcium, 1 mg iron, 380 mg potassium, 75 mg sodium, 50 mg magnesium, .8 mg manganese, 1.4 mg selenium, 1 mg zinc, .24 mg copper

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These articles appear courtesy of Early to Rise’s Total Health Breakthroughs [Issue 11-04-08] which offers alternative solutions for mind, body and soul. For a complimentary subscription, visit http://www.totalhealthbreakthroughs.com/