Do’s and don’ts for estrogen-positive breast cancer

Breast cancer is not just one disease – it comes in many variations.

One of the primary factors in determining the type of breast cancer is the sensitivity of the tumor cells to estrogen. If a breast tumor is hormone-sensitive or estrogen receptor-positive, it means there are specific estrogen receptors on the tumor cells, and when estrogen binds with these receptors, it transfers a message to the cancer cells. Like a lock and key effect, the breast tumor cells are stimulated by estrogen to grow and reproduce. Therefore, one of the main goals of therapy or intervention with hormone-positive cancer is to reduce hormonal stimulation as much as possible.

Maintain healthy weight

Estrogen is made by the ovaries during the years before menopause, but it’s also made in fat cells where enzymes convert other hormones to estrogens. After menopause, fat is the primary source of estrogen production in the body. This means that weight is a critical factor in determining estrogen levels, for both pre and post-menopausal women. Dietary choices and activities that promote a healthy weight are essential to any estrogen-reducing program.

Optimize cholesterol

New research has shown that byproducts of cholesterol are able to bind to estrogen receptors and stimulate tumor growth. Elevated cholesterol levels are positively associated with breast cancer. Lifestyle changes, medication and supplements may help.

Minimize exposure to heavy metals

Heavy metals including copper, cobalt, arsenic, cadmium, mercury and lead have been found to stimulate estrogen receptors. Sources of arsenic include some brands of rice, seafood, well water; cadmium is high in cigarettes and can be found in some soils; mercury is mainly prevalent in larger fish and old dental amalgams; and lead contamination is a component of air pollution, paint and dyes, and ceramic glazes among other sources.

Essentially, heavy metal and toxin exposure is hard to completely avoid in our world, even with careful choices. Because of this, I advise my patients to use compounds that provide safe, gentle detoxification of heavy metals and other contaminants, on a daily or periodic basis.

Modified citrus pectin, (MCP) is derived from the pith of citrus fruit and has been shown in human studies to remove harmful heavy metals and reduce toxic body burden over time. MCP is able to cross the intestinal barrier and circulate in the bloodstream, where it binds to toxins and heavy metals and helps safely excrete them, without removing essential minerals. I also recommend ingredients such alpha-lipoic acid, N-acetyl cysteine, garlic, cilantro and other herbs and nutrients that provide support for our body’s complex detoxification systems.

Chemicals and additives to avoid

Many chemicals used in agriculture, body care products, food packaging and plastic water bottles are estrogenic, called “xenoestrogens” or “estrogen mimics.” In addition to binding with estrogen receptors, these toxins are fat soluble, so they tend to accumulate in fat cells. We know that breast tissue has a high concentration of fat, particularly after menopause. Studies have shown that breast milk often contains dangerous levels of these chemicals. Reduce exposure by avoiding plastic food and beverage containers, canned foods, and body products with these common chemicals. For a list of chemicals to avoid, visit the Environmental Working Group site.

Diet and estrogen levels

Determining the effects that specific foods have on breast cancer risk and protection is an active area of research with a number of controversies still unresolved. What we do know is this:

The bad

• Regular alcohol use increases breast cancer risk. In an excellent literature review, twenty studies pointed to a positive connection between alcohol and breast cancer, though multiple effects on hormonal systems and genetic signaling.
• Fatty red meat has been associated with increased breast cancer, especially meats cooked at high temperatures.
• A 2008 study of over 15,000 women found that high-fat food choices were significantly associated with increased cancer risk. Among other negative effects, fat intake increases estrogen levels.
• Sugar intake increases IGF-1 (insulin-like growth factor) which is associated with increased estrogen.
• A 2013 study found that intake of high-fat dairy, but not low-fat dairy, was related to a higher risk of mortality after breast cancer diagnosis.

The good

• Cruciferous vegetables including broccoli, cauliflower, kale, collards, etc. have a wealth of beneficial compounds, including diindolylmethane (DIM), a compound that promotes the healthy metabolism of estrogen. The botanical breast health supplement BreastDefend contains DIM, and has been shown in multiple studies to strategically support breast health.
• Flaxseed facilitates the removal of estrogens and improves the ratio of good and bad estrogens (2:16 alpha hydroxyestrone/ AHE), and reduces breast density. These are metabolites of the parent estrogen; too much of the 16 AHE is highly stimulatory.
• A high fiber diet promotes the binding of estrogens in the colon, thus reducing estrogen exposure. Fiber also promotes healthy bacterial populations and enhances satiety, helping to keep weight in a healthy range.
• Green tea is a true star in terms of its anticancer properties, with many studies on its multiple anticancer mechanisms. In fact, green tea polyphenols are at the top of the list of 8 chemopreventive food sources named by researchers. Chemopreventive agents are proven to either suppress or reverse the molecular pathways leading to cancer development and metastasis.

Phytoestrogens and soy: the debate

Phytoestrogens are compounds that have a mild estrogenic effect and are found in whole grains, nuts and seeds, and many other botanicals, fruits and vegetables. These foods are associated with a reduced risk of breast cancer as well as reduced cancer reoccurrence.

The controversy becomes heated in the debate over soy-containing foods. This issue is complex, with some studies showing that eating soy early in life can reduce breast cancer risk. On the other hand, the consumption of concentrated soy extracts showed increased proliferation of breast cancer cells. Finally, other studies show a protective or neutral effect from whole soy foods.

My recommendation for soy is to eat whole soy foods in moderation – no more than several servings per week, preferably fermented soy foods such as miso or tempeh. Avoid soy protein isolates and supplements containing concentrated soy isoflavones.

Other dietary tips

Keep your vitamin D levels in the high normal range with some sun exposure and appropriate supplementation. Vitamin D beneficially influences a large number of genes involved in the regulation of cell growth and metabolism.

Use olive oil and foods high in Omega-3 fats including wild-caught Alaskan salmon and sardines, flax seeds and walnuts.

Diversify your diet to minimize reliance on animal protein sources. Any animal protein should be lean, organic and grass-fed to avoid chemicals and hormonal additives. Avoid sugar and processed foods.

By understanding the ways that estrogen levels increase, and other ways in which these receptors can be stimulated, we can make wise choices and engage in activities that will minimize the activation of estrogen receptors in breast cells. We can also boost overall vitality in the process – a win/win situation.