Breast Cancer & Clinical Nutrition

We have all met someone, or know someone close to us who has had a battle with breast cancer.  1 in 8women will be diagnosed with invasive breast cancer in their lifetime, and we are still seeing the rates of breast cancer climbing for women in the U.S.  We have also seen an increase in breast cancer rates amongst younger women, 40 years of age and younger, with this rate increasing by 5% in the past few years.  Although we have seen a decrease in mortality, mostly due to regular screenings and earlier detection, we are learning more and more about the risk factors involved and how to do our best to support women to reduce their risk of developing breast cancer.   There is so much fear and uncertainty involved with a breast cancer diagnosis, and also life after breast cancer and the fear of the cancer returning.  Taking a step to see how to best support your specific needs with comprehensive hormone testing, genetic testing, etc. can be great tools to supporting one’s health before, during and after a breast cancer diagnosis. From my scope as a Clinical Nutritionist we are looking at thingsl ike environmental exposures of xenoestrogens, detoxification, estrogen metabolism, adrenal testing, and genetic SNPs that may be a playing a role.  These tools do not take away from seeking proper medical treatment from your Medical Doctor.

Detoxification

We look at detoxification because proper clearance of toxins especially xenoestrogens, and supporting proper clearance of estrogens will bean important aspect of reducing cancer risk. Xenoestrogens are found in plastics (BPA), glyphosate (a pesticide),PBDEs (flame retardants), and phthalates (like those found in air fresheners are common environmental exposures to xenoestrogens.  Xenoestrogens are chemicals that mimic the behavior of estrogens.  Therefore, we can see a presentation of estrogen dominance that is heavily influenced by environmental exposures of xenoestrogens. With estrogen dominance being a major influencer of hormonally driven cancers, like breast cancer, uterine and ovarian cancer, and also prostate cancer in men.  

How can we support detoxification?

Limit Exposures

·        Move away from plastics

·        Drink clean filtered water

·        Eat grass-fed, pasture raised and organic foods whenever possible

·        Avoid glyphosate (disrupts CYPP450 enzymes necessary for proper detoxification)

·        Implement non-toxic body products

Support Detoxification with Diet

·        Limit alcohol intake (women who consumed 3alcoholic beverages per week had a 15% increased risk of breast cancer)

·        Implement cruciferous vegetables

·        Implement broccoli sprouts

Estrogen Metabolism

Next we would want to consider our own endogenous production of estrogen, our exposures (birth control use) and specific genetic SNPs that may contribute to an impaired estrogen metabolism.  Looking at estrogen is necessary since estrogen can cause DNA damage and lead to increased proliferation – or increased cell turnover, and therefore increased room for mistakes.  When looking at breast tissue, it is constantly being stimulated by estrogen and this occurs every month during the luteal phase of every cycle.  So we want to ensure our estrogen levels, and estrogen metabolism is supporting a healthier expression, and not leading to an estrogen dominant presentation that can lead to these estrogen related cancers.  

Often general hormonal testing will involve a snapshot look at estrogen and progesterone via serum. However, this does not allow for a more comprehensive look at how the estrogen is being metabolized, such as which pathway does it favor?  There are 3 pathways that play a role in proper estrogen clearance – 2-hydroxyestrone (2OH), 4-hydroxyestrone (4OH) and16-hydroxyestrone (16OH).  Our 2OHpathway is the pathway we want to favor, this allows for proper elimination and decreased risk of DNA damage.  However, we see when the 4OH pathway is favored there is an increased risk in DNA damage and oxidative stress, leading to a greater risk of developing estrogen related cancer.  For the 16OH pathway we note that there is only a potential risk when this pathway is favored in pre-menopausal women, not necessarily for post-menopausal women (per the research to date).  

What are some ways we can support healthier estrogen metabolism?

·        #1 - proper testing, such as Dutch Testing, to determine your unique presentation of estrogen metabolism to see if there is even a need.

·        Supporting proper clearance to favor the 2OHpathway by addressing CYP450 enzymes involved that are unique to the individual(genetic testing suggested)

·        Supporting methylation, as needed (genetic testing suggested)

·        Continue supporting all detoxification supporters mentioned above

Genetics

The field of Nutrigenomics is still steadily evolving, but there are various known SNPs (single nucleotide polymorphisms) that are shown in the research to play a distinct role in detoxification, hormonal balance, mood support and inflammation, to name a few. For those who have a family history of hormonal related cancers, it is likely that there are various genetics at play. Again, from my scope I am not looking for BRCA mutations or HER2expressions, these would be done by a Medical Doctor.  I would be reviewing enzymes that play a role in the underlying imbalances like detoxification, estrogen metabolism, methylation, inflammation and proper tumor suppression.  It is shown that when individuals are aware of their genetic make-up and how their SNPs may influence their health currently, or down the road, they are more likely to implement the preventative measures necessary to support their health. Knowing what your genetic expressions are can help determine the need for supporting these SNPs to provide the best genetic expression possible.  As I like to say, “Genetics load the gun, epigenetics pulls the trigger.” Therefore, we can have a specific subset of genes, but these are heavily influenced by epigenetic (diet, lifestyle, stress, medications, toxins, etc.)that influence their expression, and whether the gene is turned ‘on’ or ‘off’.

Gut Health

Gut health will always be vital and there is a unique interplay between hormones and gut imbalances that can further contribute to impaired detoxification, estrogen clearance and inflammation if the gut imbalances are not addressed.  

Addressing Adrenal& Thyroid

Chronic stress will continue to deplete the body of nutrient reserves while leading to hormonal, and potential gut imbalances.  We must always address that brain down response to slow the hormonal imbalance that can ensue and lead to estrogen dominance.  

After cancer treatment it is common to see a depletion in the adrenal response (communication always coming from the brain down).  This can lead to debilitating fatigue, and can be due to the impaired functioning of both the adrenal response and the thyroid.  

We also know that those who express a blunted Cortisol Awakening Response (found on the 4 spot salivary cortisol testing with CAR),that they have an increased risk of developing cancer.  This is commonly seen in those with chronic stress, or burnout.  Therefore, addressing the cortisol levels can be a great tool to support our cancer clients to reduce the risk of developing breast cancer, but also support them after treatment, as needed.

Conclusion

There can be various factors at play when it comes to an individual’s unique health presentation. Addressing underlying imbalances to give that individual the best tools possible to lead a healthy life, can be a great way to support them in making lifelong changes to reduce their risk, or support their recovery aftertreatment, and while they are working with their Medical Doctor.

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