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Personal Breast Cancer Risks

I wanted to address this next section on my website because I believe it is an important and very prominent issue women face today. Because of the 'space crunch' in my book I was not able to include this section, however I believe it is extremely important and wanted to share it with you here. This section was not created to make anyone afraid of breast cancer, on the contrary this will equip every one of you with tools that will tell what genetic and nutritional risks you may face when dealing with breast cancer. The information is applicable to those who have breast cancer, those who have family history of breast cancer, or those who just want to know what are your individual risks. Why have you never heard about this? The solutions I suggest here are non drug oriented and unfortunately organized medicine is not too 'keen' or too interested in solutions that are not drug oriented.


Genetic and Individual Risk Factors for Breast Cancer

In this section I am not addressing the rare and highly publicized genetic risk factors called breast cancer 1, early onset (BRCA1) and breast cancer 2, early onset (BRCA2). These genetic predispositions affect relatively few women as compared to other risks, and more importantly, they are well-known by the medical community. My aim is to focus on the lesser-known risks that are often overlooked and that affect every woman.

The development time of cancer. When I ask patients how long it takes for initial cell mutation to become a cancerous growth able to be felt by a manual breast exam, the most common answer is between three months to three years. Cancer actually takes far longer to develop than they think: It take an average of 15 years from the moment two cells change into cancer cells to the time a cancerous growth measures 1 cm, or 0.4 of an inch that is able to be felt during a breast exam administered by you or your doctor. Reference No. 27. It takes an average of 10 years for the growth to reach 1 mm, or 1/25th of an inch in size. If you are fortunate and this small breast growth has absorbed calcium, this size is the smallest that can be observed by mammogram. If a woman is diagnosed at age 50, this woman's breast cancer began developing when she was 35. However, to arrive at the moment when her two healthy cells turn into breast cancer cells, required years of multiple biochemical changes. In other words, although the woman discussed above developed her first breast cancer cell at age 35, the process required to arrive at the point where her healthy cells turned into breast cancer cells likely started when she was much younger.

Where levels of estrogen count. Despite fears about the connection between estrogen levels and cancer, nature has been increasing women's estrogen levels in a cancer-free way for all of human history. In pregnancy, estrogen levels rise sky-high, and as a consequence, women's risk of developing breast cancer drops (Reference No. 28) and their rate of survival from breast cancer to rises (Reference No. 29). The truth is, the amount of estrogen found in your bloodstream is not the concern, but the amount of estrogen found locally, in your breast tissue. In general, the amount of estrogen found in an adult women's breast tissue is as high as twenty-fold of what is found in her bloodstream, irrespective of whether she takes hormones or not, takes birth control pills or not, or is pregnant or not. Women's breasts simply evidence higher levels of estrogen. Reference No. 30.

Why are estrogen levels so much higher in breast tissue? A process called aromatization, where the testosterone found in breast tissue is converted to estrogen. Reference No. 31. This process is promoted by inflammation, that causes an increase in Nuclear Factor kappa Beta (NF-?B), Interleukin-6 and 12 and COX2 (COX-2) activity. Reference Nos. 32, 33, 34, & 35. This is how pollutants, diet and the environment are able to exacerbate the risk of breast cancer.

How estrogen metabolizes and how this relates to breast cancer. In ideal situations, estradiol (E2) converts into estrone (E1), a form of estrogen that is 85% weaker that estradiol. This process is promoted by the presence of progesterone and an enzyme called 17 Beta HSD 2. Reference No. 1. Estrone, in turn, branches out and converts into three metabolites:

  • 2 Hydroxy estrone - A metabolite that is very protective against breast cancer.
  • 16 Hydroxy estrone - A metabolite known to increase breast cancer.
  • 4 Hydroxy estrone - Another metabolite known to increase breast cancer.

The ratio of these three metabolites differs from woman to woman. When I test women who have a family history of breast cancer I am able to observe a higher ratio of the two metabolites known to increase breast cancer, as compared to the metabolite that protects against it. I am not sharing this information with you to scare you - rather, I think it's important to understand how common it is to have your estrone convert to the unfavorable metabolites.

In my practice I administer two groups of tests to determine the risk level of my patients:

The first test group I use measures the ratio between 2 Hydroxy Estrone and 16 Hydroxy Estrone. It is important to understand the ratio between these two metabolites because:

  • 2 Hydroxy estrone and its metabolites have been found to protect against breast cancer (Reference No. 3), and 16 Hydroxy estrone has been found to increase cancer. Reference No. 2.
  • Breast cancer patients have 50% higher levels of 16 Hydroxy estrone. Reference No. 5.
  • Women with breast cancer have relatively low levels of 2 Hydroxy estrone (Reference No. 6). In an Italian study of 10,000 women followed for five years, women with higher levels of 2 Hydroxy estrone have fewer incidents of breast cancer. (Reference No. 4)

Diet, Nutritional & Hormonal Supplements to Increase 2 Hydroxy Estrone. The good news is that it is possible to use a nutritional program to easily increase the level of 2 Hydroxy estrone, known to protect from breast cancer using the following two supplements extracted from cabbage, DIM (Reference No. 7) and Indol3 Carbinol (Reference Nos. 8, 9, & 10). By using these two supplements, 95% of the time you will be able to increase your level of 2 Hydroxy estrone, and in doing so you may significantly increase your breast cancer protection. Two recent studies reported that Indol3 Carbinol is able to markedly reduce epidermal growth factor receptors (Reference No. 9 & 11), factors that strongly promote breast cancer cell growth and progression. In another recent study, when Indol3 Carbinol was given to high risk breast cancer patients, it significantly increased the level of 2 Hydroxy estrone. Reference No. 8. I suggest the following for how you can increase your level of 2Hydroxy estrone and increase your protection from breast cancer:

  1. Savoy Cabbage. A diet-based method for increasing your 2 Hydroxy estrone that does not require purchasing supplements is to consume large amounts of a cabbage. The most effective type of cabbage is a Chinese variety called Savory cabbage.
  2. Indole3 Carbinol. I prefer for people with a personal history of breast cancer and family history of breast cancer to use indol3Carbinol first. I personally give much higher doses to patients I see in my office on an individual basis.
    I recommend 400mg twice a day.
  3. Estrogen Support (DIM + Curcumin).
    This is a propriety blend of DIM (a metabolite of Indole3 Carbinol), Curcumin, and a special herbal blend called Bioperine, used to enhance its absorption. I give this to women that want to improve their protection from breast cancer and to women who cannot tolerate Indole 3 Carbinol (because it creates too much flatulence).
    For general protection, I recommend 1 pill a day, but in individual cases I would give much more.
  4. SGS (sulforaphane glucosinolate). In addition, a new broccoli extract called SGS has promising scientific data supporting its protection from cancer formation. If I was asked the difficult question, "which one of the 3 would you use?" I would say that unless you have breast cancer or have a strong family history of breast cancer. I probably would take SGS because it has many wider benefits to fight cancer in the body. I use 1 pill a day and in an individual case basis, I would suggest much more.
  5. Bioidentical Estrogen. In my clinical experience, women who take bioidentical estrogen also increase their level of 2 Hydroxy estrone, the substance that protects against breast cancer.

Note: DIM and Indol3 Carbinol should not be used to simply, indiscriminately reduce 16 Hydroxy estrone - neither 16 Hydroxy estrone nor 4 Hydroxy estrone are "bad" metabolites. They perform many important functions critical to women's overall wellness, including the building of bone by 16 Hydroxy estrone. In fact, Because 16 Hydroxy estrone builds bone as it increases the risk of breast cancer, it may explain why women with breast cancer often have significantly stronger bones, and women with osteoporosis have significantly lower incidence of breast cancer. Reference Nos. 12, 13, & 14.
The point made in this section is that when they occur in less-than-ideal ratios where they do not properly balance one another, they should be balanced nutritionally.

** If you are interested in the testing I described above, the panel is called 'the Estrogen Metabolism index' and you can contact Genova Diagnostics at 828-210-7312 or 1.800.522.4762. For more information see their website: www.GDX.net

The second test group I use are for a gene defect called Single Nucleotide Polymorphisms (SNPs, pronounced snips), which provides another perspective on the connection between environmental pollutants and breast cancer. Knowing whether you have SNPs is important for two reasons:

  1. So you can identify your personal risk for breast cancer and learn about your options for preventing it, and
  2. If you have or have had breast cancer and were treated and cured, this testing will allow you to identify some of the reasons that you developed breast cancer in the first place. This is important because so many women who are in breast cancer remission develop breast cancer anew after many years, because the root cause of their initial breast cancer was never addressed. Understanding this root allows women with breast cancer to directly confront and take steps to resolve some of this cause.

The SNPs test checks for defects in sites called 1B1 and 1A1, which protect you from common environmental pollutants called Polycyclic aromatic hydrocarbons (PAHs) - created by the burning of organic materials by cars, barbeques, cigarettes and similar sources. Women who have defects in these sites are generally the ones who are more sensitive to cigarette smoke and fumes that come from boats and cars. If you discover that you have this type of SNP defect, listen to your body's sensitivities; try to avoid riding in a convertible, sitting in a street-side café, standing by a working barbeque, using an open fire place, smoking or spending time near smoke - you are far more sensitive to the toxic effects of these activities.

In every day life, it is often not possible to avoid some or all of these situations, and because of this, women with this SNPs defect have a higher free-radical load than others. For this reason, if you discover that you have this SNPs defect, have your free-radical load checked often and offset it by adding fresh fruit, vegetables and antioxidant supplements to your diet.

In addition, the 1B1 site creates an increased production of 4 Hydroxy Estrone, one of the metabolites that may significantly increase breast cancer. Reference Nos. 15, 16, 17, & 18. Women with this SNP have a 220% increased risk of developing breast cancer. Reference No. 19.

The chapter in my book The Natural Superwoman on DHEA discusses how this hormone protects against breast cancer. This section will explain one of the ways DHEA does this: by suppressing the production of 4 Hydroxy Estrone. Reference No. 20. For this reason, I strongly encourage women who have SNP 1B1 to supplement DHEA.
Supplement DHEA:
Women usually tolerate 5-25mg of DHEA. I recommend you start no higher than 5mg and take with food, preferably with protein. You should increase your dose every 2 weeks until you have signs of excess of DHEA.
How will you know if you have excess DHEA?.... you will feel agitated, nervous, you may have oily skin, you may experience breakouts, you may be unable to sleep, and rarely depression. For more information DHEA please see the corresponding chapter my book The Natural Superwoman. DHEA is available pills. The pills come in 5mg, 10mg, 25mg, 50mg. Some people cannot tolerate even 5 mg.
Supplement Indole 3 Carbinol
Supplement Estrogen Support (DIM)

Both I add to enhance 2Hydroxy Estrone that will protect the breast from the overproduction of 4Hydroxy Estrone.
Chlorophyllin Protective Support from Environmental & Dietary Toxins People with defects in 1B1 and 1A1 are more exposed to environmental toxins and this supplement is a good way to be protected. I recommend 2-6 pills depending upon how much environmental pollution I am exposed to. For example, if I am in Las Vegas for a conference I take up to six capsules 4 times a day. If I am on a beach in Hawaii, I don't take any at all.

Another aspect of this second testing group looks for SNPs in Catechol-O-methyl transferase (COMT), an enzyme that breaks down and deactivates 4 Hydroxy Estrone, the metabolite that increases breast cancer. It is important to confirm that your COMT is functioning well, as women rely on this enzyme for overall breast cancer prevention. Up to 25% of the female population has a SNP defect in COMT. Women with COMT defects have a significantly increased risk of developing breast cancer - a 70% increase if this defect was passed down from only one parent, and a 220% increase if the defect was passed down by both.

Women who are the highest risk for SNPs defects are those who are overweight and menopausal. Reference Nos. 21 & 22. If, in addition to your COMP defect, you are also Folic Acid deficient, you are at a greater risk for developing breast cancer. Reference No. 23.

SNPs testing must always be done in conjunction with your physician. If your physician is not familiar with SNPs, how to test for it, or what how to address this condition, the lab that provides the SNPs test gladly will arm your doctor with educational materials upon request.

Nutritional Supplements to Support COMP Defects
In my practice, I recommend the following supplements for women who have a COMP defects:

SAMe. I recommend 400 mg, twice daily, 30 minutes before breakfast on an empty stomach, and in the afternoon before dusk.

Folic Acid. I recommend 10mg, once daily, with food.

Methylcobalamin B-12. I recommend you chew 5 mg, twice daily, with food.

Vitamin B6 & Spectra B (Complex). I recommend 100-200 mg, 1 pill a day of B-6 and 50 mg, 1-2 pills of B-Complex, daily, with food. Spectra B (complex) is a high-potency vitamin B Complex with mineral co-factors, zinc, manganese, and chromium. Spectra B supports optimal B Vitamin metabolism and promotes healthy mitochondrial function, glucose regulation, and adrenal response.

I encourage you to use the information offered by these tests to seize the opportunity to actively, significantly reduce the risks associated with your condition.

The final aspect of the SNP testing group checks for SNPs in liver system, specifically, glutathione s transferase (GST), a family of liver enzymes that further protect us from pollutants and toxins. Reference No. 24.

The GST SNP defect alone increases your breast cancer risk by 50%. Reference Nos. 24 & 25. A combination of SNPs in COMP and GST further increases this risk. Reference No. 26.

Nutritional Supplements to Support GST Defects
In my practice, I recommend that women with the GST SNP defect enhance their consumption of antioxidant foods and supplements, in addition to the following three direct treatments to be used separately or together, depending on how many of your GST enzymes have SNPs:

N-acetyl cysteine (NAC). I recommend 600 mg, twice daily, between meals.
It is a powerful free radical scavenger and thus supports the body's natural defense system.

Recancostat increases your glutathione level. I recommend that patients take one pill twice daily, with food. This is an exclusive patentec formula that enhances and maintains the level of glutathione in your body.

Lipoic Acid. It is essential to add Lipoic Acid to either NAC or Recancostat. I currently use the following 2 forms of Lipoic Acid:

ALA 400CR (Alpha Lipoic Acid) this is an advanced formula of Lipoic Acid. Take 1pill of 400mg twice a day. ALA 400CR regenerates vitamins C, E Coq10, and glutathione, helping to destroy free radicals and thereby reducing oxidative stress and has been enhanced with biotin for optimal blood glucose utilization.
Stabilized R Lipoic Acid Supreme. This supplement is in the form of Potassium R-Lipoate, the preferred and only commercially available stable form of R-Lipoic acid.
I recommend 2 pills twice a day.

Paleo Cleanse (functional detoxification powder). In my practice I recommend a product called Paleo Cleanse. Use this unique cleansing protein mix twice a day. It can also be used as a meal replacement. I recommend you blend 2 scoops paleo cleanse with 2 teaspoons of coconut oil and ¼ cup of berries with water. As the body detoxifies you may become fatigued. At that point, use the minimum amount of paleo cleanse that does not cause any fatigue side effects and gradually increase the dose to 2 scoops.

Chlorophyllin Protective Support from Environmental & Dietary Toxins
People with defects in 1B1 are more exposed to environmental toxins and this supplement is a good way to be protected. I recommend 2-6 pills depending upon how much environmental pollution I am exposed to. For example, if I am in Las Vegas for a conference I take up to six capsules 4 times a day. If I am on a beach in Hawaii, I don't take any at all.

Medical journals echo the importance of testing for all of the conditions described above in order to better understand your personal risk of developing breast cancer for the first time, or as a recurrence. Reference No. 36. The good news about all of these tests is that they are not expensive to administer and the remedies to the conditions they reveal are nutritionally-based, safe and nontoxic. For this reason, I encourage you to be proactive. Don't settle for "no" - educate your own physician, if necessary, and encourage your friends and loved ones to do the same.

***The second set of testing is called 'the Estrogen Metabolism sub panel of EstroGenomic Profile'. To order the second set of SNPs test, contact Genova Diagnostics at 828-210-7312 or 1.800.522-4762. For more information see their website: www.GDX.net

References for the section:
Genetic and Individual Risk Factors for Breast Cancer

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  36. Fertil Steril. 2004 Jul;81 (1):132-7. Clemens B et al.

Genetic/Genomic Personal Breast Cancer Risks and
Diet, Nutritional & Hormonal Supplements for protection

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