Four
Major Health Problems in Women
Depression in Women
Unipolar major depression is the most common psychiatric condition
seen by primary care physicians, and most epidemiologic studies have
shown that it is more prevalent in women than in men. Depressive
disorders affect approximately 20 million American adults each year.
They will affect one in eight individuals over the course of a lifetime,
and are twice as common in women as in men. Depressive disorders
can begin at any age, but they most commonly begin in the 20s and
30s. In this country, depression is diagnosed in two women for every
man, on average.
(Blazer DG, Kessler RC, McGonagle KA, Swartz MS. The prevalence and
distribution of major depression in a national community sample: the
National Comorbidity Survey. Am J Psychiatry. 1994; 151: 979-986.)
(Weissman MM, Olfson M. Depression in women: implications for healthcare
research. Science. 1995; 269: 799-801.) (Weissman MM, Bland R, Joyce
PR, Newman S, Wells JE, Wittchen H-U. Sex differences in rates of depression:
cross-national perspectives. J Affect Disord. 1993; 29: 77-84.)
The sexual difference in rates of depressive disorders is not apparent
in childhood but is evident by the age of 12 and is well established
by the age of 15. The reason for this gender difference is not so clear.
Some attribute the differences to women in our society having higher
rates of victimization, role conflicts, internalization of stress,
and a greater tendency toward low self-esteem. Others counter that
it has its basis in neurobiologic and endocrinologic differences. Both
schools of thought are probably at work, and we know that there are
periods of hormonal change that tend to coincide with particularly
vulnerable times for the occurrence of depressive disorders such as
adolescence, premenstrual, pregnancy, postpartum, miscarriage, perimenopause
and postmenopause.
1. Psychotherapy
Both interpersonal therapy and cognitive/behavioral therapy are effective
against depression, although women with severe depression may not
respond as well as men to cognitive-behavioral therapy.
2. Lifestyle changes
Cigarette smoking can be a significant factor in depression. Smokers
have more symptoms of anxiety and depression than nonsmokers. Major
depressive disorders are more common among smokers than nonsmokers.
Conversely, for some susceptible women, nicotine functions as an
antidepressant and nicotine withdrawal can produce depressive symptoms.
Several studies have explored the connection between caffeine intake
and depression. (Gilliand K and Bullick W. Caffeine: A potential
drug of abuse. Adv Alcohol Subst Abuse 3:53-73, 1984.) People prone
to depressive moods or anxiety states tend to be especially sensitive
to caffeine.
Many studies have clearly indicated that exercise has significant antidepressive
effects. There have been at least 100 studies where an exercise program
has been used to treat depression. In an analysis of the 64 studies
done prior to 1980, exercise was shown to relieve depression and improve
self-esteem and work habits. (Folkins CH, Sime WE. Physical fitness
training and mental health. Am Psychologist 36: 375-88, 1981.)
Subsequent studies since 1980 have further demonstrated, with even
greater scientific confirmation, that regular exercise is an important
antidepressant. Some of these studies concluded that exercise can be
as effective as pharmaceutical antidepressants and psychotherapy. (Martinsen
EW. The role of aerobic exercise in the treatment of depression. Stress
Med 3:93-100, 1987.)
3. Folic acid
In studies of depressed patients, one third of them have been shown
to be deficient in folic acid. (Crellin R, Bottiglieri T and Reynolds
EH. Folates and psychiatric disorders. Clinical potential. Drugs 45: 623-36, 1993.)
Depression is also the most common symptom of a folic acid deficiency:
800 mcg per day of folic acid should be adequate to prevent deficiencies
although much higher doses may be needed for a treatment dose.
4. S-Adenosylmethionine (SAM)
S-Adenosylmethionine (SAM) is formed in the body by combining the amino
acid methionine with adenosyl-triphosphate (ATP). SAM is required
for the manufacture of many neurotransmitters, including serotonin.
It improves binding of neurotransmitters to receptor sites, which
then will cause an increase in serotonin, resulting in significant
improvement in depression, providing perhaps the most effective natural
antidepressant to date. (Janicak P, et al. Parenteral S-adenosylmethionine
in depression: A literature review and preliminary report. Psychopharmacology
Bulletin 1989;25:238-241.)
5. St. John's wort (Hypericum perforatum)
St. John's wort (Hypericum perforatum) is the most talked about
herbal antidepressant to date: 25 controlled studies have investigated
the antidepressive effectiveness of hypericum extracts for mild to
moderate depression. A total of 1592 cases have been included in those
25 trials. (Harrer G and Schulz V. Clinical investigation of the antidepressant
effectiveness of Hypericum. J Geriatr Psychiatry
Neurol 7 (Suppl 1):
S6-8, 1994.)
Generally, the German studies use a preparation of .3% hypericin with
dosages from 300 to 900 mg of the standardized extract daily. The results
are generally in the range of 65%-70% effectiveness for mild to moderate
depression which is only slightly less than placebo controlled studies
on fluoxetine hydrochloride (Prozac).
Obesity
Obesity is characterized by an excess of body fat and is a serious
and pervasive health problem in America today, particularly among
women. The prevalence of overweight in women is defined as a body
mass index (BMI) of 25 to 29.9 and obesity as a BMI equal to or greater
than 30.
More than half of American women and men are overweight or obese. Although
about 9% more men than women between the ages of 20 and 80 have a BMI
of 25 or greater, more women than men are seriously overweight, qualifying
as obese, having a BMI of 30 or greater; 25% of US women are obese
with higher percentages for minority women, (36.7% non-Hispanic African
American women and 33.3% Mexican American women). The prevalence of
Caucasian women who are overweight or obese, ranges from 18% among
25 to 34 year olds to 35% among 55 to 64 year olds. Sixty percent of
African American women aged 45 to 65 are either overweight or obese.
The incidence of obesity is increasing in America at a disturbing and
alarming rate. Since 1980, obesity in both men and women has increased
by over 50%. It is estimated that 33% to 40% of American women are
trying to lose weight at any given time.
Overweight and obesity are linked to numerous health risks and consequences.
Increasing weight is associated with increased mortality, diabetes,
hypertension, high cholesterol, heart attacks, osteoarthritis and infertility.
As the percentage of weight increases, mortality increases. Women who
have the lowest mortality in the US are women who weigh at least 15%
less than the average weight for other women her age.
1. Nutrition
The basic message is to improve the quality of food choices, and reduce
the calories. Whether it's a lower carb and higher protein
diet, or a lower fat and higher complex carbohydrate diet, it's
important to find an approach that works for your physiology, one
that you can live with, and one that is based on basic principles
of healthier food choices. Support, coaching, counseling, education
and the advice of a qualified and respectful practitioner are also
often needed for success.
2. Exercise
Exercise is one of the most powerful lifestyle changes we have available
to us. Regular exercise is needed to increase the metabolic rate,
burn calories, increase muscle mass, improve fitness, and reduce
the risk of many health problems associated with being overweight.
Consult your physician if you are not currently on an exercise program
to get medical clearance if you have health problems or are over
40. Keys to successful exercise programs are selecting an activity
you enjoy, make it fun, do it at least 30 minutes four times weekly,
stay motivated, and get some instruction on maximum heart rates and
weight training. It also turns out that individuals who exercise
in the morning are more successful with staying on their exercise
program.
3. A mental shift
Understanding our relationship with food, body image issues, emotional
and psychological life events that continue to have impact on our
lives, and how we respond to stressors, are all potentially influential
on our eating habits and patterns. Individual counseling, support
groups, self-help programs, and organized programs are possible approaches
to help us make a shift and truly create a holistic approach to weight
management.
4. 5-HTP
Low serotonin levels and a decreased enzyme that converts our body's
tryptophan to 5-hydroxytryptophan (5-HTP) and subsequently to serotonin
may be related to overeating. Three studies using 5-HTP in overweight
women have been conducted to assess its effects on weight loss. (Deci
F, et al. The effects of oral 5-HTP administration on feeding behavior
in obese adult female subjects. J Neural Transm 1989;76:109-117.) (Cangiano
C, et al. Effects of 5-HTP on eating behavior and adherence to dietary
prescriptions in obese adult subjects. Adv
Exp Med Biol 1991;294:591-593.)
(Cangiano C, et al. Eating behavior and adherence to dietary prescriptions
in obese adult subjects treated with 5-HTP. Am
J Clin Nutr 1992;56:863-867.)
Results have shown that 5-HTP is able to reduce caloric intake, promote
weight loss, and decrease appetite. Weight loss ranged from 3.5 to
10.3 pounds. Recommended doses are 50-100 mg 20 minutes before meals
for the first two weeks, then double the dosage if weight loss is less
than 1 pound.
5. Chromium
One of the goals for enhancing weight loss is to increase the sensitivity
of our cells, especially our fat cells, to the hormone insulin. Insulin
plays a key role in maintaining good blood sugar levels and stimulating
thermogenesis (heat production and the burning of calories). Chromium
plays a very important role in increasing the body's sensitivity
to insulin, and thus adequate thermogenesis. Supplemental chromium
has been shown to lower body weight and increase lean body mass.
(McCarthy M. Hypothesis: Sensitization of insulin-dependent hypothalamic
glucoreceptors may account for the fat-reducing effects of chromium
picolinate. J Optimal Nutr 1993;21:36-53.)
Recommended doses are 200-400 mcg three times daily.
Chronic Fatigue Syndrome
Chronic fatigue syndrome (CFS) is a disorder without a clear etiology
and poorly understood pathophysiology. It consists of prolonged or
recurring fatigue with an array of other possible symptoms including
flu-like symptoms, myalgia, muscle weakness, arthralgia, low grade
fever, sore throat, headache, sleep problems, swollen lymph nodes,
and cognitive dysfunction.
CFS appears to occur more frequently in women than in men. Most commonly,
the onset is between 20 and 40 years old, the majority of patients
are middle class and people in the helping professions such as nurses,
doctors and teachers seem to be particularly at risk for acquiring
CFS.
Since the etiology and pathophysiology are still poorly understood,
we can offer only some insights, possible mechanisms and hypotheses.
Sleep disturbance appears to be highly correlated with chronic fatigue
syndrome. But other mechanisms include a dysfunction in the hypothalamus
and pituitary glands, a deficiency of corticotropin releasing hormone
resulting in adrenal insufficiency, immunologic dysfunction, exposure
to the Epstein Barr virus, dysfunction of the mitochondria in cells,
muscle dysfunction, or a mind/body disorder. Some have proposed chronic
candidiasis, intestinal permeability and environmental sensititivities/toxicity
as underlying causes as well. More likely, this is a multifactorial
problem and no one cause accounts for all cases of CFS. 1. Rhodiola
The folklore surrounding rhodiola led to the first investigations in
its phytochemistry in the early 1960s, when scientists identified
adaptogenic compounds in its roots. These adaptogens, (believed to
help the body adapt to stress by supporting the adrenal glands and
endocrine system), as well as the antioxidant and stimulating compounds
that were later discovered in rhodiola, are responsible for its medicinal
properties.
This herb's effects on the levels and activity of serotonin,
dopamine, and norepinephrine, neurotransmitters found in different
structures in the brain, influences the central nervous system and
helps the body adapt to stress. It may be that rhodiola inhibits the
breakdown of these chemicals and facilitates the neurotransmitter transport
within the brain.
(Stancheva S, Mosharrof A. Effect of the extract of Rhodiola rosea
L. on the content of the brain biogenic monamines. Med
Physiol 1987;40:85-87.)
In addition to its impact on the central nervous system, rhodiola appears
to increase the chemicals that provide energy to the muscle of the
heart and to prevent the depletion of adrenal hormones induced by acute
stress. (Maslova L, Kondrat'ev B, Maslov L, Lishmanov I. The
cardioprotective and antiadrenergic activity of an extract of Rhodiola
rosea in stress. Eksp Klin Farmakol 1994;57:61-63. (Article in Russian.))
Historically, Rhodiola was observed to act in humans as a tonic, increase
attention span, memory and work performance. Two human studies were
able to show that individuals with fatigue, irritability, insomnia
and decline in work capacity responded favorably to a Rhodiola dose
of 50 mg three times a day. (Krasik E, Morozova E, Petrova K, et al.
Therapy of asthenic conditions: clinical perspectives of application
of Rhodiola rosea extract. In. Proceedings
Modern problems in psycho-pharmacology. Kemerovo-city, Russia: Siberian
Branch of Russian Academy of Sciences:
1970.p. 298-330.) (Krasik E, Petrova K, Rogulina G, et al. New data
on the therapy of asthenic conditions (clinical prospects for the use
of Rhodiola extract). Proceedings of All-Russia
Conference: Urgent Problems in Psychopharmacology 1970 May 26-29. Sverdlovsk, Russia:
Sverdlovsk Press; 1970.p. 215-7.)
In another human study, Rhodiola alleviated fatigue, irritability,
distractibility, headache and weakness in 64% of the cases. (Krasik
E, Petrova K, Rogulina G, et al. New data on the therapy of asthenic
conditions (clinical prospects for the use of Rhodiola extract). Proceedings
of All-Russia Conference: Urgent Problems in Psychopharmacology 1970
May 26-29. Sverdlovsk, Russia: Sverdlovsk Press; 1970.p. 215-7.)
In a study of students, physicians and scientists, Rhodiola was given
for 2-3 weeks beginning several days before intense intellectual work
such as final exams. (Spasov A, Wikman G, Mandrikov V, et al. A double-blind,
placebo-controlled pilot study of the stimulating and adaptogenic effect
of Rhodiola rosea SHR-% extract on the fatigue of students caused by
stress during an examination period with a repeated low-dose regimen.
Phytomedicine 2000;7(2):85-89.)
The extract improved the amount and quality of work and prevented decreased
performance due to fatigue.
Several studies have shown that Rhodiola increased physical work capacity
and significantly shortened the recovery time between bouts of intense
exercise. In one study, work capacity was increased by 9% and the pulse
slowed to normal much more quickly. (Saratikov A, Krasnov E. Chapter
III: Stimulative properties of Rhodiola roseas. In: Saratikov A, Krasnov
E, editors. Rhodiola rosea is a valuable medicinal
plant (Golden Root).
Tomsk, Russia: Tomsk State University; 198.p. 69-90.)
Biathlon athletes given Rhodiola also have shown statistically significant
increased shooting accuracy, less arm tremor and better coordination.
Improved recovery time, strength, endurance and cardiovascular measures
were also significantly better in those who took Rhodiola. We're
not really sure what is responsible for these effects, but animal studies
suggest that Rhodiola increases essential energy metabolites in the
muscle and brain cells. It may also increase metabolism of fats.
Many individuals may see an improvement in their mood, energy level,
mental capacity, memory, stamina and/or endurance within two to six
weeks.
2. Licorice
The properties of licorice that may have some bearing in CFS are its
immunomodulatory activity, antiviral activity, influence on steroid
metabolism, and anti-inflammatory activity. A brief summary of some
key findings are helpful to understand the role of licorice in CFS:
Glycyrrhizin (GL) and glycyrrhetinic acid (GA) are active constituents
of licorice. Licorice and GA helped the recovery of total leucocyte
count, lymphocyte count and cellular immunity in irradiated mice.
(Lin I, Hau D, Chen K, et al. Chin Med J 1996;109(2):138-142.)
GL has been shown to be particularly active against several viruses,
including human immunodeficiency virus. (Nakashima H, Matsui T, Yoshida
O et al. Jpn J Cancer Res 1987;78(8):767-771.) (Ito M, Nakashima H,
Baba M et al. Antiviral Res 1987;7:127-137.)
Glycyrrhizin also induces interferon production but GA only has weak
activity. (Abe N, Ebina T, Ishida N. Microbiol
Immunol 1982;26(6):535-539)
Both GL and GA exert influence on human steroid hormone function even
though their intrinsic hormonal activities are low. GL inhibits the
metabolism of corticosteroids and thus potentiates the effect of cortisone
and adrenocorticotrophin hormone. (Kumagai A, Yano S, Otomo M et al.
Endocrinol Jpn 1957;4(1):17-27.) Many other specific effects may have
a viable role in treating CFS through its aldosterone-like effects,
potentiating the activity of cortisol – and increasing the anti-inflammatory
activity of cortisol.
3. Siberian ginseng
The actions of Siberian ginseng can be summarized as an adaptogen (assisting
the body to counteract and adapt to stress), immunomodulator, and
tonic. The majority of animal studies have demonstrated the ability
of Siberian ginseng to act as an adaptogen under many different stressful
conditions. In the original animal research, Siberian ginseng increased
stamina in rats by up to 70%. (Fulder S. The
root of being: ginseng and the pharmacology of harmony. Hutchinson, London, 1980. pg 137.)
A preparation of Siberian ginseng has been shown to increase the phagocytosis
of Candida albicans by 30%-45%. (Wildfeuer A, Mayerhofer D. Arzneim-Forsch 1994;44(3):361-366.) Given the possible involvement of Candida in CFS,
this may be an important issue in at least some patients. In relationship
to general immune function, Siberian ginseng has shown in one clinical
trial significant improvements in a variety of immune system parameters
including an increase in helper T cells and an increase in natural
killer cell activity. (Bohn B, Neve C, Birr C. Flow-cytometric studies
with Eleutherococcus senticosus extract as an immunomodulatory agent.
Arzneimittel-Forsch 1987;1193-1196.)
Perhaps most significantly, Siberian ginseng has been used in Traditional
Chinese Medicine for centuries. They believed that its regular use
increased longevity, improved general health and restored memory.
4. Panax ginseng
Panax ginseng, also called Korean or Chinese ginseng is perhaps the
most famous medicinal plant of China. It has been used in traditional
Chinese folk medicine for a vast array of problems and syndromes
that includes fatigue, memory problems, insomnia, as a stimulant,
and the promotion of longevity. The mental and physical anti-fatigue
properties of ginseng have been demonstrated in both animal studies
and randomized clinical trials in humans. (Hikino H. Traditional
remedies and modern assessment: The case of ginseng. In: The
Medicinal Plant Industry. CRC Press, Boca Raton, Fl, 1991:149-166.) (Shibata
S, et al. Chemistry and pharmacology of Panax. Econ
Med Plant Res 1985;1:217-284.) (Hallstrom C, Fulder S, Carruthers M. Effect of
ginseng on the performance of nurses on night duty. Comp
Med East West 1982;277-282.) (D'Angelo L, et al. A double-blind, placebo
controlled clinical study on the effect of a standardized ginseng
extract on psychomotor performance in healthy volunteers. J
Ethnopharmacol 1986;16:15-22.)
Effects include increasing physical and mental performance, increasing
the time to exhaustion under tests of exertion, improving energy metabolism
and sparing glycogen utilization in exercising muscle. Ginseng also
possesses immunostimulating activity and has the ability to enhance
antibody responses, cell-mediated immnity, natural killer cell activity,
the production of interferon, and phagocytic functions. (Jie Y, Cammisuli
S, Baggiolini M. Immunomodulatory effects of Panax ginseng C.A. Meyer
in the mouse. Agents Actions 1984;15:386-391.) (Gupta S, et al. Panax:
A new mitogen and interferon producer. Clin
Res 1980;28:504A.)
Ginseng's ability to treat fatigue and stress has been well documented
in students, nurses and athletes. While improving the mental and physical
performance in these individuals is different than treating patients
with CFS who are hypofunctioning at baseline, it is none the less indicated
as a general tonic in debilitated and weakened individuals.
5. Stress, sleep, rest
The four plants discussed are key ingredients to an overall strategy
but their success is most likely influenced by attention to reducing
stressors, increasing coping behaviors, rest, enhancing sleep, supporting
moods and the nervous system, exercise that does not exacerbate the
symptoms, and other immune modulating, adrenal supportive and symptom-specific
therapies. Recovering from CFS will require time, compassion, diligent
efforts and patience.
Breast Cancer Prevention
Breast cancer prevention is important for all women, and more assertive
prevention strategies become of vital importance for women with family
history of a mother, daughter or sister with breast cancer, are significantly
overweight, or who drink more than one drink of alcohol per day.
This may include adopting dietary habits that have been scientifically
associated with lower rates of breast cancer, changes in lifestyle
habits that reduce the risk (less alcohol, more exercise, less stress),
reducing body weight, reducing exposure to estrogens (hormone replacement
therapy, pesticides, some plastics, chlorinated organic compounds)
and radiation, anti-estrogen pharmaceutical options and surgical
options. Although more research is needed, there are meaningful dietary
considerations, nutrients and herbs in supplement form that can reduce
the risk of breast cancer: fiber, dietary fat, fish, fruits, vegetables,
soy, green tea, fish oils, flax seeds, vitamin C and D. Breast Care
There are three important methods used to detect breast changes: breast
self exam, mammography and thermography, and regular examinations
by a health professional. No one method of detection is perfect,
but the three work together. Each method has advantages and weaknesses.
As science and medicine move forward, new methods of breast cancer
detection will evolve and improvements will be made. Consult with
your health care practitioner about frequency of mammograms.
Nutrition
Fats
Dietary fat has been the attention of much controversy in regard to
its impact on breast cancer. A review of some of the pertinent findings
will be helpful. About 30 years ago, the fat intake of many countries
was plotted on a graph against breast cancer rates.
(Carroll K, et al. Dietary fat and mammary cancer. Can
Med Assoc J 1968;98:590-593.) With few exceptions, the more dietary fat that individuals
in that society consumed, the higher the risk of breast cancer. Ten
out of ten international studies looking at large differences in fat
intake from one country to another continued to confirm this relationship
between higher dietary fat levels and higher rates of breast cancer.
By and large, the women who live in cultures with the lowest fat intake
like Japan and Thailand, have the lowest rates of breast cancer. Women
in the Middle East who have medium rates of breast cancer have medium
amounts of fat in the diet. Women in Europe and North America with
the highest intake of dietary fat have the highest rates of breast
cancer. However, there have been conflicting reports and in 1992, the
Nurses' Health Study group found no such link. (Willett W, et
al. Dietary fat and fiber in relation to risk of breast cancer. JAMA 1992;268:2037-2044.)
A follow-up in 1999 also found no protective benefit from lower fat
diets. (Holmes M, Hunter D, Colditz G, et al. Association of dietary
intake of fat and fatty acids with risk of breast cancer. JAMA 1999;281:914-920.)
Surprising to many, they saw no increased risk of breast cancer with
increased intake of animal fat, polyunsaturated fat, saturated fat,
or trans-unsaturated fats. They also found no evidence of decreased
risk of breast cancer with increased intake of vegetable fat or monounsaturated
fats. However, the capacity to examine breast cancer risk at the extremes
of fat intake is limited by the small proportion of women in those
groups and a greater probability of misclassification of dietary intake
in these categories.
Increased olive oil consumption was associated with a lowered risk
of breast cancer in Greek women by 25%. (Trichopoulou An, Katsouyanni
K, Stuver S, et al. Consumption of olive oil and specific food groups
in relation to breat cancer risk in Greece. J
NCI 1995;87(2):110-115.)
A recent survey was completed in Sweden studying 61,471 women from
1987 to 1990. (Wolk A, et al. A prospective study of association of
monounsaturated fat and other types of fat with risk of breast cancer.
Arch Intern Med 1998;158(1):41-45.) They reported that monounsaturated
fat reduced the risk of breast cancer by 45 percent. They credited
the effects of canola oil and olive oil, the oils highest in oleic
acid. To achieve optimum protection, 2 tablespoons per day is recommended.
It is still thought by most nutrition experts that one of the best
ways to reduce the risk of breast cancer is to consume more omega-3
fatty acids. The protective effect of omega-3 fatty acids was first
observed in Greenland Eskimo women who seemed to have a strikingly
low rate of breast cancer. These women have a diet that is probably
the highest in omega 3 fats of any women to date. Laboratory, animal
and epidemiological studies almost universally show reductions in breast
cancer associated with high omega 3 fish oils. Fish that are generally
available and contain high amounts of omega 3 oils include salmon,
tuna, halibut, mackerel, sardines and herring.
Fiber
Fiber has been underrated as a breast cancer prevention strategy. A
low fat diet, rich in insoluble fiber, has been shown to decrease
the circulation of estrogens between the intestines and the liver
and decrease plasma estrogen levels, thereby potentially reducing
the risk of hormone-related cancers. Seeds and whole grains contain
significant amounts of lignans. Once lignans are absorbed, they interfere
with estrogenic activity and have a weak estrogen blocking effect
on the breast. Vegetarians eat more fiber and more lignans, than
do non-vegetarians and vegetarians excrete a high level of lignans.
Vegetarians with a high lignan diet do in fact appear to have lower
rates of breast cancer.
Cabbage family foods
There are some specific vegetables that may have a very important role
in reducing the risk of breast cancer. Cabbage family foods (broccoli,
cauliflower, cabbage, Brussel sprouts), are high in compounds called
indoles, or specifically indole-3-carbinol (I3C). I3C has been reported
to affect the metabolism of estrogen in a way that might protect
against breast cancer. (Michnovicz J, Bradlow H. Altered estrogen
metabolism and excretion in humans following consumption of indole-3-carbinol.
Nutr Cancer 1991;16:59-66.)
A recent study in Sweden, compared the diets of 2,832 postmenopausal
women aged 50-74 years diagnosed with invasive breast cancer with 2,650
postmenopausal women of the same age with no history of breast cancer.
Women who consumed an average of 1-1/2 servings of cabbage family vegetables
each day had a 25% decreased risk of breast cancer. (Terry P, Wolk
A, Persson I, et al. Brassica vegetables and breast cancer risk. JAMA 2001;285:2975-7.)
Soy
Perhaps no other food has been surrounded by as much controversy as
soy, especially for the woman who has or has had breast cancer. Part
of the confusion is that women and often even their physicians, think
that there is estrogen in soy. However, there is not. Soy does contain
a group of compounds called phytoestrogens. The phytoestrogens in
soy are called isoflavones and the dominant isoflavones are genistein
and daidzein. These are not estrogen, but have the ability to selectively
function in some tissues in a weak estrogenic type manner, while
in other tissues, actually block the effects of estrogen. What has
been confusing is how do the soy isoflavones function in the breast?
It may be different in different hormonal environments. Perhaps differently
in premenopausal women than in post-menopausal women.
The clearest data shows that women who eat soy starting at a young
age in adolescence can clearly reduce the risk of breast cancer later
in life. Adult women may be able to reduce their risk by adding soy
to the diet both before or after menopause but not all studies show
this. The reassuring part is that no studies show that eating soy can
increase the risk of breast cancer. What is confusing is what to do
if you are a breast cancer survivor. Most the evidence points to the
safety of soy, even for those women who have had breast cancer, however
one can find some conflicting reports. For example, perhaps low dose
is stimulatory to breast cancer cells whereas higher doses are inhibitory.
Practically speaking, a higher dose would be greater than 70 mg of
soy isoflavones per day.
There are many important mechanisms by which soy foods would appear
to lower the risk of breast cancer. Women who are given high soy diets
have lower blood levels of estrogen. Soy foods also contain antioxidants
and enzyme inhibitors that can inhibit malignant cell formation and
division. The genistein in soy also is anti-angiogenic which means
that it can limit the blood supply to a tumor.
The most respected expert researchers on soy, advise breast cancer
patients that a moderate amount of soy in the diet that is consistent
with the Asian diet is probably safe. However, for those women on Tamoxifen,
soy should be avoided. The reason is that there has been conflicting
research: some show that soy interferes with the anti-estrogenic effect
of estrogen and others show that soy augments the anti-estrogenic effect
of Tamoxifen in women with ER + breast cancers. I would add that women
who are on aromatase inhibitors should also avoid soy until we have
further information.
I know that there is much information out there on the pros and cons
of soy and not all of it is either accurate or helpful, let alone conflicting.
I encourage women to look for reliable sources of information with
scientific citations and resources. The best review of the scientific
literature I have seen on the subject can be found in the (Journal
of Nutrition 2001; 131:3095S-3108S. Authors Mark Messina and Charles
Loprinzi)
Alcohol
Most but not all studies report women who drink alcohol have a higher
risk of breast cancer compared with women who do not drink. In 1988,
researchers conducted a meta-analysis of 16 previous studies. Researchers
found that two drinks per day were associated with a 40% increased
risk of breast cancer in retrospective studies. When they looked
at prospective studies, they found that two drinks per day were associated
with a 70% increase in risk. They also found that in the prospective
studies, the more the women drank, the higher their risk. A 20% increase
was found in women who averaged half a drink per day.
Antioxidants
Individual dietary nutrients may be associated with a reduced risk
of pre and postmenopausal breast cancer. Dietary sources of vitamin
C, carotenes, selenium and vitamin D may be important nutrients to
consider in prevention strategies. If you collect the results together
of 12 breast cancer/nutrition studies, the women consuming the most
vitamin C were found to have a 16% reduction in risk of premenopausal
and a 37% reduction in the risk of postmenopausal breast cancer.
(Howe G, et al. Dietary factors and risk of breast cancer: combined
analysis of 12 case-control studies. J Natl
Cancer Inst 1990;82:561-569.)
It is difficult to know if the protective association is the result
of other properties and ingredients found in the fruits and vegetables,
which are high in vitamin C, or the vitamin C specifically. Fruit,
the best dietary source of vitamin C, by itself has been found to have
a link with breast cancer protection. However, The Nurses' Health
Study could not find a link between vitamin C in food or supplements
and breast cancer prevention.
Another valuable antioxidant is vitamin A, which occurs as retinol
and beta-carotene. There is evidence that women who eat more beta-carotene
(Rohan T, et al. A population-based case-control study of diet and
breast cancer in Australia. Am J Epidemiol 1988;128:478-479.) or retinol
(Graham S, et al. Diet in the epidemiology of breast cancer. Am
J Epidemiol 1982;116:68-75.) have a lower risk of breast cancer. Both may be potentially
able to reduce cancer risk, but most evidence suggests that beta-carotene
is more protective. Women who eat the most vegetables in their diet,
the best dietary source of beta-carotene, have a lowered risk of breast
cancer; maybe as much as a 90% lower risk than that of women with the
lowest vegetable intake.
Selenium has significant antioxidant properties by activating glutathione
peroxidase. Numerous observations have been made regarding selenium
and breast cancer. Areas of the United States with low levels of selenium
in the soil have higher rates of breast cancer. In some but not all
studies, American breast cancer patients have been reported to have
lower blood levels of selenium than do healthy women. A more recent
study cast serious doubt on the protective relationship between selenium
and breast cancer and did not find a protective effect. (Clark L, Combs
G, Turnbull B, et al. Effects of selenium supplementation for cancer
prevention in patients with carcinoma of the skin. JAMA 1996;276:1957-1963.)
Vitamin D
Vitamin D has been used to prevent mammary cancer in rats, inhibit
breast cancer cell growth in the laboratory, and may have antiestrogenic
activity. Women who live in sunnier parts of the country or in the
Southern hemisphere leading to increased levels of sun exposure,
correlate with reduced risk of breast cancer. When we look at dietary
vitamin D though, there may be some correlation with an increased
risk of breast cancer. Since dietary sources of vitamin D are high
in saturated animal fat, it would seem logical to acquire vitamin
D through exposure to sunlight.
Green Tea
While this article is not attempting to deal with treatment of breast
cancer, one study that would be remiss not to mention is of Green
tea helping to reduce recurrence rates in women who had stage I and
II breast cancers. In stage I and II patients, there was a 16.7%
recurrence rate for those consuming 5 cups or more of green tea (average
8 cups) per day. For those who consumed 4 or less cups per day (average
of 2), there was a 24.3% recurrence rate. Disease-free survival was
also significantly improved in stage I and stage II breast cancer
patients with a greater consumption of green tea. Of all the predictors,
green tea was the most statistically significant predictor for a
decreased rate of recurrence in the stage I and II patients. No improvement
in prognosis was seen in stage III patients. (Nakachi K, Suemaso
K, Suga K, et al. Influence of drinking green tea on breast cancer
malignancy in Japanese patients. Japan Journal
of Cancer Research 1998; 89: 254-261.)
In the spirit of common sense, it would seem that your average woman
who does not have breast cancer and women at higher risk for breast
cancer, should drink green tea as a preventive measure. It is estimated
that one cup of green tea contains 30 to 40 mg of EGCG.
Breast Cancer Prevention Summary
Vegetarian diet (even Vegan diet) plus fish
Lower fat in the diet to 20% or less
Olive oil: 1-2 tbsp/day
Fish (salmon, tuna, halibut, sardines, mackerel): twice weekly or more
Maximize all fruits and vegetables (5 or more servings per day)
Cabbage family foods: 1-2 cups per day
High fiber diet: whole grains plus fruits and vegetables
Ground flax seeds: 1 tbsp per day
High legumes: especially soy foods- one serving per day
Green tea: 3-5 cups per day
Reduce dairy, beef, chicken, turkey, lamb, pork
Reduce saturated fats, hydrogenated oils
Reduce sugar, white flour products
Reduce alcohol intake (less than one drink per day)
|