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Life Extension Magazine

LE Magazine October 1999

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I3C Indole 3 carbinol I3C, Indole 3 carbinol
Cancer Prevention For Thinking People

The FDA's recent approval of tamoxifen for the reduction of the risk of breast cancer in high-risk healthy women prompted us to take a closer look at the drug. What we discovered may surprise you. Tamoxifen works by blocking estrogen, but blocking estrogen is not its only, or in some cases, most important action. The anti-cancer effects of tamoxifen are found in other substances that are far less toxic and just as powerful. Stay with us-what you learn may save your life.

Estrogen and breast cancer
Genuine human estrogen is a hormone with important functions in multiple areas of the body. Essentially a chemical messenger, estrogen interacts with cells as diverse as skin, gut, breast and brain.

Estrogen sends messages to cells through what are known as estrogen receptors. Receptors are essentially "doors" on cells that allow entry of substances like estrogen. In the case of estrogen, the "door" is very big, and it will also allow molecules that resemble estrogen to enter as well. This is why fake estrogens and estrogen blockers can provoke cells to react. If the receptor was very small or very particular, it wouldn't allow the fakes in.

Receptors are not like doors, however, in the sense that they're not square. They're curvy-like a jigsaw puzzle. When a molecule of the right shape comes along, it fits in the receptor and makes contact with points just inside the receptor's "door jamb." Touching these contact points sets off a series of chemical reactions that send a signal inside the cell.

One of the most important messages estrogen delivers is to grow-divide, multiply. For this reason, estrogen is crucial in the development of the fetus. For the same reason, it's usually found at the scene of breast cancer, where it eggs on hormone-responsive cancer cells. It's estimated that 50-70% of all breast cancers are estrogen receptor-positive-they grow in the presence of estrogen. And according to Dr. Kent Osborne of Baylor University, this figure could be much higher because of problems in the classification system.

Successful communication between the messenger and the cell depends on the messenger (estrogen) fitting the door (receptor) exactly so as to make all the contact points. Estrogen produced naturally in the body fits inside the estrogen receptor perfectly and sends certain predetermined signals. Estrogen look-alikes such as tamoxifen fit in the door, but don't make all the contacts because they're not exactly the right shape. As a result, they send odd signals or block them altogether.

What's disturbing about these synthetic look-alikes is that scientists don't know what signals they actually do send once they get into the receptor. They know some of the signals. For example, they know that tamoxifen blocks the "grow" signal in breast tissue. They know the same molecule promotes the "grow" signal in uterine tissue. They know Premarin sends a "grow" signal to bone. But what signals, for example, does the estrogen mimicker/blocker, raloxifene, send to the brain through its estrogen receptors? Nobody knows.

Secrets of tamoxifen

The most well-publicized aspect of tamoxifen's mode of action against breast cancer is that it blocks estrogen. What's not usually appreciated is that tamoxifen has other modes of action. The other actions are just as important, or in some cases more important, than the estrogen-blocking effect. And they are not unique to tamoxifen.

Tamoxifen also works in estrogen receptor-negative breast cancers and progesterone receptor-positive breast cancers. This is because tamoxifen not only blocks the estrogen "grow" signal, it blocks another type of "grow" signal known as protein kinase C (PKC). PKC is another one of those contact points inside the door jamb, and blocking this signal stops oncogenes (cancer genes) from activating. PKC also controls cell growth and transformation signals.

Tamoxifen promotes free radicals

A surprising study was published in the Journal of Biological Chemistry in 1996. Using estrogen receptor-negative breast cancer cells, researchers from the University of Southern California showed that tamoxifen uses free radicals to inhibit PKC. How it generates the radicals is not known. Researchers do know, however, that it takes very low doses of tamoxifen to create this effect. Estrogen receptor-positive cancer cells require much higher doses of tamoxifen. A very important finding of this study is that antioxidant vitamins E, C and beta-carotene (but not glutathione) kept tamoxifen from working in estrogen receptor-negative cells. If confirmed in vivo, this could mean that women with receptor-negative breast cancer taking tamoxifen should not take antioxidants.

A group at Zeneca Pharmaceuticals, the manufacturer of tamoxifen, has reported a similar phenomenon. In estrogen receptor-negative ovarian and leukemia cells, tamoxifen depletes the body's natural antioxidants and provokes free radicals. The radicals then cause the cancer cells to self-destruct. An important caveat of both this and the above study is that both have only been done in the test tube and only in estrogen receptor-negative cancer cells.

Tamoxifen also stops free radicals

It's not surprising that tamoxifen generates free radicals since most, if not all, chemotherapies do. However, it is surprising that tamoxifen is also a powerful antioxidant. The antioxidant effect is found in its metabolite, 4-hydroxytamoxifen.

Women who take tamoxifen for 6 months have far fewer free radicals in their blood than before they took it. They also have higher levels of antioxidant vitamins and enzymes, indicating that tamoxifen conserves the body's own antioxidant defenses (except in the above studies in estrogen receptor-negative cells).

Numerous studies show that 4-hydroxytamoxifen strongly inhibits oxidative damage to a broad range of important substances-lipids, DNA and protein. This ability to stop free radicals is part of its anti-cancer effect. In studies on animals treated with the chemical TPA, tamoxifen was effective at inhibiting free radicals so that not enough DNA damage occurred to transform the cells.

Another aspect of tamoxifen's anti-cancer action is its ability to interfere with the cell cycle. The cell cycle is a predetermined program a cell goes through to make a new cell. Normal cells "put on the brakes" at certain points during the process so that things can be checked for accuracy. This ensures that abnormal cells don't get duplicated. However, cancer cells "override" the brakes. They duplicate themselves at break-neck speed with no checks on accuracy. Chemotherapy works by "setting" the brakes. Tamoxifen is one of the chemotherapies that does this.

What's wrong with tamoxifen

All this sounds great. Why not ake tamoxifen and be happy? Because tamoxifen has severe drawbacks, some of which are just now coming to light. While some studies show that tamoxifen works better at five years than two, other research confirms that tamoxifen always "turns" on its user in months or years, and begins feeding new, tamoxifen-dependent cancer. A new chemical is being tested to combat this "problem." But the new chemical may create problems of its own.

Meanwhile, there are hints that tamoxifen "resistance," as it's known, is the result of permanent damage caused by the drug. One area that might be damaged is tumor suppressor gene p53, a player in the process that stops the cell cycle and makes sure cancer cells don't get replicated. In the healthy person, p53 sends signals that stop the cell cycle when abnormal cells are involved, and causes them to self-destruct. Using human breast cancer cells, researchers in France showed that tamoxifen stops p53 from working. While this may sensitize cancer cells to the effects of chemotherapy, the same phenomenon in a healthy person would cripple their ability to stop cancer.

The National Cancer Institute and Sloan Kettering Cancer Center have both reported that tamoxifen causes mutations in endometrial cells, including mutations in p53. More than one group has called for more research in this area, but it hasn't been done.

There is evidence that tamoxifen causes another problem which hasn't been adequately investigated. Constant exposure to the drug may permanently alter the estrogen receptor. Receptors have "plasticity"-their shape can change depending on what "fits in the door jamb." Tamoxifen doesn't fit into the estrogen receptor just right. As a result, the estrogen receptor changes its shape to fit tamoxifen. The same phenomenon happens in people who chronically take mood-altering drugs. Their neurons adapt to the drug. This is part of the phenomenon of drug tolerance and withdrawal-the receptors have adapted to the artificial drug and depend on it to function. No one knows whether tamoxifen permanently damages the estrogen receptor in the same way.

These unknowns, coupled with the elevated risk of life-threatening blood clots and uterine cancer, the lack of evidence that tamoxifen prevents breast cancer at all in healthy women, plus the lack of an accurate risk assessment tool of who is really at risk (see "Tamoxifen: Cancer-causing Drug Approved for Healthy Women," Life Extension magazine, May 1999), make tamoxifen risky as a cancer prevention strategy.

Indole-3-Carbinol: The thinking person's cancer prevention

Tamoxifen is a chemical proven to provide short-term delay in the reemergence of breast cancer in women who have already had breast cancer. There is no evidence that it prevents breast cancer in women who have never had it. There is evidence, however, that tamoxifen stops working within months and starts feeding new, tamoxifen-dependent tumors, and causes an elevated risk of uterine cancer and blood clots.

Despite these drawbacks, however, the drug possesses some very desirable characteristics. It has powerful antioxidant action, plus the ability to inhibit PKC. Its ability to block estrogen's "grow signal," and stop cancer cells from growing are very important characteristics. Yet who wants to take a drug that can potentially cause cancer and a host of other ills? Is there anything better?

In 1991 researchers at the Institute for Hormone Research in New York City announced that they had been able to induce the dy to convert the stronger form of estrogen (estradiol) into a weaker form (2-hydroxy- estrone) without using drugs. 2OHE is considered to be a more desirable form of estrogen. It is less active than estradiol, so when it occupies the estrogen receptor, it effectively blocks estradiol's strong "grow" signals.

Natural substance changes the way estrogen is metabolized

It took only one week to prove that the conversion of estradiol to 2OHE can be accomplished without drugs. Using a natural substance, researchers were able to increase the conversion of estradiol to weak estrogen by 50% in twelve healthy people.

Next, they tested the natural substance in female mice prone to developing breast cancer. Both the incidence of cancer and the mber of tumors fell significantly. What was the substance? Indole-3-carbinol (IC3), a phytochemical isolated from cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, turnips, kale, green cabbage, mustard seed, etc.).

I3C was then given to 25 women for two months. Again, levels of strong estrogen declined, and levels of weak estrogen increased. But more importantly, the level of an estrogen metabolite associated with breast and endometrial cancer (16alpha-hydroxyestrone) fell.

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