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Fibrocystic Breast Disease
Hormone Replacement Therapy (HRT)
HRT, often recommended to post-menopausal women, may actually increase the symptoms of FBD depending on the hormone combination used. As with any type of hormone administration, however, the results and effects differed widely among women studied. When on HRT, it is important to monitor any changes in breast tissue and to evaluate these changes with your physician as they relate to the positive benefits (cardiovascular, bone density) versus the risks (increased density of breast nodules) of continuing HRT (Lundstrom et al. 2001; Ozdemir et al. 1999). (See the protocol on Female Hormone Modulation Therapy.)
In a 1997 study, doctors treated women with painful FBD by giving them estroprogestins (estrogen-progesterone compounds) for 3 months. They found that 60% of the women reported reduced or improved symptoms (Leonardi 1997). However, like HRT, estrogen replacement therapy (ERT) has also been linked to higher rates of FBD among postmenopausal women; in fact, they are twice as likely to develop FBD as women who have not used estrogen replacement (Pastides et al. 1987). Women on ERT also experience more fibroadenomas. The risk seems to increase the longer the therapy is employed.
Powerful drugs with hormonal effects are also available and are prescribed with caution when pain from FBD is severe. However, physicians are hesitant to use them because of potential side effects and interactions with other drugs or conditions (such as tamoxifen and danazol).
Tamoxifen
A medicine that blocks the effects of the estrogen hormone in the body, Tamoxifen, is primarily used to treat breast cancer that is estrogen receptor positive (Chatterji 2001/2002). It has also been used in some women who do not have breast cancer, but who are at high risk to develop it. Tamoxifen has been used to relieve significant breast pain associated with FBD. An early double-blind controlled study was done with tamoxifen in 60 patients who had severe mastalgia lasting more than 6 months. The patients were treated with a placebo or 20 mg of tamoxifen for 3 months. There was relief of pain in 71% of the patients receiving tamoxifen, demonstrating that tamoxifen was valuable in the treatment of severe cyclical and non-cyclical mastalgia and that treatment can be achieved with few side effects (Fentiman et al. 1986). How tamoxifen works and its long-term effects are not precisely known. However, the use of tamoxifen requires careful monitoring by a physician to assess side effects, blood levels, and so forth.
Indole-3-carbinol (I3C) is a phytonutrient with similar properties to tamoxifen: I3C partially inactivates estrogen (Bradlow et al. 1994); fights free radicals (Arnao et al. 1996); and interferes with tumor cell production (Bradlow et al. 1999a). See the detailed description below on I3C and how it may be used as an adjunct or an alternative to tamoxifen.
Danazol
Danazol is a synthetic steroid that is prescribed for pain and infertility caused by endometriosis and for the pain and tenderness of FBD. When prescribed for FBD, danazol may produce partial or complete disappearance of nodules and relief from pain and tenderness (Greenblatt et al. 1982; Mansel et al. 1982; Lopez et al. 1996). However, danazol has undesirable side effects such as allergic reactions (particularly for persons who are allergic to preservatives or anabolic steroids) and drug interactions. For example, danazol may increase the anticoagulant effect of warfarin, a drug frequently prescribed as a blood-thinning agent, increase blood sugar levels in diabetes mellitus, and increase the occurrence of migraine headaches (Meeks et al. 1992). Additionally, this synthetic testosterone derivative may cause women to develop male sexual characteristics such as facial hair (Peress et al. 1982). Danazol is not recommended for pregnant women or women who are breast feeding because of undesirable effects on the infant. However, danazol does help alleviate breast pain. As early as 1985, a study found that the drug eased pain in 70% of women with cyclical pain and in 31% of women with noncyclical pain (Pye et al. 1985). Symptoms often recur after treatment with danazol is stopped.
Bromocriptine
Another drug, bromocriptine, also helped 20% of women with non-cyclical pain and 47% of women with cyclical pain (Pye et al. 1985). Bromocriptine is a drug that affects the pituitary gland (blocks the release of the hormone prolactin) and is prescribed for menstrual problems and to stop milk production in some women. It is also used to treat other conditions such as infertility, Parkinson's disease, and acromegaly (overproduction of growth hormone). Bromocriptine has side effects, including significant nausea, allergic reactions, and interactions with drugs taken for other conditions (hypertension, mental illness, and liver conditions).
Lisuride
Lisuride (used in Parkinson's disease), a drug with endocrine effects similar to those of bromocriptine, reduced FBD symptoms in 63% of the women studied. Estrogen levels in those patients were reduced and progesterone levels were increased (Lopez-Rosales et al. 1991).
DHEA
Dehydroepiandrosterone (DHEA) is a steroid hormone chemically related to testosterone and estrogen. It is made by the adrenal glands from cholesterol. DHEA levels in the human body peak in the mid-20s and steadily decline beginning about the mid-30s (Leowattana 2001). Researchers have studied the actions of DHEA for over 20 years and have found that it may have beneficial implications in many areas, such as improving immunity; reducing menopausal symptoms; preventing cancer, heart disease, Alzheimer's disease, and chronic inflammation; improving longevity; and aiding weight loss (Kimura et al. 1998; Kurzman et al. 1998; Murialdo et al. 2000; Leowattana 2001; Corsini et al. 2002; Polleri et al. 2002; Simpson 2002; Takayanagi 2002; Yang et al. 2002). DHEA should only be taken under the supervision of a physician who can monitor blood levels of steroids and cholesterol and existing health conditions (Nestler et al. 1988; Barrett-Connor et al. 1995; Yen et al. 1995). DHEA is contraindicated in both men and women who have hormone-related cancer. (See the DHEA Replacement Therapy Protocol. Life Extension recommends specific dosing and blood testing schedules for all persons desiring to take DHEA safely.)
NUTRITIONAL RECOMMENDATIONS
There are a number of natural treatments that may help women with FBD. These therapies may be employed alone or in combination with conventional treatments.
Nutritionists make several general recommendations concerning FBD and diet:
- Reduce fat to less than 20% of your diet, particularly saturated fats (animal products).
- Include more foods that are high in fiber. (Fiber is important in aiding bowel transit time.)
- Limit eggs, chicken, and dairy products.
- Include soy protein products (tofu).
- Reduce caffeine intake or consider avoiding coffee, tea, soft drinks, and chocolate (caffeine and methylxanthine) altogether.
- Reduce or eliminate sugar, white flour, and refined foods.
- Take vitamins (beta-carotene, vitamin C, vitamin E, vitamin B-complex, vitamin B6).
- Take minerals (selenium, zinc, copper, calcium, magnesium, iodine).
- Consume omega-3 fatty acids from cold-water fish, fish oil supplements, or Perilla-seed oil supplements.
In addition, some form of daily exercise (walking, bicycle riding, yoga, weight training) and not smoking are strongly recommended.
As with any nutritional issue, studies concerning dietary recommendations seem to often be contradictory. Therefore, many choices concerning a type of diet to follow or foods to be included or avoided will be personal ones based on each individual's particular circumstance and experience. Consult with your physician with any concerns before making nutritional changes to control or treat FBD.
Dietary Fat
Beginning as early as 1980, numerous studies have examined the relationship between FBD and dietary fat. Obesity tends to increase estrogens, free fatty acids, and triglycerides (Leijd 1980; Clarke 1981; Bates et al. 1982; Siiteri et al. 1987; Blum et al. 1988; Zumoff 1988; Kaplan 1989; Hunt et al. 1995; Singh et al. 1995; Vanhala et al. 1998; Inukai et al. 1999; Despres et al. 2000; Hudgins et al. 2000). The typical Western diet provides about 40% of its calories from fat. However, nutritionists recommend that a healthy diet should include 30% of calories from fat with only 10% of these calories coming from saturated fat. Some researchers suggest that additional lowering of dietary fat levels (to 15%) may help stabilize hormonal imbalances that can lead to FBD (Mishra et al. 1994). In an early two-part study reported by Rose et al. (1987), investigators put 16 women on a diet with fat comprising 20% of total calories. After 3 months, the investigators found significant reductions in circulating estrogens, while levels of serum progesterone remained stable.
In another early study, researchers studied women who had had severe cyclical FBD for at least 5 years (Boyd et al. 1988). These women were advised to limit their dietary fat to 15% of calories consumed, while increasing complex carbohydrate consumption. After 6 months, the women reported significant reduction in the severity of premenstrual breast tenderness and swelling (Boyd et al. 1988). In a follow-up study in 1997, 817 women were randomly assigned to two groups (an intervention group to reduce intake of dietary fat and increase carbohydrates and a control group) and followed for two years. In all subjects, baseline mammography images were taken and compared with images that were taken two years later. After two years, there was a reduction in breast mass, leading the authors to conclude that "a low-fat high-carbohydrate diet reduced the area of mammographic density, a radiographic feature of the breast that is a risk factor for breast cancer." The authors suggested that longer follow-up of a larger number of subjects is required to determine if these effects are associated with changes in the risk for breast cancer (Boyd et al. 1997).
A study conducted at Harvard University followed more than 300,000 women (Huang et al. 1999). Their data suggested that "greater waist circumference increases risk of breast cancer, especially among women who are otherwise at lower risk because of never having used estrogen replacement hormones."
Conversely, mounting evidence also suggests that some dietary fat is desirable and provides protection for the breast (Kaizer 1989; Franceschi et al. 1996; Maillard et al. 2002). Women experienced better breast health if their diet included moderate levels of fat. However, women desiring to add some dietary fat should not do so by merely increasing their consumption of meat, dairy products, and products with vegetable oils that contain saturated fat (palm and coconut oil). Better sources of dietary fat are from unsaturated fats such as fish; olive, peanut, and sunflower oils; olives; and avocados.
Beneficial Fatty Acids
Beneficial or essential fatty acids (EFAs) are vital nutrients for good health just like other vitamins and minerals. EFAs are polyunsaturated fats ("good" fats) and contribute to healthy functioning of cell membranes, the skin, the immune system, and the cardiovascular system. Although fatty acids are essential for overall health, our body does not manufacture them. We need to obtain them through our diet.
Conjugated Linoleic Acid
Conjugated linoleic acid (or CLA) is a source of natural dietary fat. CLA is an essential fatty acid occurring in dairy and other products such as whole milk, cheese, and red meats from ruminant animals. CLA is considered to be "a healthy fat" because it is polyunsaturated (liquid at room temperature). Because the CLA content in dairy products is directly related to the fat content, CLA levels are greatest in higher fat (rather than lower fat) products. Good dietary sources of CLA are homogenized milk, butter, plain yogurt, cheese, and ground beef. Interestingly, the CLA content of milk and other dairy products is highest in pasture- or range-fed cows (McBean/National Dairy Council 1999). Skim milk does not contain CLA (Roloff 1997). As stated earlier, CLA is found in dairy products; however, it occurs at relatively low levels in these dietary sources. Therefore, we probably cannot get adequate CLA from food alone. (Life Extension suggests 3000-4000 mg of a 76% CLA supplement be taken daily.)
Studies in animals have documented a number of potential health benefits of CLA: an anti-carcinogenic effect, lowered total and LDL cholesterol, a reduction of body fat, increased rate of bone formation, and improved glucose utilization (McBean/National Dairy Council 1999). Although FBD is often a benign condition, there are important tumor-modulating, anti-cancer, and anti-inflammatory effects associated with CLA that are beneficial and perhaps preventative. In studies conducted using laboratory rats, CLA was found to confer lifelong protection against mammary cancer and to also reduce the density of mammary glands.
Banni et al. (1999) continued earlier research suggesting that CLA fed during mammary gland development resulted in diminished mammary epithelial branching, which might possibly result in reduced mammary cancer risk. Data showed a "graded and parallel reduction of terminal end bud density and mammary tumor yield produced by 0.5 and 1% CLA. No further decrease in either parameter was observed when CLA in the diet was raised to 1.5-2%." Banni et al. (1999) concluded: "optimal CLA nutrition during pubescence could conceivably control the population of cancer-sensitive target sites in the mammary gland." Ip et al. (1999a,b) also conducted studies in laboratory rats to investigate the role of CLA in inhibiting mammary carcinogenesis. They found that CLA "can act directly to inhibit growth and induce apoptosis of normal mammary epithelial cell organoids and may thus prevent breast cancer by its ability to reduce mammary epithelial density" (Ip et al. 1999a). (Apoptosis is the normal, healthy programmed death of cells.) CLA is therefore recommended because of its anti-tumor effects (three to four capsules of CLA-76% supplement daily for healthy people).
Omega-3 and Omega-6 Fatty Acids
The omega-3 and omega-6 fatty acids are important members of the EFA family. Omega-3 and omega-6 are scientific names derived from the chemical composition of their fatty acid molecules. Each one contains different fatty acids. Although the names are scientifically useful, most people just need to know that both of them are essential fatty acids and the body needs both of them in balance.
Omega-6 fatty acids are generally available in adequate amounts from the grains and vegetable oils that are commonly present in the processed foods in our diet unless lifestyle (consumption of alcohol, excessive sugar, and saturated fats) or health conditions are a factor. Dried beans, including inexpensive northern beans and soybeans, are an excellent source of omega-6 fatty acids. Omega-6 fatty acids are also found in linoleic acid from safflower, sunflower, corn, and soybean oils.
Greater effort is often required to ensure that adequate omega-3 EFAs are available from our daily diet. Omega-3 fatty acids are abundant in fish oils from mackerel, salmon, halibut, and herring. Soybeans, flaxseed, and green leafy vegetables also contain omega-3 fatty acids.
Women with severe mastalgia and FBD appear to have abnormal fatty-acid levels that may lead to endocrinologic hypersensitivity (imbalance of proper hormonal ratios and the resultant affect on other systems) (Ayers 1983; Mansel et al. 1990c). FBD seems to be associated with exaggerated estrogen-progesterone ratios and increased levels of prolactin (Kumar et al. 1985; BeLieu 1994). Thus, increasing omega-6 fatty acids may reduce FBD symptoms (Mansel et al. 1990a). The correct balance of omega-6 and omega-3 fatty acids will also help to inhibit the inflammatory cascade that may precede the onset of fibrous tissue. |