Tuesday, November 17, 2015

10 Ways to Lower Estrogen

This info is from a great article on managing estrogen load - 10 Ways to Lower Estrogen Toxic Load. It's especially pertinent to me because my breast cancer is hormone (estrogen and progesterone) receptor-positive, which means estrogen can help stimulate tumor growth. I took aromatase inhibitors for two and a half years (Letrozole and Anastrozole) which block the enzyme aromatase, which turns the hormone androgen into estrogen.  I stopped taking Anastrozole a few months ago, choosing a more natural route for keeping estrogen low and moving safely through my system.

Understand how estrogen is metabolized 

Estrogen is metabolized by the liver. The liver converts excess estrogens into compounds that can be excreted by the body. The catch is there are three pathways through which estrogen can be metabolized. One is a “toxic” pathway that is linked to cancer development, the second is unfavorable for health, and the third is more benign and preferable.

If your body can convert estrogens along what is called the 2­hydroxy pathway it will be healthier and you’ll decrease your cancer risk, whereas if your body converts along the 16­alpha­hydroxy pathway it will be at greater risk of cancer. Don’t worry about the chemical names of the pathways, just remember that the C­2 pathway is healthier and the C­16 pathway and the C­4 pathway are unfavorable. The solution is to nutritionally support conversion of estrogen along the C­2 pathway, which can be initiated by ensuring you have a healthy gut.   

10 Ways to Lower Estrogen Toxic Load  

1) Improve Gastrointestinal Health
Poor gastrointestinal health can inhibit excretion of unwanted estrogen from the body and promote its reabsorption. A healthy gut with dietary fiber in the form lignan, such as flaxseeds, can bind to estrogen in the digestive tract so that it will be excreted from the body. Dietary fiber also reduces the amount of an enzyme (called B­glucouronidase) that uncouples or breaks apart bound estrogen that is on its way out of the body. When the estrogen breaks free in the large intestine, it re­enters circulation and is not removed from the body. This is a bad situation.

The solution is to eat adequate fiber and include lignans in the diet, including flax, leafy greens, and bran (oat, rye, barley). Eating plenty of probiotic foods or taking a probiotic is essential because it will increase the “good bacteria” in the gut and support neurotransmitter function.

2) Improve Diet With Low Carb, High­Protein, Omega­3 Fats
To avoid excess estrogen, you need to manage insulin because doing so is better for body composition, and persistently high insulin produces a poor endocrine profile that can inhibit estrogen metabolism. Getting your carbs from vegetable and fruit sources will provide the lignans and fiber needed for gut health and increase antioxidant levels, which can abolish free radicals that produced by estrogen that goes down the C­16 pathway. Omega­3 fats, which are found in fish, have been shown to promote the C­2 pathway over the 16 pathway, particularly EPA omega­3 fatty acids. On the flip side, diets low in omega­3s have resulted in estrogen being metabolized primarily through the C­16 pathway.

A high­ protein diet will produce a better body composition for most people. Plus, low protein diets have been shown to decrease activity of something called cytochrome P450 that metabolizes estrogen. The amino acids lysine and threonine have been shown to support liver function and since estrogen is metabolized by the liver, it is thought that these proteins can help get rid of estrogen from the body. Lysine and threonine are found in meat, fish, beans, eggs, and some seeds (sesame, fenugreek). Sesame seeds also provide fiber and fenugreek helps lower the insulin response to carbs, making both good additions to your diet.

3) Decrease Body Fat
The more fat you have, the more estrogen you’ll have because fat tissue increases levels of the aromatase enzyme that turns testosterone to estrogen. Decreasing body fat and building lean mass are key to cancer prevention and estrogen elimination. Another way to protect the tissues from circulating estrogen is to keep it bound to sex hormone binding globulin (SHBG). When it is bound to SHBG, estrogen is not available to bind with cellular receptors and won’t have its estrogenic impact. Flaxseed hulls are especially good at increasing SHBG (as well as inhibiting aromatase).

4) Use Phytoestrogens To Promote the C­2 Pathway
Include foods with phytoestrogens in your diet because they will take natural and chemical estrogens out of play in the body. Phytoestrogens are plant ­based compounds that can bind to estrogen receptors, but they have about 1/1000th of the effect on the body as real or chemical estrogen. When phytoestrogens bind to estrogen receptors they basically take up the parking sport of the true estrogen, and keep it from exerting its effect.

Lignans and isoflavones are the main phytoestrogens, and in addition to binding with estrogen receptors, they can increase SHBG levels (protects the body by binding to estrogen), decrease aromatase (prevents testosterone turning into estrogen), and shift metabolism of estrogen away from the C­16 pathway to the C­2 pathway (the safer pathway). The best phytoestrogens to include in the diet are flax, sesame, leafy greens, kudzu, alfalfa, clover, licorice root, and legumes.

5) Block Aromatase and Stop Testosterone From Turning into Estrogen
Blocking aromatase is key for getting rid of estrogen because it plays the main role in producing estrogen in men. If aromatase is present, there are two chances for estrogen to be produced in the body. First, the hormone androstenedione will be turned into testosterone unless aromatase is present in which case it will be turned into estrogen. Then, aromatase will turn testosterone into estrogen as well.

Nutrients that have a proven effect on aromatase include selenium, melatonin, zinc, green tea, and citrus flavonones—substances found in orange and grapefruit rinds along with tomato skins.

6) Improve Estrogen Metabolism By Promoting the C­2 Pathway
Promoting the C­2 pathway of estrogen metabolism is probably the most important thing you can do to prevent cancer. The first step of estrogen elimination is for enzymes to initiate metabolism by joining the estrogen molecule. This will happen at either the 2­carbon position or the 16­carbon position of the molecule, which determines the pathway the estrogen will head down. The C­2 pathway produces very weak estrogenic activity and is termed “good” estrogen. In contrast, the C­16 pathway produces robust estrogenic activity and promotes tissue damage that leads to cancer.

Key nutrients for supporting the C­2 pathway are EPA fish oils, phytoestrogens, and of special importance, B vitamins and a substance called DIM. The B vitamins, particularly B6, B12, and folic acid promote the C­2 pathway. B6 is also known to decrease gene activity once estrogen is bound to a receptor, meaning this vitamin can inhibit cell damage and cancer development. DIM is a compound found in cruciferous vegetables such as broccoli and cauliflower. It is often taken in supplement form because you would need to eat large quantities of these vegetables daily in order to provide sufficient DIM to have an effect on estrogen elimination.

7) Ensure Complete Elimination of Estrogen
Once you shift your estrogen elimination to the C­2 pathway you have to make sure it gets excreted from the body. Two things can happen along the way out that cause big problems. First, estrogen that is heading down the C­2 pathway can be easily turned into something called quinones, which are “highly reactive” and can damage DNA and cause cancer. In order to avoid the production of quinones you must have adequate amounts of two nutrients—magnesium and SAMe. This process of metabolizing estrogen to avoid quinones is called methylation and is the first place that things can go wrong on the estrogen elimination pathway.

As estrogen is heading out of the intestine, it needs to be bound to glucuronic acid, but there is a “bad” intestinal bacteria that contains an enzyme that breaks estrogen apart from the glucuronic acid. This is the second place estrogen detoxification can go wrong. When the “bad” bacteria, called glucouronidase, uncouples the bond between estrogen and glucuronic acid, estrogen re­enters circulation, effectively raising estrogen levels in the body and damaging tissue. To avoid this, you need a healthy gut, which you can get by supporting the probiotic bacteria in your gut and eating lots of fiber and lignans.

8) Supplement With Essential Nutrients
To review, the essential nutrients to help metabolize estrogen are the B vitamins, zinc, omega­3 fish oils, DIM (nutrient found in cruciferous vegetables), green tea, magnesium, selenium, and melatonin.
Vitamin E is another potent antioxidant that aids estrogen elimination. Low vitamin E is associated with elevated estrogen and it has been shown to inhibit the growth of breast and prostate cancer cells.
9) Watch What You Drink
Alcohol increases estrogen levels in men and women, and it has been shown to decrease testosterone as well. For optimal estrogen metabolism, it's recommended that you eliminate all alcohol besides certain red wine. Sardinian and Spanish wines are rich in antioxidants that help remove estrogens. Other good choices are Pinot and Merlot.  

10) Limit Chemical Estrogen Exposure
Avoiding chemical estrogens is one of the most important strategies for preventing cancer and protecting yourself. If you were able to have no contact with chemical estrogens, and you had good nutrition, a lean body composition, and a large proportion of muscle mass, it is very unlikely you’d have excess estrogen or be at risk of cancer. Unfortunately, chemical estrogens are everywhere. Because we cannot completely avoid contact with chemical estrogens, the reality is that you have to take responsibility for eliminating estrogen from your body and the bodies of your loved ones. 

Thursday, November 12, 2015

A better way to make decisions about your cancer treatment

Very glad to hear that shared decision-making is gaining traction. This is the way I prefer to work with my oncologist. Here's an overview from the American Cancer Society http://www.cancer.org/treatment/findingandpayingfortreatment/understandingfinancialandlegalmatters/informedconsent/informed-consent-shared-decision-making
Shared decision-making is a newer way of talking about treatment and treatment decisions, and some doctors are using it. It works like this: the doctor gives the patient information about the pros and cons of all the treatment options, including no treatment. This often means “homework” for the patient, such as reading, looking at DVDs, or sifting through other types of information. The patient tells the doctor about factors (preferences, health problems, home conditions, and such) that might make each treatment option better or worse than the others. Together, the patient and doctor decide which treatment is best for the patient. Or they may decide on something else, such as waiting for further developments before choosing a treatment. 
This is quite different from just saying “yes” or “no” to the treatment the doctor offers you. It may mean that you must take in more information, ask more questions, share more about yourself, and take more time to sort through your options together.This type of decision-making is especially helpful when there is no single “best” treatment option. For many people, the extra effort is worth it – they feel more certain that they made the best treatment choice for themselves. But for others, it may be too much or feel overwhelming (see the next section called “What if I want my doctor to make the decisions about my care…?). 
It’s OK to tell the doctor that you don’t want to share decision-making. But if you do want this kind of input let your doctor know. Be sure that you understand all the reasonable options for your situation, and go over them with your doctor. See the section called “What questions should I ask during informed consent?” to get some ideas of what to ask about each treatment option. Keep in mind that your doctor may not have as much information about some treatments as others, and you may need to get a second opinion to get a more complete picture.

Wednesday, November 4, 2015

Keeping glucose levels low is key to starving cancer

In 1924, Dr. Otto Warburg won a Nobel Prize for his hypothesis that cancer cells had a fundamentally different energy metabolism compared to healthy cells. Dr. Warburg showed that cancer cells exhibited a preference for the utilization of sugar (glucose) as a fuel, even when the oxygen that normal cells use for energy creation was available. He wrote:
“Cancer, above all other diseases, has countless secondary causes. But, even for cancer, there is only one prime cause. Summarized in a few words, the prime cause of cancer is the replacement of the respiration of oxygen in normal body cells by a fermentation of sugar.”
Stands to reason then, that step one of any cancer protocol would be to limit sugar, right?  Sadly, I have never once heard an oncologist mention this. What's worse, is most oncology centers have a big bowl of candy at the counter and a vending machine stocked with cookies, candy and high carb snacks. I know the people in these centers are well meaning. "It's comfort food" I heard one of them say, as I bit my tongue. "No, it's killer food" is what I wanted to say.

When I started my journey, I cut out all sweets, stopped drinking (yes that's sugar), went gluten-free, and limited meats, diary and other foods that contributed to an acidic environment. An acidic environment is a low oxygen environment. More on the pH connection later.

What I didn't realize initially was that it wasn't that simple. I had limited carbs, and had better carbs, but still didn't have the right protein-fat-cab balance. More research suggested that a ketogenic diet was a better fit.

A ketogenic diet calls for minimizing carbohydrates and replacing them with healthy fats and moderate amounts of high-quality protein. Paleo, Ideal Protein, Zone and Atkins are similar type diets, but tend to focus more on the protein, and less on the fat element and overall balance. Respectfully most diets are about weight loss, so fats are limited. With cancer, we're not as concerned about the calories.

The ketogenic diet gets its name from ketones, substances made when the body breaks down fat for energy. Fat, like sugar, is a source of energy. Unfortunately, the body goes to the glucose fuel first and only goes to ketones in long term storage when glucose is not available.

Here's the bottom line - if cancer cells don't get sugar, they die. But its not just about limiting sugar in your diet. It's about understanding the role of carbohydrates and their conversion to sugar and the importance of the protein-fat-carb balance. Getting the body to use ketones as a fuel source is an important part of the process.

Want to know more? Check out these resources: