~Fibrocystic Breast Disease, Part 3 - Nutritional Recommendations

NUTRITIONAL RECOMMENDATIONS

  • Dietary Fat
  • Fatty Acids
  • Conjugated Linoleic Acid
  • Omega-3 and Omega-6 Fatty Acids
  • Evening Primrose Oil
  • Borage and Flax Seed Oils
  • Fruits, Vegetables, and Dietary Fiber
  • Indole-3-Carbinol
  • Soy
  • Simple and Complex Carbohydrates
  • Vitamins
  • Detoxifying Herbs
  • Supplements and Herbs for Pain and Inflammation
  • Caffeine


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.

Evening Primrose Oil

Several European studies support using evening primrose oil to treat breast pain and cysts (Pye et al. 1985; Gateley 1990; Mansel et al. 1990b; Gateley et al. 1991; McFayden et al. 1992; Cheung 1999; Norlock 2002). Evening primrose oil is a good source of beneficial gamma-linolenic acid and linoleic acid. In a 1990 survey, as many as 13% of surgeons and 30% of breast surgeons in Great Britain recommended evening primrose oil, particularly for cyclic mastalgia (Pain et al. 1990; BeLieu 1994). Evening primrose oil significantly improved the fatty-acid profiles of women with FBD (Gateley et al. 1992) and improved pain symptoms.

Borage and Flax Seed Oils

These two oils modulate inflammatory prostaglandins (Mancuso et al. 1997; Belch et al. 2000), often giving considerable relief to FBD symptoms. It may take 4-6 weeks before there is noticeable improvement. Nonetheless, treatment should be continued for 4-8 months.

Fruits, Vegetables, and Dietary Fiber

A diet that emphasizes fruits and vegetables also includes benefits for women with FBD. Natural, beneficial chemicals present in fruits and vegetables assist enzymes in the body to detoxify potentially harmful compounds (called carcinogens) (BCERF 1998). In fact, women who maintain a vegetarian diet are actually able to excrete two to three times more estrogen than omnivorous women. This could be part of the explanation for why vegetarian women have a lower incidence of breast cancer (Goldin 1981, 1982).

In addition, some of the chemical components of fruits and vegetables benefit the function of (switch on) the parasympathetic nervous system, thus minimizing development of tumors and cysts. Increasing fiber consumption appears to be a component in reducing the symptoms of FBD in some women. Fiber assists elimination of waste from the system, decreasing levels of circulating estrogens (BCERF 1998). Obtain plenty of fiber from your diet. Good sources of dietary fiber are legumes (kidney and pinto beans, peas, and lentils), vegetables (Brussels sprouts, broccoli, and carrots), raw fruits (apples, oranges, and bananas), and grains (particularly bran and oats) (Anderson et al. 1988; Van Horn 1997). Additional fiber may be obtained from dietary supplements in the form of powders or capsules. (Life Extension recommends Fiber Food Caps or Fiber Food Powder.)

Indole-3-Carbinol

Indole-3-carbinol (I3C) is a naturally occurring dietary compound (a phytochemical) that is found in some fruits and the cruciferous vegetables such as broccoli, cauliflower, brussels sprouts, cabbage, turnips, kohlrabi, bok choy, and radishes. Phytochemicals are also natural anti-cancer compounds. Indole-3-carbinol appears to work in several ways: partially inactivating estrogen (Michnovicz 1997; Bradlow et al. 1994; Wong et al. 1997); fighting free radicals (Arnao et al. 1996); and directly interfering with tumor cell reproduction (Bradlow et al. 1999a). Indole-3-carbinol triggers the release of enzymes that help break down estrogen precursors into a harmless form rather than the form that is linked to breast cancer (Michnovicz et al. 1997; Bradlow et al. 1999b; Meng et al. 2000; Terry et al. 2001). Cabbage and broccoli also contain sulforaphane, another phytonutrient that has been shown to stimulate the release of enzymes that attach to cancer-causing substances and transport them from the body (Mowatt 1998).

The National Cancer Institute and the U.S. Department of Agriculture have said that by eating five servings of vegetables and fruit a day, a person can cut the risk of cancer by more than 50%. Most people do not come close to meeting this guideline, particularly the recommendation for vegetables, because they do not like cruciferous vegetables, the vegetables are not readily available, or they cannot eat the quantity required each day to meet recommended dietary guidelines for phytonutrients. Sometimes raw vegetables are not easy for the system to digest. Storage and processing by the supplier or overcooking in the home contributes to loss of phytonutrients. Often, only half the phytonutrients in any serving of raw vegetables ultimately becomes available for absorption--the other half is quickly eliminated from the body. Concentrated vegetables (particularly those with the water content removed and which are ground to the consistency of powdered sugar) are more digestible. In this form, it is estimated that 90 to 100% of phytonutrients, and all of their cancer-fighting properties, become available for absorption into the body (Mowatt 1998). (Indole-3-carbinol is available from Life Extension in capsule form.)

Studies in animals indicate that I3C is safe at recommended doses (NIEHS 2000). Trials in humans have also found no significant side effects (Wong et al. 1997). A study by Cover et al. (1999) found that the naturally occurring chemical I3C found in vegetables of the Brassica genus, is "a promising anticancer agent that we have shown previously to induce a G1 cycle arrest of human breast cancer cell lines, independent of estrogen receptor signaling." According to Cover et al. (1999), a combination of I3C and anti-estrogen tamoxifen cooperated to inhibit growth of the estrogen-dependent human MCF-7 breast cancer cell line more effectively than either agent used alone. They suggested that "I3C works through a mechanism distinct from tamoxifen." Cover et al. (1999) concluded that "these results demonstrate that I3C and tamoxifen work through different signal pathways to suppress the growth of human breast cancer cells and may represent a potential combinatorial therapy for estrogen-responsive breast cancer."

Caution: Some recommend that pregnant women should not take indole-3-carbinol. Research is continuing on indole-3-carbinol and at this time there are no well-known drug interactions. Do not attempt to treat breast nodules with indole-3-carbinol without first consulting with your physician.

Note: The Life Extension Foundation suggests indole-3-carbinol to persons seeking an alternative to tamoxifen. See the protocol on Breast Cancer for more information.

Soy

Soy has been the subject of research for overall breast health. Some studies indicate that soy foods containing phytoestrogens (natural estrogens from plants) may offer some protective benefit. Researchers also believe that soy may play a role in balancing hormone levels in premenopausal women and perhaps in relieving premenstrual syndrome and menopausal symptoms (Imaginis 2001). Good dietary sources of soy are canned soybeans, tofu, soy protein bars, and tempeh. Life Extension suggests a supplement called Natural Estrogen (containing phytoestrogens from soy extract and other phyto extracts).

Researchers speculate that some of the anti-tumor activity of soy compounds may result from production of enzymes that attack free radicals (Molteni et al. 1995). However, as with other nutrients, agreement is impossible and many authorities are reluctant to give soy universal endorsement. Others suggest that soy can modulate hormonal activity and even act as an antioxidant. If using soy, carefully monitor your breasts to assess the response of breast tissue to soy products.

Caution: Soy extract or soy products should not be used by persons with estrogen-receptor-positive cancer.

Simple and Complex Carbohydrates

Carbohydrates, whether simple or complex, might be an even greater concern in FBD than fat. Italian researchers found that heavy consumption of starchy foods, including pasta and white bread, increased breast cancer risk (Franceschi et al. 1996; Augustin et al. 2001). Carbohydrates are of two types: simple and complex. Both types are composed of sugar units. Simple carbohydrates are composed of one or two sugar units. Simple carbohydrates are found in fruit and vegetable juices, candy, soft drinks, and foods with added sugar. The problem with simple carbohydrates is that they induce an insulin spike upon ingestion. Insulin can promote cancer cell division which is why consumption of starchy foods might increase cancer risk. Complex carbohydrates are made from many sugar units that would structurally look like beads in a bracelet. Foods such as whole grain products, fruits, vegetables, and legumes (dried beans and peas) are good sources of complex carbohydrates that do not induce a sharp insulin spike because they release sugar more slowly into the bloodstream. Both simple and complex carbohydrates are converted to blood sugar by the body to use as energy or fat storage. However, complex carbohydrates are a much better nutritional value because they include vitamins, minerals, and fiber (Quagliani 1997).

Vitamins
  • Vitamin E
  • Folic Acid
  • Vitamin A
  • Vitamin C
Vitamin E

Since 1965, using vitamin E has been recommended by some researchers for treatment of FBD (Abrams 1965). However, researchers are not unified concerning the use of vitamin E to successfully treat or manage FBD and evidence has been inconclusive. Vitamin E in the form of alpha tocopherol has corrected abnormal estrogen-progesterone ratios in some patients with mammary dysplasia (London et al. 1981). Results of that study, however, were not replicated in 1985 (London et al. 1985). Another study of 105 women with FBD found that 600 mg of vitamin E for 3 months had no effect on symptoms (Meyer et al. 1990).

Vitamin E should be taken in doses of 600-800 IU daily. However, women with hypertension should start with about 400 IU. If you take a blood-thinning medication, consult your physician before taking vitamin E and monitor your usage carefully since vitamin E is known to enhance blood thinning. Vitamin E containing both alpha and gamma tocopherols may produce the most desirable results. It may be necessary to use vitamin E for several months before noticeable improvement is realized.

Folic Acid

Many physicians also recommend taking folic acid along with vitamin E. In some women, combining the two seems to have a more beneficial effect than either one taken alone. Folic acid is abundant in green, leafy vegetables, but is often deficient in the standard American diet. Women of child-bearing age are particularly encouraged to include folic acid in their diet. (Life Extension recommends at least 800 mcg of folic acid along with at least 300 mcg of vitamin B12 daily.)

Vitamin A

Studies have shown that vitamin A has been able to inhibit the growth of breast cancer cells (Fontana et al. 1992; Wu et al. 1997; Yang et al. 1999; Widschwendter et al. 2001). Therefore, there is some justification for women with FBD to take vitamin A. In one of only a few studies (Band et al. 1984), 12 women with FBD were given 150,000 IUs of vitamin A daily for 3 months. Nine of the women reported marked pain reduction.

However, large doses of vitamin A can also be toxic. Therefore, beta-carotene may be a more practical treatment. In one study, 25 women who had moderate to severe pain before their menstrual periods were given daily supplements of beta-carotene and retinol. After 6 months, most of the women reported marked reduction in breast pain with no side effects (Santamaria et al. 1989). A diet high in yellow and orange fruits and vegetables will raise beta-carotene levels. You may also wish to use a beta-carotene supplement.

Vitamin C

The immune system requires vitamin C for proper function, tissue repair, diuretic action, anti-inflammatory responses, and adrenal hormone balance. Try 2.5-6 grams daily. If using buffered ascorbate, take it with magnesium or potassium.

Detoxifying Herbs

The liver supports many mechanisms including providing a detoxifying and filtering system for all body wastes as well as binding and eliminating extra hormones (including estrogen clearance). If the liver does not adequately perform its detoxifying and binding functions, estrogen stores may increase. As noted earlier, increased fiber in the diet improves removal of toxins and waste from the system. Nutrients that support the liver include choline, S-adenosyl-methionine (SAMe), green tea, and N-acetyl-cysteine. If you have FBD, consider using these supplements daily. Detoxifying your system by aiding cleansing of the liver may also improve symptoms of FBD.

Herbs that support detoxification include echinacea (Echinacea purpurea) and goldenseal (Hydrastis canadensis). These herbs should be started about a week before menstruation begins, used for 7-10 days, and then discontinued for 4-7 days. Goldenseal should be followed by a probiotic that contains acidoph-ilus and Bifido bacteria to replace good bacteria in the gut. Life Flora provides beneficial intestinal bacteria (flora) to recolonize the gastrointestinal (GI) tract when normal GI bacteria have been destroyed by disease, digestive conditions, poor absorption of nutrients, infections, and toxins. (Life Flora contains Bifidobacterium longum and bifidum, Lactobacillus acidophilus, Streptococcus faecium, and Lactobacillus casei.)

Supplements and Herbs to Relieve Cyclical Pain and Reduce Inflammation

  • Dandelion and Milk Thistle
  • Saw Palmetto
  • Violet Leaf
  • Castor Oil Packs
  • Chasteberry


Dandelion (Taraxacum Officinale) and Milk Thistle (Silibinin Marianum) Dandelion and milk thistle will help to detoxify your system (Maliakal et al. 2001; Saller et al. 2001; Cho et al. 2002; Hagymasi et al. 2002; Kosina et al. 2002). Dandelion has also been used to treat painful breasts and relieve impacted milk glands. Drink up to two cups of dandelion tea daily (or take a 500-mg capsule two to three times daily). In large doses, dandelion can provoke hypoglycemia in some people. High potency silibinin extract from milk thistle may also be taken at a dosage of about 500 mg daily.

Saw Palmetto

Saw palmetto (Serenoa repens) is used to treat prostate problems, but its anti-estrogenic characteristics also make it useful as a treatment for hormonal disturbances. Saw palmetto should be standardized to contain 85-95% fatty acids and sterols. (One capsule containing saw palmetto extract at a dosage of 320 mg daily is recommended.)

Violet Leaf

Poultices made from violet leaf may be used for pain and inflammation. Two or more cups made of 500 mL daily may bring dramatic relief for cyclical swelling and tenderness.

Castor Oil Packs

Warm castor oil packs may help dissolve lumps and relieve pain. Sometimes lumps will shrink after only a few applications. Warm castor oil packs over the liver not only invigorate, but also reduce inflammation. Some herbalists recommend alternating castor oil packs with ginger packs.

Chasteberry

Chasteberry (Vitex agnus-castus) has been used to relieve FBD. Chasteberry may decrease prolactin, leading to increased progesterone production during the menstrual cycle, and it seems to result in a shift in the estrogen-progesterone balance, regulating hormones and inhibiting release of FSH and LH. This results in less estrogen to stimulate breast tissue. Eat the equivalent of 20-40 mg of fresh chasteberry berries daily or take 175-225 mg daily of a preparation that is standardized to contain 0.5% agnuside.

Caution: Avoid chasteberry if you take oral contraceptives or are pregnant.   Caffeine and Breast Conditions

Some women find that reducing or even eliminating caffeine intake by avoiding coffee, tea, chocolate, and soft drinks significantly decreases breast discomfort (Russell 1989). However, the topic is controversial because studies linking caffeine and FBD have had inconsistent results or have been inconclusive (Allen et al. 1985, 1987; Horner et al. 2000; Imaginis 2000).

An early study by Minton et al. (1981) was widely publicized because it claimed that abstaining totally from caffeine lessened symptoms and resolved FBD completely. According to Minton, abstinence from consuming methylxanthine (a chemical present in foods and beverages that contain caffeine) decreased the need for major breast surgery and breast biopsies because of benign disease (Minton 1979, 1981, 1989). A 2002 study of the literature on causes of breast pain found that some investigations did find an association between caffeine intake and FBD and breast pain (Norlock 2002). However, other studies over the past 20 years have examined the relationship of caffeine to breast conditions and have reported inconclusive or even the opposite conclusions (Boyle et al. 1984; La Vecchia et al. 1985; Rosenberg et al. 1985; Horner et al. 2000). One study of more than 2000 women reported by Rosenberg et al. (1985) concluded that coffee consumption was not associated with an increase of breast cancer among women with a history of FBD. Another study, reported by La Vecchia et al. (1985), even found "slight" evidence that the more coffee a woman consumed, the less likely she was to have breast cancer.

Even though the evidence of a direct link between caffeine and FBD is inconclusive, many clinicians do recommend a low caffeine intake in women with FBD. Some women report significant relief from FBD symptoms after eliminating caffeine from their diets. If you suspect caffeine might have a role in your FBD symptoms, eliminate sources of caffeine (chocolate, coffee, tea, soft drinks) from your diet for 3 months to see if your symptoms improve.

As noted above, methylxanthine is a chemical present in foods and beverages that contain caffeine. Methylxanthines increase circulating catecholamines (chemicals which are present in responses to stress). There is some evidence that women with FBD have an increased sensitivity to catecholamines. However, as with caffeine, the studies are inconclusive. Both the National Cancer Institute and the American Medical Association's Council on Scientific Affairs state that there is no association between methylxanthine intake and FBD at this time (AMA 1984; Schairer et al. 1986).

Continued . . .


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