I received an excellent question recently. I wanted to share this question and my comments with the group. I hope this will help more people to benefit from the information.
A website reader has found that she cannot tolerate any of the prescription estrogen blockers. She asks: is it possible to lower estrogen with foods or herbs?
One of the first things I suggest you do is continue to work with your doctor and your medical care team to see if you can find an estrogen blocker medication that you can tolerate. I urge you to do this because using one of these medications is the only research proven way to significantly reduce the risk of recurrence in women with a history of estrogen receptor positive breast cancer.
There are two major types of estrogen blockers in common use, which are selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). There are several choices within these two types of medication. Additionally, there is one other medication that functions as an estrogen receptor downregulator. This means there are many different medications that may be appropriate for you.
Also, there are other medications that may be able to offset the most unpleasant side effects of SERMs and AIs, such as hot flashes. Only you and your doctor can work through all of these issues and options to determine with certainty that you cannot tolerate any of the estrogen blocker medications.
You may have tried all of the possible medications and combinations of medications already, and if none of these work for you, it makes sense to use diet as much as possible to keep yourself healthy. Diet can play an important role in balancing hormones in the body.
The main drawback of trying to use food and nutrition to lower or manage estrogen is that these approaches are not research proven to reduce the risk of recurrence of breast cancer. To summarize:
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Studies prove that certain dietary changes can affect estrogen metabolism and decrease the most potent form of estrogen in the body.
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It is not proven that diet can reduce estrogen enough to reduce risk of breast cancer recurrence.
As I mentioned, diet alone is not proven to reduce risk of recurrence, but it is clear that diet can affect estrogen levels in the body in a measurable way. Other factors related to health and nutrition can affect risk of recurrence as well.
One of the most important steps you can take to reduce the risk of recurrence with diet and nutrition is to maintain a healthy body weight. Nearly a dozen studies tell us that women who are overweight or obese at the time of breast cancer diagnosis or who gain weight after diagnosis have a higher likelihood of recurrence. Health experts aren't sure why excess weight leads to higher rates of recurrence, but it is clear that this connection is real.
One study conducted in breast cancer survivors found that those who received either counseling from a registered dietitian or counseling from a registered dietitian plus coupons to attend Weight Watcher meetings, lost significantly more weight and body fat when compared to women who received only Weight Watcher coupons or did not receive any nutrition counseling and support. This suggests that if you need help managing your body weight, you should see a dietitian and attend group weight loss meetings regularly. If you're having difficulty, don't go it alone!
A recent study, published in the Journal of Clinical Oncology just a few weeks ago, found that women who both exercised and ate a diet rich in vegetables and fruit had nearly a 50% lower risk of recurrence of breast cancer as compared to women who did not practice both of these healthy behaviors. Just eating vegetables and fruit or just exercising did not lower risk.
The important conclusion from this study is that diet alone or exercise alone is not enough. But a combination of healthy eating and moderate, regular physical activity had a large measurable impact on recurrence risk.
The reduced risk came from the combination of eating 5 or more servings of vegetables and fruit per day along with walking 30 minutes or more per day at least 6 days per week. Other physical activities are fine too, as long as they are roughly equivalent to walking 30 minutes per day.
Finally, you can focus on foods and nutrients that actually may help balance estrogen in the body.
Cruciferous vegetables can shift estrogen metabolism in the body so that you have less of the most potent forms of estrogen and more of the weaker estrogens. This is proven with research on humans. Health experts speculate that reducing levels of the more potent estrogens in the body may help reduce risk of recurrence, though this is not proven yet.
Examples of cruciferous vegetables include broccoli, cauliflower, kale, chard, bok choy, mustard greens, collard greens, Brussels spouts, cabbage, kohlrabi, water cress, arugula, daikon, radishes, and rutabagas. A good goal is to eat at least a one serving of cruciferous vegetables each day. A serving ranges from ½ to 1 cup of raw or lightly cooked vegetables.
Animal and cell studies show that white button mushrooms contain compounds that can act as natural aromatase inhibitors. Shiitake, portabello, crimini, and baby button mushrooms also contain these natural aromatase inhibitors.
As you may know, animal and cell studies do not prove that the same thing will happen in humans. However, since there are no obvious downsides to regularly eating white button and other types of mushrooms, I encourage women to include them in the diet regularly. It may not help, but it certainly won't hurt to eat more of these foods.
Grape seed extract is one additional approach that is being studied for its possible actions as a natural aromatase inhibitor. A small study taking place at the City of Hope medical center in Duarte, California is enrolling 24 women ages 40 to 65 to determine how different levels of grape seed extract suppress estrogen production in the body. The researchers are looking at doses ranging from 50 mg to 300 mg of grape seed extract per day.
Unfortunately, we have no way of knowing which dose is most effective for estrogen suppression until results from this study are available. And more is not always better. Sometimes, a lower dose can give a better effect.
If you decide to try grape seed extract supplements, I strongly urge you to discuss this with your doctor. There may be medical reasons why you need to avoid grape seed extract. Also, you should not take grape seed extract in combination with vitamin C if you have high blood pressure. This combination can increase blood pressure further.
Finally, grape seed extract can interact with other medications. According to the Natural Medicines Comprehensive Database, grape seed extract may interact with the following medications: amitriptyline chlordiazepoxide, clomipramine, clopidogrel, clozapine, cyclobenzaprine, desipramine, diazepam, flutamide, fluvoxamine, grepafloxacin, haloperidol, imipramine, mexiletine, mirtazapine, naproxen, nortriptyline, olanzapine, ondansetron, propafenone, propranolol, riluzole, ropinirole, ropivacaine, tacrine, theophylline, verapamil, warfarin, and zileuton.
These interactions are not proven to occur, but based on how grape seed extract works in the body, these interactions are possible. If you are taking any of these medications, you must talk to your doctor about using grape seed extract or any other dietary supplement and please use grape seed extract with caution.
I hope this information is helpful.
Nutritionist Suzanne