Vitamin and antioxidant use after breast cancer diagnosis may improve survival

woman with vitamin EVitamin supplement use after diagnosis of breast cancer is common, but less is known about potential long-term effects on recurrence and survival. A new article published in Breast Cancer Research and Treatment reports that vitamin and antioxidant supplementation after treatment for breast cancer is safe and may even improve survival.

Researchers from Harvard University analyzed data from over 12,000 breast cancer survivors in the After Breast Cancer Pooling Project, a collection of 4 cohort studies of breast cancer survivors from the United States and China.  The analysis examined the post diagnosis use of supplements (vitamins A, B, C, D, E and multivitamins) for 1-5 years.  Sixty percent of the women reported using supplements during the 5 years after diagnosis. Breast cancer accounted for 65% of the total of 1,298 deaths that occurred during the follow-up period.

After adjusting for interactions with smoking, treatment and hormonal status, the use of any antioxidant supplement, categorized in this study as vitamins C, E or a multivitamin, was associated with a 16% lower risk of dying from any cause over follow-up, and for those who used all three supplements, the risk was 21% lower. Vitamin C supplementation was associated with a 19% lower risk of death and a 10% reduction in the risk of breast cancer occurrence, and vitamin E use reduced all-cause mortality by 15% and the recurrence of breast cancer by 12%. Vitamin D supplementation was associated with a 36% reduction in recurrence among women with estrogen receptor-positive tumors (ER+), but not in women with estrogen receptor-negative (ER-) tumors.

In this large group of breast cancer survivors, use of vitamin or antioxidant supplements was not associated with an increased risk of recurrence or death, but instead was associated with improved survival. Consideration of ER status and the use of antioxidants may be clinically relevant when evaluating associations with cancer and mortality risk.

Poole EM et al. Postdiagnosis supplement use and breast cancer prognosis in the After Breast Cancer Pooling Project. Breast Cancer Res Treat. 2013 May 10. [Epub ahead of print]

Broccoli proven to prevent cancer, particularly prostate and breast cancer.

Information from Oregon State University
CORVALLIS, Ore. – Sulforaphane, one of the primary phytochemicals in broccoli and other cruciferous vegetables that helps them prevent cancer, has been shown for the first time to selectively target and kill cancer cells while leaving normal prostate cells healthy and unaffected. 
The findings, made by scientists in the Linus Pauling Institute at Oregon State University, are another important step forward for the potential use of sulforaphone in cancer prevention and treatment. Clinical prevention trials are already under way for its use in these areas, particularly prostate and breast cancer.
It appears that sulforaphane, which is found at fairly high levels in broccoli, cauliflower and other cruciferous vegetables, is an inhibitor of histone deacetylase, or HDAC enzymes. HDAC inhibition is one of the more promising fields of cancer treatment and is being targeted from both a pharmaceutical and dietary approach, scientists say.
“It’s important to demonstrate that sulforaphane is safe if we propose to use it in cancer prevention or therapies,” said Emily Ho, a principal investigator in the Linus Pauling Institute, lead author on the study and associate professor in the OSU Department of Nutrition and Exercise Sciences. 
“Just because a phytochemical or nutrient is found in food doesn’t always mean its safe, and a lot can also depend on the form or levels consumed,” Ho said. “But this does appear to be a phytochemical that can selectively kill cancer cells, and that’s always what you look for in cancer therapies.” 
The findings were published in Molecular Nutrition and Food Research, a professional journal. Research was supported by the National Cancer Institute, National Institute of Environmental Health Sciences and the OSU Agricultural Experiment Station. 
The Linus Pauling Institute has conducted some of the leading studies on sulforaphane’s role as an HDAC inhibitor – one, but not all, of the mechanisms by which it may help prevent cancer. HDACs are a family of enzymes that, among other things, affect access to DNA and play a role in whether certain genes are expressed or not, such as tumor suppressor genes. 
Some of the mechanisms that help prevent inappropriate cell growth – the hallmark of cancer – are circumvented in cancer cells. HDAC inhibitors can help “turn on” these silenced genes and restore normal cellular function.
Previous OSU studies done with mouse models showed that prostate tumor growth was slowed by a diet containing sulforaphane. 
“It is well documented that sulforaphane can target cancer cells through multiple chemopreventive mechanisms,” the researchers wrote in their study. “Here we show for the first time that sulforaphane selectively targets benign hyperplasia cells and cancerous prostate cells while leaving the normal prostate cells unaffected.” 
“These findings regarding the relative safety of sulforaphane to normal tissues have significant clinical relevance as the use of sulforaphane moves towards use in human clinical trials,” they said. 
The results also suggest that consumption of sulforaphane-rich foods should be non-toxic, safe, simple and affordable. 
It is hard to eat broccoli several times a day, so I take a daily multivitamin which includes broccoli phytochemicals.

Women with Aggressive Breast Cancer are More Likely to Have Low Levels of Vitamin D

The article below was distributed to MD via MedPageToday.com. It is rare to see positive vitamin information being shown to MDs.

MIAMI BEACH, Fla. — Women diagnosed with aggressive and late stage breast cancer are more likely to have low levels of vitamin D compared with women with less dangerous forms of the disease, researchers reported here.

Women who were vitamin D deficient — with plasma concentration less than 20 ng/mL — were eight times more likely to be diagnosed with regional or distant spread of cancer when compared with women who had sufficient levels of the vitamin (OR 8.695% CI 1.8 to 41.2), after statistical adjustments, according to Susan Steck, PhD, MPH, of the University of South Carolina in Columbia.
Severe vitamin D deficiency — plasma concentrations less than 10 ng/mL — were found in 17% of African-American women but not in any white participants, Steck reported here at the American Association for Cancer Research Conference on the Science of Cancer Health Disparities.
About 60% of African Americans with breast cancer who participated in the study had some level of vitamin D deficiency, compared with 14.9% of white women (P<0.0001).
Conversely, just 21.7% of African-American women had sufficient levels of vitamin D compared with 42.6% of white women, Steck and colleagues found.
“We think it may be important to for doctors to monitor the vitamin D blood levels of their patients, especially among African-American patients,” said Steck at a poster presentation.
“We know that darker skin pigmentation acts somewhat as a block to producing vitamin D when exposed to sunlight, which is the primary source of vitamin D in most people,” Steck told MedPage Today. She also noted that higher body mass index and physical activity can impact vitamin D levels.
Steck and colleagues recruited 107 women who were diagnosed with breast cancer in the previous five years. Sixty of these women were African American, while the remaining 47 were white. All women donated a blood sample, and vitamin D status was measured with circulating 25-hydroxyvitamin D (25-OH-D) levels. The mean serum concentration of 25-OH-D was 29.8 ng/mL in white women and 19.3 ng/mL in African-American women.
Serum levels were lowest among patients with triple-negative breast cancer — tumors lacking estrogen, progesterone, and HER2 receptors — and diagnosed in 17 African-American women and seven white women, though the disparity did not reach statistical significance, Steck said.
She said that doctors might want to check levels of vitamin D with their patients and discuss implications of the findings. However, she said further research is required to determine if vitamin D supplementation is worthwhile.
“Vitamin D has become the flavor of the month, with studies that indicate it might be useful in heart disease, cancer, and even Alzheimer’s disease. The question that emerges from these studies is, if we do intervene with vitamin D supplementation, will we improve things for patients?” said Olveen Carrasquillo, MD, chief of general medicine at the University of Miami.
“At one time we had similar thoughts about vitamin E, but when we did the clinical trials, it showed vitamin E had little influence on improving health,” he told MedPage Today. “We don’t know if vitamin D itself is the factor or if levels of vitamin D are markers of some other factor that is related to breast cancer.”
The study’s main statistical findings reflected adjustments for age, race, body mass index, season and months since diagnosis.
——————————–
One note about the comment about Vitamin E. There is a tremendous amount of very positive research regarding Vitamin E, but vitamins and minerals are not drugs and many pharmaceutically trained researchers look at a single vitamin in isolation to see its impact on a disease. Well when you eat a meal you’re getting many different vitamins and minerals. These work together in the body and vitamin E for example is re-charged by Vitamin C. So you’d never find straight vitamin C in nature, so why would you take straight vitamin E and exclude all others. This is why it is critical to take a high quality multi-vitamin which has all the essential vitamins and minerals together and in the proper proportions.

20 New Anticancer Rules

By Dr. David Servan-Schreiber, M.D., Ph.D.

Michael Pollan’s recent little gem of a book “Food Rules” inspired me to compile my own “rules” about what I’d like every person to know about how they can help avoid cancer – or slow it down if they have it.

FOOD RULES 

1. Go retro: Your main course should be 80 percent vegetables, 20 percent animal protein, like it was in the old days. Opt for the opposite of the quarter pounder topped with a token leaf of iceberg lettuce and an anemic tomato slice. Meat should be used sparingly for taste, as when it used to be scarce, and should not be the focus of the meal.

2. Mix and match your vegetables: Vary the vegetables you eat from one meal to the next, or mix them together — broccoli is an effective anticancer food, and is even more effective when combined with tomato sauce, onions or garlic. Get in the habit of adding onions, garlic or leeks to all your dishes as you cook.

3. Go organic: Choose organic foods whenever possible, but remember it’s always better to eat broccoli that’s been exposed to pesticide than to not eat broccoli at all (the same applies to any other anticancer vegetable).

4. Spice it up: Add turmeric (with black pepper) when cooking (delicious in salad dressings!). This yellow spice is the most powerful natural anti-inflammatory agent. Remember to add Mediterranean herbs to your food: thyme, oregano, basil, rosemary, marjoram, mint, etc. They don’t just add flavor, they can also help reduce the growth of cancer cells.

5. Skip the potato: Potatoes raise blood sugar, which can feed inflammation and cancer growth. They also contain high levels of pesticide residue (to the point that most potato farmers I know don’t eat their own grown potatoes).

6. Go fish: Eat fish two or three times a week – sardines, mackerel, and anchovies have less mercury and PCBs than bigger fish like tuna. Avoid swordfish and shark, which the FDA says pregnant women should not eat because they contain a high concentration of contaminants.

7. Remember not all eggs are created equal: Choose only omega-3 eggs, or don’t eat the yolks. Hens are now fed on mostly corn and soybeans, and their eggs contain 20 times more pro-inflammatory omega-6 fatty acids than cell-growth regulating omega-3s.

8. Change your oil: Use only olive and canola oil in cooking and salad dressings. Go through your kitchen cabinets and throw out your soybean, corn and sunflower oils. (And no, you can’t give them to your neighbors or your relatives… They’re much too rich in omega-6 fatty acids!)

9. Say “Brown is beautiful”: Eat your grains whole and mixed (wheat with oats, barley, spelt, flax, etc.) and favor organic whole grains when possible since pesticides tend to accumulate on whole grains. Avoid refined, white flour (used in bagels, muffins, sandwich bread, buns, etc.) whenever possible, and eat white pasta only al dente.

10. Keep sweets down to fruits: Cut down on sugar by avoiding sweetened sodas and fruit juices, and skipping dessert or replacing it with fruit (especially stone fruits and berries) after most meals. Read the labels carefully, and steer clear of products that list any type of sugar (including brown sugar, corn syrup, etc.) in the first three ingredients. If you have an incorrigible sweet tooth, try a few squares of dark chocolate containing more than 70% cocoa.

11. Go green: Instead of coffee or black tea, drink three cups of green tea per day. Use decaffeinated green tea if it gets you too wired. Regular consumption of green tea has been linked to a significant reduction in the risk for developing cancer.

12. Make room for exceptions. What matters is what you do on a daily basis, not the occasional treat.

NON-FOOD RULES

1. Get physical: Make time to exercise, be it walking, dancing or running. Aim for 30 minutes of physical activity at least 5 days a week. This can be as easy as just walking part of the way to the office, or the grocery store. A dog is often a better walking partner than an exercise buddy. Choose an activity you enjoy; if you’re having fun, you’re more likely to stick with it.

2. Let the sun shine in: Try to get at least 20 minutes of daily sun exposure (torso, arms and legs) without sunscreen, preferably at noon in the summer (but take care to avoid sunburns!). This will boost your body’s natural production of Vitamin D. As an alternative: discuss the option of taking a Vitamin D3 supplement with your doctor.

3. Banish bad chemicals: Avoid exposure to common household contaminants. You should air our your dry-cleaning for two hours before storing or wearing it; use organic cleaning products (or wear gloves); don’t heat liquids or food in hard plastics; avoid cosmetics with parabens and phthalates; don’t use chemical pesticides in your house or garden; replace your scratched Teflon pans; filter your tap water (or used bottled water) if you live in a contaminated area; don’t keep your cell phone close to you when it is turned on.

4. Reach out (and touch someone!): Reach out to at least two friends for support (logistical and emotional) during times of stress, even if it’s through the internet. But if they’re within arms reach, go ahead and hug them, often!

5. Remember to breathe: Learn a basic breathing relaxation technique to let out some steam whenever you start to feel stressed.

6. Get involved: Find out how you can best give something back to your local community, then give it.

7. Cultivate happiness like a garden: Make sure you do one thing you love for yourself on most days (it doesn’t have to take long!).

Please visit the Anti Cancer Diet web site at: http://www.anticancerbook.com/

Vitamin D and the Reduced Risk of Many Diseases

Vitamin D and the Reduced Risk of Many Diseases
Vitamin D deficiency is associated with osteoporosis, bone fracture, muscle weakness, cancers (particularly breast and colon), autoimmune diseases, obesity, diabetes, schizophrenia, depression, asthma, lung dysfunction, influenza, kidney disease, and high blood pressure, and cardiovascular disease. During pregnancy and infancy vitamin D insufficiency is also associated with preeclampsia (pregnancy-induced hypertension), low birth weight, neonatal hypocalcemia (low blood calcium), poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases and childhood asthma.
There is no debate in the medical community that there is a vitamin D deficiency epidemic that is causing a myriad of problems, and that people need to be supplementing with much higher doses than the traditionally-recommended dose of 400 IU per day. It’s clear that optimal supplementation should be at least 2000 IU/day, if not 4000 IU/day or higher.

Osteoporosis
Vitamin D Helps Prevent Osteoporosis
For years, the recommended dose of vitamin D (400 IU/day) was to help strengthen bones and reduce falls and hip fractures. However, there has been an explosion of research (both retrospective and prospective controlled studies), particularly over the last 5 years advancing our understanding that the worldwide vitamin D deficiency epidemic has an effect on much more than bone development and maintenance.
Vitamin D May Help Prevent Insulin Resistance
Adult-Onset Diabetes begins with insulin resistance. It is known that vitamin D deficiency is a common cause of insulin resistance. Although not all studies have been consistent, the studies that have shown a reduction in insulin resistance revealed the association at blood serum vitamin D concentrations ( 25-hydroxvitamin D, or 25-OH-D) in the range of 35 – 42 ng/ml. 1, 2, 3
Vitamin D is Associated with Decreased Risk of Breast and Colon Cancer

Breast Cancer
Blood serum levels of vitamin D (25-OH-D) above 40 ng/ml are associated with a decreased risk of breast and colon cancer. Vitamin D appears to enter breast cancer cells and trigger apoptosis (programmed cell death), much like many antioxidants.
Pooled data from observational studies showed that women whose serum 25-OH-D levels were at least 52 ng/ml had a 50% associated decreased incidence of breast cancer. Certainly, prospective controlled studies are needed to provide further information, but given the safety of vitamin D and encouraging studies thus far there appears to be no reason for anyone to wait on supplementing with optimal doses now. 4, 5, 6, 7
Vitamin D and Reduced Risk of Heart Disease

Heart Disease
Although further studies are needed to determine the full extent of the protective nature of vitamin D against heart disease, it is apparent that vitamin D deficiency increases the risk of both ischemic and non-ischemic heart disease. Vitamin D may influence how heart muscle functions, helps control blood pressure, influences parathyroid hormone levels, and plays a role in reducing inflammation and calcification of blood vessels, thus reducing plaque formation.
When 25-hydroxy-vitamin D levels are below 15 ng/ml the risk for heart disease is particularly elevated. With 25-OH vitamin D levels above 30 ng/ml cardiac benefits may be substantial, and possibly even greater at the optimal serum range of 50 – 80 ng/ml. 8
Vitamin D and Reduced Risk of Influenza

Influenza Infection
Vitamin D reduces the incidence of respiratory infections. 9, 10 Children with the lowest levels of vitamin D are 11 times more likely to develop respiratory infections. 11 When 60,000 IU of vitamin D was given each week for six weeks to children susceptible to respiratory infections the children were completely free of all such infections over the following six months. 12
The influenza virus (the “flu”) causes damage and kills people by causing massive inflammation through uncontrolled over-production of pro-inflammatory cytokines. Vitamin D down-regulates the expression of pro-inflammatory cytokines (such as tumor necrosis factor-alpha). 13 This is the same destructive pro-inflammatory cytokine process that occurs as we age …leading to aging and chronic disease of all organs, vessels, joints, and neurons. 14 , 15
Much could be said about reducing the incidence and severity of influenza, let alone chronic disease, simply by down-regulating the excessive pro-inflammatory cytokine production with optimal supplementation of vitamin D, …in particular with other vitamins, minerals, and antioxidants. If this weren’t enough, vitamin D up-regulates the expression of anti-microbial peptides, (bits of proteins) in immune cells. Anti-microbial peptides damage influenza viruses, bacteria, and fungi (by damaging their outer lipid membranes), allowing the immune system to eliminate them from the body. 16
Vitamin D and Reduced Risk of Complications of Pregnancy

Pregnancy Complications
Vitamin D is essential and a key modulator of calcium metabolism in children and adults, to avoid rickets and osteomalcia, respectively. As the fetus grows during the third trimester calcium demands rapidly increase, and vitamin D requirements become crucial for proper skeletal growth and optimal maternal and fetal outcomes. As with the majority of the population, and despite prenatal vitamin supplementation, vitamin D deficiency is an epidemic among pregnant and lactating women. (As a result vitamin D deficiency is common, if not an epidemic, among breastfed infants as well.)
Adverse health outcomes such as preeclampsia, low birth weight, neonatal hypocalcemia, poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases have been linked to low vitamin D levels during pregnancy and infancy. 17, 18
Minimum adequate blood levels of vitamin D (25-OH-D) during pregnancy should be greater or equal to 32 ng/ml (and possibly closer to 50 ng/ml). In order to achieve and maintain 25-hydroxvitamin D serum levels at 32 – 50 ng/ml, pregnant and lactating women need to supplement with at least 2000 to 4000 IU/day of vitamin D3 per day, which is both safe and effective.
Childhood Asthma Linked to Vitamin D Deficiency.

Childhood Asthma
Vitamin D deficiency may partially explain the asthma epidemic. Recently, low serum vitamin D levels have been associated with higher risks for asthma exacerbations. Vitamin D plays a role in fetal lung growth and development. Epidemiologic studies have also suggested that higher prenatal vitamin D intakes have a protective role against wheezing illnesses in young children. Vitamin D may protect against wheezing illnesses through its multiple immune effects. In addition, vitamin D may play a therapeutic role in steroid resistant asthmatics. 19
Supplementing with vitamin D may help prevent asthma and the exacerbation of this disease, as well as help treat steroid resistance.
Measuring Your Vitamin D Status

25-OH Vitamin D Test
The only true way to know your vitamin D status, and therefore your proper daily dose, is with a blood test, in which the metabolically-active form of vitamin D, 25-hydroxvitamin D (25-OH-D, or calcidiol) is measured. Relatively recently (over the past 5 to 7 years) when vitamin D’s role in the prevention of degenerative diseases beyond prevention of osteoporosis was recognized, the medical experts recommended a minimum target blood level of 30 ng/ml of 25-hydroxyvitamin D. (I emphasize that “minimum target level” means just that, “minimum!” It does not mean “optimal.”) Therefore, the reference lab ranges was raised to 32 – 100 ng/ml. Most experts in the field of researching and treating vitamin D deficiencies have recommended that “optimal” serum 25-OH-D levels begin at 42 ng/ml, with the ideal target range being achieved between 50 – 80 ng/ml.
What Dose of Vitamin D is Optimal?
The vitamin D dose required to attain a serum level range of 50 – 80 ng/ml will vary from person to person, mostly based upon body mass (weight) and sun exposure. Although this will vary considerably, a 150 lb person who supplements with 2000 IU of vitamin D per day may attain blood level range of 25-OH-D between 30 and 45 ng/ml, depending upon sun exposure. To attain the optimal levels between 50 and 80 ng/ml that same person may need to supplement with 4000 IU per day or more.
On the other hand, a person who weighs 225 lbs. may require 10,000 IU/day to maintain 25-hydroxy vitamin D blood serum levels between 50 and 80 ng/ml. In all instances, the only way to accurately know the “true daily dosage” for a particular person would be to first estimate a starting vitamin D dose, get a serum 25-OH vitamin D test; adjust the dose accordingly, and get re-tested several weeks later.
Are High Doses of Vitamin D Safe?
What dose of vitamin D, or more accurately, what serum blood level, is required to prevent chronic disease and maintain optimal health AND not have toxic side effects? In other words, is long-term “high dose” vitamin D3 supplementation safe?
There is concern that high doses of vitamin D may elevate serum calcium levels and cause kidney stones in those at risk. To partially answer that question we can look at one study in which participants were administered extremely high doses of vitamin D. In a 12 week study, 69 vitamin D deficient patients received either a single oral, or a single intramuscular injection of 300,000 IU of vitamin D. During the 12 week study no cases of hypercalcemia (elevation of blood calcium) were observed. 20
There are no credible reports of vitamin D toxicity with chronic daily vitamin D3 supplementation up to 10,000 IU/day. Many vitamin D expert clinicians are routinely recommending doses well above 10,000 IU/day. Hypercalcemia (an elevated serum calcium level) is only observed with synthetic vitamin D analogues, such as calcitriol. 21
Are there Contraindications for High-Dose Vitamin D?
Primary hyperparathyroidism is the main contraindication. Also, high dose vitamin D supplementation may cause elevation of serum calcium levels in patients with sarcoidosis, tuberculosis, or lymphoma. Therefore, in such cases, patients dosing with levels above 2000 IU per day should do so only with caution AND under the care and direction of a physician.
One Last Word: Maintain Proper Ratios and Balance of Vitamins

Vitamin Ratio and Balance
Vitamin D is one powerful, important, and safe nutrient in which we all should be taking. However, it should be taken with a full balance, and proper spectrum and ratio of vitamins, minerals, essential fatty acids and other antioxidants for optimal health. One example of proper ratios and understanding of supplementation is the fact that supplementing with vitamin A can neutralize the beneficial effects of vitamin D. 22
Most people are aware that high levels of vitamin A can cause birth defects and harm the liver. However, most are not aware that vitamin A and vitamin D compete for each other’s function in the body. Supplementing with excess amounts of vitamin A can suppress the important cancer-fighting effects of vitamin D. 23, 24
Most multivitamin preparations contain vitamin A. Vitamin A (or pre-formed vitamin A) is different from pro-vitamin A, or beta-carotene. Beta-carotene does not interfere with vitamin D. Nor is beta-carotene associated with birth defects or liver problems.
Therefore, in choosing a quality, broad spectrum supplement brand, it is important to choose one that provides beta-carotene (a.k.a. “pro-vitamin A”), not vitamin A. This is just one of many criteria in choosing a quality supplement brand. As it relates to this article, choose a supplement that provides a daily dose of vitamin D3 of at least 2000 IU/day, and consider taking 4000 IU/day and having your blood tested to achieve the target range of 50 – 80 ng/ml.
References:
1. Postgrad Med J. 2010 Jan;86(1011):18-25
2. Int J Endocrinol. 2010;2010:351385.
3. Br J Nutr. 2009 Sep 28:1-7. [Epub ahead of print]
4. Cancer Prev Res (Phila Pa). 2009 Jun;2(6):598-604. Epub 2009 May 26.
5. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):708-11.
6. Osteoporos Int. 2009 Dec 3. [Epub ahead of print]
7. J Environ Pathol Toxicol Oncol. 2009;28(2):133-41.
8. Curr Atheroscler Rep. 2009 Nov;11(6):456-61.
9. Arch Intern Med. 2009 Feb 23;169(4):384-90
10. Epidemiol Infect. 2006 Dec;134(6):1129-40
11. Eur J Clin Nutr. 2004 Apr;58(4):563-7.
12. J Trop Pediatr. 1994 Feb;40(1):58.
13. J Inflamm (Lond). 2008;510.
14. Eur Heart J. 1997 Mar;18(3):470-9.
15. New Engl J Med. 1997 Apr 3;336(14):973-9.
16. J Clin Invest. 2007 Mar:117(3):803-11.
17. Am J Obstet Gynecol. 2009 Oct 19. [Epub ahead of print]
18. Clin Endocrinol (Oxf). 2009 May;70(5):685-90. Epub 2008 Sep 2.
19. Curr Opin Allergy Clin Immunol. 2009 Jun;9(3):202-7.
20. Scand J Rheumatol. 2009 Mar-Apr;38(2):149-53.
21. BMJ. 2009 Dec 31;339:b5649.
22. J Bone Miner Res. 2001 Oct;16(10):1899-905.
23. J Nutr. 2005 Jul;135(7):1647-52.
24. Virol J. 2008;529.

Our Young Girl’s Increasing Risk for Breast Cancer

Two well known risk factors for breast cancer have come in to play in a study released today: obesity and a greater number of menses over a lifetime. Now, a shocking new study out of Denmark notes that in less than 20 years, the age of menarche (first period or puberty) for young girls has gone down a FULL YEAR.

To give some perspective to this, in the 19th century, girls reached puberty at the age of 15 to 17 years of age, depending upon country of origin. In the 1960’s, the internationally stated age of puberty was set at 12. Now, these new statistics (which appear to be matched in the U.S.) reveal an average age of puberty of less than 9 years old. It is not only the lower age of puberty that is of concern. The rapidity with which this change has occurred is equally concerning.

Scientists are speculating that two causes may be at play. The first: children are more obese than they used to be causing their bodies to make more estrogen. This could result in earlier menses. The second factor: chemicals in our environment called estrogen disruptors may also play a part in this shocking development. These chemicals are found in our food supply, our water and even in the tools with which we eat and drink.

Concerns about health problems related to earlier menses, such as cancer and the associated obesity with its complications are certainly prevalent. Hitting puberty results in a longer lifetime exposure to estrogen which is a factor in breast cancer and heart disease. In addition, socially these younger girls have to face unprecedented sexual pressure. Now they have bodies that are mature before they are emotionally prepared to deal with these issues.

Ten years ago there was debate whether some of the health changes that are rapidly appearing, such as autism, obesity, MS and premature menarche, were due to better collection of data. The data we are receiving now is collected in a modern time. These are real changes and real numbers.

My rumination on this topic would be that hundreds to thousands of years used to be required for such a dramatic change in human physiology. Now, over less than 20 years, this change has been documented. We are left with the question, “What is happening to the health of our children and our citizens?” Now, that’s a question we should get to work on!!

Turmeric and black pepper fight cancer stem cells

A new study shows that a combination of turmeric and piperine can limit the growth of stem cells for breast cancer — the cells that conventional treatment have the hardest time eliminating.

Madhuri Kakarala is a physician at the University of Michigan; she’s a cancer specialist and a PhD researcher. But she’s also a nutritionist, and, during her final years of medical studies she was diagnosed with cancer — a stage IV cancer of the thyroid. Madhuri decided to invest all her talent as a researcher and clinician in the task of getting well, and she rapidly arrived at the conclusion that nutritional change could significantly improve her response to her cancer treatment.

Because Madhuri is from an Indian background, she was most interested in the medical and culinary traditions of her country, and particularly fascinated by the promising effects of turmeric in the prevention and treatment of cancers.

This month Madhuri published an important article on the effect of turmeric on breast cancer stem cells. [1] Stem cells are at the center of a theory that seeks to explain why cancer can sometimes return, despite apparently effective treatment. This is because even when all the cancer cells have been eliminated these cancer stem cells that have lied dormant and escaped treatments may be able to form entire new colonies of cancer cells. So to prevent relapse, it’s essential that we learn how to eliminate the stem cells. But unfortunately, because they don’t actively renew themselves through cell division like other cancer cells do, most existing treatments that target cancerous cells (like radiotherapy and chemotherapy) aren’t effective against stem cells. For this reason, the pharmaceutical industry has a whole sector of research devoted to developing new therapies to target and destroy stem cells.

For several years now, Madhuri’s lab at the University of Michigan has been studying the effect on breast cancer of curcumin — one of the most active substances in turmeric — and piperine, which is a substance active in black pepper. In her latest study she demonstrates that concentrations of curcumin and piperine which can be obtained through diet or from dietary supplements are capable of eliminating breast cancer stem cells, without causing any damage to the normal breast cells. In other words, this isn’t a general toxic effect on cells, like conventional anti-cancer treatments have, but an ultra-selective impact on cancer stem cells alone.

“This shows that these compounds are not toxic to normal breast tissue,” Madhuri says. “Women at high risk of breast cancer right now can choose to take the drugs tamoxifen or raloxifene for prevention, but most women won’t take these drugs because there is too much toxicity. The concept that dietary compounds can help is attractive, and curcumin and piperine appear to have very low toxicity.”

The possible anti-cancer properties of curcumin and piperine have been the object of many other studies. But this study is the first to show that they may have a targeted effect on stem cells. Medications like tamoxifen or raloxifene only act against cancers that are sensitive to estrogen. If curcumin and piperine can target stem cells, they have the potential to be useful in many types of breast cancer, particularly those that aren’t estrogen-sensitive — and these are often the most aggressive.

Madhuri’s study was performed on cell colonies in Petri dishes, in lab conditions. So we haven’t yet reached the stage of a clinical study that would establish guidelines for recommendations to take turmeric supplements at specific dosages for certain types of cancer. However, given that turmeric and pepper, taken as part of a normal diet, are practically never toxic in any way, it seems to me to be perfectly reasonable to recommend that all of us regularly consume a soupspoon of turmeric every day, with a pinch of pepper. You can use it in all your cooking, just like I’ve been doing for years.

CAUTION: Note that it is often safest to avoid turmeric during chemotherapy as well as a three days before and after the treatment. This is because it can – rarely, but it can – interfere with some chemotherapy treatments and reduce their benefits.

REFERENCE
1. Kakarala, M., et al., Targeting breast stem cells with the cancer preventive compounds curcumin and piperine. Breast Cancer Research & Treatment, 2009.

CT scan radiation linked to cancers

CT scans deliver far more radiation than has been believed and may contribute to 29,000 new cancers each year, along with 14,500 deaths, suggest two studies in today’s Archives of Internal Medicine. One study, led by the National Cancer Institute’s Amy Berrington de Gonzalez, used existing exposure data to estimate how many cancers might be caused by CT scans.

Another study in the journal suggests the problem may even be worse. In that study, researchers found that people may be exposed to up to four times as much radiation as estimated by earlier studies. While previous studies relied on dummies equipped with sensors, authors of the new paper studied 1,119 patients at four San Francisco-area hospitals, says author Rebecca-Smith Bindman of the University of California-San Francisco. Based on those higher measurements, a patient could get as much radiation from one CT scan as 74 mammograms or 442 chest X-rays, she says.

Young people are at highest risk from excess radiation, partly because they have many years ahead of them in which cancers could develop, Smith-Bindman says. Among 20-year-old women who get one coronary angiogram, a CT scan of the heart, one in 150 will develop cancer related to the procedure.

Not all doctors agree about those risks. Scientists have not yet determined whether low doses of radiation actually increase cancer risk or whether the risk rises only after exposure levels reach a certain threshhold, says James Thrall, chairman of the American College of Radiology.

He says it’s also tricky to compare cancer rates between people who have had CT scans with those who haven’t. People undergoing scans may have underlying health problems that predispose them to cancer, he says.

In many cases, CT scans can be lifesaving. In other cases, there’s no evidence a CT scan is really better than other approaches, Smith-Bindman says. Up to one-third of all CT scans are unnecessary, according to an accompanying editorial by Rita Redberg, also of UCSF.

Doctors sometimes order CT scans for convenience because they don’t have access to results at another facility, says Rosaleen Parsons, chair of diagnostic imaging at Philadelphia’s Fox-Chase Cancer Center, who wasn’t involved in the new studies.

She suggests that patients keep their medical records and ask doctors about alternatives that don’t involve radiation exposure.

Patients also should ask if a facility has been accredited by the American College of Radiology, she says.

Source USA Today 12/15/09

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Five Types of Parabens Detected Intact in Human Breast Tumors

From Cornell University – Sprecher Institute for Comparative Cancer Research.

Background

Parabens have been used as preservatives since the 1920s. Parabens are used to prevent the growth of bacteria in a wide range of consumer products, including a variety of foods and pharmaceutical drugs. The most prevalent use has been as a preservative in cosmetics, including facial and body cosmetics, skin care products, shampoos and conditioners, sunscreens, underarm products (antiperspirants and deodorants), colognes and perfumes, and soaps, including liquid hand soap. One of the most widely quoted sources of information on use, exposure and safety of the four most commonly used parabens was published in 1984 in a report authored by Elder (1). This report estimated that parabens were used in over 13,200 different cosmetic products.

Parabens have been widely accepted and used because of past reports of their effectiveness as preservatives, low cost, and rapid excretion from the body (both human and animal testing). However, recently some scientists have raised concerns that further assessment of parabens may be needed. This is based on recent evidence from over a dozen scientific studies indicating that several types of parabens can bind to the estrogen receptor and can cause estrogen-like responses when tested in laboratory animals or in a variety of tissue culture assays (see http://envirocancer.cornell.edu/Bibliography/Bibliography.cfm under Endocrine Disruption Bibliographies). In whole-animal studies, the estrogenic effects of parabens were not seen when fed to the animals, but only when applied to or injected under the skin. But, these were short-term, high-dose studies. Little to no information exists on whether use of products with low levels of parabens over many years results in accumulation of parabens in body tissues and whether there are or are not any health effects associated with use of paraben-containing consumer products.

Overview

The study by P. Darbre and colleagues (2) was conducted to assess whether any of the six parabens commonly used in consumer products in Europe could be detected in human breast tumors. The names of the parabens studied were: methylparaben, ethylparaben, propylparaben, isobutylparaben, butylparaben and benzylparaben. The prefix (e.g. “methyl”) indicates the name of the side-chain structure of each paraben. In this study, 20 samples of human breast tissue were obtained from patients undergoing surgery at the Edinburgh Breast Unit in Scotland, UK. The samples were frozen, and then tumors were minced and homogenized to help break up the tissue. Solvents were used to extract the parabens from the tumor sample, followed by the use of thin-layer chromotography to isolate any of the parabens present in the samples. Another method called high-pressure liquid chromatography with mass spectrometry was used to identify the type and the concentration of each paraben. For each batch of samples, a blank was included that had no tumor tissue, which was run through the same extraction and detection procedure. The authors were surprised that the blank was not zero, but had some parabens. The authors thought parabens in the hand soap used by technicians or in the detergent used to clean the glassware may have contaminated the laboratory equipment. Blank values were subtracted from sample paraben values to correct for this problem. At least one type of paraben was detected in 19 out of 20 tumors. Methylparaben was the most commonly observed paraben (18/20) and was detected at the highest average level.

Commentary

This study is the first report of the detection of parabens in human breast tumors. The authors are careful to point out that the results of this study do not show that any of the parabens caused breast cancer in these women. This study is not evidence of cause and effect. The study did show that five of the six parabens widely used in consumer products can be detected intact (not changed or metabolized) in human tissues. This is an important initial finding, but more research is needed to see if exposure to parabens does or does not affect breast cancer risk.

For instance, this study did not show if levels of the parabens in breast tumors were any different from nearby normal breast tissue in these women. Also, this study did not include any women without breast cancer. To evaluate breast cancer risk, a study would need to compare levels of parabens in women with breast cancer (cases) to women of similar age without breast cancer (controls). This study was very small, with only 20 tumor samples. A larger, case-controlled study would be needed to more fully evaluate whether parabens do or do not affect breast cancer risk. This study did have some other problems, such as the contamination of the blank samples mentioned above. Another problem reported was in the analytical method. An important way to measure the ability to accurately detect the chemical includes adding (spiking) a known amount of paraben to a sample to see how much of the known amount can be recovered from the sample. For instance, if you add 100 units, you would like to have a high recovery of over 90%. In this study, the recoveries of added paraben averaged just under 50%. Hence, the method used to extract the parabens from the sample needs to be improved.

This study has received attention in the popular press because the authors are interested in exploring the hypothesis of whether estrogenic parabens used in underarm products (like deodorants and antiperspirants) increase breast cancer risk. This study did not test this hypothesis. The results did show that intact parabens can be detected in human tissue. It did not however, make any attempt to find out the source of the parabens. The women who donated the tumor samples were not interviewed. In fact, no reports of their age or tumor status were included in this study. No information on other factors that may have influenced their breast cancer risk, or information on past use or patterns of use of products with parabens was obtained. It is not known if the major exposure was due to the parabens from food or via topical application of a certain type or a variety of personal care products.

Better studies are needed of whether or not long term use of paraben-containing consumer products affect human tissue levels. Given the ubiquitous nature of paraben use in consumer products and recent evidence of the estrogenicity of parabens, I would agree with other scientists who have called for a reassessment of the safety of parabens. Most of the risk assessments conducted on the safety of parabens were done before it was known that parabens can act as an environmental estrogen and before it was known that levels are detectable in human tissue. A recent study on the safety of propylparaben does acknowledge the estrogenicity of this chemical, but does not fully explore possible human health risks (3). More recent data is needed to update the 1984 study by Elder, which is one of the few reports estimating exposure to parabens from food, drug and cosmetic products. While use of parabens is widespread, product-to-product use is variable. In a survey of products in my own bathroom and kitchen, I found a type of paraben listed as an ingredient in liquid hand soap, two hand lotions, one out of three shampoos (the “natural” brand was the one with the paraben), one out of two hair conditioners, and three out of five sunscreens (including two made for use by children), but in none of the three antiperspirants that my family uses.

At this point in time we do not have information on whether or not paraben-containing products are used at a level that affects human health. But, research indicating that several parabens can act as weak environmental estrogens and the preliminary results of this study do support the need for more vigorous research in this area. Unlike other environmental contaminants, use of personal care products represents a choice made by the consumer and a choice by the manufacturer who determine the ingredients of the product.

1) Elder, RL. Final report on the safety assessment of methylparaben, ethylparaben, propylparaben and butylparaben, Journal of the American College of Toxicology, vol. 3, pp. 147-209, 1984.

2) Darbre, PD, A Aljarrah, WR Miller, NG Coldham, MJ Sauer and GS Pope, Concentrations of parabens in human breast tumors, Journal of Applied Toxicology, vol. 24, pp. 5-13, 2004.

3) Soni, MG, GA Burdock, SL Taylor, NA Greenberg, Safety assessment of propyl paraben: a review of the published literature (Review), Food and Chemical Toxicology, vol. 39, pp. 513-532, 2001.

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There are some companies which produce paraben free skin care, but often they use formaldehyde releasing agents, or natural oils to preserve the product.

Mushrooms, green tea may lower breast cancer risk

Women who get plenty of mushrooms and green tea in their diets may have a lower risk of developing breast cancer, new study findings suggest.

The study, of more than 2,000 Chinese women, found that the more fresh and dried mushrooms the women ate, the lower was their breast cancer risk.
The risk was lower still among those who also drank green tea everyday.
It’s known that the rate of breast cancer in China is four- to five- times lower than rates typically seen in developed countries — though the rate has been climbing over the past few decades in the most affluent parts of China.
The current findings suggest that traditional diets — and specifically, large quantities of mushrooms and green tea — may help explain China’s lower breast cancer incidence, according to lead researcher Dr. Min Zhang, of the University of Western Australia in Perth.
She and her colleagues report the findings in the International Journal of Cancer.
The study was conducted in southeast China and involved 1,009 breast cancer patients between the ages of 20 and 87, and an equal number of healthy women the same age. All completed a detailed dietary questionnaire that asked them how often they ate specific foods.
Overall, Zhang’s team found, women who ate the most fresh mushrooms — 10 grams or more per day — were about two thirds less likely to develop breast cancer than non-consumers of mushrooms. Meanwhile, women who ate 4 grams or more of dried mushrooms per day had half the cancer risk of non-consumers.
Finally, mushroom eaters who also drank green tea everyday had only 11 to 18 percent of the breast cancer risk of women who consumed neither.
The study does not prove cause-and-effect, the researchers point out.
They did account for several kinds of risk factors for breast cancer – such as the women’s weight, education level, and exercise frequency and smoking habits — but there could be other factors that explain the findings.
This is also the first study linking high dietary amounts of mushrooms and green tea to lower breast cancer risk, Zhang told Reuters Health.
Therefore, she said, it’s too early for women to assume that the foods will help them avoid the cancer.
Still, it is biologically plausible, the researchers point out.
Lab research has shown that mushroom extracts have anti-tumor properties and, in animals, can stimulate the immune system’s cancer defenses. For its part, green tea contains antioxidant compounds called polyphenols that have been shown to fight breast tumors in animals.

SOURCE: International Journal of Cancer, March 15, 2009