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The Connection Between Breast Cancer and The Environment

Breast Cancer is the most commonly diagnosed malignancy in women.

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There is a continually expanding and compelling volume of data linking breast cancer to exposure to environmental toxins, radiation and endocrine disrupters lead to increased incidence of breast cancers.

When taking a thorough history of our patients we must include a review of their “Exposome”

Genetic and Genomic factors, Reproductive history, lifestyle factors such as weight, alcohol consumption, smoking and lack of physical exercise all contribute to increased risk profiles. Socioeconomic status as well as psychological health and resilience, all influence outcomes. Racial and ethnic minorities are often exposed to a disproportionately higher level of environmental toxins in the US. Immigrants may have lived in areas where there are no environmental regulations or controls.

Exposures to common chemicals found in products used every day contribute to a lifetime burden of toxic chemicals. The greatest rise in the incidence of breast cancers occurred in the decades after World War II when there were exponential increases in the use of herbicides, pesticides, plastics, cosmetics and body care products.

Cancer is often a perfect storm of genetics and environment. While studies are done on single agents, the reality is that we are living in a toxic chemical soup in modern life exposing us to a myriad of chemicals from multiple sources on a daily basis.

A common chemical BPA (Bisphenol A) is an endocrine disruptor. Exposure to BPA early in life contributes to breast displasias later in life due to its impact on mammary gland gene expression. BPA is found in plastics, linings of canned food containers and credit card receipts.

Limit exposure to plastics, polycarbonate food and water containers and canned foods to reduce BPA exposures. Breastfeeding women should be cautious as BPA is found in human breast milk.

Parabens, p-hydroxybenzoic acid esters, are widely used preservatives in personal care products and cosmetics. Parabens are endocrine disruptors. Parabens enable the Hallmarks of Cancer, characteristics of tumor cell survival and proliferation through multiple pathways. Parabens are also found in human breast milk. Parabens bind to estrogen receptors, inhibit apoptosis, promote proliferation, angiogenesis and metastasis. A lifelong commitment to avoiding all products that contain parabens will dramatically reduce exposures. Many European countries have banned the use of parabens. European made products are often paraben free as well as select brands made in the US.

Visit the Environmental Working Group Cosmetics Data base https://www.ewg.org/skindeep/ for a list of safe and not so safe products.

Single Nucleotide Polymorphisms in P450 enzymes, particularly CYP1BI metabolism. Mulitple methylation pathways also influence detoxificaton pathways and estrogen metabolism.

A healthy microbiome, particularly rich in Bifidobacteria and butyrate support normal estrogen conjugation and excretion. MANY breast cancer treatments contribute to dysbiosis, increased inflammation and alterations in estrogen metabolism and mood.

Pelvic and Abdominal radiotherapy, surgeries, chemotherapy agents, steroids, antibiotics administered to cancer patients and compromise gut health, immunity and inflammation control. Increasing butryate in the intestines improves the health of the microbiome.

Butyrate and the health of intestinal microbiome can be easily increased by ingesting 6-8 grams of soluble fibers daily. The Onion-Garlic family and the Brassica-Cabblage family vegetables are high in soluble fibers.

The use of oral contraceptives, fertility drugs and hormone replacement therapy all alter breast tissue. Thus, medical care itself leads to nosocomial trends in breast cancer. Patients BEWARE!!!

Many pesticides and herbicides cause endocrine disruption. Commercial production of many animal food sources including the additional of estrogens and growth hormones to feed.

Patients should be well versed and take a tour of their home room by room to identify toxic, endocrine disrupting chemical exposures.

Patients can be overwhelmed when we give them a long list of products and foods to avoid.

In our clinic we employ nutritional health coaches to assist patients in successfully implementing a lifestyle and diet that reduces exposures to estrogenic environmental chemicals.

Download your complimentary copy of the
OUTSMART CANCER CARE PLANNER History and Intake Form

OutSmart Cancer Care Planner

Let The Oncologist Be The Disease Expert. Become The Health Expert That Cancer Patients Are Looking For.

You may not treat cancer in your practice, but you do have patients who are at risk due to personal and family history, patients who may be undergoing or recovering from treatments, patients who are survivors worried about recurrence and patients living with cancer as a chronic illness.  And you may also have patients who are family members concerned about their loved ones. 

 

There is no HEALTH MODEL in conventional oncology care, yet health and wellbeing, peace of mind and sense of agency are in the center of the hearts and minds of cancer patients, cancer survivors and their families. 

 

There will be 19 million cancer survivors in the US alone by 2024.  Who is supporting their health?  Who is trained to help them recover and keep them well??  …not the oncologist.

 

How can you help these patients?

A  breast cancer survivor who successfully completed her treatments 8 years ago comes into your office as a new patient complaining of persistent peripheral neuropathy and ongoing cognitive changes since her treatment.  How can you resolve these long-term adverse effects?

 

An ovarian cancer patient currently undergoing aggressive treatment every 21 days comes into your office complaining of severe diarrhea, neuropathy and sleep disruption.  What can you do to help her get through her treatments with less adverse effects, maintain her weight and nutritional status?

 

A colorectal cancer survivor who completed his treatment 3 months ago is continuing to have 10-15 bowel movements daily and is profoundly fatigued.  What will you do to restore normal bowel function?


A prostate cancer patient on endocrine blockade therapy is suffering from
hot flashes. Should you also be concerned about loss of bone mass and sleep cycle disruption?

 

An endometrial cancer survivor is suffering from dermatitis and colitis, adverse effects of her dramatically successful immunotherapy treatment and now has chronic autoimmune inflammation. How will you manage this?

 

A head and neck cancer patient who has trouble swallowing is losing weight and muscle mass.


How can you provide a plan for repair from oral mucositis, restoration of the oral mircrobiome and repletion of calories and nutrients?

 

These patients are searching for clinicians that can guide and support them through every phase of their cancer journey.  Just as in helping your patients navigate other chronic illnesses, patients look to you for a plan, for monitoring and guidance so that they can maintain and regain their health during and after their treatments.

 

When a patient has a collaborative team providing integrative care everyone wins, the patients, families and care providers.  Patients who have a clear plan and support have the opportunity for better outcomes, better prognosis, greater peace of mind, a sense of control and agency and an improved quality of life. 

 

Let the oncologist be the cancer expert. You can be the health expert on their team.

 

Standard of care in oncology must  change such that care includes not only a team of disease experts (usually medical oncologist, surgeon, radiologist) but ALSO a team of health experts.

 

Towards this end  I founded the American Institute of Integrative Oncology Research and Education and  have created an online self-paced training program for front line clinicians who want to expand their skills and their practice and  fill the huge need in our communities and serve these patients.  If you did not specialize in oncology, you probably had one course on this topic but you need to fill the gap in your training to feel confident in doing so.

 

The Foundations of Integrative Oncology Training is not for clinicians who want to practice oncology.  It is front-line clinicians who want to feel confident, knowledgeable and well trained in supporting the health side of the cancer equation. This self- paced online training is for clinicians who want to increase their impact, expand and grow their practice and represents 35 years of clinical practice and experience.

 

The first step is learning how to take a comprehensive and complete history of patients whose lives have been touched by cancer.  

 

You can receive a complimentary copy of the

OUTSMART CANCER CARE PLANNER History and Intake Form

and learn more about the Foundations of Integrative Oncology training here

 

OutSmart Cancer Care Planner

Omega 3 Fatty Acids: Enhanced Control of Cancer Risk and Progression

A diet high in polyunsaturated fatty acids, especially omega 3s, have been shown to be negatively associated with cancer development

 Dietary fatty acids have been recognized as influential factors in the activation of carcinogenic events or disease progression and have been associated with a direct connection to breast cancer prevention.

PUFAs differentially inhibit mammary tumor development by inflicting modifications to the morphology of cell membranes, and influencing signaling pathways, gene expression and apoptosis.

The human body is unable to synthesize long-chain polyunsaturated fatty acids (PUFAs) Omega 3 DHA, docosahexaenoic, and EPA, Eicosapentaenoic acid and Omega 6 Arachidonic Acid at a reasonable rate and therefore, supplementation is required through dietary sources or nutritional supplements. The recommended daily nutritional dose is 2,000 mg EPA+DHA, while therapeutic dosing is 4,000-6,000 milligrams of EPA+DHA per day.

 

 Omega Three Fatty Acids and the Tumor Microenvironment

  1. Supports Normal Inflammation Control by lowering COX 2, LOX5, PGE2, IL1, IL6,TNFa, CRP.
    • Increased inflammation contributes to cancer development, progression and metastasis.
    • Increased inflammation is linked to cancer related pain, fatigue, depression and cognitive impairment.
    • Increased inflammation is linked to cancer related hypercoagulation and risk of thromboembolism
    • Supporting Normal Inflammation control has a wide impact on the behavior of tumor cells and on safety and quality of life for cancer patients and survivors.
  2. Promotes Expression of M1 Type Tumor Associated Macrophages (TAMs).
    • Type M1 TAMs promote tumor regression, inflammation control and immune activation by promoting tumor infiltration by antigen presenting dendritic cells and cytotoxic T cells.
  3. Inhibits VEGF (Vascular Endothelial Growth Factor) and Promotes Normal Control of Angiogenesis .
    • VEGF promotes the development of new blood vessels to the tumor cells. Inhibition of VEGF and the development of capillaries inhibits tumor growth and profession as well as metastasis.
       
  4. Down regulates tumor promoter Protein Kinase C isoenzymes,
    • A group of enzymes that link multiple cellular processes responsible for regulation of tumorigenesis, cell cycle progression and metastasis.
  5. Inhibits Collagenase,
    • A proteolytic enzyme that breaks down the ECM (Extracellular Matrix) and allows invasion of tumor cells into tissues and blood vessels, leading to progression, invasion and metastasis.
  6. Promotes Normal Apoptosis signaling.
    • Cancer cells lose the ability to initiate apoptosis, the normal process in which a cell recognizes itself as aberrant and self destructs. The inhibition of normal apoptotic signaling in malignant cells is a hallmark  of the tumor microenvironment permissive of uncontrolled growth, persistence and immortality due to loss of normal regulation.
  7. Lowers Bcl2 and Ras oncogenes.
    • These genes inhibit normal apoptosis and promote tumor growth and progression.
  8. Acts as a Chemo-sensitizer
    • Working synergistically to enhance therapeutic effect of chemotherapy drugs. DHA has a potential to specifically chemo-sensitize tumors.
    • Tumour cells can be made more sensitive to chemotherapy than non-tumor cell when membrane lipids are enriched with DHA
    • Incorporating DHA during treatment reduces adverse effects of chemotherapy.
    • DHA can improve the outcome of chemotherapy when highly incorporated into cell membranes.
  9. Acts as a Radio-sensitizer.
    • By promoting normal membrane structure and function and by influencing the tumor microenvironment DHA acts synergistically to potentiate therapeutic effects of radiotherapy on tumor cells.
  10. Promotes Healthy 16-OH Estrogen metabolism.
    • Estrogen can be metabolized through multiple pathways. The promotion of 16-Hydroxylation of estrogen produces estrogen metabolites that are not pro-carcinogenic. Omega 3 Fatty Acids promote healthy estrogen metabolism.
  11. Inhibits Platelet Aggregation and Thrombin Formation.
    • Abnormal hyper-coagulation, increased platelet aggregation and thrombus formation are hallmarks of the tumor microenvironment. Control of platelet aggregation and thrombus formation reduces the risk of life threatening and adverse  thrombotic events.  40% of all cancer patients are at risk for the formation of thromboembolisms.  Omega 3 Fatty Acids reduce this risk.
  12. Promotes Normal Cell Membrane Functions and Receptor Binding
    • A healthy flexible cell membrane built of omega 3 fatty acids promotes an enhancement of all membrane functions, normalizing and optimizing normal and therapeutic physiology.
  13. Increases expression of Tumor Suppressor Gene PTEN.
    • Increased expression of tumor suppressor genes leads to enhanced control over carcinogenesis,  tumorigenesis and metastatic progression.
  14. Inhibits Multi Drug Resistance.
    • Tumor cells can quickly become resistant to therapeutic anti-neoplastic agents thus decreasing and shortening the efficacy of treatments.
  15. Inhibits cachexia preserves muscle mass and bone mass (inhibits proteolysis inducing factor)
    • Loss of bone mass (osteopenia) and loss of muscle mass (sarcopenia) are risk factors of aging and of the cancer physiology.  Maintaining bone mass and muscle mass are crucial to robust healthy function and quality of life.
  16. Supports normal mood regulation.
    • Depression and anxiety are common in cancer patients. Support of balanced mood allows cancer patients deep and restful sleep, improved quality of life and increased coping capacity and resilience in the face of stress.

Cautions and Contraindications

  • Patient on anticoagulant medications
  • Patients with thrombocytopenia and known hypo-coagultion clotting disorders
  • Pre and Post Surgical patients (72 hours)
  • Patients with seafood allergies


How to Measure Omega 3 Fatty Acid Status

Serum or Plasma Omega 3 Fatty Acid ratios. LABCORP Omega 3-6 Fatty Acids, Quest Diagnostics Omegacheck, Boston HeartLab Fatty Acid Balance, Cleveland HeartLab Omegacheck, Genova Diagnostics Essential and Metabolic Fatty Acids, Great Plains Comprehensive Fatty Acids, OmegaQuant Omega3 Index.

 

Selected References

 Azrad M, Turgeon C, Demark-Wahnefried W. Current evidence linking polyunsaturated Fatty acids with cancer risk and progressionFront Oncol. (2013) 3:224.

 Bartsch H, Nair J, Owen RW. Dietary polyunsaturated fatty acids and cancers of the breast and colorectum: emerging evidence for their role as risk modifiers. Carcinogenesis. (1999) 20:2209–18.

 Bournoux, P. Et al. Improving outcome of chemotherapy of metastatic breast cancer by DHA: Phase II Trial, Br.J Cancer 2009 Dec 15:101(12):1978-85

 Shweta Tiwary   Altered Lipid Tumor Environment and Its Potential Effects on NKT Cell Function and Tumor Immunity.  Front Immunol.10.3389/fimmu.2019.02187

 Zanoaga O, Jurj A, Raduly L, Cojocneanu-Petric R, Fuentes-Mattei E, Wu O, et al. Implications of dietary omega-3 and omega-6 polyunsaturated fatty acids in breast cancer.  Exp Ther Med. (2018) 15:1167–76. 10.3892/etm.2017.5515

How Evolution Helps Us Understand and Treat Cancer

The Cheating CellThe Cheating Cell: How Evolution Helps Us Understand and Treat Cancer - by Athena Aktipis

A fundamental and groundbreaking reassessment of how we view and manage cancer

Published: 03/24/2020

When we think of the forces driving cancer, we don’t necessarily think of evolution. But evolution and cancer are closely linked, for the historical processes that created life also created cancer. The Cheating Cell delves into this extraordinary relationship, and shows that by understanding cancer’s evolutionary origins, researchers can come up with more effective, revolutionary treatments.

Athena Aktipis goes back billions of years to explore when unicellular forms became multicellular organisms. Within these bodies of cooperating cells, cheating ones arose, overusing resources and replicating out of control, giving rise to cancer. Aktipis illustrates how evolution has paved the way for cancer’s ubiquity, and why it will exist as long as multicellular life does. Even so, she argues, this doesn’t mean we should give up on treating cancer—in fact, evolutionary approaches offer new and promising options for the disease’s prevention and treatments that aim at long-term management rather than simple eradication. Looking across species—from sponges and cacti to dogs and elephants—we are discovering new mechanisms of tumor suppression and the many ways that multicellular life-forms have evolved to keep cancer under control. By accepting that cancer is a part of our biological past, present, and future—and that we cannot win a war against evolution—treatments can become smarter, more strategic, and more humane.

Unifying the latest research from biology, ecology, medicine, and social science, The Cheating Cell challenges us to rethink cancer’s fundamental nature and our relationship to it.

Grab Your Copy Here

Resolving Cancer Related Cognitive Impairment - Repairing the Blood Brain Barrier

Resolving Cancer Related Cognitive Impairment – Repairing the Blood Brain Barrier

Resolving Cancer Related Cognitive Impairment - Repairing the Blood Brain Barrier

Did you know that 45% of all cancer patients self-report a decline in cognitive function after completing chemotherapy?

 

Cancer-related cognitive impairment is attributed to both cancer as well as treatment-related changes in cytokine profiles, blood brain barrier permeability, genetic susceptibility, hormonal factors and mitochondrial dysfunction.

 

Both the disease itself and the treatments, can impact attention, memory and executive functions, as well, as brain structure and anatomy.

As many as 20% of all patients report continued persistent changes in cognitive function as many as 10-20 years after completing successful treatment.

 

Eight Nutraceuticals and Phytochemicals that Promote Neuron Repair and Support Restoration of the Blood Brain Barrier and Cognitive Function


1. Melatonin (10-20mg hs) -
Maintains Blood Brain Barrier Integrity and Permeability

  • Inhibits Matrix Metalloproteinase-9 (MMP-9)
  • Inhibits NADPH oxidase-2
  • Activates SIRT1 Silent Information Regulator 1
  • Activates AMP Activated Protein Kinase (AMPK)

2. Astragalus (1-6g/day) - Decreases Blood Brain Barrier Permeability

  • Inhibition of MMP-9 Neuro-Immuno-regulation
  • Control of Oxidative Stress
  • Control of Neuro-inflammation
  • Regulation of Neuro-apoptosis
  • Inhibition of p53 Modulation of the Bcl-2/Bax

3. Resveratrol (1000mg bid x 52 weeks) - Regulates Neuro-Inflammation

  • Decreases CSF MMP9
  • Modulates neuro-inflammation
  • Induces adaptive immunity
  • Activates SIRT1

4. Pterobstilbene (50-100mg/d) - Attenuates Learning and Memory Impairment

  • Inhibitory effect on microglia activation
  • Protective effect on neuronal injury
  • Decreases production of NO, TNF-α and IL-6 in microglial cells
  • More lipophilic than Resveratrol

5. Unique Probiotic Blend (KLAIRE Target gb-X 1 packet/day) - Targets Gut-Brain Axis

  • Strengthening of the gut barrier function
  • Modulation of cytokines and inflammatory response
  • Production of potentially neuroprotective metabolites
  • Shift away from macrophage-produced cytokines to T-lymphocyte-produced cytokines
  • Reduction in circulating lipopolysaccharide endotoxins
  • Marked reduction in transcription of hippocampal genes related to HPA regulation

6. Curcumin (3-6g/day) - Improves Cognitive Function

  • Crosses Blood Brain Barrier
  • Supports Axonal Regeneration
  • Increases Brain Derived Neurotrophic Factor
  • Reduces NeuroInflammation linked to mood dysregulation and cognitive function
  • Stimulates Clearance of beta amyloid plaques

7. Omega-3 Fatty Acids (1.8g/d) - Protects Neurons From Toxic Effects of Chemotherapy

  • Opposing actions of omega-3 fatty acids and added sugars on cognitive function, neuroinflammation, and adult hippocampal neurogenesis
  • A diet rich in long-chain, marine-derived omega-3 fatty acids and low in added sugars may be an ideal pattern for preventing or alleviating neuroinflammation and oxidative stress

8. Lion's Mane Mushroom (3-5g/d) - Enhances Cognition

  • Strengthens Memory and Concentration
  • Stimulates the synthesis of Nerve Growth Factor Promotes and Accelerate Myelination
  • Immune Modulation
What If Every Cancer Patient Had a Health Plan and not Just a Disease Plan

What If Every Cancer Patient Had A Plan For Health And Not Just Plan For Disease?

“An integrative health focused cancer support plan should begin at diagnosis and persist through long term healthy survivorship and promote a body where cancer cannot thrive.”

 

By the year 2024 there will be over twenty million cancer survivors in the US alone. This rapidly growing population of survivors obliges all frontline clinicians to learn how to support patients at every stage of the cancer journey.  Read more