A Functional Medicine Approach to Breast Cancer

A Functional Medicine Approach to Breast Cancer
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    An Introduction to Breast Cancer

     

    Breast cancer is a type of cancer that forms in the cells of the breast. 

    The most commonly affected cells are lymph nodes, lymph vessels, lobes and ducts.

    Where the cancer originates determines the type of breast cancer which can include:

    • Angiosarcoma – cancer that forms in the lining of the blood vessels and lymph.
    • Ductal carcinoma – inside the milk duct of the breast
    • Inflammatory breast cancer – when cancer cells block the lymphatic vessels in the skin covering the breast
    • Invasive lobular carcinoma – cancer that begins in the lobules or milk producing glands of the breast
    • Lobular carcinoma in situ – while technically not a cancer itself, a diagnosis increases the risk of developing cancer
    • Male breast cancer – when cancer develops in the breast tissue of men
    • Paget's disease of the breast – starts in the nipple and extends to the surrounding skin of the nipple (areola)
    • Recurrent breast cancer – breast cancer that comes back after initial treatment

    Second to skin cancer, breast cancer is the most common cancer diagnosed in women in the United States.

    Some of the major signs and symptoms of breast cancer include:

    • breast lumps or thickening of the tissue underneath the skin
    • changes in color, shape and size of the breast and nipple
    • visible dimpling or a newly inverted nipple
    • peeling, scaling, crusting or flaking of the skin surrounding the nipple

    What Causes Breast Cancer?

     

    Breast cancer occurs when dysfunctional cells begin to grow rapidly within the breast tissue. 

    Cancer cells that divide more rapidly than healthy cells accumulate, forming a lump or mass. 

    These unhealthy cells can also continue to spread (metastasize) from the breast, to your lymph nodes and other parts of the body.

    While we know that cancer itself is due to cells that divide rapidly, the more important question is, 

    “Why are these cells growing rapidly?” and 

    “What is causing these cells to dysfunction?”

    While conventional medicine has been amazing at immediately treating cancer itself, it all to often fails in addressing and even recognizing, the underlying causes of cancer.

    It also doesn’t help that no two cancer cases are ever going to be the same.

    This is because no two patients (even twins), with the same type of cancer, will ever respond to the same type of treatment. 

    Just because the name of the cancer is known ⁠— doesn’t mean the underlying cause is known.

    And in order to treat a condition successfully, you must know it's cause.

    This is especially true for any form of cancer. 

    Sure, you can put together a treatment plan to remove or eliminate cancer cells, but if you don't address what caused the cells to become dysfunctional in the first place, it will return. 

    Therefore, a Functional Medicine Doctor should be considered as part of the team because they are trained in creating personalized, integrative plans of care that can be implemented along side traditional treatments. 

    All that said, conventional medicine has been phenomenal in terms of the amount of scientific inquiry into understanding what cancer is.

    Compared to just 10 years ago, our understanding of the genetics of cancer (i.e. What turns genes on and off) and the relationship between the physiology, internal and external environment of the body has led to greater understanding of the causes of breast cancer.

    Still, it's not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. 

    It's likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.

    “The cellular rhythm and dance of life is altered in response to different environmental signals, and that cancer represents an altered orchestration of that complex symphony. The cell is constantly in dynamic flux; cellular signaling creates messages that induce changes internally and externally and the cell is continually changing and morphing in response to the environment it is exposed to.” 

    -Jeffrey Bland, PhD, Founder of Functional Medicine

    A number of functional changes associated with the beginning of cancer include (but not limited to) the following [1] [2]

    • Increased DNA damage 
    • Decreased DNA repair 
    • Modified epigenetics 
    • Genomic instability 
    • Alteration in cell cycle physiology and check point integrity 
    • Alteration in specific protein kinase activities 
    • Alteration in intercellular signal transduction 
    • Altered immune system physiologic function 
    • Increased chemokine and cytokine activity 
    • Increased hormonally driven mitotic activity
    While all the above functional changes may seem complex, they all point to the fact that treating cancer should include a comprehensive protocol involving several factors of improving global health, not simply the eradication/elimination of rogue dysfunctional cancer cells.

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    What are the Risk Factors of Breast Cancer?

     

    A cancer risk factor is anything that makes it more likely to develop that particular cancer.

    But having one or even several breast cancer risk factors doesn't necessarily mean you'll develop breast cancer.

    Many women who develop breast cancer have no known risk factors, other than simply being women.

    Below, you'll find a list of risk factors that you have control over and risk factors that you may not.

    Risk Factors You Have Control Over:

    • Drinking alcohol. Drinking alcohol increases the risk of breast cancer. [3]
    • Obesity. Being obese increases your risk of breast cancer. Beginning your period at a younger age. [4]
    • Sedentarism. Evidence is growing that regular physical activity reduces breast cancer risk, especially in women past menopause. [5]
    • Having never been pregnant. Women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies. [6] 
    • Not Breastfeeding. Most studies suggest that breastfeeding may slightly lower breast cancer risk, especially if it’s continued for a year or more. [7]
    • Birth Control. Some birth control methods might increase breast cancer risk. [8]
    • Hormone therapy. Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications. [9]
    • Breast Implants. Breast implants have not been linked with an increased risk of the most common types of breast cancer. However, they have been linked to a rare type of non-Hodgkin lymphoma called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), which can form in the scar tissue around the implant. [10]

    Risk Factors You Don't Have Control Over:

    • Being female. Women are much more likely than men are to develop breast cancer.
    • Increasing age. Your risk of breast cancer increases as you age.
    • A personal history of breast conditions. If you've had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk of breast cancer.
    • A personal history of breast cancer. If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
    • A family history of breast cancer. If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.
    • Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most well-known gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don't make cancer inevitable.
    • Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.
    • Beginning your period before age. 12 increases your risk of breast cancer.
    • Beginning menopause at an older age. If you began menopause at an older age, you're more likely to develop breast cancer.

    Breast Cancer Prevention Strategies

     

    Many people confuse detection with prevention.

    And while detection is a part of prevention, it shouldn't be what we rely on to truly reduce the risk of developing breast cancer.

    Breast Cancer Detection Methods Include:

    Mammography has been the medical industry’s “gold standard” breast cancer prevention tool for nearly five decades, and the procedure has been pushed on women by physicians, public health programs, and cancer organizations. 

    However, mounting scientific evidence indicates that mammography may not only be far less effective than we have been led to believe, but that it also has numerous drawbacks that are affecting women on a massive scale. [11] [12] [13] [14] [15]

    Thermography. Breast Thermography Screening uses infrared technology to detect inflammatory patterns in breast tissue. It is noninvasive, delivers no radiation and can be done during pregnancy or while nursing. Thermography has the ability to effectively visualize dense breast tissue, unlike mammography. Thermography screening has demonstrated a high sensitivity and specificity. However, a high rate of false positives has been recognized as one of the drawbacks of this tool. Still, these false positives may in fact be abnormal thermal patterns that are foretelling a future cancer that has not yet begun to grow to a physically detectable size. 

    Ultrasound of the breast tissue is another noninvasive diagnostic tool. Ultrasound has the ability to detect breast cancer at rates comparable to mammography. A drawback to ultrasound is that it cannot detect tumors less than 1 cm in size. 

    Self-examinations of breast tissue. It's very important to become familiar with your breasts by occasionally inspecting them during a breast self-exam. Doing this enough, will help you to pick up on subtle changes in breast tissue, lumps or other unusual signs.

    Breast Cancer prevention includes:

    Optimize Fiber Intake. Fiber is critical for gut health which houses more than 80% of your immune system and therefore impacts overall health. Your goal should be 35 grams per day. High-fiber foods include vegetables, fruits, beans, nuts, and whole grains such as brown rice and ground flax seed. 

    Eat Your Meat (get enough protein). Good protein sources include fish, lean poultry, beans, nuts, eggs, and fermented soy. A 2017 nurses study found a lower risk of breast cancer recurrence and death from breast cancers with a higher intake of protein (especially from animal sources). [16]

    Let me say that louder for the people in the back..

    Eating animal protein appears to reduce the risk of breast cancer deaths and recurrence in women.

    Be Smart with Supplements. Not all supplements are good for you, especially when they're made with low quality ingredients and fillers. So if you're going to supplement, choose a premium, high quality product regardless of cost. At the very least, take a good whole food multivitamin, high quality fish oil and optimize your B vitamins.

    Develop Stress Management Skills. Studies connect chronic stress levels with increased breast cancer risk. Whether it's meditation, yoga, deep breathing, or any other de-stressor, find something that works for you and do it.

    Focus on Building up Gut Health. Leading researchers in digestive health have discovered that the gut microflora influences cancer genes and immunity. [17] [18] [19] [20]

    We all know that food is a powerful form of medicine, but if your gut is not healthy, you will not digest, absorb and utilize the nutrients from the food you're consuming.

    Reduce Toxic Load. The fact is, toxins are every where and the accumulation of toxins in our body contributes to a wide variety of diseases and dysfunctions. Increasing evidence from epidemiological studies all reinforce the conclusion that exposures to toxins – many of which are found in common, everyday products – may lead to increased risk of developing breast cancer. [21] [22]

    Exercise Every Day. Studies show regular exercise can decrease your breast cancer risk. Exercise improves insulin sensitivity, helping you balance estrogen and maintain a healthy body weight. No matter what your fitness level, you’ll find an easy-to-apply exercise plan here. [23] [24] [25]

    Go Easy on the Alcohol. One glass of wine a day increases your breast cancer risk 40 percent. Increased alcohol load means your liver can’t metabolize estrogen well. And if your gut is also not healthy or your fiber in take is low, the risk increases dramatically. [26] [27]

    If you drink, limit wine to one glass three times a week. One drink is five ounces of wine, 1.5 ounces of hard alcohol, or 12 ounces of beer.

    Optimize Sleep. Studies show an inverse association between sleep duration and breast cancer risk. Aim for eight hours of quality, uninterrupted sleep every night. [28]

    A Functional Medicine Approach to Breast Cancer

     

    Taking everything we've discussed so far, what would a Functional Medicine approach to treating breast cancer consist of?

    First, every functional medicine doctor is going to be different.

    Yet every well trained functional medicine doctor will spend time getting to know somebody, their dietary habits, their stress levels, their movement patterns, and everything else they have going on in terms of what we call comorbid conditions.

    Every bit of this information plays a key role in developing a personalized treatment plan.

    Along with all the above suggestions, we would want to do some objective testing to gain insight on nutrient status, inflammation, signs of tissue damage, glucose metabolism and hormone status.

    Below I will share some possible suggestions and recommendations for cancer patients.

    Improve General Wellness and Wellbeing

    Improving general wellness and wellbeing consists of optimizing personal dietary intake, physical activity and stress management.

    Specifically you want to figure out the best diet for your body and ensure that you're getting adequate nutrients.

    How can this be done? 

    With comprehensive blood chemistry testing you can determine how your current diet contributes to: 

    • Nutritional Status
    • Levels of Inflammation
    • Functional Digestion
    • Detoxification capacity or liver function
    • Immune function
    • Glucose regulation and metabolism

    By getting all the above information, you can then determine where your blind spots are in diet and lifestyle and begin a path towards correction.

    The primary goals of improving general wellness include improving dietary and nutrition habits, stress, sleep, movement, breathing patterns and nutrient status.

    Generally speaking you want to 

    • Increase phytonutrients (organic vegetables) to 8-10+ servings per day
    • Reduce blood sugar (eat low glycemic, high fiber foods)
    • Eliminate refined carbs (breads, pastas, rice, crackers, etc.) 
    • Increase omega-3 fatty acid intake
    • Take 5-10 minutes a day to practice deep breathing or meditation
    • Increase your physical activity
    • Increase your sleep time (8+ hours)
    Improve Gene Stability and Expression 
     
    One of the primary drivers of genetic expression and stability is oxidative stress. 
     
    Oxidative stress is an imbalance between the production of compounds that damage your cells (free radicals) and the body's ability to counteract this damage. 
     

    Assessing your the amount of oxidative damage or your ability to handle free radicals can be done by:

    • measuring liver function (Phase 1 and Phase 2 detoxification pathways)
    • measuring glutathione levels
    • assessing methylation pathways including homocysteine, methylmalonic acid and other urinary hormone metabolites
    • assessing antioxidant status

    Focus on increasing the amounts of vegetables and spices you consume. 

    Your goal is to increase antioxidant reserves by consuming carotendoids, tocopherols, anti-inflammatory compounds and methylating agents.

    These compounds can include:
     
    • All types of spices
    • EGCG (green tea)
    • Luteolin (artichoke extract)
    • Parthenolide (Feverfew)
    • Quercetin
    • Resveratrol
    • Bowellia
    • Curcumin
    • Vitamin D
    • Selenium
    • Folate
    • Flaxseed
    Assess and Control Inflammation
     

    Inflammation is at the heart of all forms of chronic disease. 

    Therefore, assessing and controlling inflammation in the body is important for any cancer patient. 

    Compounds that can help with inflammation include:

    • Bromelain
    • Quercetin
    • Boswellia
    • Curcumin
    • Resveratrol
    • Sea cucumber
    • Stinging Nettle
    • Holy Basil
    • Fish Oil
    • Ginger
    • Pancreatic Enzymes

    Optimize Immune Function

    Improving immune resilience and function comes down to several factors including diet, nutrient absorption capacity, stress, sleep, physical activity and optimization factors such as herbs, botanicals and other phytonutrients. 

    The best way to improve immune function is to improve digestive health and microbial diversity. 

    Immune supports include:

    • Vitamin C
    • Bromelain
    • Selenium
    • Maitake-D
    • Arabinogalactans
    • Garlic
    • Astragalus
    • Reishi
    • Lactoferrin
    • Cordyceps
    • Whey Protein
    • Acidophilus/Bifidus based probiotics
    • Panax Gingseng
    • Chlorella
    • Zinc
    • Vitamin D

    Provide Post Chemotherapy/Radiotherapy Support

    Finally, following any form of chemotherapy, radiotherapy or medical intervention to destroy cancer cells, it would be prudent to consider post cancer intervention strategies such as:

    • Inducing Cytostasis (cell cycle arrest)
    • Inducing Re-Differentation of Cells (supporting healthy cell development)
    • Optimizing Hormone Balance and Metabolism
    • Inhibiting Metastasis
    There are many ways to optimize your health post-chemotherapy.
     
    However, it is entirely dependent on your personal health status.

    Final Thoughts

     

    Addressing cancer is complex and should not be limited to a conventional medical model.

    What’s missing from conventional care is a personalized approach to diet, lifestyle and stress management. 

    For me, supporting any type of cancer treatment and therapy is not an either/or, but a both/and we should. 

    I think that it’s a shame, that every single person who’s diagnosed with this disease isn’t offered, right at the beginning, both natural-integrative therapies alongside conventional treatment with fully informed choice that they can make along the way. 

    The fact is, when people combine lifestyle-based therapies with their conventional treatments, they do better, feel better, and their risk for reoccurrence is lowered. 

    Functional medicine approaches to cancer are relevant to early detection, patient care during active disease, and long-term management of cancer as a chronic disease. 

    References

    1. Bland J. Cancers as systemic functional diseases, Part 1: defining the cancer domain. Altern Ther Health Med. 2010 Mar-Apr; 16(2): 52-54.
    2. Bland J. Cancers as systemic functional diseases, Part 2: clinical implications. Altern Ther Health Med. 2010 May-Jun;16(3):54-7. PubMed PMID: 20486625.
    3. https://www.cancer.org/cancer/cancer-causes/diet-physical-activity/alcohol-use-and-cancer.html
    4. https://www.cancer.org/cancer/cancer-causes/diet-physical-activity/body-weight-and-cancer-risk.html
    5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723386/
    6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723386/
    7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069526/
    8. https://www.nejm.org/doi/full/10.1056/NEJMoa1700732
    9. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext
    10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345429/
    11. https://www.bmj.com/content/339/bmj.b2587
    12. https://www.nejm.org/doi/full/10.1056/NEJMoa1600249
    13. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001877.pub5/full
    14. https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-015-0525-z
    15. https://academic.oup.com/jnci/article/89/15/1164/2526360
    16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121903/
    17. https://pubmed.ncbi.nlm.nih.gov/31456069/
    18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319098/
    19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319098/
    20. https://www.sciencedirect.com/science/article/abs/pii/S1044579X2030167X;
    21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581466/
    22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546253/
    23. https://pubmed.ncbi.nlm.nih.gov/24097200/
    24. https://pubmed.ncbi.nlm.nih.gov/23274845/
    25. https://pubmed.ncbi.nlm.nih.gov/20975025/
    26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832299/
    27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4299758/
    28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654282

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