Wednesday Bubble: herbs and breast cancer
Can herbal medicines used for hot flashes, namely black cohosh and phytoestrogens, be safely used in women who’ve had breast cancer?
If you’ve had breast cancer, you’ve probably been told to stay away from herbal medications, right? Yet, women who’ve had breast cancer know that hot flashes are a common side effect of many cancer therapies. Research also suggests that the older a woman is at the time she receives chemotherapy, the more likely she is to develop menopause as soon as treatment stops. Moreover, roughly 80% of women taking Tamoxifen have hot flashes and about a third of those women rate them as severe. Hormones are not even an option due to the increased breast cancer risk.
The good news is that an extensive analysis of scientific studies shows that black cohosh might be safe for women who have had breast cancer. Although the researchers note that the evidence for the effectiveness of black cohosh for alleviating hot flashes is mixed, they cite research from the National Institutes of Health and other reviews that suggest that use of black cohosh in former breast cancer patients requires only standard screening. They also report that there is “little reason for excluding patients with estrogen-responsive tumors from using black cohosh.” In fact, recent laboratory studies, although not yet carried out in humans, suggest that black cohosh may actually protect the breast from developing tumors.
The case for or against the use of phytoestrogens (e.g. soy, red clover, chaste tree berry and flaxseed) in women with breast cancer is not quite as clear as it appears to be for black cohosh. In one of the largest reviews examining soy or red clover for menopausal symptoms, the outcomes were equivalent to placebo. Other studies have shown that they might be beneficial for women with mild to moderate symptoms who start menopause early. Moreover, while red clover in particular does not appear to affect certain breast cancer risk markers, reports about phytoestrogens in general, especially in estrogen positive cancers is conflicting. Still, the American Cancer Society does not advise against eating soy-rich foods by women who’ve had breast cancer. Some studies have also showed improved prognosis.
If you are wondering if there are any drawbacks, one of the largest challenges is that there are not that many studies looking at herbal medications in women with breast cancer and the ones that do exist are mostly short in duration. The researchers point out that because herbs can take awhile to work, a three month study might be too short to form a conclusion.
Clearly, more study is needed. In the interim, it appears both black cohosh and soy might be safe to try if you’ve had breast cancer. As always, the most important consideration is to speak to a certified practitioner who is well versed in herbal medicine and make sure that she or he works with your oncologist.
Osteoporosis: what’s the 411?
Osteoporosis and low bone mineral density are well-known issues for menopausal women. As women enter the early stages of menopause, their bones lose their ability to retain their mass and manufacture new bone tissue, resulting in bone loss and increasing the risk for osteoporosis and its deleterious effects. What’s more, experts estimate that by the time a woman reaches the age of 50, she has a 40% risk of suffering a fracture due to osteoporosis for the rest of her lifetime. Besides the discomfort, hip fractures in women lead to a loss of mobility, a need for long-term care and even death. No bones about it; osteoporosis is no laughing matter.
Risk factors that contribute to a loss of bone mineral density are varied and include age, genetics, low calcium/vitamin D intake, body weight and menopause status. However, osteoporosis is a mixed bag and there are several underlying conditions that can also contribute to its severity:
- Medications (e.g. heparin, anticonvulsants, progesterone, chemotherapy agents)
- Parathyroid hormone (which regulates how calcium is used in the body – released in urine, absorbed in diet and stored in bones)
- Calcium imbalance due to excessive calcium excretion, aka “hypercalciuria,” Vitamin D deficiencies
Before I move into the land of boredom, there is a reason why I’m sharing some of the facts about osteoporosis, which BTW are readily available on the National Osteoporosis Foundation website (if you’ve not perused the site, I strongly encourage you to do so!): there is an indication that your practitioner might not be looking for these important secondary causes! Moreover, sometimes they are not even readily apparent.
Writing in the journal Menopause, researchers studying 204 menopausal women say that they’ve discovered that among the various factors that influence a woman’s risk for low bone density, several impact severity:
- Low vitamin D levels (82% of women in this study had below optimal levels)
- Elevated parathyroid hormone levels (35% of women in the study) — (leads to too much calcium in the blood and a loss of calcium from bones)
- Unusually high calcium excretion (20% of women in the study)
- High bone turnover rates (41% of women in the study) — (high bone turnover refers to an increase in the breakdown, or resorption of bone without a compensation for the repair of bone, leading to compromised strength, thinning, brittleness and fractures)
There are a number of dietary and lifestyle strategies to prevent osteoporosis, including incorporating Vitamin D and calcium supplementation, omega-3 and omega-6 fatty acids into the diet, and increasing physical activity. More recent findings suggest that beer, onions and even flaxseed may be effective (although more research is needed). Meanwhile, if you’ve recently learnt that your bone mineral density is low (or that you’ve actually developed osteoporosis) you need to speak to your practitioner about some of these other markers. Knowledge is power and the more you know, the greater the likelihood that you can start incorporating treatment now to prevent further bone deterioration.
That’s the 411. No bones about it!
Read MoreSeeds of the Change
Flaxseed evidently has the potential to reduce the frequency and potential of hot flashes associated with menopause.
Last Summer, researchers from the Mayo Clinic in Rochester, MN reported results of a small trial enrolling 29 postmenopausal women who were experiencing at least 14 hot flashes weekly for a month. None of the study participants were taking estrogen or herbal preparations for their symptoms, but for six weeks, ingested 40 grams (~2.8 tbs) daily of crushed flaxseed.
Not only did the frequency of hot flashes decline by 50%, but overall severity of hot flashes decreased by 57%. Study participants also reported improvements in their mood, joint or muscle pain, chills and sweating, all of which significantly improved their quality of life.
The researchers concluded that flaxseed is potentially an effective treatment for hot flashes and imparts overall health and psychological benefits.
The downside? 50% of women experienced mild or moderate bloating and 29%, mild diarrhea.
Flaxseed is a plant-based estrogen source (photoestrogen) that contains antioxidants with weak estrogen properties (lignans) and omega-3 fatty acids. It is also an excellent source of fiber. Various studies have not only touted its benefits for heart disease prevention but also suggest that it might boost the effects of conventional breast cancer therapies.
Most health experts recommend ground flaxseed over whole because it is more easily digestible in this form. It should be taken with ample amounts of water to avoid any gastrointestinal blockage. Flaxseed can also inhibit the ability of the blood to clot after injury so if you’re taking any heart medications or planning surgery, you might want to speak to your doctor before trying it. Additionally, it may exacerbate the effects of herbs that interfere with clotting such as:
- Danshen
- Devil’s Claw
- Eeuthero
- Garlic
- Ginger (in large amounts)
- Ginkgo
- Horse Chestnut
- Panax Ginseng
- Papain
- Red Clover
- Saw Palmetto
Personally, I don’t care for the taste of flaxseed. However, it can be baked or added to other foods. In fact, some of these recipes look pretty tasty.
Do you take flaxseed? How has it helped your menopausal symptoms? Any recipes you’d like to share?
Read MoreCounting Sheep
Seems like bills, the primaries, the environment, family, kids and work aren’t the only things that we’re losing sleep over. News from one of my favorite wire services suggests that severe sleep disruption, and not night sweats or irritability is one of most commonly-reported complaint among middle-aged women entering menopause. This is quite important as most of the evidence points to vasomotor symptoms like the sweats and flashes, as largely responsible for poor sleep.
I’ve heard from several of my gal pals that they are having difficulty sleeping. Equally troubling, however, is that if your go-to medical expert is a family doctor, well, he or she might not be completely clear on what to do about sleep distubances, especially when it comes to alternative therapies.
So, what works and what doesn’t when it comes to sleep issues?
In addition to the more obvious solutions, such as cutting back on caffeine and alcohol, beefing up intake of phytoestrogens (which are found in soy, flaxseed and tofu) or engaging in relaxation exercise and meditation right at bedtime, herbal extracts like valerian and passionflower might help.
Now mind you, there’s a lot of controversy over claims that valerian helps to decrease insomnia and reviews of the literature say that there’s not enough evidence to support its value. Personally, the valerian/passionflower combo has worked well for me, although I sometimes awaken with a “hangover” type feeling. There’s a relatively new black cohosh/valerian tablet on the market as well with some studies to support use in sleep disturbance. Note that while I’ve been advised to use black cohosh before bed, I personally prefer the product without the valerian component.
Another option is a supplement called 5-HTP. 5-HTP is an amino acid and natural precursor to the neurotransmitter serotonin. Serotonin is a major target for today’s antidepressants, and in addition to being involved in mood regulation, it also plays a role in modulating appetite and body temperature. An important note of caution when using 5-HTP is that if you are also using an SSRI or MAOI antidepressant, you need to speak to your doctor first before trying; too much serotonin in your system can be toxic or even fatal. 5-HTP can also interact with other agents so self-medicating without consulting a health professional is a big no-no.
Even with a little help, insomnia can persist through the perimenopause to menopause transition, especially right before your menstrual period. I believe that your practitioner can be great resource for steps that you can take to counter the sleep issues.
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