By Sangeeta Pati, MD, FACOG Medical Director of SaJune Medical Center
Mary Anne comes from the “cancer world”, status post opinions and second opinions, surgeons and oncologists, surgery, and treatment with every new chemotherapeutic agent available. She is in remission…..maybe even cured from ovarian cancer (Stage IIa). It had been a long three years and finally the Ca-125 has stayed down for 12 months. Mary Anne comes in encouraged but very tired. She can not function for a full day without several naps. She has severe back pain from vertebral degeneration and osteoporosis. She takes several sleep aids and still can not sleep for one full night. She can not think clearly. She has no sex drive and she is losing her marriage. Age 49, she can not work from her fatigue and pain and she is nearly broke. Cancer…Cured?? Or not?
Diane is a 45-year-old breast cancer survivor of two years. She had Stage I ER+, PR+ breast cancer treated with mastectomy and chemo. She was told that she is cured. She is tired, dry, having incontinence and severe osteoporosis. She has constant back pain, hip pain and stress urinary incontinence. She cannot sleep. She is on Ambien and she recently discontinued Fosamax due to acid reflux. Is she cured?
Mary Anne and Dianne are like most of our cancer patients who have endured the mainstay of cancer treatments, which is to get rid of the cancer. Cut it out. Radiate it out. Chemo it out. Get rid of the cancer, but once accomplished is the body ready for its next cancer cell? The medical literature fully supports that:
1. Cancer cells develop in the body every day.
2. The healthy immune system and Natural Killer cells detect and destroy the cancer cells on an ongoing basis.
3. Most cancers develop over a 15-20 year period of time before they are detected.1
So, underlying imbalances allow the cancer cells to develop and grow to begin with. The cancer may be gone. The imbalances remain. What are the imbalances and how should we address them? Restoring the balance means optimizing the ability of our cells to do what they do best: keep us healthy, happy, energetic and keep those cancer cells at bay. This involves correcting deficiencies of
1) hormones and 2) nutrients, 3) removing toxicities 4) mental peace and 5) a body, which is pain free, and structurally sound. All disease is a manifestation of imbalances in these five areas, rather than just one cause. So, whether we aim to cure or prevent a symptom or a disease, the basic five areas must be addressed. In our practice we have successfully used a 5-point restorative model to address a range of conditions including FM, CFS, arthritis, osteoporosis, weight gain, fatigue, PMS, PCOS, infertility, prevention of cardiac events and adjunctive fortification for those with cancer.
This article provides some insight into the main components of a restorative approach which we used to help Mary Anne and Diane feel better and have a stronger immune system to combat the next cancer cell.
When women consider hormone replacement the looming question is about the risks, especially of cancer, strokes and heart attacks. On review, women are the most protected during their 30’s when they have the highest hormone levels. It is only after menopause that women have increased risk of stroke, heart attack and cancer. Data suggests that it is hormone imbalances that contribute to cancer. We know that most cancers occur after menopause; precisely at the time when the ovaries stop producing the normal balance of hormones.
Progesterone declines from the late 30’s. Progesterone has the role of
decreasing E2 uptake by breast cells and decreasing proliferation of breast, uterine and ovarian cells.2 Therefore it is no surprise that:
1. Chronically low progesterone levels in infertile women have been associated with a 10-fold increase in all cancers and a 5-fold increase in breast cancer.3
2. Pregnancy, which results in a 15-fold increase in progesterone levels, also confers a significant long-term reduction in breast cancer risk.4
3. “Progestins” are molecularly very different from progesterone found in the body. Progestins have been shown to increase breast cancer when added to estrogen therapy in 5 trials compared with natural “progesterone” which is associated with protection.5,6,7 For example, in the WHI study the progestin, medroxyprogesterone acetate, increased the relative risk from 0.77 (CI 0.5-1.01) with estrogen alone to 1.2 (CI 1.0 to 1.59).
4. Low progesterone levels have been consistently shown to be associated with increased breast cancer in studies. 8,9,10
5. Progesterone is associated with a 400% decrease in cell proliferation when given prior to breast surgery compared with estrogen which resulted in a 230% increase in breast cell proliferation. 11
6. Progesterone has been shown to decrease proliferation of PR+ breast cancer cell lines. 12,13
Estrogens become imbalanced from the mid-forties. Estriol (E3), which is breast and clot protective, decreases from 80% to 10%. Estrone (E1), which is breast and clot stimulating, goes up from 10% to 80%. The increased E1 is undesirable as E1 can be converted to forms of estrogen (i.e. 16-OH E1) which are mutagenic and carcinogenic. The healthy liver methylates the “bad” estrogens (16-OH E1 and 4-OH E1) and excretes them safely, otherwise they collect in the body and cause cancer. This is the function of the COMT enzyme, methyl groups and liver detoxification. Fortunately, there are excellent urine tests, which can be used to measure the breakdown products to determine how the body is breaking down estrogen.14 Even for a patient who is not treated with estrogen, clearly it is important to know how they break down the estrogen that is made by their fat cells and adrenals. Some important findings on estrogen include:
1. Estradiol (E2) activates both alpha (proliferative) and beta (antiproliferative) estrogen receptors, E3 selectively activates the beta receptors, while E1 activates alpha at 5:1.15,16,17,18
2. In breast cancer survivors, estrogen therapy has not been associated with increased risk of recurrence or mortality. 19,20,21
3. Pregnancy, which results in a 1000- fold increase in Estriol (E3), also confers a significant long-term reduction in breast cancer.22
4. E3 in the urine has been found to be low in women with breast cancer. 23,24
5. Early studies by Lemon et al in rats showed a decrease in breast cancer cells with E3.25,26
Melatonin is known for its effects on sleep, however it is one of the major anti-cancer hormones in the body. Studies show that: 27
1. Breast cancer is decreased in blind women logically known to produce more melatonin due to lack of light exposure.
2. Night shift workers have lower melatonin levels and higher breast cancer rates. 28,29
3. Melatonin inhibits human breast cancer cells in culture and increases tumor suppressor genes. 30 4. Melatonin has protective effects against radiation. 31
Insulin resistance and high fasting insulin are known to be associated with increased risk of cancer, recurrence and metastases.32,33
1. Preventing sugar spikes is the best way to prevent cancer and diabetes, obesity, heart disease, stroke, and skin aging.34
2. High sugar consumption and meats increase cancer risk.35
3. IV Insulin has been used in some cancer centers to treat cancer.36
The data on Thyroid (especially T3 levels), DHEA and Growth Hormone similarly support the concept that restoration of protective hormone levels is a preventative step against cancer.
Every cell reaction produces DNA damaging free radicals, which require anti-oxidants to neutralize them. When these free radicals are not neutralized they are able to damage DNA and initiate the cancer process. Although we are in our infancy of understanding the importance of some vitamins and minerals, it is clear that we will eventually find that every vitamin and every mineral is needed for optimal function and protection and no one vitamin or mineral is more important than the other. In fact the American Medical Association has now recommended that we take a multi-vitamin/ mineral to “prevent chronic disease.” Some specific nutrients which have been studied and shown to be strongly associated with cancer include:
1. Anti-oxidants are responsible for clearing the free radicals, which cause cell and DNA damage.
2. Studies show olive oil and good fats with omega-3, which are anti-inflammatory, reduce breast cancer by 15%. 37,38,39
3. Vitamin D has been shown in numerous studies to have a strong immunoprotective function. Vitamin D receptors are present on a wide variety of tissues and also the immune cells of the body. Vitamin D causes arrest of cancer cell division through VDR receptor sites. Low Vitamin D is associated with a 30% higher incidence of cancer of the breast, colon, and prostate.40,41,42,43,44,45
4. Iodine has been found to be deficient in 72% of the world’s population. 46 Iodine deficiency contributes
to division of cells in all organs of the body and is therefore associated with cysts and cancer throughout the organs of the body.
5. Low Vitamin A and Vitamin E are associated with breast cancer.47
6. Folate supplementation has been shown to be strongly protective48
7. B-12 is another common nutrient deficiency associated with breast cancer.49
8. Methyl and sulfur groups from broccoli, cauliflower, cabbage, watercress, and brussel sprouts help convert the E1 in the body into methylated forms which are safely removed from the body.
We are exposed to 50 times the level of toxins compared to most other developed countries, through water, air, industry, computers, cell phones, preservatives, plastics and fumes. These toxins reside in the bowel, the liver and the fat tissues especially. Toxins impair all chemical reactions and cancer protective mechanisms in the body. As an example:
1. Xenoestrogens are compounds which act like E1 and increase the incidence of breast cancer. These compounds include DDT, Lindane and Bis-phenol A (from plastics), hormone-treated meats, and a plethora of petroleum based preservatives, which are in our skin and body products.50
2. Bowel toxins like Candida or other bacterial overgrowth impair absorption and production of nutrients, especially B-vitamins.
3. In the liver, Phase I toxins are converted to intermediates, which are highly reactive and dangerous. The Phase II enzymes must rapidly convert these toxic intermediates to safe metabolites, before they do damage. Phase I and Phase II detoxification steps are responsible for removing heterocyclic amines, aromatic hydrocarbons, dioxins, nitroso compounds and other carcinogenic toxins from the body. The liver is also the site where E1 is methylated for safe excretion. Liver toxins (i.e. Tylenol, prescription drugs, alcohol, fuel fumes) impair the detoxification processes of the liver including hormonal metabolism.
4. Acidity (from shallow breathing, low oxygen states, lack of vegetables, and inflammation) inhibits all chemical reactions at the tissue level, which proceed optimally at pH 7.0 and above. Alkalinizing the body with oxygenation and vegetable diet (i.e. raw vegetables, wheatgrass etc) is a major protective and curative process for any disease.
5. Electromagnetic radiation (EMF) from cell phones, computers, cordless phone bases, and WiFi zones are now known to have deleterious effects on sperm function, brain waves, thyroid function and immunity. Several studies now show that prolonged and consistent exposure is associated with higher rates of all cancers.
6. Viruses, fungi and parasites are present in all living organisms including humans. Under particular conditions these too contribute to the ability of cells to divide and multiply unchecked.
7. Heavy metals (Mercury, Lead, Cadmium, Arsenic..) diminish neurological function, immunity and bone among other things.
Toxins impair the absorption and utilization of nutrients and hormones. This is the premise for regular bowel, liver and tissue detoxification (through an alkalinizing diet) and specific detoxification as needed, for example if heavy metals or parasites are identified.
Balancing the Mind and the Body
In the entire restorative approach, the most powerful interventions are those targeting mind and body balance. A mounting body of scientific evidence supports the powerful effect of the mind on the bodily functions of repair, maintenance and prevention of age related disease.
Every disease has been shown to be associated with stress. Stress increases cortisol, which impairs the immune system, anti-cancer mechanisms, thyroid function, fat burning, vascular health, brain function and almost every other repair and maintenance function in the body. Stress also causes the utilization of all nutrients at a higher rate, leaving less for protection of the body. In that, it is the plague of the 21st century. It is during times of extreme and prolonged stress that the body is most vulnerable to infections and cancer. Every bodily process is affected by not only the state of the mind, but even the energy produced by mental “intention,” (such as a positive or negative attitude) which can produce change at a cellular level. 51,52
Circulation increases oxygenation and clears toxins. Exercise during adolescence and early adulthood reduced the incidence of breast cancer by 20%.53 Increased body fat above 25% is associated with 30-50% increase in cancer 54 partly due to the toxins which are harbored in the body fat. So, both the mind and body must be addressed actively with yoga, reduction of commitments, breathing techniques, Tai Chi, Qi Gong and exercise.
When we realize that only 4% of breast cancer is accounted for by the breast cancer genes and that less than 50% of heart attacks occur in those with high cholesterol, it becomes crystal clear that these conditions are the result of imbalances in hormones, nutrients, toxins, the mind and the body. When corrected, the reality is that the body returns to its optimal functional state. For those with cancer and for those who have beat cancer, the restorative approach is the best approach to fortifying the body’s ability to detect and overcome the next cancer cell which includes:
1. Identifying and correcting nutrient deficiencies especially iodine, Vitamin D, B-vitamins, methyl groups, anti-oxidants, selenium, zinc, ferritin, and Vitamins A, E, C.
2. Identifying and correcting the liver mechanism in Phase I and Phase II, which may be deficient, especially if methylation of estrogens is impaired.
3. Avoiding toxins by eating organic foods, avoiding hormone and antibiotic treated meats, avoiding preservative- based food, skin and body products.
4. Identifying and correcting bowel imbalances with probiotics etc.
5. Boosting alkalinization with vegetables (at least 50% or more of diet) and superfoods such as wheat grass, spirulina, chlorella, and bee pollen.
6. Boosting anti-oxidant intake with acai, mangosteen, gogi, and noni.
7. Identifying and correcting hormone deficiencies especially melatonin, thyroid, DHEA, progesterone, Estriol and insulin.
8. Engaging in an aggressive mind-body program
Mary Anne and Diane have been treated with this 5-point restorative approach. They are both feeling much better and are significantly better equipped for the next cancer cell which starts to divide.
• Anti-Aging Medicine? Reality or Myth: Published in the Anti-Aging Medical News, Winter Edition 2008 • Hormone Replacement Therapy in Women: The Evidence by Dr. Sangeeta Pati published in European Journal of Anti-Aging Medicine, March 2006 • The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? by Dr. Ken Holtorf published in Postgraduate Medicine, Volume 121, Issue 1, January 2009 Nutrition • Vitamin D Deficiency by Dr. Michael F. Holick, New England Journal of Medicine 2007;357:266-81 • Iodine: why you need it, why you can’t live without it, Dr. David Brownstein, 2006 Cancer • Keeping aBreast by Dr. Kahlid Mahmud, Author House, 2005
◗ Dr. Pati is a Georgetown University trained physician who practiced traditional and holistic medicine for fifteen years in the Washington D.C. area. Dr. Pati is multi-lingual and is renowned in her field having authored numerous scientific articles and addressing audiences both nationally and internationally. She is recognized by physicians internationally as a foremost authority in the field of Hormone Replacement Therapy