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For Your Health: Breast Health

Get the facts about fibrocystic breast disease
By Lise Alschuler, N.D.
November/December 1999
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Perfect, healthy breast tissue is smooth, of even thickness throughout, and pain-free. Unfortunately, such flawless breasts are hard to find. Most women experience at least some degree of swelling, tenderness, lumpiness, or ropelike tissue in their breasts.

Why? One common reason is fibrocystic breast disease, a noncancerous condition that affects up to 50 percent of women in the United States aged thirty-five to fifty. Yet this estimate may be conservative—some gynecologists assert that fibrocystic breast tissue, or cystic mastitis, occurs to some degree in virtually all women.

Although fibrocystic breast disease (FBD) is not cancer, nor a definitive risk factor, the conditions that favor the development of FBD also favor the development of breast cancer. In the opinion of many practitioners, FBD should be viewed as a wake-up call and, hopefully, should motivate healthy changes. Naturopathic management of FBD combines lifestyle changes, nutritional supplementation, and phytoestrogenic and detoxifying herbs—all contributors to overall breast health.

Defining the problem

The term fibrocystic breast disease is actually a misnomer. ­Although called a disease, it’s considered a benign breast disorder. It generally refers to breast tissue with poorly defined thickness or palpable lumps accompanied by pain. The lumpiness and pain fluctuate with the menstrual cycle. Symptoms include:

• multiple soft, tender masses that vary in size and occur mostly in the upper outer quadrant of both breasts
• ropey, irregularly shaped, tender masses that occur diffusely in both breasts
• a combination of the above two
• swollen, diffusely tender breasts that are more tender just before the menstrual period
• each cyst or fibrous mass merges at some point into the surrounding breast tissue.

If one divides each breast into four quadrants, intersecting at the nipple, the most common location for the lumps are in the upper outer quadrants of each breast extending all the way up into the underarm areas. The lumps may feel soft and fluid-filled or thickened and ­fibrous. All these changes can occur without the woman noticing. However, these changes can also produce pain in the breasts.

Breast pain associated with FBD is usually cyclical, worse just before menses and then disappearing afterward. This cycle is most likely due to the changes in hormone levels throughout menstruation. Both estrogen and prolactin, a pituitary hormone, cause fibrocystic changes in the breast tissue. As the relative concentration of estrogen (and prolactin) increases in the second half of the menstrual cycle, the breast tissue, already sensitized to estrogen, responds by retaining more fluid. Water accumulation is accentuated in the areas of fibrocystic changes; this causes the tissues to swell, compress nerve endings, and produce pain. Inflammation is another effect of increased estrogen activity.

The liver and bowel are also involved in this cycle, and their impaired function can also contribute to FBD. Here’s why: After estrogen is conjugated, or bound, in the liver, it’s excreted into the digestive tract, where most is eliminated. But a small portion is again unbound by bacteria in the colon. This free estrogen is then reabsorbed back into the blood. If any part of this process is disrupted, the level of circulating estrogen may increase.

The breast cancer link

The naturopathic approach to FBD is multifaceted. One overarching goal is to restore a woman’s optimal estrogen balance and normalize the breast tissue response to estrogens. It’s equally important to reduce the symptoms (pain, swelling, and nodules) by decreasing inflammation in the breast tissue.

It’s also important to reduce any potential risk of breast cancer development. The conditions that favor the development of FBD—namely, increased estrogen receptor activity and increased estrogen levels—also favor the development of breast cancer. Women younger than fifty-five with palpable breast cysts have recently been found to have a 5.9 times greater risk of breast cancer than the general population. Women older than fifty-five with palpable breast cysts are 1.7 times more likely to develop breast cancer.

Numerous lifestyle and environmental factors also contribute to the development of FBD (see “Contributing factors” below), and naturopathy focuses on identifying and correcting as many of these factors as possible. Additionally, judicious use of selected nutrients and herbs can produce favorable results.

Based upon a thorough history of symptoms and overall health, along with the use of certain laboratory tests and physical examination, a naturopathic doctor is able to determine which herbs and supplements will be most beneficial. Each woman is unique, so the combinations of herbs and supplements will be different. One woman may benefit from red clover and burdock, while another woman may benefit from soy products and vitamin E.

Lifestyle interventions are crucial

Red clover is an ideal herb for the management of FBD. 

FBD emerges as the result of a multitude of factors, the majority of which need to be addressed to achieve significant symptom relief. Naturopathic treatment begins by examining environment and health habits. The following recommendations form the basis of lifestyle interventions to reduce FBD.

Reduce exposure to xenoestrogens. These environmental compounds increase estrogen influence in the body. Unlike weak phytoestrogens, xenoestrogens usually strongly stimulate estrogen receptors. One of the most important ways to do this is to avoid cigarette smoke exposure. Cigarette smoke contains more than 200 identified carcinogens and chemicals with xenoestrogenic properties. Also avoid food stored in plastic containers and, more important, avoid heating food in plastic containers in a microwave oven. Finally, avoid pesticide exposure or ingestion—in other words, eat organic. (For more information, see “Vitamin robbers’’ on page 68.)

Reduce dietary fat to less than or equal to 20 percent of the total daily caloric intake, specifically non­­organic animal sources of fat that contain xenoestrogens. This will lessen the stimulation of estrogen receptors. Reducing fat intake will also decrease the likelihood of fatty deposits in the liver, which ­interfere with normal liver functions (including the conjugation, or binding, of ­estrogens) and will contribute to weight reduction. Fat tissue produces estrogen, and a higher percentage of body fat correlates with a higher estrogen level. A body fat level of 20 to 22 percent is ideal. A reduction in meat, dairy products, and some seafood, especially shrimp, will reduce the consumption of arachidonic acid, an omega-6 fatty acid that plays a pivotal role in the body’s inflammatory cycle.

Increase the consumption of fruits and vegetables to three to five servings daily. A variety of fruits and vegetables will ensure adequate vitamin A, a deficiency of which can contribute to FBD. Along with sufficient water intake (half of one’s body weight equals the number of ounces to drink daily), adequate fruits and vegetables provide fiber to reduce constipation. Many vegetables are also a source of phytoestrogens. Found in foods such as soy, flaxseed, whole grains, and legumes, these compounds bind weakly to estrogen receptors. In sufficient quantities, they will block our own, stronger estrogens from binding to the estrogen receptors. This has the net effect of lessening the estrogenic influence on breast tissue.

Reduce consumption of methylxanthines (found in coffee, tea, and chocolate), which decrease estrogen receptor activity. Methylxanthines encourage the development of FBD.

Exercise helps to maintain proper weight and reduces body fat composition. It also helps relieve constipation and improves liver function. Exercise four to five times each week, combining aerobic, strengthening, and flexibility exercises.


Lise Alschuler, N.D. is the clinic medical director of the Bastyr University Clinic. She has taught botanical medicine to naturopathic medical students for the past five years. She has a private practice in Seattle and has written numerous articles and lectured widely on natural health.

References

“Sixteen-year mortality from breast cancer in the UK Trial of Early Detection of Breast Cancer.” Lancet 1999, 353:1909–1914.

Dixon, J. M., et al. “Risk of breast cancer in women with palpable breast cysts: A prospective study.” Lancet 1999, 353:1742–1745.

Ghent, W. R., et al. “Iodine replacement in fibrocystic disease of the breast.” Canadian Journal of Surgery 1993, 36:453–460.

Knight. D., and J. Eden. “Phytoestrogens—a short review.” Maturitas 1995, 22:167–175.

Lichtman R., and S. Papera. Gynecology: Well-Woman Care. Norwalk, Conn.: Appleton and Lange, 1990.

London, R. S., et al. “The effect of vitamin E on mammary dysplasia: A double-blind study.”’ Obstetrics and Gynecology 1985, 65:104–106.

Pashby, N. L., et al. “A clinical trial of evening primrose oil in mastalgia” British Journal of Surgery 1981, 68:801–824.

Saloniemi, H., et al. “Phytoestrogen content and estrogenic effect of legume fodder.” P.S.E.B.M. 1995, 208:13–17.


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