Integrative Support During Breast Cancer Treatment and Beyond
The information presented here represents recommendations for supportive care in breast cancer and are not meant to be a replacement or substitute for standard oncologic care.
The information detailed below should be utilized as:
Supportive for potential preventive lifestyle changes to reduce breast cancer risk.
Safely support ongoing cancer therapies
Diet, nutrition and exercise recommendations that in survivorship might potentially reduce recurrence risk.
Nutritional Recommendations
Mushroom Therapies in Breast Cancer
Mushroom therapies can enhance immune responses, and potentially strengthen its effects. There are also lab and animal studies suggesting they can potentially reduce side effects of therapy and limited data suggest it may enhance survival.
Reishi (Ganoderma) Mushroom
The NF-Kb pathway affects invasive breast cancer by inhibiting apoptosis or tumor cell death, enhances inflammation in the tumor microenvironment and promotes tumor growth and increases VEGF, a vascular growth factor used for spread. Ganoderma inhibits the NF-Kb and
Induces cell death
Inhibits cancer growth and metastasis.
improvement of anxiety and depression and improved quality of life.
Also it can downregulate VEGF
Ganoderma
Clinical patient studies
A randomized placebo controlled trial showed ganoderma improved anxiety, depression and quality of life, including fatigue in breast cancer patients.
Improves immune T cell responses to cancer, the CD3, CD4, CD8 T cell immune responses.
In a randomized controlled study, breast cancer patients taking Ganoderma were more likely to respond to radiation/chemotherapy vs. control patients, but it needs to be combined with treatment to be effective.
Agarius (Agaricus Mushrooms)
Clinical patient studies,
In breast cancer showed in a double blind randomized controlled study, reduced GI side effects caused by chemotherapy
Increases red blood cell counts, monocytes and T lymphocytes
In breast cancer, helped maintain appetite vs. controls at 6 months
Antroda Connamonea
Is an unfamiliar mushroom that comes from the mountains of Taiwan. A lab study showed it inhibits human breast cancer cells lines when tested, and sensitized cancer stem cells to radiation and chemotherapy.
Soy Products
In women with breast cancer, the addition of soy products to the diet whether ER- or ER+PR+ and in both pre and post-menopause, improved survival. This does not mean large amounts, but is considered part of a balanced nutritional program. More is not better.
Its benefits are also shown to improve chemo toxicity, improve quality of life and improve outcomes in breast cancer.
Please buy soy products that are organic as many commercial products are GMO (genetically modified) and dangerous due to pesticides as well as toxic with arsenic.
Vitamin D:
There is an Inverse relationship with Vitamin D and breast cancer, the lower the Vitamin D level, the higher risk of breast cancer, especially in those with very low levels.
Also maintaining higher circulating Vitamin D may also offer a protective effect against breast cancer.
Artificial Light Sources
Exposure to excess artificial light at night, especially in night shift workers, poses a greater risk of breast cancer. It causes circadian rhythm disturbances and affects sleep patterns. The International Agency for Research on cancer says that persistent long-term artificial light exposure is carcinogenic. The risk appears to be most concerning for perimenopausal women and for ER- and HER2+.
Make your sleeping area is very dark, and if using a computer at night, use a blue light filter on your computer.
Also, when going to sleep, reduce exposure to EMR, electromagnetic radiation exposure, by turning off your electronic devices if close to the bed.
EGCG, epigallocatechin
This is a polyphenol molecule found in green tea. It is known to scavenge oxidative free radicals and appears to be beneficial in reducing the incidence and recurrence of cancers. This appears to be dependent on the amount of green tea ingested or the dose of capsules.
A mouse study showed that EGCG combined with pacitaxel improves its efficiency and helps to inhibit tumor growth in breast cancer.
In another mouse study, using a human breast cancer line, EGCG sensitized these breast cancer cells, for greater effectiveness and cell death from paclitaxel, when used in combination, but not when used individually.
In laboratory and animal studies of a human breast cancer cell line, EGCG inhibited breast cancer cell survival and induced cell death, apoptosis.
Studies show an association between excess adipose tissue and increased risk and progression of breast cancer, caused by low grade inflammation
Another association suggests adipose tissue cell proteins in the tumor microenvironment in TNBC, triple-negative breast cancer, are influenced to change to promote tumor growth. These factors can be prevented by polyphenols, specifically EGCG.
Vitamin C and E
Reactive oxygen/nitrogen are created during chemotherapy and are considered a significant cause of acute and chronic side effects of treatment. A study was designed to assess whether the addition of Vitamin C and E during treatment might reduce these issues.
The antioxidant enzymes, SOD, catalase, glutathione s transferase, and glutathione reductase were measured in white blood cell lymphocytes, in untreated stage 2 breast cancer patients and compared to healthy controls. The untreated breast cancer women had lower levels of these needed antioxidants and more DNA damage to normal cells than the control group of women. The untreated women were then divided into two groups, one treated with chemotherapy, a triple chemotherapy combination of 5 FU,doxorubicin and cyclophosphamide, while another group also received the chemotherapy along with Vitamin C and E in addition. The chemotherapy only treated group had similar but less pronounced antioxidant and DNA changes than the untreated group.
The chemotherapy plus vitamin C and E group had increased antioxidants and less DNA damage than chemotherapy alone, suggesting that vitamin C and E helped restore antioxidant activity and reduced DNA damage in breast cancer patients receiving chemotherapy. The researchers concluded that adding Vitamin C & E may be useful to protect against chemotherapy induced side effects from treatment.
Melatonin
Melatonin is widely used in solid tumor cancers in the integrative medical community, but not in blood cancers. It possesses
Antioxidant effects, inhibits angiogenesis or new blood vessel formation which supports metastatic spread, and also stimulates cell death, apoptosis.
It inhibits cancer’s pro survival signaling mechanisms.
Reinforces chemotherapy and decreases side effects
Studies suggest it is useful in prevention and supportive treatment in breast, prostate, colon, colorectal and gastric cancers.
Melatonin In Breast Cancer
Melatonin should be a consideration in all breast cancer patients but requires expertise in determining optimum dosage for each individual.
Melatonin is an aromatase inhibitor, it prevents the conversion of androgens, male hormones, to estrogen. It also has antiestrogen effects and inhibits estrogen production
Fatty Acids in Breast Cancer
The fatty acid DHA, Docosahexaenoic Acid, is a long chain omega 3 fatty acid. It can be converted from EPA, Eicosapentaenoic Acid. The combination of DHA and EPA is common fish oil. They come from similar sources and have complementary effects. They are generally taken in a combined form, with EPA doses being higher than DHA.
DHA
Taken alone, sensitizes breast cancer tissues to chemotherapy and radiation, but not normal breast tissue. It is available as gel caps, gummies or chewable and can be from fish or algae. The DHA dose needs to be higher than in most fish oil combinations available, but can be purchased as DHA alone.
Practitioner advice is recommended for dosing. The common ill effects are heartburn and nausea.
EPA/DHA and Selenium
In mice, with triple negative human breast cancer cells, low dose taxol, avastin and doxorubicin decreased tumor size and metastasis and with the addition of EPA/DHA and selenium these effects were enhanced.
Obesity and Cancer Risk
Many physicians consider a person to be obese when the BMI, your body mass index is > 30 and that maintaining a BMI of < 30 is considered an important step in cancer prevention. This gauge is a simple practical method of measurement, but it doesn’t directly measure body fat but is correlated to it. Because it is an indirect measure it can overestimate body fat in a muscular person.
Another method of screening is the ratio of waist to height, which correlates directly to body fat. Your waist circumference should be less than half your height in inches. For example if you are 5 feet tall or 60 inches your waist measurement should be less than 50% or less than 30 inches. Or if you are six feet tall, or 72 inches, the waist should be less than half or less than 36 inches.
Being obese causes insulin resistance, a condition where cells become resistant to insulin effects requiring the pancreas to produce increasing amounts. Insulin secretion results in the secretion of IGF-1, an insulin-like growth factor, which is necessary for growth and repair but in excess can stimulate the increased cell growth of cancer cells and inhibit their programmed cell death, apoptosis. So higher levels of Insulin, in obesity, trigger the increased IGF-1, which is an associated risk factor for colon, breast and prostate cancer.
Increased body fat also stimulates the production of pro-inflammatory molecules, called cytokines, which can damage cells and interfere with normal insulin signaling causing insulin levels to increase.
In breast cancer, being above the normal BMI levels, if premenopausal, is associated with an increase in the likelihood of presenting with triple-negative breast cancer while in postmenopausal women, an elevated BMI increases the likelihood of presenting with estrogen receptor negative disease, both of which are associated with a higher risk of invasive disease and mortality.
Adipose tissue can produce androgens, male hormones, which can be converted into estrogen in the body. In obesity, with more fat deposition, there is increased androgen production, creating higher estrogen levels. Since excessive estrogen stimulates breast cancer development and growth, obesity poses an increased but modifiable risk for breast cancer.
Obese women also have a worse prognosis for all breast cancer subtypes regardless of menopausal status, and are at a higher risk for lymph node metastasis.
Supportive Dietary Recommendations
A Plant Based Diet has been shown to reduce both cancer risk, and in cancer survivors help prevent recurrence, as well as improve quality of life. From the name, it can be deduced that this is a diet based primarily on plant products and includes:
Fruits and vegetables-which offer a combination of minerals, antioxidants, vitamins, fiber and flavors.
Nuts and seeds which are rich in essential fatty acids, micronutrients and protein coming from almonds, walnuts, chia, flax and pumpkin seeds, pecans and walnuts.
Plant oils, but in limited amounts of olive, avocado and coconut
Whole grains in the diet are composed of 3 parts, the kernel, the bran, the endosperm which are minimally processed so that the nutrients are retained. These include, brown rice, oats, quinoa, whole wheat and barley( check if you can eat gluten)
Legumes which are seeds grown with pods which include beans, peas, lentils, peanuts and soybeans, chickpeas and carob.
The Mediterranean diet
Also emphasizes plant based products and healthy fats but can be modified, when necessary. It allows for small amounts of non plant protein, with the primary protein recommendation of oily fish, salmon, tuna, mackerel and sardines. However, animal products can be recommended but less than 16 oz of chicken or turkey protein/ week and limiting red meat to very very occasional. Some diets also include limited dairy, such as yogurt and cheese and moderate amounts of eggs and tofu. Often, just eating plant based is easily adaptable, especially utilizing fish protein only.
If this is a departure from your standard dietary patterns, then initiating and converting to this as a dietary lifestyle comes with a recommendation to work with an experienced nutritional resource to provide guidance and an assessment of your individual needs.
Many cancer support groups and oncology centers have information available.
Mediterranean Diet Studies
In a study of 1000+Spanish women, with breast cancer presenting with various hormone patterns, i.e. ER+/PR+, HER-2+ or HER-2-/ PR-ER- HER-2-, the adherence to a western diet, especially in premenopausal women, increased the risk in all tumor types, but with the mediterranean diet there was lower risk. The protective effect was even stronger in triple negative breast cancer(TNBC).
A European cooperative study of 335,000 women showed that higher adherence to a MED diet was associated with lower risk of breast cancer in postmenopausal women, particularly in ER- PR- cancers.
A very recent study reviewed adherence to a Mediterranean diet in breast cancer survivors. They observed that in breast cancer survivors able to follow this diet there was a positive association with feelings of higher well-being and physical functioning and a diminishing of sleep disorders.
Additional Benefits That Can Be Derived From Diet
Flavonoids from berries, fruit, dark chocolate, spices and coffee, resveratrol, and curcumin, and quercetin all of which activate NRF-2. They also modulate signaling pathways that encourage cancer cell growth and reduce inflammation. Please read the extensive monographs on the site for more information. Resveratrol in breast cancer can also induce apoptosis or cell death in cancer cells and bring about activation of tumor suppressor genes.
Phytosterols are natural compounds found in plants which are similar to cholesterol, and lower LDL cholesterol. They are not synthesized in the body and come from nuts, seeds, veggies and oils. Studies show that increasing plant sterols lowers cancer risk. They can inhibit cell replication, invasion and migration of cancer cells in breast cancer and lung, colon, liver, and prostate.
These are potentially beneficial foods that come only from diet and include: nuts, especially almonds, cashews and pistachios, fruits like strawberries and bananas, and vegetables avocado, broccoli and carrots and natural grain and seed oils.
Components included in the diet from blueberries, black and green teas, nuts, beans and fruits and veggies can activate our internal antioxidant defense systems to neutralize free radicals capable of causing cell damage, via the NRF-2, nuclear factor erythroid-2 related factor 2.
Physical Activity
Exercise and physical movement can and should be one of the cornerstones for cancer risk reduction and for potential improvement of outcomes. Often few specific recommendations are offered as guidelines for people in treatment or after its completion, which realistically requires expertise in planning each individual’s program.
The articles below will support the benefits of exercise for breast cancer patients, but initially it is recommended that an experienced physical therapist or personal trainer help plan your personalized progressive aerobic and possibly resistance programs to determine the amount, the type, and the intensity of workouts which will allow the best opportunity to achieve the goals and its potential cancer benefits, while reducing risk of injury.
While involved in ongoing cancer treatments, or upon conclusion, and often for many months thereafter, people are debilitated with fatigue, malnutrition, loss of weight, muscle mass and strength and combined with other side effects can prevent a robust exercise program, many also have just lost their mojo to work out. When confronted with these issues it becomes difficult, initially, to exercise at high levels, and attempting to, could be harmful and prolong recovery.
Some basic general principles to consider are; avoid long periods of sitting, get up every hour from the computer or chair to move around for a few minutes. If aerobic exercise is too taxing, yoga and or tai chi are other alternatives. Articles on their benefits will be coming soon to the site.
Initially, the early post treatment recovery period should be viewed as reestablishing balance and reconnection within the body and a return to a quality life. It has been an extremely stressful time period and restoration and rejuvenation should take precedence! So beginning a planned exercise program, when ready, needs to start slowly, with very gradually increasing increments and always individually determined. A one size exercise plan is not feasible and can have a negative impact.. Pursuing advice from a physical therapist or physical trainer experienced in rehabilitation is needed to provide the needed guidance and correct instruction.
Measuring Exercise
One method of exercise measurement is based on the amount of exercise in metabolic equivalent tasks (METs) which is an objective measurement of energy expenditure during physical activity compared to when sitting quietly. It is recommended that 7.5-15 MET levels reduce cancer risk based on 10 year follow up of 700,000 participants.
Examples: Some equivalents of metabolic equivalent tasks(METs) are one hour of activity include:walking;
20 minute mile-3.3mets, uphill hiking- 6.9 mets, jogging12 minute mile 8 mets, 10 minute mile 10, stroll 2 mets.
Biking, stationary low intensity 3 mets, high intensity 5 mets, biking at 12-13mph 8 mets.
Sitting quietly 1 met, scuba 12 mets, downhill skiing, vigorous 8 mets, tennis 7mets, lap swimming, moderate 7mets, ultimate frisbee and hockey 8 mets, aerobic dance 6.5 mets, modern dance 4.8 mets, casual soccer 7 mets.
Physical Activity
Exercise utilizing aerobic conditioning and often combined with resistance training should be included as a therapeutic modality in all breast cancer patients, if possible and as a preventive strategy for all women to reduce risk.
Research from clinical studies definitively shows an advantage in prevention in breast cancer initiation as well as a reduction in the risk of recurrence and improved survival following chemotherapy treatment in patients that exercise. Higher levels of physical aerobic exercise uniformly show that exercising above your current levels were significantly associated with lower breast cancer risk, with gains toward prevention occurring even at lower levels.
Physical activity was associated with better outcomes in postmenopausal breast cancer women. A study from the National Cancer Institute showed that women doing 2.5-5 hours of moderate activity per week or 1.25- 5 hours of aerobic physical activity per week before and for two years after diagnosis had a 55% reduction in recurrence and a 68% reduction in chance of death from any cause.
Seventy three global breast cancer studies showed an association between physical activity and breast cancer prevention when comparing inactive versus active women. There was a 25% average risk reduction especially for postmenopausal women performing moderate to vigorous exercise.
Even in women with family histories of breast cancer or having BRCA genes, regular physical activity reduced all-cause mortality.
Evaluating women with breast cancer based on exercise activity before, during and after chemotherapy treatments showed active versus inactive women had significantly reduced risk of recurrence.
Yoga
One activity that has great potential benefit and could be used both independently and in conjunction with more intense physical activity is yoga. Studies showed that in those receiving chemotherapy prior to surgery, yoga reduces depression, improves quality of life and allows more women to return to work.
For women undergoing chemotherapy, besides improving overall health and quality of life, yoga improves emotional functioning and decreases fatigue, loss of appetite and constipation.
This study recognized the ongoing issues facing breast cancer patients of fatigue, chronic pain, sleep disturbance and psychological stress. It reviewed 24 randomized controlled studies with 2166 women with non metastatic and metastatic breast cancer that compared yoga with those receiving no other treatment or some other active therapy. Their assessment was that that information did support, moderately, that yoga as an intervention improved quality of life, sleep disturbance and fatigue when compared to no interventions and when compared to those receiving psychological/educational interventions, it also helped reduce anxiety and depression.
Qigong
Qigong is a Chinese approach to improving and Qi is considered circulation of vital or life energy, and gong is translated as this Qi cultivation through skill and practice. It entails an integration of physical movement, exercise and breathing and is related to Tai Chi Chuan.
Qigong exercises are unique individual movements, with several in a series, each one repeated and practiced for a period of time, before moving to the next one. They are performed slowly, with the specific intention of cultivating choreographed rhythmic movements which coordinate the breath, flexibility, strength, balance, posture, focus and circulation while evoking calm and relaxation. Its emphasis may be as a physical activity, a martial art or as a spiritual meditation.
Tai Qi originated as a martial art but has evolved as a form of movement used to promote health and well being. Many of the tai qi movements represent similar movements practiced in qigong, but tai chi chuan involves a precise repeatable sequential pattern, a form, that applies the basics to each individual move. The most common style is the Yang style, which can be very simplified and is composed of 8 movements but traditionally it is 24 to 108movements. There is also Wu style with 108 and Chen style with 74 or 83 movements. The pattern follows a template each time without variations.
Often, Qigong is often taught first, to learn basic weight shifts, rotations, and arm and leg positions, breathing, etc. before the sequence patterns of Tai Chi are taught. It allows practice of the same types of movement through repetition, where in the Tai Qi form a movement may be done only a few times.
Qigong and Radiation Support
In a randomized controlled trial, 96 breast cancer survivors, fifty percent who had had a mastectomy and had received radiation therapy were split into equal groups. The study subjectively assessed quality of life, depression, fatigue and sleep disruption, before, during and after radiation therapy and then one group was trained and practiced in qigong. Symptoms were reassessed and measured at one and 3 months later, in both groups. The patients receiving Qigong therapy noted significant improvements in quality of life, depression and fatigue but not insomnia, with minimal or no change in the control group.
Qigong in Cancer Survivors
Qigong was evaluated for its effects on cancer related fatigue, sleep disturbance and quality of life from 8 randomly controlled trials in 469 breast cancer survivors who did moving meditation or walking qigong. The conclusions were that qigong significantly reduced fatigue, sleep issues and improved QOL.
Qigong was evaluated, in a randomized study, in cancer survivors with diminished cognitive function, ranging from two months to eight years post completion of chemotherapy and radiation. Women had 8 weeks of Qigong versus gentle exercise, and the conclusion was that Qigong, as a mindful exercise, may be superior to the exercise alone in improving quality of life.
Tai Chi Chuan
A study reviewed 15 publications in which included almost 900 breast cancer patients, during and after chemotherapy or after mastectomy comparing Tai Chi to non exercise therapies, which were only educational concerning nutrition, stress, fatigue and exercise. Patients were evaluated at 12 and 25 weeks. And it was shown that Tai Chi improved pain, shoulder function, arm strength anxiety and quality of life.