If you’re dealing with Fibroids, Endometriosis or Breast Cancer you have a choice of conventional treatments and integrative options. Conventional treatments typically are a combination of prescription medication and surgical interventions, whereas integrative approaches involve natural and safe protocols which can be used to reduce symptoms and avoid surgery, or help you reduce recurrences after you’ve had surgery. Let’s take a look at these treatment options in more detail.
If fibroids are detected during a routine exam with your doctor, the conventional approach would be to do nothing until you start to have symptoms or the fibroid reaches a particular size. This is the ideal time to consider an integrative treatment plan, which is designed to prevent the fibroids from growing larger and causing symptoms.
Once you do begin to have symptoms, the common recommended surgical options are to either have your entire uterus removed (hysterectomy), remove the fibroids only (myomectomy), or to reduce the blood supply to the fibroids (uterine artery embolization). Conventional treatment might also involve using medication to induce a medical menopause in order to reduce your estrogen level. This can have severe side effects and is never a long-term solution. The medications you would take to induce menopause are only approved for 6 months and your fibroids could return within a year of when you stop taking the drug.
Conventional treatment for endometriosis is similar. It involves undergoing surgery to remove the implanted tissue, a hysterectomy if your condition is severe, or medication to decrease the stimulation of estrogen.
With breast cancer, the foundation of today’s conventional approach is focused on early detection. You’ve probably heard this coined as ‘prevention’ which is actually a misnomer since early detection is not really prevention. This can be misleading as the terms are used interchangeably in discussions around breast cancer prevention.
Conventional approaches to breast cancer prevention include the prescription medications tamoxifen and raloxifene. Both of these can help reduce your chances of getting breast cancer by 50% or more but carry with them the risk of serious sides effects, such as uterine cancer and blood clots.
Integrative Approach Part 1: Improving Estrogen Elimination
When beginning an integrative approach to these disorders the first step is to improve the elimination of estrogen. Because fibroids, endometriosis and breast cancer all involve excess estrogen, ensuring adequate elimination is fundamental to an effective integrative treatment plan. If you are familiar with detoxification programs you may have heard of the different phases involved in eliminating toxins from the body. It’s a complex process but simply put, in Phase 1 a toxic chemical is converted into a less toxic chemical, and in Phase II that chemical is bound to another molecule so it can be excreted into the gut and out of the body.
In the same way an integrative approach to eliminate excess estrogen optimizes both Phase I and Phase II detoxification. Therefore, it’s important early on to ensure adequate detoxification. Both Phase I and Phase II detoxification are important in eliminating estrogen but for different reasons. Let’s take a look in more detail at each phase.
In Phase I a process takes place called hydroxylation which alters estrogen in specific ways. What’s important to know here is that although the effectiveness of the hydroxylation process is somewhat genetically determined, you can also effect it through healthy lifestyle changes and good nutrition. This means adding physical exercise, freshly ground flax seed (and other omega 3 sources), and cruciferous vegetables like broccoli, cabbage, cauliflower and brussels sprouts to improve the hydroxylation process and reduce your risk of breast cancer.
In Phase II the estrogen becomes attached to another chemical compound so it can be excreted out of your gut. In order for this process to work well it’s important to have healthy gut flora (bacteria). Otherwise, you can be at risk of the estrogen becoming unbound and reabsorbed back into your system, defeating the whole purpose!
Treatments that I always recommend to keep the gut healthy include incorporating a low-animal-fat diet, adding probiotics and calcium-D- glucarate, and hydrating well throughout thecday to ensure proper bowel movements. In addition, you can accelerate the detox process withcdiet by adding artichoke, broccoli, green tea, garlic, pomegranate, shallots, and watercress tocyour diet.
Finally, to really know where you stand I usually recommend getting a test through a functionalcmedicine lab to determine both estrogen elimination and any detoxification abnormalities.
Integrative Approach Part 2: Assessing Estrogen Production
So now let’s look at how estrogen is produced in your body. You may not be familiar with thecbasic principles of estrogen production, but even if you are here’s a short breakdown:
1. All estrogen made in your body is produced by an enzyme called ‘aromatase’ which iscstored in adipose tissue or body fat. In other words, body fat produces estrogen.
2. Insulin as well as certain pesticides stimulate aromatase
3. Estrogen is transported throughout your body by being bound to a carrier protein called sex hormone binding globulin (SHBG). But in order for estrogen to have an estrogenic effect it must be unbound to the SHBG carrier to become free-estrogen
4. Insulin decreases the SHBG carrier causing more estrogen to become free, which in turn causes more estrogenic effect in your body
Both fibroids and endometriosis have been shown to have high levels of aromatase activity in the tissues, and breast cancer cells also have higher levels than surrounding normal breast tissue. That’s why the standard treatment has been to use pharmacological aromatase inhibitors. Likewise, the next step in an integrative treatment plan would also focus on decreasing aromatase activity, as well as adipose tissue (body fat) and insulin levels while boosting up SHBG.
So as you can see, adipose tissue plays a pivotal role in estrogen production. However, not all body fat is created equal. It turns out some types of body fat actually cause more estrogen than others. And there are additional factors involved as well.
First of all, some body fat can contain more lipid (fat) and become too full (yes, even a fat cell can become too fat!). When this happens you get a kind of domino effect where your insulin sensitivity is reduced which then decreases SHBG, leading to higher free estrogen levels.
Secondly, the chemical reactions that take place within the body fat create a pro-inflammatory state which again stimulates aromatase thus causing increased production of estrogen. And ironically, estrogen itself helps stimulate the pro-inflammatory state so you end up in a kind of ‘feed forward’ cycle that builds upon itself.
Finally, as stated before, not all body fat is created equal. The body fat or adipose tissue around the abdomen and pelvis are the most metabolically active. Therefore, a trip to the plastic surgeon for liposuction will do nothing to improve the pro-inflammatory, estrogenic effects if you have an “Apple” shaped phenotype. Liposuction does not remove the adipose tissue. The only solution here is to use lifestyle change (nutrition, exercise, stress reduction) to reduce abdominal fat.
So let’s review the essential points again:
● Body fat increases estrogen
● Estrogen causes inflammation
● Inflammation increases estrogen
● Body fat also increases inflammation
● Insulin increases total and free estrogen
Don’t worry if this gets a bit confusing, there’s no need to commit this to memory, but it’s helpful to be familiar with the various ways that body fat, inflammation and estrogen affect each other.
Integrative Approach Part 3: Normalizing Estrogen Production
After you and your doctor work on eliminating estrogen and assessing your level of estrogen production, the next step is to begin normalizing your estrogen production. This will include a functional medicine approach that works on reducing your adipose tissue (body fat), inflammation, insulin levels, and increasing SHBG.
The general treatment program I typically have my patients begin is pretty straightforward and includes:
● Maintaining a healthy weight through nutrition, stress reduction and exercise.
● Reducing inflammation by adopting a pescatarian diet and supplementing with omega 3 essential fatty acids (EFAs), bromelain, curcumin and quercetin.
● Normalizing insulin and glucose through eating a low-glycemic- index diet and through supplementing with micronutrients such as alpha lipoic acid, cinnamon, chromium, and vanadium
● Increasing SHBG by normalizing body weight, lowering insulin levels and supplementing with flax or other EFAs.
Another way to reduce the amount of estrogen in your body is by being aware of environmental and nutritional sources you are in contact with. Pesticides and plastics have long been known to have estrogenic effects, and now there are additional concerns that municipal sewage treatment plants are not able to remove all the estrogen and estrogen-like chemicals from the water supply. In addition, estrogens are routinely added during the farming of conventional chicken, beef, and dairy cows to enhance productivity, taste and consistency.
That’s why it’s so important to be sure you are consuming organic produce, spring or filtered water, organic or ideally free-range and pasture-fed beef, chicken, eggs and dairy products, as well as wild, cold-water fish.
Beyond diet there is also the impact that stress and emotional and spiritual issues have on these estrogen-related disorders. Stress in particular is known to cause an increase in inflammation so it’s important to include a stress reduction program as part of your treatment plan. And I have seen over and over again in my practice the impact that emotional and spiritual issues have on these illnesses such as child-bearing conflicts, lack of creative self-expression, sexual issues, unresolved anger, and severe self-criticism.
If you’re struggling with fibroids, endometriosis or breast cancer and are concerned about surgery and medication side effects, you can now see that there are other options that are more natural and safe. You can ask your doctor about implementing a good integrative treatment program that focuses on:
● normalizing your estrogen production
● reducing inflammation
● optimizing blood sugar metabolism and body fat
● reducing stress
● resolving conflicts
● addressing spiritual issues
I’ve seen many patients benefit from this kind of integrative program which addresses the physical, emotional and spiritual issues and allows healing to unfold naturally. So when you want an alternative to the conventional approach, rest assured that a good integrative treatment plan can help you in a natural and safe way.