Life Over Cancer Blog

Breast Cancer and Cholesterol

One of the most important strategies for treating women with estrogen-positive breast cancer is to block the action of estrogen. In estrogen positive (ER+) breast cancers, the natural estrogen in the body attaches to the estrogen receptors on cancer cells and stimulates them to divide, which makes breast tumors grow. 

Once the initial treatment of breast cancer is completed, (surgery, chemotherapy, radiation), it is usually recommended that patients with ER+ tumors undergo long-term treatment with drugs like tamoxifen, which blocks estrogen activity, and aromatase inhibitors – Aromasin, Arimidex and Femara – which block the synthesis of estrogen in fat tissue in the body. These estrogen-blocking drugs work well for most women, but unfortunately, not all women respond to them, and it is not unusual for tumors to develop resistance to these drugs. 

We are now learning more about why estrogen-blocking drugs may not work all the time, and one of the mechanisms comes from a surprising source:  cholesterol! Like most molecules in the body, cholesterol gets metabolically transformed into other molecules by various enzymes in our body. One of the molecules that is derived from cholesterol, and which is present in fairly high levels in the body, is 27-hydroxycholesterol (27-HC). This interesting molecule can attach to and actually stimulate estrogen receptors in the body. Patients with ER+ breast cancer have higher amounts of 27-HC in the normal tissue in their breasts than women who have not been diagnosed with ER+ breast cancer. And the amount of 27-HC in breast tumors is even higher. This is because the enzyme that converts cholesterol to 27-HC is found in high levels in some breast cancer cells, especially in higher-grade tumors (higher grade tumors tend to grow rapidly and spread faster than lower grade tumors), and also in immune cells called macrophages, that sometimes infiltrate breast tumors. 

Qigong Fatigue Study

Qigong is a traditional Chinese exercise modality. It aligns breathing, mental focus (or awareness) and movement for purposes of exercise, meditation and balancing of the “qi,” or life energy, in healing. It emphasizes and cultivates a calm and relaxing state of mind. At the Block Center, qigong exercises are often integrated into the physical activity component of our patients’ individualized treatment plans.  

A study recently published in the Journal of Cancer Survivorship compared qigong with stretching classes in the framework of a randomized, controlled trial. The main goal of the study was to evaluate whether qigong helps with fatigue – a common problem for many cancer patients, both during and after treatment – in prostate cancer survivors. Many studies have been done on ways to address this fatigue; of special interest to our clinicians are non-drug interventions that may be helpful. 

This study was designed especially well, which makes its conclusions even stronger than most of the previous studies that have looked at exercise for cancer patients. 40 men (average age 74) with prostate cancer were randomized to take either qigong classes or controlled stretching classes twice a week for 12 weeks. Both types of classes were an hour long, included sitting and standing exercises, and had DVDs to encourage participants to practice at home. One particular strength of the study was the fact that the control group was doing an exercise intervention at the same time as the qigong group. This ensures that it is not simply an increase in activity that would cause any beneficial effects from the qigong classes, but rather something unique about the qigong itself as an exercise system.

Antioxidants as Pro-oxidants

When is an antioxidant not an antioxidant?  This curious question was explored in a scientific poster that Dr. Block presented at the 10th International Conference of the Society for Integrative Oncology (SIO), held October 20-22 of this year. The answer to the question was suggested in the title of the poster, “Antioxidants as pro-oxidants in cancer cells.”  What, you might ask, is a pro-oxidant?  As the name suggests, it’s the opposite of an antioxidant!  Antioxidants neutralize free radicals, while pro-oxidants stimulate and produce free radicals, or, in scientific jargon, reactive oxygen species (ROS).

Why are we interested in producing free radicals in cancer cells?  Isn’t this the opposite of what we want to do?  And why would an antioxidant suddenly turn into a pro-oxidant when you put it into a cancer cell?  Actually, it’s well known that many antioxidants can act as pro-oxidants – this fact even appears in Wikipedia!  However, the Wikipedia discussion of antioxidants overlooks some new data that are coming to light about pro-oxidants and antioxidants as they relate to cancer treatment. 

Dr. Block Delivered a Presentation on Fish Oil at the Society for Integrative Oncology Meeting

What cancer-related uses of fish oil have the best scientific evidence behind them? Dr. Block presented on this topic at the 10th International Society for Integrative Oncology in Vancouver, British Columbia on Sunday, October 20. 

Laboratory studies of fish oil show that it has many effects on cancer, from modifying blood viscosity to modulating treatment resistance. It has beneficial effects on the important processes of apoptosis and angiogenesis. EPA and DHA, the major omega-3 fatty acids in fish oil, diminish inflammation, a critical driver of many cancer processes.

Besides lab studies, several important recent observational and clinical studies have shown the benefits of fish oil on different cancers. Breast cancer patients whose diets included the most EPA and DHA had 28% less risk of recurrence or metastasis, and 41% lower risk of mortality than those with the least. A randomized study of fish oil taken during chemotherapy for lung cancer found that patients had improved rates of tumor shrinkage, less weight loss and better retention of muscle mass. Prostate cancer patients who were given fish oil and a low fat diet before surgical removal of the prostate were found to have tumors with lower rates of cancer cell proliferation than those who ate typical Western diets. Fish oil also helped to maintain weight and immune function in gastrointestinal cancer patients who were receiving chemotherapy.  

There are very few side effects from taking fish oil. Gastrointestinal side effects, such as belching or stomach upset, can be minimized by taking enterically coated fish oil capsules. We recommend fish oil that contains added vitamin E to reduce oxidation, which fish oil is prone to.  Finally, fish oil has blood thinning effects and should be used cautiously with medications that thin the blood, and during times when blood platelets are low due to chemotherapy. If your doctor tells you, for instance, that you should not take aspirin due to low platelet counts, it is prudent to ask her/him if you should also stop fish oil supplements.

Dr. Block also discussed the study on omega-3 blood levels of prostate cancer patients by Brasky and colleagues that was discussed in this blog a few weeks ago, concluding that the results of this study did not offer any conclusive evidence of harm from taking fish oil. With the basis of randomized trials and observational studies of solid design showing benefit from taking fish oil, we continue to feel that this source of essential omega-3 fats is a healthful supplement for cancer patients.

For more information on The Block Center for Integrative Cancer Treatment, call (847) 230-9107 or visit BlockMD.com.

DIM and Breast Cancer

By Dr. Keith Block

Evidence-based medicine is an important precept throughout healthcare today. Evidence-based medicine relies on the best scientific evidence available at any particular time to help clinicians make decision in caring for patients, although it should never replace clinical judgment. In using evidence-based medicine, we look at randomized trials, laboratory results and systematic literature reviews to decide which medications and lab tests to use – or not to use.

A 2013 article that appeared in the Townsend Report – “Estrogen Metabolite Ratios: Time For Us To Let Go,” written by Jacob Schor – alerted us to a change in the status of evidence regarding one of the laboratory tests that we use. Along with many other practitioners, we have been using a test that measures two different metabolites, or breakdown products, of estrogen in the body to measure risk for breast cancer. Estrogen, specifically the molecule estradiol, is transformed in the body by different enzymes into other molecules. The particular molecules in question in the estrogen metabolite ratio test are 2-hydroxyestrone and 16α-hydroxyestrone. A series of studies dating back to the 1980’s had indicated that 2-hydroxyestrone had a relatively inhibiting effect on estrogen receptors, which modulate the effect of estrogen on breast cancer cells and other cells in the body. 16 α-hydroxyestrone, on the other hand, binds strongly to estrogen receptors on breast cancer cells, where it is thought to cause a long-lasting stimulation of the estrogen receptors. This might increase breast cancer risk or promote breast cancer growth. Because of the interest in predicting breast cancer risk, a lab test was developed that measured the ratio of “good” 2-hydroxyestrone to “bad” 16 α-hydroxyestrone. In this lab test, women with higher ratios of “good” estrogen to “bad” estrogen were thought to have less risk of breast cancer than women with low ratios (i.e., more “bad” estrogen). 

12-Year Study Shows Doubling of Life Expectancy

EVANSTON, IL – A 12-year study conducted by the Block Center for Integrative Cancer Treatment has shown a doubling of life expectancy for a group of 90 metastatic breast cancer patients. The results were published in the July/August issue of The Breast Journal. The women, diagnosed before 1998, participated in a comprehensive clinical program that combined conventional treatments—surgery, chemotherapy, and radiation—with individualized nutrition and supplementation, as well as fitness and mind-spirit regimens.

Through the 1990s, median survival reported in metastatic breast cancer research ranged on average from 12 to 24 months. Median survival for Block Center consecutive case series patients was 38 months, and their five- year survival was 27%, versus 17% for comparison patients. Published literature on populations with more favorable prognostic factors treated in conventional clinics showed median survivals of 20 to 23 months. 

Survival of metastatic breast cancer patients at the Block Center was approximately double that of comparison populations, and possibly even higher compared to several randomized trials published during this period. It would appear that the advantage relative to just conventional treatment alone stems from the individually- tailored nutritional, nutraceutical, exercise and psychosocial interventions in the Center’s program.

In addition to age and occurrence of relapses several other factors, not typically assessed in conventional settings, can impact survival in breast cancer patients, among them: body weight, psychosocial distress with elevated catecholamines, cortisol, inflammatory and oxidative mediators, diet and physical activity. Randomized trials of single-agent therapies or one-dimensional interventions appear inadequate to address this complexity, and there is a need for new clinical models to research and test whole systems interventions, such as the integrative care program at the Block Center.

"New cancer drugs are routinely approved for extending survival for 2 to 3 months,” said Dr. Keith I. Block, medical and scientific director of the Block Center. “There currently is no drug that has demonstrated the potential to double the life expectancy of metastatic breast cancer patients, as evidenced in these findings. These data are another compelling argument for conducting further research into an integrative treatment model for cancer.

“Our statistics were derived from our community-based patient population. While our group was comparable on major prognostic factors, we had a higher proportion of relapsed and younger patients (the median age at onset of metastasis was 46 years) than the comparison patients, which usually means a poorer prognosis. One would have expected worse survival rates, but that is the opposite of what we saw.”

“This is the first time that treatment outcomes using integrative cancer therapy for this disease have been documented,” Dr. Block said. “The survival times for our population were substantially higher than for patients who received conventional treatment alone.”

Dr. Azra Raza, Director of the Myelodysplatic Syndrome Center, St. Vincent’s Comprehensive Cancer Center, New York, characterized the Block Center’s comprehensive, integrative program as “superior….This evidence- based integrative approach should serve as a wake-up call for oncologists to overcome their obsession with treating cancer as an isolated target, but rather pay attention to the cancer patient whose own faculties need to be harnessed as agencies to win this war.”

Citation: Survival Impact of Integrative Cancer Care in Advanced Metastatic Breast Cancer, Block KI, Gyllenhaal C, Tripathy D, Freels S , Mead MN, Block PB, Steinmann WC, Robert A. Newman RA, & Shoham J. The Breast Journal, 2009, 15(4), pp 357-366.

For more information on The Block Center for Integrative Cancer Treatment, call (847) 230-9107 or visit BlockMD.com.

 

Study: Global Effects of Sugar on Diabetes

As if we need another reason to stay away from sugar, an interesting one was recently provided by a team from California that includes Robert Lustig, a professor of clinical pediatrics at the University of California, San Francisco. Because this study concerns sugar and diabetes, it has an important message for cancer patients: type 2 diabetes is one of the major risk factors for getting cancer. In addition, we know that the nutritional processes involved in diabetes have implications for cancer patients.

Lustig and his colleagues assessed the relationship between sugar availability, obesity, economic development and diabetes prevalence in 175 countries around the world between 2000 and 2010; they also included data on several other food types, as well as variables like aging and urbanization. Rather than using data on individual patients, like clinical trials, they used data that applied to entire countries. For instance, the Food and Agriculture Organization has data on availability of sugar (including all types, sucrose, fructose and others), as well as things like fruit, meat or calories eaten per day. Other country-level data that the authors used included: how much of the population was obese or overweight, gross domestic product (a measure of overall economic development), and percentage of elderly people in the country. All these variables have previously been correlated to diabetes.

The study combined all the variables in a statistical model that allowed them to determine how much each of them contributed to diabetes prevalence in a country, which they obtained from the International Diabetes Federation. They checked on the data in several ways to make sure their results made sense. Here is some of what they found:

• Worldwide prevalence of diabetes increased by 27% from 2000 to 2010. That’s a frightening statistic if ever there was one!
• Sugar availability on its own accounted for a quarter of this increase. If a country experienced an increase of 150 calories per person per day in sugar availability (that’s the amount of sugar in a single can of soda!), its rate of people with diabetes increased by 1.1%. This was much more than any other food contributed to diabetes, and more than even total caloric consumption, which increased diabetes by only 0.1% with an increase of 150 calories per day per person of total food consumed.
• The other major contributors to increasing diabetes prevalence were obesity and gross domestic product. 

We know that obesity is related to diabetes, especially type 2 diabetes (this study does not distinguish type 1 from type 2 diabetes, but type 1 makes up only 10% of all diabetes). Gross domestic product is rather interesting: it’s a complex variable that impacts everything from the prevalence of desk jobs to dietary changes to stress. Every increase of 1% in gross domestic product resulted in a 1.07% increase in diabetes prevalence.

Some other interesting findings from the study confirm these major trends:

• In some countries, such as the Philippines, Sri Lanka and Bangladesh, diabetes rose rapidly but obesity did not. In these countries, it turned out, sugar availability rose by at least 20% in the 10 years surveyed in the study.
• The longer a country was exposed to high sugar availability (over 300 calories worth of sugar per person per day), the more its diabetes prevalence increased.
• If a country’s sugar availability decreased (usually due to changes in trade agreements) its diabetes prevalence decreased significantly.

The authors point out that changing the details in the variables used (for instance, adding alcohol or physical inactivity or smoking), did not change the sugar relationship to diabetes, and these variables did not make a statistically significant difference in diabetes prevalence. 

So what can we conclude from this study?

Mainly, we see that sugar consumption contributes much more to diabetes prevalence than we had thought. However, sugar consumption is not the only dietary concern when it comes to diabetes prevention – fiber intake, the consumption of healthy fats, and total caloric intake also play a role. (In addition, it should be noted that regular exercise can also help in the prevention of diabetes.) But if we were to select a single food to target for population-wide reduction or elimination, sugar looks like the one to go after!

If you are a cancer patient, it’s important to know that type 2 diabetes, and even pre-diabetes, can result in high insulin levels in your blood as well as high blood sugar levels. And elevated levels of insulin in the blood have been found to increase the risk of several cancers.

We know it isn’t easy to break long-standing dietary habits, but hopefully understanding the link between sugar and diabetes will help inspire you in your efforts to eliminate unhealthful sugars from your diet!

Reference: Basu et al. PLOS One.  2013; 8(2) e57873.

 

Healing Power of the Terrain: Blood Circulation

In the last in our series on the “terrain,” we’ll take a look at Blood Circulation.

When you are healthy, your blood is neither too thin nor too thick. If it becomes too viscous, it is in a state of hypercoagulation. This can happen when you have cancer: tumors cause clot-forming platelets to become overactive, and they stimulate production of a protein called fibrin, which kits blood cells together and thus makes the blood “sticky.” If your blood becomes too fluid or “thin,” on the other hand, it is in a state of hypocoagulation. This can happen from a loss of platelets, impairment in liver function, or use of anticoagulants, either pharmaceutical or nutritional. Too few platelets or their loss of “stickiness” can lead to capillary leakage or a full-blown hemorrhage. Both hypercoagulation and hypocoagulation are problematic. The first raises the risk of thrombi and embolisms and can promote tumor progression and metastasis. The second can lead to uncontrolled bleeding. These conditions are especially dangerous for cancer patients, because they have an impact on several aspects of your disease. 

Healing Power of the Terrain: Glycemia

Tumors are gluttons for glucose. They consume this blood sugar at a rate ten to fifty times higher than normal tissues. PET scans, which detect glucose consumption, have shown that the higher the rate of glucose accumulation in cancer cells, the more aggressive the tumor – that is, the more invasive and likely to metastasize it is.

In addition, having high levels of blood glucose – as diabetics do – can make you more susceptible to several different cancers and lead to a worse outcome if you do develop cancer. However, even without diabetes, small elevations in glucose or insulin can wreak havoc on your health and fuel malignancy. Patients who have what’s called pre-diabetes (blood sugar levels that are high but not high enough to be diabetes) or metabolic syndrome (a precursor to type 2 diabetes) have abnormally high blood sugar. They also tend to have elevated levels of insulin because of what is called “insulin resistance.” Insulin is the molecule that transports glucose into muscle, brain and other tissue. In insulin resistance, cells block the entry of glucose. When this happens, blood levels of both insulin and glucose increase in a futile attempt to overcome that resistance.

Healing Power of the Terrain: Inflammation

Evidence of the ability of inflammation to both initiate and fuel cancer has been accumulating since at least the 1980s. In fact, any chronic inflammatory disease – such as arthritis, bronchitis, fasciitis, colitis, and asthma – can increase the risk of cancer. For example, according to a 2000 study, approximately one in every ten patients with ulcerative colitis will eventually develop colorectal cancer. However, it isn’t just the risk of cancer that is a concern when chronic inflammation is present. A study published in the May 2009 issue of the Journal of Clinical Oncology demonstrated that patients with high blood levels of C-reactive protein (CRP) and serum amyloid A (SAA) were two to three times more likely to die prematurely or have their cancer return than patients with lower levels. 

These markers indicate the presence of inflammation in the body. While acute inflammation is a healthy immune system response, chronic inflammation is not. Inflammation is one of the mechanisms that initiate the cascade of molecular events that lead to cancer and promote the growth of existing tumors. If a cellular mutation is the spark that lights the malignant fire, then inflammation is the fuel that keeps the fire growing. In general, the higher your CRP levels, the more unfavorable your prognosis. Indeed, in advanced cancers, CRP levels are often the most reliable indicator of prognosis, particularly with colorectal, lung, pancreatic, and prostate cancers.

The converse is also true: controlling inflammation can reduce the risk of and decrease the aggressiveness of cancer. Most, if not all patients, are dealing with high levels of inflammatory biochemicals that are produced by malignancies, and increased by surgery, radiation and chemotherapy. At the Block Center, we measure and monitor the inflammation levels of all of our patients, and encourage them to make lifestyle and dietary changes that can significantly minimize other sources of inflammation. It is important to note that being overweight, especially with excess abdominal fat, can be particularly harmful. People who are overweight have a higher level of inflammatory compounds in their blood, regardless of lifestyle or medical history.