Sunday, June 5, 2016

How to reduce your risk for breast (or prostate) cancer

Are you worried about breast cancer?  (Or prostate cancer?) You certainly, aren’t alone!  This is the number one concern I hear about when I am talking to patients about hormone balance.  Many men are not aware that their estrogen level can affect their risk for prostate cancer (high estrogen levels may increase the risk).   

Estrogens are essential for health and well being in both women and men. Estrogen plays a role in mood, energy, memory, sleep and sexual function.   Estrogen is important for bone health, brain health, heart health, breast health and prostate health.  

Every day, the body has to clear today’s estrogen to make way for tomorrow’s estrogen.  This is true whether you are making your own estrogen or whether you are taking estrogen replacement (synthetic or bio-identical).  If you are not clearing the estrogen properly, levels can climb and lead to symptoms.  Another factor to consider is HOW your body is clearing the estrogen.

Some estrogen metabolites (or “breakdown” products) have been shown to be harmful and increase risk for breast cancer in women, and prostate cancer in men.  On the other hand, some estrogen metabolites are protective, and associated with a REDUCED risk of breast cancer.  Wouldn’t you like to know which ones you are making?

The levels of the various metabolites can be measured, and we can use this information to help assess breast cancer (and prostate cancer) risks.  The good news is that armed with this information, there are many steps we can take to CHANGE the risks.  

How does it work?

There are 2 main estrogens we need to consider here.  Estrone,  also called E1, is the predominant postmenopausal estrogen.  Estradiol, also called E2, is the predominant pre-menopausal estrogen and the one that we replace in estrogen replacement therapy.   Men also have these estrogens, and estrogen levels tend to increase in men with age.

In “Phase One” of detoxication of estrogen, the liver metabolizes these estrogens into 3 different possible metabolites:

2-hydroxyestrogen (2-OH) is breast protective, so we want the most of your estrogen to go down this pathway.

16-hydroxyestrogen (16-OH) is bone protective (reduces the risk of osteoporosis) but is not breast protective.  We used to think that the ratio of 2 to 16 hydroxyestrogen (or the “2 to 16 ratio”) was a good predictor of breast cancer risk, but the current research does not support this.

4-hydroxyestrogen (4-OH) is the metabolite that you really don’t want.  This one has been associated with an increase in the risk for breast cancer.   This is also the one that breast cancer cells release into the bloodstream, so an increased level of 4-OH is concerning.  This is a newer test, and was not available in the past.   If the level of 4-OH is too high, we can help correct this with cruciferous vegetables (like broccoli, cauliflower,  kale, brussels sprouts), ground flax seed and fish oil.  We can also use a nutritional supplement called DIM.

In “Phase Two” of estrogen detoxification, the metabolites are altered further:

2-methoxyestrogen (2-Me) and 4-methoxyestrogen (4-Me) are made when 2-OH and 4-OH estrogens are “methylated” into methoxyestrogens.  This is a biochemical event where a “methyl” molecule is attached to the estrogen.  Even if estrogen has been converted into the “bad”  4-OH, once it is “methylated”  into 4-Me,  it becomes harmless.  Some people have a genetic variation resulting in reduced ability to methylate, and this leaves more 4-OH.  If the level of 4-OH is too high, we can help reduce it with supplements such as folate, B12 and SAMe which help methylation.

If the 4-OH is not methylated, it can be “oxidized” to a quinone-estrogen which can damage DNA and cause cancer.  But here too, we can intervene to prevent this!  Anti-oxidants, including glutathione (an important anti-oxidant produced in your liver), protect the 4-OH from being oxidized into a quinone-estrogen.  We can help clear the 4-OH safely by increasing your levels of glutathione.  This can be done by eating foods such as garlic, onions and beets, and with a supplement called N-acetylcysteine (NAC).  

Where should you start?

Previously we could only test for 2 and 16 estrogen metabolites, which didn’t give us the whole picture.  Now we can also measure for the 4 estrogen metabolites, which allows us to map out your personal estrogen metabolism  pattern.  We can also test for genetic variations that may be pushing your estrogen metabolism in the undesirable direction, as well as test for levels of anti-oxidants such as glutathione which help to clear the “bad” estrogen metabolites.   With this information we are able to make recommendations to alter your pattern so you make more of the protective estrogen 
metabolites and less of the harmful ones.  Then we can repeat the test to make sure we got it right! 

There are many other factors that are important for reducing cancer risk, including maintaining a healthy weight, eating a whole foods diet rich in fruits and vegetables of many colors, getting regular exercise, coping with stress in a healthy way, avoiding environmental toxins and making sure your estrogen is balanced with progesterone.  

Knowing your estrogen metabolism pattern, and optimizing it, is an example of how emerging medical science can help guide our nutritional recommendations to help you reduce your risk for hormone sensitive cancers.  The test is not covered by health insurance, and the cost is $200 or less, depending on the lab.  I recommend this test be done at least once in all patients.  If it is abnormal, we can talk about further testing for the gene variants, so we can compensate for any genetic weaknesses.  
If you are interested in being evaluated for your estrogen metabolism pattern, please contact the office for more information, 704-752-9346 or email us at   You can find more information at

Yours in health,


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