Dr. Tori Hudson, N.D.

Reference: Anderson L, Cotterchio M, Vieth R, Knight J. Vitamin D and calcium intakes and breast cancer risk I npre- and postmenopausal women. Am J Clin Nutr 2010; 91(6): 1699-1701.

A recent study on vitamin D and breast cancer risk was published that once  again points the way to vitamin D as a safe and important strategy in lowering breast cancer risk. The study included about 6,500 women between the ages of 25 and 74. Approximately half the women were diagnosed with breast cancer and half were not. According to the study results, a vitamin D supplement intake greater than 400 IU/day compared with no vitamin D supplement intake, reduces the risk of breast cancer by about 25%. This Canadian population-based, case-control study also observed that there was no influence of calcium supplement intake and breast cancer risk.

Commentary: This is just one study in a growing list of research publications demonstrating that vitamin D deficiency is associated with an increased risk of breast cancer, and other studies demonstrating that raising one’s serum level of vitamin D can lower the risk of breast cancer and breast cancer recurrence. Included below, is an article I published in the Townsend Letter for Doctors. While perhaps a bit technical for the non medical reader, I think the message is clear enough: Vitamin D is associated with a lower risk of breast cancer with the optimal guide of a maintenance dose that would achieve a serum 25 hydroxyvitamin D level of > 52 ng/mL in order to have a 50% reduction in breast cancer incidence.

Here is the article in total:

The Vitamin D and breast cancer link: Understanding associations, prevention, intervention; Townsend Letter for Doctors and Patients; August/Sept 2010, Issue #325/326

Tori Hudson, N.D.

Vitamin D deficiency has been associated with the increased risk of several cancers, including breast cancer. Given that breast cancer is the most common cancer in women in the United States, efforts towards identifying modifiable risk factors, targets for prevention with any lifestyle modification or nutritional influence is especially appealing.

One of the initial observations suggesting the potential for vitamin D to reduce breast cancer risk and mortality was from ecologic studies where higher latitude and therefore lower UV light, was associated with increased breast cancer incidence and

mortality. [i], [ii] , [iii] Other early evidence came from in vitro studies of breast cancer cell lines showing antiproliferative and proapoptotic effects of 1,25(OH)₂ D. [iv], [v] , [vi]

Epidemiological evidence is limited but in the first National Health and Nutrition Examination survey Follow-Up Study, higher sun exposure or high dietary or supplemental vitamin D intake, while not statistically significant, was consistently observed as an association with a decreased risk for breast cancer.[vii] In the Nurses’ Health Study, a higher dietary intake or total intake of vitamin D including supplementation was significantly associated with a lower risk of premenopausal breast cancer.[viii] An updated study was done with a cohort in a case-control study nested within the Nurses’ Health Study. The relationship between plasma levels of 25 (OH)D and 1,25 (OH)₂ D and breast cancer was prospectively examined.[ix] Women in the highest quintile of 25(OH)D had a nonsignificant lower risk of breast cancer compared with those in the lowest quintile, when both metabolites were analyzed. The association was stronger in women ages 60 years and older, but still, results were not statistically significant. The authors concluded that high levels of 25(OH)D, and perhaps 1,25 (OH)₂ D may be modestly associated with a reduced risk of breast cancer. This association with low levels of serum D and higher risk of breast cancer was very significant in a previous study, where women in the lowest quartile of serum 1,25(OH)₂D had a risk of breast cancer 5 times higher than those in the highest quartile.[x]

This suggestive evidence led to a population-based case-control study in Ontario, Canada.[xi] Women with invasive breast cancer diagnoses and women without breast cancer were identified and telephone interviews were completed for 972 cases and 1,135 controls. A reduced risk of breast cancer was associated with increasing sun exposure for girls aged 10-19 in those with the highest quartile of outdoor activities versus the lowest. A breast cancer reduced risk was also associated with cod liver oil use and > 10 glasses of milk per week vs none. The associations were weaker for women ages 20 to 29 and there was no evidence of an association for ages 45 to 54. In this study, it appears that vitamin D could be associated with a lowered risk of breast cancer, but particularly in ages when the breasts are developing.

Two calcium and vitamin D studies have not shown any relationship. The relationship between vitamin D and breast cancer was prospectively assessed among 10,000 premenopausal and 20,000 postmenopausal women who were enrolled in the Women’s Health Study.[xii] Intake of calcium and vitamin D was determined from self-reported questionnaires about diet and vitamin use.

During an average follow-up of 10 years, the overall incidence of invasive breast cancer was 2.6% among premenopausal women and 3.6% among postmenopausal women. Among premenopausal women, the hazard ratio for developing breast cancer was 0.61 for women in the highest versus lowest quintiles of calcium use and 0.65 for vitamin D intake. No benefit was seen for these nutrient intakes and breast cancer risk in postmenopausal women.

Another calcium plus vitamin D study was conducted, but in this study, postmenopausal women in the Women’s Health Initiative clinical trial were randomly assigned to 1000 mg of elemental calcium with 400 IU of vitamin D daily, or placebo, for an average of 7.0 years. [xiii] While this was primarily a study to determine the effects of supplements on hip fracture incidence, invasive breast cancer was a secondary outcome. The incidence of invasive breast cancer was similar in the supplement vs placebo group. The results of this study were such that calcium and 400 IU of vitamin D supplementation per day did not reduce the incidence of invasive breast cancer in postmenopausal women, and serum 25-hydroxyvitamin D levels were not associated with breast cancer risk.

The Long Island Breast Cancer Study Project was conducted to investigate environmental factors associated with breast cancer risk. [xiv] Blood samples and data were collected from this study, to examine the relationship of plasma 25-OHD levels with breast cancer risk. Plasma 25-OHD was inversely associated with breast cancer risk. Compared with women with a vitamin D deficiency, defined as a serum 25-OHD level < 20 ng/mL, levels above 40 ng/mL were associated with a decreased breast cancer risk, and was greater in postmenopausal women, and independent of tumor hormone receptor status.

Another important study of Long Island women was a population-based case-control study where blood samples were obtained from 1,026 incident breast cancer cases and 1,075 population-based controls.[xv] Compared with women with a vitamin D deficiency, that is a serum level of 25-OHD, < 20 ng/mL, levels above 40 ng/mL were associated with a decreased risk of breast cancer, and the risk reduction was greater in postmenopausal women, nor did the effect vary according to tumor hormone receptor status.

Women with a current or past history of breast cancer might also take note of the influence of vitamin D and their breast cancer recurrence rate and mortality. Low 1,25 (OH)₂D levels have been associated with a faster progression of metastatic breast cancer.[xvi] The results of the prognostic effects of 25-hydroxyvitamin D levels in women with early stage breast cancers is one of the most frequent strategies I employ in breast cancer prevention and in reducing the risk of breast cancer recurrence. This prospective study of women with early breast cancers analyzed blood levels of vitamin D. [xvii] Vitamin D levels were deficient (< 50 nmol/L) in 37.5% of women, insufficient in (50 to 72 nmol/L) in 38.5% and sufficient (> 72 nmol/L) in only 24.0% of women. Women with vitamin D deficiency had an increased risk of distant recurrence and death compared with those with vitamin D sufficiency. One of the errors that many clinicians make however when reading a study like this is confusing the lab values of nmol/L with ng/mL. Most laboratories report in ng/mL. It should be noted that 75 nmol/L is equivalent to 30 ng/mL. This study then reports that sufficiency, and a better outcome, is associated with a serum Vitamin D level of 30 ng/mL. A more rigorous standard for serum levels and breast cancer risk reduction was proposed by combining data from observational studies.[xviii] The first visible increment in prevention of breast cancer was evident with serum 25 OHD levels > 32 ng/mL. In a paper analyzing combined data from several studies on colon, ovary and breast cancer, the authors determined that prevention of 30% of breast cancer incidence could be achieved if one sustained blood levels > 42 ng/mL and they projected that a 50% reduction could occur by lifelong maintenance of serum 25 OHD levels > 52 ng/mL.[xix] They estimated that the first meaningful increment of breast cancer prevention would required a minimum of 2,000 IU/day. It is this serum level of > 52 ng/mL that I have targeted as the optimal prevention dose I utilize in my practice.

Vitamin D food/supplement intake and sufficient sun exposure are the major factors that determine serum 25 OHD levels. Several factors influence the serum increases in response to vitamin D supplementation, including body mass index (BMI) with smaller responses in individuals with a high BMI compared to those with a normal BMI.[xx], [xxi] Estrogen therapy increases serum 25 OHD levels but does not alter the serum 25 OHD response to vitamin D supplementation.[xxii] Likewise, while serum D levels decline with aging, the response to a dose of supplemental Vitamin D is not affected by aging. [xxiii]

The average increment responses to 100 I.U. per day of vitamin D supplementation varies from an increase of 1.1 ng/mL serum 25 OHD at low starting serum D levels to 0.7 ng/mL at higher or near optimal starting serum 25 OHD levels. [xxiv] The average vitamin D requirement for older adults needed to reach a serum 25 OHD levels of 30 ng/mL is 800 to 1,000 I.U. per day. Higher doses may be needed in individuals who are obese, are homebound, have malabsorption, and are dark skinned individuals. Due to declining serum levels with aging, higher doses are needed for most older adults in order to maintain 30 ng/mL. Vitamin D dosing in order to reach > 52 ng/mL requires individual assessment/testing, and follow-up testing, generally at 3 month intervals until the desired serum level is reached. A maintenance dose would then be determined, based on the desired serum level, and as I have asserted, I would recommend a 25 OHD level of > 52 ng/mL in order to have a 50% reduction in breast cancer incidence.

[i] Gorham E, Garland F, Garland C. Sunlight and breast cancer incidence in the USSR. Int J Epidemiol 1990;19:820-824.

[ii] Garland F, Garland C, Gorhan E, Young J. Geographic variation in breast cancer mortality in the United States: a hypothesis involving exposure to solar radiation. Prev Med 1990; 19:614-22.

[iii] Grant W. An ecologic study of dietary and solar ultraviolet-B links to breast carcinoma mortality rates. Cancer 2002; 94:272-281.

[iv] Bortman P, Folgueira M, Katayama M, et al. Antiproliferative effects of 1,25-dihydroxymitamin D3 on breast cells: a mini review. Braz J Med Biol Res 2002;35:1-9.

[v] Coston K, Hansen C. Mechanisms implicated in the growth regulatory effects of vitamin D in breast cancer. Endocr Relat Cancer 2002;9:45-59.

[vi] Welsh J. Vitamin D and breast cancer. Insights from animal models. Am J Clin Nutr 2004;80:1721-4S.

[vii] John E, Schwartz G, Dreon D, Koo J. Vitamin D and breast cancer risk: the NHANES I Epidemiologic follow-up study, 1971-1975 to 1992. National Health and Nutrition Examination Survey. Cancer Epidemiol Biomarkers Prev 1999;8:399-406.

[viii] Shin M, Holmes M, Hankinson S, et al. Intake of dairy products, calcium, and vitamin D and risk of breast cancer. H Natl Cancer Inst 2002;94:1301-1311.

[ix] Bertone-Johnson E, Chen W, Holick M, et al. Plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D and risk of breast cancer. Cancer Epidemiol Biomarkers Prev 2005;14:1991-1997.

[x] Janowsky E, Lester G, Weinberg C, et al. Association between low levels of 1,25-dihydroxyvitamin D and breast cancer risk. Public Health Nutr. 1999;2(3):283-291.

[xi] Knight J, Lesosky M, Barnett H, et al. Vitamin D an reduced risk of breast cancer: A population-based case-control study. Cancer Epidemiol biomarkers Prev 2007;16(3):422-499.

[xii] Lin J et al. Intakes of calcium and vitamin D and breast cancer risk in women. Arch Intern Med 2007, May 28; 167(10):1050-1059.

[xiii] Chlebowski R, Johnson K, Kooperberg C, et al. Calcium plus vitamin D supplementation and the risk of breast cancer. J Natl Cancer Inst 2007;100:1581-1591.

[xiv] Gammon M, Neugut A, Santella R, et al. The Long Island Breast Cancer Study Project : description of a multi-institutional collaboration to identify environmental risk factors for breast cancer. Breast Cancer Res Treat 2002;74:235-254.

[xv] Crew K, Gammon M, Steck S, et al. Association between plasma 25-hydroxyvitamin D and breast cancer risk. Cancer Prev Res 2009;2(6):598-604.

[xvi] Mawer E, Walls J, Howell A, et al. Serum 1,25-dihydroxyvitamin D may be related inversely to disease activity in breast cancer patients with bone metastases. J Clin Endocrinol Metab. 1997;82:118-122.

[xvii] Goodwin P, Ennis M, Pritchard K, et al. Prognostic effects of 25-hydroxyvitamin D levels in early breast cancer. J Clinical Oncology 2009;27(23):3757-3763.

[xviii] Garland C, Gorham E, Mohr S, et al. Vitamin D and prevention of breast cancer: pooled analysis. J Steroid Biochem Mol Biol. 2007;103:708-711.

[xix] Garland C, Grant W, Mohr S, et al. What is the dose-response relationship between vitamin D and cancer risk? Nutrition Reviews 2007;65(8):S91-S95.

[xx] Wortsman J, Matsuoka L, Chen T, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000;72:690-693.

[xxi] Blum M, Dallal G, Dawson-Hughes B. Body size and serum 25 hydroxyvitamin D response to oral supplements in healthy older adults. J Am Coll Nutr 2000;27:274-279.

[xxii] Harris S, Dawson-Hughes B. The association of oral contraceptive use with plasma 25-hydroxyvitamin D levels. J Am Coll Nutr 1998;17:282-284.

[xxiii] Harris S, Dawson-Hughes B. Plasma vitamin D and 25OHD responses of young and old men to supplementation with vitamin D3. J Am Coll Nutr 2002;21:357-362.

[xxiv] Heaney R, Davies K, Chen T, Holick M, Barger-Lux M. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 2000; 77:204-210.

This meta-analysis was done to assess the association between tea consumption and endometrial cancer. A total of 7 studies with 2 cohort studies and 5 case-control studies met the criteria for inclusion in this meta-analysis. Green teas and black teas were included in the search. A total of 3487 cases and of endometrial cancer and 104,643 non cases appeared in the pooled analysis. The results suggested that tea consumption was statistically significantly associated with reduced risk of endometrial cancer. The combine relative risk for ever drinkers vs. non/lowest drinkers was 0.85. Compared with non/lowest drinkers, the relative risk was 0.88 for low to moderate drinkers and 0.75 for high drinkers. An increase in tea intake of 2 cups per day was associated with a 25% decreased risk of endometrial cancer. In analysis by subgroup, green tea consumption was significantly associated with decreased risk whereas an association with black tea was not observed.

Commentary: The mechanisms whereby tea reduces the risk of endometrial cancer are multifactorial. Tea, even green tea, contains caffeine, which lowers free estrogen levels. A number of antioxidants are in green tea, and these “catechins” affect carcinogenesis in numerous ways including inducing apoptosis (cell death), inhibiting estrogen-induced activation of endometrial cells and scavenging free radicals. Tea also contains phytoestrogens and can have an estrogen antagonist effect on endometrial cells. Tea consumption also modifies genetic polymorphisms relevant in the development of endometrial cancer.

Reference

Tang N, Hua L, Qiu Y, Zhou G, Ma J. Tea consumption and risk of endometrial cancer : a metaanalysis. Am J Obstet Gynecol 2009;201:605.e1-8

Several studies of St. John’s wort alone and St. John’s wort with black cohosh have been able to demonstrate that these products are good options for perimenopausal and menopausal women with hot flashes, mood issues, sleep problems and quality of life.

In the newest of the St. John’s wort studies in perimenopausal/menopausal women, a total of 100 Iranian women with an average age of 50 participated in a randomized, double-blind, placebo-controlled clinical trial comparing St. John’s wort with placebo in the treatment of hot flashes.[1] 50 women received 20 drops three times daily of St. John’s wort extract (Hypericin) that contained hypericin 0.2 mg/mL and 50 women received a placebo of distilled water. The study duration was two months. Clinical exams and interviews were performed at baseline, 4 weeks and 8 weeks. Treatment effectiveness was measured evaluating frequency, duration and severity of hot flashes as the main objective of the study.

In women taking St. John’s wort, the frequency began to decline during the 1^st and 2^nd months, but showed more improvement during the 2^nd month. There was no statistical change in hot flash frequency during the first month of placebo but did improve during the second month. Women who used St. John’s wort showed more improvement in hot flash frequency than placebo. The decline in duration of hot flashes was statistically significant at week 8 and the decline was much more evident in the St. John’s wort group. The severity of hot flashes was relieved in the St. John’s wort group during the 2 months of treatment and was more significant in the second month. Women in the placebo group did not show any significant decrease in severity of hot flashes during the 1^st month, but they did have some improvement during the 2^nd month, but not as great as those women in the St. John’s wort group.

Comments

St. John’s wort has emerged as an important clinical tool in treating perimenopausal/menopausal women—for hot flashes and/or depression and/or mood swings, and/or sleep problems either as an encapsulated standardized extract from 300 mg twice per day to three times per day, or a tincture/liquid extract ½ tsp 2-3 times per day, or in combination with other menopause therapies such as black cohosh, maca extract, kava or others.

Reference

[1] Abdali K, Khajehei M, Tabatabaee R. Effect of St. John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause 2010;17(2): 326-331.

Chaste tree berry has been a very important plant for premenstrual syndrome (PMS) and premenstrual dysphoric disorder. There are numerous studies that demonstrate this, and I have reported previously on the use of chaste tree berry for PMS. A very specific PMS use for chaste tree is for cyclical mastalgia, also called premenstrual breast pain/tender/lumpiness.

The evidence for the use of chaste tree berry in the treatment of mastalgia has been reported in both randomized and non-randomized studies. A large open study without a control group of 1634 women with cyclic mastalgia as part of their premenstrual syndrome demonstrated that after 3 months of treatment, 80% of patients rated their response as a good and 81% rates it as a very good treatment for their mastalgia. [1] In a prospective, multi-center trial using chaste tree in 50 patients with premenstrual cyclic mastalgia, 43 women were treated daily with chaste tree for three consecutive menstrual cycles.[2] By the end of the study period, cyclical mastalgia decreased significantly along with a smaller degree of improvement even 3 months after stopping the plant. Thirty-eight women rated the effectiveness as moderate to excellent, with 5 reporting no effect. In a randomized controlled trial, 97 women with cyclical mastalgia had twice the decrease in intensity of pain after one or two treatment cycles as compared to placebo.[3] The duration of pain also improved in the chaste tree group. In the chaste tree group, half the women did not have severe pain at all during any time of the menstrual cycle and only 25% had severe pain for 4% of the days compared with severe mastalgia one fifth of the time before their use of chaste tree began. In a randomized trial of premenstrual dysphoric disorder, comparing chaste tree with an SSRI, 58% of patients being treated with chaste tree had an improvement in their cyclical mastalgia and 68% of patients had improvements in their psychological symptoms.[4] In a randomized controlled placebo controlled trial, 170 women were given chaste tree or placebo for three consecutive cycles. The improvement in breast pain was greater in the chaste tree group (52%) compared with the placebo group (24%). [5]

Consider a standardized extract of chaste tree berry—usually one capsule per day all month long for a minimum of two but preferably three consecutive months.

References

[1] Loch E, Selle H, Boblitz N. Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus. J Womens Health Gend Based Med 2000;9:315-320.)

[2] (Berger D, Schaffner W, Schrader E, Meier B, Brattstrom A. Efficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome. Arch Gynecol Obstet 2000;264:150-153.)

[3] ( Halaska M, Beles P, Gorkow C, Sieder C. Treatment of cyclical mastalgia with a solution containing a Vitex agnus castus extract: results of a placebo-controlled double-blind study. Breast 1000; 8:175-181. )

[4] (Atmaca M, Kumru S, Tezcan E. Fluoxetine versus Vitex agnus castus extract in the treatment of premenstrual dysphoric disorder. Hum Psychopharmacol 2003;18:191-195.)

[5] (Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. Br Med J 2001;322:134-137.)

The American Herbalists Guild 21st Annual Symposium is scheduled for October 1-3 (with preconference intensives on Sept 30th) in Austin TX.

More information and registration online at www.americanherbalist.com

You can also register by phone (203) 272-6731

The results of a randomized, double-blind, placebo-controlled crossover trial using St. John’s Wort for PMS sufferers were recently published. 36 women with regular menstrual cycles who were diagnosed with mild PMS were randomly assigned to receive St. John’s Wort tablets (900 mg/day and standardized to 0.18% hypericin and 3.38% hyperforin) or placebo for two menstrual cycles. After a one month no treatment cycle, women were crossed over to the opposite group, for two additional cycles.

Symptoms were rated using the Daily Symptom Report, The State Anxiety Inventory, the Beck Depression Inventory and the Aggression Questionnaire and Barratt Impulsiveness Scale. Numerous hormones and physiological markers were also measured in the follicular and luteal phases: follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, prolactin, testosterone, cytokine interleukins= IL-1B, IL-6, IL-8, interferon and tumor necrosis factor alpha.

St. John’s wort was statistically more beneficial than placebo in food cravings, swelling, poor coordination, insomnia, confusion, headaches, crying and fatigue. There were no significant effects of St. John’s wort compared with placebo in any of the biochemical blood measurements. St. John’s wort was not statistically more beneficial in anxiety, irritability, depression, nervous tension, mood swings, feeling out of control and pain-related symptoms during two cycles of treatment. However, these pain-related symptoms appeared to improve more than placebo towards the end of each treatment period

Commentary: The results of this PMS study demonstrate once again, the benefit of St. John’s Wort for the treatment of PMS. In this study, it was determined their PMS was mild. The benefit received by women taking St. John’s Wort was achieved during the first menstrual cycle in which it was taken. While St. John’s Wort did not prove to be statistically better than placebo for mood and pain-related PMS symptoms, the pain symptoms did appear to improve more than placebo towards the end of each treatment period, implying that there may be more pain benefits with St. John’s wort after a longer duration of treatment. Several other studies have shown benefit with St. John’s wort.

Reference: Canning S, Waterman M, Orsi N, et al. The efficacy of Hypericum perforatum (ST John’s Wort) for the treatment of premenstrual syndrome. CNS Drugs 2010; 24(3):207-225.

A proprietary product called Nutrafem is a combination of botanical extracts derived from Vigna radiate (mung beans) and Eucommia ulmoides bark. This phase II, double-blind, randomized, placebo-controlled, multicenter clinical study was conducted in 159 postmenopausal women who had at least 21 hot flashes per week. 131 women completed the study. One group received the product containing 75 mg of E. ulmoides plant extract and 150 mg of V. radiate plant and was given 2 capsules morning and night for 12 weeks, the other placebo.

Results: The botanical combination reduced the number of vasomotor symptoms by 46% from baseline compared with 26% in the placebo group. Forty-three percent of women taking the botanical had at least a 50% reduction in the number of symptoms compared with only 6% in the placebo group.

Commentary: New options in botanical interventions for menopause related hot flashes are always welcomed. Mung beans are familiar to many, as a dietary source of nutrients-whether in sprouted form or other use. It is typically consumed for its protein and essential fatty acid content. E. ulmoides is rich in polyphenolic compounds such as lignans and flavonoids. I look forward to continued research on botanical therapies for menopause symptoms and the ability to expand our treatment options.

References:

Garcia J, Gonzaga F, Tan D, et al. Use of a multi-botanical (Nutrafem) for the relief of menopausal vasomotor symptoms: a double-blind, placebo-controlled study. Menopause 2010; 17(2):303-308.

Cyclic breast pain, called cyclic mastalgia is one of the most common problems in menstruating women. A recent study has determined once again, the therapeutic value of vitamin E as a safe and effective treatment for cyclic mastalgia.

This study was a double blind clinical trial in 150 women in Iran. Two groups of 75 women each were evaluated for severity and duration of breast pain which was measured according to a breast pain chart and something called a Visual Analog Scale.

Chewable tablets of either vitamin E 200 mg tablets or a placebo were given twice a day for 4 months, and again, the severity and duration of breast pain was evaluated at the end of the second and fourth month. The results at two months for vitamin E were dramatically better than placebo in severity and duration, and appear to be achievable in about 70% of the women. The improvement was seen as soon as two months, and no continued improvement after 4 months.

Commentary: Other studies have been conducted in vitamin E and breast pain. In 1997, Khanna et al compared vitamin E with a drug called Danazol. Vitamin E reduced pain in 41% of the women in the studies and Danazol had similar pain reduction in 72% of the women. Clearly the drug helped more women, but the side effects of that drug are significant and one third of the women developed other side effects. Meyer et al did a study in 1990 but did not show any benefit from Vitamin E. Ernester in 1985 studied 201 women with mastalgia as it relates to fibrocystic breast disease. He concluded that vitamin E was not effective, but he was not evaluating breast pain as a distinct issue. In 2004, Bespalov et al studied 66 women with a combination of beta-carotene, vitamin E, vitamin C and garlic powder. There was a reduction in the severity of mastalgia, premenstrual syndrome, infrequent menses and menstrual cramping as well as a reduction in symptoms of fibromatosis in 75% of the women compared with 45% of women on placebo.

If vitamin E alone is not sufficiently helpful in reducing mastalgia, evening primrose or borage oil should be considered, as well as carotenoids, iodine, eliminating caffeine, lowering saturated fats in the diet and increasing fiber.

References

Parsay S, Olfati F, Nahidi S. Therapeutic effects of vitamin E on cyclic mastalgia. The Breast Journal 2009;15(5):510-514.

A meta-analysis of five case-control and two cohort studies examined the effects of soy intake on endometrial and ovarian cancer. 169,051 women and, 3516 with endometrial or ovarian cancer in the U.S., China, Italy and Japan with an average age of 54 were evaluated for their soy intake based on soy containing foods or soy isoflavone intake.[i]

In each of the studies, women who consumed the highest dietary intake of soy had a lower risk for endometrial and ovarian cancers compared with the women who had the lowest intake.

Commentary: It is not surprising to see this report as we have seen previous observational studies with similar results, showing lack of endometrial proliferation, endometrial safety and/or reduced risk of endometrial cancer. Only one previous study that I’m aware of, did demonstrate that after 5 years, but not after one year or 3 years, who were given 150 mg per day of soy isoflavone tablets had an increased occurrence of endometrial hyperplasia (but no cases of atypical hyperplasia or endometrial cancer).[ii]

The mechanisms whereby soy appears to have an influence on lowering the risk of hormonal cancers, including breast, appear to be multiple. These include: through its ability to bind to certain estrogen receptors and actually have an estrogen blocking effect, raising sex hormone-binding globulin which decreases circulating estrogens, affecting selected enzyme pathways which result in anti-carcinogenic effects, direct tumor growth inhibition, and having antioxidant effects.

My advice: for most women, and for those who are not allergic to soy or have indigestion with soy products, I recommend 1-2 servings per day of the following soy foods: cooked soy beans, roasted soy nuts, soy milk, tofu, tempeh, edamame, tofu pate (my favorite).

[i] Myung S- K et al. Soy intake and risk of endocrine-related gynaecological cancer: A meta-analysis. BJOG 2009 Dec; 116:1697

[ii] Unfer V, et al. Endometrial effects of long-term treatment with phytoestrogens: a randomized, double-blind, placebo-controlled study. Fertility and Sterility 2004;82:145-148). 150 mg of soy isoflavones per day is above the average intake in an Asian diet (ranging from about 40-90 mg per day

Trip to Canyon de Chelly
April 28-May 2, 2010

Dear all,
I’m taking another group trip to the sacred holy land of the Navajo-Canyon de Chelly. 
Our base camp is in the valley of the canyon, surrounded by beautiful canyon walls, moon and sun rises and sets.   We do group cooking and eating in an outdoor kitchen.  We camp in our tents with an outhouse and primitive outdoor shower.  Our Navajo guides are Lupita and Jon McClanahan, who are local canyon residents, and very special people.  We will be camping on their ancestral land, in the remote regions of the canyon.

Our daily activities include incredible hikes.  Not too strenuous although for some people the heights can be a problem occasionally.  We hike up and down the canyon walls, hike to Anasazi ruins, and visit a traditional birthing Hogan.  One of my favorite parts is that we will hear incredibly wonderful stories-Navajo and Anasazi history, cultural insights, ceremonial healing ceremonies and some of the healing traditions of the Navajo.  We hear of the birthing traditions, Navajo spirituality, and "the beauty way".    At night, we sit around the fire and talk; Jon or Lupita also tell some stories= grandfather fire, stories from Lupita’s childhood living in the canyon in the traditional ways, and more. 

I have been to the canyon many times in the last 6 years.  Jon and Lupita have become close friends and deeply meaningful teachers.  They are beautiful in their ways and speaking and living.  Their spirituality and their commitment to living their lives in keeping with their traditional spirituality is evident in all that they do.  My life has changed in extraordinary and powerful ways as a result of knowing them. 

If you are interested in this fantastic trip, write Tori Hudson, N.D. at womanstime@aol.com or call, 503-222-2322. You can also learn a bit more about the canyon and Jon and Lupita, from their website, www.footpathjourneys.com

The cost of the trip is affected by the number of people on the trip but I anticipate it to be between 750.00 and 950.00. Your transportation costs to and from Chinle, Arizona are extra. I can work with you to arrange car pools from Phoenix, Arizona.

                                                                                    Tori Hudson, N.D.