DESCRIPTION

A common condition in the female breast that occurs in 20-40% of menstruating women, fibrocystic breast disease (FBD) is characterized by multiple non-malignant lumps, which vary in size throughout the month and are frequently accompanied by premenstrual breast pain and tenderness. A benign component of PMS (premenstrual syndrome), FBD is considered a risk factor for breast cancer, but is not as significant a risk factor as family history, early onset of menstruation, and late or no first pregnancy.

FREQUENT SIGNS AND SYMPTOMS

• Multiple lumps, typically in both breasts (solitary lumps may occur, but multiple lumps are more common).
• Lumps offer resistance when pressed and may be tender.
• Lumps often enlarge before menstrual periods, and then shrink afterwards.
• Lumps vary in size. Larger lumps near the surface can be moved freely within the breast; lumps deep within the breast may be indistinguishable from lumps due to breast cancer.
• Generalized breast pain and tenderness.
• Nipple discharge
• Consult a physician immediately if a breast lump of any kind is noticed. Although pain, cyclic variations in size, high mobility, and multiplicity of lumps indicate FBD, these clinical criteria do not definitively differentiate FBD from breast cancer. Non-invasive procedures, such as ultrasound, can help aid conclusive diagnosis, but at this time, definitive diagnosis depends upon biopsy.

CAUSES

• Increased estrogen-to-progesterone ratio: excessive estrogen is responsible for numerous feminine ills, including FBD.
• B vitamin deficiency: a well-supported theory, initially proposed in the 1940’s by Dr. Morton Biskind, suggests that excessive estrogen levels are the result of decreased detoxification and elimination of estrogen by the liver due to B vitamin deficiency. The liver uses various B vitamins to detoxify estrogen and excrete it in the bile.
• Elevated levels of other hormones (e.g., prolactin): estrogens, both internally produced and ingested as birth control pills or Premarin, are known to increase prolactin secretion by the pituitary gland. In women with FBD, levels of prolactin are typically found to be elevated, but not to levels high enough to cause amenorrhea (loss of menstruation).
• A high-fat diet: particularly saturated fat, significantly increases the level of circulating estrogens.
• Environmental estrogens in food: there has been widespread environmental contamination by a group of compounds known as halogenated hydrocarbons. Included in this group are the toxic pesticides DDT, DDE, PCB, PCP, dieldrin, and chlordane. These chemicals are stored in fat cells, mimic estrogen in the body, and are thought to be a major factor in the growing epidemics of estrogen-related health problems including FBD.
• Caffeine and other methylxanthines: population studies, experimental evidence, and clinical evaluations indicate a strong association between caffeine consumption and FBD: Caffeine, theophylline, and theobromine are all members of a family of compounds known as methylxanthines, which promote the production in breast tissue of the fibrous tissue and cyst fluid evidenced in FBD. Coffee, tea, cola, chocolate and caffeinated medications are sources of methylxanthines.
• Sugar: a high intake of sugar impairs estrogen metabolism and is associated with higher estrogen levels. Incidence of PMS as well as FBD is much higher in women who consume a sugar-laden diet.
• Low-fiber diet: women who have fewer than three bowel movements per week have a 4.5 times greater rate of FBD than women who have at least one bowel movement per day. This probably results from the action of unfriendly bacterial flora in the large intestine, which can transform excreted steroids into toxic derivatives or allow these excreted steroids to be reabsorbed.
• Hypothyroidism and/or iodine deficiency: An absence of iodine makes breast cells more sensitive to estrogen, which leads the breast ducts to produce small cysts and later fibrosis (hardening of the tissue because of deposition of fibrin similar to the formation of scar tissue). Thyroid hormone replacement therapy in patients with low or even normal thyroid function has been shown to decrease breast pain, serum prolactin levels, and breast nodules. Experimental iodine deficiency in rats results in changes very similar to FBD.

RISK INCREASES WITH

• Disease-promoting diet: the liver’s ability to detoxify and eliminate estrogen is directly related to the quality of foods routinely eaten. A diet based on animal products and processed foods, with little consumption of fresh vegetables, legumes, fruits, nuts and seeds, whole grains, and cold-water fish, is low in factor that promote estrogen’s clearance from the body-B vitamins, fiber, vitamins A and E, and essential fatty acids-and high in factors that promote excessive estrogen-sugars, saturated fats, and environmental estrogens from pesticide residues in foods and animal growth stimulators.
• Use of oral contraceptives
• Consumption of caffeine and other methylxanthines
• Constipation
• Low thyroid function.

PREVENTIVE MEASURES

• A high-potency multiple vitamin and mineral supplement including 400mg of folic acid. 400 mg of vitamin B12 and 50-100mg of vitamin B6. (folic acid supplementation should always be accompanied by vitamin B12 supplementation to prevent folic acid from masking a vitamin B12 deficiency). A daily multiple providing all of the known vitamins and minerals serves as a foundation upon which to build an individualized health-promotion program.
• Consume a nutrient-dense, high-fiber diet rich in whole, unprocessed, preferably organic foods, especially plant foods (fruits, vegetables, beans, seeds, and nuts), and cold-water fish, and low in animal products.
• If using oral contraceptives, switch to another form of birth control.
• Limit consumption of coffee, tea, cola, chocolate and caffeinated medications.

Expected outcomes

Progressive reduction in signs and symptoms with maximum benefit achieved within 6 months.

TREATMENT

Diet

• The diet should be primarily vegetarian with large amounts of dietary fiber. Emphasize whole, unprocessed, fiber-rich foods, such as whole grains, legumes, vegetables, fruits, nuts, and seeds.
• Eliminate all methylxanthines (coffee, tea, cola, chocolate and caffeinated medications) until symptoms are alleviated; they may then be reintroduced in small amounts.
• Avoid animal products with high estrogen content such as meats raised with the help of growth stimulators, etc.
• Substitute soy foods such as tofu, tempeh, soyburgers, soymilk, soynuts, etc. as an excellent source of protein and phytoestrogens. Phytoestrogens are often called antiestrogens because their estrogenic effect is only 2% as strong as human estrogen. Because they are capable of binding to estrogen receptors, phytoestrogens prevent estrogen from binding, thus decreasing its effects.
• Drink at least 2L (3US pints) of water daily.

Nutritional supplements

• High-potency multiple vitamin and mineral supplement (as described in Preventive measures above).
• Lipotropic factors: these are substances that hasten the removal or decrease the deposition of fat and bile in the liver through their interaction with fat metabolism, thus improving liver function. Estrogens are excreted from the body via the bile: Dosage: choline: 500-1,000mg q.d.; methionine: 500-1,000 mg q.d.
• Vitamin B6: the liver requires B6 (along with folic acid and other B vitamins in the multiple formula and in the healthful diet outlined above) to detoxify estrogen by binding (conjugating) it to glucuronic acid, so it can be excreted in the bile: B6 has been used in the management of women’s cyclical conditions since the early 1970’s. at least a dozen double-blind, placebo-controlled trials have demonstrated positive effects of B6 supplementation in relieving PMS symptoms, including FBD. Dosage: 25-50mg t.i.d.
• Vitamin E: vitamin E has been shown to normalize circulating hormone levels in PMS and FBD patients, relieving many symptoms of these conditions: While vitamin C protects the body’s water-soluble areas, vitamin E is the primary antioxidant in the fat-soluble compartments such as cell membranes and fatty molecules like cholesterol. Vitamin E also significantly enhances both types of immune defenses: non-specific or cell-mediated immunity and specific or humoral immunity. Cell-mediated immunity is the body’s primary mode of protection against cancer. Dosage: 400-800 IU q.d.
• Vitamin C: an essential antioxidant found in all body compartments composed of water, vitamin C strengthens and maintains normal epithelial integrity, improves wound healing, enhances immune function, and inhibits carcinogen formation: Vitamin C works synergistically with vitamin E, regenerating vitamin E after it has used up its antioxidant potential. Dosage: 500mg t.i.d.
• Beta-carotene: also known as pro-vitamin A since it can be converted to vitamin A in the body, beta-carotene is a powerful antioxidant essential to epithelial health. A strong inverse correlation has been shown between serum levels of beta-carotene and cancer. Studies have also found that the higher the intake of beta-carotene, the lower the risk for cancer; dosage: 50,000 IUD q.d.
• Iodine (caseinate or liquid iodine): breast cells lacking sufficient iodine are hypersensitive to estrogen stimulation. Iodine deficiency leads the breast ducts to produce small cysts and later fibrotic (lumpy)tissue: In the clinical trials, iodine has been an effective treatment in FBD in about 70% of subjects. Iodine was, however, associated with a high rate of side effects (altered thyroid function in 4%; iodine poisoning, characterized by a watery nose, weakness, excessive salivation, and bad breath, in 3%; and acne in 15%). The most significant side effect was short-term increased breast pain, which was viewed as a positive sign since it corresponded with a softening of the breast and disappearance of the fibrous tissue. Dosage: 70-90mg of iodine (caseinate or liquid iodine) per kg of body weight q.d. (other forms of iodine 500mg daily).
• Zinc: zinc is required for proper action of many body hormones, including sex hormones. Low zinc levels promote prolactin secretion, whereas high zinc levels inhibit its release. Zinc levels are frequently low in women with PMS: Dosage: 15-30mg q.d. (target dosage to address elevated prolactin levels is actually 30-45 mg q.d., which should be reached by the combined amounts of zinc in the multiple supplement recommended above plus this additional dose.)
• Flaxseed: flaxseed promotes a healthy menstrual cycle, alleviating numerous ills associated with hormonal imbalances, and providing protection against cancer: Flaxseeds contain a group of phytoestrogens called lignans with weak estrogenic and antiestrogenic effects; these promote normal ovulation and lengthen the second half of the menstrual cycle, in which progesterone is the dominant hormone, thus helping to restore hormonal balance. Lignan-rich fiber has also been shown to decrease insulin resistance, which also reduces bioavailable estrogen. Flaxseed oil: women with PMS are frequently deficient in vitamin B6, magnesium and zinc, nutrients necessary for essential fatty acid metabolism. Providing these nutrients along with adequate levels of essential fatty acid metabolism. Flaxseed oil is nature’s richest source of essential fatty acids. Dosage: 2 tbsp of flaxseed meal and 1 tbsp flaxseed oil q.d. Both are highly perishable, should be kept in opaque containers in the refrigerator, and never heated.
• Lactobacillus acidophilus: lactobacilli are friendly bacteria with numerous beneficial effects on intestinal health, one of which is that they supplant less friendly bacteria, such as those which transform excreted estrogen into a form which can be reabsorbed; Dosage: 1-2 billion live organisms q.d.