PCOS Review Newsletter #18

Natural Health Ideas for Polycystic Ovary Syndrome
A free monthly newsletter for women with ovarian cysts or PCOS.

Issue #018      December 5, 2004
Nancy Dunne, N.D., Naturopathic Physician
Bill Slater, Research Associate

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TABLE OF CONTENTS

1) PCOS and Cancer

2) Which Is Better for Balancing Estrogen - Soy or Flax?

3) Glucose Metabolism Implicated in Breast Cancer

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1) PCOS and Cancer

If you have PCOS, you've probably heard that you have a much higher risk of cardiovascular disease and diabetes. But what about cancer? Are you at risk?

The relationship between PCOS and cancers in general is not completely clear, although women who are overweight are more likely to get some kind of cancer. Women who are infertile (whether they have PCOS or not) are more likely than fertile women to get a cancer of the reproductive system.

The strongest link between a cancer and PCOS is endometrial cancer. A few studies have suggested a correlation between PCOS and breast cancer, while some have not. There doesn't seem to be any relationship between PCOS and ovarian cancer.

Breast cancer and endometrial cancer are described as "estrogen-sensitive" cancers, meaning that the presence of estrogen may cause these cancer cells to multiply.

The risk of estrogen-sensitive cancers is relevant to PCOS women because many have "estrogen dominance" or "unopposed estrogen", which means there is too much estrogen available to the cells, and there is too much estrogen in relation to progesterone.

There are three aspects of estrogen to be concerned about:
(1) Too much total estrogen.
(2) Imbalance of individual estrogens.
(3) Metabolism of estrogens.

In addition to having an excessive level of total estrogen, you could also have an imbalance of the individual estrogens that make up the total estrogen level. The 3 primary estrogens are: estradiol, estrone, and estriol. Some women are low in estriol, which means they may have high estradiol and estrone, even though their total estrogen level is "normal".

An estrogen imbalance is significant for endometrial cancer, because the cells of the endometrium (lining of the uterus) have receptors for estradiol but not for estriol. Therefore, estriol cannot stimulate endometrial cancer cells. A woman with excessively high levels of estradiol and low levels of estriol has an increased cancer risk. Seeking the optimal balance of individual estrogens is a significant but overlooked health-building tactic.

The third aspect of estrogen to be concerned about is estrogen metabolism (how it is processed in your body).

Estrogen can be metabolized in two ways. Along one metabolic pathway, it is converted into a powerful metabolite, 16alpha-hydroxyestrone (16alpha-OHE1) that acts to stimulate target tissues. Levels of 16alpha-OHE1 can rise in response to obesity, alcohol consumption or toxic exposure.

Alternately, the body can break down estrogen into a much weaker metabolite, called 2-hydroxyestrone (2-OHE1). This hormone metabolite binds weakly to cell receptors and may slow cell proliferation.

High levels of 16alpha-OHE1 and low levels of 2-OHE1 have been linked to breast cancer, uterine cancer, cervical cancer and lupus. However, excessively high levels of 2-OHE1 may increase the risk of developing conditions associated with estrogen deficiency, such as heart disease, depression, and osteoporosis.

There are things you can do to achieve a healthy balance of 2-OHE1 and 16alpha-OHE1 estrogen metabolites. A healthy diet, healthy lifestyle, good liver function, clean environment, weight control, good bowel function, and selected supplements can all help you to metabolize estrogen in a healthy way.

What we've just discussed is pretty technical and may be hard to understand. But even if it's hard to understand, we think it's important to give you information that you may not be getting from other sources. PCOS is a very complex hormonal and metabolic disorder that represents a threat to your good health. We think a simplistic approach of just taking birth control pills is not the answer to PCOS and infertility. Whether chronic consumption of birth control pills will reduce your risk of cancer, cardiovascular disease or diabetes is questionable.

If you're looking for a more comprehensive approach for treating PCOS and balancing your hormones, we suggest you consult with a licensed naturopathic physician, or have a phone consultation with Dr. Dunne.

Sources:
Wild, S et al, Long-term consequences of polycystic ovary syndrome: results of a 31 year follow-up study, Hum Fertil, 2000, 3(2):101-105
Balen, A, polycystic ovary syndrome and cancer, Hum Reprod Update, 2001, 7(6):522-5
Lord, RS et al, Estrogen metabolism and the diet-cancer connection: rationale for assessing the ratio of urinary hydroxylated estrogen metabolites, Altern Med Rev, 2002, 7(2):112-29

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2) Which Is Better for Balancing Estrogen - Soy or Flax?

Phytoestrogens are plant substances that have biologic actions in your body similar to estrogen, although much weaker. They are abundant in flax seed and soy.

You've probably heard that eating soy may reduce or "balance" your estrogen. If you are consuming soy foods for this reason, you may want to consider flax seeds.

A study conducted at the Department of Nutritional Sciences, University of Toronto compared the effects of consuming flax seed versus soy on estrogen metabolism in 46 postmenopausal women.

In the flax seed group, urinary concentrations of the 2-OHE1 estrogen metabolite, but not 16alpha-OHE1, increased significantly, suggesting that 2-OHE1 levels increased relative to 16alpha-OHE1. In the group who ate soy, there was no change.

As we said in the previous article, an optimal balance between 2-OHE1 and 16alpha-OHE1 is a key to good health and may reduce your risk of cancer. A substantial proportion of women have too much 16alpha-OHE1, which leads to problems such as breast cancer.

If you have a high level of total estrogen, it's possible that you are also producing too much of the 16alpha-OHE1 estrogen metabolite. So adding flax seeds to your diet may be a good idea.

Flax seed provides significant fiber and mucilage for proper bowel function. This fiber helps to reduce cholesterol by holding it in your bowel to be eliminated regularly. Flax is also quite high in omega-3 fatty acids, which are beneficial to women with PCOS.

We suggest you buy fresh flax seeds and grind them up in a coffee bean grinder. Put the ground-up seeds on your cereal, salads, and other foods. Or add them to soups, casseroles, etc. Try 1-3 tablespoons of freshly ground up flax seeds daily. It is important to drink 8 ounces of water for every tablespoon of flax seed you take each day.

Source: Brooks, JD et al, Supplementation with flaxseed alters estrogen metabolism in postmenopausal women to a greater extent than does supplementation with an equal amount of soy, Am J Clin Nutr, 2004, 79(2):318-25.

3) Glucose Metabolism Implicated in Breast Cancer

Many PCOS women have elevated or fluctuating levels of blood sugar (glucose). A study conducted at the University of Buffalo has shown that high blood sugar levels leads to increased breast cancer risk in premenopausal women.

The study followed 10,786 women for 5.5 years. They found that women with the highest blood glucose levels were 2.8 times as likely to develop breast cancer as compared to those with the lowest glucose levels.

If your blood tests have shown that you have a high-normal or clearly elevated blood glucose level, you will want to take steps to control both your blood glucose and your insulin levels in order to reduce your risk of developing breast cancer later on. A healthier diet and regular exercise is an excellent way to get started.

Source: Muti, P et al, Fasting glucose is a risk factor for breast cancer: a prospective study, Cancer Epidemiol Biomarkers Prev, 2002, 11(11): 1361-8

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