Tag Archives: aromatase inhibitors side effects

What Is Aromatase And Why Inhibit It?

http://MarnieClark.com/What-Is-Aromatase-And-Why-Inhibit-It

What Is Aromatase And Why Inhibit It?

One of the pages of my website that is visited a lot is 18 Natural Aromatase Inhibitors and I suspect the reason for this is that people with hormone-driven breast cancer, known as estrogen-receptor-positive (or ER+) breast cancer, are being prescribed drugs known as aromatase inhibitors. There is a lot of interest in using natural medicine and nutrients to do this job. So what is aromatase and why would we want to inhibit it?

What Is Aromatase?

Aromatase, also known as estrogen synthetase, is an enzyme that is responsible for the synthesis of the hormone estrogen in the body.  Aromatase plays a key role in the conversion of testosterone and androstenedione to various forms of estrogen (see diagram above). You can see that aromatase is required for the conversion to take place.  Aromatase is located in special cells in the ovaries, adrenal glands, testicles, placenta, fat cells and the brain.

Why Inhibit Aromatase?

In the search for drugs that will offer people the best chance of living without breast cancer recurrence, science offers us aromatase inhibitors (AIs).

Two approaches have been developed to reduce the growth-stimulatory effects of estrogen in ER+ breast cancer:

1.  Interfering with the ability of estrogen to bind to its receptor
2.  Decreasing circulating levels of estrogen

AIs are unable to stop ovaries from creating estrogen, however, so AIs are generally only offered to postmenopausal women.

Three Aromatase Inhibiting Drugs

There are currently three main aromatase inhibiting drugs:

letrozole – Femara, made by Novartis
anastrozole – Arimidex, made by Astra-Zeneca
exemestane – Aromasin, made by Pfizer

Exemestane (Aromasin) was approved by the United States Food & Drug Administration for those who have already been treated with tamoxifen.  The other two drugs, letrozole (Femara) and anastrozole (Arimidex), have been approved as either first-line treatment without prior use of  tamoxifen or for use following tamoxifen treatment.

The Problem Is… Those Awful Side Effects

As with many pharmaceutical drugs, there are side effects associated with taking AIs. Estrogen plays a huge part in a woman’s wellness and depriving our bodies of its effects can have some fairly serious complications.

In 2008, Breast Cancer Action, an education and advocacy organization dedicated to supporting people living with breast cancer, released a report entitled Side Effects Revisited: Women’s Experiences With Aromatase Inhibitors 1. BCA sent out a survey to 1,199 women taking aromatase inhibitors to discover what some of the side effects were and how debilitating they might be. See the results of the study at reference 1 below.  In particular see Table 3 on page 7.

The most common side effects  were pain, particularly joint pain, stiffness, and arthritis but other common side effects included hot flashes, bone pain, muscle pain, tiredness, insomnia, weight gain, loss of mental acuity, anxiety, depression and hair thinning. Only 2.3% of women reported they experienced NO side effects. If you are considering taking AIs, you owe it to yourself to read this report.

Estrogen is Important

Estrogen is a hormone we need in our bodies. Outside of its huge role in reproduction, estrogen also exerts major effects on the health of our bones. It works closely together with vitamin D and minerals to build and maintain our bones. All aromatase inhibitors moderately enhance bone loss. 2

Estrogen is also necessary for maintaining healthy cholesterol levels and offers protective benefits by increasing triglyceride concentrations in the bloodstream, which helps to guard against atherosclerosis.

Remember reading that some of the side effects of the AI drugs is loss of mental acuity? That’s because estrogen is very involved in brain health. It plays a role in memory retention, increasing serotonin levels, production of endorphins, and it even has a protective effect for nerves.

There are also estrogen receptors in the eyes, and vision changes are often one of the side effects people complain about after taking AIs.

Natural Medicine Approach

When we inhibit the biosynthesis of estrogen in every tissue of the body, no wonder the side effects are so life altering. Is it worth it? Are AIs really helping to keep recurrences at bay? Or are we suffering these side effects and still having recurrences?

Studies indicate that AIs are helping to keep recurrences at bay.  A 2005 study, Aromatase Inhibitors in the Treatment of Breast Cancer 3 indicates that the above three drugs are very effective, in vivo (meaning in the body) inhibition of whole-body aromatization ranged between 96.7% – 98.9%.  Most oncologists feel that AIs are the most effective hormonal therapy available for post-menopausal women.

But those side effects are very real and for many women, unendurable. These drugs are toxic to the body and could have repercussions down the line that we have no idea about because they have only been used since about 2000.

As a breast cancer coach, I can tell you that I am in contact with quite a few women who have taken these drugs and still suffered with recurrences and while I don’t possess statistical data, I can tell you that it does happen, all too frequently. No, it won’t happen for everyone, obviously, but I do believe there is a much better way to move forward.

Within the archives of this website you will no doubt read my words “it’s not all about estrogen” several times. What I mean by that is that having breast cancer, even ER+ breast cancer, is not all about having an overabundance of estrogen floating through our bodies. Cancer is a multi-factorial disease, with genetic, lifestyle and environmental factors interacting to create the havoc that cancer can be.

Natural medicine offers other ways of dealing with this problem, for instance:
1.  Looking into why estrogen levels are high in the first place and then managing that. Is it the body’s own estrogen, or is it an overabundance of xenoestrogens?
2. What is the patient’s diet like?
3.  What factors in the patient’s life may have contributed to the development of breast cancer?
4. What kind of stress was the patient under prior to diagnosis?
5.  What is the status of the patient’s immune system? What can we do to support it?
6.  What therapies has the patient already undergone to address the cancer? (Knowing this helps to establish the level of toxicity present.)
7.  What natural foods and supplements can assist the patient with blocking aromatase if that proves necessary?

These are just some of the questions a natural medicine practitioner will ask, looking at the patient as a whole and not just treating one small aspect of the disease.

References:
1. Side Effects Revisited: Women’s Experiences With Aromatase Inhibitors –http://bcaction.org/wp-content/uploads/2011/03/AI-Report-June-2008-Final-ONLINE.pdf

2. The potency and clinical efficacy of aromatase inhibitors across the breast cancer continuum – http://annonc.oxfordjournals.org/content/early/2010/07/08/annonc.mdq337.full

3. Aromatase Inhibitors in the Treatment of Breast Cancer – http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.327.1025&rep=rep1&type=pdf

GET MY BEST TIPS on getting through breast cancer and preventing recurrences by signing up for my free e-newsletters and e-books on the right. You can also “like” me on Facebook (MarnieClark.com) to get my inspirational snippets, news and updates. I promise to do my utmost to keep you informed and empowered on your healing journey… and beyond.


Disclaimer: The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional. You should not use the information on this site for diagnosis or treatment of any health problem and please be sure to consult your chosen health care professional when making decisions about your health.

18 Natural Aromatase Inhibitors

Artwork courtesy of rgbstock.com and Idea Go

18 Natural Aromatase Inhibitors

The number one topic in breast cancer communities, and the thing I get asked about most often, is definitely about natural aromatase inhibitors.  People are suffering from the effects of hormone inhibiting drugs – the list of side effects these drugs are capable of producing is seemingly endless. As a breast cancer coach, I hear all about them and have a great deal of sympathy for those taking these drugs.

It’s a subject near and dear to our hearts and we can spend plenty of time trying to dig up research on new natural alternatives – I know I do because I chose not to take Tamoxifen, much to my oncologist’s annoyance.  I just wasn’t willing to risk the side effects, such as cardiotoxicity and blood clots, etc. 

Update: I recently wrote an article sharing why I chose not to take Tamoxifen, in case you’re interested: Why I Chose Against Hormone Blocking Drugs

It worries me that the side effects of these drugs can be so debilitating and disruptive to quality of life.  More than that, I know quite a few who were on AIs for the requisite period of time (usually 5 years) and suffered recurrences anyway.  That indicates to me these drugs aren’t working as well as they are meant to.

A Good Article

While doing some research recently, I came across a lengthy article, on the NIH website,  “Natural Products as Aromatase Inhibitors” [1]. Be warned, that article will do your head in, unless you are a doctor, researcher or medical professional! 

I will attempt to boil it all down into layman’s language for you – you can read for yourself all of the reasons why AIs are prescribed, how they work in breast cancer, and how scientists are actively researching many natural products to discover which ones can be utilized to help breast cancer patients.  I know what you are really after — the list of natural things that exhibit AI activity. 

18 Natural Aromatase Inhibitors

  1. Dioon Spinulosum – or gum palm, a cycad which grows in Veracruz and Oaxaca, Mexico
  2. Encephalartos ferox – also a cycad which grows mainly in Africa
  3. Riedelia – a genus of plants in the Zingiberaceae family, comprises approximately 75 species that are distributed among New Guinea and the Maluku and Solomon Islands
  4. Viscum album – a species of mistletoe, also known as European Mistletoe or Common Mistletoe to distinguish it from other related species. It is native to Europe and western and southern Asia
  5. Cycas rumphii – also a cycad, commonly known as queen sago or the queen sago palm, it grows in the Moluccan island group (New Guinea, Java, Indonesia)
  6. Cycas revoluta – also a cycad, native to southern Japan
  7. Alpinia purpurata – also known as Red Ginger, a native to Malaysia
  8. Coccothrinax Sarg – Coccothrinax is a genus of palms in the Arecaceae family, there are more than 50 species described in the genus, plus many synonyms and sub-species, and they grow in a variety of places
  9. Five red wine varieties, the most active being Cabernet Sauvignon from Tanglewood (France), the other mentioned was Pinot noir from Hacienda (Sonoma, CA)
  10. Brassaiopsis glomerulata – a deciduous tree found in North Vietnam
  11. Garcinia mangostana L. (Clusiaceae) – also known as mangosteen, has a long history of use as a medical plant, found mostly in Southeast Asia
  12. Euonymus alatus – also known as winged spindle, winged euonymus or burning bush, it’s a species of flowering plant in the family Celastraceae, native to central and northern China, Japan, and Korea
  13. Isodon excisus Kudo var. coreanus – a small herbaceous plant that grows in Western Asia (Japan, China, Korea)
  14. Scutellaria barbata – a plant used in traditional Chinese medicine, other names include ban zhi lian’, scullcap or skullcap, it grows in Korea and southern China
  15. Camellia sinensis – also known as green tea (easily obtainable every morning for breakfast!)
  16. Vitis L. sp – also known as grape seed extract, the report cited a study where a water extract of grape seed extract was utilized and it had AI activity
  17. Agaricus bisporus – also known as white button mushrooms
  18. Trifolium pratense L. – also known as red clover flowers.  There is a lot of misinformation out there about red clover, please read my article Red Clover Controversy – Safe For Breast Cancer Or Not?

Update: See two more discussed below – selenium and pomegranate.

The article also mentioned that coffee, cocoa, collards, stout beer, tomato leaves and even cigarette smoke (!) strongly inhibited aromatase using a microsomal assay.  I don’t know about you but I’m not eating tomato leaves or breathing in cigarette smoke intentionally!

Many of the above listed things are not currently being produced as natural supplements.  I would suggest you print out this list and take it to your naturopath to see which ones would be available and safe for you to use.  Some of the listed items will be easily available (like #9, #15, #16, #17 #18) and you could easily incorporate them into your diet. 

Something not listed is selenium, we do have research indicating that it acts as a natural aromatase inhibitor, see my article  Why Iodine and Selenium Are Useful For Breast Cancer.

2017 Update – I found an older study from 2010 [2] indicating that the ellagitannins (phytochemicals) in pomegranates also had anti-aromatase activity. So make that 20 natural aromatase inhibitors (including selenium, above).

The above list is not exhaustive – the report did also discuss 125 flavonoids, 36 terpenoids, 19 peptides, 18 lignans, 16 xanthones, 15 fatty acids, 10 alkaloids, and 43 miscellaneous compounds having been evaluated but there was not sufficient information for me to feel it was worth listing them all.

Unfortunately, there is no information on dosages for any of the above nutrients, more information is clearly needed.

Just Remember Estrogen Is Not The Only Factor Involved In Breast Cancer

The important thing I would like you to take away from all of this is that we can drive ourselves crazy looking for the tiniest things that will give us an edge over this disease.  I hope you don’t get bogged down in this. Please remember, estrogen is not the only factor involved in breast cancer.  An overall anti-cancer strategy is to eat a healthy diet full of  fresh organic fruits and vegetables and super foods,  take the supplements that have research backing them (see my page discussing that topic), limit your exposure to toxic skin care products, get plenty of exercise DAILY and keep your stress levels down through the use of meditation or prayer. 

You may want to read some of my other articles about aromatase inhibitors:

The Down & Dirty on Aromatase Inhibitors for Breast Cancer Treatment

Acupuncture: How It Helps With Cancer Treatments

Aromatase Inhbitors Natural vs Toxic

Researchers Discover Mushrooms Could Be Potent Natural Aromatase Inhibitors

Why Vitamin D is So Important for Breast Health

Is Chrysin a Good Natural Aromatase Inhibitor?

References:

[1] Natural Products as Aromatase Inhibitors — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074486/

[2] Pomegranate ellagitannin-derived compounds exhibit antiproliferative and antiaromatase activity in breast cancer cells in vitro – https://www.ncbi.nlm.nih.gov/pubmed/20051378

GET MY BEST TIPS on healthy ways to beat breast cancer and prevent recurrences by signing up for my free e-newsletters and e-books on the right.  You can also “like” me on Facebook (Marnie Clark, Breast Health Coach) to get my inspirational snippets, news and updates.  I promise to do my utmost to keep you informed and empowered on your healing journey… and beyond.