The Merits, or Otherwise, of Ten Years of Aromatase Inhibitors

 

If you have been diagnosed with hormone receptor positive breast cancer, meaning that the cancer cells were shown to be fueled by estrogen, and sometimes progesterone, no doubt as part of your post-surgery treatment plan, your doctor recommended that you take hormone inhibiting drugs. You would have been recommended to take either Tamoxifen, which blocks the action of estrogen and is normally offered to premenopausal women, or an aromatase inhibitor like Femara, Arimidex, Aromasin or Evista, which block the production of estrogen, and are normally offered to postmenopausal women.

You probably then went to the Internet, had a look at the side effects of these drugs, and got worried. It seems that taking them for five years was hard enough – so what are the merits or pitfalls of taking them for ten years?

For Tamoxifen, a study released In 2012 [1] found that extending treatment with Tamoxifen from five years to ten years reduced both recurrence of and death from breast cancer. Because of this study, many women have been recommended to continue on with Tamoxifen for ten years rather than five.

For those taking aromatase inhibitors, however, many wondered if the findings about Tamoxifen could be extrapolated to aromatase inhibitors. A study published in 2016 [2] in the New England Journal of Medicine investigated whether or not extending the taking of the aromatase inhibitor letrozole (Femara) from five to ten years for women with hormone receptor positive breast cancer would be beneficial.

1,918 postmenopausal women were enrolled in the trial and half of them were assigned to either take letrozole for five additional years (after already taking it for five years), the other half were given a placebo. 959 women were treated with letrozole for ten years and compared with 959 women who took letrozole for five years and a placebo for five years. On average, the participants were followed for just over six years so that researchers could examine their recurrence rates in the same breast, or a new breast cancer diagnosis in the opposite breast. They also looked at overall survival and quality of life.

Researchers found that although there was a “statistically significant” improvement in disease-free survival (women experiencing neither a recurrence in the same breast nor a new diagnosis in the other breast), for women taking the letrozole there was no difference in actual survival at the five year mark. So in effect this means that 91% of women who did not take the letrozole for the additional five years were disease-free five years later and 94% of women who did take letrozole for an additional five years were disease-free five years later. That’s a difference of 3% between the two groups, with no difference in overall survival. The study was partly funded by Novartis, the maker of letrozole.

Those Pesky Side Effects

The problem is that there are significant side effects from hormone blocking medications. The side effects and toxicity of Tamoxifen and the aromatase inhibitors are rather different, but each definitely has a significant impact on health and quality of life for a large percentage of the women who take these drugs.

In my experience as a health coach, a small percentage of women tolerate these treatments fairly well, but for most, these drugs come with fairly severe side effects. Many women stop the medication before completing the recommended course due to life-altering side effects. What are some of the most common side effects? Here’s a partial list:

• joint pain and stiffness, feelings of being far older than you actually are
• muscle pain and weakness, leg cramps
• bone pain, bone fractures, higher risk for osteoporosis
• hot flashes and night sweats
• headaches
• dizziness
• vaginal dryness and loss of libido
• uterine lining abnormalities, and a higher risk for needing hysterectomy
• tiredness, fatigue, lethargy
• anxiety, depression (sometimes severe)
• vision changes, dry eyes, damage to cornea and retina
• insomnia
• weight gain
• loss of mental acuity and brain fog
• hair thinning
• blood clots and pulmonary embolisms
• fatty liver

I believe that any treatment which fails to significantly improve overall survival while at the same time exposing women to that many serious side effects should be considered very carefully. It’s also important to know that the World Health Organization considers Tamoxifen to be a human carcinogen.

I believe we need our estrogen, keeping it in balance is the key. Many women are not even checked to see what their estrogen levels are after surgery, chemotherapy and radiation have taken their toll – they are just told that blocking the action of estrogen is imperative and they “need” to take these drugs to improve their chance of survival.

The Many Functions of Estrogen

Besides its functions in reproductive health, which can be found in any book on the subject, here’s what our body’s own estrogen also does for us [3]:

• helps maintain body temperature
• involved in energy production in the body including muscles
• enhances the effects of certain neurotransmitters, the brain’s “feel-good” chemicals, so intimately involved in mood regulation
• improves the thickness and quality of skin, as well as collagen content
• alters disposition of fat cells around abdomen
• helps to preserve bone strength
• prevents bone loss
• promotes pancreatic health and regulates insulin secretion
• regulates cholesterol production in the liver, so has cardioprotective properties
• maintains vaginal health
• affects vascular tone and blood flow in organs and tissues, including the eyes
• protective to brain and nervous system

The Role of Xenoestrogens in Hormone Receptor Positive Breast Cancer

I believe that xenoestrogens (environmental estrogens, known hormone disrupters) are much more dangerous to our health than our body’s own estrogen, and I’m not alone. In the book “Molecules of Emotion“, author and scientist Candace Pert stated “… accumulated environmental pollutants within our bodies are mimicking and disrupting the action of our sex hormones — estrogen, progesterone, and testosterone — which run the male and female reproductive systems.” She continues with this line of thought, stating “A recent report on receptor binding in Science, for example, has shown that environmental toxins have estrogenlike effects and bind to estrogen receptors, where they can stimulate breast cancer tumor growth. Similarly, various toxins can act like testosterone in the male body and stimulate prostate cancer, which is embryologically similar to breast cancer. Although this has been suspected for a long time, only recently have we gotten the hard proof that accumulation of these toxins in our bodies chronically stimulates our estrogen and testosterone receptors, putting them into a state of overdrive and leading to cancer.”

Dr Pert is not alone in these thoughts. Countless others have seen the problems associated with xenoestrogens on hormonal health. It is my belief that we need to start there – by detoxifying our food, our body products, our household cleaning supplies, etc. See my article for more information.

Bottom Line: Please evaluate the potential benefits and harms of hormone blocking medications, and talk to your health care provider about your concerns. Please be aware that estrogen is not the only factor involved in breast cancer. For a tumor to begin growing, and to be allowed to continue to grow, a good many things have to go wrong first. A good overall anti-cancer strategy would be to eat a healthy diet full of fresh organic fruits and vegetables, include particular super foods, take supplements that have research backing them (see my page discussing that), detox your household from toxic skin care, hair care and household cleaning products, get plenty of exercise every day, and keep your stress levels down. If you’d like my help putting together a personalized program, I’d be happy to assist you. You might like to consider my coaching services.

References:

[1] Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial – https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61963-1/fulltext

[2] Extending Aromatase-Inhibitor Adjuvant Therapy to 10 Years – https://www.nejm.org/doi/full/10.1056/NEJMoa1604700

[3] The Role of Estrogens in Control of Energy Balance and Glucose Homeostasis – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660717/

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.

The Problem with Taking Antidepressants Along with Tamoxifen

https://marnieclark.com/The-Problem-with-Taking-Antidepressants-Along-with-TamoxifenThe Problem with Taking Antidepressants Along with Tamoxifen

One of the most prevalent side effects from taking tamoxifen, the often-prescribed endocrine therapy drug for estrogen-receptor positive breast cancer, is depression. Whether the depression is associated with a cancer diagnosis or from taking tamoxifen (or both) we do not know. We do know that up to 25 percent of breast cancer patients suffer what is termed “clinically significant depression” following diagnosis. [1]

Depression is not the only side effect of tamoxifen, by any stretch of the imagination, but it is one of the most prevalent and debilitating side effects. Breast cancer patients and survivors on this drug commonly share with me just how debilitating the depression was for them. Many choose to stop taking it because of this. One told me that coming off the drug was like emerging from a long, dark tunnel out into the sunlight.

SSRI Drugs Prescribed For Depression

So what happens when a woman on tamoxifen goes to her doctor and complains of depression? Yes, you guessed it – she gets prescribed another drug, usually in the form of an SSRI antidepressant. That stands for selective serotonin reuptake inhibitor. Without getting too heavily into the chemistry of how these drugs work (which is not my purpose with this article), in a nutshell, they work by increasing serotonin levels in the brain, serotonin being a neurotransmitter (chemical messenger) that carries signals between brain cells. SSRI drugs work by blocking the reabsorption (aka reuptake) of serotonin, thus making serotonin more available for use in the brain. This is supposed to help ease the depression.

Estrogen’s Role in Brain Health

So why does tamoxifen cause depression? It is an estrogen antagonist, meaning it blocks the receptor sites on cells that estrogen would normally take up and direct the action of those cells. The problem with blocking the body’s natural estrogen is that it has a huge role to play in brain health (among many other biological activities). Estrogen has a protective effect on brain neurons and affects the nervous system in many different ways. By blocking estrogen, tamoxifen quite effectively compromises a person’s moods and cognitive health, even normal coordination and movement. It is a known fact that high doses of estrogen exert an anti-depressant effect in humans.

So What’s the Problem with Antidepressants and Tamoxifen Use?

A 2010 study by Canadian researchers, published in the British Medical Journal, had some interesting (and rather worrisome) findings. The researchers were hoping to discover whether using SSRI antidepressants concurrently with tamoxifen reduced the effectiveness of tamoxifen. The study was done with 2,430 women in Ontario, Canada, aged 66 years or older. These women started taking tamoxifen between January 1, 1993 and December 31, 2005.

What they discovered was quite remarkable. For women taking the SSRI drug Paxil (generic name paroxetine – one of the most commonly prescribed drugs for depression) along with tamoxifen, there was a much higher risk of death from breast cancer, namely a 24% – 91% higher risk, depending on length of time the drugs were taken together. The researchers stated that of the women taking tamoxifen and Paxil, 374 (or 15.4%) of them died of breast cancer during follow-up (mean follow-up 2.38 years). They saw no such risk with other anti-depressants, mainly paroxetine/Paxil. Researchers concluded that the use of Paxil during tamoxifen treatment was associated with an increased risk of death from breast cancer, supporting the hypothesis that Paxil can reduce or abolish the benefit of tamoxifen in women with breast cancer. These researchers concluded “We estimate that treatment with paroxetine for 41% of tamoxifen therapy (the median in our study) could result in one additional breast cancer death at five years for every 20 women so treated.” [2] (bold type added for emphasis)

That’s huge.

A newer American study reported in December 2015 in the Journal of the National Cancer Institute found no such increased risk for those taking paroxetine together with tamoxifen. The study followed 16,887 Californian breast cancer survivors diagnosed from 1996 to 2007 and treated with tamoxifen. Of this group of women 8,099 (roughly 50 percent) also took a variety of SSRI antidepressants. 2,946 of the women developed subsequent breast cancer in the 14-year follow-up period. Researchers stated “we did not observe an increased risk of subsequent breast cancer in women who concurrently used tamoxifen and antidepressants, including paroxetine. [3]

Huh? Of 8,099 survivors, 2,946 develop subsequent breast cancer and there’s no correlation? What the…?

Uninformed medical practitioners continue to prescribe Paxil and other SSRI drugs that are known to inhibit CYP2D6 enzymes (required by the body for the metabolization of tamoxifen). One 2013 study by Dutch researchers stated that “In clinical practice, one should strive to avoid potent CYP2D6 inhibitors as much as possible in tamoxifen-treated patients to reduce the risk of compromising the efficacy of the hormonal therapy.” [4]

To make matters worse, doctors are prescribing SSRI anti-depressant medications for hot flashes and menopausal symptoms. I was too, but I politely declined my doctor’s offering of this when I was going through terrible hot flashes related to breast cancer treatments. I’m suspicious of these drugs anyway, so that made NO sense to me. Back in 2004 I didn’t even have access to any studies that suggested taking SSRI’s could put me at a higher risk for breast cancer. I just didn’t want these drugs in my body. I also refused tamoxifen due to its long list of side effects and the fact that the State of California and the American Cancer Society have listed it as a carcinogenic agent. Why on earth would we want this in our bodies?

Truthstream Media has an interesting video on this subject on YouTube:

In this video, it is stated that Paxil has a weak estrogenic effect, but enough of an effect to promote breast cancer. Also mentioned is that FORTY to FIFTY PERCENT of American women aged 40-50 are taking these SSRI anti-depressants.

The video also references an older 1999 study entitled Antidepressant Medication Use and Breast Cancer Risk, published in the American Journal of Epidemiology [5]. This study found that taking tricyclic medications (ie SSRI drugs) for more than two years was associated with a two-fold increase in the risk for breast cancer. So we have known since at least 1999 that the use of SSRI drugs could put us at a higher risk for breast cancer.

I just thought you should know about this. As a natural therapist, I wonder about the combined toxicity of tamoxifen and SSRI drugs. Taking these drugs in combination gives the liver a lot of work to do to detoxify them. If the liver is involved in detoxification of these two drugs all the time, that taxes it to an extraordinary degree.

I think there’s a much better way to go. I believe our bodies were uniquely designed to use natural foods, herbs, essential oils and other remedies for our healing. If you’d like to find out more, sign up for my free newsletters over on the right-hand side of this page.

References:

[1] Breast Cancer Recurrence Risk Related to Concurrent Use of SSRI Antidepressants and Tamoxifen – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892037/

[2] Selective Serotonin Reuptake Inhibitors and Breast Cancer Mortality in Women Receiving Tamoxifen: a Population Based Cohort Study – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2817754/

[3] Tamoxifen and Antidepressant Drug Interaction in a Cohort of 16,887 Breast Cancer Survivors – https://www.ncbi.nlm.nih.gov/pubmed/26631176

[4] Unjustified Prescribing of CYP2D6 Inhibiting SSRIs in Women Treated with Tamoxifen – http://link.springer.com/article/10.1007/s10549-013-2585-z

[5] Antidepressant Medication Use and Breast Cancer Risk – http://aje.oxfordjournals.org/content/151/10/951.full.pdf

Estrogen Effects on the Brain: Much More than Sex – http://misc.karger.com/gazette/66/mcewen/art_05.htm

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 (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.

Searching for Tamoxifen Alternatives?

Image source: freedigitalphotos.net / stockimages

Image source: freedigitalphotos.net / stockimages

Searching for Tamoxifen Alternatives?

One of the most searched phrases on the Internet for women fighting breast cancer is “tamoxifen alternatives”.

For those of you who have been prescribed the estrogen blocking drug Tamoxifen because your breast tumor had estrogen receptors on it, one of the first things you undoubtedly did was Google something like “Tamoxifen side effects”. And what you read scared you, with good reason. The list of side effects, as well as women complaining about those side effects, is pretty darned long.

When I was going through breast cancer in 2004, I was prescribed Tamoxifen as well, even though I didn’t have an estrogen-receptor-positive tumor – mine was progesterone-receptor positive (which in itself is odd, nobody knew quite what to do with me). I couldn’t see how blocking my body’s estrogen was going to help that situation and all my doctors could say in response was to mumble something about “well, it may have some therapeutic benefit anyway.” I found that hard to believe, especially after I learned a few things about it – and back in 2004 there was nowhere NEAR the amount of research available, or chat rooms, or online support groups, that we have available to us now. What I did find was pretty distressing, so I refused Tamoxifen. Then I went in search of other, better things I could do to support my health, well-being and ability to stay healthy. I will share some of those things later in this article.

Those Pesky Side Effects

As a breast cancer coach I am in regular contact with women who took Tamoxifen and some of the other inhibitors like Femara, Arimidex, Aromasin and Evista. With the rare exception, everyone complains about the side effects. Apparently only a small percentage of women taking the drug do NOT have any side effects.

What are some of the most common side effects? Here’s a partial list (and inside the parentheses are comments made to me by others taking these drugs): joint pain, muscle pain, bone pain, joint stiffness, feelings of arthritis (“I felt like I was 85 years old on this drug!”), hot flashes (“You could fry an egg on my head!”), leg cramps, vaginal dryness (“It’s a desert down there!”), tiredness, anxiety, depression (“I felt like killing myself”), vision changes, uterine lining abnormalities (“I had to have a hysterectomy.”), insomnia, weight gain, loss of mental acuity (“I couldn’t think straight while taking it.”), hair thinning and, most worryingly, unexplained blood clots.

And we MIGHT be prepared to put up with some of those side effects if the drug actually worked well. I don’t know what the statistics are, but what I am discovering with my clients is that many of the women who took this drug still had recurrences of breast cancer, despite putting up with the side effects and toxicity. I hear this all the time! Now we also are finding out that some women don’t metabolize them well.

What Does the Research Tell Us?

Plenty of studies have been done on Tamoxifen, far too numerous to list here. Several studies have established that there is an increased incidence of endometrial cancer among women taking Tamoxifen [1], [2]. In 1993, British researchers found that Tamoxifen administered to rats induced liver cancer and several subsequent studies confirmed those findings. [3] In other animal studies (again there have been many of them) Tamoxifen caused all sorts of reproductive organ cancers including testes, uterine, cervical, and vaginal cancers. In 2000, one researcher found that a key metabolite of Tamoxifen is mutagenic (DNA damaging) when particular conditions for its metabolism are met. Those conditions are discussed at length (if you can wade through the terminology) in the research paper listed at [4]. Notably, this researcher stated: “tamoxifen presents something of a problem in the arena of regulatory testing of pharmaceuticals for genetic toxicity: negative in the battery of short-term tests, but demonstrably genotoxic (and carcinogenic) in vivo.” (In vivo means inside a living body, either animal or human, not just a test tube.)

Of course, there do exist numerous studies which indicate Tamoxifen saves lives. Indeed one recent Lancet study [5] (funded in part by the pharmaceutial company making the drug) indicated that taking it for up to ten years substantially reduces breast cancer recurrence. We all heard about that not so long ago. However, all is not what it seems. I will point you to my learned friend, Sayer Ji, of GreenMedInfo.com, who has spent some time with the facts and figures on Tamoxifen, which culminated in his 2012 comment on this research: Tamoxifen: Praised As “Life Saving” But Still Causing Cancer.

It’s clear that the medical establishment believes that Lancet study because Tamoxifen continues to be one of the most-prescribed drugs for hormone-receptor-positive breast cancer. It irritates me that they remain stubbornly blind to the fact that natural medicine has many wonderful (and side-effect free) ways to stay well that can both help to prevent and also to treat cancer safely.

For those in the natural medicine arena, the bottom line is still what we see out there in the trenches – the terrible side effects from these drugs, the fact that so many women taking it are still having recurrences, and the fact that it is classed by the World Health Organization (WHO) and the State of California as a human carcinogen.

So What Should an Empowered Survivor Do?

I can share with you what I did and what I am teaching others to do.

First of all, I disagree that our body’s own estrogen (a hormone we both want and need in our bodies) is causing breast cancer. If that were truly the reason, it seems to me that breast cancer would have been a problem since ancient times and it has only really become the huge problem that it is in recent decades, with the advance of processed foods, chemically-laden body products and cosmetics, environmental toxins and rising stress levels. Breast cancer is a multi-factorial disease and must be addressed on many other levels, not just hormonal. The medical establishment seems to be totally focused on the presence of estrogen receptors on breast cancer tumors. Of course they are there, estrogen plays a huge part in breast health. But complicating the problem is that there are synthetic estrogens in our body products, our drinking water, our cosmetics, our environment — they are coming at us from all directions – and I believe these synthetic estrogens, termed xenoestrogens, are just part of what is making us sick. For more about xenoestrogens, see my articles Protect Yourself From Xenoestrogens and Estrogen Dominance and Unraveling the Mystery of Xenoestrogens and Estrogen Dominance.

So my plan involved, firstly, detoxing my household of chemicals. I got rid of all that crap and began using only natural, organic products. If I couldn’t find them, I made them myself.

I began using some very particular essential oils, massaging them, undiluted, into my breast tissue on a daily basis. See my page Essential Oils for Overall Health and Specific Health Problems for a list of the oils I use.

I had my husband fit a filtration system to the kitchen sink and filtered the drinking water. I also had him install a shower filter.

I began buying only organic produce and when I couldn’t get it organically grown, I either learned how to grow it myself or washed the hell out of it (for things I really wanted/needed) or avoided it completely (I mean who really needs a rutabaga?).

I began working on building up my immune system. Here’s my page on how to do that:  8 Ways To Build a Super Strong Immune System.

I found out which supplements really made a difference in breast cancer and I discovered which foods had real research on them indicating they had anti-cancer activity and began eating those foods. Lots of them! See my page Diet and Cancer.

I got my hormone levels checked periodically. Even though I don’t believe our body’s own estrogen causes breast cancer, it made sense to me to keep an eye on things. When necessary, I use a natural wild yam cream trans-dermally to boost progesterone levels and I take certain supplements that contain wild yam and other things for breast health.

I also got my vitamin D levels checked periodically. When low, I take supplements. See my article: Why Vitamin D is So Important for Breast Health.

I amped up my exercise after reading a study called The Women’s Healthy Eating and Living (WHEL) study [6]. It involved 1,500 women from 1991-2000 who had early stage breast cancer. It found that women who ate plenty of vegetables and fruit every day as well as got regular physical activity were nearly 50 percent less likely to die. So I began getting more regular exercise (in addition to all those lovely plant based foods)!

I learned meditation, because I felt very strongly that a long period of badly managed stress was what undermined my immune system to such a degree that it let cancer in the door. I even created a downloadable how-to-meditate course to help others who don’t have access to meditation classes like I did. Here’s the link: Change Your Life Meditation Course

I learned how to improve my sleep because I found out that bad sleep also undermines the immune system, messes with your hormones and just generally makes you feel crappy. See my page about that: Want To Sleep Better?

I also learned how to do cleanses. A yearly or twice yearly bowel and liver cleanse is one of the best ways to get toxins and xenoestrogens out of your body and keep things running beautifully.

I am still well, healthy and here to tell the story.

References:

[1] Endometrial Cancer in Tamoxifen-Treated Breast Cancer Patients: Findings From the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14 – http://jnci.oxfordjournals.org/content/86/7/527.abstract?ijkey=f6e51d3ed6a435030236801eb63df2f1c9279a5d&keytype2=tf_ipsecsha

[2] Risk and Prognosis of Endometrial Cancer after Tamoxifen for Breast Cancer. Comprehensive Cancer Centres’ ALERT Group. Assessment of Liver and Endometrial cancer Risk following Tamoxifen – http://www.ncbi.nlm.nih.gov/pubmed/11036892

[3] Two-year Carcinogenicity Study of Tamoxifen in Alderley Park Wistar-derived Rats – http://www.ncbi.nlm.nih.gov/pubmed/8358718

[4] Understanding the Genotoxicity of Tamoxifen? http://carcin.oxfordjournals.org/content/22/6/839.full#content-block

[5] Long-term Effects of Continuing Adjuvant Tamoxifen to 10 Years Versus Stopping at 5 Years after Diagnosis of Oestrogen Receptor-positive Breast Cancer: ATLAS, a randomised trial – http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961963-1/abstract

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 (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.

Natural Remedies For Tamoxifen Withdrawal Side Effects

https://marnieclark.com/Natural-Remedies-For-Tamoxifen-Withdrawal-Side-EffectsNatural Remedies For Tamoxifen Withdrawal Side Effects

If you are in the process of weaning yourself off of tamoxifen (and there are many reasons why you might want to do so) and need help with the resulting withdrawal side effects, this article shares some tried and true natural remedies to help you out.

The side effects of tamoxifen can be heinous.  There are many reasons for these side effects but the major one is that while tamoxifen initially acts as an estrogen-blocker, over time it begins to have estrogen-like activities. When a person has been on tamoxifen for a lengthy period (and that time period varies between people) they can begin to metabolize the drug as they would estrogen, so withdrawing from it can bring on quite a few menopausal symptoms.

Dr Scott M Sedlacek, an oncologist with Colorado Breast Specialists in Denver stated back in 1998 that when a woman stops taking the drug, she can experience estrogen withdrawal.  Dr Selacek stated “Perhaps the longer a woman takes tamoxifen, the more likely it will be metabolized as an estrogen and therefore stimulate some of these cancers to recur.”

And that is just what we are finding – the very drug that is meant to protect us from breast cancer recurrence CAN also cause it.  I can’t tell you how many women I have personally spoken with who have told me that they took tamoxifen for the recommended five years, only to have breast cancer come back later.

Tamoxifen Is Toxic To The Body

Tamoxifen is toxic to the body, especially to the liver.  Even the US Government website http://livertox.nih.gov advises “Long term tamoxifen therapy has been associated with development of fatty liver, steatohepatitis, cirrhosis, and rare instances of clinically apparent acute liver injury.” 1

California has a law called Proposition 65 that requires the state to publish and maintain a list of known carcinogens. In May 1995, California’s Carcinogen Identification Committee voted unanimously to add tamoxifen to that list, and in 1996 the World Health Organization designated tamoxifen a human carcinogen.

As you can see, there is ample reason to stop taking it.

To Wean Yourself Off Tamoxifen

There is no need to taper off the use of Tamoxifen, you can just stop taking it.  However, some women report that they fared better when tapering the use of it, that tapering off helped to lessen the side effects.  To do this:

1.  Rather than taking your usual daily dose, take a dose every other day and do this for two weeks.  For instance, take it on Monday, Wednesday, Friday, Sunday the first week and Tuesday, Thursday, Saturday the next week.
2.  Then take a dose every third day for one to two weeks.  For instance, if the last dose was on a Saturday, take the next dose on Tuesday and Friday and the following week Sunday and Wednesday.  At this point, you can stop altogether.

Natural Remedies To Help With Tamoxifen Withdrawal Side Effects

You may experience some side effects from withdrawal of tamoxifen, depending upon how long you have been taking it.  Woman speak to me of depression, terrible hot flashes, joint pains, body aches, lethargy, feeling like they have the flu, just an all-over-not-feeling-so-great experience. These side effects do not occur with everyone, but just be aware that they can happen, it’s not out of the ordinary.

For Depressed Mood or Mood Swings:
Food: Ensure you are eating well and including plenty of fresh organic vegetables and organic protein in your diet. Protein is especially important because it is necessary for good hormone levels, it has a hormone balancing effect. Also include legumes, nuts, seeds, roasted soy nuts, freshly ground flaxseed and other omega-3 fats for good brain health and neural connections, raw cruciferous vegetables, lukewarm chamomile tea (not too hot as that can usher in a hot flash!)
Exercise:  Also helps to elevate the mood. Whatever you like to do for exercise, get up and do it (even though you may not feel like it – it really does help lift the mood.)
Essential Oils: Basil, frankincense, lemon, a blend called Clarity – diffuse them in the room where you are sitting, massage them into the sides of your neck (dilute first if your skin is sensitive), rub them onto the bottoms of your feet before you go to bed.
Supplements: B vitamins assist a proper functioning nervous system, St John’s Wort, Transfer Factors (strengthening the immune system is known to help reduce depression), Panax Ginseng
Massage therapy: Research indicates massage therapy is excellent for depression, and being a massage therapist I can highly recommend it. I see a marked change in my clients that have depression after receiving a massage. You can’t beat a pair of highly trained hands for nurture-ability and easing your burdens.
Meditation: Helps to calm and balance the nervous system in ways we haven’t even learned yet. Try my guided meditation.

For Hot Flashes:
Food: Eating well is crucial for healthy hormonal balance. The same list of foods as those mentioned for Depressed Mood or Mood Swings can help with hot flashes as well. Also 1 tbsp of Bragg’s Organic Apple Cider Vinegar has been used successfully by some to help with hot flashes. Avoid alcohol, caffeine, white flour, hot drinks and sugar as they are all known to increase incidence of hot flashes. You can drink herbal tea, just let it cool down a bit first. Cruciferous vegetables are particularly helpful – broccoli, kale and cabbage contain indole-3-carbinol which naturally helps to balance estrogen levels.
Exercise: Recent studies indicate exercise does not really help hot flashes, but I beg to disagree, they obviously didn’t use yoga in their studies. I found yoga to be extremely beneficial because it helps on so many levels to calm the nervous system, it plays a part in hormonal balancing, yoga is an amazing resource.
Essential Oils: Essential oils can have a positive effect on the endocrine system by stimulating particular neurotransmitters that help to relieve hot flashes.  Clary sage, peppermint, spearmint, lavender and thyme all have a positive effect on hot flashes. If you are in the midst of a hot flash, a single drop of peppermint on the back of your neck will soon have you feeling much better.
Supplements: Omega-3 fats, black cohosh, vitex or chasteberry, American ginseng, maca – all appear to alleviate the frequency and incidence of hot flashes.
Meditation: Helps to calm and balance the nervous system, even 5-10 minutes of meditation can be very beneficial for hot flashes.
Acupuncture: Studies indicate that acupuncture does indeed help with frequency and severity of hot flashes and my clients who have tried it confirm this. 2

For Joint Pains and Body Aches:
Food: Eating lots of fresh produce definitely helps with joint pains and body aches.  Please avoid food known to be inflammatory such as caffeine, white flour and sugars.  Fresh ginger and turmeric (curcumin) are extremely good for joint pain, as are freshly ground flaxseed and other omega-3 fats.
Essential Oils:  Can be very helpful for joint pain and body aches. My favorites are wintergreen, peppermint, ginger, and a blend called Deep Relief. Rub into affected area.
Supplements: Glucosamine sulphate, omega-3 fats, MSM, ginger, turmeric
Hot Epsom Salt Baths: Use 1 cup of Epsom salts in bathtub, soak for 20 minutes (careful, not too hot as this will exacerbate hot flashes). The magnesium is a wonderful pain reliever and helps draw toxins out of the body.
Arnica Montana ointment: Very helpful for joint pain.

For Fatigue:
Food: The same list of foods as those mentioned for Depressed Mood or Mood Swings can help with fatigue as well.  Especially good quality protein (organic), legumes, vegetables (especially cruciferous), spinach and kale (high in magnesium), avocados, bananas. Drink plenty of filtered water too because dehydration can cause fatigue.
Sleep: If you are feeling especially fatigued, don’t try to fight through it.  Nurture yourself and get to bed early.  Rise later if you can, take naps, and know that this won’t last forever.
Supplements: B complex vitamins, Transfer Factors, Siberian ginseng, Coenzyme Q10.
Massage therapy: A healing massage session can definitely help with fatigue, it helps to unblock your energy channels.

Bone Density Problems After Withdrawal of Tamoxifen

Estrogen is necessary for good bone health, our bones rely upon it.  When taking tamoxifen, premenopausal women are at a higher risk for osteoporosis, and while postmenopausal women have been told that tamoxifen strengthens bone and reduces the risk of osteoporosis, its other side effects make that one particular benefit not worth risking, in my opinion.

According to Professor David S Goodsell, tamoxifen is “serendipitously specific. It is chemically very similar to estrogen, and binds in the same site on the estrogen receptor as the normal hormone. Tamoxifen is not a typical inhibitor, blocking action completely. It is found to have a range of effects, sometimes blocking the action of the receptor, but other times actually activating it…” Professor Goodsell goes on to state that tamoxifen “appears to act like estrogen in bone cells, actually providing the proper signals for bone maintenance.” 3

Maybe so, but still not worth the risk, there are many other, less toxic ways of building good bones and they don’t have the toxicity of this drug.

When withdrawing from tamoxifen, it is important to find out what state your bones are in. Research indicates that withdrawal from tamoxifen does put women at a higher risk of osteoporosis. 4

To help you find out which tests are the best ones to monitor your bone health, go to www.betterbones.com, run by Dr Susan E Brown, a bone specialist and nutritionist.  She has a very good article discussing which bone assessment techniques she feels are most advantageous: Bone Density Tests Are Not Enough.  Highly recommended reading.

Final Note:

If you have decided you wish to discontinue the use of tamoxifen, first of all I would suggest you discuss it with your oncologist or primary care physician.  You should always do this.  Some will be supportive, others may not be, so just be aware of that.  This is your body, however, and your quality of life and you have every right to do what you feel is right for you.

References:

1.  http://livertox.nih.gov/Tamoxifen.htm

2.  The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial – http://aim.bmj.com/content/29/1/27.abstract

3.  The Molecular Perspective: Tamoxifen and the Estrogen Receptor – http://theoncologist.alphamedpress.org/content/7/2/163.full

4.  Prevention of Bone Loss After Withdrawal Of Tamoxifen – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140137/

xxx FOR HELENA xxx

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 (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.  

Fatigue In Breast Cancer Survivors Linked To Inflammation

Image source: freedigitalphotos.net / Marin

Image source: freedigitalphotos.net / Marin

Fatigue In Breast Cancer Survivors Linked To Inflammation

A common complaint amongst breast cancer survivors, especially if they have been through the gamut of conventional medicine treatments, is fatigue.  I hear this all of the time and, indeed, suffered through it myself after going through 6 months of chemotherapy.

The Link Between Fatigue, Inflammation and Chemotherapy

An interesting study reported in 2012 [1] found that high levels of inflammation may promote fatigue in women treated for breast cancer.

The study followed 633 women, all breast cancer survivors with an average age of 56 years and treated for stage I, II or III breast cancer.  It was discovered that 40% of the women in the study had elevated levels of C-reactive protein (CRP) in their blood, which is a marker of inflammation.  40% of the women also suffered from fatigue.  Interestingly, women with elevated CRP levels were 1.8 times more likely to feel fatigue.

“Fatigue is common among breast cancer survivors and may persist for years after cancer treatment, clustering with comorbid symptoms such as depression, anxiety, sleep disturbance, and pain that reduce participation in life activities and quality of life”, researchers reported.

This makes sense, especially in view of the fact that chemotherapy and radiation are both associated with increasing inflammation in the body.  In fact, a recent study [2] indicated that chemotherapy leaves a long-lasting epigenetic imprint in the DNA of the blood cells of breast cancer patients and that imprint is associated with inflammation up to 6 months after treatment is completed!

Omega-3 and Omega-6 Fats Play A Role In Inflammation

Going back to the first study and those 633 women [1] the researchers investigated the intake of omega-3 fats, which are highly anti-inflammatory, as well as omega-6 fat intake, which tends to be pro-inflammatory.  It was found that a higher intake of omega-6 fats (found in most cooking oils and processed foods) was associated with both higher CRP levels and a 2.6 greater likelihood of feeling fatigued.

Conversely, women who were including omega-3 fats in their diet had the lowest levels of CRP and reported feeling less fatigue.

Inflammation Is Associated With Reduced Survival

It is well known that inflammation is associated with reduced survival among women with breast cancer [3] and inflammation also increases the risk of atherosclerosis and development of further cancers.  Cancer is, after all, an inflammatory condition.

The good thing is there is something we can do about all of this.

Good Nutrition and Omega-3s Are Helpful

Both inflammation and fatigue can be improved with simple dietary changes.  Follow the recommendations on my page Diet And Cancer and include plenty of fresh salads, vegetables, whole grains and modest amounts of fruit in your diet. And most especially, get those healing omega-3 fats into you!

Omega-3 fats are easily included in the diet and the best source is freshly ground organic flaxseed.  Freshly ground is best because the fats have not degenerated as with some commercially prepared flaxseed oils and freshly ground includes the best quality fiber and lignans.

The 15 Best Reasons To Take Flaxseed

Flaxseed has been shown to have wonderful health benefits – here are 15 of the best things it does for us:

  1. May protect against primary breast cancer [4], [6] 
  2. Decreases incidence of hot flashes [6]
  3. Increases cancer cell death [6]
  4. Decreases HER2 expression (a protein associated with breast cancer malignancy) [6] 
  5. Decreases breast cancer cell proliferation [5], [6]
  6. Improves normal cell membranes
  7. Improves breast density
  8. Exhibits anti-invasive properties [5] 
  9. Decreases risk of primary breast cancer [4], [5], [6]
  10. Reduces risk of breast cancer mortality by 33-70 percent [5], [6]
  11. Increases effectiveness of tamoxifen [5]
  12. Increases effectiveness of Herceptin [5]
  13. Improves mental health and depression [6], [7]
  14. Good for bowel health due to high fiber content
  15. Great for cardiovascular health

16 Tips For Including More Flaxseed Into Your Diet

A common complaint among breast cancer survivors is that they simply forget or can’t be bothered grinding up the flaxseed and finding ways to incorporate it into their diet, so here are my best tips on delicious ways you can use it:

  1. Sprinkle it on salads
  2. Add it to freshly prepared juices
  3. Put it in smoothies
  4. Put it in sandwiches by mixing it with mustard, mayo or mashed avocado (that way it doesn’t fall out!)
  5. Mix it into muesli, granola, or oatmeal
  6. Mix it into hummus or dips
  7. Mix it into guacamole
  8. Mix it into protein shakes
  9. Add it to organic yogurt
  10. Combine it with organic cottage cheese for some extra special anti-cancer properties (see the Budwig Diet)
  11. Sprinkle it on vegetables
  12. Sprinkle it on soup just before serving
  13. Mix it into baked goods
  14. Mix it in with any nut butter
  15. Sprinkle it into casseroles
  16. Mix it into pancake batter

References:
1. Fatigue, Inflammation, and Omega-3 and Omega-6 Fatty Acid Intake Among Breast Cancer Survivors — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341143/
2. Epigenetic changes associated with inflammation in breast cancer patients treated with chemotherapy — http://www.sciencedirect.com/science/article/pii/S0889159114000567
3. Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717751/
4. Consumption of flaxseed, a rich source of lignans, is associated with reduced breast cancer risk — https://www.ncbi.nlm.nih.gov/pubmed/23354422
5. Flaxseed and its lignan and oil components: can they play a role in reducing the risk of and improving the treatment of breast cancer — https://www.ncbi.nlm.nih.gov/pubmed/24869971
6. Flax and Breast Cancer: A Systematic Review — https://www.ncbi.nlm.nih.gov/pubmed/24013641
7. Omega-3 fatty acids and major depression: A primer for the mental health professional — http://www.biomedcentral.com/content/pdf/1476-511X-3-25.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 (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.

Coping With Tamoxifen Side Effects

https://marnieclark.com/ Coping-With-Tamoxifen-Side-EffectsCoping With Tamoxifen Side Effects

As a breast cancer coach, one of the most asked questions is how to cope with Tamoxifen side effects, so today I’m offering assistance!

Tamoxifen is a drug recommended for people whose breast cancer cells exhibited estrogen receptors, termed ER+ breast cancer.

The Action of Tamoxifen

Tamoxifen is in a class of drugs called “SERMs” – selective estrogen-receptor modifiers.  Tamoxifen’s action is to occupy an estrogen receptor on a cell, thus paralyzing the receptor and preventing it from triggering the events that result in cell division.  It does not kill cancer cells, rather it disables them or puts them to sleep.  Tamoxifen targets not only the estrogen receptors in breast tissue, but also all of the other cells in the body that have estrogen receptors.

Tamoxifen Side Effects

Tamoxifen is currently the “gold standard” treatment recommended for all women with hormone driven breast cancer, regardless of the stage.  The recommendation of most oncologists for women with ER+ breast cancer is that taking this medication for 5 years after a breast cancer diagnosis can supposedly reduce the risk of recurrence by up to 50%, which is a very persuasive figure.  They are now recommending Tamoxifen use for up to 10 years.

I am not convinced that Tamoxifen is such a wonder drug, and I discuss why in my article Why I Chose Against Hormone Blocking Drugs.

Part of my problem with Tamoxifen is the wide range of side effects which include headaches, dizziness, nausea, hot flashes, night sweats, vaginal dryness, leg cramps, hair thinning, brain fog, pins and needles in hands and feet, joint pain, moodiness, depression and anxiety.

Tamoxifen may also put a patient at a higher risk for blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary embolism), endometrial cancer and overgrowth of the lining of the uterus.

Since women are recommended to be on this drug for 5-10 years, their concerns about the side effects and loss of enjoyment of life are very real.

It Doesn’t Work For Everyone

What we are finding out here in the trenches is that this drug works for some but definitely not all.  I cannot tell you how many times I’ve been told by a woman that she took the Tamoxifen for the prescribed amount of time and is still battling her second or even third round of breast cancer.  So it is clear that the drug doesn’t work for everyone.

Are There Alternatives To Tamoxifen?

At this time, there do not appear to be any good research studies that directly compare specific diets or nutritional strategies with the use Tamoxifen to prevent breast cancer recurrence.  Having said that, we do know that a healthy diet and plenty of exercise are truly important, they do make a big difference, and this has been proven by research studies.

The Women’s Healthy Eating and Living (WHEL) study followed 1,500 women with early stage breast cancer who were treated between 1991 and 2000, and found that women who both ate plenty of vegetables and fruit every day as well as got regular physical activity were nearly 50% less likely to die during the study follow up.  In this study both women taking Tamoxifen and not taking Tamoxifen were included, so it is clear that diet and exercise are incredibly important for staying well.

For those who choose to take Tamoxifen, some of the side effects can be quite troublesome and these people really need some help.

Here Are My Best Recommendations For Coping With Tamoxifen Side Effects:

Headaches – Having a regular deep tissue massage and/or acupuncture from qualified practitioners can make a huge difference with headaches.  Also, as simple as it may seem, drinking plenty of filtered water can assist your body to clear the drug from your system a little better.  So make sure to drink plenty of water (and not tap water!).

Dizziness – As odd as it may seem, meditation can be very helpful with the dizziness associated with Tamoxifen use.  If the dizziness becomes severe, however, seek the advice of your doctor.  You may need to go off the Tamoxifen or reduce your dosage.  As with headaches, drinking more water can often help to ease dizziness.

Nausea – Drink ginger tea.  You make it with organic ginger root (not the dried spice), slice off a small chunk of it and put it in hot (just off boiling) water and let it steep for several minutes.  Sip as needed.

Hot Flashes & Night Sweats – These are more difficult to solve – these symptoms show that the Tamoxifen is doing its work.  You may find that certain herbal remedies like Remifemin assist with the frequency, intensity and duration of hot flashes and night sweats.  Traditional Chinese Medicine has a number of herbs that are helpful, so seek the help of a qualified Chinese medicine doctor.  For a list of other helpful hints, see my article Tips Tricks and Support For Hot Flashes.

Vaginal Dryness – This is one of the most distressing of the side effects and not often discussed.  There is one very safe product I can recommend, a natural lubricant called Sylk.  Highly recommended.  Also organic coconut oil is very useful.

Leg Cramps – Take 500 mg of magnesium citrate twice daily.  Magnesium is also found in plenty of green leafy vegetables, so eat your salad!

Brain Fog – Essential oils are extremely helpful here because they help to clear off the neuron receptor sites of any accumulated gunk (which can result in brain fog).  Deep breathing of oils like basil, peppermint, and frankincense helps to clear your mind, improves memory and brain function.  Meditation is also very helpful.

Pins & Needles in Extremities – Again, I recommend the use of massage therapy and/or acupuncture, drinking plenty of water, and it would also be helpful to do a bowel cleanse and a liver cleanse because Tamoxifen is a toxic drug, and cleansing will help you clear chemical residues which may be building up in the tissues of your body.

Joint Pain – This is one of the more widely experienced side effects of Tamoxifen.  Yoga is helpful, as is massage therapy, and I also recommend a good quality glucosamine sulfate supplement for joint health, together with plenty of omega-3 fatty acids in the diet.

Moodiness, Anxiety, Depression – Sometimes associated with Tamoxifen use, but often these problems arise just from the fact that you are going through cancer.  It’s better not to ignore them and I recommend getting some counseling.  Meditation is extremely helpful for anxiety and moodiness.  For depression related to Tamoxifen, check with your doctor to see if you can reduce your dosage of Tamoxifen.  Some women are taking it every other day, rather than daily, and still getting good results.   Dietary assistance for these problems includes eating lots of fresh organic veggies and fruit, omega 3 fatty acids, and vitamin B complex – all of these are surprisingly beneficial.  One last word about depression – it can come on slowly over a period of several months, and some women will not realize that they are depressed.  Pay close attention to this please and get some help if you need it.  You may want to discontinue the use of Tamoxifen if the symptoms are severe (discuss this with your doctor).  I would not recommend the use of anti-depressants because they may make Tamoxifen less effective.

If you are having problems with any of these side effects (or anything not mentioned above) associated with Tamoxifen and would like more information from me, please feel free to contact me.  I have plenty of information about all of the things I have recommended and would be happy to share it with you.  I also have a more holistic protocol for staying well without the use of hormone blockers, so please contact me if you would like information about that.

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).  I promise to do my utmost to keep you informed and empowered on your healing journey… and beyond.

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