Image source: freedigitalphotos.net / Grant Cochrane
Vitamin D May Assist Some Side Effects Of Tamoxifen
One of the things that most women who are going through breast cancer treatments complain about (and being a breast cancer coach, I do hear these complaints every single day) is all of the side effects of Tamoxifen and other aromatase inhibitor drugs. Things like terrible hot flashes, joint pain, muscle pain, carpal tunnel syndrome and even trigger finger (a painful painful condition that causes the fingers or thumb to catch or lock when bent, it happens when the tendons in the finger or thumb become inflamed) are quite common side effects.
A chance conversation with one of my subscribers this week led me to do some research on vitamin D because she shared with me that she was on Tamoxifen and had been recommended to take some higher-than-normal doses of vitamin D for her joint pain, and it was helping!
Studies Indicate Vitamin D May Assist Musculo-Skeletal Pain
Spanish researchers at the Hospital Del Mar in 2011  discovered that the bone and joint pain associated with taking aromatase inhibitors like Tamoxifen was responsible for many women discontinuing their use. They studied 290 breast cancer patients undergoing treatment with Tamoxifen or another of the aromatase inhibitor drugs. At baseline, 90% of the women had serum vitamin D levels under 30 ng/ml, which is considered a deficiency. All of the patients were given 800 iu daily of vitamin D, and those who were especially deficient also got an additional 16,000 iu every two weeks.
Of the women who were pain-free at baseline, those who reached serum levels of 40 ng/ml were 50% less likely to experience drug-associated joint pain than those who remained vitamin D deficient. The authors noted that it is challenging to raise blood levels to the protective level, noting that at 3 months, 50% of the women treated with the booster doses were still deficient. The researchers stated that a vitamin D deficiency was quite common in women treated with AIs but felt more research was required to ascertain whether AIs actually cause the deficiency.
In an article appearing in the Annals of Oncology website titled “Aromatase Inhibitor-Induced Arthralgia – A Review”  I found the following helpful information which goes a long way toward explaining how a lack of estrogen caused by AIs could certainly cause suboptimal levels of vitamin D: “Vitamin D is closely tied to estrogen because estrogen increases the activity of 1-α hydroxylase, the enzyme responsible for conversion of 25OHD to the biologically active 1,25-dihydroxyvitamin D form. Estrogen also increases the activation of the vitamin D receptor. Thus, it seems logical that the drop in estrogen levels caused by AIs may cause a decrease in vitamin D, and thus, a vitamin D deficient-like arthralgia syndrome.”
Another study titled “Non-herbal Nutritional Supplements For Symptoms Relief In Adjuvant Breast Cancer: Creating A Doctor-Patient Dialogue”  indicated that vitamin D had been “shown to be effective in reducing the incidence and severity of arthralgia resulting from treatment with the aromatase inhibitor letrozole.” No dosages were recommended, however.
A more recent study released in March 2014, “Hypovitaminosis D Is A Predictor Of Aromatase Inhibitor Musculoskeletal Symptoms” appearing in The Breast Journal  agreed with the Spanish study, finding that women with vitamin D levels under 40 ng/ml and taking AIs were much more likely to suffer with musculo-skeletal pain, concluding that “Further research should be carried out on identifying additional modifiable risk factors for this syndrome.”
Yes, indeed. Or maybe we could just get our vitamin D levels checked before starting the aromatase inhibitors and, if they are found to be suboptimal, start supplementing with vitamin D3. The test you want your doctor to perform is 25(OH)D, also referred to as 25-hydroxy-vitamin D.
The Bottom Line
Dosages will depend upon how deficient you are, but up to 4,000 iu/day have been well tolerated by most healthy people. If you are taking AIs, however, you may be able to tolerate more than that. I would highly recommend seeking the advice of a qualified professional because vitamin D is one of the fat soluble vitamins, meaning that it can accumulate in your body, it isn’t flushed away like excesses of water soluble vitamins such as vitamins B and C.
Not only will the vitamin D most likely assist in the joint pain associated with taking aromatase inhibitors, it just might also reduce risk of recurrence.
My own personal preference was to avoid these drugs and I explain why in my article “Why I Chose Against Hormone Blocking Drugs” (in case you’re interested). I feel it’s much more important to keep my immune system nice and strong so that it can be doing its job effectively, keeping stress levels down, and eating lots of super foods and targeted nutrients.
I’d be glad to teach you how too – just sign up for my free newsletters and e-books on the right hand side of this page. It would be my pleasure and my honor to assist you.
 Vitamin D threshold to prevent aromatase inhibitor-induced arthralgia: a prospective cohort study — https://www.ncbi.nlm.nih.gov/pubmed/20665105
 Aromatase Inhibitor-Induced Arthralgia – A Review — https://academic.oup.com/annonc/article/24/6/1443/180703
 Non-herbal nutritional supplements for symptom relief in adjuvant breast cancer: creating a doctor-patient dialogue – https://www.ncbi.nlm.nih.gov/pubmed/24644186
 Hypovitaminosis D is a Predictor of Aromatase Inhibitor Musculoskeletal Symptoms — https://www.ncbi.nlm.nih.gov/pubmed/24467395
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Because of the fact that women with breast cancer are generally deficient in vitamin D – and this is the time of year when we start to get deficiencies, when sunlight is less available or we’re all covered up, I wanted to raise awareness that this is a good time of year for vitamin D supplementation.
Vitamin D is known as the sunshine vitamin because certain amounts of it come from sunshine in an interesting chemical reaction that happens in the skin. While soaking in the sun may seem like a great idea for getting the vitamin D we need, as you are probably aware, it can create problems for us by giving us wrinkly skin and increasing our risk of skin cancer.
Vitamin D is required for a healthy, functioning immune system. It is also required for the proper absorption of calcium and phosphorus — two minerals that are crucial to bone health. Vitamin D also contribute to brain and heart health, as well as maintaining a healthy weight.
The importance of vitamin D cannot be stressed enough. It is no ordinary “vitamin”, it is in fact a steroid hormone that influences nearly every cell in your body. Receptors that respond to vitamin D have been found in nearly every type of human cell, from the bones to the brain, which is why it has such a powerful part to play in the human body.
Vitamin D’s Role In Estrogen Receptor Positive Breast Cancer
As we know, many breast cancers are fueled by estrogen and for those whose tumor cells have estrogen receptors (known as ER+, meaning that this sort of tumor appears to depend on estrogen to grow) there is some really great news about vitamin D.
In a 2012 animal study , researchers reported that calcitriol (the hormonally active form of vitamin D) inhibits the growth of many cancerous cells, including breast cancer cells, by arresting the cancer cells’ replication cycles. Researchers also found that vitamin D suppressed aromatase, the enzyme that assists with estrogen synthesis in breast cancer cells. That makes vitamin D a natural aromatase inhibitor.
2018 update: A 2018 study  found that women who were aged 55 years or older who had a vitamin D serum level of 60 ng/ml or greater had a whopping 80% reduced risk of breast cancer compared to those with a vitamin D level of 20 ng/ml or less. Three different analyses of the data showed similar results.
The Top 6 Food Sources of Vitamin D
According to the website Nutrition Data , these are the top 6 food sources of vitamin D:
Fatty fishes like salmon, tuna, sardines, herring, catfish, oysters, trout, halibut (fish oils and cod liver oils have the highest concentrations)
Fortified orange juice (make sure yours has vitamin D in it)
Plain yogurt, milk
100% whole grain cereals such as oatmeal
Soy milk, tofu
What I wanted you to be aware of is that most foods do not contain sufficient amounts of vitamin D. Additionally, many fatty fishes are now also being found to be polluted with Fukushima radiation, so eating more fish is not necessarily the answer to our vitamin D problems. Supplementation is the best route, this allows you to attain therapeutic doses and avoid possible toxins, especially if you choose a certified organic vitamin D3 supplement.
So How Much Is Enough and What Kind of Vitamin D?
According to mercola.com : “When you do supplement with vitamin D, you’ll only want to supplement with natural vitamin D3 (cholecalciferol). Do NOT use the synthetic and highly inferior vitamin D2, which is the one most doctors will typically give you in a prescription unless you ask specifically for D3. According to the most recent findings, which involved research on nearly 10,000 people, shows the ideal adult dose appears to be 8,000 IU’s a day to get most into the healthy range.”
If you are concerned about your vitamin D levels, get them checked. The best way to determine the correct dose for you personally is to get your blood levels of vitamin D tested. The test you want to ask for from your doctor is the 25(OH)D, also called 25-hydroxyvitamin D, which is the better marker of overall D status. This is the marker that is most strongly associated with overall health.
Additional Info: The folks over at Grassroots Health have more information and research about vitamin D and an enrollment for something called D*action Breast Cancer Prevention Project. Go check it out by clicking here.
 The potential therapeutic benefits of vitamin D in the treatment of estrogen receptor positive breast cancer — http://www.ncbi.nlm.nih.gov/pubmed/22801352
 Breast cancer risk markedly lower with serum 25-hydroxyvitamin D concentrations =60 vs <20 ng/ml (150 vs 50 nmol/L): Pooled analysis of two randomized trials and a prospective cohort — https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199265
Dr Mercola article – Vitamin D for Breast Cancer –http://articles.mercola.com/sites/articles/archive/2012/08/01/vitamin-d-for-breast-cancer.aspx
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (Marnie Clark, Breast Health Coach). When you’re in a desperate situation, you need an ally. You can depend on me to help you through this.
Responding to research showing that vitamin D may slow the progression of breast, colon and other common cancers, some doctors have begun recommending their patients add vitamin D to their “tool kit” of cancer therapies alongside more conventional treatments such as surgery, radiation and chemotherapy.
Vitamin D is known as the sunshine vitamin. When the sun shines on the skin, the ultraviolet rays activate a form of cholesterol which is present in the skin, converting it to vitamin D1. Because the body can provide sufficient vitamin D to meet its needs simply through exposure to sunlight, some feel it is not really a vitamin, but rather a hormone.
What must be taken into account, however, is the fact that the amount of vitamin D converted through sunlight exposure varies according to the time of year, latitude and longitude where you live, the color of your skin, and whether or not you wear a sunscreen whenever you go out. So not everyone gets the same amount of vitamin D.
Recent studies have indicated that women in North America and northern European countries exhibit the highest incidence rate of breast cancer, whereas women in southern regions are relatively protected.
While not all doctors are convinced that the studies are strong enough evidence to warrant taking an extra dollop of vitamin D, those recommending it say popping the pills is a simple health strategy that has few, if any, risks and has the added benefit of also improving bone health in those with cancer.
Doctors Discuss the Data on Vitamin D
“There is emerging data on breast cancer recurrence rates and vitamin D levels that are quite compelling,” says Tracey O’Connor, an oncologist at the Roswell Park Cancer Institute in Buffalo who treats breast cancer and is having her patients take the vitamin.
Dr O’Connor recommends high doses of the supplement to the most deficient patients immediately after they are diagnosed to quickly raise blood levels of the nutrient.
Dr. O’Connor says that having a low level of vitamin D “is quite common” among women with breast cancer, and most patients – about 80% – are either deficient or have insufficient amounts.
Dr. O’Connor says some breast-cancer patients have such low stores of the nutrient that they need to embark on a crash course of taking up to 50,000 iu a week for several months to bring up their levels. Other patients whose starting levels aren’t so poor take a few thousand iu per day. She also monitors blood levels to make sure people don’t get too much.
International units are the standard measurement of how much vitamin D is contained in supplements or foods. Multivitamins typically have either 400 or 800 iu, and a cup of fortified milk has 100 iu.
Longer Survival Times
In recent years, vitamin D has emerged as one of the most intriguing areas of cancer research. There have been numerous epidemiological studies finding that people with less vitamin D in their blood are at a higher risk of developing cancer compared with those who have higher levels. 18 different cancers have been identified for which this trend has been observed and includes colon and breast cancer.
Other research has found that people diagnosed with cancer in summer and fall – when blood levels of vitamin D are at seasonal highs because of sun exposure – have longer survival times than people whose cancers are detected in winter and spring.
I’m not advocating using ONLY vitamin D to fight breast cancer. I truly believe, however, that it is beneficial to add to your arsenal of weapons against breast cancer. If you’re newly diagnosed with breast cancer, generally wear sunscreen or don’t spend much time in the sun, and don’t drink milk, it might be a very good idea to go and get your vitamin D levels checked and start supplementing if your levels are low. Watch this compelling video by Dr Joseph Mercola on vitamin D testing and supplementation.
If you’d like to stay connected, sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com) and I’ll do my utmost to keep you informed and empowered on your healing journey.
In that blog post, I’ve already described what aromatase inhibitors are, how they work, why doctors prescribe them and how the women that take them feel about them, so I won’t be covering those topics here. I want to present information on the differences between synthetic and natural aromatase inhibitors (let’s call them AIs for the sake of brevity).
Synthetic Aromatase Inhibitors
The main problem with synthetically produced AIs is the fact that they have unpleasant side effects. One of the most prescribed, Arimidex, has a list of side effects that includes hot flashes, nausea, weakness or fatigue, headaches, arthritis, general pain, joint pain, sore throat, bone pain, back pain, cough, difficulty breathing, osteoporosis, vomiting, broken bones, insomnia, swelling or water retention in the arms or legs, abdominal pain, constipation, diarrhea, high cholesterol, infections, weight gain, breast pain, dizziness, urinary tract infections, and loss of appetite.
Some of these side effects such as bone pain and arthritis may not go away even when use of the drug is discontinued. Not particularly pleasant, by any means. But then (I hear you saying) neither is BREAST CANCER! Stay with me here.
Drugs are foreign substances that do not occur in nature. Your liver must detoxify them and that places a strain on it. Livers that are stressed from prolonged drug use can become enlarged and even cancerous. Because drugs are foreign substances they don’t work synergistically with your body and your immune system mounts a defense against them. Since the drug is taken daily, your immune system is continuously overworked and not available to do the job for which it was intended, which is keeping your body healthy and well.
Eventually the immune system is able to render these drugs ineffective. Women who have relied on AIs to keep them safe from a recurrence of breast cancer are then left unprotected and uneducated as to what to do to protect themselves.
A research study done at Princess Margaret Hospital in Toronto compared AIs to Tamoxifen in post-menopausal women. More than 30,000 breast cancer patients were involved in multiple trials to obtain their data. It was found that longer use of AIs led to more bone fractures and heart disease, while prolonged use of Tamoxifen resulted in higher rates of cancer of the womb and blood clots. Although AIs were found to prevent breast cancer recurrence, they were not found to prolong life.
There is still one more problem regarding AIs. They take the focus off the real issue which is why a breast cancer developed in the first place. Since cancer is an obvious wake up call that something is radically wrong in the body, this something needs to be addressed!
AIs may keep breast cancer away for awhile, but how about the rest of the body? If the conditions that promoted the breast cancer have not been addressed, there is danger of cancer to other organs and tissues as well as chance for other degenerative disease to get started because this is a body that has already exhibited a willingness to promote disease.
8 Natural Aromatase Inhibitors
These are the things found in nature – the things with which we were provided by nature for our pharmacy. They don’t come with a myriad of side effects. Most natural therapists agree: natural AIs are the only good choice for preventing breast cancer.
They work as effectively as drugs with none of those aforementioned side effects! According to research conducted at the University of Munster in Germany, when women who have estrogen imbalances consume foods rich in natural AIs, breast cancer never gets the opportunity to begin. Eating an unhealthy diet of processed and refined foods high in unhealthy fats, simple sugars, artificial sweeteners and other food chemicals will have the opposite effect.
Quercetin – a powerful flavonoid easily obtainable from apples, cabbage, onions and garlic.
Apigenin – another powerful flavonoid, found in ample supply in celery, parsley, artichokes, basil, and chamomile.
Naringenin – a flavonoid with potent antioxidant benefits, you can get it in all citrus fruits. However, be warned that you shouldn’t eat too much grapefruit or grapefruit juice because it has an inhibitory effect on cytochrome P450, an enzyme which is involved in breaking down and metabolizing sex hormones and preventing their excess accumulation in the body, so inhibiting it is not something you’d want to do.
Oleuropein – a flavonoid that comes from the olive tree, found in abundance in olive leaves and oil.
Keep your weight in check – The aromatase enzyme resides in fat cells. This is why being overweight is linked with breast and other hormone sensitive cancers. With fewer fat cells in the body, less unbalanced estrogen is produced.
Book: “What Your Doctor May Not Tell You About Breast Cancer” by John R Lee, MD
Research paper: B Ebert et al, Phytochemicals Induce Breast Cancer Resistance Protein in Caco-2 Cells and Enhance Transport of Benzo [a] Pyrene-3 Sulfate, Toxicology Science, April, 2007.
Research paper: Pelissero C, Lenczowski MJ, Chinzi D, Davail-Cuisset B, Sumpter JP, Fostier Effects of flavonoids on aromatase activity, an in vitro study. J Steroid Biochem Mol Biol. 1996 Feb;57(3-4):215-23.
If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com). It is my honor to help you through this.
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About Marnie Clark
Hi I'm Marnie Clark, breast cancer survivor, and breast cancer coach. I have 20+ years of experience in natural medicine. In 2004/05 I battled breast cancer myself. You can see more about my journey on my page Breast Cancer Diary.
I've been healthy and recurrence-free since 2004 and in 2012 I became a Breast Cancer Coach because I became aware of the fact that whilst there is now a wealth of information on the Internet, much of it is confusing, conflicting, and sometimes just wrong!
Why should you work with me? Because:
(1) You don't want to go through this journey alone, feeling unempowered, frightened or just plain
clueless about what to do to help yourself.
(2) You will have someone working tirelessly on your behalf, putting together a healing plan for
you so you don’t have to lose your precious energy researching what food you should eat,
what supplements you should take, and what other things you can do that will give you the
best chances for survival. Instead you can spend that time resting, meditating, healing.
(3) You will learn what questions to ask your doctor (and have someone to turn to for the
questions they can't or won't answer).
(4) You will be armed with the tools and strategies you will need to get through the therapies you
choose so you can make your body hostile terrain for cancer.
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.