Is Estrogen The Problem and Does Hormone Blockade Solve It?

Hello and welcome to keeping abreast with Dr. Jen. I had an excellent question about whether or not to go on hormone blockade. So let's talk about why people think that estrogen causes breast cancer, what the role is for hormone blockade, and what you can do instead. So the reason that we are under the misconception that estrogen causes breast cancer is kind of twofold. First of all, there are estrogen receptors on all breast cells. Let's just understand that breast cells are stimulated, signaled, messengered by estrogen. And so the way that that happens is that on the surface of a breast cell, you will have an estrogen receptor that fits an estrogen molecule. So that is normal on a breast cell. When a breast cell transforms into a cancer cell, sometimes there is upregulation of that receptor, meaning that there'll be more estrogen receptors. And remember, our breast cancer cells are our cells that have taken a different path. It is a normal response to an abnormal environment. So because there's upregulation of estrogen receptors on some breast cancer cells, that is where the thought that estrogen causes breast cancer came from. Now, in addition, we do see states that have increased estrogen, and those states are associated with more breast cancer. So in postmenopausal women, when postmenopausal women are overweight or obese, they do have increased levels of circulating estrogen. Because when you are premenopausal, the vast majority of your estrogen is made by the ovaries. But when you're postmenopausal, a little bit is made by the adrenal glands, and then it is also made in the fat cells. So a post menopausal woman who is overweight will have more circulating estrogen. And so that is where that thinking comes from. Because overweight postmenopausal women have more breast cancer than normal weight postmenopausal women. And premenopausal women, the thought was that it must be the estrogen. Now, I want to make something clear. Association, commonality, that does not translate into causality. Just because there's more estrogen doesn't mean that that is the reason behind more cancer. I want to be clear that people who are overweight, and especially people who are overweight around the middle, those people have more visceral fat. Visceral fat or the fat that surrounds the abdominal organs, this is very dangerous fat. It is secreting lipokines, it is secreting chemicals that are very pro inflammatory. And we know that breast cancer is an inflammatory condition. It is due to chronic Chronic inflammation. And it's the combination of chronic inflammation and an immune challenge that leads to breast cancer, that leads to changing your chemistry and leads to breast cancer. So that is where the thinking comes from. But I want to be clear that estrogen does not cause breast cancer. If estrogen caused breast cancer, we would see far more breast cancer in the premenopausal woman than we see in the postmenopausal women, because the premenopausal woman has a, an exponentially higher level of circulating estrogen than the postmenopausal woman. And we would see way more cancer in pregnancies when estrogen is exponentially higher than even in the non pregnant premenopausal state. So estrogen does not cause breast cancer. Now, there are estrogen like substances that do contribute to breast cancers. So breast cancer is an environmental disease. And there are things in our environment that act like estrogens. So those things are things like plastics, like antibiotics, like fragrance, other chemicals, cleaning products, things that are used on dryer sheets. And so all of these, all of these chemicals can act like estrogen. They're called xenoestrogens. And they can be cancer causing, they can be cancerogenic. However, these are synthetic things. This is not estrogen, this is not what your body is producing. These are two very different, different molecules. And so I don't want to confuse the two. So talking about the treatment of breast cancer, and traditionally what's happened is for hormone positive tumors, we have used estrogen blockade with the thinking that if estrogen causes breast cancer, then blocking estrogen will prevent breast cancer from recurring. So these are generally used, sometimes they're used for prevention, like in the case of tamoxifen. And sometimes they're used after treatment. Tamoxifen or the aromatase inhibitors for women who are postmenopausal. And I want to talk about these treatments and talk about what they do and talk about some alternatives to them. So tamoxifen, for someone who believes that estrogen causes breast cancer, tamoxifen is a synthetic estrogen. So if you can't wrap your head around taking estrogen, then you shouldn't wrap your head around taking tamoxifen, because it is estrogen, but it's a synthetic estrogen. So along with what it does in the estrogen, like beneficial ways, it does have non beneficial things. So it may protect against breast cancer in the short term. And we talk about all of these drugs in the short term, but I'm not sure that it has the impact that people think it has in the long term. In the long term, it does cause other cancers. It is responsible for a certain degree of uterine cancers. We have to be very careful when we talk about tamoxifen and its safety and its true efficacy, because I'm not sure that it's there. The aromatase inhibitors, that is the class of drugs that prevents the formation of estrogen. So when we make our hormones, we make them in a stepwise obligatory pattern. So in order to make estrogen, you first had to have made testosterone. Before making testosterone, you had to have made progesterone. So it goes in a stepwise fashion. And so what the aromatase inhibitors do is they prevent the conversion of testosterone to estrogen. And while that does lower circulating estrogen levels, it also has a whole host of other effects. Those look like accelerating cardiac disease, accelerating dementia, increasing your chances of Alzheimer's, accelerating bone loss, causing joint pain, discomfort. So these drugs are not benign entities. And the number one killer of women is not breast cancer. Even in the population of women that get breast cancer, the number one killer of women is heart disease. And if we are taking a drug to prevent breast cancer recurrence that causes heart disease, I think we need to take a lot of pause here because essentially what we're doing is trading in one disease for one that's worse. The other thing I want to mention is it does accelerate bone loss and it causes a significant amount of pain and discomfort for women. And as many women die every year as a result of a fracture as do die of breast cancer, I think that we need to be as a society far more cognizant of the side effects, the unwanted effects of these drugs and thinking about not solving a short term problem only to give people a long term problem and being far more selective on who does and does not get these drugs. Because just having an upregulation of estrogen receptors, I'm not sure is enough. Especially if we are causing a certain degree of heart disease in people. If we are increasing the incidence of Alzheimer's, these are dreaded diseases. This is not, this is not something that's benign that someone can just deal with. These are life changing, life altering conditions. I really do think that we need to be far more selective. What is someone faced with this to do? Well, if you go back to the estrogen argument and you want to optimize your estrogen levels, I think that first means optimizing your weight. And just having a normal BMI in this country is not enough, because the normal BMI in this country is Pretty overweight. And so you really want an optimal BMI. You want your BMI to be somewhere between 20 to 22. And that is going to come from eating the right kind of diet and fasting in the right kind of way for you. That diet that I'm talking about is a whole food, non processed, plant based, low glycemic, grain free diet. And if you want to learn about fasting, I couldn't possibly do it justice right now. But there's a great book by Dr. Mindy Pelz called Fast Like a Girl and I recommend it very highly. And then you also should be having daily movement. You need to be active. Our bodies were meant to move. You need to have a good mindset because having a bad mindset will affect your health and your longevity. If you're sure that this disease is going to kill you, it's going to kill you. And if you're certain it's not, it's not. So having the proper mindset around this is very important. And then having a big toolbox that you can go to to help you manage the stressors of life, because the stressors of life are always going to be there. You're never going to get rid of stress, you're never going to avoid stress. But it's not the stress that matters, it's the meaning that you give to the stress that matters. Prioritizing sleep. We are a society that prioritizes waking hours. So but sleep is where the healing happens. And if you're not sleeping, you are not healing. So making sure that you have a sleep routine. We are creatures of habit. And you should be sleeping, if you're a woman, seven to nine hours a night, avoiding toxins, avoiding all the plastics and the pesticides and herbicides and fungicides and fragrance and nonstick and all the things that we know, the antibiotics, all the things that we know that really adversely affect our immune system and drive disease. These are xenoestrogens and they're quite damaging to our immune system and to our system in general. Then learning to put detoxification practices in your life every single day. Learning to dry brush, making sure that you're drinking filtered water, moving your bowels a few times a day and then, you know, making sure that you're sweating. And if you have can, if you have conventional ways to do that through exercise, great. If you're taking hot baths, great. If you're able to get in a sauna, great. If you're able to have an infrared sauna, great. Even better. So there are so many ways that you can detox and you can detox on your own. You can go to places that specialize in detoxification procedures, but it should become part of your routine and then living a purpose driven life. So if you want to go on hormone blockade, that's up to you. And I completely understand. But there are options and the options are optimizing your health. If you are not going to make the changes, then you probably would benefit from hormone blockade. But it does come at a price and in my opinion, that's too high a price to pay.