Nitrosamines From Food and Cancer in General

I have written about acrylamides and heterocyclicamines in relation to breast cancer risk. This is the first post touching on the subject of nitrosamines.

There are no good studies linking nitrosamines to breast cancer, however, nitrosamines cause many types of cancer, most notably along the gastrointestinal tract.

Theoretically, nitrosamines could be contributing to the non-estrogen dependent breast cancers as this chemical causes DNA mutations in general, according to mammalian laboratory studies.

There are obvious sources of nitrosamines; nitrite preserved food like luncheon meats, bacon or smoked fish. But there are non obvious sources as well; some beers contain nitrosamines from the brewing process, tobacco products and any food item that is in a non breathing container. Sodium nitrate is used as a preservative specifically against botulinum toxin.

Another non obvious source is our own stomachs. Under a reduced acidic environment, our stomachs turn nitrates to nitrites. This is important to remember as many foods have nitrates and many people are unfortunately on acid blockers. (there's a good reason our stomach PH is supposed to be highly acidic, and messing with the PH leads to all sorts of dangerous consequences).

Ascorbic acid or vitamin C, reduces the amount of nitrites produced from nitrates. Take plenty of vitamin C, just not with sodium benzoate as this combination leads to benzene, another known carcinogen.

Beer as it turns out is a big source of nitrosamines which forms in the malting process. The beers with the highest levels tend to be the cheaper domestic types. Stick with higher quality and imported beers and consider drinking it with limes or lemons for the ascorbic acid.

Green tea with a high catechin concentration has been also shown to inhibit nitrosamine formation. Green tea with low catechin concentration may actually promote nitrite formation.

It is important to use ample green tea leaves and drink only the first two infusions if you want the benefit of reducing nitrosamine formation. I prefer high quality Japanese green teas like Sencha or Gyokuro. For instant green tea, I use Matcha powder which is a powdered form of sencha or gyokuro, both have high catechin levels.

Why I'm Blogging About Breast Cancer

We hear so much about "finding the cure".

While I feel it is important to find cures for any disease process, I am very frustrated over the fact that many disease processes are preventable.

For many of my patients, their breast cancers were preventable.

It's true that for some patients with breast cancer, it's a genetic throw of the dice leading to the disease.

But, for the majority of patients with this disease, it was a preventable mix of dietary and other lifestyle choices, environmental exposures and possibly poor emotional hygiene.

I doubt any women say to themselves, "what can I do today to increase my risk for breast cancer".

After interviewing hundreds of patients, I believe that most people are unaware of the dangers of their choices.

I would like to arm people with knowledge to help prevent illness from even beginning.

Prevention is much less painful than treatment physically, psychologically and financially.

I can't tell you how many patients with cancer walk into my office with the intention of learning what to do in order to keep their cancer at bay. I just wish they had come in years ago.

I also see many women who have been on either hormone replacement or the birth control pill without ever having their hormone levels checked. This is a travesty and is actually medical negligence.

It is time for everyone to take the future of their health in their own hands and learn about environmental, emotional and dietary triggers for disease.

More on Ethnicity and Types of Breast Cancer

Hispanic women also tend to suffer from more estrogen receptor negative cancers and, like African American women, have higher mortality rates from breast cancer.

Part of this, is that both African American women and Hispanic women present with more advanced forms of the disease than other women.

There are studies currently under way looking specifically at Hispanic women and risk factors, but not many conclusions yet.

Jewish women from an Ashkenazi (eastern European) background, have a 1 in 40 chance of carrying a tumor suppressor gene known as BRCA1 or BRCA2. The ones that do, have about a 40% chance of developing cancer related to breast, ovarian or both types of tissue.

This tends to be a much more aggressive cancer than the more common hormone sensitive cancer and has higher mortality rates.

In conclusion, even though certain ethnic groups of women have a greater chance of developing a more aggressive form of breast cancer, the most common type in any group is still the hormone dependent, less aggressive form.

And this is the type most understood in terms of risk factors and diet.

Prudent Diet and African American Women

African American women tend to have a greater risk for non-estrogen dependent breast cancer. They tend to get breast cancer at a younger age than other women, and they tend to have higher mortality rates irregardless of the type of cancer.

In 1995, a longitudinal study was launched by the US National Cancer Institute following over 50,000 African American women, looking at breast cancer rates and the subjects diets.

What was found when the study ended in 2007, was that a prudent diet rich in fruits, veggies fish and whole grains was associated with lower breast cancer rates in thin, and in pre-menopausal women.

The "prudent" diets were also low in red and processed meat, carbohydrates and sugars. Overweight women who ate a prudent diet did not show a lower rate, only slim women appeared to be protected by this diet.

There certainly needs to be more studies on risk factors and African American women.

Chocolate, Tea and Coffee

Real dark chocolate does have high amounts of flavinoids, mostly epicatechin. So far the research shows real benefit in warding off heart disease. I can't find much in relation to breast cancer. However, flavinoids are always a good thing. The caveat is that not all dark chocolate is created equal. look for at least 75% cocoa content or higher. Look at the total glycemic load. In order to do that subtract the fiber from the carbohydrates and put that number over the protein. A healthy chocolate has about 5 grams of fiber and 5 grams of protein with a total carbohydrate listing of 11 to 17 grams total.

Just because the research isn't there doesn't mean it's not helpful. In general, the more flavinoids one consumes the better. Chocolate is up there with green and white tea, rooiboos has even more than green or white tea. Black tea and coffee have lower amounts.

Flavinoids in order, from highest to lowest:

Rooiboos

White Tea

Green Tea and Real Dark Chocolate

Black Tea and Coffee

More Info on Soy and Heterocyclicamines

When thinking about soy as food, remember that the epidemiological studies we have showing soy to be beneficial involves Asian women eating typical local forms of soy.

Fermented is always better. Miso paste is so easy to work with as a soup base or even as part of a sauce or dressing base. Tempeh is a great alternative to tofu when wanting to saute as a substitute for meat. But, even the soy milk in asia is usually made at home after soaking the beans for a few hours and therefore made from semi-sprouted soy beans.

I personally use mung beans, lentils and nuts more than any other form of protein.

If you eat meat, remember that cooking on fire or at high temps create heteracyclicamines. Sushi is therefor preferable to BBQ fish. steak tartar is preferable to a burger if the meat is safe.

And when cooking carbs (some veggies and peas included) high heat and frying creates acrylamides.

so lay off the french fries and crackers!

Benefits of a Vegetarian Diet

Choose plant sources of protein over animal. Women with the highest intake of animal fats and proteins, have higher rates of breast cancer.

Lentils, beans, seeds and nuts are all loaded with wonderful chemical constituents. Try soaking mung beans or other pulses(lentils) they are soft enough to eat after a day or two of soaking and have the beneficial enzymes and nutrients of sprouts. Even soaking almonds or sunflower seeds for a few hours begins the germination process.

The latest skinny on soy involves a study looking at 5000 women in china. the conclusion which went viral around dec 8 2009 was that soy IS protective. the women with the highest intakes had the lowest rates of breast cancers. This is contrary to what many people were hypothesizing.

Many oncologists thought soy had too many estrogen like-compounds.

In reality, most estrogen-like compounds in soy mimic estriol or E3, a weak estrogen.

If a weak estrogen meets an estrogen receptor and they decide to get it on, this is a beautiful thing. Now, a strong estrogen can not connect with the receptor and stimulate the tissue the receptor is sitting on.

However, I am not encouraging anyone to only eat soy. There are benefits to all vegetarian sources of protein.

Flavinoids in The Diet

One of the latest press releases I've received is about the discovery of a compound called ellagitannins in pomegranates.

At the City of Hope Breast Cancer research center, researchers found that this compound inhibits our "aromatase" pathway.

I previously wrote about how our fat cells make estrogens. The aromatase pathway is the mechanism of estrogen production within the fat cell. Aromatase actually converts androgens to estrogen (this is one reason why men need to wear bro's or manzier's as they get chubby, they actually have high estrogen levels and some grow breasts).

The researchers are saying that a metabolite produced from the pomegranate compound has the potential to prevent estrogen-responsive breast cancers.

Pomegranate seeds make a salad very photogenic. Pomegranates can be found most of the year at the middle eastern and Indian grocery stores and often the seeds are sold out of the pom in plastic containers.

The aromatase pathway is the pathway in which fat cells convert androstenedione ( a testosterone precursor) to estrogen(E1). This occurs in males and females. How active this pathway is depends upon diet, toxin load and alcohol consumption.

We are bombarded with environmental toxins, so it's safe to assume we need to slow down the pathway and make less estrogen.

The best ways to do this is to eat lots of fiber, drink less alcohol, avoid most medications unless really necessary and buy anything at the top of the food chain organic or, at least hormone and antibiotic free. The are also minerals such as zinc and plant flavinoids that can slow this pathway down like the ellagitannin in pomegranate.

Keeping this pathway less active is most important in estrogen sensitive breast cancers.

Something to note, is that men also produce high quantities of estrogen via this pathway and they are at risk for some forms of prostate cancers because of this.

There have been numerous studies looking at specific groups of women based on local and dietary habits. Many of the studies look at intake of plant flavinols and their effect on reducing not only breast, but also ovarian cancer and heart disease (the no.1 killer of women).

the outcomes have all shown a decreased risk of these diseases with an increase intake of dietary flavinols.

The specific flavinols have been the kinds found in green tea, flax,grapefruit, celery, soy, green pepper and malabar spinach, just to name a few. There are many more that will be named based on the research I'll be citing. Most of these studies are looking at women in the peri or post menopausal age, and most of those breast cancers are estrogen dependent. This is why the aromatase pathway and it's inhibitors are so important.

I will be writing about other breast cancers as the typical breast cancer for a jewish woman is different than for an african american and again different from pre-menopausal and hispanic women.

What you need to take away from the previous notes on the aromatase pathway is this:the most common type of breast ca in the peri-menopausal and post -menopausal woman is estrogen sensitive. This is typically associated with over production of estrogen via the aromatase pathway, therefore dietary behaviors that reduce the pathway are important to adopt for everyone. Eat a naturally colorful diet. Dark and colorful pigments always equal flavinoids. Raw is better in many cases, but not in all. Eating a diet of 75% raw in the summer and 50% in the winter is a good bet that you're getting what you need.

Understanding Estrogens

We have three major estrogens; estrone or E1, estradiol or E2, an estriol or E3. E1 goes through the liver to be detoxified and metabolized. How it is metabolized is very important and impacts whether one is more at risk for estrogen related cancers or not. When your ob/gyn tests your estrogen level she is typically only speaking about E2, or estradiol. This is the estrogen predominantly seen from ovulation. Many peri-menopausal and postmenopausal woman have low levels of this type but might still have high levels of other estrogens. Fat cells convert cholesterol to estrone (E1), this is not measured on standard tests. E1 can then breakdown into metabolites, some are more powerful than estradiol. How well estrogen breaks down depends on your liver and the bacteria in your bowel. This is one reason that there are now studies underway looking at the link between anti-biotic use and increased risks for breast cancer. Anti-biotics alter your bowel flora, typically wreaking havoc. If your liver is very busy detoxifying alcohol, tylenol and pesticides as well as various other medications such as anti-depressants, it may not detoxify or metabolize your estrogens in a balanced manner and can leave you with a hormone imbalance or at risk for estrogen related cancers like breast cancer.

Hormone Testing

There are insurance reimbursable tests out there that you can bet are have not been offered to you.

Did you know that we have three different estrogens in our body. And, the estrogen degrades into metabolites. Some of the metabolites are stimulating (not that way), meaning they promote the growth of breast and endometrial tissue. Other metabolites are weak, but said to be protective against the strong stimulating type.

It is possible with a blood sample to determine if you have a balance of these estrogens metabolites. If you are out of balance in the direction of the strong stimulating type, you are more at risk for breast cancer, if you don't have enough, you might be at risk for osteoporosis.

It is prudent to obtain hormone levels and for anyone on hormone replacement, even if the hormones are bio-identical.

In my Chicago area office, I draw blood for E1, E2, E3, DHEA, SBG,Testosterone, Progestererone, 2 alpha hydroxyestrone and 16 hydroxyestrone. I follow these levels carefully for patients on hormone replacement, or for patients at risk for hormone related cancers. I typically look for imbalances that might predispose someone to disease and then make nutritional recommendations to address the problem

more to follow......

Acrylamide Production in Food

Back on the acrylamide issue. Fermentation seems to lower this compound. Therefore, sourdough bread is preferable to non-soured dough bread. The european equivalent of our FDA has been all over this issue since the research was published. The goal in Europe has been to lower acrylamides in crackers, breads, chips and coffee. Yes, I wrote coffee. It seems that roasting can create this compound. Believe it or not, but dark roast is better than medium roast. The chemical peaks in the medium roast and declines in dark.

I recommend toasting until golden and not brown. Frying carbohydrates just shouldn't be done (there goes the french fries). But, a whole baked potato smothered in extra virgin olive oil or whatever turns you on is ok.

In order for acrylamide to form, there needs to be the amino acid asparagine and sugars, both exposed to high heat (no more tempura asparagus).

The Bermuda Triangle of Breast cancer Risk Factors

The biggest concern I have regarding future breast cancer rates is in relation to some common behaviors seen in the 20 and 30 year olds.

The Bermuda Triangle of risk factors are being on birth control pills, drinking alcohol and eating grilled meats. These are common behaviors of college and graduate school women.

Birth control pills are 90% of the time estrogenic and suppress the cycle. This allows women to go all month and in many cases now, a third of the year without ample progesterone. Breast tissue needs a balance of estrogen to progesterone, in fact our brains need progesterone for optimal functioning.

Alcohol unbinds estrogen from something called SBG, or sex binding globulin. Unbound estrogen is more active.

Meats, especially fast food burgers and grilled or BBQ chicken are very high in heterocyclicamines, a known carcinogen. Fried carbohydrates are also high in a carcinogenic compound called acrylamide