Breast Cancer, Integrative Medicine, and Vitamin D

October is breast cancer awareness month. By this point in time all of us are fully aware of the impact of breast cancer upon our families and our society. The American Cancer Society has estimated that in 2009, there will be over 192,000 new cases of invasive breast cancer diagnosed and 62,000 new cases of DCIS (localized breast cancer), with 40,000 women dying of breast cancer.

I am looking forward to the day when October is renamed "Breast Cancer Prevention Month". Integrative medicine doctors have an increasing toolbox of tests and natural treatments in our armamentarium that can reduce the risk of breast cancer or the recurrence of breast cancer, and I see new patients every week who want this extra help.

Prevention is the hallmark of the approach to breast cancer. Even with a woman who has been diagnosed with breast cancer, once she has completed her treatment of surgery, chemotherapy and/or radiation, she is back in breast cancer prevention mode. At that point, she is trying to prevent a recurrence of her breast cancer.

In the integrative medicine doctors' toolbox there are many approaches to help prevent breast cancer. These range from correcting estrogen dominance imbalances to detoxification of environmental estrogens from her body, using the techniques of naturopathic medicine.

At the present time, there is no integrative medicine modality for the treatment and prevention of breast cancer, with more data and research than vitamin D. There is so much information showing that this vitamin, which is really not a vitamin but a hormone, in sufficient daily doses can help protect against breast cancer.

Because for the last year I have been focusing my work in integrative medicine through the lens of vitamin D, I would like to review in this article several of the studies showing the importance of sufficient vitamin D to protect against breast cancer.

The Lappe Prospective study of Vitamin D and cancer prevention

In this study, Joan Lappe PhD, RN and colleagues looked prospectively at more than 400 postmenopausal women over a four-year period of time. In one group the women were given 1100 IU of vitamin D and 1000 mg of calcium daily. The control group did not receive this. The results of the study were that the women who took the vitamin D and calcium over the ensuing four years reduced their rate of cancer by an amazing 60%. In fact the authors looked in more detail and found that for every 10 ng/ml increase in a woman's vitamin D blood level, the relative risk of cancer dropped by 35%. These data were not limited to breast cancer but included all cancers.

Goodwin Study

In this study originally presented in 2008, Pamela Goodwin, M.D. and colleagues, retrospectively looked at more than 500 women over a period of 11 years. What she and her colleagues found was that those women who had been deficient in vitamin D at the time of their breast cancer diagnosis were 73% more likely to die from breast cancer than those with sufficient vitamin D at the time of diagnosis. In addition those that were deficient in vitamin D at the time of their diagnosis of breast cancer were almost twice as likely to have recurrence or spread over those years.

My wife and I had the pleasure to listen to an interview of one of the authors of this article. Much to our shock and chagrin the author pointed out that because the study was retrospective they would never recommend that a woman newly diagnosed with breast cancer take more than the minimum daily requirement (RDA) of vitamin D. They specifically said that they would never recommend additional vitamin D until more randomized placebo-controlled prospective studies were done. This will take an additional 5 to 10 years.

When I presented this information to my staff of mostly women they too were shocked that in light of the data the researcher was not recommending newly diagnosed breast cancer patients take additional vitamin D.

In my own practice of medicine, I have never had a newly diagnosed breast cancer patient who came to me for integrative medicine support of her breast cancer diagnosis, have a vitamin D level measured by her oncologist. What is wrong with this picture?

Epidemiological Study about breast cancer

In a major epidemiological study by Cedric Garland PhD and others, the researchers exhaustively reviewed the medical literature on the relationship between breast cancer and vitamin D levels. According to the analysis done in this article, if women kept their vitamin D blood levels at approximately 52 ng/ml, we could expect a 50% reduction in the risk of breast cancer.

In light of this study I endeavor to keep all of my patients who have a high risk for breast cancer or who have had breast cancer already above a blood level of 52 ng/ml.

So what should we do?

The gold standard for medical decision making is the randomized placebo-controlled double-blind prospective study. The study I presented above by Dr. Lappe is one of the few such prospective studies that have already been published using vitamin D. Of course more are on the way.

So the question arises should a woman raise her blood levels higher than the current national average, and will she be harmed by taking a dose of vitamin D that allows her to do this?

My position, and the position of many vitamin D researchers is that because vitamin D is so inexpensive and because the relative risk of overdose of vitamin D is very small, what is the harm in raising women's blood levels to protect against breast cancer? We would only be raising her level into what is now recognized in the medical literature to be optimal. In my opinion, given that vitamin D overdose does not begin until blood levels of 100 ng/ml and more probably 150 ng/ml, what is the harm in women taking doses of vitamin D high enough to get their blood levels up this high, as long as they monitor their blood on a regular basis to assure there is no overdose?

The data is so strong and every year getting stronger. Why don't we take action now? How many more women need to get breast cancer or die from it before we make a move?

As written about in The Structure of Scientific Revolutions, by Thomas Kuhn, it takes many years or even decades, for new findings in science and medicine to take hold in a way that the population as a whole can benefit. In many cases this is because of an unreasonable need for certainty.

Arthur Schopenhauer, the famous philosopher, said this best when he stated: "All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident."

I believe we are in transition between the second and the third stages of Schopenhauer's description in regards to vitamin D. Appropriate (higher) levels of vitamin D are being opposed but not violently so at this point in time. But just the same, these higher levels of vitamin D are still not yet encouraged by the majority of physicians.

Unfortunately I believe it will take another 5 to 10 years until the prospective studies are strong enough to convince the most conservative physicians of the benefits of this amazing vitamin, so that all Americans and all people of the world can benefit from what many of us see as a necessary dose of this very important vitamin.

But ask yourself if you need to wait that long?

I invite your comments and thoughts.

To your improving health!

Soram Khalsa, M.D., has practiced integrative medicine and been a member of the medical staff at Cedars Sinai Medical Center for over 30 years. He is a clinical professor of medicine at the Southwest College of Naturopathic Medicine and a member of the Naturopathic Medicine Advisory Council for the state of California.

He is the author of The Vitamin D Revolution and writes a blog on the newest findings about vitamin D.

You can follow him on Twitter. Or become a fan of his on Facebook.

 

 

Follow Dr. Soram Khalsa on Twitter: www.twitter.com/vitamindrev

Comments

[IzzyCA]

My doctor supports my taking D3 - to a point - she seemed to think that taking 1000IU daily was too much. So she ran the proper blood test, and my level was 29! And I have been getting sun every day. So I know I need to at least double, if not triple my supplement level.

Added bonus: she told me that the pain management clinic is now recommending D supplements, as there is evidence that it can help reduce chronic pain.

[BirgitCalhoun]

For me the knowledge about Vitamin D having a metabolite that really is a hormone made in the kidneys started about 30 years ago (1979) when I had to beg doctors to give my mentally handicapped son the Vitamin D metabolite 1,25 (OH)2 D3 (calcitriol) because he had Legg Calve Perthes disease. He got the substance which made him able to walk again. But the doctors did not allow him to have more than six weeks’ worth. My son was able to live without pain into the early '90s. His ability to walk diminished and eventually in 1998 he was diagnosed with a slipped capital femoral epiphysis. When I saw my son's x-rays at the time, I thought they looked as if he had rickets. When I mentioned that to his orthopedic surgeon, he told me that Erik did not have rickets. But he operated on Erik even though he was extremely osteopenic. The operation put my son in a wheelchair due to contractures. The situation with Erik's Vitamin D deficiency got me interested for myself. I was tested, and was found to be very low at 14ng/ml. I have been reading up on Vitamin D including cancer as well as depression, schizophrenia, multiple sclerosis, diabetes, autism etc. I have become convinced that doctors should screen their patients for Vitamin D deficiency. Thank you for the article. The importance of Vitamin D cannot be stressed enough.

[vincealy]

The Lappe study where vitamin d and calcium reduced breast cancer rates by more that 60 % was peculiarly impressive. Soon after the Canadian health recommendations changed on vitamin d. The American Cancer Society has taken a far more cautious approach . Do you think the tremendous fund raising done during the walk may have an influence? An interesting view on this
..." Doctors Balk at Cancer Ad, Citing Lack of Evidence "
Published: July 10, 2007 NYT http://www.nytimes.com/2007/07/10/he...fesKnSanSBhseQ 940800&adx­nnl=1&adxn­nlx=118582­4075-qM3Jx­TDEfesKnSa­nSBhseQ

[vincealy]

Here is the link http://www.nytimes.com/2007/07/10/he...fesKnSanSBhseQ

[essfox]

must make it clear to supplement with d3 not d2!!

[LMarley]

Thank you, Dr. Khalsa. I, too, look forward to a time when instead of talking constantly about medical tests for dread diseases, medicine (and patients) concentrate on a healthy lifestyle which precludes the development of those illnesses! We can start by eating real food and detoxifying our environment. Once begun, the process isn't that hard.

[LaurieLee]

Vitamin D also seems to prevent MS. Looking at the prevalence maps of MS you can clearly see that the incidence increases the further you get from the equator and the less sunlight you receive. The correlation between sun and MS is very easily seen.

Are there similar maps for breast cancer available?

[IntegralVision]

Yes! Go to http://www.naturalnews.com/report_breast_cancer_deception_0.html

You will see it all!

David

[Conk]

Sorry if you stated so, but let's not forget the importance of iodine and selenium in consideration of good breast health. Very important!

And no sugar! Sugar kills. Avoid processed fats. Death awaits those who indulge in putrid fatty acids!!! Dr. Joanna Budwig knows her stuff about fats. Real, untreated, unheated, unprocessed fats may be one of the most importance foods anyone can eat. The whole fat avoidance scare is driving people to eat more sugar and fewer of the healthful fatty acids their body craves.

[canuck59]

My Doctor is recommending Vitamin D3 to all her patients now, especially in the fall and winter months, when sunlight levels are lower in the northern latitudes.

[Gildersleeve]

vitamin d saves lives.

get sunshine everyday, and if you can't, you should supplement.

I take 4000 IUs everyday.

[empress of green]

ive been taking my 5000 IU everday and ive been coughed and sneezed on, and everyone around me has been gettning sick, besides me! im so excited to tell ppl about this! but of course, they dont listen

[newpantaloons]

I'm listening. Be your own cause.

[phet]

"At the present time, there is no integrative medicine modality for the treatment and prevention of breast cancer..."

In fact, my mother went to the Block Center for Integrative Cancer Treatment with breast and ovarian cancer almost 2 years ago. Their methodology -- for which I had desperately searched without knowing the term -- was such a relief to discover that i cried. Hopefully it will become better known following Dr. Block's recent book, Life Over Cancer: The Block Center Program for Integrative Cancer Treatment.

I should say though that there are choices to be made along the way. Various conservative doctors recommended a preventative double mastectomy. Likewise -- and this would be my only criticism -- following treatment, she was encouraged even by the Block doctors to take a prophylactic aromatase inhibitor, which basically stalls hormone function, something like the idea of sucking the air from a fire. The effects were really dreadful for the weeks she allowed herself to be frightened into it. The human body needs hormones to function, and while it is the conventional protocol (which there is a kind of legal obligation to promote), it is certainly not an "integrative" therapy. But then, no hospital or pharma company going to get fat on people keeping their breasts and eating their cauliflower. The medical orthodoxy wants correction against the profit motive, even in the case of well intentioned physicians. Instead she chose an informed, preventative regimen and hormone *balancing*, and is doing fantastically well.

[LadyXoc]

Considering that most of us have been terrified (by the media and their physicians) of sunlight not filtered through cancer-causing chemicals, and that indoor work hours and total workdays have increased for most of us, it's no wonder that many people are low in Vitamin D. Now the same sources are urging high rates of supplementation, which may throw the body out of whack. When are we going to learn not to jump every time "experts say" and the press reports?

[LMarley]

A naturopath measures Vit. D. levels in patients' blood, and thoughtfully prescribes the optimum dose. Ideally, every M.D. would also have some naturopathic training!

[LadyXoc]

Yeah, well, most people will only read the "studies" and swallow handfulls of the stuff.

[MrsPeel]

As a 54-year-old post-menopausal female who has been combating increasing osteopenia since I was 46 (when I still had all my own hormones), last December it was recommended by the counselor where I have my DEXA scans and mammograms to increase vitamin D greatly. She said 2-3,000 IU had become standard for preventing osteoporosis in many women. She predicted this recommended level would increase to 4,000IU+ over the next couple years..

I have osteopenia despite decades of rigorous cardio and weight-bearing exercise, and supplementation with calcium tablets since the age of 28.

I supplement with bioidentical estradiol cream, but for quirky systemic reasons, I am unable to apply or ingest enough to benefit my bones.

I researched OL, and found recent studies supporting the recommendation to increase vitamin D..

My nurse-practitioner, who monitors the health of my endocrine system and Pap smears, etc., readily confirmed the wisdom of increasing vitamin D.

Six months later I saw an internist about an unrelated problem. She was also concerned about my worsening osteopenia. She agreed wholeheartedly with the higher level of vitamin D.

I now take 630mg. calcium with 400 IU vitamin D b.i.d., along with an extra 1,000 IU vitamin D, b.i.d. I.e., 2,800 IU daily, split morning and evening.

I switched to calcium citrate many years ago, and added magnesium glycinate a few years back. I look forward to my next DEXA 14 months from now.

[MerrieWay]

Thank you. I'll take the vitamin...

[sun2go]

Loved the article and I will follow that author more deeply into the subject.

The BEST way to get Vitamin D is also the oldest, moderate exposure to UVB, without overexposure or burning, a few times a week, from outdoor sun, or controlled indoor exposure.

[Subiani]

Vitamin D (hormone D) has stepped into the limelight as being very important. I have been wondering a lot about why vitamin D is low. I am a dermatologist, and of course am very aware of the behaviors of sun avoidance leading to low vitamin d. But I wonder if something else could be contributing to the consistently low levels we see. Vitamin D is created in the skin by a conversion of cholesterol by the sun. What if there is something happening to cholesterol levels that is causing less vitamin d to be made? so many patients tell me they cannot get their D up despite pretty extensive sun exposure. We have all been hearing about medications showing up in drinking water. I wonder if zocor, lipitor, etc, which inhibit the body's own synthesis of cholesterol, are ending up in drinking water and causing lower skin cholesterol levels.
Regarding breast cancer: another very important potential cause of breast cancer, in addition to low vitamin D, is endocrine disruptors. Bisphenol A and phthalate from plastics, brominated fire retardants--even oxybenzone, in sunscreen, are all endocrine disruptors suspected to cause thyroid disease, breast cancer and developmental abnormalities.

[LMarley]

It's thrilling to hear from an M.D. who is aware of all these things. Thank you. And bless you!

[odyssey58]

I, too, have wondered about "cholesterolphobia" and its effects on vitamin D levels and on osteoporosis. My anatomy professor in nursing school didn't seem to think that there was a connection. But I'm inclined to think that there is. It would be interesting to see if there is a correlation between blood levels of D and cholesterol.