59 yo F post radical hysterectomy following a diagnosis of endometrial cancer, suitable supplements

Dear Rowena,

Many thanks for your question about your client with endometrial cancer looking for support for menopausal symptoms.

Endometrial cancer is a multifactorial disease, but one of the strongest risk factors is exposure to excess oestrogen and/or a relative lack of progesterone.

Carlson MJ, Thiel KW, Yang S, Leslie KK. Catch it before it kills: progesterone, obesity, and the prevention of endometrial cancer. Discovery medicine. Sep 2012;14(76):215-222. https://tinyurl.com/yb85mrp5

This is because oestrogen stimulates rapid growth of endometrial cells, whereas progesterone counters this action. Long-term exposure to unopposed oestrogen can lead to accelerated or abnormal growth of endometrial cells, and in some cases may lead to tumor formation. Numerous studies have shown that treatment with conventional hormone replacement therapy consisting of unopposed oestrogen (oestrogen without a progestogen) leads to an increased risk of developing endometrial cancer

In addition to unopposed oestrogen therapy, other risk factors that have been associated with endometrial cancer include obesity, diabetes, and diets high in sugar, animal fats, and cholesterol.

McTiernan A, Irwin M, Vongruenigen V. Weight, physical activity, diet, and prognosis in breast and gynecologic cancers. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Sep 10 2010;28(26):4074-4080. https://tinyurl.com/yc3jqt4a

Clarke CL, Sutherland RL. Progestin regulation of cellular proliferation. Endocr Rev. May 1990;11(2):266-301. https://tinyurl.com/y7go7wvz

Agarwal VR, Ashanullah CI, Simpson ER, et al. Alternatively spliced transcripts of the aromatase cytochrome P450 (CYP19) gene in adipose tissue of women. J Clin Endocrinol Metab. 1997 Jan;82(1):70-4. https://tinyurl.com/y8ycy7qg

Diabetes mellitus and hyperinsulinemia (elevated insulin levels) have been shown in many studies to be associated with endometrial cancer.

Berstein LM, Kvatchevskaya JO, Poroshina TE, Kovalenko IG, Tsyrlina EV, Zimarina TS, . . . Thijssen JH. Insulin resistance, its consequences for the clinical course of the disease, and possibilities of correction in endometrial cancer. J Cancer Res Clin Oncol. Nov 2004;130(11):687-693. https://tinyurl.com/y8qp84p7

Hysterectomy can be common following such a diagnosis and therefore can lead to the onset of menopause symptoms. During menopause, a woman undergoes profound and extreme biochemical changes in all aspects of her body. It can be one of the most trying periods in a woman’s life. Typical symptoms include hot flashes, night sweats, mood swings, and sleep disturbances. You have mentioned that her main symptoms appear to be the night sweats. While I appreciate that the consultants are concerned about certain supplements / herbals there is much she could do to help alleviate the symptoms and at the same time make dietary changes to help with the diagnosis of the cancer.

Endometrial cancer appears to be especially influenced by dietary and lifestyle factors. A variety of factors related to diet and lifestyle can increase the chances of developing endometrial cancer; chief among them is the consumption of foods high in animal fats and sugars whereas diets high in vegetables and fruits (especially those high in lutein) have lower risk. High intake of iron from red meat has also been modestly associated with increased risk.

Genkinger JM, Friberg E, Goldbohm RA, et al. Long-term dietary heme iron and red meat intake in relation to endometrial cancer risk. Am J Clin Nutr. 2012 Oct;96(4):848-54. https://tinyurl.com/y8d89daa

Blood sugar balance and stress management are particularly important for reducing the prevalence of hot flushes – if needed I would consider blood sugar support and resilience support. In addition, increasing protein and vegetables at each meal – with a focus on vegetable based protein would be helpful. Keeping inflammatory foods low in the diet – caffeine, alcohol, sugar, processed foods, meats, ready meals, fruit juices etc is also recommended.

One area to look at in the diet is to increase foods rich in Lignans. Lignans are a group of natural phytoestrogens found in plants like flaxseed and sesame. After consumption, lignans can be metabolized into enterolactone – a compound that promotes cancer cell death and decreases the capacity of hormone-responsive cancer cells to grow new blood vessels to facilitate tumor growth. While several studies are currently aimed at determining how enterolactone may promote endometrial cancer cell death, it has been postulated that phytoestrogens may compete with endogenous estrogen for binding to the estrogen receptor Given the oestrogen-dependence of endometrial cancer, this hypothesis is consistent with studies showing that women who consume high amounts of lignans have a 32% lower risk of developing uterine cancer. In postmenopausal women, this risk was 43% lower.

Cederroth CR, Nef S. Soy, phytoestrogens and metabolism: A review. Mol Cell Endocrinol. May 25 2009;304(1-2):30-42. https://tinyurl.com/ybgjtxq2

Therefore, I would certainly recommend a more plant based diet with plenty of lignan rich foods, beans and pulses.  Lignans can also be very helpful for hot flushes as well.

Isoflavones are a class of plant phytochemicals found in soy and other legumes. Greater intake of isoflavones is associated with reduced endometrial cancer risk. Soy isoflavones bind to oestrogen receptors and modulate oestrogen signaling. Thus, they may act in a manner similar to lignans to compete with endogenous oestrogens, which exert more pronounced oestrogenic activity. In 2011, a clinical study of postmenopausal women found that those consuming higher amounts of soy isoflavones (including genistein and daidzein) and total isoflavones were significantly less likely to develop endometrial cancer.

Tao MH et al. A case-control study in Shanghai of fruit and vegetable intake and endometrial cancer. British journal of cancer. Jun 6 2005;92(11):2059-2064. https://tinyurl.com/y9ml29x8

Indole-3-carbinol, or I3C, is a phytochemical concentrated in cruciferous vegetables such as cabbage, cauliflower, radishes, broccoli, and Brussels sprouts. When ingested, it is quickly converted into diindoylmethane (DIM). Several studies suggest these compounds may possess anti-cancer properties, especially in malignancies in which hormones exert considerable influence, such as breast, endometrial, and prostate cancer. Specifically, these compounds reduce the conversion of oestrogens into 16-hydroxyestrogens, which more strongly promote cellular proliferation, and promote conversion into 2-hydroxyestrogens, which are weaker, and far less proliferative on hormone-responsive cell growth.

Aggarwal BB, Ichikawa H. Molecular targets and anticancer potential of indole-3-carbinol and its derivatives. Cell cycle (Georgetown, Tex.). Sep 2005;4(9):1201-1215. https://tinyurl.com/ybztubem

Cruciferous vegetables, especially broccoli, are rich in isothiocyanates and may be particularly helpful during the menopause. You could also consider adding some super green powder and probiotics to further support detoxification.

Hops are the female flowers of the hop plant (Humulus lupulus). Their bitter, floral taste has been used for centuries as a flavouring and natural preservative in beer.  Rich in various compounds including a molecule called 8-prenylnaringenin (8-PN), which research suggests is the most potent known phytoestrogen.

Studies in rats whose ovaries had been removed in order to produce experimentally-induced menopause show that the animals underwent hot flashes, just like women. Administration of either estrogen or 8-PN from hops was able to reverse these symptoms (measured as increased temperature of the tail skin). Hops extracts, rich in 8-PN, provide relief of menopause-associated symptoms. In addition, hops extracts are now beginning to show important and promising benefits in the fight to prevent cancer, particularly cancers of the breast, which are most commonly dependent on oestrogen for their growth.

Hemachandra LP, Madhubhani P, Chandrasena R, et al. Hops (Humulus lupulus) inhibits oxidative estrogen metabolism and estrogen-induced malignant transformation in human mammary epithelial cells (MCF-10A). Cancer Prev Res (Phila). 2012 Jan;5(1):73-81. https://tinyurl.com/y9659mwk

SUGGESTED SUPPLEMENTS

The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

Stress support

Stabilium 200 (ARG) – take 4 in the morning – https://tinyurl.com/hhz7228

Detox Support

Pro Greens (ARG) – take 1 scoop daily – https://tinyurl.com/27uruzy

Ca D-Glucarate (BRC) – take 1 twice daily

Nutri Clear (BRC) – take 1 serving daily – https://tinyurl.com/z7k2x57

Hot Flushes – hormone balance

EstroPrime Plus (ARG) – take 1 capsule twice daily – http://tinyurl.com/ojykzzt

Estroprime plus contains four unique ingredients which include 3 Korean botanicals, patented Gravinol grape seed extract, patented Lifenol female hops cone extract and succinic acid.

Ground Flaxseed powder (ARG) – take 1tbsp three times daily

EFA-Sirt Supreme (BRC) – take 2 at each meal – https://tinyurl.com/h3czc9x

I hope this helps with your client

Christine