Fibrocystic Breast Changes
Chasteberry (Vitex agnus-castus)
Chasteberry, also known as Vitex agnus-castus, is commonly used for breast pain in Europe (van Die 2013), and the German Commission E (a regulatory body that oversees dietary supplements in Germany) supports the use of Vitex agnus-castus for the treatment of breast tenderness, especially premenstrually (Altern Med Rev 2009).
In a randomized controlled trial in 97 women with cyclical breast pain, daily dosing with a solution containing about 32.4 mg of chasteberry extract significantly reduced breast pain compared with placebo. The improvement was observed over two menstrual cycles, and half of the patients receiving chasteberry extract reported that they were free from severe pain after the second treatment cycle, with some women reporting that pain relief was noticeable beginning with the first cycle (Halaska 1999). Chasteberry is believed to exert its effect through inhibition of excessive release of the hormone prolactin by means of activity at dopamine receptors in the pituitary gland (Carmichael 2008; Wuttke 2003). This mechanism of action is similar to that of the drug bromocriptine. According to a rigorous review of the literature, chasteberry benefits other conditions influenced by hormonal fluctuations, including premenstrual syndrome, and menstrual cycle irregularities (van Die 2013; Altern Med Rev 2009).
A randomized trial compared chasteberry extract and bromocriptine in the treatment of 40 women with cyclical breast pain and 40 women with mildly elevated prolactin secretion. Prolactin secretion and breast pain were significantly reduced by both treatments. The authors pointed out that the necessity of long-term treatment of breast pain makes tolerability and low toxicity a priority, so patients are more likely to adhere to treatment with chasteberry extract (Kilicdag 2004).
Lignans, Flaxseed, and Enterolactones
Lignans are polyphenolic compounds present in a variety of plant foods, with high concentrations found in flaxseeds and sesame seeds, as well as in certain plant extracts such as Norway spruce (Pandey 2009; Willför 2003; Liu 2006). Plant lignans are converted by intestinal bacteria to the biologically active “mammalian lignans” such as enterolactone (Lampe 2003; Liu 2006; Higdon 2010). Enterolactones have been shown to concentrate in breast cyst tissue and potentially mitigate breast cancer risk in certain patients (Boccardo 2003). Both lignans and enterolactones have been studied in pre-clinical settings and observational studies, and found to have substantial anticancer activity. This quality is particularly evident in protection from breast cancer abnormalities, and in an association with reduced breast cancer risk (Fabian 2010; Thompson 1996; Guglielmini 2012; Suzuki 2008; Boccardo 2004).
Enterolactones appear to have aromatase-inhibiting activity (Adlercreutz 1993; Lu 2012). Aromatase is the enzyme responsible for creating estrogen from precursor compounds (Bulun 2005). This property could account for the ability of enterolactones to protect against breast cancer and benign breast changes (Su 2010). Tamoxifen is one of the few drugs used to treat fibrocystic changes and severe breast pain, but is associated with significant side effects. Since fibrocystic changes are known to be closely associated with female sex steroids, and possibly with estrogen excess, dietary and supplemental lignans may be one of the more promising approaches to managing benign breast changes (Sugg 2014; Jones 2011; Vaziri 2014).
A population-based study compared the diets of 121 women with benign breast disease and 121 control women. Women who consumed the most food sources of lignans were 52% less likely to have benign breast changes than those with the lowest consumption of these foods (Galvan-Portillo 2002).
In a randomized controlled trial, 56 women with severe cyclical breast pain were given a 25 g flaxseed-containing muffin daily, while 60 women received a placebo muffin. The treatment phase of the trial lasted three months, during which the women assessed breast pain, swelling and lumpiness each cycle, as well as daily breast pain. Median reduction of pain score was significantly greater in the flaxseed group compared to placebo at the end of three cycles. There were no significant side effects. Lignans measured in urine increased in the flaxseed group (Goss 2000).
A randomized trial in 181 women with cyclical breast pain assigned participants to receive either 30 g flaxseed per day in specially prepared bread; plain bread without flaxseed; or a capsule containing a modest amount of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The intervention lasted for two menstrual cycles. The severity of breast pain was significantly reduced by about 56% in the flaxseed group, 17% in the plain bread group, and about 42% in the omega-3 group (Vaziri 2014).
Two professional organizations endorse flaxseed consumption for the treatment of benign breast conditions. The Society of Obstetricians and Gynecologists of Canada recommends flaxseed as first-line treatment for cyclical breast pain (Rosolowich 2006), and the Canadian Cancer Society recommends consumption of flaxseed for fibrocystic breast changes (CCS 2015).
Vitamin E was shown to be effective in reducing the most severe premenstrual breast pain, and showed a trend towards overall reduction of cyclical breast pain, in a trial that compared vitamin E, evening primrose oil, a combination of the two, and placebo (Pruthi 2010). Another study compared women with existing proliferative abnormalities to women with non-proliferative conditions or women who did not require a breast biopsy. This study found that women with the highest serum concentration of alpha- and gamma-tocopherol, two forms of vitamin E, showed a trend towards lower risk of both proliferative disease without atypia and breast cancer. Women with the highest consumption of vitamin E from food had a significantly lower risk of breast cancer, and a similar trend was present for those with the highest consumption of vitamin E from both supplements and food (London 1992). A dietary study among girls found that those who consumed the most vitamin E during adolescence had a significant 21% lower risk of proliferative benign changes as adults compared with those who consumed the least vitamin E (Baer 2003).
Evening Primrose Oil and Gamma-Linolenic Acid
Evening primrose oil may relieve breast pain (Vaidyanathan 2002; Kosir 2013). Gamma-linolenic acid (GLA), which is believed to be the active constituent of evening primrose oil, may also be useful in this context (Sugg 2014). It is important to note that up to four months of treatment with evening primrose oil may be necessary for breast pain relief (Onstad 2013).
A randomized controlled trial compared six months of 3 g evening primrose oil, 1200 IU vitamin E, a combination of the two, or placebo each day in 41 women with premenstrual breast pain. All three treatments reduced the most severe pain, with the clearest effect for evening primrose oil alone; there was a trend for all three treatments to reduce the incidence of cyclical breast pain (Pruthi 2010).
Iodine may be necessary for normal function of breast tissue, and iodine deficiency has been shown, in preclinical and clinical trials, to be related to precancerous and cancerous changes in breast tissue (Eskin 1977; Patrick 2008). In rodents, dietary restriction of iodine creates a syndrome very similar to fibrocystic changes (Krouse 1979), and in another study, supplementing rodents with iodine was shown to suppress breast tumor growth (Funahashi 1996). Lower incidence of benign breast disease occurs in Japanese women, and some researchers hypothesize that this may be related to greater iodine intake in this population, via consumption of seaweed (Cann 2000).
A review of three clinical studies found that treating women who had fibrocystic breast changes with iodide or iodine led to clinical improvement in about 70% of cases. Side effects of iodine treatment, which included changes in thyroid hormone levels, acne, headaches, thinning hair, and others, occurred in about 11% of subjects in one of the studies (Ghent 1993).
Omega-3 Fatty Acids
Supplementation with the beneficial omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) may effectively reduce cyclical breast pain and lower the risk of fibrocystic breast changes.
A randomized trial gave one group of women with cyclical breast pain a daily omega-3 supplement containing 180 mg EPA and 120 mg DHA. In this group, pain intensity was significantly reduced by about 42% after two cycles among women who received the omega-3 supplement, while women who did not receive the omega-3 supplement experienced a reduction of only about 17% (Vaziri 2014).
In another study, women with the highest EPA concentration in their red blood cells had a 62% lower risk of developing fibroadenoma compared with women with the lowest EPA concentrations (Dijkstra 2010). Similar research found that women with the highest red blood cell EPA concentration had a 67% lower risk of non-proliferative fibrocystic changes than women with the lowest red blood cell omega-3 concentrations (Shannon 2009).
Vitamin D deficiency is strongly linked to breast cancer risk and may be associated with fibrocystic changes. A study that compared vitamin D levels in women with no breast lumps, fibrocystic changes, or breast cancer found that severe vitamin D deficiency (blood levels of less than 12.5 ng/mL) increased the risk for breast cancer by threefold. Importantly, women with fibrocystic changes had vitamin D levels higher than women with breast cancer but lower than healthy controls (Alipour 2014). One trial found that women who consumed more than 533 IU vitamin D per day from diet and supplements showed a trend towards lower incidence of proliferative benign breast changes (Rohan 2008). A survey in 682 women with proliferative breast changes found that those in the highest one-fifth of vitamin D intake during adolescence had a 21% lower risk of proliferative benign changes compared with women whose intake was in the lowest one-fifth as adolescents (Su 2012).
Indole-3-Carbinol and Diindolylmethane
Indole-3-carbinol (I3C) and diindolylmethane (DIM) are related molecules found in cabbage family vegetables such as broccoli, kale, and cauliflower. I3C is metabolized in the body to form DIM, a biologically active compound. I3C and DIM can modulate estrogen receptor activation and estrogen metabolism, properties that may help counter the known role of estrogen excess in fibrocystic changes (Weng 2008; Higdon 2008). Neither I3C nor DIM have been studied in clinical settings in the treatment or prevention of fibrocystic changes; however, rats treated with dietary I3C showed a reduction in the incidence of fibroadenomas (Kojima 1994). More studies are needed before conclusions can be reached about the role of I3C and DIM in the treatment of fibrocystic changes (Weng 2008).
A study in which higher consumption of fruits and vegetables significantly decreased the risk of proliferative fibrocystic breast conditions and breast cancer also found that higher consumption of grapes was especially associated with a lower risk of proliferative fibrocystic breast conditions and breast cancer. The authors of this study pointed out that resveratrol, a natural polyphenolic compound present in grapes and related foods, has powerful anticancer effects (Li 2005; Vang 2011).
Disclaimer and Safety Information
This information (and any accompanying material) is not intended to replace the attention or advice of a physician or other qualified health care professional. Anyone who wishes to embark on any dietary, drug, exercise, or other lifestyle change intended to prevent or treat a specific disease or condition should first consult with and seek clearance from a physician or other qualified health care professional. Pregnant women in particular should seek the advice of a physician before using any protocol listed on this website. The protocols described on this website are for adults only, unless otherwise specified. Product labels may contain important safety information and the most recent product information provided by the product manufacturers should be carefully reviewed prior to use to verify the dose, administration, and contraindications. National, state, and local laws may vary regarding the use and application of many of the treatments discussed. The reader assumes the risk of any injuries. The authors and publishers, their affiliates and assigns are not liable for any injury and/or damage to persons arising from this protocol and expressly disclaim responsibility for any adverse effects resulting from the use of the information contained herein.
The protocols raise many issues that are subject to change as new data emerge. None of our suggested protocol regimens can guarantee health benefits. The publisher has not performed independent verification of the data contained herein, and expressly disclaim responsibility for any error in literature.