Assessing Your Inflammation Status in breast cancer survivors

Assessing Your Inflammation Status in breast cancer survivors

Other than some obvious signs—puffy gums, sore joints, chronic nasal stuffiness—
how can you tell if your inflammation levels are higher than they should be?
Several tests can be useful here.

C-Reactive Protein

C-reactive protein (CRP) is a powerful inflammation marker. The production of
CRP is an indispensable part of the inflammation process, and its measurement
mirrors the level of inflammation in the body. We believe that measuring
inflammation with a high-sensitivity CRP test (HS-CRP), a simple blood test, is one
of the most important steps you can take if you have had cancer. If the results are
elevated, above 1.0, then it’s time to take action to bring down your CRP levels. You
might want to retest at three-month intervals. If you don’t have cancer but have risk
factors, you might consider having the test run on an annual basis as part of your
regular physical exam. Some practitioners like to look at other inflammatory
markers. A complete inflammatory profile might include, interleukin-1 (IL-1) beta,
interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor (TNF).

Fibrinogen

Fibrinogen is a protein produced by the liver that helps the blood to clot
properly. Its levels increase in reaction to inflammation, so if inflammation levels
are high, it may be wise to check fibrinogen levels as well. We recommend that
fibrinogen levels range between 215 and 300 milligrams per deciliter of blood.
Bringing levels into normal range has the added benefit of keeping the blood
flowing more smoothly, making it more difficult for metastases to develop.

Food Sensitivity Panel

If your inflammatory markers remain stubbornly high, consider the possibility
of food allergies or sensitivities. Common allergens like casein (from dairy) and
gluten (from wheat) are known to spark an inflammatory cascade in sensitive
individuals. So, one way to cool inflammation on a cellular level is to pay attention
to foods that may cause headaches, digestive upset, or skin eruptions, like acne or
eczema. Keep in mind that as we age, foods that may not have bothered us before,
like dairy and wheat, may trigger chronic low-grade inflammation. Even seemingly
innocuous foods, when eaten repeatedly, can cause a food sensitivity to develop. If
you think you might have a food sensitivity, we recommend going on an
elimination diet for two weeks to see how you feel. We deal with the specifics of this
later in the chapter. You might also consider doing a food allergy panel through one
of the labs listed in appendix B, available through your nutritionist or other holistic
practitioner.

Factors That Influence Inflammation in breast cancer survivors, part 2

Factors That Influence Inflammation in breast cancer survivors, part 2

Weight and Blood Sugar

Keeping your weight in check is crucial for preventing inflammation, as well as
conditions associated with it and obesity, such as heart disease and diabetes.
Research indicates that visceral fat (the fat located deep in the abdominal area) is
more metabolically active than other types of fat, secreting large amounts of
inflammatory cytokines (Maury and Brichard 2010). The good news? Maintaining a
healthy weight greatly reduces and, in some cases, even eliminates inflammation.

Remember that the hormone insulin, itself, is associated with inflammation (see
chapter 6). So, the lower you can keep your fasting glucose and insulin levels, the
less you will have to worry about them as a source of unwanted inflammation.
Stress and Sleep Deprivation
In addition to diet, certain lifestyle choices may contribute to inflammation.
According to Dr. Isaac Eliaz (pers. comm.), who practices integrative medicine in
Sebastopol, California, both stress and sleep deprivation can lead to inflammation
through the elevation of the hormone cortisol. Chronic stress, Dr. Eliaz explains,
leads to the overproduction of cortisol, the body’s most abundant stress hormone.
This rise in cortisol disrupts normal hormonal function, raising blood sugar levels
and contributing to the inflammatory cascade.

Excessive Exercise

Everyone feels better with regular exercise. While improving physical fitness
and enhancing overall well-being, it may also strengthen the immune system. It’s
tempting to be impatient and ignore our bodies’ protests when we are trying to
reach a physical goal, but be careful! When combined with inadequate rest and other
stresses, overexercising, sometimes called “overtraining syndrome,” can lead to an
impaired immune system and inflammation (MacKinnon 2000). One theory as to
what causes this chain reaction is that your overtaxed muscles and tissues trigger the
release of pro-inflammatory cytokines, the proteins that act as messengers between
the cells. When sufficient rest is allowed, pro-inflammatory cytokines facilitate the
healing process—but only if rest is allowed. That’s why we often feel better if we
rest after a long bike ride and why it’s best to alternate periods of exercise with
periods of healing, recuperative rest.

Factors That Influence Inflammation in breast cancer survivors

Factors That Influence Inflammation in breast cancer survivors

A number of lifestyle factors play a role in contributing to chronic inflammation.
Inflammation can be set in motion by your fork and knife. Not surprisingly,
packaged foods that are high in sugar or trans fats are among the most potent of
pro-inflammatory foods. And the type of fat you eat just might play the biggest role
of all in determining levels of systemic inflammation, as you’ll see shortly.

Oxidative Stress

Your body continually combines the oxygen you breathe with nutrients from the
food you eat to produce energy. One result is oxidation: the stripping of an electron
from each atom or molecule the oxygen combines with, creating what biochemists
call free radicals (which we’ve mentioned a number of times previously). Since
electrons come in pairs, when molecules lose an electron, they “steal” electrons
from other molecules. These molecules then “steal” electrons from other
molecules, and so on.

Free-radical activity is a normal part of being alive, and when it is under
control, it’s part of the engine that drives metabolism. But heavy metals, toxic food,
smoking, and all sorts of other internal and external assaults—even an imbalance of
nutrients—can rev up this process. This is oxidative stress. Unchecked, oxidation
can behave like an out-of-control fire, damaging cells, tissues, and organs
indiscriminately—the dangerous chain reaction known as free-radical damage. In an
attempt to repair such damage, the body calls for an immune response, which, in
turn, initiates inflammation, and this causes even more free-radical generation. It’s a
vicious cycle.

One way to keep inflammation and oxidative stress under control is to eat a diet
rich in antioxidants. Eight to twelve servings a day of fruits, vegetables, or both
should do the trick.

Inflammation Enables Angiogenesis

Inflammation Enables Angiogenesis

Another important characteristic of chronic inflammation is its relationship to
angiogenesis, the development of new blood vessels. COX and LOX are enzymes
that promote inflammation, and hormonelike chemicals from these enzymes play a
major role in creating new blood vessels. While this is a natural and normal
process, it is also one that tumors (even those too small to show up on a
mammogram) can hijack to build a blood supply to accommodate their growing
needs. Inflammatory cells stimulate the formation of new blood vessels that then
transport nutrients and oxygen to the tumor. This is a recipe for chronic
inflammation, with each process promoting the other. Clearly, inflammation and the
resulting angiogenesis are outcomes that need to be kept under control.

On the flip side, research suggests that enzymes that block inflammation also
inhibit angiogenesis, so by inhibiting one of these processes, you are positively
affecting both (Jackson et al. 1997).

Inflammation and Breast Cancer: An Unwholesome Relationship

Inflammation and Breast Cancer: An Unwholesome Relationship

We’ve known for quite some time that inflammation and cancer have shared some
sort of functional relationship. In fact, as long ago as 1863, German pathologist
Rudolph Virchow first hypothesized that cancer originated at sites of chronic
inflammation (Coussens and Werb 2002). Now it seems that modern science has
caught up with nineteenth-century observations. It wasn’t easy.

It took twelve years and the breeding of a highly specialized mouse for
researchers to finally prove that inflammation in the breast is one key to the
development of breast cancer (Liu et al. 2010). The researchers in this study
specifically tested the activity of a principal inflammatory pathway known as NFkappaB
to assess its effect on breast cancer—no easy task, as the researchers had to
find a way to turn off inflammation in the breasts only. And, ingeniously, they did,
paving the way to their discovery.

Another noteworthy study (Pierce et al. 2009) confirmed a link between chronic
inflammation and breast cancer recurrence. In this study, scientists at the Fred
Hutchinson Cancer Research Center at the University of Washington noted that
women with high levels of two other inflammation markers—C-reactive protein and
serum amyloid A—were more likely to die early or have a cancer recurrence than
women with lower levels.

Although many inflammatory substances have been shown to have a relationship
with cancer, three of the most widely researched enzymatic compounds to date are
known as COX, LOX, and the chemical signal NF-kappaB (and no, Dr. Seuss did not
come up with these names!). While the particulars of each enzyme are not critical to
this discussion, it is important to understand the need to keep a balance between the
“pro-inflammatory” and “anti-inflammatory” forces at work in our bodies.

What Is Inflammation? in breast cancer survivors

What Is Inflammation? in breast cancer survivors

Inflammation is your immune system’s natural response to an injury, such as a
pulled muscle, or to germs, allergens, chemical irritants, and other threats. Your
immune system reacts by releasing white blood cells and chemicals into the
bloodstream, which infiltrate your tissues, causing the indicators of inflammation
that most of us are familiar with: redness, heat, swelling, and pain. There’s a
biological domino effect at work here: all of these symptoms are created by the
activity of immune cells breaking down injured tissue so that fresh, healthy tissue
can replace it. This is a normal and appropriate response; our bodies need to stay
vigilant in order to fend off an invasion or injury with aggressive proinflammatory
mechanisms, such as clotting, fever, and swelling. But too often,
inflammation becomes a chronic condition, and in this state, we leave ourselves
more vulnerable to breast cancer occurrence and recurrence.

Here’s how: When inflammation arises, chemicals known as inflammatory
cytokines, or chemokines (proteins that serve as messengers between cells) are
released into the blood and tissues. These types of cytokines are created primarily
by immune cells engaged in the process of mounting an inflammatory response, as
a way of dealing with a health threat to the body. By relaying messages between the
cells, the cytokines help to modulate the immune system response to whatever threat
is at hand. But the presence of too many inflammatory cytokines harms our normal
cells—and there’s the rub.

Inflammation Stokes the Fire

Inflammation Stokes the Fire (for breast cancer survivors)

A fire can spread quickly and devastatingly, or slowly, making it easier for
firefighters to subdue. Inflammation is the fire in the growth and spread of cancer.
In a healthy body, inflammation represents a protective response to an emergency,
such as invasion by a bacterium, virus, or parasite. Inflammation is a time-tested
process that initiates the body’s innate healing process, a lifesaving response to
wounds and infections that might not heal without it. An inflammatory state can
become chronic, however, which is when it causes problems.

The same inflammatory chemicals that are used to heal wounds can promote
cancer growth. One way that this happens is when white blood cells rush to the site
of an injury, initiating the development of new blood vessels in a process known as
angiogenesis. What’s more, inflammation seems to play a variety of roles in all
phases of cancer: its initiation, promotion, and invasion (Sgambato and Cittadini
2010).

Fortunately, we are well aware of several natural anti-inflammatory foods and
nutrients. Quercetin, a bioflavonoid phytonutrient found in apples, onions, and tea;
curcumin; ginger; and omega-3 fatty acids are among the best. Likewise, sunlight,
which allows the body to make vitamin D, is a natural antioxidant and is antiinflammatory.

Identifying and eliminating food sensitivities is another key to alleviating undue
inflammation. By discovering your own particular food sensitivities, you can avoid
foods that are provocative to your system. This is one key to taming the
inflammation beast, but we’ll discuss several others in chapter 8.

The Breast Cancer–Iodine Connection

According to Dr. David Brownstein (2008), author of Iodine: Why You Need It,
Why You Can’t Live without It, iodine is one of the most essential nutrients for breast
health. In fact, decades of work have been painstakingly undertaken to confirm this
protective role. It is believed that iodine does its work through modulation of gene
expression and estrogen containment, while remaining intimately involved in the
process of cell division and replication, and apoptosis, the process of normal cell
death (ibid.).

From epidemiological studies, we learn that iodine deficiency is linked to a
higher rate of goiter and breast cancer, undoubtedly because iodine exerts the lion’s
share of its effect on both thyroid and breast tissue. Conversely, high levels of
iodine intake are associated with reduced goiter and breast cancer rates (ibid.).
Japan, for instance, has the highest dietary intake of iodine (approximately 13
milligrams per day), and the lowest rates of goiter and breast cancer (ibid.).

Interestingly, when Japanese women move to the United States and consume the
same amount of iodine as American women, their breast cancer rates increase. Dr.
Brownstein (personal communication) has tested more than four thousand patients
in his practice, and his results have been remarkably consistent: over 95 percent of
his patients are iodine deficient. How can this be, when our saltshakers are
brimming with iodized salt? Perhaps it’s because Americans also consume three
other chemicals in large amounts that compete with iodine for absorption: fluoride,
chlorine, and bromide. In chapter 5 we’ll talk more about these iodine-disrupting
chemicals and what you can do to make sure that you have enough iodine to confer
the maximum degree of breast cancer protection.