How to Cure a Yeast Infection Naturally

What is a Vaginal Yeast Infection?

A vaginal yeast infection is an infection of the vagina, most commonly due to a fungus known as Candida. It is known in the medical community as vulvovaginal candidiasis (VVC). At least 75% of women will have a yeast infection at some point in their lives, with nearly 45% experiencing two or more in their lifetime, and 5-8% having recurrent episodes ( a condition known as RVVC, and is defined as four or more episodes within one year). Although they are not life-threatening in women with a healthy immune system, they can greatly impact the quality of a woman's life, especially in chronic cases. The symptoms range from very mild to severe, and although they are not officially considered an STI, they can be transmitted between sexual partners and to children at birth. Therefore, it is important to understand how to properly treat them.

Signs and Symptoms of Vaginal Yeast Infections:
Yeast infections can have a broad range of presentations, ranging from women who have colonization of yeast but no symptoms to those who have frequent, recurrent, symptomatic episodes.

Here is a list of the most common signs and symptoms: 

• Vaginal and labial itching and burning
• Redness and swelling of the vulva
• Abnormal vaginal discharge: 
• This can range from a slightly watery, white discharge to a thick, white, chunky discharge resembling cottage cheese.
• Note: Most women have some sort of discharge throughout the month, especially during ovulation. However, if you notice any changes or have any questions regarding discharge you are seeing, it is important to contact your doctor right away, as a change in vaginal discharge could indicate something more serious.
• Pain with intercourse
• Painful urination  
• Red rash surrounding the vagina and extending toward inner thighs

Symptoms of VVC are often worse the week before your period, with some relief experienced after the onset of menstrual flow. Symptoms of a vaginal yeast infection can include all or only a couple of these symptoms, so it is important to contact your doctor as soon as possible if you notice any of the above changes.

How Do I Know For Sure That It's Yeast?
This is a very good question. Unfortunately, because many women are hesitant to contact their doctor regarding vaginal symptoms, they will try to diagnose themselves.  This results in frequent misdiagnosis and can create more serious consequences, especially if the cause of vaginal symptoms is something that requires a different treatment, such as chlamydia or gonorrhea. For example, although VVC is often assumed to be the cause of vaginitis, only 33% of cases are actually due to VVC. Furthermore, even if it is a yeast infection,  over the counter anti-yeast infection treatment does not work for everyone and can lead to chronic Candida infections. Therefore, it is crucial to have a doctor diagnose your vaginitis as being the result of a yeast infection before attempting to treat yourself for this condition.

The greatest concern with self-diagnosis and self-treatment is of women who have recurrent VVC (RVVC). Approximately 5% of women have four or more vaginal yeast infections per year.  The danger with self-diagnosis and self-treatment of RVVC is that when women try to treat themselves for what they think is a simple vaginal yeast infection, the underlying cause of their infection may go undiagnosed.

Some of the underlying causes for RVVC include:

• HIV/AIDS
• Addison's Disease
• Cushing's Disease
• Hypothyroidism or hyperthyroidism
• Leukemia

There are also a number of predisposing factors for RVVC that are the same for VVC, and are listed later on in this article. 

Note: If you have had a yeast infection diagnosed by a doctor in the past, are certain you are having the same symptoms, do not have recurrent yeast infections, are not pregnant, and have no concern about having acquired an STI, then treating yourself for a yeast infection is probably ok.

How a Doctor Determines You Have Yeast:

Yeast Viewed Through speculum

In order to determine if you have a vaginal yeast infection, your doctor will need to take a thorough history, as well as do a visual inspection of the area. This requires a pelvic examination, which may show swelling and redness of the skin of the vulva, in the vagina, and on the cervix, as well as vaginal discharge consistent with yeast. However, some women have no vaginal discharge or one that appears normal. Your doctor may also notice discreet, pustulopapular peripheral lesions, and cracks in the skin of your vulva. Vaginal pH will be normal (3.5-4.5). As your doctor examines your vaginal canal with the use of a speculum, he or she may also notice a whitish, adherent discharge, although some women may have normal-looking mucus.

In order to confirm a diagnosis of yeast, your doctor may examine a small amount of vaginal discharge under a microscope and/or take a vaginal culture to be analyzed by a lab.

Note: It is becoming increasingly common that even health practitioners are misdiagnosing yeast infections. For example, the most candida-specific criterion for VVC is itching without discharge, but with criterion alone, only 38% of patients actually have VVC.

What Causes Yeast Infections: 

Candida albicans is a fungus and is responsible for 85% to 90% of vaginal yeast infections. Other species, such as C. glabrata, C. tropicalis, and C. krusei can also cause vulvovaginal symptoms and tend to be resistant to conventional therapies, such as Monistat and Diflucan. Of the nonalbican species, C. glabrata is the most common.

There are also a number of predisposing factors for VVC, including:

• Hormone inbalance
• Antibiotic use
• Estrogen therapy
• Cytotoxic drugs
• Contraceptive devices
• Hormonal birth control
• Immunosuppressive drugs
• Chemotherapy/Radiation
• Pregnancy
• High sugar diet
• Food sensivities
• Non-cotton underwear 

Although the sexual transmission of candida is still controversial, there is evidence to suggest that sexual transmission might be a likely source for recurrent infection. Furthermore, men do get yeast infections on their penis from having sex with a woman with a yeast overgrowth. Therefore, I think it is safe to speculate that if that man does not have that infection treated, he could give it back to his partner. Research has also shown that male sexual partners of women with RVVC had the same strains of candida as their partners. One study also found reservoirs of infection in the oral cavities of 36% of 33 heterosexual couples, the rectums of 33% and the ejaculate of 15% of the men. These results suggest that oral-genital contact is a probable method of sexual transmission. 



Conventional Treatment:
The conventional medical approach to the treatment of VVC includes the following:

• Fluconazole (Diflucan), Nystatin: These are prescription oral anti-fungal medications.  Although these drugs are effective in treating 80-90% of yeast infections, they have a number of known side effects, and may actually promote more yeast overgrowth. They should always be taken with probiotics. Furthermore, the species other than Candida albicans are typically resistant to them.
• Topical Anti-Fungal Medication: There a number of over-the-counter medications available for the treatment of VCC. Although they are relatively effective in the treatment of a simple yeast infection due to Candida albicans, the other species of Candida are mostly resistant to these medications. The list of some of the available medications include: butoconazole (Femstat 3), clotrimazole (Lotrimin), miconazole (Monistat), terconazole (Terazol 3).

Naturopathic Treatment Approach:
Although treating the local symptoms of a vaginal yeast infection may be warranted in an acute case, in general, naturopathic doctors treat the gastrointestinal system as well as the vagina when utilizing a VVC protocol. This is due to the fact that clinical evidence has shown that women with yeast infections are also suffering from concurrent gastrointestinal issues and if those are not addressed properly, the yeast infection in the vagina will never resolve completely. Furthermore, a 1977 study demonstrated that in 98 women with RVVC, candida was always found in the feces of those women currently experiencing a yeast infection and not in the women who did not currently have symptoms. In addition, factors that determine a woman's susceptibility to vaginitis, such as vaginal pH and microflora, vaginal immune tissue and hormonal cycles are all influenced by our general health and dietary habits.  This understanding is crucial in the successful management of VVC and especially in managing cases of RVVC.

First Steps:
Get the Symptoms Under Control:  There are a variety of way to treat the symptoms of a yeast infection. Below are listed some of the most effective suggestions for women who are not pregnant:

• Garlic Oral Supplementation and Vaginal Suppositories: Garlic extracts contain a component called allicin, which inhibits the growth of Candida albicans by blocking the lipid production. It is an excellent antifungal agent. When choosing a form of garlic for oral supplementation, the garlic product with the highest amount of allicin in its stable form should be chosen. A garlic clove can also be inserted into the vagina to kill the yeast off locally. Peel the garlic clove carefully, so as not to nick it, and insert it vaginally at bedtime for 6-8 hours. You can also thread the garlic like a necklace for easy removal. Otherwise, the garlic may occasionally be harder to remove. Relax. It is in there somewhere! In all seriousness, it can sometimes tuck itself behind your cervix. Bearing down as if you are having a bowel movement while searching for it usually does the trick. 
• Vaginal and Oral Probiotics: Several species of lactobacillus populate the vagina. There are several explanations for why lactobacillus does such a remarkable job at treating vaginal yeast infections. Firstly, lactobacilli produce lactic acid, which contributes to the low (acidic) pH of the vagina. Having an acidic vaginal pH is essential for maintaining a healthy flora and problems arise when the pH becomes more basic. Research has shown that vaginal infections are associated with a decreased amount of vaginal lactobacilli, so it seems logical that vaginal insertion of lactobacillus would be a good treatment for VVC. Secondly, vaginal lactobacilli  produce hydrogen peroxide which is a known antibacterial agent. Therefore, lactobacilli act directly as antibacterials and may act as a local immune stimulant in managing microbial levels in the vagina. The following factors have been shown to reduce the amount of lactobacilli in the vagina:

• Sperm
• Nonoxynol-9
• Frequent oral sex
• Douching
• Alkaline environment
• Racial differences
• Menses 
• Menopause

         Furthermore, studies have shown that women with
         hydrogen-producing lactobacilli in their vaginas
         are less likely to have Candida vaginitis or bacterial
         vaginosis. There are a variety of studies showing
         the efficacy in Candida prevention with oral supplementation of lactobacilli strains. Lastly, a 2003
         study reported that oral or vaginally administered lactobacillus is able to colonize the vaginal
         ecosystem and that supplementation is necessary for 2-6 months in order to sustain colonization.
         Lactobacillus rhamnosus has been established as the most effective strain of lactobacillus for both
         prevention and treatment of VVC and RVVC and seem to be equally as effective if taken orally
         or vaginally.

• Goldenseal (Hydrastis canadensis) and Oregon Grape Root (Berberis vulgaris): Both of these herbs contain berberine, a substance that acts as both an immune enhancer and an antibacterial agent. The immune effect of berberine is especially specific to epithelial mucus membranes found in the mouth, stomach, and vagina. Berberine has also been shown to possess antimicrobial activity against Candida albicans. Goldenseal and Oregon Grape can be prepared for both oral and vaginal supplementation.

• Boric Acid: Based on both the research I have done and on clinical results, I would state that this is the most efficacious treatment for VVC and RVVC, especially in combination with the use of appropriate probiotics. Both laboratory tests and human trials support the use of boric acid for the treatment of both Candida glabrata and albicans, even in cases that are resistant to anti-fungal prescription drugs. Studies have shown up to a 98% efficacy rate with  the use of boric acid in recurrent vulvovaginal candidiasis (RVVC). Boric acid is extremely effective in treating VVC, RVVC and in the prevention of VVC.  In one study comparing boric acid to Nystatin, the boric acid cured 92% after 10 days, and 72% after 30 days, compared to Nystatin, which cured 64% and 50%, respectively. The only side effect noted is slight burning during urination in cases where the infection has already irritated the tissue. This can easily be managed through the use of topical vitamin E.  
• Zinc:  Zinc plays a crucial role in immune function.  Therefore, sub-optimal zinc levels can make a woman more susceptible to VVC. Furthermore, one study found significantly lower plasma zinc levels in women with RVVC than in controls. 
• Homeopathic Remedies: There are a variety of homeopathic remedies that can be used to treat VVC and RVVC. 
• Ozone Therapy: Major Autohemotherapy is a form of ozone therapy that is an excellent option for  stubborn chronic yeast infections that may not respond to other treatment.  This should only be performed by a qualified ozone therapist.   Vaginal insufflations are another alternative. 

Whole-Body Approach: 

• Avoid Sugar:  Numerous practitioners have noticed that in many women with a history of RVVC, consumption of even a small amount of sugar can trigger a yeast infection, and for women with an acute yeast infection, sugar consumption can certainly make it linger longer. One of the theories behind this is that yeast feed off sugar and will only get worse if you eat it. Hopefully, this sensitivity can be reduced after proper treatment of RVVC, however, I would suggest a complete avoidance of sugar during treatment and as much as possible for prophylaxis.  Sugar consumption has been linked to a whole host of ailments other than VVC, so it is wise to avoid it for optimal health and well being.
• Eliminate Food Allergens: Allergic reactions appear to target the vulvovaginal mucosa in susceptible women, and food allergens can cause irritation in the gut and can lead to the overgrowth of Candida. A Candida overgrowth in the gut can very easily lead to a Candida overgrowth in the vagina.  Therefore, eliminating food allergens can make a significant difference in the treatment of yeast infections.
• Alcohol: There are a number of reasons to avoid alcohol. With regards to Candida, most alcohol is mainly sugar, which feeds the yeast and makes it worse.
• Refined Carbohydrates: The consumption of carbohydrates in general raises your blood sugar and feeds Candida, with refined carbohydrates being the worse culprits. Therefore, it is advisable to avoid refined carbohydrates and significantly reduce your consumption of carbohydrates in general. 

The most appropriate way to receive an accurate diagnosis for your symptoms is to see a licensed healthcare practitioner who is familiar with the clinical picture of yeast infections, can perform a gynecological exam, knows what to test for, and can properly collect samples during your exam.  If you are certain of what kind of infection you currently have, you can attempt home treatment, but be sure to recognize if your home treatment isn't working and seek professional care at that time. It is also important to seek professional treatment if you have yeast infections that occur more than three times per year, if you have a chronic yeast infection that will not resolve, or if you are pregnant.

With patience, motivation and proper medical care, even the most most stubborn yeast infections can be successfully treated!

References:
Pubmed Health
Medicinenet
WebMD
Women's Encyclopedia of Natural Medicine: Tori Hudson
Nutritional Medicine: Alan Gaby

Natural Treatment of Heavy Periods

Definition:

According to The World Health Organization, 18 million women aged 30-55 years perceive their menstrual bleeding to be excessive. Clinical reports demonstrate that 10% of these women experience blood loss severe enough to be clinically defined as menorrhagia.  Menorrhagia is defined as prolonged or excessive menstrual bleeding that occurs at regular times each month, with a blood loss greater than 80 ml (2-3 ounces or about 1/4 cup) per menstrual period, and may have a flow lasting longer than 7 days. In comparison, a normal menstrual period has a flow measuring 25-80 ml, and can last anywhere from 3-7 days.


There are many causes of excessive menstruation, including uterine fibroids, polyps, endometriosis, endocrine imbalances, trauma, infections, or other disorders, including cancer.  The term, dysfunctional uterine bleeding (DUB), is defined as excessive uterine bleeding that occurs in the absence of an underlying medical condition or structural abnormality.  The term DUB can only be used when these other causes of excessive menstruation have been ruled out. DUB can occur with or without ovulation.

DUB can occur at any age, but is most common in adolescents and perimenopausal women. Approximately 20% of DUB cases are adolescents after their first menstrual cycle. These cases are due to an immature endocrine system, most notably an immature hypothalamus. Perimenopausal women account for approximately 50% of DUB patients due to decreasing ovarian function. The remaining 30% of DUB cases fall into women aged 20-40 and are typically due to polycystic ovarian syndrome (PCOS), emotional stress, athletic training, elevated prolactin levels, or anorexia.

There are four subcategories of DUB: Menorrhagia, metrorrhagia, menometrorrhagia, and intermenstrual bleeding. For the purposes of this post, I will be referring to the treatment of the subcategory, menorrhagia.

How Can I Tell If I Have This Condition?
This is a very common question.  In the U.S., statistics show that anywhere from 10-20% of women suffer from diagnosable menorrhagia. However, it is likely that the percentage may be higher.  Many women experience periods heavy enough to qualify as menorrhagia but consider it to be normal, commonly because their mother or some other woman in their family experiences the same type of period.   Furthermore, as with other subjects of a similar nature, women often feel embarrassed to ask anyone about their periods, and may find ways to adapt without looking for medical answers. Often, women will experience menorrhagia for years, and will only seek treatment if it becomes so extreme that they cannot function normally, or once they are ready to have children.  It is best to get a handle on this condition earlier rather than later as some of the causes of menorrhagia can be obstacles to conception, and prolonged DUB can very easily lead to anemia. In fact, menorrhagia is the most common cause of anemia in premenopausal women.

Signs and Symptoms of DUB:
One of the most common signs of having menorrhagia is soaking through one or more sanitary pads or tampons every hour for several consecutive hours.  To put this in perspective, I have done some research into various methods used for menstruation management and how they compare to monthly blood loss.
Remember, menorrhagia is defined as blood loss greater than 80 ml (2-3 ounces or 1/4 cup) per monthly flow:

• DivaCup: The DivaCup holds one full ounce of menstrual flow (30 ml). If you are having to change it twice in one day and it is full both times, you have already reached 60 ml. One more change with a full cup has already put you over the 80 ml mark.
• Super Tampon: Holds 0.3-0.4 ounces (about 3 saturated tampons per ounce, 6 per 1/4 cup)
• Super Plus Tampon: Holds 0.4-0.5 ounces (about 2 saturated tampons per ounce, 4 per 1/4 cup)
• If you are saturating a pad every hour than you are probably bleeding too much. 

 Other signs and symptoms of menorrhagia may include:

• Needing to use double sanitary protection to control your menstrual flow.
• Needing to wake up to change sanitary protection during the night.
• Bleeding for a week or longer.
• Passing large blood clots with menstrual flow.
• Restricting daily activities due to heavy menstrual flow.
• Symptoms of anemia, such as tiredness, fatigue or shortness of breath.

A common finding with menorrhagia is the passing of blood clots. There are varying medical perspectives as to the cause of menstrual clots. One view is that the clots form if blood accumulates faster than the body's ability to transfer it out of the uterus through the cervix. As it pools in the uterus, clots form. Another theory is that the body releases anticoagulants during a woman's period that are designed to keep the blood from clotting. If the flow is heavy, the blood may be expelled too rapidly for the anticoagulants to work, resulting in the formation of clots.  Many women experience clots during their period.  This does not necessarily mean you have menorrhagia. However, if you are noticing clots in your period, it is important to mention the size and general amount to your doctor.

Dietary Suggestions for Treatment of Menorrhagia:
If you are suffering from menorrhagia, it is important to make some dietary changes to help improve your condition. Some of these suggestions are as follows: 

• Consume a diet rich in the following: Vegetables, fruits high in vitamin C, whole grains, legumes, fish high in omega-3 oils, nuts, seeds, and iron rich foods such as brewer's yeast, wheat germ and blackstrap molasses.
• Reduce saturated animal fats (beef, chicken, dairy) to support good prostaglandin formation. 
• Eat organic as much as possible, especially organic meat. Otherwise you are adding hormones, antibiotics and other chemicals to your body that will likely worsen menorrhagia. 
• Eliminate food sensitivities, as they are notorious for causing inflammation in the body, which can aggravate menorrhagia.
• Avoid alcohol, as consumption may increase inflammation and worsen your symptoms. 

Supplements:

• Flavonoids and Vitamin C: In healthy women, the integrity of capillaries decreases both after ovulation and premenstrually.  Flavonoids and vitamin C enhance capillary integrity, and have been shown to reduce menorrhagia in trials. Furthermore, bioflavonoids may occupy the estrogen receptor sites on the uterus, thereby reducing the estrogen-stimulating effect on the endometrium.  This, in turn, could reduce menstrual blood loss. Therefore, women who have menorrhagia may need greater amounts of vitamin C and bioflavonoids than the average woman.  Vitamin C also helps in the absorption of iron. Note, vitamin C supplementation alone has not been shown to be as effective as using it in conjunction with bioflavonoids.
• Iron: Although it is well known that heavy menstrual bleeding can lead to iron-deficiency anemia, it is not as well recognized that iron-deficiency anemia can actually cause or worsen menorrhagia. Iron deficiency may cause the muscles of the uterus to weaken, thereby reducing the ability of these muscles to clamp down on blood vessels, which is necessary to decrease or stop bleeding.  Heavy bleeding may then worsen iron deficiency, which then worsens the bleeding, thus creating a vicious cycle. Therefore, it is very important to access iron-deficiency anemia when treating patients with menorrhagia and supplement with iron accordingly.
• Vitamin A: Research has shown that a deficiency in vitamin A impairs hormone production and enzyme activity in the ovaries of animals.  Although the mechanism of action of vitamin A on blood loss during menstruation is unclear, studies have shown it to have a complex interaction with estrogen. For example, the administration of estrogen has reduced the serum vitamin A levels of these animals. Furthermore, women suffering from menorrhagia have been found to have lower serum levels of vitamin A than healthy women. Note, a deficiency in vitamin C, zinc, protein, or thyroid hormone may impair the conversion of carotenes to vitamin A, thus creating a deficiency in vitamin A.
• B Vitamins: Studies have shown that a deficiency in B vitamins causes the liver to lose its ability to inactivate estrogen, which could theoretically result in an estrogen excess.  Since some forms of menorrhagia are caused by an estrogen excess, supplementation with B vitamins may restore the liver's ability to properly metabolize estrogen, thereby reducing the flow of the period.
• Vitamin E: Reduces capillary fragility and encourages the production of beneficial prostaglandins. 
• Vitamin K: Although a vitamin K deficiency is fairly rare, its role in the manufacture of clotting factors has clear implications for the treatment of menorrhagia. However, vitamin K supplementation has also been shown to eliminate excessive menstrual loss in women without a known clotting disorder, so it may be wise to include this in a treatment plan. 
• Ginger: Menorrhagia is believed to be due to an altered prostaglandin-2 ratio and ginger has been shown to inhibit the enzymes related to this altered ratio: prostaglandin synthetase and cyclooxygenase. 
• Vitex Agnus Castus (Chaste Tree): This may be the best-know herb in all of Europe for managing hormonal imbalances in women. It acts on the hypothalamus and pituitary glands to increase LH production and mildly inhibit FSH release. This results in a shift in the ratio of estrogen to progesterone, thereby helping to reduce menstrual flow. Vitex has also been shown to inhibit the release of prolactin by the pituitary gland, particularly when a woman is under stress. This herb may take 4-6 months to take effect. 
• Other Herbs to Consider:  Shepherd's purse, cinnamon, yarrow 
• Other Supplements to Consider:  Flaxseed oil, fish oil, evening primrose oil (all have been shown to encourage the formation of beneficial prostaglandins).
• Bio-Identical Hormones: These lab-manufactured hormones are derived from Mexican wild yams or soy beans and are biologically identical to the progesterone in a woman's body.  Natural progesterone substitutes for a lack of progesterone due to insufficient ovarian production. It is several times less potent than an synthetic progestin. 
• Treatment for Hypothyroid: Hypothyroidism is a common cause of menorrhagia. This is included  under treatment for DUB because studies have shown reduction in menstrual blood loss in women treated for hypothyroid who had normal thyroid results but showed clinical evidence of the condition. Treatment may include thyroid hormone or relevant natural approaches. 
• Chinese Herbal Formulas:  I have seen great success with  the use of Chinese herbal formulas for the treatment of menorrhagia and will refer my patients to a TCM specialist for additional diagnosis and the use of acupuncture if necessary.

Other Treatment Considerations:

• Acupuncture
• Therapies to integrate body, mind and spirit

Conventional Medical Approaches:

• NSAIDs
• Oral Contraceptives
• IUDs
• Dilation and Curettage (D & C)
• Endometrial Ablation
• Hysterectomy

If you or someone you know is experiencing menorrhagia, please seek a qualified health care provider to begin treatment for this condition. Note: It is important to rule out other causes of menorrhagia before assuming it is DUB.


References:

Center for Endometriosis Care: www.centerforendo.com
WebMD: www.webmd.com
The Merck Manual: www.merckmanuals.com
www.womenshealthzone.com
Medscape: www.medscape.com
Nutritional Medicine: Dr. Alan Gaby, MD
The Complete Natural Guide to Women's Health: Dr. Sat Dharaum Kar, ND
Women's Encyclopedia of Natural Medicine: Dr. Tori Hudson, ND
Fibroids: The Complete Guide to Taking Charge of your Physical, Emotional, and Sexual Well-Being:
     Johanna Skilling  

An Alternative View of Breast Cancer Support: Part I

Breast Cancer Overview:
Breast cancer is the most common cancer of women in North America, with only 1% of breast cancer patients being male. In North America, approximately 1 in 7 women will develop breast cancer at some point in her life. Breast cancer is the second leading cause of death in American women, second only to lung cancer. Fortunately, due to the fact that it is reasonably treatable, the 5-year survival rate is approximately 84%.

What is Breast Cancer?
Cancer cells are often present as much as 10 years before a mass is finally detected.  By the time a breast cancer is detectable, it has grown to at least one centimeter in diameter and consists of one billion cells. Cancer cells go through a process called doubling time, which is the time required for one cell to divide into two cells.  The rate varies from about 21 to 188 days, depending on age and the type of breast cancer. Aggressive cancers have a faster doubling time. Breast cancer in young women tends to be much more aggressive than breast cancer occurring in post-menopausal women.

When palpable, breast cancer is most often felt as a hard, irregular-shaped, non-tender mass that feels as if it is attached to the tissue beneath it. There may be associated nipple discharge, changes in nipple size or shape, swollen axillary lymph nodes, and/or puckering of the skin near the site of the mass.

Risk Factors:
There are a number of risk factors involved in your chances of developing breast cancer. Some are within your ability to modify and some are not.

Non-Modifiable Risk Factors:

• Genetics (BRCA-1, BRCA-2, HER-2)
• Family History of Breast Cancer
• Personal History of Breast Cancer
• Age
• Early Onset of Menses
• Race and Ethnicity
• Certain Types of Fibrocystic Breasts
• Prior Radiation Exposure
• Diethylstilbestrol Exposure (DES)

Modifiable Risk Factors:

• Recent Oral Contraceptive Use
• Hormone Replacement Therapy
• Nulliparous (Never Having Children)
• Having Children After Age 30
• Not Breast Feeding
• Alcohol Use
• Lack of Exercise 
• Overweight or Obesity
• Diet High in Saturated Fat
• A High Glycemic Diet
• Depression
• Exposure to Dopamine Antagonists
• Environmental Toxins
• Night Workers
• Not Sleeping Enough

Types of Breast Cancer:
There are approximately 30 different types of breast cancer, as well as a series of different grades and levels indicating severity. Generally, breast cancer is divided into two categories: Ductal and Lobular. The majority of breast cancers are ductal and this category includes papillary, mucinous, and combination cancers. Paget's Disease and inflammatory carcinoma are examples of breast cancer that are neither ductal or lobular.

Approximately 86% of breast cancers originate in the ducts, whereas 12% start in the lobes, which are located at the end of the ducts. The term "in situ carcinoma" refers to cancer at its early stages, when it is isolated to the immediate area where it originated. With regards to breast cancer, this would refer to the ducts (ductal carcinoma in situ) or the lobules (lobular carcinoma in situ). This type of cancer has not invaded the surrounding fatty tissue in the breast, nor has it metastasized to other organs in the body. If the cancer does move from the immediate area where it began, it becomes described as "invasive".





Non-Invasive Breast Cancers:

Ductal Carcinoma In Situ (DCIS):
DCIS is the most common form of non-invasive cancer, with one-fifth of all new breast cancer cases falling into this category.  DCIS is the presence of abnormal cells inside a milk duct in the breast and is considered the earliest form of breast cancer. It is classified as being Stage 0 due to the fact that it is limited to an immediate area inside the duct. DCIS typically has no accompanying symptoms, although as the ducts clog with cancer cells, you may be able to feel a soft thickening of the breast. As a result, DCIS is almost always found via mammogram, where the image appears to have tightly clustered, irregularly shaped microcalcifications. Although DCIS is not life-threatening, if left untreated, 20-25% of women would develop invasive cancer up to 25 years after the initial biopsy. If tumor necrosis is present, the DCIS is considered more aggressive and is termed "comedocarcinoma". Women who opt for a lumpectomy with radiation have a 5-15% risk of local recurrence. For women having mastectomy, the risk of local recurrence drops to less than 2%. This risk is further reduced by half if women choose to take post-surgical hormonal therapy.  If DCIS is treated with excisional biopsy alone, women have a 30-50% chance of developing an invasive ductal cancer within the same breast. Routine axillary dissection is unnecessary with DCIS, as axillary metastases occurs in less than 5% of patients. Nearly all women diagnosed in  the early stages of DCIS can be cured, with a five-year survival rate of more than 99%.

Lobular Carcinoma In Situ (LCIS):
Although LCIS sounds like a type of breast cancer, it actually is not. Rather, it is a risk factor or marker for a 2.4% higher risk of developing invasive ductal or lobular carcinoma in either breast. LCIS is an uncommon condition, occurring only about 2% of all breast biopsies. LCIS will not become invasive and will not develop into breast cancer, so removing it is not the answer. However, women with LCIS have a 1% per year and up to a 30% lifetime risk of developing an invasive breast cancer. Although the cause of LCIS is unclear, it begins when cells in a lobule of a breast develop genetic mutations that cause the cells to appear abnormal. LCIS is typically discovered as a result of a biopsy for other reasons, and does not usually show up on mammograms.


Invasive Breast Cancer:


Invasive Ductal Carcinoma:
Representing 80% of cancer diagnoses, IDC is the most common form of breast cancer. IDC is cancer that originated in the duct and has now invaded the surrounding fatty tissue of the breast.  As with any cancer, there may be no signs or symptoms. However, signs and symptoms which warrant a trip to the doctor include the following: breast lump (usually feels hard, firm and irregular), thickening of breast skin, swelling in one breast, rash or redness of the breast, new pain in one breast, nipple pain or nipple inversion, dimpling around the nipple or on the breast skin, lumps in the underarm area, changes in the appearance of of the nipple or breast that are differ from the normal monthly changes you may typically experience.  Conventional treatment of IDC is determined by the exact type of cancer and at which stage. Depending on these factors, most women undergo a combination of any of the following: lumpectomy, mastectomy, sentinel node biopsy, axillary node dissection, radiation, chemotherapy, hormonal therapy, biologic target therapy, breast reconstruction.
There are four additional types of IDC that are less common:

• Medullary Ductal Carcinoma: This type of cancer is rare, accounting for only 5% of breast cancer. It is less aggressive, with a five-year survival rate of 82%. This tumor usually shows up on mammogram and can feel like a spongy change of breast tissue rather than a lump.
• Mucinous Ductal Carcinoma: In this type of breast cancer, cancer cells also produce mucous, and the mucous and breast cancer cells come together to form a tumor. The five-year survival rate for this type of breast cancer is 95%.
• Papillary Ductal Carcinoma: This type of cancer becomes invasive only in rare cases and has a five-year survival rate of 96%. It is common among women age 50 and it treated like DCIS.
• Tubular Ductal Carcinoma: This type of cancer is usually less aggressive and accounts for less than 2% of all breast cancers. The five-year survival rate is 96%.

Invasive Lobular Carcinoma: 
ILC is the second most common form of breast cancer in the U.S., representing between 10-15% of all diagnosed invasive breast cancers. This type of cancer is harder to detect on mammogram because of the way it grows. Women with ILC must choose their surgeon carefully. In order for a breast cancer surgery to be successful, the cancer must be cleared from the tissue all the way around the tumor. ILC has a branch-like growth pattern, which makes this more difficult. From a conventional perspective, ILC is treated with a lumpectomy or mastectomy, and treatment may also include radiation, chemotherapy, hormonal therapy and/or biologic targeted therapy. The five-year survival rate of ILC is 84%.

Inflammatory Breast Cancer:
Inflammatory breast cancer is rare, accounting for only about 1% of all breast cancers. It also develops rapidly, making it an aggressive form of breast cancer. This form of cancer forms when cancer cells block the lymphatic vessels in the skin covering the breast, causing the characteristic red, swollen appearance of the breast.  The skin of the breast may also feel warm and have a thick, pitted appearance. Inflammatory breast cancer is considered a locally advanced cancer, which means it has spread from it origin to nearby tissues and possibly to local lymph nodes. It is considered a Stage III breast cancer, which may quickly become stage IV. Due to its presentation, this type of cancer can be confused with mastitis or dermatitis. If you have what appears to be a rash or infection, see your doctor immediately. Conventional treatment of inflammatory breast cancer includes the following: Neoadjuvant chemotherapy, mastectomy, radiation, hormonal therapy, biologic target therapy, mastectomy.  The five-year survival rate of this type of breast cancer is 18%.

Paget's Disease:
Paget's disease is a form of breast cancer that begins in the ducts adjacent to the nipple and spreads to the nipple and then to the areola. It accounts for between 1-5% of all breast cancers, making it relatively rare. The cause of Paget's Disease is unknown, but experts speculate that it is due to an underlying ductal carcinoma, typically DCIS, although it can be associated with an invasive cancer. Sign and symptoms of this type of breast cancer include the following: redness, irritation, crusting, scaling, bleeding, oozing. burning, itching, all of the skin of the nipple and/or areola. Signs and symptoms may also include: a tingling or burning sensation, straw-colored or bloody nipple discharge, a lump in the breast, thickening of the skin of the breast, a flattened or turned-in nipple. A painless mass felt under the reddened area is usually indicative of invasive cancer. Some of these signs and symptoms are similar to eczema and the skin changes may fluctuate early on, giving you the impression that your skin is healing on its own. As a result, women generally have this condition for six to eight months before a diagnosis is made. Conventional treatment includes the following:  Lumpectomy, mastectomy, radiation, hormonal therapy. The five-year survival rate for Paget's Disease is 79%.

Naturopathic Approach to Supportive Breast Cancer Treatment: 
The following list is meant to illustrate some of the tools naturopathic doctors have at their disposal to help women on their journey through breast cancer. It is my professional opinion that breast cancer care requires the combination of traditional as well as alternative medicine, and this list is in no way suggested as a replacement for conventional care.  Furthermore, as it is lacking in crucial information regarding dosage and safety, as well as the fact that some of these supplements may interfere with certain cancer treatments, it is imperative that you work closely with a qualified, licensed naturopathic doctor before starting anything outside the scope of your conventional doctor's instructions.

• Vitamin A: Helps to improve the tissue tolerance of women undergoing chemotherapy or radiation. Cells with a fast turnover time are affected most by chemotherapy and the use of vitamin A results in less damage to these cells, particularly those lining the inside of the intestines and mouth.  Vitamin A is more effective when taken with zinc and adequate vitamin E. 
• Beta-Carotene: Has been shown to reduce the risk of pre-menopausal breast cancer by up to 90%. 
• Vitamin B6: Reduces prolactin levels. Results in higher levels of progesterone, as well as the production of more protective estrogens and less harmful estrogens. 
• Vitamin B12: Can relieve side of effects of certain chemotherapy drugs, including peripheral neuropathy and low white blood cell count.
• Inositol and Inositol Hexaphosphate (IP6): Evidence has demonstrated that IP6 has a positive effect on tumor suppressor genes, such as p53. When inositol is combined with IP6, they enhance the ability of natural killer cells to target cancer cells. 
• Vitamin C: According to the lowest estimates, supplementation with vitamin C can reduce the risk of breast cancer in menopausal and post-menopausal women by 5-10%. Higher estimates suggest that risk could be reduced up to 16% in menopausal and up to 37% in post-menopausal women. Vitamin C also helps to prevent tumor growth and metastasis by assisting white blood cell activity to improve immune system function. Taking vitamin C with bioflavonoids helps the vitamin C to stimulate detoxification of chemicals, toxins, and drugs in the liver.
• Vitamin D3: This vitamin is crucial in the treatment of ER- breast cancer, and very beneficial in the management of breast cancer in general. Vitamin D3 also reduces risk of aggressive premenopausal breast cancer and strongly activates macrophages to destroy tumors.  Low vitamin D status is also associated with poorer breast cancer outcomes, when compared to normal vitamin D levels, including a 94% increased risk of metastases, and a 73% increased risk of death. 
• Vitamin E: Heals damaged tissue, regulates hormones and acts as an antioxidant. Vitamin E as alpha-tocopherol has also been shown to reduce the risk of breast cancer in pre-menopausal women with a family history of the disease. Vitamin E in the form of tocotreinols inhibits both estrogen positive and estrogen negative breast cancer cells.
• Vitamin K: Works synergistically with vitamin C to create fee radicals in cancer cells, which produces hydrogen peroxide, which thereby fragments the DNA, damages the cell membrane, reduces the cell cytoplasm, and eventually causes cancer cell death.
• Astragalus  This herb boost the immune system, thereby helping to improve cancer outcomes. 
• Alpha Lipoic Acid: Reduces the ability of cancer to metastasize or become invasive, as well as reduces the cancer-causing effects of environmental toxins on breast tissue. This should not be used during the active phase of our conventional medical treatments, but during the detoxification and recovery phase.
• Artemesia: Is an effective pro-apoptotic agent that research has shown kills 100 cancer cells for every 1 healthy cell, vs chemotherapy which has been shown to kill 1 healthy cell for every 5 cancer cells.
• žAshwaganda: In vitro studies have shown that this herb reduces cell proliferation and increases apoptosis in ER+ and ER- human breast cancer cells.
• Boswelia:  An anti-inflammatory agent.
• Bromelain: Controls growth and angiogenesis, inhibits invasiveness and growth of tumor cells and helps control progression and metastasis.
• Calcium-D-Glucarate: High risk of cancer has been associated with low levels of this nutrient. Supplementation with calcium-D-glucarate increase glucoronidation in Phase II liver detoxification pathways, which helps to regulate estrogen metabolism, decrease levels of estradiol, and  thereby prevent hormone dependent breast cancer.
• Chromium: This mineral is crucial in the maintenance of blood sugar levels and for maintaining low blood levels of insulin. Women with increased levels of insulin have a threefold increased risk of breast cancer.
• Co-Q-10: Evidence has shown this nutrient to be effective in treating breast cancer in human trials, with evidence of tumor regression.
• Flaxseed Lignans: Has been shown to be significantly effective at preventing the spread of breast cancer and has been shown to reduce the rate of growth of breast tumors.
• Glutathione: The most powerful antioxidant. It is a detoxifier of pollution, heavy metals, alcohol, drugs, pesticides, tobacco, herbicides, xenobiotics, smog, petroleum hydrocarbons, many carcinogens and tumor promoters. This should not be used during the active phase of our conventional medical treatments, but during the detoxification and recovery phase. 
• Grape Seed Extract: Has a profound effect on breast cancer as being an aromatase inhibitor, antiangiogenic and cytotoxic.
• Green Tea EGCG: Antioxidant, inhibits angiogenesis. At higher doses it must be taken with vitamin E to prevent liver and kidney oxidative stress. It has been shown to prevent recurrence of Stage I and II cancers by at least 17%.
• Indole-3-Carbinol (I-3-C) and DIM: Converts 16-hydroxyestrogens (the bad estrogens) into 2-hydroxy forms (the good estrogen). Both I-3-C and DIM have demonstrated an ability to inhibit the growth of breast cancer cells in humans and to stimulate cell death. I-3-C has also been shown to prevent metastasis.
• Iodine: There is an association between iodine deficiency and fibrocystic breasts. Since certain types of fibrocystic changes are associated with a higher risk of breast cancer, raising iodine levels can have a protective effect. Furthermore, iodine is naturally found in the epithelial cells lining the ducts and lobules of the breast and reduces their sensitivity to estrogen.
• Magnesium: Use of this mineral reduced the incidence of malignant breast tumors in rats by 50%.
• Melatonin: Down-regulates estrogen receptors, reduces circulating levels of estrogen and prolactin, blocks estrogen and epidermal growth factors and suppresses tumor fatty acid uptake. Very effective in ER+ breast cancer. 
• Milk Thistle: Helps detoxify the liver and inhibits or modulates epidermal growth factor, which may make it useful in modulating estrogen receptors. 
• Mistletoe: Main properties include DNA stabilization and protection, cytotoxic killing of cancer cells, immune modulating and anti-inflammatory. Mistletoe stimulates the immune system to remove cancer.
• Modified Citrus Pectin (MCP): This is essential for patients undergoing tumor biopsy, surgery or any therapy  that may cause the tumor to shed cells.  MCP helps to prevent metastasis by inhibiting the clumping of cancer cells together, as well as their adhesion to normal cells.
• N-Acetyle Cysteine (NAC):  An essential antioxidant that helps clear the cells of toxins, increase glutathione production and reduce the toxicity of chemotherapy. This should not be used during the active phase of our conventional medical treatments, but during the detoxification and recovery phase.
• Quercitin: An aromatase inhibitor. Use with bromelain for better absorption.
• Resveratrol: Has several anti-cancer properties, including being anti-inflammatory, an antioxidant, and inhibits BRCA-1 mutant cancer cells. It is a phytoestrogen so caution must be used in certain cases as with all phytoestrogens.
• Selenium: Deficiencies of this mineral are linked to higher breast cancer rates. 
• Therapeutic Mushrooms (Reishi, Maitake, Coriolus): All of these mushrooms have properties that are shown to have significant anti-cancer effects, mostly through their ability to activate the immune system in unique ways. 
• Tumeric (Curcumin): Has a number of anti-cancer properties, including being an antioxidant, pro-apoptotic, immune modulator, and anti-angiogenic.  Must be used with bromelain or black pepper to ensure absorption.
• Zinc: Angiogenesis, or the formation of a blood supply to tumor cells, is dependent upon copper. Copper levels can be reduced by taking higher levels of zinc. Therefore, zinc is important in the regulation of angiogenesis and tumor growth.

Supplements to Avoid With Breast Cancer:

• DHEA: Boost IGF-1 and sex hormones.  

Other Considerations: 

• Acupuncture, Ozone Therapy, Nutritional Interventions, Mind-Body Medicine, Meditation, Yoga (Kundalini in particular), Counseling

Your Naturopathic Doctor will work closely with you to determine which supplements would be best for you and your type of breast cancer, as well as what can be done to help you through conventional treatments such as chemotherapy and radiation. 

References:

Berek & Novak's Gynecology; Berek 
Institute of Women's Health and Integrative Medicine- Women and Cancer; Dr. Tori Hudson
Naturopathic Oncology- An Encyclopedic Guide for Patients and Physicians; Dr.Neil McKinney 

The Breast Cancer Companion; Dr.Barbara MacDonald and Dr. Kelly Jennings
The Complete Natural Medicine Guide to Breast Cancer; Dr. Sat Dharam Kaur 

www.hopkinsmedicine.org

www.mayoclinic.com

www.medicinenet.com