Nutrition and Fibrocystic Breast Disease

Nutrition and Fibrocystic Breast Disease

Beth Fontenot

Is there a connection ?

Women diagnosed with fibrocystic breast disease (FBD) and experiencing its uncomfortable symptoms may find themselves bombarded with all manner of nutritional advice: No coffee. No cola. No chocolate. Take evening primrose oil. Take flaxseed oil. Take vitamin E. Take vitamin A. Don’t take vitamin A. Drink an herbal tea. Avoid herbal teas. Take natural hormones. Limit fat and sodium. Take iodine. Take vitamin [B.sub.6]. Eat raw foods. Try some coenzyme Q10. Rub evening primrose oil on your breasts! What’s a woman to believe?

FBD is essentially the presence of benign breast lumps (cysts). They can often be felt in the breast and can fluctuate with the menstrual cycle. The condition may become progressively worse until menopause. Pain and swelling are the most common complaints, and the discomfort increases as menstruation approaches. The symptoms usually subside once menstruation begins. It is estimated that 30% of American women have FBD. Relatively few women with FBD develop breast cancer.

The cause of FBD is unknown but is believed to be related to hormonal stimulation. In particular, excessive amounts of estrogen, the main female hormone, and prolactin, the milk-release hormone, have been implicated. Dietary factors have also been traditionally thought to be a factor. The most common advice given to women is to avoid caffeine and to take supplemental vitamin E.

Is E the Key?

Early research on the effectiveness of vitamin E against FBD seemed promising, but clinical trials in the past few years have not backed up the original optimism. In the 1960s a study published in the New England Journal of Medicine (272:1080-1081) suggested that vitamin E was beneficial in the treatment of FBD, and studies that followed appeared to confirm that belief. However, since then several better-designed studies have cast doubt on vitamin E’s ability to provide relief for women with FBD.

In a double-blind, randomized, placebo-controlled trial of 128 women, published in 1985, researchers concluded that vitamin E had no effect on FBD (Obstet Gynecol 1985 Jan; 65[1]:104-106). Later that year, another study of 73 women confirmed those findings (Surgery 1985 Apr; 97[4]:490-494). More recently, a double-blind, placebo-controlled crossover study of 105 randomly selected patients with FBD also indicated that vitamin E was not beneficial in the treatment of FBD (Surgery 1990 May; 107[5]:549-551).

Despite these findings, vitamin E is still commonly recommended for treating FBD. Some health professionals recommend doses as high as 1,500 IU a day. But at high doses, vitamin E can interfere with blood clotting. This could increase the risk of excessive bleeding and could be especially dangerous in people who are taking anticoagulant drugs or herbs that act as a blood thinner (like Ginkgo biloba).

Some women with FBD do report favorable results when taking vitamin E. But in the studies cited above, many who took a placebo also reported favorable results. The bottom line? It is unlikely that vitamin E is an effective treatment for FBD.

Caffeine and More

Avoiding caffeine or, more specifically, foods containing methylxanthines also seems to be standard advice for a woman with FBD. (Methylxanthine-containing foods include coffee, tea, caffeinated soft drinks, and chocolate.) This advice was apparently based on one uncontrolled clinical study. According to several more recent studies, however, caffeine may not be the culprit after all.

A case-control dietary study published in the late 1970s included 854 women diagnosed with FBD. The researchers found no association between coffee or methylxanthine consumption and FBD (JAMA 1985 Apr 26; 253[16]: 2388-2392). At least two subsequent studies agreed with these findings (Surgery 1986 May;99[5]:576-581; Surgery 1987 Jun;101[6]:720-730). So the best available evidence suggests that cutting out caffeine won’t help with FBD.

Vitamin A has also been suggested as a treatment for FBD. In a single study, 12 women who were treated with 150,000 IU of vitamin A daily for three months showed improvement in symptoms, leading the researchers to conclude that vitamin A may be effective for FBD (Prev Med 1984 Sept;13[5]:549-554). But the study was too small to support any such conclusion. In addition, that amount of vitamin A is 30 times the Daily Value, and women of childbearing age should limit their intake of vitamin A to 100% of the Daily Value or about 5,000 IU due to the potential for birth defects.

Evening primrose oil has received some attention as an FBD treatment. A British study of 200 women was conducted to evaluate its effectiveness. This randomized, double-blind trial showed a slightly lower–but not significant–incidence of cyst formation in the group given evening primrose oil (Ann N Y Acad Sci 1990;586:288-294). Other studies are needed before we can conclude that evening primrose is any help.

Some believe that a low-fat diet may help to prevent or treat FBD. Studies indicate that the risk of developing FBD rises with an increased intake of fats, particularly saturated fats. When dietary fat is reduced to 20% of calories, blood levels of the female hormones estrogen and prolactin also decrease. A reduction in these hormones is linked to a decreased risk of developing cancer, but the relationship to FBD is not certain.

While there is much published research and an abundance of anecdotal evidence, there seems to be little solid information about the relationship between diet and FBD.

There is no scientific evidence that any dietary manipulation or supplementation is effective as a preventive or treatment for FBD. Until more is known, it seems prudent for women with FBD to follow a low-fat, nutrient-dense diet.

Beth Fontenot is a freelance nutrition writer and the Nutrition Coordinator on the faculty of the Louisiana State University Medical Center-Shreveport Family Practice Residency Program at Lake Charles Memorial Hospital in Lake Charles, LA.

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