Foods to eat and avoid during tamoxifen treatment

 Tamoxifen (Nolvadex) is effective in preventing and treating estrogen receptor-positive (ER+) breast cancer. Women who complete their prescribed anti-estrogen treatments have been found to have better recurrence and survival profiles than women who do not. There are some foods that appear to enhance the effectiveness of tamoxifen treatment and others that reduce it.

Tamoxifen is associated with higher risk of endometrial cancer for women who have not had a hysterectomy and higher risk of developing blood clots, among other side effects. However, there are some foods that can protect against endometrial cancer and blood clots while not interfering with tamoxifen's effectiveness.

Certain selective serotonin reuptake inhibitor (SSRI) antidepressants such as Paxil (paroxetine) and Prozac (fluoxetine), as well as the serotonin antagonist and reuptake inhibitor Oleptro (trazodone), have been found to interfere with tamoxifen treatment in some women. However not all studies have found a link. Exposure to light at night suppresses melatonin production, which in turn can lead to tamoxifen resistance. Regular aspirin use appears to enhance the effectiveness of tamoxifen. Preliminary evidence suggests that long-term tamoxifen use might increase the risk of macular degeneration.

Tamoxifen and body weight

There is some evidence that overweight women have a more favorable prognosis than normal weight women after tamoxifen treatment. However, one study reported that secretions from adipose stem cells of obese women were able to counteract the treatment effects of tamoxifen, suggesting that being overweight could contribute to tamoxifen resistance. In addition, weight gain, which is common during tamoxifen treatment, has been found to be associated with less favorable prognosis.

Tamoxifen and cholesterol

Breast cancer typically eventually develops resistance to tamoxifen. Using tamoxifen can reduce cholesterol levels, which can rebound at the end of tamoxifen treatment. There is some evidence that breast cancer cells that don't respond to tamoxifen may be using cholesterol to shield themselves against the drug. While it is not clear that reducing dietary cholesterol would greatly affect this process, it may make sense for breast cancer patients on tamoxifen to reduce their cholesterol to low-normal levels.

Tamoxifen might increase risk of type 2 diabetes

It has been reported that tamoxifen use in breast cancer survivors is associated with an increased risk of type 2 diabetes. This risk may be higher in women who have other risk factors for diabetes.

Vitamin D and other micronutrients influence tamoxifen treatment

Vitamin D has been shown to inhibit the growth of tamoxifen-resistant breast cancer cells in the laboratory and resveratrol has been found to reduce their proliferation. Selenium and conjugated linoleic acid (CLA) may enhance the effectiveness of tamoxifen, whereas vitamin C, vitamin E, red clover and tangeretin have been shown to reduce it. In addition, brassica vegetables contain sulforaphane, an histone deacetylase (HDAC) inhibitor that may cause a synergistic increase in apoptosis and cell death in combination with tamoxifen

Foods that enhance the effectiveness of tamoxifen treatment

The following foods (or major components) have been found to increase the anti-breast cancer effects of tamoxifen treatment:

Arctic char Artichokes Arugula Bell peppers Black cumin Black pepper Blackberries Blueberries & bilberries Bok choy Broccoli & broccoli sprouts Brussels sprouts Buckwheat Butternut squash Cabbage Cantaloupe Carrots Cauliflower Celery & celery hearts Cherries, especially sour or tart Chicken, organic, but not chicken livers or skin Chives Cilantro Coffee Collard greens Cranberries & lingonberries Currants, black Flaxseed & flaxseed oil Garlic, fresh Ginger Grapes & grape juice, red

Green tea Herring Horseradish & wasabi Hot peppers Kale Kefir Lake trout Lemons Limes Mackerel Mushrooms Mustard Mustard greens Olive oil, extra-virgin & olives Onions, green or red Parsley Pomegranates & pomegranate juice Pumpkins Raspberries Rice, brown, black or purple Salmon, wild Sardines Seaweed, brown Strawberries Tomatoes Turkey, organic Turnips & turnip greens Walnuts & walnut oil Watercress & garden cress Zucchini

Foods and supplements that should not be used during tamoxifen treatment

The following foods (or major components) and supplements have been found to reduce the effectiveness of tamoxifen and should be avoided during tamoxifen treatment:

Alcohol Apigenin supplements Clementine juice Curcumin or turmeric supplements Genistein, daidzein or equol supplements Goldenseal supplements Grapefruit High protein diet HRT, combined (estrogen plus progestin) I3C or DIM supplements L-carnitine supplements Orange or tangerine peel- found in orange tea, orange marmalade, Szechuan Orange Chicken

Red clover supplements Red meat Sesame seeds Si-Wu-Tang supplements Skullcap supplements Soy foods, especially soybeans, soy protein isolate, soybean paste St. John’s Wort supplements Suan-Tsao-Ren-Tang supplements Tangeretin supplements Vitamin C supplements Vitamin E supplements

There is abundant cell and animal study evidence that the curcumin found in turmeric can enhance the effectiveness of tamoxifen. However, curcumin supplements can interfere with treatment with tamoxifen because they potentially provide curcumin at pharmacological (rather than chemopreventive doses). See Tamoxifen and curcumin binding to serum albumin in the study list below.

There is also some evidence that exposure to bisphenol A (BPA), parabens, or cigarette smoking could interfere with the effectiveness of tamoxifen treatment.

Foods that reduce the risk of endometrial cancer

The following foods (or major components) have been associated with lower risk of endometrial cancer while also protecting against breast cancer:

Arugula Bell peppers Black pepper Black tea Brazil nuts Broccoli Brussels sprouts Carrots Cherries, sour Collard greens Garlic Green tea Herring Honey, minimally processed* Hot peppers Kale Lake trout Leeks

Lettuce, romaine Mackerel Mustard greens Onions Pomegranates & pomegranate juice Pumpkins Raspberries, especially black Saffron Salmon, wild Sardines Seaweed Tomatoes Turnip greens Walnut oil Watercress Watermelon Zucchini

*In moderation.

Foods that increase the risk of endometrial cancer

The foods and supplements listed below have been associated with increased risk of endometrial cancer. Sweets and other foods with high glycemic index, as well as animal fats, have been shown to increase the risk. Exposure to cadmium is associated with increased risk. Foods with high acrylamide content, such as French fries, cereal, potato chips, potatoes, and baked goods, have also been shown to increase risk of endometrial cancer.

Bacon

Beef

Bread, baguettes & croissants

Butter

Cheese, full fat

Cookies, candy and cake

Fried ripe plantains

Genistein & daidzein

Granola

Milk, whole

Potatoes, potato chips & French fries

Shellfish

Sugar

Sweet desserts

Sweetened breakfast cereals

Well done or fried meat

White rice

Long-term electric blanket use has also been found to be associated with increased risk of endometrial cancer and should be avoided.

Foods that reduce the risk of blood clots

The foods below have been reported to decrease the likelihood of blood clots while protecting against or being neutral with respect to breast cancer risk.

Garlic

Herring

Honey, minimally processed

Lake trout

Mackerel

Saffron

Salmon, wild

Sardines

Strawberries

Walnuts & walnut oil

Foods that reduce cholesterol

The following foods have been shown to improve cholesterol profile while at the same time protecting against breast cancer:

Apples Artichokes Bell peppers Blueberries Broccoli Brown rice Brussels sprouts Buckwheat Cabbage Carrots Celery Cherries Cranberries Cucumbers Dry beans

Fatty fish Flaxseed oil Grapes Greens Horseradish Hot peppers Kale Lettuce Mushrooms Olive oil Pomegranates & pomegranate juice Seaweed Walnuts & walnut oil

Foods that increase cholesterol

The following foods have been shown to worsen cholesterol profile:

Bacon

Beef

Butter

Caviar

Cheese

Coffee

Milk, whole or cream

Partially-hydrogenated oil

Pork

Additional comments

Tamoxifen is a selective estrogen receptor modulator (SERM), down-regulating ERα but not ERβ (in contrast, aromatase inhibitors such as Arimidex up-regulate ERβ). Tamoxifen is effective in preventing ER+ breast cancer and in treating early stages, but this effectiveness may be lost over time if the cancer progresses despite treatment. Also, tamoxifen does not prevent ER- breast cancer. Women who develop primary breast cancer or a recurrence despite tamoxifen treatment are at increased risk of developing ER- breast cancer, a more aggressive disease than ER+.

Therefore, it is important for women being treated with tamoxifen to eat a wide variety of the foods from our recommended list and limiting or avoiding those on our avoid list, in addition to paying particular attention to the foods listed above. Please see our article on how to optimize your breast cancer diet for information on what to eat during all stages of treatment and recovery.

Below are links to recent studies on this topic. For a more complete list of studies, please click on tamoxifen diet.

Fonte: Food for Breast Cancer

As informações e sugestões contidas neste blog são meramente informativas e não devem substituir consultas com médicos especialistas.

É muito importante (sempre) procurar mais informações sobre os assuntos