What's worse than getting breast cancer? Getting breast cancer twice.

Have you noticed that some women have a recurrence of breast cancer while others don't? One reason for this has been known for a century, yet most doctors — even oncologists — don't talk to us about it. This is unconscionable, because when you understand what can cause breast cancer to return, you can take steps to prevent it from happening.

The reason for relapse was first discovered in premenopausal women. Now, researchers are finding that it applies to some postmenopausal women as well. The explanation has to do with a phenomenon that occurs after surgery. For some women, surgery is both the solution and the problem. It removes the tumor, but it causes others to grow!

How surgery affects breast cancer relapse

Any injury — including surgery — stimulates blood vessel growth. This development of blood vessels, called angiogenesis, is a normal reaction to tissue trauma. Angiogenesis is not just helpful, it's a major function in healing. It carries an increased blood supply to a damaged area so it can repair itself more quickly.

But surgical wounding from breast cancer surgery is different, especially for younger women with positive lymph nodes. Blood vessels in a small but significant number of these women often grow at a greatly accelerated rate after the primary tumor has been removed.

At the same time, surgery "wakes up" dormant cancer cells. You see, breast cancers go through periods of being temporarily dormant. Surgery can interrupt this dormancy. Suddenly, these fast growing blood vessels become a food supply for hungry cancer cells.

This phenomenon occurs most frequently in premenopausal women. Why? We think it may be because their hormones "turn on" an angiogenic switch. If this is the reason, postmenopausal women on hormone therapy may be more at risk for a relapse after breast cancer surgery than women who are not taking hormones.

The angiogenesis theory has been tested in mice injected with lung cancer cells. One hundred percent of these mice had no growth in cancer cells as long as the primary tumor remained. Nor were additional blood vessels formed. But as soon as the main tumor was removed, their lung cancer cells began to grow rapidly.

Explaining the angiogenic surge

Early relapse is often triggered by surgery when single dormant cells are stimulated, resulting in angiogenesis and tumor growth. For small primary breast tumors, 50 percent of all relapses fall into this category. For larger tumors, this accounts for 75-83 percent of relapses.

A number of factors could be responsible for this sudden increase in blood vessels. You probably realize by now that every function in our body contains checks and balances. There are signals that generate the production of blood vessels, and signals that slow them down. It's possible that surgery removes the signals that slow down angiogenesis, allowing blood vessels to multiply.

Or, surgery could increase blood vessel stimulators or growth factors that "turn on" cancer cells. This would cause temporarily dormant cancer cells to wake up and attach themselves to blood vessels in a feeding frenzy, producing rapid tumor growth.

Whatever the mechanism is, there's a strong connection between increased blood vessels after breast cancer surgery and a relapse. However, there are some steps you can take to prevent a recurrence.

(1) Look for angiogenesis

Breast thermography shows changes in heat in your breasts. Mammograms don't. Since blood vessels emit heat, increased blood vessel activity can be detected easily with thermography. Get a thermogram one month after surgery, and every three months for the next six months. Repeat thermograms twice a year for the next two years.

(2) Stop angiogenesis

The best way to stop angiogenesis is to take modified citrus pectin (PectaSol) as soon as you can after surgery. It not only stops angiogenesis, it also keeps cancer cells from clustering. Chances are there are at least a few tiny cancer cells floating around after surgery. If you can keep them from forming into a tumor, they'll die. PectaSol is the singular most important nutrient I know of for all kinds of cancer. It's especially useful after surgery, but you can also take it as a preventive. PectaSol is the only modified citrus pectin product that has been rigorously studied in scientific studies.

(3) Avoid synthetic hormones

I've been talking about the dangers of hormone replacement therapy (HRT) for years. We already know estrogen and progestin increase your risk of breast cancer. If you've been on HRT and you have breast cancer, it's quite possible the hormones were the cause. In July 2003, the Women's Health Initiative (WHI) hormone study was stopped because the researchers found that HRT significantly increased your risk for breast cancer. We also know that when this breast cancer is diagnosed, it's at a more advanced stage.

While this new study doesn't prove hormones cause the breast cancer relapses, it does indicate that as a possibility. If you have breast cancer and take HRT, you need to stop taking it. Work with a doctor to get you off of these drugs and onto something far safer.

The best way to go is to avoid hormones altogether. But if you must take hormones, work with a doctor who understands natural hormones and monitors you very closely. Natural hormones are much safer than synthetic. For more information on this, read my articles from May and June 2001 on my website. In those articles, I give you all you need to know about hormone replacement.

(4) Consider additional treatment, including chemotherapy

I'm not a big fan of chemo, especially for older women. This is because chemotherapy doesn't work as well with us as it does in laboratory cell tests or on laboratory animals. However, researchers think that during this sudden burst of angiogenesis, these newly-awakened cancer cells are more sensitive to chemotherapy than usual. If you're going to use chemotherapy, this could be the best time to use it.

After breast cancer surgery, you have a window of time when chemo works best to delay a relapse or cure you. Within six months after surgery, some chemotherapy drugs have reduced relapses by 80 percent! As time goes on, this percentage decreases. Studies show that this is of some value to any woman who has had positive lymph nodes.

Always monitor chemotherapy's effectiveness with thermograms. They can tell you whether or not the drug you're taking is working.

Retsky, M., et al. "Hypothesis: Induced angiogenesis after surgery in premenopausal node-positive breast cancer patients is a major underlying reason why adjuvant chemotherapy works particularly well for those patients," Breast Cancer Research, 2004, May 14, 2004.

Retsky, M., et al. "Breast cancer screening: controversies and future directions," Curr Opin Obstet Gynecol, February 2003.

Is This Weight Loss Product Too Good to Be True?

The worst time to order a miracle cure is when you're feeling desperate. You're likely to be disappointed in the results. I've watched this happen with friends and patients over the years with complicated medical problems. And I've seen it over and over again with people looking for that magic bullet to help them lose weight.

We're particularly vulnerable to wild claims each year after any New Year's resolutions to exercise more and eat better have been broken. That's when people look for a quick fix. I received news about one recently that I'd like to warn you about. It's an expensive weight loss product with little evidence to show that it works.

The product sounds remarkable!

The literature said I could lose weight without changing what I ate or exercising. I read the information carefully several times, but I could find no list of ingredients. What was this miracle substance?

So I put on my "Health Detective" hat and went to the Internet to do a quick search, just to satisfy my curiosity. Silly me. Two hours later, I still had no information either on the product's ingredients, the medical doctor who sent me the mailing, or the chiropractor who is the clinical director of this doctor's weight loss clinic.

Further searches (sometimes I just can't stop!) led me to letters from people who had also tried to track down this doctor, his clinic, and the product. One woman was on vacation in a nearby town and was so impressed with the information she'd received that she decided to stop and meet the doctor behind the product.

His address was a post office box. The attendant told this woman that she'd heard a lot of complaints about the product and knew of people who wanted their money back. Good luck!

I did eventually manage to find the name of the clinic that sold this weight-loss product and sent them a request for their ingredients and for copies of the studies they claimed had been done on their products. It turns out that the main ingredient in this weight loss pill is chitosan, made from shellfish skeletons.

Now, bear with me, because this is an important point. The product's website says this product is "100% natural, safe...." But because chitosan is made from shellfish shells, the e-mail from someone at the clinic warned that people allergic to shellfish shouldn't take it. Doesn't sound 100% safe to me! And shouldn't this in-formation be in their literature and on their website?

The other ingredients for this miracle weight-loss product are gelatin, maltodextrin (a simple sugar), and silicon dioxide (silica, found in quartz and beach sand). There's nothing here that indicates the formula has superior qualities to help you lose weight.

Chitosan and weight loss —a match or a miss?

Chitosan has been used to help lower cholesterol, and there are some studies that suggest it does. But can it really help with weight loss? An Australian randomized, double-blind, placebo-controlled study, published in the International Journal of Obesity, says it doesn't.

The researchers gave three grams of chitosan a day to 125 overweight people for six months. An equal amount took a placebo. While the people taking chitosan did lose weight, compared with those on a placebo, the amount of weight they lost was negligible. The researchers concluded that the "chitosan treatment did not result in a clinically significant loss of body weight compared with placebo."

Here's the theory behind the supplement, and why some people are selling it as a miracle cure: Chitosan binds to fats and prevents them from being digested and absorbed. The trouble is, you need a huge amount for it to do much good.

I located a study that said the amount of fat being blocked by a daily dose of chitosan was insignificant. This study claims you would have to take 10 capsules of chitosan to increase fat excretion — and block its absorption — by just one gram! That's right! Ten capsules of this product save you nine calories!

To be fair, I did find one study showing that taking six capsules of chitosan resulted in a three-pound weight loss over two months. The women all ate a diet where more than 30 percent of their calories were from fat. The company that sells the product funded this study. A one-month supply of this product will set you back $60 plus shipping costs.

Looking further, three other studies found no significant difference in weight loss in people who used chitosan over those who took a placebo.

(By the way, I discounted a study on weight loss and chitosan that appeared in a toxicology journal, because it wasn't a journal on weight loss or nutrition that's been reviewed by experts in the field.)

If chitosan does block fat absorption, it blocks oil-soluble vitamins A and E as well. In a rat study, it also blocked the absorption of calcium, magnesium, and iron.

Bottom line

We don't have enough information to say that chitosan is both safe and effective as a weight-loss supplement. It certainly isn't a cost-effective method.

The British Advertising Standards Authority agrees. It has asked British advertisers of products containing chitosan to state that this ingredient hasn't been proven to help lose weight. I guess they don't consider the study paid for by a company selling chitosan to be sufficient proof.

In this country, the FDA keeps warning companies to stop their overblown — and inaccurate — claims for chitosan and weight control. But it seems that as soon as one company stops selling chitosan for weight loss, another starts up.

So here's my suggestion. Don't buy anything when you're feeling desperate. Take your time to research it, first. When something sounds too good to be true, it often is. Read advertising copy carefully before you buy. Look at the ingredients and make sure there are good, sound, scientific studies, preferably on humans, to back up any claims that are being made.

Better still, buy only from reputable companies with easy-to-find phone numbers for customer service. All supplements I talk about in Women's Health Letter have been carefully scrutinized, whether they're sold through this newsletter, by mail, or in health food stores. I stand behind every supplement I mention. Some of them can even help promote weight loss. But not if you eat a diet high in fats and refined carbohydrates and don't exercise.

Barrett, Stephen, MD, "Is chitosan a 'fat magnet'?" Quackwatch, Inc, (www.quackwatch.org).

Mhurchu, C. Ni, et al. "The effect of the dietary supplement, Chitosan, on body weight: a randomized controlled trial in 250 overweight and obese adults," International Journal of Obesity, September 2004.

Schiller, R.N., MS, CN, et al. "A randomized, double-blind, placebo-controlled study examining the effects of a rapidly soluble chitosan dietary supplement on weight loss and body composition in overweight and mildly obese individuals," Journal of the Amer Nutrac Assn, Spring 2001.

The Free Solution to Your Fatigue and Depression

Being around my friends calms me down and gives me energy. That hasn't always been true. In the past, I had some friends and other people in my life who drained me. I didn't understand that they were robbing me of energy and contributing to my fatigue.

My fatigue led to depression and a suppressed immune system that ended in frequent colds and flu. Since then, I've gently extricated myself from them and my energy and overall health have both improved.

The relationship of energy to our health is no longer "woo woo" medicine. It's now being studied scientifically. Energy medicine is being more widely accepted — and utilized — by acupuncturists, homeopaths, and doctors of integrative medicine.

The National Institutes of Health (NIH), which doesn't throw our money around frivolously, is now funding centers at several universities to study energy therapies. Sloan-Kettering hospital in New York City is one of dozens of hospitals that uses energy-healing programs for both patients and staff. Yes, energy medicine is here to stay.

But using such therapies as acupuncture, homeopathy, yoga, or tai chi isn't enough. You'll always be depleted if people in your life are draining you. If you tend to be tired or depressed, look beyond your diet and supplements. See if some of how you feel is coming from the people in your life and how you handle them.

Create personal space

Dolores is a patient of mine who lives with her daughter, son-in-law, and grandchildren. The boys are young and active. The house is full of their chaotic energy and Dolores often feels exhausted after being around them.

She loves her grandchildren, but complained of being tired all the time. Dolores had no place to go to get away from the boys because her bedroom had been piled high with her belongings ever since she moved in several years ago.

The first homework I gave Dolores was to clean up her bedroom and make it a calm refuge. After just beginning a long cleaning-up process, Dolores' eyes now sparkle when she comes in for an appointment and she's much less tired.

Make sure you have some place you can go to when you need to be quiet.

Create boundaries

Some people are eternal victims. They blame others for whatever's wrong in their lives. They concentrate on their problems rather than on any solutions. They sound like a broken record, repeating their problems over and over. Afterward, they feel energized and you feel exhausted. What can you do?

Set boundaries to prevent them from exchanging your energy for theirs. For instance, set limits on how long you'll listen to their complaining, and excuse yourself from the conversation when you hit that limit. I know. It's not easy. But give it a try because it gets easier the more you do it.

You may not be able to do this at work. But after listening to a complaining co-worker for a few minutes, you can tell him or her you need to get back to work.

Put a time limit on your conversations with victims or people who want you to fix their problems.

Breathe deeply

Then there are people who talk and talk and talk. They just won't stop. Their talking doesn't seem to tire them, but it wears you out. If you can, just excuse yourself and say you need to use the restroom.

If that fails, it's time to take a deep breath. Smile at the person and take the opportunity to concentrate on your breathing. Pay attention to your breath going in and out. Breathe deeply and slowly. Don't allow their one-sided conversation to irritate you. The longer the person talks, the calmer you will become. And the more energized.

Deep breathing calms you and removes you from annoying talkers when there's no other escape.

Walk away

Many years ago, I had married friends who bickered in public. Once, at a dinner party with another couple, they made derogatory remarks about one another throughout the evening. It was miserable for all of us.

Arguing spreads depression to everyone in the room. When you recognize that someone else's bad mood or arguing is making you feel depressed, walk away from them. Go outside, go to a different room, or go to the restroom if there's nowhere else to go!

Pay attention to how you feel when you're around different people. If you notice your energy getting low, or you start to feel a little depressed, identify the cause and change the way you handle yourself. The changes you make can boost your mood, your overall energy, and your health.

Nutrition Detective

Selenium's Role in Preventing Heart Attacks

Periodically, I'm asked if we really need to spend our money on vitamins and minerals. And periodically, I answer, "yes." Even on an ideal diet (and who among us is on an ideal diet?), we're not getting everything we need. Take selenium, a mineral that has been linked to cancer when there's a deficiency. Even if you're on an extremely healthy diet, you're probably not getting enough selenium — unless you're taking a supplement.

A new study is showing that selenium lowers homocysteine and helps prevent heart problems in older people. I'm getting older, so this interests me!

High homocysteine is a risk factor for heart disease. When a group of doctors in Spain measured blood selenium levels along with homocysteine levels, they found that the people who had the highest selenium had the lowest risk for heart disease. Selenium comes from the soil. Good soil. Even in Spain, soil has been depleted of important nutrients. This one little mineral could mean the difference between getting heart disease and staying healthy. My advice: take a multivitamin/mineral with 200 mcg of selenium (such as Vitality Plus, 800-728-2288). This amount has been found in the past to be protective against cancers, and will protect your heart as well.

Gonzalez, S., et al. "Serum selenium is associated with plasma homocysteine concentrations in elderly humans," J Nutr, 2004 July.

New Information on Alcohol/Osteoporosis Connection

This is an age-old question. One study says "yes," while another says "no." If only we could clone people in studies, perhaps then we'd finally know. One person could drink alcohol while its clone would not. Oh ... this has just been done. Not with clones, but with identical twins!

Forty-six pairs of identical twin women were separated into two groups: women who had eight drinks a week and controls who drank little or no alcohol. Their bone density was checked both at their hip and spine. The twins who drank had significantly denser bones. Researchers believe that alcohol might actually improve the micro-architecture of bone — building better bones.

Some people have argued in the past that drinking could lead to more falls and fractures. This is unlikely with one drink a day, say the researchers, whose study was published in the Annals of the Rheumatic Diseases.

I'm not suggesting that you drink to improve your bones, if you don't already. But if you enjoy one glass of wine or a cocktail a day, I won't tell you to stop.

Ask Dr. Nan

Q: You've said that Usnea barbata is an herb that strengthens the lungs, but you don't say how long to take it. Can you help? — L.V., New York, NY

A: The length of treatment depends on your age and physical condition. It also depends on the severity of your lung problems. I use Usnea prophylactically to prevent lung infections in patients who are prone to getting them. In this case, one dropperful a day for six months usually works. By the way, this is an excellent time to strengthen your lungs. Don't wait until next fall just before old and new viruses hit us.

For the onset of an acute infection — a cold or bronchitis — I suggest taking one dropperful of Usnea every hour for one to two days. Then, you can take it three times a day until all signs of the cold are gone. I always use the tincture from HerbPharm (800-348-4372).

Q: A Harvard research team tested dozens of supplements containing resveratrol and found that only one, Longevinex, activated the crucial SIR2 enzyme. Is it better than other formulas, such as Resveratrol Plus from Women's Preferred? — G.B., e-mail

A: SIR2 is not an enzyme, but a protein gene that has been found to extend the life-span of yeast, worms, and flies. In fact, that's precisely what the study you referred to examined. Humans don't have the SIR2 gene. Instead, we have a similar gene called SIRT1. We know that in mice, SIRT1 increases fat metabolism and reduces the formation of new fat cells. But right now researchers are saying it's too early to know just what effect SIRT1 has on humans.

Many grape seed extracts have been shown in scientific studies to have significant antioxidant activity. Some, but not all, of this activity is attributed to resveratrol. While I think that the report you mentioned is interesting, it's not conclusive. Until I have more information from additional studies, I still recommend any good resveratrol product, including Longevinex and Women's Preferred.

Lindsay, Caroline. "Sir2 Protein: an important link in aging and metabolism," online.

Singer, Emily. "Red wine chemical extends life – in yeast," NewScientist.com news service, August 24, 2003.

Q: I take a medication for high blood pressure. Can I also take a potassium supplement? How much potassium should women get each day? — J.M., e-mail

A: When you're on any medication at all, check first with your doctor or pharmacist about increasing any supplement beyond the amount found in a good multivitamin/mineral. You want the proper balance of nutrients, not just a lot of one vitamin or mineral.

That said, potassium is very safe. Toxicity levels begin when you take more than 18 grams a day. This translates into 18,000 mg. Most supplements contain 99 mg. Unless you have kidney disease, 99-300 mg is considered safe. Stick with 99 mg unless you're told you need more.

One reason for limiting extra potassium is that this mineral works closely with sodium and chloride. The three are electrolytes — substances that conduct electricity and help regulate our blood pressure, among other things and must remain in balance. You can read my full take on potassium on my website (http://www.womenshealthletter.com). Simply visit the archives, then login and go to the August 2001 issue.

Lieberman & Bruning. The Real Vitamin & Mineral Book, Avery Publishing, 1990.