1 in 8 women in the world will be diagnosed with breast cancer in her lifetime, which makes it the most commonly diagnosed cancer in women. It is also the second leading cause of cancer death among women of all ages.
Breast cancer is often diagnosed by receptor type; and terms such as estrogen receptor-positive, progesterone receptor-positive, HER-2 positive, triple-negative, triple positive are used to denote these receptor types. These diagnoses (made after biopsy or examining tissue from surgery) are helpful in identifying the aggressiveness, hormone sensitivity, and many other factors in breast cancer.
Hormone receptor status refers to breast cancer cells that have certain proteins that are estrogen or progesterone receptors. Breast cancer cells can have one, both, or none of these receptors. If you are hormone receptor-positive, then hormone therapy such as estrogen that blocks these receptors or lowers hormone levels is used.
About one in five women with breast cancer have tumors with a higher level of a protein known as human epidermal growth factor receptor 2–positive (HER2/+), often referred to as HER2. This is known as HER2-positive breast cancer. HER2 is a growth-promoting protein that promotes more aggressive cancer growth. Drugs such as Herceptin are often used as part of conventional treatment for HER2 positive breast cancer.
Triple-positive breast tumors are estrogen positive, progesterone positive, and HER2 positive.
The term triple-negative breast cancer means that breast tumors are not HER2 positive and do not have estrogen or progesterone receptors. This type of breast cancer grows and spreads more quickly than hormone-positive breast cancers. Hormone therapy and HER2 drugs are not indicated, although other treatments can be used.
According to the data, the majority of breast cancers are actually driven by hormones, about 80% of them are Estrogen-Receptor positive and 65% of them are Progesterone-Receptor positive. (ER/PR positive).
DIM - Anti-cancer and other biological effects
Thus for breast cancer, it's important that the diet should have organic vegetables from the cruciferous family. These include broccoli, cauliflower, kale, Brussels sprouts, cabbage, bok choy, turnips, collard greens etc. This group of vegetables are rich sources of dietary bioactive compounds, namely, indole-3-carbinol (I3C) and its major metabolite 3,3ʹ-diindolylmethane (DIM). When you eat cruciferous vegetables, your stomach acid breaks down a compound called indole-3-carbinol to produce a new compound called DIM.
There are some observational studies that associate high cruciferous vegetable intake with a reduced risk of certain cancers, including breast and prostate cancer. While the exact mechanism is unknown, I3C/DIM is thought to be partly responsible.
DIM has a direct effect on the hormone estrogen and how it is metabolized. Estrogen has many beneficial activities in the human body: regulating the growth and development of reproductive organs, controlling the growth of the uterine lining, assisting in the promotion of fertilization and pregnancy, maintaining the normal structure of skin and blood vessels, maintaining bone structure, and regulating various metabolic processes. However, excessive prolonged exposure to estrogen is also associated with serious health problems. Women with higher levels of estrogen circulating in their bloodstreams have a higher incidence of breast cancer. Also, certain estrogen metabolites are directly linked to the development of several types of cancer.
Although research on DIM is still quite limited, it’s thought to help balance estrogen levels in your body. Specifically, DIM may stimulate the production of a less potent, more beneficial form of estrogen known as 2-hydroxyestrone. It may also help reduce the effects of a stronger form called 16 alpha-hydroxyestrone, which has been linked to weight gain and an increased risk of some cancers, including breast and uterine cancer. Additionally, DIM has been shown to inhibit an enzyme called aromatase, which converts testosterone to estrogen.
Scientists have discovered that 2-hydroxyestrone, one of several types of estrogen, can actually inhibit the growth of malignant tumors. Researchers have speculated that increasing the production of this “good” estrogen would be very beneficial. This is where DIM enters the picture-DIM can successfully increase the ratio of “good” to “bad” estrogen. DIM supplementation specifically promotes beneficial estrogen metabolism and helps restore a healthy hormonal balance.
DIM vs I3C
DIM provides many advantages over indole-3-carbinol, another cruciferous phytochemical available as a dietary supplement (I3C). I3C is an unstable precursor that requires activation in the stomach to be converted into DIM. This means I3C must be taken at a much higher amount and can undergo unpredictable and undesirable chemical reactions in your stomach or colon. DIM is by far the preferable supplement.
DIM safety
DIM has been taken as a dietary supplement for many years without any reports of adverse effects, and DIM’s safety has been evaluated. The use of DIM in an animal study at hundreds of times the amount provided in dietary supplements produced no adverse effects. Some individuals may notice some minor stomach upset with DIM supplements. Taking DIM supplements with food often eliminates this problem. Harmless changes in urine colour may occur with the use of DIM supplements. This colour reflects the presence of DIM metabolites that have an amber color. Individuals who eat large amounts of DIM-containing cruciferous vegetables would notice similarly coloured urine. Drinking 6-8 glasses of water per day will often eliminate this problem.
Dosage for DIM supplementation
In human research, doses typically range from 108–900 mg per day — through these studies were only related to treatments for cancer and prostate enlargement
However, a study in 24 healthy people found that although DIM doses of up to 200 mg were well tolerated and didn’t cause side effects, one person experienced nausea, headache, and vomiting after taking a 300-mg dose, suggesting that higher doses may be associated with adverse side effects. Therefore, it’s best to talk to your healthcare provider to obtain personalized dosage recommendations based on your intended use.
In conclusion, DIM is a compound your body creates when you eat cruciferous vegetables. It’s also concentrated and available as a supplement. As it affects estrogen levels, DIM may help treat a variety of hormone-related conditions, including hormone-sensitive cancers, acne, PMS, menopausal and prostate issues etc.
References:
Thomson CA, Chow HHS, Wertheim BC, Roe DJ, Stopeck A, Maskarinec G, Altbach M, Chalasani P, Huang C, Strom MB, Galons JP, Thompson PA. A randomized, placebo-controlled trial of diindolylmethane for breast cancer biomarker modulation in patients taking tamoxifen. Breast Cancer Res Treat. 2017 Aug;165(1):97-107. doi: 10.1007/s10549-017-4292-7. Epub 2017 May 30. PMID: 28560655; PMCID: PMC5571834.
Bradlow HL. Review. Indole-3-carbinol as a chemoprotective agent in breast and prostate cancer. In Vivo. 2008 Jul-Aug;22(4):441-5. PMID: 18712169.
Minich DM, Bland JS. A review of the clinical efficacy and safety of cruciferous vegetable phytochemicals. Nutr Rev. 2007 Jun;65(6 Pt 1):259-67. doi: 10.1301/nr.2007.jun.259-267. PMID: 17605302.
Amare DE. Anti-Cancer and Other Biological Effects of a Dietary Compound 3,3ʹ-Diindolylmethane Supplementation: A Systematic Review of Human Clinical Trials. Nutrition and Dietary Supplements. 2020;12:123-137