Approach to Fibrocystic Breasts with Hashimoto’s

Though we may not think of it very often, the health of our breasts and the health of our thyroid are deeply connected.

We know there’s an association between thyroid disease and thyroid cancer. Studies have shown that Hashimoto’s patients are three times more likely to develop thyroid cancer. (1,2)

More recent studies have shown that there’s also an association between breast cancer and those with autoimmune thyroid disease. (3,4)

There’s another breast condition that’s been shown to be connected to Hashimoto’s – fibrocystic breasts. (5) While having fibrocystic breasts is not associated with cancer, fibrocystic breasts can be painful and uncomfortable for the women who experience the condition.

Experts aren’t sure exactly what causes the development of fibrocystic breasts, but it’s believed that estrogen plays a large role. (6) If you’ve read my book, Hashimoto’s: The Root Cause, you will know that hormone imbalances, such as excess estrogen – also known as estrogen dominance – can trigger Hashimoto’s. (6)

A 2015 study of women with polycystic ovarian syndrome (PCOS) examined why some women with PCOS got Hashimoto’s and others didn’t, and ran hormonal tests on all of the women in the study. (7) The study showed more Hashimoto’s thyroiditis, elevated thyroid stimulating hormone (TSH), and elevated thyroid antibodies in the study participants with higher estrogen levels.

Even though fibrocystic breasts are a common condition, there’s not a lot of information or resources about this condition. Conventional medicine typically doesn’t offer much treatment or support, while old-school alternative medicine recommendations have focused on using high-dose iodine, a potential Hashimoto’s trigger, so I wanted to provide some additional approaches to ease the symptoms and pain of women who are experiencing this condition.

In this article, you’ll learn about:

• The symptoms of fibrocystic breasts and who has them
• The conventional approach to fibrocystic breasts
• Alternative approaches to and supportive products for fibrocystic breasts

Fibrocystic Breast Facts

Fibrocystic breasts is a common noncancerous condition among premenopausal women. Between 50 to 90 percent of women experience fibrocystic breasts at some point during their lifetime, and it’s most common in women between the ages of 20 and 50. (6,8)

The condition is characterized by changes in a woman’s breast tissue, which may fluctuate with their period. Symptoms include breast tenderness or discomfort (which may worsen before their period), sudden development of masses in the breasts, and a change in breast texture. Most breast lumps are non-cancerous and do not lead to breast cancer. (9)

Fibrocystic breast changes can be cyclic or noncyclic. Cyclic changes occur with your period, while noncyclic ones are not impacted by the different stages of your menstrual cycle, and pain can persist throughout the month.

As mentioned above, the exact cause of fibrocystic breasts is unknown, but it’s believed that reproductive hormones, especially estrogen, play a role. Aside from hormonal fluctuations, fibrocystic breasts can develop when excess fluid isn’t reabsorbed or adequately drained by the lymphatic system and turns into cysts. (10)

Our lymph system relies on the proper functioning of muscles and joints, and can get backed up when we’re exposed to excess toxins or when we don’t physically move enough. Lymphatic function and thyroid disease are closely tied, as lymphatic dysfunction may contribute to the development of autoimmune diseases. (57) A study from 2015 found that Hashimoto’s is associated with an increased number of enlarged lymph nodes, which indicate inflammation in the body. (58)

Cysts are fluid-filled lumps or sacs that may move around, appear, and disappear. In some cases, the fibrous tissue surrounding them can thicken and firm up, like scar tissue. These cysts inflame and enlarge the breast ducts, causing lumpiness, discomfort, and pain in the breast. (11)

Because of fibrocystic breasts’ connection to estrogen, and the connection between estrogen dominance and Hashimoto’s, it probably won’t come as much of a surprise that you have a higher chance of developing fibrocystic breasts if you have Hashimoto’s. (12)

Fibrocystic breasts used to be labeled as a disease, but given how common they are, they’re now simply referred to as “fibrocystic breasts.” (7) Conventional medicine doesn’t offer very much in terms of support for women who are experiencing this often painful and uncomfortable condition, while the alternative medicine approach has traditionally focused on using high doses of iodine, a potential trigger for Hashimoto’s.

If you know me, you know that taking a root cause approach to my own health helped me reverse my Hashimoto’s symptoms. I want to provide you with the same root cause approach for taking care of your breast health, which overlaps with many of my strategies for addressing Hashimoto’s symptoms! First, let’s go over the conventional approach to fibrocystic breasts.

Conventional Approach to Fibrocystic Breasts

If you find a lump in your breast, the first thing you want to do is visit your doctor and rule out the possibility that it’s cancerous. They’ll help you determine if you need an ultrasound or a mammogram. Most cases of fibrocystic breasts are not cancerous!

If your symptoms are mild, typically no treatment is offered. Your doctor may recommend over-the-counter pain relievers, such as acetaminophen or ibuprofen. (13) Occasionally you may be offered a prescription painkiller to help ease the pain. (13)

Your doctor may also recommend oral contraceptives, to balance out hormones and ease cycle-related fibrocystic breast changes. (13) While this may help with symptoms, it won’t truly correct a hormonal balance. To do that, you’ll have to take a root cause approach to balancing hormones.

If symptoms are severe and there are cysts present, a fine-needle aspiration may be performed, which may collapse the cyst and relieve discomfort. (13)

While these interventions may provide some relief, I like to dig deeper. 🙂 Let’s take a look at some alternative and “root cause” approaches to fibrocystic breasts.

The Root Cause Approach to Fibrocystic Breasts

Here are some strategies that will not only support breast health, but also support any Hashimoto’s symptoms you might be experiencing. Rather than suppress symptoms with OTC painkillers or birth control pills, these suggestions help target the root cause of symptoms.

Check Your Iodine Levels

Iodine deficiency has been linked to breast disease, so it is often recommended as a supplement to support breast health. (14,15)

When it comes to thyroid health, iodine is a controversial nutrient. Because it is a necessary nutrient for thyroid health, some people have assumed that supplementing with high doses of iodine can help the body make more thyroid hormone, thereby improving hypothyroidism and Hashimoto’s; and it is often recommended by many alternative health books and doctors. (16)

However, what they do not understand is that iodine is what pharmacists call a “Goldilocks” nutrient, meaning that, while adequate levels are necessary for thyroid health, higher levels can have a negative effect. (17)

Research has shown that excessive doses of iodine can trigger (and worsen) Hashimoto’s in people who are genetically predisposed to Hashimoto’s and may have certain “vulnerabilities”, such as a selenium deficiency. (18) In fact, through clinical experience, I have found that most people with Hashimoto’s actually have iodine excess!

If you have fibrocystic breasts and Hashimoto’s, I generally do not recommend supplementing with iodine unless you know you’re low in iodine, as it may exacerbate your thyroid symptoms. But don’t worry! There are still plenty of other strategies to support fibrocystic breasts. 🙂

Adopt a Fibrocystic Breast-Friendly Diet

A diet to support fibrocystic breasts is actually quite similar to a diet that can support Hashimoto’s symptoms! By removing our personally reactive foods, we can help lower inflammation in the body, support the health of our liver, and balance hormones, which can help with the pain and discomfort of fibrocystic breasts. (19-21)

I recommend starting by removing gluten, dairy, soy, eggs, and corn. These foods can contribute to inflammation in the body, which can exacerbate symptoms of fibrocystic breasts. Interestingly, these foods can also contain estrogen-mimicking compounds, which can contribute to estrogen dominance. A 2018 study found that a compound called zearalenone, an estrogen-like fungi, can colonize wheat, corn, and other grains. In the study, they found that zearalenone can reduce the anti-estrogen effectiveness of drugs for breast cancer. (59)

Dairy, soy, and eggs contain phytoestrogens, which mimic the effects of estrogen in the body. Because eggs are produced in the animal’s ovaries, and milk is a product of the lactation cycle, they can contain higher levels of these phytoestrogens. (60) If you have fibrocystic breasts or high levels of estrogen, you may want to consider removing these foods to see if your symptoms improve.

These foods are also some of the most highly reactive foods for those with Hashimoto’s. In my survey of over 2000 people with Hashimoto’s, corn and gluten were common triggers for symptoms, and eggs were a trigger for 48 percent of participants. Seventy-nine percent felt better when they removed dairy, and 63 percent observed soy as a trigger for their symptoms.

I recommend identifying other foods you’re reactive to by following an elimination diet for four weeks. You can learn more about doing an elimination diet in my article.

I encourage you to focus on a diet rich in nutrient-dense foods like vegetables, fruits, meats, herbs, and spices. Bone broth and green smoothies are two of my favorite ways to pack in plenty of healing nutrients to fight inflammation and support the liver (more on this below).

Another potential trigger of symptoms is caffeine, especially coffee. Coffee can contribute to estrogen dominance because of how it impacts the adrenal glands, which impact our body’s production of progesterone. (22,23) When progesterone is too low, this leads to a relative estrogen dominance.

Additionally, most of the coffee out there is contaminated with toxins like acrylamide and molds like ochratoxin A (OTA), which can put an extra burden on our liver. (24,25) Most people with Hashimoto’s have an overburdened liver and an impaired ability to eliminate toxins. (26,27) It’s also essential to have an optimally functioning liver to help us filter out excess estrogen!

I personally experienced fibrocystic breasts during a time period when I was drinking too much caffeine. Simply reducing my caffeine intake resolved my fibrocystic breasts, so if you are a big caffeine drinker, you may want to consider this as a strategy.

If you’re going to cut out caffeine, I do not recommend going “cold turkey.” My article on coffee weans can guide you through the 25 percent reduction method, which will make the process a lot less painful.

Consider Lifestyle Changes

When it comes to fibrocystic breasts, one of the most important things we can do is support the lymphatic system, which is part of the immune system and is responsible for protecting us from illness-causing invaders, maintaining fluid balance, and removing cellular waste. (28,29)

The breast and underarm area has a high concentration of lymphatic nodes and channels. (28) Fibrocystic breasts can develop when excess fluid isn’t reabsorbed or adequately drained by the lymphatic system. (30) Those with Hashimoto’s tend to have a sluggish lymph system. (57,58) Here are some ways you can support your lymphatic system and breast health:

• Increase your movement: Exercise can help the fluid in our lymphatic system move around more freely, which prevents the stagnation that could contribute to symptoms of pain and inflammation in the breast. (31) Any type of exercise you enjoy works to support lymph fluid movement, even gentle movements like walking and yoga. Some people enjoy using a rebounder (a mini trampoline), as the bouncing stimulates lymph flow.

• Try breast massage: A simple massage can relieve much of the pressure and pain that can accompany fibrocystic breasts. It also stimulates flow of lymph fluid. (32) Later in this article, there are more detailed instructions on how to give yourself a breast massage.

• Ditch underwire bras: When worn all the time, bras with underwire can block the drainage of lymph fluid from the lymph nodes around the breasts and armpit. As we know by now, we want that fluid moving as freely as possible! Authors Sydney Singer and Soma Grismaijer reported that in studying 4000 women, they found that about 90 percent of women with fibrocystic breasts experienced improvement when they stopped wearing bras. Opt for wireless bras and try to reduce your time wearing bras, if possible. I personally started to wear sports bras on most days, and have found them to be more comfortable.

Support the Liver

Supporting our detoxification system is a crucial part of healing Hashimoto’s, and it’s just as important for optimal breast health. (33) Here are some of my favorite ways to support the liver:

• Remove toxins: I highly suggest removing potentially triggering foods like the ones I listed above (gluten, dairy, soy). These foods could be irritating the gut and disrupting nutrient absorption, which can impact toxin build up in the liver. (20)
  • I also recommend that you cut out alcohol, as it puts a tremendous burden on the liver. (34)
  • Conventional household cleaning and personal care products contain many toxins. (35,36) Try swapping them out with non-toxic versions. For example, I like Branch Basics for cleaning products and Annmarie for beauty products. You can also check out my Resources page for a full list of product recommendations.

• Consider supportive supplements: Here are a few of my favorite supplements for supporting the liver:
  • Liver & Gallbladder Support: This comprehensive formula is designed to support bile flow for the normal processing and elimination of toxins. (37)
  • Liver Reset: This contains a natural pea protein isolate and high levels of antioxidants to fuel the detoxification pathways. (38)
  • NAC: This supports tissue levels of glutathione, a key component of the antioxidant defense system. (39)
  • Glutathione: This antioxidant plays a major role in the detoxification process. (40)
  • Vitamin E: Another important antioxidant, vitamin E is also supportive of liver health. (41)
  • Magnesium: This mineral activates the enzymes necessary for a number of physiological functions, and is closely linked with liver function. (42)
  • B vitamins: These vitamins, which are crucial for so many functions in the body, are also essential for liver health. (43)

• Herbal support: Herbs can be helpful in supporting liver function as well. Here are a few I’d recommend:
  • Andrographis: This herb has been traditionally used in Ayurveda and Chinese medicine for liver support. (44) It’s high in antioxidants, has exerted liver-protective mechanisms, and modulates liver enzymes. (45)
  • Dandelion Root: A 2017 study showed that polysaccharides in dandelion root can be beneficial to liver function. (46)
  • Red Root: This herb has been used traditionally to support the liver. (47,48)

• Elimination of toxins: In addition to reducing our toxic load and incorporating liver-supporting supplements and herbs, it’s also important that we are able to eliminate accumulated toxins. There are two main ways we can do this:
  • Sweating: When we sweat, we excrete toxins. We can do this through exercise or through spending time in a sauna. (49)
  • Bowel Movements: Having regular, daily bowel movements ensures we’re eliminating toxins. If you’re constipated or not having a bowel movement at least once per day, I recommend taking magnesium. (50) I typically recommend magnesium citrate for constipation, as it has a laxative effect, and magnesium glycinate for stress and to improve sleep quality. Check out my full article on magnesium for dosing and precautions.

Balance Hormones

Because excess estrogen is likely associated with fibrocystic breasts and the uncomfortable symptoms they cause, hormone balance is a crucial part of addressing them (as well as underlying root causes of Hashimoto’s symptoms). In addition to diet changes and liver support, there are some herbs and supplements that can help with hormone imbalances as well.

• Hormone-balancing herbs include red clover, yerba santa, and borage oil. (51-53) Red clover has been shown to inhibit the binding of estradiol, making it supportive for estrogen dominance. Because it possesses a high antioxidant content, yerba santa, traditionally used for respiratory health, can also reduce inflammation and support the liver, which is crucial to estrogen metabolism. Borage oil is rich in GLA (gamma-linolenic acid), which can help reduce sensitivity and pain in fibrocystic breasts by reducing inflammatory prostaglandins (compounds that contribute to inflammation and are associated with breast sensitivity). (61,62) By reducing inflammation, borage oil can also be supportive for hormone balance. (63)
• Other supplements that can be helpful include DIM, sulforaphane, and calcium d-glucarate. (54-56) DIM (diindolyl-methane) and sulforaphane are compounds found in cruciferous vegetables that support the body’s metabolism of excess estrogen (so eat your broccoli!). Calcium d-glucarate aids in our body’s detoxification of excess estrogen as well.
• You may also consider topical bioidentical progesterone if your estrogen dominance is due to low progesterone. Always work with your doctor and test your hormone levels before starting bioidentical hormones.

Consider Other Supportive Products

While having fibrocystic breasts can be painful, there are some products that make managing them a lot easier. My friend Magdalena Wszelaki, who has personally struggled with breast health and lumps for decades, was told that “it’s common and normal” and that “lumps are no big deal.” She realized many other women were having a similar experience, and knows that the emotional and physical toll it takes on women is huge.

I first reached out to Magdalena in 2013, after publishing my book Hashimoto’s: The Root Cause. She was a health coach specializing in hormones. I loved her empowering approach, and our theories on how to address Hashimoto’s were very much in alignment. I knew we would be fast friends, and I remember one of our many conversations about health topics focused on iodine and fibrocystic breasts in women with Hashimoto’s. High-dose iodine is a potential trigger and/or exacerbating factor for Hashimoto’s, but it can also help fibrocystic breasts. I was conflicted when I spoke to Magdalena, as I didn’t have any solutions for the women with Hashimoto’s that were reaching out to me about their breast health.

This was almost a decade ago, and I am so grateful that since that time she’s done a deep dive into researching fibrocystic breasts, and finding solutions for women with Hashimoto’s, who may not be able to use high-dose iodine. 🙂

As such, she developed a special kit with two targeted products to support women with fibrocystic breasts:

• Happy Sisters supplement: I love this supplement because it’s designed to address estrogen dominance, inflammation, and lymphatic stagnation by combining many of the herbs and nutrients mentioned throughout this article, including borage oil, yerba santa, andrographis, red root, red clover, magnesium bisglycinate, calcium d-glucarate, and DIM.

• Happy Sisters Cream: This topical cream combines poke root-infused oil, St. John’s wort-infused oil, borage seed oil, ginger-infused oil, black seed oil, rose geranium essential oil, and bergamot essential oil. This highly effective formula helps to reduce pain, soothe inflammation, move the lymphatic system, and shrink lumps. In addition to addressing root causes of fibrocystic breasts, it’s so nice to have a product that can help reduce symptoms right away. You can use this cream while performing a self-breast massage, which supports lymph flow and can reduce inflammation. It has a lovely scent and texture, and is made of an all natural, non-toxic base of aloe, olive oil and shea butter.

You can purchase both of these products as the Happy Sisters Kit, which also includes instructions on how to do a lymphatic breast massage (I’ve copied the instructions below, with Magdalena’s permission).

How to Do Lymphatic Breast Massage with Happy Sisters Cream:

• Scoop out 1/4 to 1/2 teaspoon of the cream and lightly spread it over your breast tissue.
• Massage with your opposite side hand in the direction of lymphatic flow – from the nipple toward 12:00, 2:00, 4:00, 6:00, 8:00, and 10:00. Go slow, using gentle but deep pressure, about three to five seconds per sweep.
• Repeat this, for a total of two times per breast, twice daily.
• Visualize the breast as being made of sponge containing thick honey. Slow, deep sweeps make the honey flow out.
• Finish by visualizing your breasts being nourished, cleansed, and healed.
• When you don’t have time for the full lymphatic massage, your sisters will still reap the benefits with a quick application of the cream.

Image by: Wellena

I hope you will enjoy Happy Sisters as much as I have. For a limited time, Magdalena is offering a special discount on Happy Sisters for my readers. Use code TP-SISTERS at checkout, now through October 30th, to save 10% off!

Takeaway

If you have fibrocystic breasts or know someone who does, there are many ways you can support yourself using a root cause approach. I’m so happy that Magdalena has created these wonderful products to help women address this extremely common condition. It’s the perfect way to take care of yourself, or to give the gift of health and self-care to any woman in your life who may be experiencing painful symptoms!

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References

1. Chen YK, Lin CL, Cheng FT, Sung FC, Kao CH. Cancer risk in patients with Hashimoto’s thyroiditis: a nationwide cohort study. Br J Cancer. 2013;109(9):2496-2501. doi:10.1038/bjc.2013.597
2. Hu X, Wang X, Liang Y, et al. Cancer Risk in Hashimoto’s Thyroiditis: a Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2022;13:937871. Published 2022 Jul 12. doi:10.3389/fendo.2022.937871
3. Hu X, Wang X, Liang Y, et al. Cancer Risk in Hashimoto’s Thyroiditis: a Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2022;13:937871. Published 2022 Jul 12. doi:10.3389/fendo.2022.937871
4. Chen S, Wu F, Hai R, et al. Thyroid disease is associated with an increased risk of breast cancer: a systematic review and meta-analysis. Gland Surg. 2021;10(1):336-346. doi:10.21037/gs-20-878
5. 5 Anil C, Guney T, Gursoy A. The prevalence of benign breast diseases in patients with nodular goiter and Hashimoto’s thyroiditis. J Endocrinol Invest. 2015;38(9):971-975. doi:10.1007/s40618-015-0269-8
6. 7 Fibrocystic breasts: Is it a disease, causes & symptoms. Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/22080-fibrocystic-breasts. Published November 2021. Accessed September 27, 2022.
7. 6 Arduc A, Aycicek Dogan B, Bilmez S Imga Nasirouglu N, Tuna MM, Isik S, Berker D, Guler S. High prevalence of Hashimoto’s thyroiditis in patients with polycystic ovary syndrome: does the imbalance between estradiol and progesterone play a role? Endocrine Research. 2015;40(4):204-210. doi:10.3109/07435800.2015.1015730.
8. 8 Chen YY, Fang WH, Wang CC, et al. Examining the Associations among Fibrocystic Breast Change, Total Lean Mass, and Percent Body Fat. Sci Rep. 2018;8(1):9180. Published 2018 Jun 15. doi:10.1038/s41598-018-27546-3
9. 9 Stachs A, Stubert J, Reimer T, Hartmann S. Benign Breast Disease in Women. Dtsch Arztebl Int. 2019;116(33-34):565-574. doi:10.3238/arztebl.2019.0565
10. Malherbe K, Khan M, Fatima S. Fibrocystic Breast Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 24, 2021.
11. Kowalski A, Okoye E. Breast Cyst. In: StatPearls. Treasure Island (FL): StatPearls Publishing; December 13, 2021.
12. Anil C, Guney T, Gursoy A. The prevalence of benign breast diseases in patients with nodular goiter and Hashimoto’s thyroiditis. J Endocrinol Invest. 2015;38(9):971-975. doi:10.1007/s40618-015-0269-8
13. Fibrocystic breasts. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/fibrocystic-breasts/diagnosis-treatment/drc-20350442. Published June 23, 2021. Accessed September 27, 2022.
14. Ghent WR, Eskin BA, Low DA, Hill LP. Iodine replacement in fibrocystic disease of the breast. Can J Surg. 1993;36(5):453-460.
15. Rappaport J. Changes in Dietary Iodine Explains Increasing Incidence of Breast Cancer with Distant Involvement in Young Women. J Cancer. 2017;8(2):174-177. Published 2017 Jan 13. doi:10.7150/jca.17835
16. Leung A, Pearce EN, Braverman LE. Role of iodine in thyroid physiology. Expert Rev Endocrinol Metab. 2010;5(4):593-602. doi:10.1586/eem.10.40
17. Rose NR, Bonita R, Burek CL. Iodine: an environmental trigger of thyroiditis. Autoimmun Rev. 2002;1(1-2):97-103. doi:10.1016/s1568-9972(01)00016-7
18. Duntas LH. The Role of Iodine and Selenium in Autoimmune Thyroiditis. Horm Metab Res. 2015;47(10):721-726. doi:10.1055/s-0035-1559631
19. Tuck CJ, Biesiekierski JR, Schmid-Grendelmeier P, Pohl D. Food Intolerances. Nutrients. 2019;11(7):1684. Published 2019 Jul 22. doi:10.3390/nu11071684
20. Shiue I. Is abnormal liver function correlated with food sensitisation in adults? US NHANES, 2005-2006. Allergol Immunopathol (Madr). 2015;43(4):361-368. doi:10.1016/j.aller.2014.02.009
21. Tsuchiya Y, Nakajima M, Yokoi T. Cytochrome P450-mediated metabolism of estrogens and its regulation in human. Cancer Lett. 2005;227(2):115-124. doi:10.1016/j.canlet.2004.10.007
22. Lovallo WR, Farag NH, Vincent AS, Thomas TL, Wilson MF. Cortisol responses to mental stress, exercise, and meals following caffeine intake in men and women. Pharmacol Biochem Behav. 2006;83(3):441-447. doi:10.1016/j.pbb.2006.03.005
23. Lam M. In-depth article on hormone imbalance symptoms and the Oat Axis. Dr. Lam Coaching – World Renowned Authority on Adrenal Fatigue Recovery. https://www.drlamcoaching.com/articles/hormone-imbalance-symptoms-and-the-oat-axis/. Accessed August 12, 2022.
24. Mojska H, Gielecińska I. Studies of acrylamide level in coffee and coffee substitutes: influence of raw material and manufacturing conditions. Rocz Panstw Zakl Hig. 2013;64(3):173-181.
25. Pakshir K, Dehghani A, Nouraei H, Zareshahrabadi Z, Zomorodian K. Evaluation of fungal contamination and ochratoxin A detection in different types of coffee by HPLC-based method. J Clin Lab Anal. 2021;35(11):e24001. doi:10.1002/jcla.24001
26. Malik R, Hodgson H. The relationship between the thyroid gland and the liver. QJM. 2002;95(9):559-569. doi:10.1093/qjmed/95.9.559
27. Piantanida E, Ippolito S, Gallo D, et al. The interplay between thyroid and liver: implications for clinical practice. J Endocrinol Invest. 2020;43(7):885-899. doi:10.1007/s40618-020-01208-6
28. Rinaldi RM, Sapra A, Bellin LS. Breast Lymphatics. In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 12, 2022.
29. Lymphatic system: Parts & Common Problems. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/21199-lymphatic-system. Published February 2020. Accessed September 28, 2022.
30. Malherbe K, Khan M, Fatima S. Fibrocystic Breast Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 24, 2021.
31. Lane K, Worsley D, McKenzie D. Exercise and the lymphatic system: implications for breast-cancer survivors. Sports Med. 2005;35(6):461-471. doi:10.2165/00007256-200535060-00001
32. Williams AF, Vadgama A, Franks PJ, Mortimer PS. A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema. Eur J Cancer Care (Engl). 2002;11(4):254-261. doi:10.1046/j.1365-2354.2002.00312.x
33. Piantanida E, Ippolito S, Gallo D, et al. The interplay between thyroid and liver: implications for clinical practice. J Endocrinol Invest. 2020;43(7):885-899. doi:10.1007/s40618-020-01208-6
34. Maher JJ. Exploring alcohol’s effects on liver function. Alcohol Health Res World. 1997;21(1):5-12.
35. Zota AR, Singla V, Adamkiewicz G, Mitro SD, Dodson RE. Reducing chemical exposures at home: opportunities for action [published online ahead of print, 2017 Jul 29]. J Epidemiol Community Health. 2017;71(9):937-940. doi:10.1136/jech-2016-208676
36. Panico A, Serio F, Bagordo F, et al. Skin safety and health prevention: an overview of chemicals in cosmetic products. J Prev Med Hyg. 2019;60(1):E50-E57. Published 2019 Mar 29. doi:10.15167/2421-4248/jpmh2019.60.1.1080
37. Hundt M, Basit H, John S. Physiology, Bile Secretion. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 1, 2021.
38. Kumar D, Gangwar SP. Role of antioxidants in detoxification of Cr (VI) toxicity in laboratory rats. J Environ Sci Eng. 2012;54(3):441-446.
39. 37 Khoshbaten M, Aliasgarzadeh A, Masnadi K, et al. N-acetylcysteine improves liver function in patients with non-alcoholic Fatty liver disease. Hepat Mon. 2010;10(1):12-16.
40. 38 Sacco R, Eggenhoffner R, Giacomelli L. Glutathione in the treatment of liver diseases: insights from clinical practice. Minerva Gastroenterol Dietol. 2016;62(4):316-324.
41. Sato K, Gosho M, Yamamoto T, et al. Vitamin E has a beneficial effect on nonalcoholic fatty liver disease: a meta-analysis of randomized controlled trials. Nutrition. 2015;31(7-8):923-930. doi:10.1016/j.nut.2014.11.018
42. Liu M, Yang H, Mao Y. Magnesium and liver disease. Ann Transl Med. 2019;7(20):578. doi:10.21037/atm.2019.09.70
43. Vitamin B. National Library of Medicine . https://www.ncbi.nlm.nih.gov/books/ NBK548710/. Published May 2021. Accessed September 28, 2022.
44. Chua LS. Review on liver inflammation and antiinflammatory activity of Andrographis paniculata for hepatoprotection. Phytother Res. 2014;28(11):1589-1598. doi:10.1002/ptr.5193
45. Okhuarobo A, Falodun JE, Erharuyi O, Imieje V, Falodun A, Langer P. Harnessing the medicinal properties of Andrographis paniculata for diseases and beyond: a review of its phytochemistry and pharmacology. Asian Pac J Trop Dis. 2014;4(3):213-222. doi:10.1016/S2222-1808(14)60509-0
46. Cai L, Wan D, Yi F, Luan L. Purification, Preliminary Characterization and Hepatoprotective Effects of Polysaccharides from Dandelion Root. Molecules. 2017;22(9):1409. Published 2017 Aug 25. doi:10.3390/molecules22091409
47. Casey PA, Wynia RL. Culturally significant plants. USDA. https://efotg.sc.egov.usda.gov/references/Public/VA/NRCS_CulturallySignificantPlants_2010.pdf. Published September 2010. Accessed September 29, 2022.
48. Banerjee A, Chakrabarty SB, Karmakar SR, et al. Can homeopathy bring additional benefits to thalassemic patients on hydroxyurea therapy? Encouraging results of a preliminary study. Evid Based Complement Alternat Med. 2010;7(1):129-136. doi:10.1093/ecam/nem161
49. Sears ME, Kerr KJ, Bray RI. Arsenic, cadmium, lead, and mercury in sweat: a systematic review. J Environ Public Health. 2012;2012:184745. doi:10.1155/2012/184745
50. Pereira NBF, Ramos CI, de Andrade LS, et al. Influence of bowel habits on gut-derived toxins in peritoneal dialysis patients. J Nephrol. 2020;33(5):1049-1057. doi:10.1007/s40620-020-00819-9
51. Ghazanfarpour M, Sadeghi R, Latifnejad Roudsari R, et al. Effects of red clover on hot flash and circulating hormone concentrations in menopausal women: a systematic review and meta-analysis. Avicenna J Phytomed. 2015;5(6):498-511.
52. Deng Z, Hassan S, Rafiq M, et al. Pharmacological Activity of Eriodictyol: The Major Natural Polyphenolic Flavanone. Evid Based Complement Alternat Med. 2020;2020:6681352. Published 2020 Dec 12. doi:10.1155/2020/6681352
53. Asadi-Samani M, Bahmani M, Rafieian-Kopaei M. The chemical composition, botanical characteristic and biological activities of Borago officinalis: a review. Asian Pac J Trop Med. 2014;7S1:S22-S28. doi:10.1016/S1995-7645(14)60199-1
54. Rajoria S, Suriano R, Parmar PS, et al. 3,3′-diindolylmethane modulates estrogen metabolism in patients with thyroid proliferative disease: a pilot study. Thyroid. 2011;21(3):299-304. doi:10.1089/thy.2010.0245
55. Cao S, Wang L, Zhang Z, Chen F, Wu Q, Li L. Sulforaphane-induced metabolomic responses with epigenetic changes in estrogen receptor positive breast cancer cells. FEBS Open Bio. 2018;8(12):2022-2034. Published 2018 Nov 14. doi:10.1002/2211-5463.12543
56. Calcium-D-glucarate. Altern Med Rev. 2002;7(4):336-339.
57. Schwartz N, Chalasani MLS, Li TM, Feng Z, Shipman WD, Lu TT. Lymphatic Function in Autoimmune Diseases. Front Immunol. 2019;10:519. Published 2019 Mar 20. doi:10.3389/fimmu.2019.00519
58. Jones MR, Mohamed H, Catlin J, April D, Al-Qurayshi Z, Kandil E. The presentation of lymph nodes in Hashimoto’s thyroiditis on ultrasound [published correction appears in Gland Surg. 2015 Dec;4(6):E2]. Gland Surg. 2015;4(4):301-306. doi:10.3978/j.issn.2227-684X.2015.05.11
59. Warth B, Raffeiner P, Granados A, et al. Metabolomics Reveals that Dietary Xenoestrogens Alter Cellular Metabolism Induced by Palbociclib/Letrozole Combination Cancer Therapy. Cell Chem Biol. 2018;25(3):291-300.e3. doi:10.1016/j.chembiol.2017.12.010
60. Shaikh DJ. What foods are high in estrogen? MedicineNet. https://www.medicinenet.com/what_foods_are_high_in_estrogen/article.htm. Published March 1, 2022. Accessed October 10, 2022.
61. Miller SB. Prostaglandins in health and disease: an overview. Semin Arthritis Rheum. 2006;36(1):37-49. doi:10.1016/j.semarthrit.2006.03.005
62. Malherbe K, Khan M, Fatima S. Fibrocystic Breast Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 24, 2021.
63. Chang CS, Sun HL, Lii CK, Chen HW, Chen PY, Liu KL. Gamma-linolenic acid inhibits inflammatory responses by regulating NF-kappaB and AP-1 activation in lipopolysaccharide-induced RAW 264.7 macrophages. Inflammation. 2010;33(1):46-57. doi:10.1007/s10753-009-9157-8