Flax and Cancer Processes
Flax contains three constituents that may reduce the risk of developing some cancers: Alpha-linolenic acid (ALA), the essential omega-3 fatty acid; the lignan secoisolariciresinol diglycoside (SDG); and dietary fibre. The actions of ALA, lignans and dietary fibre may inhibit certain cancer processes, as described below.
| • | ALA alters the fatty acid composition of cell membranes in important ways and inhibits the release of pro-inflammatory eicosanoids, which are among the many factors that control the growth and invasiveness of tumour cells and modulate the cycle of cell death (171). In a study of liver cancer cells transplanted into male mice, ALA was as effective as eicosapentaenoic acid (EPA) in blocking the tumour’s uptake of fatty acids, particularly linoleic acid (LA), from plasma and in preventing the conversion of LA to a tumour growth-promoting compound (172). In a human study – the Lyon Diet Heart Study, described in Chapter 5 – participants who ate a Mediterranean diet rich in ALA had a 61% reduction in cancer risk (173). |
| • | The lignan SDG functions as a phytoestrogen and antioxidant. In a mouse model of melanoma (a darkly pigmented cancerous growth), SDG decreased the number of tumours, the size of tumours, and the rate or extent of metastasis (174,175). |
| • | Foods rich in dietary fibre are sources of bioactive substances like antioxidants that may inhibit cancer processes. The greater fibre intake of Asian populations may contribute to their lower risk of cancer compared with Western populations (176). |
Flax and Breast Cancer
Breast cancer is a hormone-sensitive cancer, meaning that in the early stages of development, tumour growth is influenced by the sex hormones, particularly estrogen. (Refer to Chapter 4 for a description of sex hormones.) Other hormone-sensitive cancers include those of the endometrium and prostate.
Flax oil and ground flax inhibit the growth and development of mammary (breast) tumours in animal studies. In one study of female mice given a chemical to induce mammary tumours, flax oil had the greatest preventive effect of the oils tested – mice given flax oil in their rations for six weeks had the fewest number of mammary tumours, fewer even than mice fed fish oil. Mice fed corn oil or safflower oil, 52 both rich in omega-6 fatty acids, had the greatest number of tumours
(177). In a similar study, mice fed flax oil for eight weeks had smaller tumours, lower tumour weights and less metastasis to the lungs compared with mice fed corn oil or fish oil (178).
In a study of mice injected with human breast cancer cells, adding ground flax to the rations resulted in a slower growth rate of mammary tumours compared with mice fed a control diet. Metastasis to other organs and lymph nodes was also significantly decreased in mice fed ground flax. This study provided evidence that ground flax decreased the concentration of vascular endothelial growth factor (VEGF). VEGF appears to promote angiogenesis in breast tissue (179).
Studies in rats suggest that diets containing pure SDG, ground flax (also rich in SDG) or ALA-rich flax oil affect mammary tumour growth. Pure SDG exerts its greatest inhibitory effect on new tumour development in mammary tissue, whereas flax oil and ground flax affect established mammary tumours at a late stage of tumour development (180–182). The size of established tumours in mammary tissue was reduced by more than 50% when rats were fed flax oil for seven weeks (181).
In humans, a preliminary study suggested a benefit of flax for women with breast cancer. Dr. Lilian Thompson and her colleagues at the University of Toronto studied 39 women with newly diagnosed breast tumours. The women were randomized to eat daily a muffin containing 25 g (about 3 tbsp) of ground flax or a control muffin made with whole-wheat flour for about 51/2 weeks. Women who ate flax muffins experienced significant reductions in breast cancer cell proliferation and tumour growth compared with women who ate whole-wheat muffins (183).
The ALA and lignans in flax both appear to affect breast cancer development in humans. In a case-control study among women with invasive, nonmetastatic breast cancer (the cases) and women without breast cancer (the control group) living in Tours, central France, ALA intake was inversely related to breast cancer risk (184). That is, women with the highest level of ALA in adipose tissue had the lowest risk of breast cancer. High levels of DHA and total omega-3 fatty acids in adipose tissue were also related to a low risk of breast cancer. The ratio
of omega-3 to omega-6 fatty acids may play a role in breast cancer, with omega-3 fatty acids protecting against and omega-6 fatty acids promoting breast tumour development (185). In another case-control study, women
with a high dietary intake of lignans tended to have a lower breast F LAX – A Health and Nutrition Primer 53 cancer risk. The main sources of lignans in this study were tomatoes, bananas, broccoli and carrots (186)
Flax and Colon Cancer
A role for flax in the prevention of colon cancer is plausible because the colon is the region where mammalian lignans are produced from plant lignans. Indeed, a study in rats treated with a cancer-causing chemical showed that rats fed diets supplemented with either 5% or 10% ground flax or defatted ground flax for four weeks had a significantly lower number of aberrant crypts and less cell proliferation in the colon compared with control rats. Aberrant crypts are considered early markers of colon cancer risk (187,188). The mammalian lignans derived from flax have also been shown to inhibit the growth of human colon cancer cells grown in test tubes. Enterolactone was more than twice as effective as enterodiol in reducing the growth of human colon cancer cells in test tubes (189).
Flax and Prostate Cancer
Prostate cancer, like breast cancer, is hormone-sensitive and in the early stages of development, tumour growth is influenced by the sex hormone testosterone and its active metabolite, dihydrotestosterone (176). The exact cause of prostate cancer is not known (190). Although a small number of studies suggest a beneficial effect of ground flax on prostate cancer biology in humans and animals, a controversy about the role of ALA in prostate cancer has emerged.
Blood Pressure
There are not enough studies to be confident about the effects of flax on blood pressure. Blood pressure is the force or pressure of blood against the walls of arteries. In a study of 15 obese adults, consuming flax oil daily for four weeks resulted in a significant decrease in mean arterial pressure compared with a control period (150). In a study of 399 middle-aged men, the ALA content of adipose tissue was negatively correlated with blood pressure (217). By comparison, two studies found no effect of flax oil consumption on blood pressure (149,218). A longer intervention may be needed to demonstrate an effect of flax on blood pressure.
Diabetes
Flax contains three components that may protect against diabetes – dietary fibre (219), the lignan SDG (220–222) and ALA (74, 221). Indeed, flax consumption lowers blood glucose in healthy young adults (40). In one study, six healthy volunteers fasted overnight and, in the morning, consumed in random order a test meal containing 50 g of carbohydrate as bread made from ground flax or white flour. The blood glucose response was 28% lower after eating the flax bread test meal compared with the standard white bread test meal. In the same study, volunteers who consumed flax mucilage gums mixed with glucose showed a 27% decrease in the blood glucose response compared with consuming glucose alone (55).
Does flax help manage blood glucose levels in people with diabetes? A study currently underway at the University of Manitoba is evaluating the effects of ground flax and flax oil on blood glucose control and insulin levels in people with type 2 diabetes mellitus (223). Type 2 diabetes mellitus is the non-insulin-dependent form of the disease that accounts for about 90% of all diabetes cases (219).
Hemostasis
Hemostasis refers to the control of bleeding by either natural means (as occurs when blood clots form at the site of a cut or wound) or artificial means (as occurs when a deep wound is pressed to staunch blood flow) (224). In the few studies conducted to date, consuming flax oil or ground flax did not affect hemostatic factors such as platelet clumping (aggregation) (144,225), bleeding time (148,225) or coagulation of the blood (36,225). However, in one study (225), consumption of flax oil produced hemostatic effects that were similar to those seen with the consumption of fish oil, leading the researchers to conclude that the effects of ALA on hemostatic factors were mainly in the same direction as the effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
Immune Function
Flax favourably affects immunity – the body’s ability to defend itself successfully against foreign substances like bacteria and viruses. Two components of flax, ALA and lignans, affect immune cells and compounds like eicosanoids and cytokines that control immune reactions. ALA, for example, affects the production of eicosanoids and cytokines, and suppresses the delayed hypersensitivity response to certain antigens (226). Lignans also influence certain mediators of immune reactions such as platelet-activating factor (PAF) (78). The
ALA and lignans in flax may play a beneficial role in the clinical management of autoimmune diseases like arthritis and systematic lupus erythematosus, described below (227).
Kidney Disease
Ground flax reduces inflammation and improves kidney function in patients with systematic lupus erythematosus (SLE). SLE is a chronic, inflammatory autoimmune disease with major health consequences, including renal failure, arthritis, thrombosis and seizures (228). The cause of SLE is not known, but oxidative stress, cytokines (229), platelet-activating factor (230) and certain eicosanoids (231) appear to be involved in the pathology of the disease. In rats and mice, ground flax and flax oil reduced kidney inflammation and improved kidney function
(78,227,232–234). In people with SLE, consumption of ground flax (15 g, 30 g or 45 g daily) for four weeks improved kidney function and reduced inflammation (122).
Laxation
Flax, like cereals and legumes, has the potential to increase laxation because it provides dietary fibre which absorbs water, increasing intestinal bulk. This has been demonstrated in healthy young adults and the institutionalized elderly, who often have chronic difficulties with laxation due to their inactivity, low-fibre diet and/or use of medications. In one study of 10 healthy, young adults, bowel movements per week increased by 30% when subjects ate two muffins providing 50 g of ground flax daily (40). In a study of seven volunteers whose average age was 78 years, the daily frequency of bowel movements and the number of consecutive days with bowel movements increased among subjects who complied with the dietary regimen of eating 50 g of
ground flax daily. The flax was provided in muffins and consumed for four weeks (235).
Osteoporosis
Phytoestrogens may help prevent osteoporosis (236). Osteoporosis is a disease in which bone mass is low and the risk of bone fractures is high (237). Indeed, osteoporotic bones are so thin and brittle that even normal activities of daily living such as walking or bending over can result in fractures (238). Investigations of the effects of flax on bone health are just beginning. Researchers at Oklahoma State University reported that flax may have a positive effect on bone in postmenopausal women by enhancing antioxidant activity. They noted that free radicals generated in bone tend to cause bone resorption, which increases bone loss. Flax lignans and ALA may help prevent bone loss and osteoporosis by blocking the production of prostaglandins and decreasing the rate of
bone resorption (239). However, one 3-month study of postmenopausal women found no effect of flax consumption on measures of bone formation and resorption (145). Longer-term studies are needed to clarify
the effects of flax on bone health.
Menopause
There have been anecdotal reports that flax helps relieve menopausal symptoms such as hot flashes. One study provided support for these reports. Twenty-five menopausal women with mild symptoms either ate 40 g of ground flax daily or took an oral estrogen-progesterone hormone replacement (0.625 mg conjugated estrogens per day) for two months. After a two-month period free of treatment, each group crossed over to the other intervention for two months. In this trial, flax was as effective as hormone replacement therapy in improving mild menopause symptoms (136). A longer-term trial of flax benefits for menopausal women is being conducted at the Pavillon Saint-François d’Assise, Centre Hospitalier Universitaire de Québec.
Vegetarian Nutrition
Vegetarians living in affluent countries enjoy good health with low rates of cancer and cardiovascular disease (240) and a substantially lower mortality rate than national rates (241). Their good health is due, in part, to their eating diets rich in fruits, vegetables and whole-grain breads and cereals. However, there is a concern that some vegetarians may not be getting enough omega-3 fatty acids in their diets. Vegans, whose diets are totally lacking in meat, fish and dairy products, obtain omega-3 fatty acids only from plants, which are a source of ALA but not EPA and DHA. Indeed, strict vegans have low levels of omega-3 fatty acids in their red blood cells, platelets and in serum phospholipids. Moreover, they tend to have higher levels of linoleic acid, the essential omega-6 fatty acid, than omnivores (242,243). Vegetarians who add flax oil to the diet can improve the omega-3 fat content of their tissues. (Refer to Chapter 3 for a discussion of the importance of omega-3 fatty acids in the diet.) In vegetarian men, for example, consuming flax oil and margarine made with flax oil daily for 28 days increased the ALA, EPA and total omega-3 fatty acid content of their platelet phospholipids (244).
Sources
|