excerpted from the Banyan Botanicals free newsletter, Banyan Vine, Dec 09.

Supporting Sthanyavaha Srota: A Guide to Breast Health
by Alakananda Ma (Ayurvedic Physician)

Breast health comprises a complex topic on several counts. The female breast is both an exocrine gland and a secondary sexual characteristic, it responds both to an array of endogenous hormones and to exogenous oestrogens and pollutants and it fluctuates both with the menstrual cycle and the life cycle. In this article we will consider issues in breast health during puberty, reproductive years, pregnancy, lactation, and the post-menopausal years and will look at simple suggestions for ahara, vihara and aushadhya (diet, lifestyle and herbs) for each phase.

The breast consists of glandular tissue, adipose tissue (fat cells), nerves, blood vessels and lymphatics. Anatomically it overlies the pectoralis major muscle and is anchored to the pectoralis fascia by suspensory ligaments known as Cooper’s ligaments (1,2). The breast contains about 15 to 25 lobes formed by groups of milk glands, or lobules. Each lobule is composed of hollow milk producing alveoli or acini, and feeds into a milk duct leading to the nipples. The ducts converge near the areola, the darker area round the nipple, to form ampullae or milk storage cavities. Around the areola are small glands known as Montgomery's glands which secrete an oily substance that protects the nipples during nursing. Lymph nodes within the breast drain into the axilliary lymph nodes in the armpit—the first place to which breast cancer will typically metastasize.

The breasts have several functions. As exocrine glands, they produce milk for suckling the young, a function shared in common with the mammary glands of all mammalian species. As a secondary sexual characteristic they form an intrinsic part of a woman’s attractiveness and hence of her self esteem and body image (3). And as detailed in ancient texts such as Kama Sutra and Ananga Ranga Sutra, and established in current studies in sexual medicine (4), the breasts also play a significant role in sexual arousal.

Telarche, or the appearance of breast buds, technically known as Tanner Stage 2 breast development, is typically the first change of puberty. The age of telarche has been dropping from a mean of 11 to a mean age of 8.87 years for African-American girls and 9.96 years for white girls (5). Various factors that may be associated with a younger age of onset of pubertal changes include a changing diet pattern, adolescent obesity, stress, sexual abuse, and oestrogen-like environmental pollutants. Earlier pubertal changes carry a host of potential social and psychological issues. It has been found that a vegetarian diet high in fiber can slow the age of onset of puberty (6) and obesity can speed puberty (7). Hence an important step for a pre-adolescent girl would be adoption of an Ayurvedic diet high in vegetables rather than a standard American teen diet of pizza, fries and soda. In terms of lifestyle, it is important to encourage an exercise program suited to prakruti, to work to reduce stress within the family system and to discourage the use of bisphenol-containing plastic water bottles, which are tied to a host of developmental issues including early puberty (8, 9, 10). Shatavari Kalpa is likely to be well tolerated by teens as it has a pleasant taste and will help support healthy breast development. Roast an ounce of shatavari with one or two tablespoons ghee in a cast iron pan until light brown and add two tablespoons of sucanat, rapadura or turbinado sugar, two pinches saffron and a pinch of cardamom.

During the reproductive years, the breasts undergo cyclical changes. Breast size may increase by up to 10-15% during the late luteal phase, bringing on mild breast tenderness, swelling, pain, or lumpiness in 60% of healthy women, while another 10% may endure moderate to severe symptoms. Fibroadenomas, the most common benign mass breast lumps, frequently occur in women in their early 20s, although they are not uncommon to age 35. After age 35, as the cycle begins to change, breast cysts are more common.

Some very important lifestyle changes must be introduced during the reproductive years, to help prevent fibrocystic breast disease and breast cancer. Encourage women to avoid tight bras or bras with underwire and to select only natural fibers such as cotton to be worn over the breasts (11). Daily breast massage with strokes towards the axilla increases blood flow to the breasts, stimulates lymphatic drainage and enhances oxytocin production (12). Breast Balm can be used for daily massage. Ideally, daily breast massage will be perceived by women as an essential self care feature, like brushing the teeth. Appropriate diet for dosha can help reduce troublesome premenstrual breast symptoms. A formula that supports healthy hormonal balance such as Women’s Support helps promote a regular menstrual cycle and its attendant breast changes. Shatavari and vidari will support healthy hormonal balance and punarnava can be used to reduce excess kapha and promote breast comfort.

During pregnancy there is significant ductal, lobular, and alveolar growth occur due to luteal and placental sex steroids, placental lactogen, prolactin, and chorionic gonadotropin. Prolactin levels gradually rise during the first half of pregnancy. Breast pain is often the first symptom of pregnancy. During the second month the breasts enlarge and engorge and the areola becomes pigmented. Breast size continues to increase throughout the pregnancy as the mammary glands mature and prepare for milk production. During this time, building foods should be used, such as urad dal, almonds, coconuts, dates and whole milk. Daily breast massage using Breast Balm is useful both to promote breast comfort and support the natural suppleness of the nipples. Use of soap on the nipples should be avoided as this will wash away the antibacterial secretions from the Montgomery glands and may also lead to drying and cracking of the nipples (1). Vidari is a vital herb during pregnancy as it supports healthy growth of both the placenta and mammary tissue (13). Be sure to introduce Vidari early on in pregnancy as herbs may not be well tolerated if introduced for the first time during the third trimester.

During birth, prolactin increases. This, in combination with growth hormone, insulin, and cortisol effects, converts mammary cells from a presecretory to a secretory state. Tactile stimulation of the nipple by the baby’s sucking leads to release of prolactin and oxytocin from the pituitary gland, which causes myoepithelial cells surrounding the lobules and small ducts to contract and express milk. Common problems with breastfeeding include insufficient milk, lack of support and knowledge and cracked nipples (12, 13). Because support and education are so important, an Ayurvedic post partum doula is a valuable member of the team. Breast milk is an upadhatu of rasa dhatu, hence liquid foods such as ojas drink, date shake and pomegranate juice are more advisable than the traditional cheese and crackers in supporting milk production. Shatavari Kalpa (16) vidari and licorice (17) support milk production and are valuable at this time.

Ojas drink - Almond Restorative Drink, serves 1, sattvic
Ingredients:
10 raw almonds (soaked overnight)
1 c pure water
1 c milk (non-homogenized if possible)
1 T organic rose powder
1 t ghee
1/32 t saffron
1/8 t ground cardamom
pinch of black pepper
½ t of sweetener

Peel almonds. Blend all ingredients until smooth.

Galactoceoles, or milk cysts, can occur during pregnancy or lactation. These present as palpable lumps, often tender. If milk cysts occur the mother can apply castor oil packs. If cysts occur during lactation, (not during pregnancy) she can take turmeric internally.

During menopause, declining ovarian function results in regression of breast tissue. Lobules are reabsorbed, and to a lesser extent, so are ducts. Over decades of menopause, nipples may flatten or retract. This normal change should occur gradually and bilaterally. Beware of rapid (over 1-2 years instead of decades) or unilateral retraction. This could signal subareolar breast cancer. Women in their menopausal years should continue daily breast massage and should focus on a high quality diet. Of the three types of food - beneficial, neutral and harmful, post menopausal women can be guided to consume only the first category. Treats can include such delights as Energy Balls (made from tahini, almond butter, honey, shatavari and vidari rolled in coconut flakes), sweet potato halvah and carrot halvah rather than M&Ms and cookies. Shatavari and vidari provide systemic support during these years.

Women taking hormone replacement therapy constitute a special category as, “Current use of HRT is associated with an increased risk of incident and fatal breast cancer” (18). Fibroadenomas may also enlarge with HRT and breast cysts may develop. Castor oil packs can be applied to the chest and punarnava, shilajit and calamus can be taken internally to support healthy breast tissue. However, any enlarging solid mass should be evaluated since this group faces a very significant cancer risk. Daily breast massage, breast self-examination and regular checkups are essential for these women.

The health and beauty of a woman’s breasts form an important part of her well-being and self esteem. At every stage of a woman’s life, Ayurvedic ahara, vihara and aushadhya provide important keys to maintaining breast health.

1. Breastfeeding: A Guide for the Medical Profession by Ruth A. Lawrence, Robert M. Lawrence: Elsevier Science: March 2005
2. Breast Anatomy, Allen Gabriel, MD http://emedicine.medscape.com/article/1273133-overview
3. Anders Pape Møller, et al. (1995). "Breast asymmetry, sexual selection, and human reproductive success". Ethology and Sociobiology 16 (3): 207–219.
4. Roy Levin, PhD, Cindy Meston, PhD Nipple/Breast Stimulation and Sexual Arousal in Young Men and Women Journal of Sexual Medicine Volume 3 Issue 3, Pages 450 - 454 27 Feb 2006
5. Neinstein LS and Kaufman FR, chapter 1: Normal Physical Growth and Development from Neinstein L.S. Adolescent Health Care: A Practical Guide, 4th edition, Lippincott Williams and Wilkins 2002
6. M de Ridder, JH Thijssen et al Dietary habits, sexual maturation, and plasma hormones in pubertal girls: a longitudinal study, American Journal of Clinical Nutrition, Vol 54, 805-813,
7. Paul B. Kaplowitz, MD, PhD Eric J. Slora, PhD Earlier Onset of Puberty in Girls: Relation to Increased Body Mass Index and Race PEDIATRICS Vol. 108 No. 2 August 2001, pp. 347-353
8. Honma S, Suzuki A, Buchanan DL, Katsu Y, Watanabe H, Iguchi T. 2002. Low dose effect of in utero exposure to bisphenol A and diethylstilbestrol on female mouse reproduction. Reprod. Toxicol. 16:117-122 (2002); Howdeshell KL, Hotchkiss AK, Thayer KA, Vandenbergh JG, vom Saal FS. 1999.
9. Exposure to bisphenol A advances puberty. Nature 401:763-764 (1999); Nikaido Y, Yoshizawa K, Danbara N, Tsujita-Kyutoku M, Yuri T, Uehara N, Tsubura A. 2004.
10. Effects of maternal xenoestrogen exposure on development of the reproductive tract and mammary gland in female CD-1 mouse offspring. Reprod. Toxicol. 18:803-811 (2004)
11. Singer, S. R. Grismaijer, S. Dressed to Kill. The Link Between Breast Cancer & Bras Journal of Applied Nutrition 1995, VOL 47; NUMBER 3, pages 90-92
12. Yuji Yokoyama, Toshihiro Ueda et al, Releases of oxytocin and prolactin during breast massage and suckling in puerperal women European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 53, Issue 1, January 1994, Pages 17-20
13. Bulusu Sitaram tr. Bhavpakasha of Bhavamishra Chaukhambha Orientalia ,Varanasi, 2006 p 27
14. EE Gulick -Informational correlates of successful breast-feeding MCN: The American Journal of Maternal/Child Nursing, 1982
15. GL Bourgoin, NR Lahaie, BA Rheaume, MG Factors influencing the duration of breastfeeding in the Sudbury region Canadian Journal of Public Health, 1997
16. Bulusu Sitaram, op. cit. p 278
17. ibid p 159
18. V Beral, E Banks, G Reeves, D Bull Breast cancer and hormone-replacement therapy in the Million Women Study The Lancet, Volume 362, Issue 9382, Pages 419 - 427, 9 August 2003