Posts made in January, 2009

Change

Posted by Liz on Jan 20, 2009 in Inspiration | 0 comments

[credit: Bella, T-shirt mojo http://tinyurl.com/7jyss5]

It’s all in the spin

Posted by Liz on Jan 19, 2009 in herbal medicine | 2 comments

I’d like to believe that researchers have patients’ best interest at heart but an article in this month’s British Medical Journal’s Drug and Therapeutic Bulletin has led me to believe that objectivity can be difficult.

The piece, entitled “Herbal medicine for menopausal symptoms,” positions itself as a review of the effectiveness and safety of herbal medicines commonly used for relief of vasomotor symptoms, including hot flashes and night sweats.  The herbs covered within the piece include black cohosh, red clover, dong quai, evening primrose, ginseng, and briefly wild yam, chaste tree, hops, sage leaf and kava kava.

However, within the first two paragraphs, it becomes abundantly clear that the review is aimed at attacking the validity of so-called “alternative” therapies and consequently, attempts to provide the evidence that does so.

The author correctly points out that the consumer might automatically deem such products safe since they are natural, and that many products on the shelves do not comply with good manufacturing standards. In fact, I’ve written on these very essential considerations.

However,  s/he blatantly (and incorrectly) states that “there has been a lack of studies of herbal medicines for menopausal symptoms,” emphasizing in particular (but not defining) the following:  faults in study design, number of participants and length of study. The author also criticizes the use of traditional herbal systems (e.g., Traditional Chinese Medicine), which s/he says has little published research that supports its use in treatment of menopausal symptoms.

Although I did not review each study individually, I would like to point out that the author’s claim of a lack of published studies can be easily  disputed. Using the search term:

• “Herbal medicine for menopause,” I pulled 6 pages (104 studies) of scientifically-designed, herbal medicine trials on the National Institute of Medicine’s Pub med database
• With the term “black cohosh,” I pulled 20 pages or 431 studies
• With the term “red clover,” I found an additional 76 studies
• Ginseng and menopause – 20 studies
• Traditional Chinese medicine and menopause – 47 studies
• Dong Quai – 24 studies
• Evening Primrose – 25 studies

Notably, I did not search databases that specialize specifically in complementary therapies or more importantly, the Traditional Chinese Medicine database.

The gist of the data cited within the DTB Review suggest that save for black cohosh, there is little or no evidence to support the utility or effectiveness of herbal medicines for  relief of menopausal symptoms.  Claiming that the “efficacy and safety of such products is under researched and information on potentially-significant herb-drug interactions is limited,” the author urges healthcare professionals to routinely ask their female patients if they are using such preparations.

A few bones to pick:

1) The author has reviewed only 8 trials on black cohosh, one meta-analysis of 30 trials on red clover, 1 trial of don quai, 1 trial in evening primrose, and 1 trial of ginseng. Yet, ten minutes on Pub Med revealed over 700 published trials.

2)The author has provided no indication of which database(s) s/he searched, which begs the question, is the identification of well-designed trials with ample numbers of participants been thoroughly conducted? What’s more, definitions of  “well-designed” or “ample numbers” are not addressed within the entire review, leading one to believe that this assessment is subjective.

Give me a well-designed, well-defined review of the evidence and let’s talk. Think about the following and let’s have an intelligent dialogue. And in the interim, check out the topics in this blog. I think that you’ll find plenty of evidence to support the utility and safety of alternative therapies to address menopausal symptoms.

It’s all in the spin, isn’t it?

What do you think?

A new equation for midlife: calcium+vitamin D+physical activity+better eating =

Posted by Liz on Jan 16, 2009 in health, general, weight | 1 comment

Weight gain. Data abound that show that women between the ages of 50 and 79 experience age-related changes in body composition, metabolism, and hormones, often accompanied by a decline in physical activity. This leads to a propensity for fat and weight gain.

Okay, so that’s the not-so-good news.

The good news is that daily calcium (1000 mg) plus 400 IU of vitamin D may have a small effect on the risk of weight gain. Even better, coupled with other dietary and lifestyle changes (nutrition counseling, physical activity), weight gain may be a thing of the past, or at least, something that is a lot more controllable than we think!

In one study, 36,282 women who were already participating in the Women’s Health Initiative trial and undergoing dietary modification or hormone replacement therapy were assigned to 1000 mg calcium plus 400 IU vitamin D or placebo daily. Weight and height were measured annually for seven years.

Study results, which were published in the May 2007 edition of Archives of Internal Medicine, suggest that women taking daily calcium plus vitamin D supplementation were 11% less likely to experience  modest weight gain (2 to 6 pounds) and also 11% less likely to gain more than 6 pounds. Interestingly, a reduced risk was seen in women who were ingesting less than 1,200 mg calcium daily, which is the recommended daily amount (RDA) by the Food and Nutrition Board of the National Academy of Sciences. Notably, the researchers do caution that the findings do not alter the RDA and that women should still aim for the 1,200 mg daily RDA of calcium.

In a second, more recent study published in the online edition of  Maturitas, 101 postmenopausal women were assigned to dietary intervention (1200 mg calcium plus .75 mc vitamin D plus fortified dairy products daily), 1200 calcium daily or placebo. Women in the dietary intervention also attended biweekly dietary and lifestyle intervention sessions.

Similar to results of the first study, women receiving dietary interventions had significantly lower increases in skin thickness measures and experience declines in fat mass compared to the other two groups.

In concert, these results suggest that daily intake of calcium plus vitamin D, coupled with dietary restrictions and physical activity, may help to stave off the extra pounds in midlife. As with any regimen, it is essential to discuss a new regimen with your healthcare practitioner before taking the leap.

I’ve written previously about the value of calcium, dietary restrictions and physical activity to overall health, preventing osteoporosis and heart disease, and lowering the risk of weight gain. The addition of vitamin D appears to make the equation even more effective.

Although there have been many articles written of late that tout the benefits of vitamin D, like anything, it’s not the panacea for all that ails. Good health starts with thoughtful, well-informed choices. But it’s inspiring to know that there are positive steps you can take to feel good and look even better!

Wednesday Bubble: The incredible shrinking brain

Posted by Liz on Jan 14, 2009 in HRT | 2 comments

WHAT?!

New research from the Women’s Health Initiative Memory Study hormone trials demonstrates that HRT may shrink women’s brains. No wonder I can’t forget where I placed those files..

The data, which are reported in the January 13 edition of Neurology, show that women who took hormone replacement comprising estrogen with or without the addition of progesterone had an increased risk for dementia and overall decline of cognitive function.

Researchers measured brain volume and size of microscopic brain lesions in 1,403 women who took estrogen therapy for 18 months or combined estrogen/progesterone for three years or a placebo. The women who participated in the study were on average, about 77 years old.

The findings showed that women who took HRT had brains that were several centimeters smaller than women who took placebo.

The areas of the brain that were most affected by therapy? The hippocampus, which is involved in memory formation, and the frontal lobe which is involved in memory recall. However, no differences were seen in the sizes of brain lesions, which negates the possibility that HRT is leading to tiny strokes that cut off the brain’s blood supply and affecting memory.

When I looked into other reports of this study, I found quotes from the researchers that suggest that the greatest risk may be in women who already have memory problems. More importantly, the findings imply that the risks of postmenopausal hormone therapy may greatly outweigh the benefits.

These data do potentially provide some explanation as to why many women going through menopause experience increased forgetfulness. However, it is clear that the story is not yet complete, as many of us not taking hormones still seem to go through weekly, if not daily memory lapses.

Now…where did I put that….

Pink elephant

Posted by Liz on Jan 12, 2009 in career | 6 comments

In 1980, I worked as an intern on the municipal bonds floor of a well-known brokerage/financial institution. Although it was certainly not my “thang,” I learned a tremendous amount about how the business world operated, and most importantly, about the games that people play.

One thing that struck me in particular at that time was the role of women in this business and how they dressed and behaved. Women were not abundant in positions of power, and those who were, well, in some respects, they emulated men; they were aggressive, competitive and not particularly kind to one another.

Clearly, things have changed drastically in the almost three decades that have followed. But one thing that hasn’t changed much is how sisters act in the workplace.

A line from this wonderful article that appeared in yesterday’s New York Times made me realize that certain stereotypes continue to perpetuate bad behavior. And, that as Author Peggy Klaus so aptly writes, “the pink elephant is lurking in the room and we pretend it’s not there.”

The pink elephant is lurking in the room.

Klaus’ point is that rather than help build each others career, women often work to derail each other, engaging instead in “verbal abuse, job sabotage, misuse of authority and destroying of relationships.” She cites data suggesting that this type of behavior is directed from women to women >70% of the time, while the men who are “bullies in the workplace,” direct their aggression equally to both genders.

Klaus offers numerous reasons why women become aggressors in the workplace: scarcity of positions, bootstrap (I pulled myself up, why should I help you?) and hyperemotionality that leads to an overinvestment in workplace occurrences that cause them to hold grudges.

Her point, however, is not to determine the why but rather, engage one another to put an end to this type of behavior.

I’ve written previously that as we grow older, friendships and support of one another are essential to our overall wellbeing. Regardless of whether its in the workplace or in our personal lives, supportive relationships allow the soul to flourish and grow. Personal resources as they pertain to social support also help see us through the rougher aspects of menopause.

Should women give preferential treatment to one another? No, absolutely not. But as Klaus says, perhaps we should start treating one another as we want our “nieces, daughters, granddaughters an sisters to be treated.” We should simply… acknowledge the pink elephant in the room. And show it the door.