Posts made in January, 2011

Hormone replacement therapy…timing is everything, right?

Posted by Liz on Jan 31, 2011 in breast cancer, HRT | 5 comments

Hormone replacement therapy (HRT) continues to be a hot topic in the menopausal world. And no wonder! Because the deeper we dive into the controversies, the more information we seem to learn about its dangers.

If you search for hormone replacement or HRT on this blog, you’ll find that the dialogue has nothing but consistent. And while naysayers may try to accuse me of a personal vendetta against hormones, it’s actually not the case. I started Flashfree for several reasons, the most important being that I wanted to provide enough information about menopause and aging and treatment strategies to enable women to think on their feet, consider the facts and have intelligent dialogues with their peers and practitioners before making any decisions that could affect their health and wellbeing as they grow older. Moreover, although I am a strong proponent of alternative strategies to combat the unpleasantries of dwindling hormones, I still believe strongly in the benefits of certain Western approaches to treating illness. However, I also a strong believer in integrative strategies that combine the best of our knowledge in an individualized fashion; my mantra is ‘treat the individual, not the masses.’ Hence, when I read about the history of the menopause in general and HRT in particular, what I see is disease mongering at its finest, examples of fear and loathing and mostly, a disrespect of women. And I care too much about women’s health to remain silent.

Last Friday, several of my colleagues sent me a link to the following study:

“Breast cancer risk in relation to the interval between menopause and starting hormone therapy.”

This newly-published study in the Journal of the National Cancer Institute is one of the largest to date since the findings of the now infamous Women’s Health Initiative (WHI) study linking Preempro to breast cancer. In it, investigators used observational information culled from over a million postmenopausal women in the United Kingdom to determine how type and timing of hormone therapy might influence the risk of developing breast cancer.

A bit of context is necessary for those of you who are unfamiliar with the major criticisms of WHI, namely that that the women studied were not representative of the normal menopausal population, were older, started hormone therapy later in life (i.e. >5 years from when menopause started) when their risks for disease were greater, and that the type of hormone replacement, namely the progestin component, were not taken into consideration. WHI was also criticized for not focusing on the small percentage of women in the study who took estrogen-only and were not at greater risk for breast cancer. (If you want to read more about that particular issue, check out the write up on data presented at this past year’s San Antonio Breast Cancer Conference.)

In the UK study, the average age of participants was 56.6, considerably younger than the study population in WHI. More than half (55%) of participants reported having used hormones at some point and 35% were current users, and the rest, had never used hormone therapy. Study participants were matched by socioeconomic status, childbirth information, BMI, physical activity, alcohol consumption and smoking to insure that these factors did not influence the study findings.

Overall, 15,759 breast cancers developed and were diagnosed approximately a year and a half after the last point of contact:

• Despite contentions by some experts that starting combination hormonal therapy within 5 years of menopause is safe, women between the ages of 50 and 50 who began HRT less than 5 years after menopause had the highest rates per year of breast cancer — .61% per year — that twice that of women who had never used hormones (.31%).
• Current users of estrogen also demonstrated increased breast cancer rates (.43%) who started hormones within or less than 5 years after menopause started.
• The risk of developing breast cancer was roughly 1.5 times higher among women on combination hormone therapy who started within 5 years than women who started 5 year or more from menopause.
• The risk of developing breast cancer among past users of hormonal therapy tended to decline over time after use of hormones stopped, and within 14 years, were almost equivalent to never users.

Mind you, the study is not without fault and may be criticized on the basis of the fact that it relied on observational information rather than randomized controlled results. In other words, data were collected and then analyzed based on what they inferred.  The research might also be questioned due to the fact that information about use of hormones was reported over a year before cancer was diagnosed, thereby possibly leading to mischaracterization of hormone users/non users and estimates of the risk for developing breast cancer. Nevertheless, the researchers say that taking these factors into account, breast cancer risk among hormone users regardless of type, would have increased by a factor of at least 1.2.

The key take-away message from this new study is that it’s may be impossible to define the safest parameter for using hormone therapy. For certain women, HRT may never be safe. For others who are willing to risk life-threatening conditions for fewer hot flashes, HRT may be worth the gamble. As always, ask the hard questions.

Timing is everything, right? Maybe not when it comes to hormone replacement.

Ice Ice Baby

Posted by Liz on Jan 28, 2011 in Uncategorized | 0 comments

[youtube=http://www.youtube.com/watch?v=rog8ou-ZepE]

Dear Flashfree fans:

I’ve been without power and freezing under the covers since Mama Nature directed her fury at the East Coast (that bitch!). I am behind on my posts but I promise, lots of great stuff coming next week. Meanwhile, I always believe in sharing the love so this one’s for you, Mama.

See you Monday!

Wednesday Bubble: ‘ch ch ch Chia’

Posted by Liz on Jan 26, 2011 in weight | 3 comments

[youtube=http://www.youtube.com/watch?v=tzY7qQFij_M]

I ran across a piece in yesterday’s New York Times that has ‘Wednesday Bubble’ written all over it: the connection between weight loss and chia seeds.  WHAT?!

If you are as old as me, you will remember when Chia Pets first hit market; they were all the craze. Water the terracotta figurine and grow ‘hair.’ Somehow, Chia has both made its way into the “stupid” hall of fame and just keeps on giving; in fact, I’ve lost track of its many iterations since it first appeared on the scene. And yet, it appears that the ‘pet that needs nothing but wet’ has transcended the doopid and entered the health arena.

After I saw the headline in the New York Times and delved into the post, I started to realize that this is no joke;  chia is actually being touted as a weight loss agent. In fact, a quick search on Google yielded pages and pages of results and health claims.

Chia or as it’s known in the plant world, Salvia hispanica, is a flowering plant that is native to Mexico and Guatemala. Its seeds are rich in omega-3s and dietary fiber, hence its nutritional value is not without merit. Nevertheless, claims that it can be used for weight loss or to promote health appear to be.

Before you run out to your local health food store, here’s what you need to know:

• Chia originally demonstrated promise in animal (rat) studies in terms of its effects on blood fats and blood sugars, leading to interest in its potential usefulness in humans and health.
• Thereafter, studies evaluating chia seed in humans did not show any specific benefit in terms of weight loss and questionable benefit on heart disease and diabetes. Other claims, such as use in allergies, to enhance athletic performance, prevent cancer, or boost the immune system are currently considered to be false.
• Chia has been safely consumed for decades and continues to be ingested regularly. But it is not without risk and both its high fiber content and omega-3 content can lead to digestive problems if chia seeds are ingested in huge amounts.

Like any quick fix, chia isn’t going to solve your weight issues. Battling weight gain in the face of aging and swinging hormones is tough!  However, it’s important to be sensible; there’s only two rules of thumb: move your body, frequently and watch your intake of calories, fats, sugar and alcohol.

The Chia? Water it, watch it grow and move on. Ain’t no weight loss panacea and chia ain’t nothing but a pet.

Ain’t no “woo woo” going on. Mind, body, relaxation and health

Posted by Liz on Jan 24, 2011 in health, general, Meditation/mindfulness therapy | 6 comments

Relaxation.

It’s so elusive for many of us. And yet, so important to our overall health and wellbeing. In fact, researchers are finally discovering how relaxation actually counters changes that occur in our bodies that result from exposure to constant stressors.

For decades, Dr. Herbert Benson, founder of the Mind-Body Institute in Cambridge, MA and an associate professor at Harvard University, has been writing about the relaxation response, a “mind-body intervention that elicits deep changes in the physical and emotional response to stress.” Strategies that elicit the relaxation response include meditation, yoga, tai chi, Qi gong, deep breathing, controlled muscle relaxation and guided imagery. And although many would like to point to the “woo woo” factor at-play, an evolving and wide body of published literature is indicative of how interested the medical community is in the mid-body connection and the positive changes that these practices promote, including a slowing or heart rate, a reduction in blood pressure, improvements in blood sugar and fats, and even boosts in our immune system. However, what has long eluded researchers is what actually happens in the body to achieve these improvements.

In a novel study published in 2008 in PLoS ONE,  Dr. Benson and his colleagues looked closely at 19 volunteers who had practiced relaxation response strategies (e.g. meditation, yoga, repetitive prayers) for as long as 20 years and compared them to 20 novices, individuals with no relaxation practice experience. These novices were provided with training sessions for 8 weeks that included information about how to reduce daily stress and the relaxation response and a 20 minute, individually-guided session comprising diaphragmatic breathing, a body scan and meditation.For 8 weeks thereafter, the novices then used a 20-minute relaxation CD at home and were asked to review the informational brochures. Blood samples and analysis of gene expression between experienced and novel relaxation practices, and pre- and post-training were then compared.

Importantly, while the researchers observed distinct changes in the genes in experienced relaxation practitioners compared to novices, when the novices started to incorporate relaxation practice into their lives, they also started to express similar positive alterations in their genes. Moreover, these changes are directly related to how cells respond to stress and create free radicals and inflammation that can lead to long-term damage. Additionally, type of relaxation strategy that was practiced was of no important; by achieving a relaxation state, individuals could make positive changes in their cellular structures thought to promote health.

Both inner and outer psychological states and environmental factors play a role in how women experience peri and post-menopause, their self-esteem, attitudes and severity of symptoms. If a daily practice of some sort of relaxation strategy can actually alter genes in a way that improves health and well-being, why can’t that daily practice also improve the menopausal/midlife experience?

While I’ve long embraced the idea, I’ve never actually made a concerted effort to incorporate some sort of relaxation strategy into my daily activities. I’m going to change that. Ain’t no woo woo but a woot woot so far as I can tell.

Depression and menopause: can acupuncture help?

Posted by Liz on Jan 21, 2011 in depression | 4 comments

Depression and menopause. It keeps coming up as a topic and so I’m going to continue to write about it until researchers find an effective way to battle depression during menopause, effective meaning that it is an acceptable strategy for women who prefer alternatives to pharmaceutical agents, effective in that it addresses the underlying causes of depression in menopausal women, including fluctuating estrogen levels, sleep disturbances, night sweats, hot flashes and life factors, and effective in that it is affordable. It’s a tall order, isn’t it?

As I’ve noted time and again, depression is an important issue for many but not all menopausal women, affecting approximately 20% to 40% in a some way or another. Just this week, I wrote about use of the SSRI antidepressants as an alternative to HRT for hot flashes and depression, and possibly as a stop-gap measure until practitioners more widely embrace alternative strategies. On the heels of this study comes another in the  Online Edition of Menopause journal, examining data from one of my favourite studies, ACUFLASH. If you don’t feel like clicking on the link and updates about this study, briefly, in ACUFLASH, researchers randomized 399 postmenopausal women (1 year since last menstrual period) regularly experiencing at least 7 hot flashes daily to acupuncture or no treatment. Moxibustion was used at the practitioner’s discretion and sessions could also be extended by two weeks (from 12 weeks), if needed.  Although the practitioners met beforehand to discuss possible diagnoses and recommended treatment points, all treatment was individualized. Both groups of patients also received self care recommendations, which consisted of a one-page information leaflet on care of menopausal symptoms (e.g. soy, herbs, physical activity and relaxation techniques) which they were free to add at their own discretion.

Overall, the mean frequency of hot flashes declined by 48% in women receiving acupuncture compared with 28% of women using self-care methods only. This means that 50% of women receiving acupuncture experienced a 50% or greater reduction in how often their hot flashes occurred, compared to 16% of women using self-care. Significant reductions were also seen in hot flash intensity. Additionally, the acupuncture group reported significant improvements in vasomotor, sleep, and somatic symptoms over the course of the study.

So, what about acupuncture and depression?

In the current study, researchers examined a sample of 72 women who had participated in ACUFLASH and had either received self-care only or self-care plus acupuncture. At the start, almost 31% of these women reported depressive symptoms and of these, about 17% were determined to suffer from moderate to severe depression (based on a scientific method that measures the severity of depressive symptoms). Although these figures are higher than what is normally seen in the general population, severe depression is often seen among women experiencing very frequent hot flashes (7 or more in a 24 hour period for at least 1 week). And while both groups reported significant declines in depressive symptoms during the 12 week study period by as much as 16%, the declines were similar in both groups, indicating the acupuncture,while helpful for lessening the severity of hot flashes, did not have a specific effect on depression.

If acupuncture doesn’t help depression, why did the results indicate such a high level of improvement that under normal circumstances, an individual could forgo drugs for needles?

A key finding of the original and follow up ACUFLASH studies was the feeling of control over symptoms that was imparted by being educated about self-care. However, here’s the rub: even though acupuncture was shown to significantly benefit both the intensity and frequency of hot flashes, it didn’t provide an edge over depressive symptoms compared to self care alone. The researchers say that this leads them to believe that although a domino effect is at-play (i.e. hot flashes lead to sleep issues lead to symptoms of depression) there is something else that also influences the depression part of the equation.

In the interim, it’s frustrating, right? You can deal with your hot flashes but you still feel blue, low, out of sorts. There is clearly a link between the hot flashes and sleep and depression. It simply needs to be teased out a wee bit further. Keep the faith. We’ll get there!