Posts made in June, 2011

Cocoa loco? The lowdown on chocolate and heart disease

Posted by on Jun 17, 2011 in heart disease | 0 comments


If you are a chocoholic, I bet you’ve noticed the headlines linking chocolate to a reduced risk of heart disease. In fact, data from the Kuna Indians (a tribe indigenous to Panama) have shown that cocoa and in particular dark chocolate are associated with declines in blood pressure. More recently, a large government study showed an even greater benefit in terms of a significant reduction in coronary heart disease prevalence. And in women, who have an increased risk for heart disease as they age (not only due to the increase in abdominal fat or changes in their blood fat levels but also to loss of ovarian function), chocolate has ben shown to slightly lower the risk of dying from heart disease.

Sounds promising and quite frankly, awesome, right?

Well…before you run out to the grocery or chocolate shop, you may want to read further…

Researchers have long been interested in flavonoids and in particular (at least in so far as menopause goes) in isoflavones. (See soy posts for more on isoflavones). The specific compound or molecule of interest in cocoa (the non-fat component cocoa bean extract or liquor) are flavanols, which are also found in lower concentration in apricots, peaches, apples, green and black tea, red wine and cider). Note that the quantity of flavanols in chocolate depends on manufacturing, including fermentation and roasting, and how much treatment is given to reducing bitterness and improving consistency. What this means is that dark chocolate has the highest concentration of flavanols and milk, the lowest.

What have researchers learned so far?

  • Flavanols found in cocoa and cocoa powder may be powerful antioxidants and as such, help to mitigate certain factors that contribute to atherosclerosis, such as the formation of plaques in the arteries that lead to stroke and other coronary events. Thus, as antioxidants, they may actually neutralize toxic oxygen species circulating in the bloodstream.
  • Experimental data suggest that ingestion of flavanols may help to regulate proteins and other compounds that encourage an inflammatory response to leads to heart disease.
  • Flavanols may also help to stabilize the lining and muscular tone of the arteries and prevent them from narrowing.
  • Additionally, flavanols may moderately protect against high blood pressures, although studies have been mixed.
  • Finally, flavanols may help to maintain blood sugar levels and improve the ratio of good to bad fats in the blood.

Wow, this sounds fantastic! And all it takes is a daily diet of dark chocolate?

Here’s the great news. Researchers are devoting increasing amounts of time toward learning how certain foods affect (and benefit) health. However, in so far as chocolate goes? In a thorough review published online in Maturitas, they write that of the studies that have been conducted, it’s truly difficult to determine whether or not there is a causal relationship, i.e. eating A causes B, or eating chocolate prevents heart disease. In the case of chocolate in particular, factors like manufacturing can influence study findings. Moreover, researchers still aren’t sure if they should be focusing on flavanols or some other component of cocoa. It is also possible that only people who already have some sort of problem or condition will benefit  from eating more chocolate.

The bottom line? Dark chocolate in moderation, won’t hurt you and may actually help you. However, you may want to temper expectations. At least a wee bit. Dare to dream though…perhaps cocoa will ultimately defy explanation!

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Wednesday Bubble: Depression and midlife – “overmedicalizing” the menopause

Posted by on Jun 15, 2011 in depression, menopause | 4 comments

What’s the lowdown on depression, midlife and women? And how does the menopause come into play?

I written previously that depression may affect as many as 20% to 40% of women during menopause. However, gender differences in depression evidently begin well before the menopause and women are 1.5 to 3 times likelier than men to report a lifetime history of depression. Moreover, these distinctions start as early as the teen years and continue until the mid 50s, which researchers say, corresponds to female reproductive. Hence, experts have connected waning and altered hormone levels to high rates of mood and anxiety disorders in women.

Is this hypothesis valid? And, where did it originate?

According to a review in the early online edition of the Journal of Affective Disorders, some research has suggested that premenstrual, post partum and menopausal mood disorders are linked and that women are especially vulnerable during certain time periods. This has led to a proposal that reproductive-related depression have its own classification, and that during midlife in particular, all women should be routinely screened for symptoms. Interestingly enough, however, it has also led some researchers to question if we are “overpathologizing the menopause?” Hallelujah! (If you want to read more on medicalizing the menopause, check out one of my favourite Flashfree posts.)

The key finding?

Although studies demonstrate that significant numbers of women in midlife report depressive symptoms, menopause is only one of a range of factors purported to lead to depression during this timeframe. Others include stress, family life, general health issues and a lack of exercise, as well as a history of some sort of anxiety disorder. What’s more is that how women perceived the effect of menopause on their physical health almost doubled the risk that they would first develop depression at the onset of menopause.

The researchers say that although women might score high on self-reported mood scores, these scales or instruments tend to exaggerate the rate of depression in women in midlife and menopause. They also note that if a score is only taken at one time point that is might indicate temporary distress rather than a long-term problem. They add that during menopause, certain symptoms, such as sleep disturbance and fatigue, may be easily confused with depression even though they have nothing to do with a mood disorder and everything to do with hormones.

The bottom line is that symptom overlap and environmental factors can confuse a diagnosis, and that depression is not necessarily more prevalent during menopause than during other periods in a woman’s life. Consequently, like many things, the studies that are out leave more questions than provide definitive answers. Hence, the call for all women to be screened for depression during menopause may be an example of extreme assumption and not based in true necessity.

Is it possible that depression is just the tipping point in the medicalization of menopause?

What do you think?

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Baby’s [got] back… just because

Posted by on Jun 13, 2011 in weight gain | 1 comment

True confessions.

I love this post. Which I originally ran in January of ’10.

The reason I love it?

I am tired of hearing that women need to do something about their bodies, especially as they age. So this one is for you, and you and you. Because if you’ve got ‘back,’ good on ya!


Maybe Sir Mix-a-Lot has a point. It seems that a large derriere and thighs may actually extend your life. The reason? Researchers say that fat particles that end up in these areas help trap harmful fatty acids in our diet.

Although they are unsure of the exact reasons why, researchers do say that unlike abdominal fat, which has been linked to metabolic syndrome, lower body fat, i.e., fat that accumulates in the thighs and backside, has actually been confirmed to play a protective role in the body. In fact, it not only stores unhealthy fatty acids, but may also release harmful compounds more slowly than say, abdominal fat.

So if you’ve got back, are you in the clear to eat whatever you want? Not so fast. Even though “back” may offer a protective role, there are other reasons to eat and stay healthy – not only to maintain optimal cholesterol levels, but also to counteract some of the natural effects of declining estrogen, such as weakening bones.

(The study appeared in the January 12 online edition of the International Journal of Obesity.)

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Newsflash: International Menopause Society has issued updated guidelines on HRT

Posted by on Jun 10, 2011 in HRT | 7 comments

Got news?

I sure do!

The International Menopause Society has issued updated recommendations on the use of hormone replacement therapy (HRT, a term that they use to refer to estrogen, progesterone, combined therapies, androgens and tibolone). They note that the current guidelines are similar to those issued in 2007 but “include additional clinical data where needed.” And while they claim that there are “no reasons to place mandatory limitations on how long HRT is used (which by the way, runs counter to current recommendations of several major national and international medical associations), they do emphasize that HRT “should not be recommended without a clear indication for use, i.e. significant symptoms or physical effects of estrogen deficiency.”

The following are some highlights of the updated report:

  • HRT should be used at the lowest effective dose to effectively reduce symptoms and maintain life quality
  • Women who enter early menopause either spontaneously or due to hysterectomy or other condition before age 45 and particularly before age 40 may be at increased risk for heart disease, osteoporosis, mental disorders or dementia. Notably, the evidence of reduction of this risk via HRT is limited but is nevertheless recommended to preserve bone and reduce symptoms, at least until they enter the average age for menopause (i.e. ~52)
  • Progestogen should be added to estrogen in all women with an intact uterus to prevent endometrial malignancies and cancer (except for in the case of low-dose estrogen)
  • HRT is recommended to preserve bone health although it should not be started after age 60 and loses its effectiveness once therapy is stopped.
  • Despite the controversy as to whether or not HRT is heart protective, the IMS says that it has the potential to boost or improve one’s risk profile because of how it affects the vascular system, metabolism of blood sugar, blood pressure and cholesterol levels. However, this recommendation is also framed within the recommendation that women adopt major primary prevention measures, such as stopping smoking, regular exercise, weight control, blood pressure reduction, and control of diabetes and blood pressure.

So, what about the risks of HRT that I’ve long written about on this blog? The convened panel disputes the conclusion of the Women’s Health Initiative (due to average older age of participants and when they started HRT) as well as data that have come down the pike since 2002. In fact, they say that the link with breast cancer is controversial and that HRT doesn’t initiate cancer (but rather, promotes an existing tumour). They also concur that data are still lacking with regards to type of HRT, doses, and administration type and incidence of breast cancer. And, with regards to endometrial cancer or stroke? They write that women with a uterus should be certain to add a progesterone component to their hormones to counteract any undue stimulation of their endometrium, and that stroke risk is related to increasing age and obesity, noting that risks may be avoided by using an estrogen patch or stopping use of hormones after the age of 60.

In general, the conclusion of the panel is than “most menopausal women have little to fear from the adverse effects of HRT” and that the benefits of hormone therapy outweigh the risks. Still, they do suggest that the decision to take HRT should be discussed with a physician and reviewed annually.

Not surprisingly, alternative therapies are completely
discounted in the IMS guidelines and they do not support the use of any bioidentical hormones whatsoever. Moreover, they make a point to place blame on the media without providing clear examples of their claims for “superficial and uncritical evaluations” of HRT, as if all media were one and the same.

I am not quite sure what to make of these recommendations. On one hand, they claim to have reviewed all the data since WHI but this panel convened four years ago. And while they are sure to promote HRT within a cautious framework, menopause continues to be positioned as a disease requiring treatment.Indeed, one of the report authors, Dr. Roger Lobos (Columbia University, New York), says that “the bottom line is that most doctors nowadays should feel comfortable about prescribing HRT to most women going through the menopause [but] like most medicines, you need to look at individual circumstances before deciding to taken it.”

Notably, media are once again positioned as the big bad wolf that misconstrue findings and attack  pharmaceutical companies for their profit motivations.

Has anything really changed except the date of the report? Well, the good news is that the IMS acknowledges that there are risks associated with HRT, at least for some women. And yet, the report still appears lack objectivity.

Do yourself a favour. Speak to your practitioner. HRT will shut down your symptoms. Period. But you must ask yourself, at what cost? Do your research. Ask the hard questions. And then ask them again.

You may be sweating. But the issue is greater than the sum of all sweats.

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Wednesday Bubble: wrinkles and bone density – what’s the connection?

Posted by on Jun 8, 2011 in bone health, menopause, osteoporosis | 5 comments

There’s a connection between wrinkles and bones? When I caught wind of the research, I thought immediately of a Wednesday Bubble. But this one appears to be the real deal.

Researchers presenting at The Endocrine Society’s Annual Meeting this past weekend say that severity of facial wrinkles during the early years of menopause may indicate a low bone density (thereby leading to an increased risk for osteoporosis). Wow!

This information comes out of the ongoing Kronos Early Estrogen Prevention Study (KEEPS), which is looking at the effect of oral and transdermal estrogen therapy on measures of the carotid artery that might indicate thickening of the arteries (and eventual heart disease) as well as the build up of calcium in the blood. A subgroup of 114 women in their late 40s and early 50s and within three years of starting menopause were examined for this part of the trial.

The researchers looked at and scored severity and depth of skin wrinkling based on number of sites on the face and neck. They also measured skin rigidity (or firmness) on the forehead and cheek. Additionally, they evaluatd total body bone mineral density as well as at the lumbar spine and left hip.

The findings? Higher wrinkle scores (meaning more severe wrinkles) were associated with lower bone density measures at all sites, while firmer skin on the forehead and face were related to greater bone density, especially at the hip and spine.

The connection? Pun unintended but the researchers say that collagen, protein that naturally occurs in connective tissue in tendons, ligaments and even bones, is the common factor. They add that as women age, changes in collagen not only contribute to sagging skin and more facial lines but may also negatively affect both the quality and quantity of bone.

Although more research is needed, it might be worthwhile to obtain a dermatologic and bone density assessment at the start of menopause to see where you stand. And then speak to your health practitioner about the need for regular follow up and monitoring to insure that fragile bones don’t lead to fractures. Ultimately, if the link between wrinkling and bone quality is proven, it might eliminate or at least lessen the need for costly DEXA ( dual energy X-ray absorptiometry)  that are currently used to measure how tightly calcium and other minerals are packed into bone.

Who would thunk that wrinkles could actually be useful?!

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