Posts by Liz

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!

Wednesday Bubble: hot flashes and antidepressants

Posted by Liz on Jan 19, 2011 in hot flash | 4 comments

Researchers have been studying antidepressant therapy (namely selective serotonin reuptake inhibitors – SSRIs, and serotonin/norepinephrine reuptake inhibitors –SNRIs) for some time now in hopes of discovering an effective treatment for hot flashes and an alternative to hormone replacement therapy (HRT). However, antidepressants’ ability to ameliorate hot flashes have yielded mixed results in the study arena. One potential advantage of using an antidepressant in this regard is the ability to also effectively address mood swings and depression that occur as hormone levels wane and decline throughout menopause. Hence, I was intrigued by a new study, published this week in the Journal of the American Medical Association, that not only evaluated the benefit of using the SSRI Lexapro for hot flashes but also, whether or not factors such as race and coexisting depressed mood and/or anxiety would affect the results. Notably, African-American women are reportedly more likely than report having particularly bothersome hot flashes.

In this particular trial, 205 menopausal or postmenopausal women reporting at least 28 hot flashes or night sweats per week over a three week period that were bothersome or severe the majority of time were asked to take 10 mg escitalopram (Lexapro) or placebo tablet daily for 8 weeks. This dosage was increased midway through the trial if hot flash frequency didn’t decrease by at least 50% and if severity did not change.

The findings:

• More than half of women reported that the frequency of their hot flashes declined by at least 50% from the study starts (compared to slightly more than a third of women taking placebo)
• Women taking Lexapro reported that the severity of their hot flashes decreased by 24% compared to the study’s start (and a 14% decline in severity among the placebo group)
• The response to Lexapro was rapid and improvements started to be seen within one week
• Reported side effects between the two groups were fairly equal, and mostly related to feeling tired, stomach issues and dry mouth
• Race did not appear to play a role in either group
• Hot flashes returned after Lexapro was stopped

Although the researchers caution that the group of women in the study were highly motivated and not necessarily reflective of women in the general population, I would argue that a woman with severe and frequent hot flashes is motivated, period. I’m not a huge fan of using pharmaceutical medications to address menopausal symptoms for two reasons: 1) menopause is not a disease and, 2) as evidenced by the archives, there is an evolving body of literature that supports the use of alternative strategies for managing menopause. Nevertheless, as someone who has had lifelong bouts of depression that are exacerbated by hormones, I welcome an effective alternative to HRT that might be more broadly embraced by the medical community. Until a greater proportion of healthcare practitioners begins to accept the distinctions between between eastern and western medical philosophies and the potential advantages of complementary strategies, the learning (and begging) curve will continue to be steep.

Perhaps antidepressants are an initial stop-gap while the body of evidence supporting alternatives like acupuncture or isoflavones for hot flashes and depression grows. I’m optimistic we’ll get there. And I will always be happy to see women provided with an alternative to HRT.

In training? Make sure it’s resistance!

Posted by Liz on Jan 17, 2011 in exercise | 4 comments

For some time now, experts have advised that aerobic exercise is preferred over other forms of physical activity for reducing the risk of heart disease. One key reason is that it confers favorably changes in the arteries, making them pliant and able to assist with blood flow and maintenance of normal blood pressure. Although our arteries tend to stiffen naturally with age (losing their elasticity), other factors, including high cholesterol, an unhealthy diet, obesity and sedentary behavior also contribute. Unfortunately, the stiffer arteries become, the more difficult it is for blood to flow, meaning that the heart has to work harder to pump blood. This leads to high blood pressure, stroke and of course, death.

So, is the only physical option aerobic? Evidently not.

Historically, resistance training has been shown to increase the stiffness of the arteries. However, it also protects bone (thereby lowering the risk for osteoporosis), helps to maintain normal weight and promotes general health and wellbeing. These factors in particular, are essential to women as they age. However, for the first time, researchers are now saying that resistance training may confer heart benefits that are similar to aerobic exercise.

In a very small study published last year in the Journal of Strength and Conditioning Research, the effects of resistance training on the arteries and blood flow were thoroughly examined in young adult men, who, following a brief warm up, performed resistance exercises on weight machines; repetitions ranged from 3 to 15, and subsequent weight was added or reduced in increments to achieve the most optimal effort from each man. They found that 45 minutes moderate intensity resistance training, despite causing the arteries to stiffen, actually increased blood flow and as a result, lowered participant’s blood pressure by as much as 20%. What’s more, these benefits were greater than those seen with aerobic exercise, but, residual effects appeared to continue at least 30 to 60 minutes after resistance training stopped and recovery started. Among individuals who trained 30 to 45 minutes three times a week, these benefits continued for at least 24 hours.

The researchers point out that although it’s difficult to directly compare aerobic activity and resistance training, particularly with regards to exercise intensity, they believe that resistance training has an important role in lowering blood pressure and may be as “good as or better” than the benefit seen with antihypertensive medications.” They also say that for people who have orthopedic or weight limitations and can’t walk or run for long distances, these findings offer an important alternative: resistance training.

At the end of the day, any training is good, so long as it is supervised. Now it appears that adding resistance training to aerobic activity imparts a lot more benefits than previously thought. Aerobic AND resistance training = win/win for your heart and your health. Want to learn more? The American Council on Exercise has a great website on resistance and strength training. My friend Andrea Metcalf also provides some wonderful guidance in her new book, Naked Fitness.

Sleep and energy: what’s in a good night’s sleep?

Posted by Liz on Jan 14, 2011 in sleep disturbance, weight | 0 comments

Did you know that a lack of sleep adds up to a whole lotta energy? For the first time ever, scientists have quantified how much energy we lose when we lose a full night’s sleep…and how much we save when we get the required 8 hours.

I’ve written about sleep, aging and menopause often on Flashfree, and the outlook isn’t great. In fact:

• Difficulty falling asleep appears to be associated with menopausal symptoms in general, stress, and lower stress hormone levels.
• Awakening during the night appears to be associated with age, being late in the menopausal transition (before moving into full-blown menopause), having had early menopause, hot flashes, depressed mood, joint pain and stress.
• Early morning awakening appears to be associated with age, hot flashes, depressed mood, anxiety, joint pain, stress, and lower estrogen/higher fallopian stimulating hormone (FSH)  levels.

Now, researchers are saying that a night’s sleep actually depletes the body of energy while getting 8 hours of sleep conserves it.

In a very small study, 7 young adults were asked to stay in bed and consume a carefully regulated diet comprising of 30% fat, 50% carbohydrates and 20% protein During the study period,  they had 8 hours of sleep, followed by two days of sleep deprivation (40 hours total) followed by another 8 hours of sleep.

Compared to a typical 8 hours sleep, losing a night’s sleep actually increased the amount of energy expended by as much as 7%. This is equivalent to about 135 calories (i.e. two slice of bread) or walking about two miles. In contrast, getting a normal nights sleep actually saved almost as much energy.

Hence, it appears that sleep deprivation is a waste of energy, literally! And while it may generate some returns in terms of immediate weight loss, other researchers have shown that over time, sleep deprivation actually impairs functioning and leads to weight gain.

So, what’s in a good night’s sleep? Apparently, sleep provides a means by which we are able to conserve enough energy to support other important functions that we need to survive. However, the challenge lies in that magic 8 hours, which appears to be constantly interrupted during the menopausal period. If only we could put that energy to good use and figure out the answer to this particular dilemma that plagues us as we age.

Any thoughts?