Posts by Liz

Wednesday Bubble: Are you dazed and confused?

Posted by Liz on Dec 22, 2010 in women's health | 6 comments

Every now and then I like to reach into the Flashfree archives and repost a piece that either has lasting relevance or is a must-read for those of you who are new to the blog. This post originally ran in May of 2008 but continues to occupy the top ten list of importance in my mind. The topic? How do you discern information in a study and what do you need to look for. Plus, there’s an added bonus for all you Led Zeppelin fans.

Today’s Bubble – are you dazed and confused?

[youtube=http://youtube.com/watch?v=Xajqf-PhO8s&feature=related]

A gal pal mentioned to me this morning that she often feels so confused about study findings proving or disproving the value of certain medications or herbs that she often just throws up her hands and does nothing. Many of us are as dazed and confused as she is so that I thought that a few key points about clinical studies might help.

Mike Clarke from the School of Nursing and Midwifery at Trinity College in Dublin wrote a great article last year about the need to standardize results of studies for a specific disease ( in this case, rheumatoid arthritis). He defined the problem as follows:

“Every year, millions of journal articles are added to the tens of millions that already exist in the health literature, and tens of millions of web pages are added to the hundreds of millions currently available. Within these, there are many tens of thousands of research studies which might provide the evidence needed to make well-informed decisions about healthcare. The task of working through all this material is overwhelming enough without then finding the studies of relevance to the decision you wish to make…”

So what do you do? A few key points:

• Consider that every study has the potential for bias. Perhaps researchers are using 7 instruments to measure depression and only highlight findings from 3 of these in order to preserve the most positive or significant results. Clearly, the reader is being led towards certain outcomes and away from others.
• Study designs, types of patients studied, age of patients studied, gender, you name, can differ so it’s difficult, if not impossible to draw definitive conclusions when comparing results of one to another.
• Another issue of great interest to practitioner of Western medicine is whether or not a study is controlled. This means that two groups are compared that are identical in every way except one group is given an experimental treatment and the other, a placebo or standardized treatment. Note that often, real world conditions are often recreated rather than conducted in a real world setting and many studies are not controlled, meaning that the science behind the findings is questionable.
• Alternative and complementary medicines are still incompletely understood among many practitioners of Western medicine. What’s more, products are not regulated as carefully as medicinal agents and manufacturing practices vary. Consequently, studies of these agents or modalities are often inconclusive. And of course, often underfunded and under-appreciated.

No wonder we all feel so dazed and confused!

I’ve written several times about the importance of consulting a practitioner or medical expert before embarking on any regimen for perimenopausal symptoms. Even if you only see someone once, at least that dialogue may be useful for defining a regimen that may work best for you and what you’re going through. And if you live off the beaten track without access toa good practitioner, well then excellent resources like Medline or the American Botanical Council may be be of help in discerning what’s what.

The short answer is that there are no short answers. But with careful guidance and a bit of prudence, you may just be able see the light and smooth out the bumps on this rollercoaster ride we’re all on.

Monday A-Musings…It’s a pillow. No. It’s Chillow!

Posted by Liz on Dec 20, 2010 in hot flash | 2 comments

Newsflash: hot flashes and soy…more on genistein

Posted by Liz on Dec 17, 2010 in hot flash | 0 comments

There’s some exciting news on the soy isoflavones front: for the first time, researchers have shown that a synthetic formulation of genistein, a plant-based estrogen component of soy, may actually reduce both the frequency and severity of hot flashes. Genistein is an interesting isoflavone, in that studies have linked it to some truly potentially important benefits, including preventing or reducing heart disease risk and attenuating bone loss in menopausal women. While the verdict is still out on its role in these conditions, it does appear to influence hot flashes and only in the best way possible! Moreover, this is the first time that a synthetic formulation has shown to have some degree of benefit in this regard.

Granted, this is a small study of only 84 menopausal women, 40 of whom took synthetic genistein for 12 weeks and 40 who took a sugar placebo tablet. The results? By the study’s end, women taking 1, 30-mg capsule daily reduced the number of hot flashes by half (51%, from about 10 per day to 5 per day) and also experienced significant declines in how long they lasted. The synthetic formulation, which was standardized, was also shown to be safe and did not detrimentallly impact the lining of the uterus. Notably, however, the researchers did note that there are not enough data to recommend isoflavones to women who’ve had breast cancer or at high risk for developing, even though current data suggest that exposure does not adversely affect breast tissue density or cancer cell proliferation, meaning that it is likely that with more study, they will ultimately prove safe for use in breast cancer patients.

Your key take-away is that there may be a viable option for women who are flashing but want to stay away from hormones. However, this is what we still need to know:

• Will genistein work on larger groups of menopausal women?
• Is formulation important?
• Is the 30 mg dose the lowest dose that will confer these sort of benefits?
• Are there any other factors that these women had in common that might be influencing outcomes?

As with any novel data like these, it’s great to be cautiously enthusiastic. Stay tuned!

Wednesday Bubble: word to the wise – move early, move often, keep moving

Posted by Liz on Dec 15, 2010 in weight | 2 comments

I’m not bursting bubbles this week but rather  illusions about physical activity.  This advice is for women AND men. And not just for the midlife set:

Maintaining high activity levels throughout the young adult years may help to reduce weight gain during middle age.

It’s intuitive, isn’t it? And yet, obesity has been steadily increasing since 1973 and now affects almost a third of adults in the US. And while battling the bulge definitely becomes more challenging with age,  it appears that there is a rather easy solution: Move early. Move often.

In a newly published study of over 3,000 men and women, researchers found that habitual activity, described as maintaining high intensity activity (including sports, exercise, home maintenance and occupational activities) totaling roughly 150 minutes/week over a period of 20 years resulted in:

• A weight gain of approximately 6 lbs to 13 lbs less per year in men and women respectively, compared to peers who were exercising only moderately or lightly
• A lower increase in body mass circumference (measured by BMI) by as much as 1.2 inches to 1.5 inches per year in men and women, respectively, compared to peers who were only exercising moderately or lightly

These outcomes, which were especially notable in women, remained even when the researchers accounted for such factors as race, education, smoking, age, BMI at the study’s start, alcohol use and daily caloric intake.

One of the remaining questions is how much activity is needed to sustain these sort of changes, especially as we transition into middle age. That’s where experts disagree, with some claiming that 30  minutes daily is enough and others, suggesting that women in particular require at least 60 minutes daily. There is also indication that higher activity alone might not be enough to counter age-related weight gain although the findings only partially support this.  The bottom line is that there is no time like the present to start instilling good habits, which why I’m challenging you to share this post broadly, especially among the young adult women in your life. As I’ve written time and again, the earlier the intervention, the likelier you are to remain healthy and stave some of those troublesome menopausal symptoms.

Young or old, start moving, move often and keep moving.

Estrogen only? Fanning the flames of the HRT debate

Posted by Liz on Dec 13, 2010 in breast cancer | 6 comments

A study presented at the esteemed San Antonio Breast Cancer Symposium last week has fanned the flames about the benefits versus risks of hormone replacement for menopausal symptoms. In this study, which ironically was pulled from the site press release highlights after experts questioned its merit, researchers did a reanalysis of data from the Women’s Health Initiative trial, the infamous 2002 study that was halted after Preempro was shown to increase breast cancer risk. Their findings? That women who had participated in the estrogen only arm of the study, had had benign breast disease, had had hysterectomies and had family histories of no breast cancer actually had significant reductions in breast cancer incidence. What’s more, 75% of women who did not have benign breast disease at the study’s start also had a reduced risk of developing breast cancer.

So, this is good news, right?

Well, estrogen alone can only be used by women who have had hysterectomies; estrogen plus progestin is used in women with intact uteri in order to avoid uterine cancer. This means that only a subset of women with menopausal symptoms are eligible to use estrogen alone. Moreover, as a physician blogger points out, the findings run counter to most data that show that estrogen use is actually associated with an increased risk of breast cancer. He also notes that abstracts that are accepted as posters at major medical meetings often have flawed or spotty data; in fact, in my years as a medical writer, I’ve often run across abstracts that ultimately disagree with published works.

The bottom line here is that despite the news, using estrogen alone to treat menopausal symptoms might only be an option for a very small percentage of women and may still place them at risk for cancer. At the end of the day, prescribing hormone replacement therapy continues to challenge the Hippocratic Oath: first do no harm.