Fat…to boldly go where where none has gone before
That body tire around the middle that tends to plague most women in their late forties and fifties and into old age reminds me of Star Trek – boldly going where no fat has ever gone before. Despite an hour at the gym daily, eating healthy and moderate (okay sometimes more than moderate) intake of alcohol, I still can’t seem to conquer that bulge that’s creeping into my midsection. I’ve spoken to trainers and nutritionists about it and have even tried conjugated linoleic acid (CLA), which theoretically helps reduce deposits of body fat. And still, fluctuating hormones and aging seem determined to redistribute that midsection bulge in ways that remain unacceptable (at least, to me). More importantly, however, is the fact that fat that settles in the abdominal areas increases the risk for impaired blood fat and insulin levels that can lead to diabetes and heart disease.
I’ve written about weight and the middle-aged bulge several times in the past and you can find some of these posts here. My friend Mollie Katzen and I collaborated on a post earlier this year about eating habits, food and midlife. And still, an effective solution to the bold bulge continues to elude women, trainers and researchers alike.
Still, a very small study published in the online edition of Menopause shows that hope may still spring eternal. In fact, results suggests that women who took 70 mg isoflavones daily (i.e. 44 mg daidzein, 16 mg glycitein, 10 mg genistein) for six months and then added at least an hour of intensive aerobics, circuit training and resistance training at least three times weekly for another six months experienced significant declines in blood pressure, fat mass and total body weight, and a small reduction in waist circumference (of about an inch and a half). In this particular study, the researchers selected women who were known to respond physically and beneficially to exercise. However, only the women who supplemented their exercise with isoflavones had demonstrable improvements in their fat mass and distribution. These women also experienced improvements in their insulin levels.
Clearly, the benefits of isoflavones added to exercise from both a weight and health perspective need to be explored more thoroughly and with larger numbers of women. However, it is possible that the addition of soy to a regular exercise routine may help to address that elusive bulge from entering the black hole that we call midlife.
Stay tuned!
Read MoreDazed and Confused – Revisited
Two years ago i wrote a post about the confusion surrounding therapies, effectiveness, and discerning right from wrong when it comes to clinical trials. Herbal and integrative therapies are perfect examples of the grey areas; many trials have not incorporated some of the most important tenets supporting the use of these strategies, most important of which is individualization. Hence, I wanted to share the post with you again, and hopefully, spark some dialogue that might lead to improvements in how we study and write about the therapies that are offered to patients.
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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 a few years ago 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.
Read MoreWednesday Bubble: rhubarb rules the day
Today’s Bubble is straight from the research files and it’s not burstable. In fact, I’m pretty excited about this.
Researchers say that a phytoestrogen extract from Siberian rhubarb (rhapontic rhubarb), better known in studies as “ERr 731,’ is an effective alternative to HRT for alleviating menopausal symptoms.
Evidently Siberian rhubarb has been used for decades to treat menopausal symptoms, both in Germany, where it is readily and commercially available, and in Chinese medicine. Clinical studies suggest that ERr works very similar to estrogen in the body and in fact, has been shown to have properties that are equivalent to SERMS – selective estrogen receptor modulators – which are synthetic compounds that mimic the action of estrogen in the body without necessarily causing some of its harmful effects.
When I delved further into ERr 731, I found numerous, well-designed studies that demonstrate its benefits in perimenopausal women including:
- A significant decline in the number and severity of hot flashes over the short-term (i.e. 3 months) by as much as 50%, with further improvements through the long-term (i.e. 6 months).
- Improvements in other menopausal symptoms such as sleep disruption, mood and vaginal dryness.
- Improvements in self-reported quality of life.
- Minimal if any side effects and no changes in uterine or vaginal tissues among women taking the extract, suggesting that it may be safe in terms of breast or uterine cancer.
In the U.S., ERr 731 is marketed as a supplement called Estrovera. Although it appears to be safe, like any drug, you should speak to your practitioner before trying it.
I’m heartened to see that an herb that been in use for decades in both Western and Eastern cultures in finally available to US women. I’ll continue to monitor for additional studies but in the interim, I’d love to hear from you if you are taking Estrovera.
Read MoreWednesday Bubble: herbs and breast cancer
Can herbal medicines used for hot flashes, namely black cohosh and phytoestrogens, be safely used in women who’ve had breast cancer?
If you’ve had breast cancer, you’ve probably been told to stay away from herbal medications, right? Yet, women who’ve had breast cancer know that hot flashes are a common side effect of many cancer therapies. Research also suggests that the older a woman is at the time she receives chemotherapy, the more likely she is to develop menopause as soon as treatment stops. Moreover, roughly 80% of women taking Tamoxifen have hot flashes and about a third of those women rate them as severe. Hormones are not even an option due to the increased breast cancer risk.
The good news is that an extensive analysis of scientific studies shows that black cohosh might be safe for women who have had breast cancer. Although the researchers note that the evidence for the effectiveness of black cohosh for alleviating hot flashes is mixed, they cite research from the National Institutes of Health and other reviews that suggest that use of black cohosh in former breast cancer patients requires only standard screening. They also report that there is “little reason for excluding patients with estrogen-responsive tumors from using black cohosh.” In fact, recent laboratory studies, although not yet carried out in humans, suggest that black cohosh may actually protect the breast from developing tumors.
The case for or against the use of phytoestrogens (e.g. soy, red clover, chaste tree berry and flaxseed) in women with breast cancer is not quite as clear as it appears to be for black cohosh. In one of the largest reviews examining soy or red clover for menopausal symptoms, the outcomes were equivalent to placebo. Other studies have shown that they might be beneficial for women with mild to moderate symptoms who start menopause early. Moreover, while red clover in particular does not appear to affect certain breast cancer risk markers, reports about phytoestrogens in general, especially in estrogen positive cancers is conflicting. Still, the American Cancer Society does not advise against eating soy-rich foods by women who’ve had breast cancer. Some studies have also showed improved prognosis.
If you are wondering if there are any drawbacks, one of the largest challenges is that there are not that many studies looking at herbal medications in women with breast cancer and the ones that do exist are mostly short in duration. The researchers point out that because herbs can take awhile to work, a three month study might be too short to form a conclusion.
Clearly, more study is needed. In the interim, it appears both black cohosh and soy might be safe to try if you’ve had breast cancer. As always, the most important consideration is to speak to a certified practitioner who is well versed in herbal medicine and make sure that she or he works with your oncologist.
Chamo chamo chamomile-on
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Is chamomile the ultimate chameleon, good for both anxiety in depression?
Back in February, I posted information about a small study that showed that a daily chamomile tablets (containing 220 mg of pharmaceutical grade extract) significant reduced anxiety and improved well-being among postmenopausal women. Thanks to a fellow reporter and Twitter colleague Miriam Tucker, I learned that the researchers of this study presented findings at a recent Anxiety Disorders of American meeting that might be of equal interest, i.e. that benefits of chamomile might extend to depression as well.
In a second part of this study, the researchers looked at the effect of chamomile on the same women who currently suffered from anxiety and depression, who had a past history of depression or who had never had depressive symptoms. Although the results were not as striking as in the first study, they did see what they characterized as meaningful reductions in depression ratings among women who had both anxiety and depression. Across all the groups, the researchers observed significant declines in depressed mood, guilt and thoughts of suicide).
Women entering perimenopause have twice the risk for developing depressive symptoms than during other phases of their lives. Researchers have also shown that attitude towards menopause can also increase the risk. While various interventions including antidepressants, exercise and maybe even moderate intake of red wine may help, it’s wonderful to know that scientists are seriously looking into the role of chamomile and studying it under controlled conditions to prove or disprove its power over our moods.
Is chamomile the ultimate panacea when it comes to mood swings and the blues? Perhaps not. But it may provide a wonderful option to women and men alike, who are seeking solutions out of the medicine cabinet.
Read MoreIs black cohosh a flash in the pan?
I am a true believer of black cohosh, that wonderful herb that for many women, simply stops hot flashes in their tracks. The clinical evidence in support of the effect of black cohosh on symptoms has also been pretty positive, except when it comes to bone health. Admittedly, I’m a bit in the dark on this one because I had never read anything associating the two…until now.
To examine the effect of black cohosh on bone density, researchers randomly assigned 128 postmenopausal to one of three regimens:
1) Six weeks of highly intensive exercise directed towards protecting bone mass (e.g., strength training, aerobic activity) interspersed with 10 weeks of moderate intensity exercise (e.g. brisk walking)
2) The above program plus 40 mg/day black cohosh
3) Wellness program (light exercise for one hour a week, such as stretching, walking, balance)
Although exercise had a definite and positive effect on bone mineral density, taking black cohosh provided no additional benefit. However, women who were assigned to wellness only did experience a minor decrease in the bone density in their spine compared with women who exercised. Other variables, including lean body mass, heart disease risk and menopausal symptoms, were also favourably impacted by physical activity but again, not by the addition of black cohosh. The study was published in the online edition of Menopause.
Clearly, when it comes to bone density, exercise is the winner. Black cohosh does not appear to add any additional benefits, although it may ultimately prove to enhance any positive effects on menopausal symptoms, especially since previous clinical trials have been favourably in this regard.
Time will only tell. In the interim, keep moving and don’t rely on black cohosh to preserve your bone health.
As always, Reuters Health has done great reporting on this same study. I encourage you to check it out!
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