WISHFIT: women’s research takes a village.
I was heartened to read that the folks at Rush University Medical Center in Chicago have partnered with a community of local women to fight obesity and promote a healthier menopausal transition. What’s especially novel about this program, which is called WISHFIT (Women in Southside Health FIT), is that during the first year of the five-year study, it will be relying on “pioneers” for guidance in designing and testing the program and subsequently spreading the word. One of the program’s primary researchers, Dr. Sheila Dugan, who is an Associate Professor in the Department of Physical Medicine and Rehabilitation at Rush University Medical School, characterizes the approach as “community-based participatory medicine,” with a critical grassroots component. I would go one step further and call it a health 2.0, social media approach to medical research.
The goals of WISHFIT are to ultimately change the behavior of women who are sedentary or engage in physical activity only occasionally in order to help reduce the fat rolls around the midsection (called visceral fat). If you’ve been reading Flashfree for awhile, you will recall that visceral fat is a common problem in menopausal women that is likely related to fluctuating hormone levels as we age. Not only is it unattractive, but the development of fat around the midsection is dangerous because it has been linked with metabolic syndrome, a variety of symptoms that in concordance, increase the risk for heart disease.
Importantly, the National Institutes of Health, National Cancer Institute, National Institute of Diabetes, Digestion and Kidney Diseases are joining forces with Rush to take the study out of the laboratory setting and into the community. In fact, Dr. Dugan explains that research has shown that “there are millions of studies out there that show if we bring women into the University and have them exercise, they will lose weight and improve their fat composition. But when they are left to their own devices, they go back to themselves.” She says that by having a community of postmenopausal women involved in developing a ‘tool kit’ of physical and stress-reducing activities or activities that help them to embrace healthier eating habits, the researchers are hoping that they can help their premenopausal peers incorporate new ways of thinking and acting so that they can get through menopause in healthier ways. She also points to data showing that change is better maintained not only by motivating the individual but also through the support of friends and social networks, which are needed for change to last.
Dr. Dugan notes that two Southside Chicago communities- Beverly and Morgan Park – have been the subject of prior research (Study of Women’s Health Across the Nation or SWAN) that identified the link between hormonal changes and visceral fat. In fact, some of the data also firmly established the link between markers of chronic disease and stress and sedentary lifestyles. The 30 Pioneers selected to lead the project will be women who participated in SWAN.
The five-year program also includes two studies examining 1) how social networks play a role in influencing health behaviors, and 2) if positive reinforcement works as well as financial incentives in getting women to change their lifestyle and become more physically active. An additional component entails before and after ‘person on the street’ interviews to educate and engage the community about what happens during menopause, heart disease and other risks and steps that can be taken to combat it.
“Midlife women already have all sorts of concerns on their minds. They need to have support around allowing themselves to take care of themselves and give themselves the freedom to actually step out of all their roles to do so. Our goal,” she emphasizes,”is to bring energy — spiritual and financial — to the community because we truly believe that the only way that these women will have a chance to take care of themselves is by everyone around them buying into how important it is.”
Noting that they are taking a three-pronged attack that entails community, social and individual level interventions, Dr. Dugan adds that community and social support are the links that have been missing in obesity research in particular. I’d like to believe that these links have also been missing in gender research that focuses on women; in fact, perhaps this model isthe breakthrough that is needed to change some gender inequities in our healthcare.
It really does take a village, doesn’t it? Only time will tell.
Read MoreTrans fats are not your friend
Do you want to live well past menopause? One way to do it is to cut out the trans fats (or partially hydrogenated oils) now!
Trans fats are found mostly in fried (e.g. french fries, donuts) and processed foods (e.g. pastries, pizza dough, cookies, crackers). In the body, trans fats significantly raise LDL cholesterol levels and lower HDL cholesterol levels (read: raise bad fats, lower good fats). And since we already know that elevated cholesterol right around menopause is a major factor in heart disease in women, it makes sense that the stroke risk might also come into play.
In a study presented last week at the American Stroke Association International Stroke Conference 2010, researchers analyzed data culled from 87,230 women who had participated in the Women’s Health Initiative and followed for about 8 years. After adjusting for possible factors that might influence results (e.g.s age, race, smoking, physical activity, alcohol, body mass index, hormone therapy, diabetes, aspirin use, fruits, vegetables and dietary fiber intake) they found that women who ate the most total fat had a 40% increased risk for ischemic stroke. Women who ate trans fat in particular, had a 30% increased risk for ischemic stroke. (Ischemic stroke is caused by blocked blood vessels in or leading to the brain.) So, how much fat were these women eating? Women who reported eating the most fat averaged about 86 grams of total fat and 7 grams of trans fat daily (compared to 26 grams and 1 gram, respectively, in women who ate the least).
It seems pretty simple, doesn’t it? Cut down on the fats and processed food and increase the healthy stuff. In the supermarket, stick to the store periphery where fruits, vegetables and all the good stuff can be found. Read the label…often.
Truly, trans fat is not your friend.
Read MoreWednesday Bubble: Another nail in the coffin for HRT
Still hearing that HRT can’t hurt your heart? Findings from yet another study, this time published in the February 16 edition of Annals of Internal Medicine, confirm the dangers that HRT poses to your heart, especially in the short-term.
In this latest analysis, researchers evaluated data derived from 16,608 postmenopausal women enrolled in the Women’s Health Initiative trial who still had their uterus. The findings?
Compared to women who had never used hormone replacement therapy, those who had used it continuously over 10 years had more than twice the risk of developing heart disease over the first 2 years, and more than 1.5 times the risk over the subsequent 8 years. For women who started hormone therapy after 10 years of entering menopause, there was also a trend towards developing heart disease over the first 2 years. Of note, researchers did observe a possible protective effect after 6 years in the women who started therapy closer to menopause as risk did start to level off at this time.
The upshot is that the first two years of taking HRT can be a dangerous time for women regardless of whether they start hormones closer to menopause.
Another nail? Yes, I’d say so.
But don’t take my word for it. Knowledge is power. Educate yourselves. And if you’d like to learn more about heart disease and menopause, I’ve written about it numerous times on this blog. I also encourage you to visit the American Heart Association website. Finally, I’d love for you to take a stand. Don’t you think it’s time for the FDA to start paying attention? These drugs are dangerous for women. Yet, they remain on the market and are prescribed daily. Whose nail, whose coffin?
Read MoreWednesday Bubble: heart disease, depression and menopause
Today’s Bubble is not exactly bursting with good news. On the other hand, it more a matter of erring on the side of caution.
Depression in menopause and midlife is a common occurrence. Although researchers are not quite sure of the exact reasons for its surge during the transition, (e.g. declining hormone, life stress, prior history), many women tend to suffer the blues during this time. In addition to physical activity or herbs, many practitioners recommend that women incorporate a low-dose antidepressant into their daily strategy. Yet, while this might help to maintain mood balance, researchers are starting to question whether or not using antidepressants may increase the risk for dying from heart disease during menopause. Yikes! So, we are given drugs to help boost our moods during menopause but they may end up killing us in the long run? Somehow the old adage, ‘what doesn’t kill you makes you stronger’ doesn’t make me feel better this time.
In a study that appears in the Archives of Internal Medicine, researchers examined information collected from over 136,000 women who had participated in the Women’s Health Initiative Study who either were or were not taking antidepressants over a period of about 6 years. The findings? Women who used SSRI antidepressants had a 45% increased risk of stroke, and a 32% increased risk of death. This risk remained even after researchers took other heart disease risk factors into account, such as diabetes, high cholesterol and smoking.
Here’s the rub: depression is a known risk factor for heart disease and death from heart disease, and has also been linked to an increased risk for stroke. So, researchers are not certain if it’s the chicken (depression) or the egg (antidepressants) that is accounting for these study results.
So, what can you do? Should you throw away the pills?
Not so fast. Speak to your doctor. Get tested for known heart disease risk factors, such as overweight, high blood pressure, high cholesterol, family history, diabetes and of course, smoking. Incorporate heart healthy changes into your life, such as physical activity, a better diet, yoga, meditation and laughter. And then figure out if the benefits of antidepressants are worth the risks. These data are early and inconclusive. Just something to be mindful of if you are in menopause.
Read MoreHRT – the cat’s outta da bag
Does Wyeth’s hormone replacement therapy agent Prempro cause breast cancer? Yes, according to a jury, who recently awarded Connie Barton $75 million in punitive damages.
According to a statement quoted in a New York Times expose, a spokesperson for the pharma giant Pfizer (which recently merged with Wyeth) emphatically claims that Preempro is “a safe, federally approved drug that did not cause [the woman’s] breast cancer.”And yet, Preempro is the very same drug caused the abrupt halt of the Women’s Health Initiative trial when it was found to double the risk for breast cancer as well as increase the risk for heart attack, stroke and blood clots. Moreover, later analysis of the Women’s Health Initiative data showed that hormones also increased the risk for dementia in a subset of women. Still, the company plans to fight every Preempro award, maintaining that it has acted responsibly and has posted every warning in line with FDA guidelines.
So what do you do when a drug has known dangers, a warped risk-benefit ratio and is still widely marketed? As I’ve written time and again on this blog, many in the medical profession continue to believe in HRT and prescribe it regularly, not for “good health” or to slow the aging process but to control the more troublesome symptoms of menopause (e.g. hot flashes, night sweats and vaginal dryness). And thousands of women continue to toe the party line, believing that that hormone replacement is essential to easing the aging journey (as the article’s author so aptly points out, the term “replacement” implies that it is something that is needed).
Interestingly the article maps out strategies that have been used to influence physicians, professional societies and women so as to deflect attention away from cancer concerns towards the positive, risk-preventive properties of hormone therapy. And while this piece makes me want to jump on my soapbox, I won’t attempt to dissect it further because it’s one of the most thorough and well-researched articles I’ve read in some time. The only thing I will leave you with is that Wyeth’s actions are a true reflection of everything that’s wrong with the modern view of menopause, from menopause as a disease to waning estrogen as a symbol of all that is unattractive about an aging woman.
Rather than “rebalancing” our bodies through modern medicine, shouldn’t we be focusing on what we can do to balance the transition as we move through our lives by focusing on our relationships, our activity levels, our psyches, our connections and our diets? You can’t fix something when it’s not broken. And the only thing that appears to be broken here is the hype.
Yes, the HRT cat’s outta da bag. What do you think?
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