Wednesday Bubble: Are you dazed and confused?
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.
Read MoreIs your sleep elusive?
Ever since I discovered Zeo, I’ve become pretty interested in sleep and in discovering the reasons why my sleep (and so many other women’s that I know) is lousy. What I’ve learned is that it’s while it’s easy to define the problem, it’s not so easy to assign an overriding factor. In fact, it appears that the more researchers delve into this elusive but necessary component of our lives, the less they truly understand.
Sleep issues tend to plague both men and women as they age. Indeed, deep sleep (or at least its electrical representation, also known as “electroencephalographic wave amplitudes”) has been shown to dwindle was we grow older, resulting in lighter and frequently interrupted sleep. Add factors such as hormones, health, life strain/midlife issues and psychological stress and you may end up exacerbating an already existing sleep deficiency or creating an entirely new problem. Moreover, researchers have shown that distinct sleep patterns might be associated with different influencing factors. For example:
- Difficulty falling asleep may be associated with menopausal symptoms in general, stress, and lower stress hormone levels.
- Awakening during the night might 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 may be associated with age, hot flashes, depressed mood, anxiety, joint pain, stress, and lower estrogen/higher fallopian stimulating hormone (FSH) levels.
Let’s add to the confusion, shall we?
In a study appearing in the upcoming November/December Menopause journal, researchers evaluated health, menopausal status and sleep difficulties in 962 women who were assessed annually from birth through the ages of 48 to 54. The findings?
- The percentage of women experiencing moderate (trouble sleeping a little) or severe (trouble sleeping a lot) sleeping difficulties increased by more than 10% between the ages of 48 and 54.
- Menopause status (i.e. perimenopausal, postmenopausal, perimenopausal, early menopause due to hysterectomy or initiation of hormone therapy) appeared to be related to the presence/severity of sleeping difficulties. In fact, women who had had a hysterectomy, were postmenopausal or had started hormone therapy in the previous year had 2 to 3.5 times greater odds of severe sleep difficulty compared to premenopausal women. Of note, some of these women had not experienced poorer physical or psychological stress than their peers.
- However, with regard to moderate sleep difficulties it becomes more difficult to pin down: once the researchers accounted for certain factors that might skew the results, such as psychological stress, vasomotor symptoms/hot flashes and depression, only women who had had a hysterectomy remained at risk. Although the reasons for this are not entirely clear, the researchers say that sleep difficulties among these women in particular may be related to underlying health before they entered menopause.
The key take-away of this study is that for some women, menopause transitions (i.e. hormonal shifts as they go from pre to perimenopause, and then from peri to postmenopause) influence the severity of sleep disturbances regardless of age or other life or emotional factors. This finding is in line with findings from other studies, which have linked specific hormone-related symptoms such as night sweats to sleep disturbance/fragmented sleep.
However, having had a hysterectomy appears to lead to moderate interruptions in sleep, possibly as a result of prior health issues. So, severe sleep issues = menopause, and moderate sleep issues = ???
The downside of this research truly lies with semantics: how do you define moderate sleep disturbances and in turn, treat them? Do you look for and address the cause or influencing factors? As noted in an accompanying editorial, multiple factors in various combinations in certain women may very well contribute to overall sleep quality.
In other words, when it comes to sleep, treat the individual, not the masses. Aging, life, hormones all come into play in certain individuals at certain times.
When it comes to sleep, one size does not fit all.
Read MoreA bicycle built for…weight!
I’d love to be writing to tell you that researchers have discovered a bicycle specifically built to boost weight loss. However, better yet, it seems that any bicycle may be able to help you prevent weight gain during the premenopausal years. Moreover, the more you need to lose, the greater the benefits.
For some time now, experts have been telling us that daily exercise, even walking can help stave off weight gain. But is all walking created equal? And what about bicycling, which evidently, only 5% of the population over the age of 16, and mostly women, engage in?
Researchers report that among a pool of over 18,000 women studied between 1989 and 2005 (as part of the ongoing Nurses Health Study):
- Increasing the amount of biking over the study period seemed to hold weight gain to a mininum even if that biking equaled only 5 minutes a day.
- Women with normal weight who biked for more than 4 hours a week by the study weight had about a third lower odds of gaining about 5% of their body weight than women who did not bike at all.
- Women who were considered overweight and obese had about half the odds of gaining weight if they biked for at least 2 to 3 hours a week.
- Brisk walking was much better at holding off weight than slow walking — by about a half pound.
The key take-away points of this study is that exercising is not created equal as we age. In this case, more is less is the rule of thumb, meaning that if you weigh more, you may gain less over time if you start bicycling at least 2 to 3 hours a week. If you are lean and mean, well, biking can still yield some significant benefits when it comes to weight gain.
Biking is definitely built for staving off weight gain. Go for it!
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.
[youtube=http://www.youtube.com/watch?v=pau8Zf7srlU]
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 MoreLittle Girl Blue
[youtube=http://www.youtube.com/watch?v=FVpDOIPx_sY]
Depression in the perimenopause and postmenopausal years is no joke. I’ve written about it several times on this blog and will continue to do so until experts figure out an effective, acceptable strategy for combating the blues.
As I’ve noted before, researchers are not quite sure of the exact reasons for the depression surge during the transition, (e.g. dramatic surge and declines in hormones, vasomotor issues, sleep issues, life stress and prior history). However, they do acknowledge that many women tend to suffer the blues during this time.
In the latest bit of research, published in the online edition of the journal Menopause, researchers found that over 40% of women studied (out of a pool of 685) suffered from symptoms of depression. What was more interesting, however, is that depression was almost twice as likely to develop in the peri/post menopausal stages than before menopause. (Note that other studies have found this likelihood to be as high as 4 times during the perimenopause). Moreover:
- Women who reported having had experienced some sort of negative event in their were 3.6 times likelier than those who hadn’t to develop depression
- Weight appeared to play a role, with obese women twice as likely as those of normal weight to develop depressive symptoms
Although I’ve discussed some potentially effective strategies for combatting the menopausal blues (e.g., exercise, chamomile, antidepressants, red clover, St. John’s Wort, soy isoflavones), none are a quick fix or a ‘one size fits all.’
Personally, I’ve noticed that fluctuating hormones coupled with elevated stress tends to heighten depression at specific times, while at other times, it’s easier to deal with. Pile it on and well, I become a pile of mush. My strategy entails an insane amount of physical activity, deep breathing, therapy and admittedly, some medication. Still, I’ve found that while I can usually keep the blues at bay, they do tend to crop up at the most inopportune moments.
What do you do to chase the blues away? Have they gotten worse or stayed the same during your transition? What advice do you have to offer for other readers? I’d love to hear!
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