March 08, 2018

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diet ›   exercise ›   menopause ›   sleep ›   stress ›  


Sleep! We’re in Favor.

If you’re wearing a Fitbit to bed, like a patient I saw last week, you might be seeing pretty colored charts that confirm just exactly how poorly you slept last night. And if you’re like her, it may only be increasing your stress about what you already know: You’re tired! You’d like to sleep through the night!

Yes, as you’re likely tired of hearing, it’s hormones. Estrogen and progesterone are in decline, and the mix of hormones (add cortisol, the “stress hormone” to the cocktail, too) may be less friendly to sleep than it once was. Hot flashes, which can happen day or night, come with a surge of adrenaline, from which you need to recover before you can settle back to sleep.

What you're thinking of in the middle of the night is spam. Delete it!A few of the people I’ve talked to for The Fullness of Midlife, our podcast, have had some light to shed on our sleeplessness. Joan Vernikos, a retired NASA health science researcher, says sleep is “like a cleaning service in an office. ...The cleaning service starts out by emptying the garbage cans, by tidying up, picking up—and that’s what happens with the brain during sleep in the various cycles. If you wake up and you don’t sleep well, not only are you going to make mistakes the next day, but you’re not going to detox your brain.”

Menopause can sometimes bring its own befuddlement, right? Memory lapses. Foggy thinking. Well, add in some sleep deprivation and a brain in desperate need of a “detox,” and you can imagine a day that you’d rather forget.

Another podcast guest, Dr. Pamela Peeke, gave us a pep talk about making “sleep hygiene” a priority. She points out the relationship between sleep and diet: We’re much better able to be in control of our appetite—not because we lack self-discipline but because of busy hormones at work in our bodies—when we’re well-rested.

Make “sleep hygiene” a priority? Well, it sounds good. And there’s plenty of reason to do it, from easier healthy eating to clear-headed days. Here’s what it takes:

  • Make your bedroom comfortable for sleep. Is it dark enough? Cool enough? You might want to layer your bedding like you layer your outerwear for a hike on an early spring day—so both you and your partner can be comfortable throughout the night. Consider white noise if sounds are keeping you awake. If now is not the time to invest in your good sleep, when is?
  • Exercise. To patients in my office, I recommend 45 minutes five days a week of real exercise—walking, swimming, biking. Something that gets the heart-rate up. If some part of that can be outdoors, even better, because natural light helps us with our sleep-wake cycles. Get it in early, so you can avoid exercise in the three hours just before bedtime.
  • Stay awake during the day. I know it’s tempting to nap when you’re not sleeping well at night. But napping for more than 20 to 30 minutes can make it more difficult to sleep deeply overnight, which is when that brain detoxing Joan talked about happens.
  • Ease away from stimulants and heavy foods. The effect of caffeine can change as our bodies change. And the relaxing effect of alcohol wakes us up later when we’re metabolizing it. Digesting heavy foods can do the same.
  • De-stress generally, but especially as part of a pre-bed routine. Excess stress is a health challenge for us at any age. While it’s unlikely you can eliminate stress from your life, you can at least develop some routines for putting it in its place before you turn in for the night. Set a routine—yoga for relaxation, reading a novel, writing in a gratitude journal, taking a hot bath—that signals that it’s time to settle down. Avoid screens in the hour before bed, especially contentious text or Facebook exchanges or upsetting documentaries. And remember what Joan said when you’re churning at night: “What you’re thinking of in the middle of the night is spam. Delete it! You can’t do anything about it.”

A perhaps unexpected side effect? Since stress and fatigue are two of the three most common obstacles to sex (the third is lack of privacy), you just might find yourself with a little more romance in your life.

Makes “sleep hygiene” sound a little sexy.

Q: Will vitamins be effective for hot flashes and other symptoms?

You mention joint pain, weight gain, and food cravings in addition to hot flashes as symptoms of menopause. Menopause has such a variety of symptoms, depending on each individual. Lifestyle matters more; exercise is more important; adequate sleep and good nutrition—all of these have a greater impact to quality of life now than they did previously.

I wish I could tell you there is good data suggesting vitamins have a favorable impact on menopausal symptoms, but the trials looking at the specific supplements you mention and others suggest no benefit greater than placebo. But, hey, placebo has about a 30-percent response rate in any trial, so there is certainly no harm in using them. They provide some general vitamins that will not be harmful, and may help if you aren’t getting them in your diet.

The symptoms you mention could all potentially benefit from hormone therapy (HT). The loss of estrogen is huge for most women, and the loss of progesterone to some extent as well. For many women the only way to address symptoms adequately is to consider HT. More and more data suggests that HT is beneficial for women specifically with weight gain; that was a lead article in one of my journals just this week.

It’s a complicated journey that is nuanced, and each woman needs to assess her own symptoms and goals and determine the best approach to managing through menopause. It’s difficult to address all of the treatment options in a single Q&A. You might find the North American Menopause Society (NAMS) website helpful: menopause.org. They cover many issues related to menopause.

Good luck!

 

Make Your Diet Cancer-Resistant

 According to the experts, the three most important things you can do to avoid cancer are to maintain a healthy weight, to exercise regularly, and to be smart about your diet. All three are interconnected, and none of them is easy, especially if achieving them requires confronting and changing lifelong habits.

Luckily, these happen to be the most important things you can do to avoid all kinds of disease and to enjoy a high quality of life as well. (Not to mention having the strength and stamina for better sex.)

Listen to your body and respect its signals.Weight control has two parts: energy in and energy out—the number of calories (energy) that you ingest every day relative to the calories you burn in daily activity. But metabolism and calorie recommendations change with age and stage of life, so a moderately active 36-year-old mom needs about 200 calories per day more than a 65-year-old, post-menopausal woman.

So unfair.

I’m sure you’ve read the gospel of good nutrition: Eat a variety of fresh fruits and vegetables, whole grains, modest servings of fish, chicken, and some red meat, very limited amounts of salt, fats, sugars, and processed carbohydrates, such as those in white bread, pasta, and pastries.

Diet is complex and the interaction of many foods in the human system isn’t easy to study nor is it well-understood. Credible connections between cancer and a single food, vitamin, additive, or supplement require multiple studies over a period of time. So the correlations are rarely clear and straightforward, and lots of fad diets and “magic bullet” vitamins and supplements are debunked over time. For example, no research supports antioxidant supplements to reduce cancer risk.    

The best approach is to follow the general guidelines for good nutrition established by the ACS and other groups. People who prepare a variety of fresh foods at home and who limit empty calories in sweets and sugary drinks, fats in chips and fried foods, and excess calories and unpronounceable additives in heavily processed foods are more likely to maintain a healthy weight and to avoid illness and disease, including cancer.  

According to the American Cancer Society, “A dietary pattern that is rich in vegetables, fruits, poultry, fish, and low-fat dairy products has been associated with a reduced risk of breast cancer in observational studies.”

That said, a few causal links about specific dietary habits and cancer have been established:

  • Alcohol consumption increases breast cancer risk. “Compared with nondrinkers, there is a 10 percent to 12 percent higher risk of female breast cancer associated with each drink per day,” according to the ACS. One alcoholic drink per day is the recommended limit for women. One. Any kind of alcohol.
  • Processed meats are linked to “modest but significant” increases in various cancers. This includes bacon (ouch!), sausage, lunch meat, hot dogs. Red meats should also be limited.
  • Fresh fruits and vegetables are beneficial for many reasons, but diets that contain a lot of fresh produce tend to carry a lower cancer risk. There is some indication that caretenoids, a substance found in dark, leafy greens and colorful vegetables, such as sweet potatoes and carrots, slightly reduces the risk of breast cancer. The ACS recommends 2.5 cups of fresh produce daily.

 Environmental pollution is embedded into our daily lives, and it is impossible to avoid. Some, such as radon or dioxin, are known carcinogens, while the cancer-causing status of many, many others hasn’t been determined.

 “Many pollutants in the environment have biological effects, so even in the absence of specific information linking these chemicals to diseases it is not safe to assume that they are benign,” said Dr. Larry Norton, deputy physician-in-chief for Breast Cancer Programs, Sloan Kettering Cancer Center.

 A few simple steps to reduce environmental exposure makes sense.

  • Test your drinking water and consider a filter, if necessary. All filters aren’t created equal: some just filter chlorine while others eliminate heavy metals and specific chemicals. Here’s objective information from the gold standard of testing outfits (the NSF).
  • Buy organic—sometimes. The ACS makes no recommendation for the safety of organic over non-organic foods. However, there is intuitive sense in buying organic options of specific foods that are known to be otherwise laced with pesticides and agricultural pollutants. Every year, the Environmental Working Group (EWG) publishes a list of the “Dirty Dozen”—products with the highest level of contaminants. (Sadly, strawberries top the list this year.) Consider buying organic in these categories—or grow your own!
  • Avoid plastics labeled #3, #6, and #7, which are known to leach harmful chemicals like BPA into food and water. Don’t microwave food in plastic containers.
  • Reduce the impact of stress and physical exhaustion. Modern stressors take their toll on our cells and make us less resistant to illness and disease. Take time to decompress, do yoga or some other exercise, meditate. Don’t overcommit or try to do everything perfectly. Listen to your body and respect its signals.

There’s no pill to keep you cancer-free. Personally, however, I find it very hopeful and motivating that I can make lifestyle choices that will not only improve my quality of life dramatically but will make me more resistant to disease and illness as well.

Don't try to do everything perfectly.Exercising regularly and eating healthfully isn’t easy, but the effects are holistic and powerful. As Chris Crowley, co-author of the Younger Next Year series, says bluntly, “The most important thing you can do is work out—pretty hard—six days a week until the day you die. Got to quit eating garbage, too.” ‘Nuff said.

 

 

Lifestyle Choices to Beat Breast Cancer

In the last post, we talked about the major risk factors for breast cancer. Unfortunately, a whole lot of them, such as a family history of cancer, you can’t do anything about. But there are some really important things you can do to affect your chances of getting breast cancer—and other cancers as well.

Every five years, the American Cancer Society (ACS) brings together a panel of experts who review hundreds of the latest scientific studies and create detailed guidelines for healthy, cancer-resistant living that are based on sound science.

According to the latest guidelines from the ACS: “For the great majority of Americans who do not use tobacco, the most important modifiable determinants of cancer risk are weight control, dietary choices, and levels of physical activity.” Then the guidelines offer up the latest findings on what lifestyle habits, specifically, make a difference—and what don’t. (Tip: No evidence that garlic reduces cancer.)


Healthy diet and regular exercise are your best bets for reducing risk.The drumbeat from the ACS and most other sources is very consistent and very clear: diet and exercise are your best bets for reducing cancer risk. Even better, a healthy diet, regular exercise, and maintaining a good weight critically impacts your overall quality of life. You will be more flexible, have more energy, and a better sex life. You will preserve your joints; you are less likely to have heart problems, diabetes, and dementia. And…you’ll just feel better.

Such a deal!

So, let’s drill down into some of the details. Breast tissue is particularly susceptible to environmental insult because breast cells take longer to mature than those in other organs and because immature cells react more to environmental hormones. “The breast is a sponge for everything in the environment,” says Dr. Jose Russo, breast pathologist at Fox Chase Cancer Center. In fact, breast cells don’t completely mature until a woman has a full-term pregnancy. Then, breastfeeding completes that maturation cycle.

Additionally, the way we live and the environmental stresses that surround us are different from even a generation ago. We are more sedentary at our jobs and at home; more of us are carrying a lot more weight than is good for us; we are exposed to thousands of new and often untested chemicals in water, air, earth, and food; animals grown for food are routinely given antibiotics and hormones that we then ingest.

This could seem like a depressing list of uncontrollables, but we can do a lot to limit our exposure to carcinogens and to create a healthy, cancer-resistant life for ourselves.

The main focus of the ACS (and other) guidelines is to encourage us to maintain a healthy weight (“Be as lean as possible without being underweight”). According to the ACS, being overweight or obese accounts for 14 to 20 percent of all cancer deaths, and specifically breast cancer because fat cells release an estrogen-like hormone in postmenopausal women. The guidelines state: “Overweight and obesity are clearly associated with an increased risk of developing many cancers, including cancers of the breast in postmenopausal women.”

Determining your body mass index (BMI) is the most accurate way to determine where you fall on the skinny-to-fat continuum. Here’s an informative calculator that gives you a “smart” BMI range based on gender, age, height, and weight.

In order to lose weight, you have to both reduce the calories you take in as food and to burn more calories than you ingest—i.e. by being physically active. In fact, evidence suggests that physical activity all by itself is a protective factor against breast cancer. The ACS recommends 150 minutes (2.5 hours) of moderate activity per week, such as walking or yoga, or 75 minutes of vigorous activity per week, such as jogging, swimming, or cross-country skiing. “This level of physical activity has been shown to have clear health benefits, including reduced rates of premature death and reduced incidence of or mortality from various cancers,” according to the ACS guidelines.

Now, I completely understand how difficult changing lifelong habits can be. I also understand that exercise can be hard and even unpleasant. If you sit in front of the computer at work and flop in front of the TV at home because you’re mentally exhausted, it’s going to be very hard to begin a half-hour daily workout regimen.

Here’s the deal: a little is better than none, especially at first. So if you can only do fifteen minutes, or ten, or five, just start there. If you miss a day or two (or three), don’t make that an excuse for giving up. The trick is to persist. Yes, it’s hard to get started again, but the point is to just do it, not to do it perfectly.

Psychologically, you’ll tend to stick with a change if you make a commitment to a specific regimen (say, walking for a half-hour five days a week) and then tell someone about it. Choose an activity you like and do it with others. Join Curves or the local gym or just walk for a certain distance or period of time. Honestly, it’s a better way to chill after a stressful day at work than sitting in front of a screen.

I will tell you from personal experience that when regular physical activity becomes a habit, however haltingly, you will notice the change—in your mood, in your flexibility, in your strength, and, often, in how those nagging little aches and pains begin to fade. I’m a true believer because I’ve experienced the benefit. (And I will confess that it’s still hard to make myself get off the couch—but I always feel great after.)

Physical activity is one critical part of a healthy, cancer-resistant lifestyle. Diet is another, and both work together to keep weight at an appropriate level. There is no magic bullet for absolute protection from diseases like breast cancer, but the ACS guidelines offer “…a decreased likelihood that the disease will occur…” Plus, an increased likelihood of a higher quality of life.

Which is about the best promise anyone can get in life, don’t you think?

 

 

A Little Olive Oil with Your Workout?

So my medical journals are telling me, AGAIN, that I need I need to eat better and keep moving. Gee, folks, thanks for the news!

But I rarely receive such specific advice as I have these past few weeks. They have handed me very, very clear directions: 

  • Eat a Mediterranean Diet including extra-virgin olive oil.
  • Exercise 300 minutes a week.

Wait… Really?

Specifically….  for menopausal women… my medical journals are suggesting we do this to avoid breast cancer.

Well! That’s pretty specific! And pretty awesome when scientists are paying special attention to my favorite people!

So let’s look at these studies suggesting ways we just might, through diet and exercise, provide our bodies an optimal environment for fighting off breast cancer. 

The PREDIMED study, published in JAMA, September, 2015, was conducted in Spain from 2003 to 2009, wherein more than 4,000 women at high cardiovascular risk, aged 60 to 80, were randomly placed on three diets: the Mediterranean diet, supplemented with extra-virgin olive oil (first cold-pressed), The Mediterranean Diet supplemented with mixed nuts, or a Low-Fat diet.

The results of this study have been coming out for some time, and have been fascinating. This latest release shows that those on the olive-oil-supplemented diet had a 68-percent lower risk of developing breast cancer than the other participants in the study. It’s one study, of course, and needs to be repeated, but it’s rather fascinating. Earlier outcomes of the PREDIMED study suggested the same diet resulted in a delay in cognitive decline for the same population. There will be more news from this cohort. We will stay tuned. 

By the way, when shopping for olive oil, it is best to stick with first-cold-pressed, extra-virgin olive oil for your good health. It costs a little more, but that’s the healthy choice that this study is based upon. Cheaper oils have been heat-treated or chemically treated, and are no longer a healthy choice for your body. 

The exercise link is a the Breast Cancer and Exercise Trial in Alberta, Canada, published in JAMA Oncology in 2015. The study followed 400 women. Half of them worked out for a half an hour a day, 5 days a week. The other half worked out for an hour a day, 5 days a week. They worked out at 65 to 75 percent heart rate for at least half of their workouts. All without changing their usual diets. The women were overweight, disease-free non-smokers, and they were followed for three years. Subcutaneous and abdominal fat and waist-to-hip ratio decreased significantly more in the high-exercise-volume group.

Since body fat increases postmenopausal breast cancer risk, this suggests this higher dose is a better dose of exercise for us to keep the weight off, the body fat down. Lower body fat is a better environment for lower breast cancer risk. 

So I’m going to take a brisk walk to the grocery store, buy two big bottles of my favorite extra-virgin oil, and do biceps curls with them on the way home. Or maybe I'll just stay a little longer on my treadmill and have a nice salad with dinner. 

Lifestyle Choices for Breast Health

You know that silly song about the thigh bone being connected to the hip bone—and so on?

Well, the kernel of truth in the ditty is that, when it comes to health and our bodies, things are indeed beautifully and intricately connected.

You can’t do healthy things for your thigh bone—or your heart or your sex life—and not have it affect other corporal systems as well. So, while we might focus on breast health in honor of Breast Cancer Awareness Month, rest assured that healthy, cancer-free breasts involve habits and choices that are good for the rest of your body as well.

There’s a lot to celebrate when it comes to breast cancer, like steadily decreasing rates since the year 2000. But we still have a long way to go. About 12 percent—1 in 8 women in the US—will develop invasive breast cancer sometime in her life. Our most significant risk factors are 1. being a woman and 2. being older.

Women over 55 account for two-thirds of invasive breast cancers diagnosed each year. This is because, over time, we tend to accrue genetic mutations, and with age we’re less adept at repairing them.

Those are the facts. But we don’t have to helplessly wait for the shoe to drop. We can make lifestyle adjustments that will lower our risk of getting this cancer and improve our overall quality of life, including our sex life. (And don’t forget that a healthy sex life is also good for our health.)

Because it’s all connected, right?

So here are lifestyle changes that you can make specifically targeted toward breast health:

Maintain a healthy weight. Being overweight or obese—those with a body mass index (BMI) over 25—increases one’s risk of developing breast cancer, especially in postmenopausal women. This could be because estrogen is stored in fatty tissue, and women who have more fat are also exposed to higher levels of estrogen, which has been undeniably linked to breast cancer. But other issues related to obesity may also be involved, such as insulin and glucose levels. Some estimates suggest that 17 percent of breast cancers in North America could be avoided simply by maintaining a healthy body weight. Check out this page for a solid, common-sense approach to weight loss.

Eat healthy food. Not only will a healthy diet help maintain a healthy weight, but it’s a critical component to avoiding cancer. Some foods contain properties that help repair the wear and tear to our bodies in the normal course of life. These “super foods” contain antioxidants that help protect our bodies from cancers.

The link between food and cancer isn’t always straightforward or well-understood, and dietary fads change with the season. Basically, though, the approach to healthy eating remains the same: eat a variety of foods with an emphasis on fruits, vegetables, and whole grains. Avoid processed foods. Avoid fats and sugars. Above all, avoid super-sugary beverages, which are directly linked not only with obesity but also with some forms of cancer.

Finally, eat fresh and eat at home. (You can’t control what goes into your food at a restaurant.) Eat organic foods to avoid exposure to synthetic chemicals.

While the voices touting various diets and food fads are myriad, confusing and contradictory, here are some basic food facts from breastcancer.org. The USDA also has a website with tons of food and diet information here.

Exercise. Weight, diet, and exercise. This is the trifecta of good health. Some well-regarded sources say that 30-40 percent of cancers could be avoided simply with these healthy lifestyle choices. That’s staggering. And when you add in quality of life factors that come with the trifecta, well, it’s overwhelmingly worth the difficulty of losing weight, eating well, and exercising regularly, wouldn’t you say?

Regular, moderate exercise can lower your risk of breast cancer. Not to mention all the other good things you get with exercise, such as better mood, cardiovascular and joint health, greater stamina and flexibility, better sleep, better bones, and more regular bowel movements. What are we waiting for?

Even women who have already been diagnosed with breast cancer may improve survival rates or prevent recurrence with moderate exercise, like walking only 4-5 hours per week, according to the American Cancer Institute.

Don’t have time? As the trainers in my exercise video say, “Make time.” It doesn’t matter what your physical ability is right now—just start slow and keep on going.

Don’t drink. Sorry to be a killjoy, but the more you drink, the greater your risk. A woman who has three alcoholic drinks per week is 15 percent more likely to get breast cancer than a woman who doesn’t drink at all. If you’re on hormone replacement therapy or if you’ve already been diagnosed with breast cancer, you should be one of those non-drinking women.

What about that healthy glass of red wine? Sorry, it all counts. The benefit of red wine doesn’t outweigh the risk. If you’ve never had breast cancer, just don’t drink every day, but if you have risk factors, switch to non-alcoholic options.

Don’t smoke. This almost goes without saying. Yes, the major risk is lung cancer, but actively smoking as well as exposure to second-hand smoke increases the risk of breast cancer in premenopausal smokers. Plus, women who smoke have greater difficulty recovering from breast cancer treatment.

Avoid chemical exposure. This is like trying to dodge raindrops, given the chemical soup we live in every day. And most of the chemicals in our environment and in the things we use have never been tested for toxicity or carcinogenic properties. Some types of chemicals are known to be hormone-disrupting, which alter the way our natural hormones function. Research is ongoing about the way these substances work and their link to possible cancers, but the connection isn’t well understood.

In the meantime, how do we negotiate the reality of the world we inhabit without neurotic overreaction but also without putting our heads in the sand? Of greatest concern with regard to breast cancer are those chemical with hormone-disrupting properties, including those in pesticides, growth hormone residues in meat and dairy products, and certain plastics.

In general, some precautionary practices would be to

  • Buy organic food. Here’s a list of the “dirty dozen”—the foods that have the highest levels of pesticide residue.
  • Plant a garden. Put up your own food.
  • Use fewer and simpler cleaning and personal care products. Look for certified “green” cleaning products (with GREENGUARD or EcoLogo insignias, for example) or make your own.
  • Don’t use pesticides on your lawn or garden.
  • Use BPA-free plastics or glass or stainless steel jars and bottles. Avoid #3 (PVC), #6 (polystyrene) and #7 (polycarbonate) plastics, which are linked to breast cancer.
You may not be able to tackle everything on this admittedly intimidating list, but it’s better to make a few changes than not to do anything at all. And the foundation you lay now will become even more important in maintaining health and functionality as you age.