Eat Healthy and Get Active
Poor diet and lack of exercise can increase your cancer risk, and an astounding one third of all cancers are attributed to diet and activity factors. Good news, you can control these risk factors.
What is healthy eating?
The goal of healthy eating is to eat a diet rich in variety of unprocessed foods in order to obtain the nutrients that your body needs and maintain a healthy weight throughout life. Two tips for healthy eating that I learned from my patients: if it has an ingredients list that you can’t read, don’t buy it (this avoids processed foods) and shop the periphery of the supermarket, not the middle aisles (fresh, unprocessed products are in the cooling cases, while processed packaged foods are typically in the middle of the market).
In order to reduce cancer risk, the American Caner Society recommends a diet that is low fat and has an emphasis on plant sources.
General Guidelines
- 5 servings of fruits and vegetables a day, and try to eat those with the most color (they have more nutrients). Advantage – high in cancer fighting antioxidants and good for weight control (low in fat and calories).
- 3 servings of whole grains a day.
- Limit processed and red meats in your diet.
- Limit alcohol consumption. The American Cancer Society recommends no more than 1 drink a day for women.
- Practice portion control.
A note on portion control and plate size
The size of a dinner plate in the United States has increased in the past few decades from a mere 7 to 9 inches, now up to 11 to 12 inches. This means that the surface area has increased by 50% and we are naturally eating 50% more food! Important to note, the average European dinner plate is still 9 inches. Since we tend to eat whatever is on our plate, use a smaller plate. Studies have shown that people feel more satisfied with less food when they are served on an 8-inch salad plate in place of a 12-inch dinner plate.
How much exercise and what kind do I need?
The American Cancer Society recommends 30 minutes of moderate to vigorous physical activity 5 or more days of the week. 45 to 60 minutes of intentional physical activity are preferable. Children and adolescents should engage in at least 60 minutes per day of moderate to vigorous activity at least 5 days a week.
Resources
BMI calculator
http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html
Posted: January 22nd, 2011 | Author: drpoynor | Filed under: cancer prevention, general health, great health at every age, nutrition & diet | Tags: news, reviews | No Comments »
Smoking Cessation
If you stop smoking, you will feel healthier immediately and be healthier for the rest of your life.
Stopping smoking is not simple – but about half of the people that do not stop will die of smoking related causes. Smoking is the leading cause of cancer in the United States. Not only does it cause lung cancer, but also increases the risk of a number of other cancers including: throat and mouth cancer, stomach and esophageal cancers, cervical cancer, kidney and bladder cancers. Other health problems include: cardiac disease, stroke, and emphysema. Immediately after quitting, the risk of developing cancer begins to drop more and more each year, and your cardiac and lung function begin to improve.
When deciding to quit smoking, it is important to realize that it is not easy and you may need a few attempts before successful. Common side effects of stopping tobacco use include irritability and weight gain. Some people will just decide to quit and go “cold turkey”, however there are many methods to help you stop smoking. Discussing your decision with your health care provider is important as they can offer guidance along the away. You may decide to work with a therapist to stop smoking. The therapist can provide you with behavioral therapy in which your triggers for smoking are identified and methods to deal with cravings are instituted.
Other methods to help you quit include drug treatment such as nicotine replacement products. These products contain nicotine in the form of gum, patches, and lozenges and allow you to slowly taper off of nicotine. They are not for everyone however and their use should be reviewed with your physician. They can cause problems especially in individuals with uncontrolled high blood pressure, insulin dependent diabetes, ulcers, esophagitis, heart rhythm problems and asthma. Teenagers and women who are pregnant or who are breast feeding should avoid these products.
Non-nicotine containing medicines include Zyban (bupropion) and Chantix (varenicline). These medicines lessen cravings and symptoms of nicotine withdrawal, but may cause serious psychiatric problems including suicidal thoughts and attempts. They should only be used under the careful guidance of you physician after a thorough review of the risks, benefits and alternatives. Zyban is not right for pregnant women, people with seizures, people with eating disorders and heavy drinkers. Chantix is not right for individuals with kidney disease.
Alternative approaches to smoking cessation include hypno therapy, acupuncture and guided imagery. A combination of the above methods may be right for you. It is important to realize that it may be very tough to quit, but the benefits are huge. It is important to know your triggers for smoking and avoid them if possible. It also important to know, that each time you have a craving to smoke and don’t give into it, you chances of stopping go up.
Resources to help you stop smoking www.smokefree.gov
http://www.nlm.nih.gov/medlineplus/quittingsmoking.html
Posted: January 2nd, 2011 | Author: drpoynor | Filed under: cancer prevention, general health, great health at every age | Tags: news, reviews | No Comments »
An unlikely source of inspiration
I recently got stuck in my hometown of Tulsa, Oklahoma during the big holiday blizzard in New York. While confined in my family’s home and far away from my busy medical practice, I spent a lot of time reading medical material, thinking, working on how to most effectively evolve this bog, and a lot of time at the local Border’s bookstore. Although most of my reading is technical and my medical life, by nature, is very serious stuff, my frivolous passion and hobby is fashion and design. My surgeon husband tells me that all surgeons are “visual” by nature and passions such as this are to be expected. During this period of rest, I also decided that emotional health and well being are important for women of all ages and we do not discuss this enough in the office. I vowed in the New Year to spend more time with my patients examining the emotional issues of the medical problems which they may be experiencing, as well as the emotional health in my patients who are well. All at the same time, I planned a book review section for the Balanced Women’s Health Bog. It is unlikely that I would choose a coffee table, picture book about an heiress to be the first book to place on this blog, devoted to women’s health. For, I am not an heiress, not wealthy, and not a member of the design world. The book not only did resonate with my desire to be visually stimulated by beautiful photography, but also with my ability to be inspired by stories of emotional fortitude in life and self reinvention. Ms. Vanderbilt was dealt an unusually tough set of emotional cards ranging from no parental guidance during her youth, to the suicide of her child in her adulthood. But she survived this and persevered to become a creative force in fashion, as well as an accomplished business woman and writer. She indeed, at the age of 85, has penned an erotic novel. “One wishes that there had been a bouquet of happy memories from which to choose. But the thing that is evident in Gloria Vanderbilt’s life is that her strength and resolve and invincible warrior spirit didn’t come from the wastelands of imagining “what if”. Her invincible journey has been built on dealing with “what is” and the hard work and courage it takes to transform the uncontrollable in life into something positive and enriching.”(page 200).
This is the beauty of life, experience and exploration; you never know where inspiration comes from, even from the seemingly most unconventional places.”
Posted: December 31st, 2010 | Author: drpoynor | Filed under: general health, great health at every age, menopause, Uncategorized | Tags: reviews | No Comments »
For a number of years now scientists have been studying the effects of the so called Mediterranean diet, and it all looks good. The diet is called the Mediterranean diet because it mimics the eating and lifestyle patterns of the residents of the Mediterranean costal region. The diet and lifestyle emphasize eating primarily plant based foods such as fruits and vegetables, whole grains, legumes and nuts, replacing butter with healthy fats such as olive oil and canola oil, using herbs and spices to flavor food instead of salt, eating fish and poultry at least two times a week, limiting red meat intake to no more than a few times a month, getting plenty of exercise, and drinking red wine in moderation (optional). The diet and lifestyle have been demonstrated to be associated with healthy weight loss, lower blood pressure and cholesterol levels, a reduction in the risk of diabetes and heart disease, as well as associated with lower risks of cancer. Most recently new study has demonstrated that brain function is improved with this diet and lifestyle. For more information on the Mediterranean diet and what it can do for you go to: The Mediterranean Diet http://www.harpercollins.com/books/Mediterranean-Diet/?isbn=9780060783532 and Anticancer: A New Way of Life http://www.anticancerbook.com/book.html.
Posted: December 30th, 2010 | Author: drpoynor | Filed under: cancer prevention, general health, great health at every age, nutrition & diet, Uncategorized, weight loss | Tags: news, reviews | No Comments »
For a number of years now, women have recognized that soy supplements, which contain phytoestrogens, or plant derived estrogens, may help to control their menopausal symptoms related to lowered estrogen levels. Despite their widespread use, few studies have demonstrated the safety of long term soy supplement use. As soy contains plant derived estrogenic compounds, safety concerns include the risk of estrogen related cancers such as breast and uterine cancers. A recently published study in American Journal of Clinical Nutrition demonstrated that daily supplementation for 2 years with up to 120 mg of soy hypocotyl isoflavones carried minimal risk in healthy postmenopausal women. Although this information is encouraging, it only applies to the safety of the specific isoflavone supplement utilized. The studied supplement is manufactured in the Netherlands (Frutarom, Belgium www.frutarom.com) and contains only the hypocotyl portion of the soy bean. The contents of this supplement may be very different than those of over the counter supplements sold in the United Sates.
Posted: December 29th, 2010 | Author: drpoynor | Filed under: estrogen, general health, great health at every age, gynecology, menopause, nutrition & diet | Tags: news, reviews | No Comments »
Hormone Replacement Therapy Is Linked to More Aggressive Breast Cancer
It was demonstrated in the initial analysis of the Women’s Health Initiative Study that women who were treated with estrogen and progestin had an elevated risk to develop breast cancer. This recent analysis has further demonstrated that these cancers are also more likely to be more advanced at the time of diagnosis.
Estrogen Therapy Accelerates Ovarian Cancer Growth
Researchers from the University of Colorado have demonstrated that estrogen can cause some types of ovarian cancer to grow faster in mouse models. About 60% of ovarian cancers will have estrogen receptors, and estrogen can cause these cancers to grow faster in these animal models.
Soy based Supplement, Natural S-equol, Can Reduce Hot Flashes, and Muscle and Joint Pain in First Study of US Women
This information was recently presented in poster form at the North American Menopause Society. S-equol is a whole soy germ –based supplement. It was recently shown to decrease the frequency of moderate to severe hot flashes and reduces menopausal associated muscle and joint pain. S-equol [7-hydroxy-3-(4'-hydroxyphenyl)-chroman] is a compound resulting — when certain bacteria are present in the digestive tract — from the natural metabolism, or conversion, of daidzein, an isoflavone found in whole soybeans. However, not everyone who consumes soy can produce s-equol. S-equol selectively binds to the estrogen receptor, most strongly to the receptor beta. Additional clinical evidence has also demonstrated that S-equol can help preserve bone.
Manufacturing Plan for Hot Flash Drug Candidate Menerba Approved by the FDA
Menerba is an oral, botanically derived drug candidate designed to treat hot flashes associated with menopause. Its action is through the estrogen receptor beta. The designs for the definitive studies are currently being planned with the FDA and the drug’s manufacturer, Bionovo.
The National Institute of Health is Increasing Funding to Study the Health Effects of Botanical Estrogens
The Botanical Research Center based at the University of Illinois, will receive a large portion of the funding, as well as University of Mississippi, Oregon State University and the FDA’s National Center for Toxicological Research. The research will utilize the expertise of a multidisciplinary team of researchers to address the many unknowns associated with use of botanical estrogens. Examples of naturally derived phyto estrogens are from soy, licorice root, wild yam and dong quai, Prior research related to the efficacy of the naturally derived estrogens has lead to mixed results. Some research has even demonstrated that some of these agents may interfere with breast cancer treatment and induce cognitive problems.
Non-Hormone Treatments of Hot Flashes
A new Cochrane review finds that a variety of non-hormonal treatments (mostly non-hormonal drugs) can offer women who have had breast cancer some relief from hot flashes. Relaxation therapy, the anti hypertensive Clonidine, the anti convulsant gabapentin and the anti depressants that inhibit serotonin reuptake were found in review to have a mild to moderate effect.
Menopause Associated Depression Can be Treated with an Antidepressant
Pristiq was recently demonstrated to be effective in treating menopause associated depression in the Journal of Clinical Psychiatry. . This data was recently published study generated from Virginia Commonwealth University. This is the first study to demonstrate the effectiveness of an antidepressant specifically related to perimenopause and post menopause.
Progestin Type May Alter Breast Cancer Risk in Hormone Replacement Therapy
In animal studies recently published in Cancer Prevention Research from the University of Missouri, researches compared synthetic progestins (medroxyprogesterone acetate – MPA), norgesterel, norethindrone, and megesterol acetate. Animal studies have demonstrated that MPA is a tumor promoter, however norgesterel and norethindrone are tumor inhibitors.
Posted: November 1st, 2010 | Author: drpoynor | Filed under: estrogen, general health, gynecology, menopause | Tags: news, reviews | No Comments »
HPV stands for human papilloma virus and is the most common sexually transmitted infection; it is also the virus that causes cervical cancer. If you have HPV on your Pap smear it does not mean that you have cervical cancer, but may be more likely to develop pre cancerous and cancerous changes in the genital and oral areas. For some women, your health care provider may suggest that you have more frequent Pap smears or a test called a colposcopy, a more detailed examination of the genital area. Most women who are infected with HPV do not know it, because most of the time there will be no symptoms.
Approximately 20 million Americans are infected with HPV and 6 million will be newly infected each year. Indeed, approximately 50% of sexually active women will be infected. About 1% of sexually active adults in the U.S. have genital warts at any one time.
There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the anal region, mouth and throat. HPV is passed on through genital contact, anal sex, oral sex and genital-to-genital contact.
A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV.
Most women do not develop serious problems from an HPV infection, and the vast majority of the time a woman’s immune system will clear the virus. However, HPV infections may lead to warts in the genital or oral areas (throat), precancerous and cancerous changes in the cervix, vulva and vagina, and head and neck (tongue, tonsils and throat).
The over 40 HPV types that can infect a woman are generally categorized as high-risk (linked to cancers and significant, high-grade precancerous changes) and low-risk (linked to warts and low grade precancerous changes). HPV infections can cause the cells of the genital and oral areas to turn abnormal. Genital warts can appear weeks to months after infection, cancer most often takes years to develop. If the immune system if effective at clearing the HPV infection, abnormal cells may also go back to normal. Women who have weakened immune systems due to conditions such as HIV or are on immunosuppressant drugs are at higher risk for some HPV-related problems.
HPV can be prevented though vaccines, condoms, and limiting the number of sexual partners. There are currently two HPV vaccines available, Gardasil and Cervarix. These vaccines do not protect against all types of HPV types and are targeted to the most common types. Gardasil protects against the two most common low risk types 6 and 11, as well as the two most common high-risk types 16 and 18. Cervarix protects against HPV types 16 and 18. To be most effective the vaccines should be given before first sexual contact. They are FDA approved for use up to the age of 26 years.
Condoms may lower the risk of transmission of HPV. To be most effective, they should be used with every sex act, from start to finish. They are, however, not 100% effective as the virus can still be transmitted through skin-to-skin contact.
If you do have the presence of an HPV infection, review management with your health care provider. Make sure that you get your Pap smears on a regular basis and recommended more intense screening for precancerous changes of the genital areas, such as colposcopy. If you are having anal intercourse, review this with your health care provider. Currently, there are no screening recommendations for the anal areas, however an anal Pap smear may be recommended. The HPV tests on the market are only used to help screen for cervical cancer. There is no HPV test approved for the mouth or throat. There are no formal recommendations concering head and neck screening for people with HPV. However, symptoms of a persistent sore throat; persistent hoarse voice, neck lump or mouth lesions may be present. These should be reported to your health care provider. You should see a dentist on a regular basis and talk to your health care provider concerning seeing a head and neck physician for screening.
There is no proven effective treatment for the virus itself, but there are treatments for the diseases that HPV can cause. Eat a healthy diet rich in antioxidant nutrients with a variety of fruits and vegetables.
In summary, HPV usually goes away on its own, without causing major health problems. However, infection can lead to precancerous and cancerous changes of the genital, anal and head and neck areas. Review prevention and screening strategies with your healthcare provider.
Posted: October 23rd, 2010 | Author: drpoynor | Filed under: cancer diagnosis & treatment, cancer prevention, general health, gynecology | Tags: reviews | No Comments »
What are vitamins?
Vitamins and minerals are substances that the body cannot manufacture on its own, with the exception of vitamin D, and necessary for normal functioning of the cells. These must be obtained from the foods that we eat.
Vitamins can be divides into two groups: fat soluble, which are found in fats and oils of foods and stored in body fat, and water soluble which dissolve in water and mix easily in the blood. The body has limited stores of water soluble vitamins, because they are excreted in the blood. Some vitamins are classified as antioxidants, which protect cells against free radicals, and help to protect against disease. The best way to get necessary amounts of vitamins is through a diet rich in variety, fruits and vegetables, whole grains, low fat dairy products, fish, poultry and meats.
What vitamins are recommended for women?
Although it is strongly recommended that most vitamins and minerals come from the foods that we eat, many women will need one good daily multivitamin/mineral to supplements their diet. Massive doses of vitamins should be avoided, as they can be harmful. A vitamin with iron should only be taken if you are iron deficient, or still menstruating, as excess levels of iron are linked to heart disease.
Calcium is necessary for strong bones and other processes. An adult woman should consume 1200mg of calcium daily and post menopausal women should consume 1500mg daily.
A note on vitamin D
Over the past few years, the medical community has identified the vital importance of vitamin D to a variety of physiologic processes. At the same time, we have also recognized that a large proportion of women are vitamin D deficient.
Vitamin D refers to both vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D2 is synthesized by plants, and vitamin D3 is synthesized by humans in the skin when exposed to UVB rays from sunlight. Vitamin D is found in dietary sources such as fish, eggs and fortified milk. Recently, a variety of foods have been fortified with D2 and D3.
The main function of vitamin D is to regulate blood levels of calcium and phosphorus. More recently, vitamin D has been noted to be important in protection against osteoporosis, cancer, autoimmune illness and high blood pressure. In adults, vitamin D deficiency can lead to weak bones (osteomalacia), muscle weakness, and possibly mood disorders. Women who do not have any sun exposure are at risk for vitamin D deficiency, as well as those with fat malabsorption syndromes and inflammatory bowel disease.
The recommended daily allowance for vitamin D is 200 IU to 600 IU per day. Vitamin D is included in most multivitamins, usually in strengths from 50 IU to 1,000 IU. However, it has been recently questioned whether the recommended daily intakes are sufficient to maintain adequate and optimum levels of vitamin D of 50ng/ml. Indeed, there may be great variations of adequate vitamin D intake among individuals.
The upper limit of safe intake has been set at 2,000 IU by the Institute of Medicine, due to toxicities that can occur when taken in higher doses. However, for vitamin D deficient individuals, this will not be enough. For most women, their vitamin D level should be checked, as many will be deficient, and daily intake adjusted accordingly by a health care professional.
Special situations
Women who are vegans may suffer from vitamin B12 deficiency. This vitamin is synthesized by bacteria and found in meat, eggs and dairy products. It appears that B12 availability from plant sources is limited, and has been concluded that no plant foods can be relied on as a safe source of vitamin B12. B12 is necessary for DNA during cell division and is therefore necessary for tissues in which cells are rapidly dividing, such as: bone marrow and red blood cell production. B12 deficiency can lead to anemia. Vitamin B12 is also necessary for the nervous system, because it also functions in the proper maintenance of myelin, which composes the cover of nerve cells. Vitamin B12 deficiency can lead to nerve damage. Good sources of vitamin B12 for vegans are dairy products or free range eggs. Vegans are recommended to include foods fortified with B12.
Women who are in their reproductive years should consume 400micrograms of folic acid daily in order to help prevent birth defects.
Recommended vitamin and mineral intake for women
Recommended Daily Calcium Intake for Healthy Women with Normal Bone Densities
Pre-Menopausal Women
Suggestion: Take 1 multi-vitamin daily.
Total: 500 mg of Calcium daily
Total: 400 IU of Vitamin D daily, but have your level checked and adjust accordingly.
Post-Menopausal Women not on Hormone Replacement Therapy
Suggestion: Take 1 multi-vitamin and 2 calcium tablets daily.
Total: 1500 mg of Calcium daily
Total: 800 IU of Vitamin D daily, but have your level checked and adjust accordingly.
Post-Menopausal Women on Hormone Replacement Therapy
Suggestion: Take 1 multi-vitamin and 1 calcium tablet daily.
Total: 1000 mg of Calcium daily
Total: 800 IU of Vitamin D daily, but have your level checked and adjust accordingly.
Peri-Menopausal Women
Suggestion: Take 1 multi-vitamin and 1 calcium tablet daily.
Total: 1000 mg of Calcium daily
Total: 800 IU of Vitamin D daily, but have your level checked and adjust accordingly.
Vitamin/Mineral Sources and Function
Vitamin A Helps maintain normal vision, healthy skin, and proper function of the immune system.
Found in: Orange and yellow fruits and vegetables, liver, egg yolks, fortified milk.
Beta Carotene Acts as an antioxidant and the body converts it to Vitamin A; performs the same functions as vitamin A.
Found in: Orange and yellow fruits and vegetables.
Vitamin D Prevents bone deformation; regulates use of calcium in mother and baby.
Found in: Fortified milk, sardines, sunlight.
Vitamin E Helps prevent anemia.
Found in: Whole grains, nuts, vegetable oils.
Vitamin C Promotes healthy capillaries gums and teeth, helps make collagen in connective tissue; helps wound healing.
Found in: Citrus fruits, broccoli, green tomatoes, strawberries, cabbage, potatoes, red peppers, brussel sprouts.
Folic Acid Helps prevent anemia and certain birth defects of the spine and brain, helps to make DNA.
Found in: Green leafy vegetables, enriched -cereals and legumes.
Thiamine Helps release energy from carbohydrates, maintains healthy brain and nerve cells, and maintains heart function.
Found in: Whole and enriched grains, beans, pork.
Riboflavin Helps utilization of other B vitamins.
Found in: Milk, cheese, eggs, green leafy vegetables, whole and enriched grains.
Niacin Helps metabolism of fats and carbohydrates, helps functioning of nervous and digestive systems; maintains healthy skin.
Found in: Meats, poultry, fish, whole and enriched grains.
Vitamin B6 Helps prevent anemia and skin lesions, helps normal brain function; is essential for processing carbohydrates, lipids, and fats, and for making DNA.
Found in: Green leafy vegetables, meats, poultry, fish.
Vitamin B12 Helps prevent anemia; maintains the nervous system.
Found in: Meats, fish, milk, eggs, yogurt.
Calcium Promote strong bones and teeth, and nerves and muscles respond.
Found in: Milk, cheese, yogurt, tofu, sardines, green leafy vegetables.
Copper Helps body use iron; helps energy metabolism.
Found in: Water, shellfish, nuts, legumes.
Iron Helps prevent anemia by carrying oxygen in the blood. Helps the immune system.
Found in: Meats, fish, poultry, legumes - green leafy vegetables, whole and enriched grains.
Zinc Necessary for many enzymes, helps wound healing and synthesis of protein, DNA, and RNA.
Found in: Meats, whole grains, legumes, nuts.
Calcium Rich Foods:
Food Serving Size Calcium per serving (mg)
Milk
- skim, low-fat, whole 1 cup 300
- lactose-reduced 1 cup 250
- soy, fortified 1 cup 280
Yogurt
- plain low-fat 1 cup 415
- fruit low-fat 1 cup 343
- frozen 1 cup 200
Ice Cream or Ice Milk – 1 cup 190
Cheese
- Swiss 1 ounce 245
- Cheddar 1 ounce 205
- Muenster 1 ounce 205
- Mozzarella 1 ounce 185
- American 1 ounce 175
- Ricotta ½ cup 335
- Cottage ½ cup 80
Sardines in oil (with bones) 3 ounces 325
Salmon, canned (with bones) 3 ounces 180
Broccoli 1 cup 100
Calcium-fortified Orange Juice 1 cup 350
Recommendations
- Take a good multivitamin daily.
- Eat a healthy diet with variety, rich in fruits, vegetables, low fat dairy and lean meats.
- Many women will need to supplement their calcium and vitamin D intake. Calcium supplementation will depend on age and menopausal status. Vitamin D supplementation will depend on baseline levels which should be drawn in your health care practitioner’s office and supplementation may need to be increased in the winter months.
- Women who are vegetarian will have special vitamin requirements.
- Before taking any vitamin or mineral supplementation, check with your health care practitioner.
Posted: October 14th, 2010 | Author: drpoynor | Filed under: general health, great health at every age, nutrition & diet, Uncategorized | Tags: reviews | No Comments »
Why is my cholesterol level important?
Cardiac disease is the number one killer of women. Too much cholesterol leads to narrowing or “hardening” of the arteries and eventually cardiac disease. Cholesterol is a fatty substance that is generated from the liver, but also enters the body through dietary sources. All women should have their cholesterol levels checked at regular intervals throughout their lives, in addition to participating in a healthy lifestyle in order to minimize their risk of cardiac disease.
What is cholesterol?
Cholesterol is a fat like substance that is present in all cells of the body. Since it is a fat like substance, it does not mix with blood, which is water like substance. Cholesterol is therefore packaged by the body into lipoproteins. These packets allow cholesterol to be carried to the cells of the body where it is needed. There are two major types of lipoproteins: LDL (low density lipoproteins) also referred to the “bad cholesterol” due to the fact that elevated levels of LDL leads to plaque buildup in the arteries of the body and thus cardiac disease, and HDL (high density lipoproteins) also referred to as the “good cholesterol” since it carries cholesterol from other parts of the body to the liver, where it is removed from the body, and thus elevated levels lead to a lower risk of developing cardiac disease. Cholesterol is used to make hormones, vitamin D and substances that are involved with digestion. Additional important fat components in the blood are triglycerides, which are usually analyzed and evaluated with cholesterol.
What affects cholesterol levels?
Cholesterol levels are primarily affected by the food we eat, genes, age and gender. They are also affected by weight and activity. Fats in the diet can alter cholesterol levels, LDL cholesterol levels are raised most by saturated fats. Examples of foods containing a high proportion of saturated fats include: dairy products, animal fats, fatty meat, coconut oil, palm kernel oil, chocolate and some prepared foods. Trans fatty acids also raise cholesterol levels. Being overweight can also increase your LDL levels. High cholesterol levels can also run in families, and thus can be inherited. Individuals which have high cholesterol from birth may have a heart attack at an early age. As we age, our LDL cholesterol levels may also increase. Cholesterol levels in women may vary with their menstrual cycles, with as much variation as 19% in a month. As the level of estrogen rises during a woman’s cycle, her HDL level will also rise and peaks around the time of ovulation. In contrast, total cholesterol and LDL levels, as well as triglycerides, decline as estrogen levels rise. Estrogen containing compounds, such as oral contraceptives and hormone replacement therapies, can also influence cholesterol levels. Oral contraceptives have a modest positive effect on cholesterol levels, raising HDL-cholesterol and lowering LDL-cholesterol. This is a result of the estrogen component, as some progestins alone have a modest negative effective on cholesterol levels. Hormone replacement therapy has a broad scale impact on cholesterol metabolism. Estrogen therapy can increase HDL levels as well as decrease Lp(a), which is a cousin to LDL, and important mediator of cardiac disease.
Triglyceride levels are elevated by: being overweight, cigarette smoking, excessive alcohol use, very high carbohydrate diet, genetic disorders, certain drugs.
Why are elevated levels of cholesterol bad?
Elevated cholesterol levels can increase a woman’s risk to develop heart disease, and many women with elevated levels do not have symptoms. Elevated levels of cholesterol lead to buildup cholesterol containing plaques in the walls of the arteries. This eventually leads to narrowing of the arteries which can lead to decreased necessary blood flow to crucial organs of the body. Coronary arteries are the arteries which supply the heart with blood. When these are narrowed sufficiently, the heart does not receive the necessary oxygen and heart attacks can ensue. Some plaques can also rupture and lead to blood clots which block the flow of blood, leading also to a heart attack or stroke.
What do your cholesterol levels mean?
It is best to have your blood checked after not eating or drinking anything for 9 to 12 hours before the blood draw, so called “fasting” levels. Generally four levels are checked in a lipoprotein profile: total cholesterol, LDL, HDL and triglycerides. If it is not possible to fast before a blood draw, total cholesterol and HDL levels can be drawn in order to give you a general idea about your cholesterol levels. Additional testing should be done of your total cholesterol is greater than 200 mg/dL or your HDL is less than 40 mg/dL. Elevated levels of triglycerides can also increase a woman’s risk to develop heart disease.
Total Cholesterol
Less than 200 mg/dL – Desirable
200-239 mg/dL – Borderline high
240 mg/dL and above – High
LDL Cholesterol Level
Less than 100 mg/dL – Optimal
100-129 mg/dL – Near optimal/above optimal
130-159 mg/dL – Borderline high
160-189 mg/dL – High
190 mg/dL and greater – Very high
HDL Cholesterol Level
Less than 40mg/dL – A major risk factor for cardiac disease
60mg/dL and greater – Considered protective against heart disease
Interventions to lower your cholesterol
For all, lifestyle changes will be advised in order to lower cholesterol levels. This includes eating a low cholesterol diet and increasing exercise. For some women, medications may be prescribed in addition to lifestyle changes, based on other cardiac disease risk factors and level of LDL. Because the risk of heart disease is linked to the level of LDL cholesterol and other risk factors, the main goal of cholesterol treatment is to lower the levels of LDL cholesterol. This can be accomplished through diet, exercise, medications and some alternative therapies. Risk factors for cardiac disease in addition to elevated LDL cholesterol levels include: cigarette smoking, high blood pressure, diabetes, HDL levels less than 40 mg/dL, family history of heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65), age (women greater than 55 years and older). Interventions that a physician will employ based on LDL levels and risk factors include: lifestyle changes and drug treatment. Your LDL goal will be determined by your risk of developing heart disease.
In order to decrease LDL cholesterol through lifestyle changes it is recommended to: limit the amount of saturated fat, trans fat, and cholesterol that your eat, achieve a healthy weight, increase soluble fiber in the diet, and add cholesterol lowering foods, and participate in regular physical activity (30 minutes each day of the week). A diet high in fruits and vegetables, nuts, and seeds is recommended. Goals of a cholesterol lowering diet include: increase fiber (through consumption of fruits, vegetables, legumes and unrefined grains), increasing soy protein in the diet (tofu, soy milk, edamame and other soy products – if you have a history of breast cancer or are at elevated risk for breast cancer, review with your health care professional), and increase phytosterols (whole grains and vegetables).
Cholesterol lowering medications, in additional to change in diet and physical activity, may be prescribed for women who have cardiac risk factors in addition to elevated LDL cholesterol. There are five types of cholesterol lowering medications: statins, bile acid sequestrants, nicotinic acid, fibrates, and ezetimibe. Statins are the first line drug choice for many women; they block the production of cholesterol in the liver itself. They lower LDL, the “bad” cholesterol, and triglycerides, and have a mild effect in raising HDL. Side effects can include intestinal problems, liver damage, and in a few people, muscle tenderness. Examples of commonly prescribed statins include: atorvastatin (Lipitor), fluvastatin (Lescol), lovasatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), and simvastatin (Zocor). Nicotinic acid, a B-complex vitamin, is found in food, but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. Bile acid resins bind bile from the lever, made largely from cholesterol, and prevent it from being resorted into the circulatory system and thus deplete the body’s store of cholesterol. Examples of bile acid resins include: Questran and Welchol. Fibrates reduce the production of triglycerides and can increase HDL cholesterol. Examples include: Lopid and Tricor. Ezetimibe lowers bad LDL cholesterol by decreasing its absorption from the intestine. It can be used alone such as Zetia, or combined with statins, such as Vytorin when statins alone do not control cholesterol levels.
There are a number of alternative remedies for lowering LDL cholesterol, however these agents may interact with other medications and have serious and significant side effects. Therefore, you should always review with your health care professional whether these agents are safe and right for you. Supplements that may help to lower cholesterol levels include: garlic (may prolong bleeding and blood clotting time), guggulipid (gum resin of the mukul myrrh tree), red yeast rice, policosanol (from sugar cane). Most of these require additional, well controlled clinical trials to establish their effectiveness. As with any alternative therapy or supplement, the contents of these agents are not regulated by the major safety body for pharmaceutical agents in the United States, the FDA.
Prevention
- Check your cholesterol levels
Healthy adults are recommended to have their levels checked every five years. Total cholesterol, HDL, LDL and triglyceride levels should be checked as part of a lipoprotein profile.
30 minutes of aerobic exercise on a dally basis is recommended
Guidelines from the National Cholesterol Education Program include:
- Saturated fat should account for less than 7% of calories consumed
- Less than 200 mg of cholesterol should be consumed daily
- Up to 30% of calories should be from total fat, but most should be unsaturated fat
- Consume soluble fiber and phytosterols
- Read food labels
Posted: October 10th, 2010 | Author: drpoynor | Filed under: general health, great health at every age, nutrition & diet, weight loss | Tags: reviews | No Comments »
Endometriosis is a condition which usually affects women in their childbearing years and can lead to pelvic pain and infertility. Endometriosis consists of clusters of endometrial cells (the cells which form the lining of the uterus and are shed each month with menstruation) growing outside the uterus. These clusters of endometrial cells, or implants, can be found most commonly in the pelvis including the ovaries, fallopian tubes, and the surface of the uterus. They can also be found on the intestine, upper abdomen or in other parts of the body such as the lung. Because endometriosis cells are subject to the same monthly hormonal changes that normal endometrial cells are, but cannot be shed, this can lead to scar tissue, cysts, and pain. Women who have endometriosis may have a higher risk of developing ovarian cancer. This risk has been difficult to quantify and the mechanism of this elevated risk is unknown.
It is estimated that endometriosis affects over one million women in the United States, and most cases are diagnosed in women between 25 and 35 years of age. However, because many women have no symptoms, the exact prevalence is unknown. The condition is uncommon in postmenopausal women. Other risk factors for endometriosis include being Caucasian (compared to African American and Asian), being tall and thin with a low body mass index, being infertile and delaying pregnancy until older ages.
We do not know the exact causes of endometriosis, but there are several theories. It is thought that estrogens contribute to the formation of endometriosis. Other possible causes of endometriosis include: retrograde menstruation – when endometrial tissue is deposited in strange locations because of menstrual flow that backs up into the fallopian tubes and abdominal cavity, immune system problems – causing the body to not recognize and destroy cells or tissue that is growing where it should not be, and cellular metaplasia – the cells of the areas lining the pelvic organs have certain cells that can grow into other forms of tissue such as endometrial cells.
Many women will have no symptoms of endometriosis, and the amount of the endometriosis does not correlate with the degree of symptoms. The predominant symptom of endometriosis is pain. Endometriosis associated pain may be located in the pelvis, lower abdomen, rectum, vagina, or lower back. It may vary with different points in the menstrual cycle. It may also occur during sex, bowel movements, ovulation, or all the time. Abnormal bleeding is also a symptom of endometriosis. Heavy periods, spotting or bleeding between periods, bleeding after sex, or blood in the urine or stool can occur as a result of the condition. Infertility can also be caused by endometriosis. Disrupted bowel habits such as constipation or diarrhea can also occur.
In order to diagnose endometriosis, a thorough medical history and physical examination will be taken in order to ascertain for the symptoms of the condition. Some health care practitioners will prescribe medical treatments for endometriosis; an improvement in symptoms after medication usually indicates that the problem was endometriosis. Imaging tests, such as ultrasounds, magnetic resonance image (MRI) tests, and CT scans also may be employed However, endometrial implants will many times not show up on even the most sensitive of imaging tests. The only way to truly diagnose endometriosis is through directly evaluating the abdominal and pelvic cavity. This most commonly accomplished through the use of laparoscopy, which is minimally invasive or “belly button” surgery. Biopsies are usually taken in order to rule out other conditions such as ovarian cancer.
Treatment options consist of medical treatments and surgical treatments. The route of treatment will depend on the goal of the woman and can differ if the woman wants to get pregnant or is focused on treating pain. Medical treatments include pain medicines such as NSAIDs (non steroidal anti inflammatory), birth control pills, hormone therapy such as GNRH (gonadotropin-releasing hormone analogs) such as Lupron, Danazol and progestins, and aromatase inhibitors. Many of the medical treatments provide only temporary relief while they are being utilized and can have side effects. Some, like Lupron, can only be used for a limited period of time due to their side effects of bone loss. Surgery may be an option chosen for some women who are attempting to get pregnant or in which medical management has failed. This may consist of ablation techniques or accomplished by excision techniques. This form of surgery, when conducted properly, is quite complex and a gynecologic surgical sub-specialist is encouraged to be consulted. The ovaries and uterus may also be recommended to be removed for some women. This type of surgery, while may be successful in the short run for relieving the symptoms of endometriosis, may not provide long-term pain control for all women,
Take home message:
Endometriosis may be a cause of unexplained pelvic pain, abnormal bleeding, or infertility.
Endometriosis is not an uncommon problem in women.
Diagnosis is usually made on the basis of symptoms and laparoscopy may be used.
Treatments may be either medical or surgical.
If surgery is being entertained as a treatment option, in order to assure that you have the best outcome, consult and expert gynecologic surgeon.
Posted: August 8th, 2010 | Author: drpoynor | Filed under: endometriosis, general health, gynecology | Tags: reviews | No Comments »
