Kimberley J Horner, ND, MS
September 2013 Prostate Cancer Prevention
Hello, everyone! Much of the focus of my practice is on women's medicine, but I don't want the men to feel left out! September is Prostate Cancer Awareness Month, giving me the perfect opportunity to discuss a topic that is of major concern to men. As usual, I will talk some stats and then get to the things you can do to reduce your risk of prostate cancer. Let's get started.
In the United States in 2013, it is estimated that 217,730 men will be diagnosed with prostate cancer and 32,050 will die from the disease. The lifetime risk of the disease is 1 in 6. There are over 2 million men alive today in the U.S. who have had this condition at some point in their lives. So, it is a pretty big issue. Because of increased prostate specific antigen = PSA screening over the last decade or so, the rate of detection has increased. One of the latest trends over the last few years is the evolving understanding that some prostate cancers are much less aggressive than others - the medical term often used is indolent. This means that men with these low-grade tumors often have an increased likelihood of dying from a disease other than the prostate cancer. There is increasing concern about the overtreatment of patients with indolent or low-risk disease. Not only is it very expensive, but the side-effects of treatments used for prostate cancer, such as surgery and radiation, are often unpleasant and permanent. Therefore, the medical community is rightly directing some attention to the importance of distinguishing between aggressive and indolent disease in order to lower the use of unnecessary and potentially harmful treatments. Additionally, the U.S. Preventive Services Task Force now recommends against PSA screening for healthy men not at high risk for prostate cancer. This can be confusing for men who might be used to getting screened each year. Most patients just take the recommendation of their physicians. So, if you have questions or concerns about screening, talk to your physician who knows you best. He or she can assess your personal risk for the disease and make a recommendation. The absolute number of the PSA seems to be less important than any change in the number, which is called the PSA velocity. If a patient is screened and prostate cancer is suspected, a biopsy is typically performed and the tissue examined to determine the Gleason score, which quantifies on a scale of 1 to 10 the aggressiveness of the tumor. Low-risk disease has a Gleason score of 6 or less and a PSA of 10ng/ml or less. Also, the tumor must be confined to only one half or less of one side of the prostate . Any other disease is considered high-risk disease. This is the point at which a patient and his physician would decide the proper course of treatment. As we have said, surgery and radiation are the most common therapies for prostate cancer. However, watchful waiting can be an option and should be at least considered in cases that are low-risk. As a naturopathic physician, I feel strongly that patients can do more than just "watch and wait" in these cases. To me, there is sufficient evidence that certain lifestyle habits encourage the growth of prostate cancer and certain habits protect against prostate cancer. It is my opinion that employing the factors that prevent prostate cancer and stopping or reducing the factors that promote prostate cancer just makes sense in most cases, whether you are trying to prevent the disease, "watchfully waiting", or treating with surgery, radiation, or drug therapy. Besides, most of these lifestyle changes also protect against cardiovascular disease, the number one killer of men in the United States. That is a win-win!
Whether you want to prevent or treat prostate cancer, you need to understand the known risk factors and other factors associated with prostate cancer. Remember to focus on what you can change and don't worry about what you can't change. Risk factors include:
- Older age
- African-American race
- Family history of prostate or breast cancer
- BRCA-1 or BRCA-2 mutation
- Obesity = a BMI of 30 or more
- High waist-to-hip ratio
- Sedentary lifestyle
- Testosterone replacement therapy
- Chronic prostatitis
- Sexually-transmitted diseases = STD's
- Immunosuppression due to prescription drugs, HIV, etc.
- Exposure to Agent Orange, PCB's, some organophosphate pesticides, some organochlorine pesticides, bisphenol A, arsenic, radiation
- Sleep disruption/ night-shift work/ light at night/ exposure to EMF's/ low melatonin
- Living at higher latitudes/ less sunlight/ low Vitamin D
- High serum insulin and insulin-like growth factor-1 = IGF-1 levels
- High total cholesterol
- High testosterone levels
- High estrogen levels
- High blood calcium levels/low blood magnesium levels
- Chronic inflammation/ high serum C-reactive protein is a possible risk factor
- Smoking increases the risk of aggressive prostate cancer
- Heavy drinking increases the risk of aggressive prostate cancer
- Dietary factors: high in calcium, dairy products, calories, carbohydrates, animal fat, red meat, overcooked meat, heterocyclic amines found in burned foods, processed meat, trans fats, hard liquor, conventional eggs, seaweed; low in fruits, vegetables, nuts, seeds, vegetable oils, fiber
- Note that benign prostatic hypertrophy = BPH or enlarged prostate is not a risk factor
Protective factors include:
- Proper weight/ BMI
- Regular exercise
- Aspirin use
- Statin use
- Good sleep/ adequate melatonin levels
- Adequate Vitamin D levels/intake, apparently best in supplement form vs. dietary
- Dietary factors: low in calories, carbohydrates, animal fat, meat, overcooked meat, processed meat, hard liquor, dairy products, calcium; high in lycopene, magnesium, the gamma tocopherol form of vitamin E, boron, quercetin/bioflavonoids, cold water fish, soy - organic is best, vegetable fats, almonds, pecans, walnuts, seeds, coffee, tea, dark chocolate, cayenne pepper, curry, ginger, fiber, fruits, and vegetables, in particular tomatoes - best cooked and with olive oil, broccoli, cauliflower, brussel sprouts, leafy greens, garlic, onions, shallots, carrots, sweet potatoes, pomegranates, cranberries, raspberries, blueberries, apples, mangoes, guavas, watermelon, grapes; light to moderate consumption of wine, particularly red wine
This is a lot to take in, but it is important information if you want to live a longer, healthier life, which I hope you do, both for yourself and for those who love and depend on you. So, it is really not too complicated! The bottom line? Eat a healthy diet as outlined above and in my previous newsletters, don't get too much calcium - remember it can even be in orange juice and non-dairy milks, get good sleep and regular exercise, maintain a good weight, don't drink excessively or smoke, get adequate sunlight and maintain your Vitamin D, stay away from pesticides/bisphenol A/arsenic, don't take testosterone replacement therapy unless it is really necessary, and ask your doctor if a daily low-dose aspirin would work for you. If you are a woman reading this, please share it with your male friends and partners. All the effort we put into living healthy lives will serve us now and in the future! Good health and happiness to you!
August 2013 Nature Prescription
Since I gave you the "sun" talk last month, I thought I would give you, and me too, a break from statistics and facts this month. I'm just going to give you a reminder to get out and enjoy nature while the weather is still good. Spend some time outdoors with your friends and family or just take some quiet time for yourself if that is what you need. Nature not only nourishes the body, but it relaxes the mind and comforts the spirit. So, get out there and go hiking, biking, walking, running, or even just sitting! Take time to watch nature around you and to stop and smell the roses, as they say, before summer comes to an end. Always be careful, and let's have fun out there!
July 2013 Ovarian Cancer
If you follow my newsletters, you know by now that cancer prevention and treatment are main interests of mine. Ovarian cancer was in the news recently, with actor Pierce Brosnan losing his daughter, a 41-year-old wife and mother of two children, to this disease in early July. Ovarian cancer is diagnosed in approximately 22,000 women in the United States every year, with about 14,000 deaths each year. It is the tenth most common cancer in American women, but it is the fifth most common cause of cancer death in American women due to its relatively high mortality rate. An American woman's lifetime risk of getting ovarian cancer is 1 in 72. Half of the cases occur in women over 65 years old. Mortality rates are slightly higher in Caucasian women than in African-American women.
Unlike breast and cervical cancer, early diagnosis of ovarian cancer is difficult because there is currently no reliable screening method comparable to mammograms or pap smears. To make early diagnosis even more problematic, early warning signs of ovarian cancer often are vague, non-specific symptoms such as: pain or pressure in the abdomen, pelvis, back, or legs; pain with intercourse; abdominal bloating or swelling; gastrointestinal issues such as indigestion, gas, constipation, diarrhea, nausea, trouble eating, and feeling full quickly; urinary problems such as urgency and frequency; unexplained weight loss or gain; unusual vaginal bleeding; shortness of breath; and fatigue. Since these symptoms occur commonly in women who do not have ovarian cancer, it can be confusing. Often there are no symptoms in the early stages of ovarian cancer. The result of all of this is that only about 15% of ovarian cancers are diagnosed early. For now, what is recommended is that if any of these symptoms are persistent, ask the advice of your physician.
Over ninety percent of ovarian cancers develop in the epithelial cells of the ovary; only ten percent develop in the stromal and germ cells. The information discussed from here forward refers to epithelial ovarian cancer. The causes of ovarian cancer are not as well known as those of other cancers like breast cancer. Just like we need to find a reliable screening method for ovarian cancer, we need to gain more understanding about the causes. Many women who get ovarian cancer have none of the known risk factors, telling us we have much to learn. However, here is some of what we currently know about it.
Risk factors include:
- Increasing age
- BRCA-1 gene mutation
- BRCA-2 gene mutation - less of a risk and better prognosis than BRCA-1
- Family history of ovarian cancer - highest risk if two or more first-degree relatives such as a mother, sister, daughter; higher risk if second degree relatives such as aunt, grandmother
- Family history of other cancers: breast, uterus, colorectal
- Personal history of other cancers: breast, uterus, colorectal
- Obstetrical/gynecological factors: early menses before 12 years old; late menopause after 50 years old; no pregnancies; few pregnancies; first child after 30 years old; no breastfeeding; infertility; use of fertility drugs; never used oral contraceptives; PCOS = polycystic ovaries; PID = pelvic inflammatory disease; endometriosis; chronic ovarian cysts - though this is not a big risk factor; use of post-menopausal hormone replacement therapy = HRT, in the form of estrogen with or without progesterone, and/or testosterone
- Elevated insulin/diabetes
- Chronic inflammation
- Night shift work/altered melatonin
- Low vitamin D
- Vaginal use of talcum powder in the past when asbestos fibers were in the powder
- Exposure to bisphenol-A and phthalates
- Use of selective serotonin reuptake inhibitors = SSRI's for depression, etc.;
- Elevated platelet levels
- Autoimmune hyperthyroidism
- Dietary factors: low in vegetables; high in fat, dairy products, calcium, lactose, processed meats, overcooked meats, and eggs.
Protective factors include:
- Daily aspirin use - it is anti-inflammatory
- Ob/gyn factors: late menses after 13 years old, early menopause before 45 years old, increasing number of pregnancies; breastfeeding; oral contraceptive use - over 5 years; tubal ligation; hysterectomy; oophorectomy = removal of the ovaries - this can be done prophylactically in high risk patients to reduce risk
- Sunlight/ vitamin D
- Dietary factors: high in vegetables - in particular those rich in the flavonoid kaempferol, such as broccoli, spinach, onions, endive, and kale, green tea, fish; low in fat, dairy products, processed meats, overcooked meats, eggs
In conclusion, my recommendations to prevent ovarian cancer are the following:
- Know your family history and understand your risk of this and other cancers.
- If your risk seems high to you based on the number of relatives with ovarian and the other cancers listed above, make sure your doctor knows about your family history; he or she might recommend BRCA testing.
- Don't worry about what you cannot change, focus on what you can change.
- Know your body well and watch for signs of illness; if they persist, consult your physician.
- Eat a healthy diet, as I outlined in the January newsletter; in particular, increase vegetables, green tea, fish; reduce processed meats, overcooked meats, dairy products, eggs, fat; only consume dairy products, eggs, and meats raised naturally, without hormones and antibiotics.
- Address chronic inflammatory conditions, with diet, lifestyle factors, and other natural methods whenever possible; ask your doctor if a daily low-dose aspirin would be appropriate for you.
- Get adequate sunshine, following recommendations about skin cancer outlined in the June newsletter.
- Monitor your vitamin D levels; make sure they are adequate.
- Address diabetes and high insulin levels, with natural methods if possible.
- Address obesity.
- Exercise regularly.
- Reduce exposure to bisphenol-A and phthalates.
- Avoid use of HRT and SSRI's if possible.
- Get good sleep for adequate melatonin; if you are at high risk, try not to work the night shift.
- If you are at high risk and don't want a prophylactic oophorectomy, consider oral contraceptive use; ask your doctor for advice.
- If you get pregnant, breastfeed.
- Continue to learn and spread the word so that we can work together to really prevent cancer.
Have a great July!
June 2013 Skin Cancer
Summer is nearly upon us! As we approach the start of the summer season, I thought I would provide you with a reminder about skin cancer. We all love the sun, and research shows that it is beneficial for several reasons, including providing us with the essential Vitamin D that we need for optimum health. However, too much sun can be detrimental. We must strike a balance. As usual, being informed is key.
Skin cancer is the most common form of cancer in the United States, with about 3.5 million cases in over 2 million patients diagnosed each year. The risk of getting some form of skin cancer in your lifetime is about 1 in 5. The incidence of skin cancer is lower in African American, Hispanic, and Asian American populations, but mortality from skin cancer is higher in these minority populations, in part because the disease is often diagnosed at a later stage. Skin cancer is typically divided into two categories: melanoma skin cancer and non-melanoma skin cancer. The latter includes basal cell carcinoma = BCC, squamous cell carcinoma = SCC, and some other rare forms of skin cancer.
BCC is the most common form of skin cancer in the U.S., with approximatley 2.8 million cases diagnosed per year. It is the most common form of skin cancer in Caucasian, Hispanic, and Asian populations in the United States. SCC is the second most common skin cancer in the U.S., with about 700,000 cases diagnosed each year. It is the most common form of skin cancer in African Americans, and it tends to be very aggressive in this group. Over 2 million Americans will be treated for non-melanoma skin cancer each year, and it is estimated that 3,170 Americans will die of non-melanoma skin cancer in 2013.
Melanoma is the third most common form of skin cancer in the U.S., with 76,690 cases of melanoma estimated for 2013, 45,060 cases in men and 31,630 cases in women. It is estimated that 9,480 Americans will die of melanoma in 2013. While melanoma accounts for less than 5% of skin cancer diagnoses in the U.S., it accounts for the vast majority of skin cancer deaths. Men have increased mortality from melanoma when compared to women. The incidence of melanoma is increasing worldwide. It is interesting to note that the effort to reduce people's exposure to the sun has not led to a significant reduction in the incidence of melanoma.
In order to prevent skin cancer it is important to understand the risk factors, which include the following:
- Radiation - from the sun, tanning beds/UV nail dryers, and radiation therapy
- Fair skin, red or blond hair, blue or gray eyes, and/or many freckles
- Immunosupression - from HIV, leukemia, or lymphoma; and from the use of immunosupressive medications such as those given to organ transplant patients, chemotherapy, biologic agents used in the treatment of autoimmune diseases, and steroids such as prednisone
- Increasing age
- Personal history of skin cancer
- Family history of skin cancer
- Increased number of moles, greater than 50 increases the risk of melanoma
- Increased number of actinic keratoses, which are precancerous skin lesions affecting 58 million Americans that can turn into BCC or SCC
- Chronic inflammatory skin disorders and chronic skin ulcers
- Scars from severe burns
- Some strains of Human Papilloma Virus = HPV can increase the risk of SCC
- Exposure, in particular occupational exposure, to arsenic, coal, industrial tar, creosote, and radium
More specific information about the risk from radiation is important here.
- Sunburns, more than 5 at any age, increases the risk of skin cancer.
- One or more blistering sunburns in childhood or adolescence also increases the risk.
- High overall lifetime sun exposure is a risk factor, but one 2005 study seemed to indicate that a continuous pattern of sun exposure, as in occupational sun exposure, may actually be protective while intermittent sun exposure may be more of a risk.
- Both UVA and UVB rays can cause skin cancer, with UVB more likely to cause sunburn.
- The sun's rays are strongest from 10am to 3pm and still penetrate even on cloudy days.
- Since the sun's rays are most intense at higher elevations and at lower latitudes, those who live now or have ever lived in these areas are at increased risk of skin cancer.
- In March 2013, a study was released showing an increased risk of skin cancer on the hands of people who used UV lamps to dry gel manicures.
- Radiation sometimes used in the treatment of psoriasis increases the risk of SCC.
- Several common medications increase the skin's sensitivity to the sun, including: tetracycline, sulfa drugs, and some other antibiotics; naproxen and some other NSAIDS; tricyclic anti-depressants; thiazide diuretics used for hypertension; sulfonylureas used for diabetes; phenothiazines; and possibly oral contraceptives.
- The use of tanning beds is also a risk factor for skin cancer. Thirty million Americans use tanning beds every year, 2-3 million are teens.
While understanding the causes of skin cancer can help us prevent it, detection of skin cancer is also important to discuss. It is a good idea to do monthly skin self-examinations. Also, have someone else examine areas that you cannot see well, such as your scalp and back. Ask your physician about how often you should get a professional examination. So, where do you look? Skin cancers typically occur on sun-exposed areas such as the scalp, neck, face, lips, ears, chest, back, arms or hands but can also occur in other locations that have not been exposed to sun, such as the palms of the hands, soles of the feet, and in the nailbeds. Melanoma in men most often occurs on the trunk, head, or neck, but in women occurs most often on the lower legs. What are you looking for? With BCC and SCC, you are looking for change, which can mean a new growth, a change in an old growth, or a sore that does not heal. With melanoma, follow the mnemonic ABCDE. Look for: Asymmetry; Border that is irregular: Color that is uneven: Diameter that is changing: and Evolving - any change. Alert your physician to any suspicious lesion. He or she may refer you to a dermatologist for biopsy and further evaluation. It is important to find skin cancers early, before they have the chance to spread to other tissues and organs. Treatment is likely to work better if the cancer is found early.
As stated above, I think it is important to be informed and strike a balance. These are my general recommendations to prevent skin cancer:
- Do not allow you or your children to get sunburned, in particular blistering sunburns.
- Avoid times of very intense sunshine during the day. Seek shade during these times.
- Use hats, clothing, and sunglasses to protect against the sun's rays.
- Use sunscreen and lip balm as needed. Broad spectrum protection means protection against both UVA and UVB rays. Apply in adequate amounts and reapply as needed. Avoid sunscreens with retinol and oxybenzone. Retinol may increase the risk of skin cancer, and oxybenzone is a hormone disruptor. Read The Environmental Working Group's 2013 Guide to Safer Sunscreens for great information about which sunscreens are best.
- Avoid the use of tanning beds and UV nail dryers.
- Avoid drugs that increase sensitivity to the sun whenever possible.
- Avoid drugs that increase the risk of skin cancer whenever possible.
- Avoid exposure to arsenic and the other toxins listed above.
- Treat any chronic skin inflammation, preferably with natural therapies if possible.
- Evaluate your overall risk of skin cancer and take precautions based on that risk. For example, if you have a family history of melanoma, live at high elevation, and take a drug that increases sensitivity to the sun, you had better exert extra caution.
- Get your Vitamin D tested to make sure you have adequate levels.
- Monitor yourself as described above and discuss any questions you have with your physician.
Have a safe and wonderful summer!
May 2013 Allergies
Happy May to you! It is allergy season here in Oregon and in many other parts of the country. About fifty million Americans, young and old, experience problems with allergies. Symptoms vary and can include: runny nose or rhinitis; post-nasal drip; sneezing; itchy, watery eyes; skin reactions such as hives; gastrointestinal symptoms such as cramping and vomiting; and anaphylactic reactions. Complications can include asthma and chronic sinusitis. People can be sensitive to a variety of allergens: pollens, grasses, trees, and flowers; animal dander, including that of cats, dogs, and other critters; feathers; fabrics; molds and fungi; dust and dust mites; insects such as cockroaches; stings of bees and wasps; chemicals; cigarette smoke; metals such as nickel; medications; and foods. There are some general recommendations of natural treatments for allergies and some specific suggestions about how to reduce your exposure to specific allergens.
Let's start with reducing your exposure, the allergy burden the body must handle. Then we'll discuss treatments. I recommend that even if you have just one allergy that bothers you the most, it is wise to keep the other allergens at reasonable levels in order to reduce your overall allergy burden. Here are my recommendations:
- During pollen season, be mindful that pollen can stick to your clothes and shoes. Take these off before entering your bedroom, as this is a place where you spend a large portion of your time. Remove clothes that you have worn outside, putting them in the laundry room directly. Shower before going to bed to get the pollen off your skin and hair. Keep windows closed during pollen season, particularly if the day is windy. Because pollen settles lower to the ground at night, definitely close windows at night. Bathe pets often during pollen season, as pollen can cling to their coats. Keep floors and other surfaces clean. Wash bed linens often. Also, obviously reduce direct contact with known plants that cause you symptoms. If you have those plants in your yard, replace them with other plants. If you are allergic to grass and you have a yard full of it, consider reducing the area devoted to grass.
- Pets are great! So, try to find one that does not create allergies for you. Some breeds of dog are less "allergenic" than others. If you have a dog, bathe it often, and remove excess fur by brushing it frequently. Vacuum pet hair off floors to keep exposure to a minimum.
- If you are sensitive to feathers, clearly avoid pet birds, and do not use feather pillows or comforters. I do not generally recommend non-natural fibers such as polyester for pillows and comforters. You can get wool, bamboo, or cotton stuffed pillows. Use synthetic fibers only as a last resort.
- On the other hand, some people are sensitive to wool or other natural fibers. Clearly, just reduce your exposure to that fiber, replacing with another natural fiber whenever possible.
- Do your best to keep your home free of dust. Carpets harbor dust mites. Wood and other hard floors are easier to keep clean and free of dust mites. If you do like rugs, use natural fiber rugs such as cotton that are washable, and wash them frequently, at least every month. Use a vacuum with a HEPA filter, and do so often. Keep beds clean and free of dust by frequent washing of sheets. You can get pillow covers with zippers that are dust mite-resistant. I do not recommend anything treated with chemicals, such as anti-bacterial chemicals, as I feel this leads to more allergies in the long term. Also, keep window shades clean, and get rid of items like stuffed animals and other knick knacks that can accumulate dust. For the allergy sufferer, less is more! Consider a HEPA filter for your home.
- Keep your home free of cockroaches. Many, many children suffer greatly with allergies and asthma from infestations of cockroaches in their homes. Keep food items unavailable to these insects by keeping them in sealed glass containers. As you may know, I am not a big fan of plastic containers. Thankfully, glass containers are readily available. Keep other food in the refrigerator. Keep your home as clean as possible. Use insecticidal chemicals as a last resort.
- Reduce mold in your home by preventing the accumulation of moisture. Use fans in bathrooms and other areas where moisture collects. Clean any problem areas often. Wash bath towels often. Consider reducing foods containing members of the mold family, such as yeast.
- Allergy to the stings of bees and wasps can be very serious, even life-threatening. If you have serious allergic reactions to stings or to any other allergen, make sure your doctor is fully aware of this and has provided you with medication that you can carry with you to treat any serious acute allergic response.
- Chemical sensitivity is getting to be quite a problem, with the overload of chemicals we are all exposed to these days. If you have read my newsletters in the past, you know how strongly I feel about this. I think it is very smart to greatly reduce the synthetic chemicals typically used in personal care and home cleaning products. In particular, remove artificial fragrances from your home, as they can aggravate allergies. There are many truly natural cleaning and personal care products available that likely have less of a chance of exacerbating allergies. Also, choose building and paint products that do not contain Volatile Organic Compounds = VOC's and formaldehyde, which are both respiratory irritants. In addition, it is generally a good idea to reduce pesticides in your home and yard.
- Cigarette smoke is a problem for the person smoking and everyone around them. The horrible effects on the respiratory tract are well-documented. If you smoke, ask for the help you need to stop. If you live with someone who smokes, ask them to smoke outside to prevent the chemicals and allergens from accumulating in your home and in your respiratory tract.
- If your skin reacts to nickel-plated jewelry, only wear jewelry made of silver or gold.
- Keep track of any known allergies to medications, and make all your physicians aware of these allergies.
- Avoid foods that cause serious allergic reactions, and reduce foods that just seem to aggravate your allergies. Common food allergens are: nuts, peanuts in particular; milk; wheat; eggs; soy; shellfish; and sulfites. Eat a generally healthy diet as outlined in previous newsletters.
- If you have young children and want to reduce their risk of allergies, breast feed. Also, do not use anti-bacterial products containing triclosan. Studies show that children exposed to standard bacteria in childhood develop more normal reactions to allergens than those whose environment was overly bacteria-free. For example, children who grow up with pets in early childhood have been shown to have fewer allergies. Researchers think this is because the children are exposed to standard bacteria carried by the pets. Playing in soil, for example in a non-toxic backyard, one that has not been treated with pesticides and other chemicals, may confer the same benefit by exposing children to normal bacteria. This theory is called the Hygiene Hypothesis. Find a reasonable balance. Hand-washing with natural soaps and water is as effective as using soaps with anti-bacterial chemicals, without the risk of allergies and bacterial resistance. Also, the use of antibiotics in children appears to increase their risk of allergy. Keep this in mind when deciding whether or not to use antibiotics for acute illness. This does not mean never to use antibiotics, but just to use them only when truly necessary, taking into account the risk/benefit ratio.
- When you have taken the necessary steps to reduce your allergy burden, you can augment those steps with anti-allergy herbs and supplements. My favorites are: nettle leaf capsules, vitamin C, and bioflavonoids, in particular quercetin. Take any herbs and supplements under the supervision of a physician.
April 2013 Environmental Medicine
Happy Earth Month, everyone! April 22nd is Earth Day, but why not celebrate the whole month? The health of the planet has a direct influence on the health of humans in so many ways, yet few of us think about this on a daily basis. It is really worth understanding. So, let's begin with the basic definition of environmental medicine. It is the interaction between factors in the environment and human health. Of course, we humans impact the environment, as well, often creating the environmental factors that harm us. This is bad, of course, but at least if we cause the problems, we know we have some power to change the situation. Many topics fall within this broad subject, including toxic chemicals, plastics, climate change, etc. Since I have been promising some extra information about toxic chemicals, let's begin there.
About 80,000 chemicals are approved by the EPA, but only about 10% of those are actually tested for safety. Many chemicals remain in the environment and in human tissues long after their intended use. It is imperative that we apply what is referred to as the precautionary principle, which means if we are not sure whether a chemical is safe or not, we should take caution in its use. Makes sense, right? Yet we freely use so many chemicals, man-made compounds that did not exist in nature until about 100 years ago. They may offer us convenience or some other temporary benefit, but at what cost? Unfortunately, the cost is often discovered much later, and it is often in the form of chronic diseases such as cancer and cardiovascular disease. Let's discuss a few chemicals of particular concern.
- : This chemical is a synthetic estrogen-like compound. It is an endocrine disruptor, which means it mimics natural hormones and causes disruption to our bodies. It is widely used, and there is widespread exposure to it. It is estimated to be in the blood of at least 93% of U.S. residents. It is found in a wide variety of products such as, canned foods, canned soda, some plastic beverage containers, some aluminum water bottles, and other sources, such as some dental resins and coatings to children's teeth to prevent cavities. BPA is the chemical that was known to be in plastic baby bottles. Many companies have made baby bottles Bpa-free. Many moms are choosing to breastfeed or using glass baby botttles instead. Bpa is not just bad for babies. It is linked to obesity in adults -- yes, it can help make you fat -- and an increased risk of diabetes, breast and prostate cancer, cardiovascular disease, and infertility. Anyone who has these diseases or does not want to get these diseases should greatly reduce their exposure to Bpa. We are still learning about the myriad bad effects of this chemical. The good news is that, unlike many other toxins, apparently if you reduce exposure, blood levels drop in about 3 weeks. So, we can fix this one! Stop or greatly reduce drinking beverages out of plastic bottles or cans. Drink juice in glass bottles or aseptic cartons instead. To save money and increase health, dilute juices half with water. Secondly, reduce canned foods. Use fresh or frozen veggies and fruits, and get pasta sauce in jars instead. Use only stainless steel water bottles.
- : These chemicals are found in a wide variety of products, used primarily to make synthetic fragrance last longer and to soften and increase the flexibility of plastics. In the U.S., over 470 million pounds of phthalates are produced every year. Human exposure is widespread and pervasive. They are found in many personal care and household products, basically anything with a synthetic fragrance, such as shampoo, conditioner, bodywash, handsoap, lotion, perfume, makeup, sunscreen, laundry detergent, fabric softener, air freshener, cleaning products, etc. They are also found in polyvinyl chloride or PVC products, such as vinyl shower curtains, vinyl miniblinds, vinyl flooring, wallpaper, IV tubing, and many other plastics. Exposure is through air, soil, water, food, blood, and breastmilk. Like Bpa, phthalates are endocrine disruptors. They have been linked to obesity, diabetes, cancer, infertility, eczema, allergies, and asthma. Here the solution is a little more complicated because plastics are so prevalent in our society. One obvious remedy is to reduce the use of plastics. Don't get products in plastic; get products in glass whenever possible. The other obvious remedy is to reduce the use of products with synthetic fragrance. These are widespread but unnecessary and contribute to allergies and asthma, epidemics in our country. Use personal care and home cleaning products that are fragrance-free or only have truly natural, non-synthetic fragrance. There are many such products on the market, and if we want to be truly healthy we will choose those products.
- : This chemical is an anti-microbial compound used in anti-bacterial soap, hand sanitizer, deodorant, toothpaste, toothbrushes, mouthwash. bodywash, shaving cream, lotion, cosmetics, acne treatments, diaper cream, detergent, dishwashing liquid, fabric softener, carper shampoo, fabrics, clothing, shoes, socks, towels, sheets, pillows, blankets, duvets, mattresses, kitchenware, cutting boards, plastic food containers, toys, etc. It might be in products labeled " anti-bacterial", "fights germs", "protection against mold", "odor-fighting", or "keeps food fresher longer". If it is in the product, you will see it listed on the label. It is lipophilic, which means it accumulates in fat. One study said that 80% of Americans have triclosan in their bodies. It is an endocrine disruptor. It increases the risk of allergies. One major concern is that it contributes to microbial resistance. Use of triclosan in hand washing is unnecessary; a comprehensive analysis from the University of Michigan School of Public Health indicated that washing with plain soap and water is as effective as washing with soap with triclosan in preventing illness and removing bacteria from hands. The American Medical Association made a formal statement way back in 2000 stating that "it may be prudent to avoid the use of antimicrobial agents in consumer products."
There are many other environmental issues that are relevant, such as: other chemicals we have not discussed; pollution of air, water, and soil; pesticides used in agriculture, in the home, in gardens, in schools, in occupational exposures, in recreational exposures such as on golf courses and playing fields, etc.; heavy metals like lead, cadmium, and mercury; chlorine; fluoride; the many, many problems with plastics; and climate change. These are very serious and urgent issues facing humanity and deserve our attention and action. Our health depends on us understanding the very real risks and doing something to protect ourselves from ourselves. We can learn. We can live in a different way.
One final thought. Humans often hope to create a world in which we routinely live to be
100 years old. We hope to be healthy and happy. Thinking very broadly, in order to achieve this goal, with so many people on the planet, we must create sustainable solutions to food systems, healthcare, homes, schools, workplaces, transportation, recycling, energy, etc., systems that will allow us to thrive within the very real context of a planet of finite resources that we share with many other organisms. I would love for us to really learn to see our health from this broad perspective. If most of us made decisions about the foods and products we purchase and use in our homes, knowing that when we use these products, some goes into our bodies, some goes into the water supply, some goes into the soil, some goes into the air, affecting not only us but the wider ecosystem, we could change the world for the better.
Environmental Working Group www.ewg.org
U.S. Environmental Protection Agency www.epa.gov/oppt
National Institutes of Health www.toxtown.nlm.nih.gov
Healthcare Without Harm www.noharm.org
Our Stolen Future www.ourstoelfuture.org
Message in the Waves, a BBC Documentary about plastic pollution, on You Tube
March 2013 Colorectal Cancer
Hi, everyone! Because March is Colorectal Cancer Awareness Month, I thought I would make that the topic for this month's newsletter. First, let's talk statistics. The American Cancer Society estimates that in the United States in 2013, approximately 142,000 cases of colorectal cancer (CRC) will be diagnosed, and about 52,000 Americans will die of the disease. CRC is the third most common cancer diagnosis in men after prostate and lung cancer, and it is the third most common cancer diagnosis in women after breast and lung cancer. However, since it more deadly than breast and prostate cancer overall, it is the second leading cause of cancer death in both men and women after lung cancer. The lifetime risk of getting CRC is about 1 in 20. The five year survival rate is much higher if it is found at an earlier stage. The 5 year survival rate is 90% if it is localized, 70% if it has spread only regionally to the lymph nodes, and only about 12% if it has spread distantly or metastasized. Though the incidence of CRC has not decreased over the last 20 years, the death rate from CRC has decreased. This is thought to be largely due to increased screening. Screening guidelines for people over 50 years old without significant risk factors may include: annual fecal occult blood tests, flexible sigmoidoscopy every 5 years, and colonoscopy every 10 years. If you have risk factors, these procedures would be done earlier and more often in order to find any cancers at an early stage and/or eliminate precancerous polyps.
Colorectal cancer is mostly a disease of developed countries, with a western lifestyle. It is widely considered to be an environmental disease, which means that it is mostly due to diet and lifestyle issues. In fact, only 1 in 5 people who are diagnosed with CRC have a family history. Furthermore, cancer can "run in families" due to either genetics or shared diet and lifestyle habits or a combination of both.
Risk factors for CRC include: age; male gender; African American race; family history of CRC; personal history of a previous CRC; personal history in a woman of breast, or uterine cancer; presence of the BRCA-2 gene mutation; familial adenomatous polyposis = FAP; history of adenomatous colon polyps; inflammatory bowel disease = Crohn's disease and ulcerative colitis; smoking; moderate to heavy alcohol use; obesity and central adiposity; Type-2 diabetes and insulin resistance; chronic inflammation; a sedentary lifestyle; a diet high in processed meat, red meat, overcooked meat, eggs, animal fat, and refined carbohydrates and low in vegetables, fruits, whole grains, and possibly fiber; high total cholesterol and low HDL, the "good" cholesterol; night shift work and disrupted circadian rhythms, resulting in low melatonin; living in the northern latitudes and Vitamin D deficiency; folic acid deficiency; slow bowel transit time; a history of radiation to the abdomen; arsenic exposure; and bisphenol A exposure.
Protective factors include: regular physical activity; maintaining proper weight; a diet high in vegetables, fruits, and whole grains, in particular the green leafies and the cruciferous veggies like broccoli, high in dairy products and calcium, high in folic acid, and high in fish, mushrooms, ginger, coffee, green tea, and chocolate; adequate sunlight and Vitamin D; normal circadian rhythms; daily aspirin; high HDL cholesterol; possibly statins; estrogen; anti-inflammatory medications; and possibly Vitamin C.
What I would like you to take away from this newsletter is that the healthy lifestyle habits that protect against CRC also protect against most other cancers, as well as cardiovascular disease, diabetes, and other chronic diseases. We are absolutely not powerless to decrease the epidemic of chronic disease taking over our country. Don't worry about what you cannot control. Focus on what you can control. As you have learned, that is alot! We most definitely have the power to modify our lifestyle and change the trajectory of our personal futures as well as our country's future.
One other note.... If you can, be sure to watch the documentary just released called "A Place At The Table" which discusses food, nutrition, and poverty issues. It is a compelling film, giving us alot to consider. As always, the best of health to you!
February 2013 Women and Cardiovascular Disease
An estimated 43 million women in the United States live with some form of cardiovascular disease, which includes heart disease, peripheral artery disease, and cerebrovascular disease. Women account for more than half of the almost 1 million deaths caused by cardiovascular disease in the U.S. each year. The approximate number of deaths from cardiovascular disease in American women -- 485,000 -- is more than twice the number who die of all forms of cancer combined. So, it is a pretty serious problem. In 2010, an estimated 785,000 Americans had a new heart attack; 470,000 additional people had a recurrent heart attack. Every 25 seconds, an American dies of a heart attack, and about every minute an American dies from one. Also, approximately 795,000 strokes occur each year in the U.S., 425,000 in women and 370,000 in men, with about 144,000 deaths.
Coronary heart disease is the single largest cause of death for women in the U.S. Each year, about 435,000 American women experience a heart attack, and of these, 267,000 die. Seventy-five percent of men survive a first heart attack versus sixty-two percent of women. What factors explain these statistics? Early warning signs of a heart attack in women can be much more subtle than the classic severe chest pain with radiation down the left arm often seen in men. Women can experience the following symptoms: mild chest pain; pain in the jaw, neck, shoulder, and back; abdominal discomfort and/or indigestion-like symptoms; paleness; shortness of breath; sweating; nausea and/or vomiting; dizziness and/or lighthheadedness; rapid and/or irregular pulse; unusual fatigue; flu-like symptoms. These more mild symptoms can lead women to delay going to an Emergency Room to receive evaluation and care. In addition, studies show that women get fewer heart disease risk reduction talks from their physicians than men do!!! That is all changing. February is American Heart Month, and The American Heart Association has established a Go Red for Women Campaign and a National Wear Red Day to increase awareness about the importance of heart health for women. The good news is that evidence shows that women seem to respond better to lifestyle changes than their male counterparts. Prevention really works for women, so let's get started!!!
Prevention involves understanding all the factors that promote a certain disease as well as all the factors that protect against that disease.. For cardiovascular disease, there are many factors. Some we cannot change, but the majority of factors are under our control, giving us a tremendous amount of power to influence the direction of our health. Thankfully, most of the lifestyle changes needed to prevent cardiovascular disease also reduce the risk of cancer and other chronic conditions. Once we know what to do, it is just a matter of doing it!!!
The risk factors for heart attack and stroke include the following: increasing age; male gender; race/ethinicity; low birth weight; genetic predisposition; family history of cardiovascular disease; personal history of a heart attack or stroke; atrial fibrillation and other cardiac conditions; coronary and/or carotid artery stenosis; peripheral artery disease; abdominal aortic aneurysm; chronic kidney disease; diabetes, both Type-1 and Type-2; hypertension; obesity; physical inactivity; smoking and seconhand smoke exposure; dyslipidemia or "high cholesterol" in the form of high total cholesterol, high ratio of total cholesterol to HDL, high LDL, low HDL, high triglycerides, high lipoprotein a, high Apo-B; high uric acid; high homocysteine, a marker of low folic acid and Vitamin B12; hemochromatosis and high ferritin, a measure of iron; high levels of fibrinogen; elevated inflammation as measured by high sensitivity C-Reactive protein, which can be high in patients with any chronic inflammastory disease, including periodontal disease and autoimmune diseases such as rheumatoid arthritis and lupus, all of which are independently associated with elevated risk of cardiovascular disease; certain infections, such as Chlamydia; poor diet in the form of low fruits and veggies, high in processed foods, sodium, trans fats, saturated fats, diet soda, calories; low levels of certain nutrients including omega-3 fatty acids, folic acid, Vitamin B12, taurine, bioflavonoids such as quercetin, Vitamin C, Coenzyme Q10, and magnesium; excess calcium intake, especially in supplements; Type-A personality; excess anger; depression; marital and/or other stress; poverty; too little or too much sleep; sleep apnea and/or poor sleep; shift work, light at night, and low melatonin; exposure to electromagnetic fields; exposure to other forms of radiation; exposure to high levels of air pollution, including ozone and diesel; exposure to certain toxic chemicals, such as but not limited to mercury, cadmium, arsenic, lead, nickel, and BPA; alcohol and/or drug abuse, including cocaine, methamphetamine, and anabolic steroids; history of cancer therapy with radiation and/or anthracycline drugs or trastuzumab, which can damage the heart; some other prescription drugs, such as oral contraceptives, postmenopausal hormone replacement therapy, ibuprofen, and celecoxib; history of gestational diabetes, preeclampsia, and/or delivery of a preterm infant in women; history of early or surgical menopause in women; sickle cell disease; allergies and asthma; gout; migraine; and interestingly, the presence of a diagonal earlobe crease. Also note that, after age 65, low cholesterol confers an increased mortality risk for all diseases, including cardiovascular disease. Some studies indicate that for women the main lab values to look at to determine cardiovascular risk are the TC/HDL ratio and the high sensivity CRP; the ratio should be less than 4 and the CRP should be less than 3.
Protective factors are: eating a healthy diet, including lots of fruits and vegetables, especially tomatoes and garlic, fish, olive oil, whole grains, fiber, nuts and seeds, honey, green tea, coffee, and moderate alcohol consumption, particularly in the form of red wine, a basic Mediterannean diet; maintaining a healthy body weight; exercise; anger management; stress reduction; dog ownership; vacations; restful sleep of a moderate duration; sunlight; normal circadian rhythms; controlling hypertension, diabetes, chronic inflammation, and infection; reduction in exposure to toxins in food, in air, in water, in the home, at work, etc.; blood thinners such as low-dose aspirin; specific nutrients, such as fish oils, magnesium, zinc, chromium, iodine, Vitamin C, folic acid, Vitamin B12 and other B vitamins, Vitamin D, Vitamin E, taurine, melatonin, bioflavonoids such as quercetin, Coenzyme Q10, and other antioxidants. Red yeast rice and other statin drugs can be beneficial if dyslipidemia or high levels of inflammation are present, but my preference is to treat these conditions with natural therapies, such as hibiscus extract and/or the anti-inflammatory bromelain.
Overall, I employ a holistic perspective that suppports body, mind, and spirit, focusing on a healthy diet and lifestyle that nourishes the inherent ability of the body to heal. The general goal is to create a long and healthy life, utilizing all the tools in the box as necessary and appropriate, but relying primarily on the most basic, simplest, most cost-effective, most efficient, and most natural therapies to prevent and treat disease and to build health. I hope to provide you with the most complete information and the best solutions to empower you to create a happy, healthy life.
January 2013 A Happy and Healthy New Year!
I thought I would begin the new year with some basic tips about healthy eating, as it is on the minds of many people right now as they set their goals for the year. I imagine that patients could get annoyed when they hear from their doctors "eat a good diet" and then don't get any explanation as to what that actually means! So, here are some of my ideas about what a "good diet" is:
- Eat lots of fresh fruits and vegetables, organic whenever possible. Eat a wide variety of different colors of produce to get the broad spectrum of phytonutrients. Cook - roast or steam - vegetables lightly versus overcooking or eating them raw.
- Standard American diets tend to be carb heavy. So, make sure you eat adequate amounts of healthy proteins, which can include meats and poultry raised without antibiotics and hormones. Beef can be healthy for you when it is pasture-raised and raised without hormones. I feel it is very important to consume only poultry products which are not fed antibiotics as producers often use arsenical antibiotics in chicken and turkey which can leave slight residues in the meat. If you are going to eat smoked meats like hotdogs, sausage, bacon, and lunch meats, get only products that are free of nitrates/nitrites, which can be carcinogenic.
- Rules about no hormones or antibiotics refer to dairy products and eggs, too. Milk products - milk, butter, cottage cheese, sour cream, yogurt, half-and-half, etc. - from cows that are pasture-raised can be high in healthy omega-3 fatty acids. This is very important to understand. If you are going to consume dairy products, get organic and, if you can, pasture-raised. Eggs should be at the minimum free-range. Organic eggs mean the chickens were fed organic food, which I think is superior. Of course, people can raise their own birds and feed them organic seed and organic food scraps, or get eggs from someone local. The yolks of healthy eggs tend to be a nice deep orange color. Don't be afraid to consume moderate amounts of egg yolks from good sources. There are healthy compounds in there.
- I don't personally eat alot of soy. However, I know some people are vegetarian and do consume significant amounts of soy. I strongly suggest that if you do eat soy that it is non-genetically modified soy. Most of the soy produced in the United States is genetically modified. Organic soy cannot by law be genetically modified. So, if you are going to eat soy, particularly as a staple, make sure it says organic or non-GMO soy on the label.
- Increase certain foods that science has shown to be healthy, such as olive oil, green tea, garlic, and culinary spices like rosemary, oregano, thyme, basil, cilantro, ginger, etc. It is my preference that these be organic. Olive oil should be in glass bottles only - dark glass is better - and should be stored away from heat to prevent oxidation.
- One hint is to cook your tomato products well and combine them with olive oil. This makes the lycopene in them more nutritionally available and absorbable in the body. In fact, the carotenes, which include lycopene and the familiar betacarotene, are not absorbed without some fat, such as olive oil. So, if you want to absorb your carotenes, forget the fat-free dressings. I like to take organic pasta sauce, add lots of my favorite organic olive oil from Italy, a pound of healthy beef, maybe some mushrooms, and let it simmer for about 30 minutes. This gives it time to make that lycopene more available! It helps prevent cancer!!
- I recommend reducing exposure to the chemical Bpa = bisphenol A. I will be doing an entire newsletter on this soon, but for now just let me say that it is present in canned foods, including canned soda, and many plastic bottles. One study showed that the levels of Bpa can be reduced in just a few weeks if the sources of Bpa are eliminated. I have reduced my consumption of canned foods like soup, stewed tomatos, soda - even the natural kind, etc. I get products such as organic pasta sauce in glass. I get either frozen or fresh vegtables. I only get juices in glass bottles. I do not get bottled water in plastic bottles. I have a stainless steel water bottle and a water filter at home. This greatly reduces plastic pollution as well, as glass is easily recycled.
- Reduce processed foods, artificial flavors, artificial colors, artificial sweeteners, MSG, trans fats, smoked meats with nitrates/nitrites, high-fructose corn syrup, and preservatives. You must read the ingredient labels. It is definitely worth the effort. You will be shocked to see what is in the food items commonly consumed by most Americans! Once you eliminate the products with these chemicals in them and substitute products without the unnecessary additives, you will be much better off.
- Use microwave ovens sparingly. Never microwave in plastic or with plastic wrap. Never put hot food in plastic. Use stainless steel or ceramic cooking pans versus non-stick cookware. Use stainless steel cooking tools instead of plastic. To serve, use ceramic and glass serving ware instead of plastic. Lastly, store food in glass containers instead of plastic. I think you get my message -- less plastic!!!
- I know that sometimes cost can be an issue purchasing natural and organic foods. I suggest eating smaller portions of healthier meats and poultry and large portions of vegetables and fruits. Also, packaged foods tend to cost more than fresh food. So, if you can learn to prepare food from scratch, it will save money. In addition, we throw money in the garbage when we throw away food. So, waste as little food as possible. Lastly, you find that once you stop spending money on a bunch of foods you know are bad for you and start redirecting that money towards healthy foods, you will just feel better about taking better care of yourself. The result is typically that less of your money is spent on healthcare costs and you feel great!!
- These rules don't apply 100% of the time. Be flexible and live your life! If you follow the rules about 90% of the time, you will likely feel alot better and you will likely be preventing cancer and cardiovascular disease and creating great overall health!
- Be adventurous when it comes to healthy eating. Experiment with foods you have not tried before. Take a healthy cooking class. Read a new book about food, such as Michael Pollan's In Defense of Food. See what local food producers can offer you. Grow some of your own food. Become a real foodie! Have fun with it!
Wishing you a great start to a healthy and happy new year!
December 2012 Taking Care Of Yourself Over The Holidays
With the holiday rush, I've decided to give everyone a break from the big amount of complex information that I usually provide in my newsletter. We'll have plenty of time for that next year! Instead I want to give you a simple reminder to take good care of yourself during this time and into the new year. Have fun, but don't make yourself sick. Let yourself have some foods that you wouldn't normally have, but don't overdo it. Breathe. Take time to relax a little and enjoy the season. Consider giving gifts that are both fun and healthy, such as a gift certificate for a massage, a book about health or a nice cookbook, a subscription to a natural health or natural living or foodie or travel magazine, natural personal care products like handmade soaps or lotions or bath salts that don't contain alot of unhealthy chemicals, organic food products like chocolate or coffee or jams, or a food gift basket filled with healthier -- but still yummy, nothing too boring --foods. Of course, the gift of love is always the best gift!!! Wishing you the happiest of holidays!
November 2012 Osteoporosis: Another Important Topic For Women
Osteoporosis is a silent disease characterized by reduced bone density and abnormal bone architecture, conditions which make bones more fragile and susceptible to fracture. Approximately 10 million Americans, mostly women, have osteoporosis. About 34 million more Americans have osteopenia, the precursor to osteoporosis. About half of all women over 50 will break a bone due to osteoporosis. The hips, spine, and wrists are common sites for fractures due to osteoporosis, but other bones can break, too. Broken bones can be more than painful and inconvenient; they can be extremely serious. Twenty percent of seniors who break a hip die within one year. Osteoporosis is responsible for about 2 million fractures in the U.S. each year, costing around $19 billion annually -- yes that is billion with a b!!!.
Bone mineral density or BMD is the measurement made to determine whether or not a person has osteoporosis. The screening method is called a DXA scan, done on the hips, spine, and wrist. It is quick, simple, safe, and accurate. A baseline scan should typically be done around menopause then, depending on the results, should be repeated every few years to follow changes in bone density over time.
In women, bone density typically rises until age 30, levels off, then begins to decline after age 40. The first 5 years after menopause shows the greatest decline, then the rate of loss slows. For this reason, it is important to maintain your bone mass at high levels in your 20's and 30's so that you are at less risk of osteoporosis later in life. Studies show that teenage girls who regularly consume dark sodas are at greater risk for osteoporosis in the future.
The many risk factors associated with osteoporosis are as follows: increasing age; female gender; caucasian and asian race; menopause - natural or due to surgery or chemotherapy, particularly if premature; family history of osteoporosis; low body weight; being very short or very tall; blond hair; blue eyes; premature graying of the hair; history of broken bones or height loss; poor diet and/or nutritional deficiencies, particularly calcium and Vitamin D; inadequate sunlight; a diet low in fruits and vegetables; excess salt and sugar; excess protein; insufficient protein, particularly in the elderly; increased caffeine; excess soda containing phosphoric acid; potato chips and french fries; physical inactivity; smoking and secondhand smoke; cadmium; lead; excess alcohol; excessive weight loss; chronic inflammation; low stomach acid; high homocysteine; and excess Vitamin A intake.
There are several conditions associated with an increased risk of osteoporosis: periodontal disease, worse if with tooth loss; obesity; high cholesterol; autoimmune diseases such as rheumatoid arthritis and lupus; multiple sclerosis; Parkinson's Disease; stroke; gastrointestinal conditions such as celiac disease, Crohn's Disease, and ulcerative colitis; lactose intolerance; gall bladder disease; gastrectomy; weight loss surgery; diabetes; hyperparathyroidism; hyperthyroidism; thyroid gland removal; Cushing's Disease; chronic kidney disease; low testosterone; hypertension during pregnancy; no history of pregnancy; anovulation; late onset of or irregular periods; female athletic triad = loss of menstrual periods, an eating disorder, and excessive exercise; eating disorders such as anorexia nervosa; depression; some cancers, including breast cancer; sickle cell disease; some blood and bone marrow disorders; organ transplants; spinal cord injuries; paralysis; prolonged bed rest; scoliosis; history of chronic low back pain for more than 15 years; increased cortisol from stress.
There are also several drugs that increase the risk of osteoporosis, including: anti-depressants such as Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline); benzodiazepines such as Valium (diazepam), Ativan (lorazepam), and Librium (chlordiazepoxide); tetracycline; steroids such as cortisone and prednisone; antacids that contain aluminum; acid-blocking proton pump inhibitors such as Nexium (esomeprazole), Prevacid (lansoprazole), and Prilosec (omeprazole); some anti-seizure medications such as Dilantin (phenytoin) and phenobarbital; aromatase inhibitors such as Arimidex (anastrazole), Aromasin (exemestane), and Femara (letrozole); some cancer chemotherapy drugs; methotrexate; tacrolimus; cyclosporine; excess thyroid hormone; Depo-Provera (medoxyprogesterone); some diabetes drugs such as Actos (pioglitazone) and Avandia (rosiglitazone); Lasix (furosemide); isoniazid; heparin; lithium; barbiturates; Lupron (leuprolide) and Zoladex (goserelin).
Now for some better news....Factors that protect against osteoporosis include: a healthy diet, including lots of fruits and vegetables, in particular tomatoes, onions, and prunes; whole grains; olive oil; tea; dairy products; moderate alcohol consumption; soy; adequate protein; physical activity; estrogen; progesterone; testosterone; calcium, magnesium, potassium, zinc, manganese, boron, chromium, essential fatty acids like fish oils, carotenes like lycopene, taurine, Vitamin D, Vitamin C, Vitamin K, Vitamin E, folic acid, Vitamin B12, other B VItamins, higher weight, sufficient sunlight, weight-bearing exercise; and some prescription drugs such as hydrochlorothiazide, beta-blockers, tamoxifen, and possibly statins. Naturopathic prevention and treatment of osteoporosis focuses on reducing the risk factors listed above whenever possible and then employing exercise, stress reduction, diet, and nutritional supplementation, with medication used only if truly necessary as a last resort.
Prescription drugs for osteoporosis include:
1) bisphosphonates such as Boniva (ibandronate), Actonel (risedronate), Fosamax (alendronate), and Reclast (zoledronic acid) -- side effects can be severe and include nausea, abdominal pain, difficulty swallowing, inflamed esophagus, osteonecrosis of the jaw, femoral fractures, irregular heartbeat, visual disturbances, and possible increased risk of esophageal cancer with long-term use
2) selective estrogen receptor modulator Evista (raloxifene) -- side effects include hot flashes and blood clots
3) calcitonin nasal spray -- side effects include nasal irritation
4) parathyroid hormone analog Forteo (teriparatide)
5) hormone replacment therapy such as estrogen, progesterone, testosterone -- was previously used often for osteoporosis but is no longer the first choice due to the long-term increased risk of breast and uterine cancer as well as cardiovascular disease
In conclusion, osteoporosis is a condition that for most women is easily prevented and/or treated with natural medicine approaches -- another very important disease that women should be aware of and informed about. I'm very proud of you if you have made it to the end of this detailed newsletter! I know it is alot of information, but the more you know, the more empowered you are! Share this info with your friends and help them build their health, too!!
Christian Northrup, MD Wisdom of Menopause, Women's Bodies Women's Wisdom
Tori Hudson, ND Women's Encyclopedia of Natural Medicine
National Osteoporosis Foundation
October 2012 Breast Cancer
October is Breast Cancer Awareness Month. I thought I would share some thoughts on breast cancer that I hope will be helpful in furthering the understanding of how we can address this disease.
Firstly, let's discuss some statistics. In 2011, in the United States,it was estimated that about 290,000 women and about 2,000 men were diagnosed with breast cancer, and just under 40,000 women and 500 men died of the disease. There is a 1 in 8 risk that a woman will get breast cancer in her lifetime; for men it is 1 in 1,000. Breast cancer is the most common cancer in women and the second most common cause of cancer death in women after lung cancer. Breast cancer is the second leading cause of death in women, the first being cardiovascular disease. There are many types of breast cancer with varying degrees of aggressiveness. Only 15% of women who get breast cancer have a family history; the vast majority -85%- have no family history.
Secondly, keep in mind that detection of breast cancer, for example through mammography, though important, is different than prevention. Actual prevention of breast cancer -meaning reducing the number of women who get breast cancer in the first place-can only occur with a thorough understanding of the complex set of risk factors and protective factors associated with the disease. This information also helps those who already have a diagnosis of breast cancer because understanding the causes of any disease and whenever possible removing the causes will likely help prevent recurrence of the disease. So let's get started!
Risk factors for and factors associated with breast cancer include the following: female gender; age; race, with white women having a higher incidence, but black women having a higher mortality; a personal history of breast cancer, ovarian cancer, and endometrial cancer; a family history of breast cancer, ovarian cancer, endometrial cancer, prostate cancer, and/or certain other cancers; BRCA gene mutations; early onset of menstrual periods, before age 12; late onset of menopause, after age 55; no pregnancies or pregnancies late in life; no breast feeding; increased height; large size at birth, meaning weight, length, and head size; being the first born; use of post-menopausal hormone replacement theraoy, including estrogen, progesterone, and testosterone; use of some prescription drugs, such as some oral contraceptives, many antidepressants, some anti-pschotics, some anti- anxiety agents, some stomach acid blockers, chronic use of antibiotics, chronic use of ibuprofen, some chemotherapy drugs, fertility drugs, and exposure to a drug no longer in use called DES; hypothyroidism; excessive radiation exposure; sedentary behavior; obesity; chronic inflammation; diabetes; tobacco use and environmental tobacco exposure; alcohol use; diets high in calories, animal protein, processed meats, burned and overcooked meats and low in fruits and vegetables; nutrient deficiencies, including Vitamin D and Coenzyme Q10; northern latitudes; living in areas known as breast cancer clusters, such as Long Island, New York and Marin County, California; night shift work, exposure to light at night, and low melatonin levels; exposure to chemicals such as bisphenol A and pthalates as well as some pesticides such as atrazine and DDT, which appear to act as hormone mimicking chemicals.
Protective factors include: late onset of menstrual periods, after age 13; early onset of menopause, before age 45; early pregnancies, before age 20; multiple pregnancies; pre-eclampsia in pregnancy; removal of the ovaries before age 40; removal of breasts, also called prophylactic mastectomy; exercise; maintenance of appropriate weight; sunlight; adequate Vitamin D; use of certain drugs such as aspirin, raloxifene, and ACE inhibitors; dietary factors such as low total calories, low proportion of animal calories, increased fruits and vegetables, especially cooked broccoli, onions/garlic, tomato, legumes, whole grains, nuts, fiber, fermented dairy foods, green tea, butter, and olive oil.
So, here is what you can do to reduce your risk of getting breast cancer:
- Focus on what you can change. Don't worry too much about what you can't change. Still, inquire about your family history. If you have a strong family history, talk to your doctor about testing for the BRCA and other gene mutations.
- If you get pregnant, breast feed.
- Avoid all unnecessary prescription drugs, especially post-menopausal hormone replacement therapy. Be aware that combining alcohol with HRT increases the levels of estrogen significantly, likely multiplying the risk.
- Avoid all unnecessary radiation exposures, in particular CT scans which typically expose a patient to very high levels of radiation.
- Manage chronic inflammation, hypothyroidism, and diabetes.
- Maintain a healthy body weight and get routine exercise.
- Don't smoke or allow yourself to be exposed to secondhand smoke.
- Use alcohol only minimally or moderately; don't combine with HRT.
- Eat a healthy diet, low in total calories, animal calories, processed foods, artificial flavors/colors, preservatives, and trans fats. Reduce meat or dairy from animals raised with hormones or antibiotics. Avoid processed meats containing nitrates and nitrites. Avoid burned or overcooked meats. Eat lots of fruits and vegetables, organic whenever possible.
- Get adequate sunshine and Vitamin D.
- Reduce exposure to chemicals in general, in particular bisphenol A, phthalates,and pesticides. This applies to your diet, your home, your garden, and your workplace.
- Avoid light around you at night, as this decreases melatonin levels. If you are at high risk, don't work a night shift if you don't have to. Have healthy sleep patterns.
- Consider an 81mg aspirin per day, but consult a doctor before initiating any aspirin regimen.
- Continue to gather knowledge and stay informed about the emerging causes of breast cancer.