Exercise May Reduce Risk of Endometrial Cancer

Dr. Bev Blessing FNP, PHD

I ran across a study this morning on the impact of exercise on endometrial cancer.  Endometrial cancer is the most common gynecological cancer we see. The good news is the prognosis is often very good for patients with this type of cancer. The study shows that those who exercised for a total of 150 minutes per week (about 22 minutes per day) had a 34% reduced risk of this cancer, regardless of their weight.  
In addition, they also said that a body mass index (BMI) of less than 25 moved it even more to a 73% lowered risk. Other studies on endometrial cancer show that 1) Vitamin D is important, 2) we need to minimize alcohol intake, and 3) the drug Metformin may provide protection against it.  

Just so you are aware, we look for endometrial cancer in women with heavy irregular menses, especially after 40, in women with post-menopausal bleeding, and in women whose endometrial lining on ultrasound is greater than 5.5mm. The take away from the article: Let’s get exercising, and if you have any of the symptoms shown above, contact our office for further evaluation. 


See the article here: http://www.sciencedaily.com/releases/2010/11/101109133139.htm

www.fleurhealth.com

Eating Fish Benefits Mother and Baby During Pregnancy

      

Dr. Enrique Jacome MD

One reason that fish is such an important food for pregnant women is that it is the primary dietary source for omega-3 fatty acids, including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Humans cannot make these nutrients; they need to consume them. The developing fetus and breastfeeding infant are entirely dependent upon the mother's omega-3 intake.

Eating fish 2 to 3 times per week helps mothers meet their need for DHA and EPA intake, while providing other vital nutrients such as vitamins B and D, iron, and selenium. Fatty fish typically are higher in DHA content. The role of omega-3 fatty acids in neurologic development is likely why eating fish during pregnancy is linked to improved brain development, including cognition, vision, social/behavioral skills, language/communication skills, and motor skills in babies. Animal model data suggest that with insufficient DHA during brain development, neuron growth and synaptic development are diminished.

The Lancet published results from the Avon Longitudinal Study of Parents and Children (ALSPAC) in 2007. This study followed 5,449 babies born in Bristol, England, for 8 years. Researchers observed that mothers who ate fish while pregnant had smarter children than those who did not. The study went on to say that limiting fish may be detrimental to a child's brain development. These findings have led the United Kingdom to reevaluate its current fish intake limits for pregnant women.

The American Journal of Clinical Nutrition published a separate study in March 2008 with similar results. This study was designed to determine whether low omega-3 DHA levels among some pregnant women can result in poor infant development. Researchers concluded that if wo-men eat too little food containing omega-3 DHA, it may negatively affect their infants' development, including their eyesight.

Fish also is good for mothers. It has been associated with reduced preterm labor and perinatal depression. In a Norwegian study, prematurity rates among women were compared against high and low fish intake. It was noted that eating fish twice or more a week was associated with a lower risk of preterm birth. Additionally, omega-3 DHA has been shown to help prevent peripartum depression. Pregnant mothers in the ALSPAC study who ate no seafood were nearly 50% more likely to have depression symptoms than those who ate seafood at least 3 times per week.

Eating whole foods such as fish makes it easier for women to maintain a balanced diet. Plant sources of omega-3 (eg, walnuts, canola oil, and flaxseed) contain a-linolenic acid (ALA), a short-chain omega-3 fatty acid. Most women's bodies inefficiently convert ALA to DHA, and for some there is no conversion at all.

Despite fish's clear benefits, most women eat too little of it. On average, according to one national (but nonrepresentative) survey, pregnant women eat less than 2 oz of fish per week, while nonpregnant women eat less than 3 oz per week. This is partly because of confusion about mercury resulting from media coverage of the FDA/EPA guidance and because physicians reinforce these concerns.

Instead, prenatal DHA supplements or DHA-fortified food sources such as eggs and infant formula have been commercially endorsed. Although this approach is popular with some patients and their physicians, it ignores the complex nutritional benefits of eating the whole food.

In conclusion, women should try to eat fish regularly, especially fish types higher in DHA such as salmon, trout, herring, sardines, and Atlantic mackerel. Up to 6 oz of albacore tuna is great, but they should avoid shark, king mackerel, tilefish, and swordfish, as well as raw fish such as sushi or ceviche. It is also wise to check local advisories regarding self-caught fish in lakes and streams and to consume only fish that has been fully cooked.  If a women is unable to eat 2 to 3 servings of fish per week, she should take an omega-3 DHA supplement as a secondary alternative; however, whole fish consumption is preferred to supplementation because the best evidence for beneficial impact comes from studies that involve whole food consumption with its complete nutritional content.

For more information and related science, visit the Perinatal Nutrition Working Group, a program of the National Healthy Mothers, Healthy Babies Coalition, at http://www.hmhb.org/pnwg/.

www.fleurhealth.com

The Effect of Apples on Lipid Levels

Dr. Bev Blessing CNP, PHD

I love apples. They are one of my favorite fruits and I eat them routinely. So I was excited today when the news reported that apples lower LDL levels in women. MSN reported that Florida State University studied the effect of apple ingestion daily over a period of six months in a group of women between the ages of 45-65. What they found was that after six months this group had a 23 percent decrease in bad LDL cholesterol.  This is a significant finding.  We know that physiologic changes occur in women at the time of menopause that cause their LDLs to rise and the HDLs to decrease.  It is thought that leads to an increase the amount of inflammation and plaque in the vessels, limiting flow and ultimately completely blocking off the vessel in some women. The result: A heart attack. This is clearly a simplified version of the process but this change in the LDL is one of the factors that make the menopausal woman more susceptible for heart disease after menopause.  Since menopause is essentially inevitable for women, anything we as women can do to mitigate any detrimental effects will be helpful. That is why the apple study is significant.

The researchers used dried apples- about 1/3 cup daily. That is roughly equivalent to a medium sized apple daily.  They compared the group eating the apples with women who ate a different dried fruit.  They did not see the same changes in the other group. They also did not study fresh apples, but the researchers felt the finding would be the same.  The group did increase their calories slightly in eating the dried apples, but overall noted a slight decrease in weight.  The researchers speculated that the weight loss could also be a factor in the results.  Overall, they are unsure the exact mechanism of the decrease, but they also noted a decrease in C reactive protein in this group, which is an indicator of inflammation in the cells.


What is truly interesting to note is the effect of the apples on the lipid levels, which is similar to the effect that estrogen has on those levels.  Remember, estrogen has been shown to have some great preventive qualities when it comes to lipids, especially in the earlier phases of menopause.  Bottomline: When looking at some of the cardiovascular effects of estrogen and other lipid-lowering therapies in postmenopausal women, most researchers are giving the nod to a combination of strategies to include diet (apples of course), exercise, weight control, and hormone therapy as some of our strongest defenses in prevention and treatment.


If you would like to look at some of the studies they can be found at:
http://www.msnbc.msn.com/id/42555503/ns/health-womens_health/
http://circ.ahajournals.org/cgi/content/full/93/10/1928
www.fleurhealth.com

Dr. Jacome, A Medical Student's Perspective

Sana Khan, Medical Student

Recently I was privileged with an intriguing opportunity that few medical students acquire during their training years. I was thrilled to complete an Ob/Gyn rotation with one of the regions top robotic surgeons - Dr. Enrique Jacome. This was no ordinary experience; it was an educational experience for the mind, body and soul. From the moment he would greet the patient, it was so gratifying to observe how he pleasantly evolved the conversation and tailored it to every patient’s individual needs. No patient left without a thorough understanding about their diagnosis or their upcoming surgical procedure. He is one of the most dedicated physicians I have ever encountered. The dedication doesn’t end at providing medical care with excellence; He commits his valuable time to countless public projects and research to promote healthy lifestyles.

      In the surgical suite, Dr. Jacome works with elegance and precision. His control over the Da Vinci is flawless and I truly believe he has maximized this robot’s surgical potential. Not all robotic surgeons will present like Dr. Jacome, he bears a burning passion for the device, and he respects its capability. It is so motivating and refreshing to see a well established physician still arrive at work every morning with such a great attitude and sustained patience into the late evening hours. He is a gift to this beautiful Southern California community! I truly hope that in my career as a physician I can emulate his outstanding qualities, provide my own patients with such compassion and excellent medical care! 

Sincerely,

Sana Khan                                                   

4^th year Medical Student                                            

www.fleurhealth.com

Do I Need To Take Supplemental Calcium To Treat Or Prevent Osteoporosis?

Dr. John D. Carr M.D.

The question of whether to take supplemental calcium to treat or prevent osteoporosis is discussed often in the media and in my practice. The current dogma is that since bone contains alot of calcium, if you lose bone (osteopenia or osteoporosis), then supplementing with calcium will correct the problem.

The truth is that bone loss does NOT represent a calcium deficiency. The only reason to take extra of anything is if the body is deficient in the substance. The reason that most women ( and a growing number of men) lose bone is primarily because they lose the hormones necessary to grow bone, especially testosterone.

Testosterone is the most important bone building hormone in the human body. The primary reason that bone loss occurs in peri-menopause and beyond is not that women suddenly stopped ingesting enough calcium. It is that the production of the bone building ovarian hormones (i.e. testosterone, estradiol and progesterone) diminishes significantly during this time period, causing the rate of bone loss (osteoclastic activity) to exceed the rate of bone building (osteoblastic activity).

In addition to the loss of hormones, with advancing age there is usually a decrease in physical activity necessary to build bone. Despite the current recommendations, walking is just not enough. Bone, like muscle, grows in response to resistance training (weight training). Walking, though better than sitting on the couch, is not a sufficient enough stress on the bone to cause the osteoblasts to lay down new bone.

Adequate vitamin D is necessary for absorption of dietary calcium from the gut and in the formation of bone. Vitamin D is the most common deficiency I see in my practice. How much vitamin D should you take? Nobody can answer that without testing blood. I have seen patients on the golf course all day in sunny Southern California still significantly deficient in vitamin D ( we lose the ability to convert sunlight to vitamin D with age). One patient in particular golfed 6 days per week, was taking 21,000 units of vitamin D daily, and his blood tests showed he was still deficient!

Remember that taking supplemental calcium is not without risks. Many of you will remember the media hype about a medical report last summer suggesting that calcium supplementation may increase the risk of heart attacks. The report was from the British Medical Journal which reported on a survey of fifteen trials in which participants (all over age 40) were given at least 500 mg of elemental calcium per day. The researchers concluded that calcium supplements increase the risk of myocardial infarction by about 30% over five years.
(http://www.foxnews.com/health/2010/07/30/calcium-supplements)
I have read the full study and although there are some flaws in the study design, my belief is that the authors conclusion in theory is correct.

Remember that calcium is part of plaque, the hard material that builds up in the lining of our blood vessels. You may have heard of a test called a Coronary Calcium Score, which is a CAT scan test that detects the amount of plaque in the blood vessel walls. Where there is calcium, there is plaque. If there is too much calcium in the blood, it can stick to blood vessel walls.

Many patients do not understand that the calcium level detected in blood tests is NOT a reflection of the amount of calcium in the bone.
There is a very narrow range of calcium that the body needs in order to be healthy (approximately 8.5 to 10.2 depending on the lab). Ingesting a few thousand milligrams of calcium in a pill is too much to be taken up by the bones rapidly enough. The excess calcium will stick to tissues, including the lining of blood vessels, and contribute to plaque formation.

So how much extra calcium should one take? That is like asking what size shoe should one wear-it depends completely on the individual. In the active person with good vitamin D and hormone levels (as tested and followed with blood tests), the answer is none. You didn't need calcium supplementation in your 20's because you had optimal levels of bone building hormones, were likely more physically active, and still youthful enough to convert sunlight to vitamin D. Age should not be an excuse for not having everything necessary to build bone. As far as using drugs for bone loss, I never prescribe them. You don't develop a Fosamax deficiency, so why take drugs that have nothing to do with the normal, healthy bone buidling process, and can have serious side effects. www.fleurhealth.com

Opportunities Versus Obstacles -- Remember to Jump

Dr. Bev  Blessing CNP, PHD

Sometimes we need a fresh coat of paint. We have discussed ways to look with fresh eyes, the idea of entrepreneurship, and a beginning discussion on how to freshen up who we are. The result is that we begin opening the doors for new possibilities and new adventures. 

I believe we should be adventure-preneurs in our lives. As a result I have been getting out there looking for the small adventures. I have taken vacations that last only a few hours (ok, in truth, we just got lost!) I have changed my diet to add a few new foods and spices, and am working on taking in a healthier balance of foods. (That could explain why my husband is eating out on the way home!)  Recently I had a meeting with our local congresswoman. When I left that meeting, I felt energized with the idea of really getting more involved with the issues of our country. You know, really being a part of the solution to turning our economy around. This morning I woke up in a great mood, ready to take on the challenges of the world. But then it happened! I read the paper, looked on the internet, listened to the news, and in the process, dampened my desire to make any effort. It just seems so overwhelming. Have you ever felt that way? If you stay in touch with the news, you see concepts such as a loss of business optimism, more bank failures, rising unemployment, and a change in consumer outlook, further worsening over the last six months. Why would anyone want to try something new at a time like this? There are too many forces against us. Too many obstacles! Right in the middle of this impending funk, a close friend of mine called and said, you know I see this too, but did you ever think that “obstacles were purposely put in our pathways so we always remember how to jump?” What?? Is that right?

A quick online review of our recent history shows that some companies believe that a downturned economy is the perfect time to launch new ideas and take on new ventures. For example, Hyatt Corp, Burger King, IHOP Corp, FedEx Corp, Microsoft, CNN, MTV Networks, Trader Joe's, Wikipedia Foundation, Sports Illustrated, GE (General Electric Co) and Hewlett Packard all launched during tough economic times. It turned out pretty well for them. But I could also list another group of names of people who started business during those times but you wouldn’t recognize their names. Why, because they didn’t make it. What made the difference? Why did some people succeed and others fail? Was it the brilliance of the idea, the fit with the need, or was it the spirit and passion of the company’s leaders? I think probably all of these are important. When I looked on the internet to find out the real answer to the question, I found there were 5,850,000 results or opinions. Wow, that is a lot of opinions! Maybe there is no real concise answer. Many people think the major determinants lie in the attitudes of the individuals. Did they look at the challenges to starting the company as obstacles or opportunities? 

Does that mean we should all have that PollyAnna attitude that “everything will always turn out fine” and just jump in? Is it the “don’t worry, be happy” carefree person who makes the successful entrepreneur? I don’t think so. I ran across an interesting 2010 study by Liang and Dunn that looked at entrepreneurs to find out if they were unrealistically optimistic, and oblivious to other input. Did they ignore other factors and always forge ahead? The results were interesting. The authors found that although most entrepreneurs were clearly optimistic, the more successful ones did use other information to keep them more balanced, and protect them from making risky decisions by being too idealistically skewed. Balance seems like the operative word here.

Matt Ridley in his book The Rational Optimist, puts it slightly differently as he explores the cycles of human history. He states “the human race has become a collective problem-solving machine which solves problems by changing its ways”. Hmm. Maybe it is addressing and finding the solutions to the problems that makes us really good humans. Now what? History shows us that we are at our best when we identify the problems, create solutions, and change to incorporate them. When we refuse to do that we are frozen in time, stuck and we feel powerless. While I was doing all this research, I also saw the tremendous amount of study done on the physical health of the individual that is optimistic, with a problem solving attitude versus the person who has a pessimistic, obstacle searching attitude. Those with positive attitudes live longer, have less medical problems, and have less cognitive decline. That means that we are meant to see the challenges as opportunities to solve problems. It keeps us healthier and functioning at our peak for longer periods. So next time when you feel overwhelmed, and see the challenges as more than you can deal with, remember it is probably time to JUMP! http://www.fleurhealth.com

What Causes Lack Of Sleep In Women?

Dr. Enrique Jacome MD

I was speaking with one of my friends this morning, and she was talking about how poorly she slept the night before.  I thought it is interesting that she is mentioned this because in Washington this week they are discussing Sleep Health and Safety. I was not surprised to see women have twice the incidence of problems with sleep as men have! They are also significantly affected at times of hormonal changes such as menstrual cycles, pregnancy, and menopause.  Caffeine and alcohol both decrease sleep quality, as well as many diseases. For women, lack of sleep quality may mean the hormone imbalances need to be more fully addressed.  If it is recurrent, you may want to talk to your medical provider about it.  In the meantime, here are a few things you can do:                                     (from National Sleep Foundation, Tips for Sleeping Smart)

• Establish a regular bed and wake time 
• Avoid nicotine altogether and avoid caffeine close to bedtime 
• Avoid alcohol 
• Exercise regularly (but complete the workout at least 3 hours before bedtime) 
• Establish a consistent relaxing “wind-down” bedtime routine 
• Create a sleep-conducive environment that is dark, quiet and comfortable 
• Discuss the appropriate way to take any sleep aid with a healthcare professional