The Truth About 'Bio-identical' Hormone Therapy

(HealthDay News) -- They're marketed as "bio-identical" hormones or "bio-identical hormone replacement therapy," and they claim to do everything from helping menopausal women lose weight to preventing senility.

They're touted as safer and sometimes even more effective than conventional hormone-replacement therapy.

But the U.S. Food and Drug Administration warns that these claims are "unproven" and that the products are "potentially dangerous." What's more, bio-identical hormone replacement therapy -- or "BHRT" -- is a "marketing term not recognized by FDA," the agency said.

Experts also are expressing some concerns about the products.

"We don't know anything [about these products]," said Dr. Suzanne Steinbaum, director of Women and Heart Disease at Lenox Hill Hospital in New York City. "This isn't FDA-approved. It's the same thing as a hormone. What concerns me is that people believe if it's not from a drug company, it's safe."

Added Dr. James Liu, chairman of the department of obstetrics and gynecology at MacDonald Women's Hospital at Case Medical Center, University Hospitals in Cleveland: "Over-the-counter products that are not listed as drugs can make some claims, and they have to be careful about it. Usually these are considered supplements. Suffice it to say, there is science behind some of what they say and a little bit of lack-of-science in other things."

And the Endocrine Society issued this position statement back in October 2006, expressing concerns about these products: " 'Bioidentical hormones,' particularly estrogen and progesterone, have been promoted as safer and more effective alternatives to more traditional hormone therapies, often by people outside of the medical community. In fact, little or no scientific and medical evidence exists to support such claims... Additionally, many 'bioidentical hormone' formulations are not subject to FDA oversight and can be inconsistent in dose and purity."

Since the release in 2002 of a Women's Health Initiative report, hormone replacement therapy (HRT) -- used to relieve symptoms of menopause -- has generated worrisome, and sometimes conflicting, headlines. While linked to a reduced risk of colon cancer and fractures, the therapy has also been associated with an increased risk of breast cancer, stroke, blood clots and heart attack. And -- so far, at least -- there are no indications that HRT has any effect on the development of dementia.

The not-inconsiderable list of potential risks of hormone-replacement therapy has left an opening for manufacturers of "natural products" to step up with supposedly better and safer versions of hormone therapy, according to the FDA.

Marketers of bio-identical hormones often say the products are identical to hormones produced by the body, and these "all-natural" pills, creams, lotions, and gels don't carry the risks of menopausal hormone therapies approved by the FDA. Agency-approved HRT drugs are typically prescribed to treat symptoms of menopause, such as hot flashes and vaginal dryness.

But the FDA said it hasn't approved compounded "BHRT" drugs and can't assure their safety or effectiveness.

Liu said that " 'bio-identical' really means that the structure of the compound you're claiming to be identical is biologically identical. It [the term] is applied primarily to female hormones that are used in hormone therapy."

But, Liu added, "the main problem is how a woman would obtain [bio-identicals]. If it's pharmaceutical grade, FDA-grade, it's prescribed. It's just how it's made."

Some of the bio-identical hormones are "compounded," meaning they are mixed specially to meet an individual's needs. For example, some dyes or preservatives may be eliminated if a person is allergic to them, according to the FDA.

"The pharmacist assumes that responsibility and the physician should specify that on the prescription," Liu said. So the bio-identical product may not have exactly the same ingredients as a standard product, he said.

But be leery if a pharmacy claims that such compounded mixtures are safer or more effective than other hormone formulations, the FDA warned. They may not be mixed according to a licensed health-care professional's instructions, the agency said.

"Women should be cognizant that both products have similar potencies, similar biological action and similar side effects," Liu said. "There's no reason to think bio-identicals are superior. There are either anecdotal or testimonial claims that one is better than the other. We're swayed by that as human beings."

Here are some points the FDA says to keep in mind:

• Approved hormone therapies are available by prescription only.
• Bio-identicals will have the same risks as the products they're identical to -- namely a heightened risk of breast cancer and serious heart problems. There may be other, as-yet-unknown risks, as well.
• Beware of claims that bio-identical products can be made based on hormone levels measured from a woman's saliva sample. Hormone levels fluctuate constantly. Saliva tests, which are FDA-approved, aren't specific enough to determine drug dosages.
• No drug containing the hormone estriol (the weakest of the three estrogens produced by the body) has been approved by the FDA. Only prescribers who have an investigational new drug (IND) application can compound drugs with estriol.
• In general, when using approved hormone-replacement therapies, the FDA and health-care professionals recommend using the lowest dose possible for the shortest period needed.

More information
Visit the FDA for more on menopause and hormones.

Health Tip: Douching Isn't Recommended

(HealthDay News) - Douching is a method of cleansing the female genitalia with a fluid mixture, often of water.

According to the U.S. National Women's Health Information Center, douching is generally not recommended by doctors, as it can adversely affect the body's natural balance of bacteria.

The agency offers these additional potential side effects of douching:

• Irritation of the vagina.


• An infection called bacterial vaginosis.


• Increased risk of sexually transnitted disease or pelvic inflammatory disease.


• Vaginal infections that could spread to other parts of the female reproductive system.

FDA Warns Clot Risk Higher in Birth Control Patch Than Pill

(HealthDay News) -- A birth control skin patch used by many American women carries a risk of serious blood clots that is higher than the risk already recognized for the birth control pill, the U.S. Food and Drug Administration warned late Friday.

Based on the results of a new study that discovered the increased danger, the agency said it has approved changes to the labeling for the Ortho Evra Contraceptive Transdermal Patch, to better warn women and their doctors of the potential risk.

"For women that choose to use contraceptives, it is important that they thoroughly discuss with their health-care providers the risks and benefits involved," Dr. Janet Woodcock, deputy commissioner for scientific and medical programs at the FDA, said in a statement.

The warning followed reports out of Canada last week of two deaths, one heart attack and 16 cases of blood clots since 2004 among women who used the patch.

Approved by the FDA in 2001, the patch is sold by prescription and releases ethinyl estradiol (a type of estrogen), and a progestin called norelgestromin via the skin into the bloodstream. But the FDA noted that the body processes hormones delivered in this way differently than hormones delivered in pill form, so that "women using the product will be exposed to about 60 percent more estrogen than if they were using typical birth control pills."

Blood clots called venous thromboembolisms (VTEs) -- which can travel to the lungs as life-threatening pulmonary embolisms -- have long been known to be a rare but potential side effect of the birth control pill, and for the patch as well. In fact, the FDA had already revised the Ortho Evra label once in 2006, after a study found it doubled women's odds for VTE. Another study found use of the birth control patch boosted women's odds for the clots by about the same amount as did the Pill.

However, an epidemiological study just conducted by the Boston Collaborative Drug Surveillance Program, on behalf of drug maker Johnson & Johnson -- has found the patch may carry an even higher clotting risk than the Pill does. According to the FDA, that study looked at women aged 15 to 44 and "found that users of the birth control patch were at higher risk of developing serious blood clots than women using birth control pills."

The patch does have a checkered past. In November 2006, a group of 43 women sued the product's New Jersey-based maker, Ortho-McNeil Pharmaceutical Co. (a subsidiary of Johnson & Johnson), and San Francisco-based distributor McKesson Corp, alleging that they suffered blood clots and other health woes after being placed on Ortho-Evra.

"This product should not be on the market," Shawn Khorrami, an attorney for the plaintiffs, told the Associated Press at the time. "When you put out a product that gives women more hormones than they need, then you're increasing their risk of developing those ailments."

Similar worries have surfaced in Canada. But Janssen-Ortho, the patch's Canadian distributor, defended the product. "The risk of serious adverse events is small in healthy women, but increases significantly if associated with the presence of other risk factors, such as obesity or smoking," the company said in a statement.

The FDA is also stressing proper use of the Ortho Evra patch. In its statement issued Friday, the agency said it believes the product "is a safe and effective method of contraception when used according to the labeling, which recommends that women with concerns or risk factors for serious blood clots talk with their health-care provider about using Ortho Evra versus other contraceptive options."

Sidney Wolfe, director of the Washington, D.C.-based consumer advocacy group Public Citizen, told Toronto's The Globe and Mail newspaper that women "shouldn't use [the patch]. It shouldn't be used because it's a new product with no unique advantage."

One gynecologist begged to differ, however. "When you look at any estrogen-containing contraceptive product available on the market, whether it's the Pill or the Evra patch or NuvaRing, the vaginal ring, all of them slightly increase the risk of blood clot," Dr. Melissa Mirosh, former fellow of the contraceptive advice, research and education fellowship program at Queen's University in Kingston, Ontario, told the Canadian Press.

More information
There's more on reproductive health at the U.S. Centers for Disease Control and Prevention.

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Low Testosterone Might Shorten Men's Lives

(HealthDay News) -- Men aged 40 or over with low levels of testosterone may be at increased risk of fatal heart attacks or death from any cause, a British study suggests.

In fact, "The magnitude of the effect was very similar to that of [high] cholesterol or blood pressure," said lead researcher Dr. Kay-Tee Khaw, professor of clinical gerontology at the University of Cambridge School of Clinical Medicine.

However, more work is needed to see whether testosterone supplements should be recommended for men with naturally low levels of the hormone, she said.

"We need to replicate these findings," Khaw said. "We hope we can entice other investigators to look at testosterone levels and see if these findings are confirmed."

Her team published the findings in the Nov. 27 issue of Circulation.

The study included more than 11,600 men ages 40 to 79 who were free of known cardiovascular disease and cancer at the start of the trial. It was done because "there have been lots of studies suggesting that low testosterone may not be good for health," Khaw said. "So, we wanted to see if this could be demonstrated in a large population. Testosterone is hard to measure, the test can be expensive."

The men were divided into four groups based on their blood testosterone levels.

Those men in the highest quarter of testosterone readings -- with at least 19.6 nanomoles of the hormone per liter of blood -- had a 41 percent lower risk of dying over 10 years than those in the lowest quarter of testosterone readings -- less than 12.5 nanomoles of testosterone per liter of blood.

One major question is whether low testosterone is a risk factor itself or just a marker for other risk factors, said Dr. Victor Montori, associate professor of medicine at the Mayo Clinic in Rochester, Minn. He has done his own studies on testosterone replacement therapy.

"It does not mean that replacing or normalizing levels of testosterone would reverse the outcome," he said. "There are other hormones in the blood that are related to other risk factors, such as diabetes and hypertension."

In any case, a testosterone replacement regimen "would not be a walk in the park," Montori said. "It would be a major intervention."

According to Dr. Jorge Plutzky, director of the Vascular Disease Prevention Program at Brigham and Women's Hospital in Boston, the experience of women taking hormone replacement therapy (HRT) shows that hormonal regimens can have their dangers.

Beginning in the 1990s, millions of older American women took HRT, which replaced two female hormones, estrogen and progestin. Early trials had indicated that the therapy might reduce the risk of cardiovascular diseases such as heart attack and stroke in older women.

Instead, the Women's Health Initiative, a major study released in 2002, found that women taking HRT were at increased incidence of stroke, blood clots and breast cancer, noted Plutzky, who is also a spokesman for the American Cancer Society. HRT prescriptions dropped off precipitously after the study's release.

So, much more research is needed on the link between testosterone levels and mortality before doctors can recommend the regimen to men, Khaw said. Such studies might provide "insights and better understanding of disease mechanisms, such as how and why testosterone might be related to poorer health through, for example, insulin metabolism, lipid metabolism or inflammation," she said.

More information
There's more on testosterone at the U.S. National Library of Medicine.

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Simple Tips Keep the Flu at Bay

(HealthDay News) -- Between 5 percent and 20 percent of Americans will get hit by the flu bug this year, but some simple precautions can keep you from becoming one of that number, an expert said.

The flu shot is the most effective method of preventing the flu, said Dr. Robert C. Goldszer, associate chief medical officer at Brigham and Women's Hospital in Boston. It's important to get your shot early in the flu season -- October and November -- and to get a shot every year, Goldszer said. Everyone is eligible for a flu shot, and many places offer it for little or no cost.

If you do start to feel symptoms of the flu (tired, nauseous, congested, achy), get extra rest and drink plenty of fluids -- at least a quart of water every day. Proper hydration and nutrition can help lessen flu symptoms.

If you have the flu, try not to spread it to people around you. Flu viruses are spread by coughing and sneezing. Most people can spread the flu beginning one day before symptoms develop to up to five days after they become ill.

If you do have symptoms, stay home from work or school and avoid public places. Cover your mouth and nose when coughing or sneezing.

Take steps to protect yourself from getting the flu. If you use public transit or work in a crowded place, disinfect your hands regularly and avoid close contact with people who appear to have flu symptoms.

More information
The U.S. Centers for Disease Control and Prevention has more about seasonal influenza.

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New Test Criteria Spots Rheumatoid Arthritis Sooner

(HealthDay News) -- More patients with early rheumatoid arthritis could be identified and enrolled in clinical studies if the process of diagnosis included one new type of assessment and excluded two traditional assessments, according to a new study.

Researchers looked at 292 people, average age 54, seen at the Arthritis Center of Brigham and Women's Hospital in Boston. The average duration of the patients' symptoms was four years.

Their findings showed that by including anti-CCP (cyclic citrullinated peptide) testing and excluding rheumatoid nodules and radiographic changes, the number of patients correctly classified as having rheumatoid arthritis increased from 51 percent to 74 percent.

When this approach was used in patients who had rheumatoid arthritis symptoms for less than six months (when signs such as nodules and radiographic changes may not yet be apparent), the percentage of patients correctly classified as having rheumatoid arthritis increased from 25 percent to 63 percent.

The study was to be presented Saturday at the American College of Rheumatology (ACR) meeting in Boston.

"Anti-CCP testing is now widely used in clinical practice to aid in the diagnosis of rheumatoid arthritis but is not included in the current ACR criteria for the classification of rheumatoid arthritis. Additionally, rheumatoid arthritis therapies available today are able to slow or halt disease progression. It is important that new therapies are tested early in the disease course before significant damage has occurred," lead investigator Dr. Katherine P. Liao said in a prepared statement.

"The current criteria for rheumatoid arthritis diagnosis include elements that may not become apparent until later in the disease. Minor modifications in these criteria may allow us to correctly identify rheumatoid arthritis patients earlier, when intervention may be more effective," she added.

More information
The American Academy of Family Physicians has more about rheumatoid arthritis.

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No Clear Winner in Diabetes Treatment Trial

(HealthDay News) -- A study designed to tell which insulin-plus-drug regimen might best control type 2 diabetes has produced disappointing preliminary results, with none of the three strategies tested coming out on top.

"What this shows is that none of the strategies in the study can be recommended" as being superior to the other, said Dr. Graham T. McMahon, an assistant professor of medicine at Brigham and Women's Hospital in Boston, and co-author of an editorial accompanying the report, published online Friday in the New England Journal of Medicine.

Instead, he said, the insulin regimen would probably have to be tailored to each patient, McMahon said.

The report was released early, because the preliminary, one-year results of the four-year study are being presented at a meeting of the European Association for the Study of Diabetes, in Amsterdam.

The study, led by British diabetes specialists at the University of Oxford, included 708 participants with type 2 diabetes. Type 2 diabetes, which affects about 95 percent of diabetics, typically occurs in adulthood and is often tied to obesity.

All of the trial participants were given maximum doses of two diabetes drugs, metformin and sulfonylurea, and a different regimen of injected insulin three times a day, two times a day or just once a day. The once-a-day group got an extra dose if deemed necessary.

The goal was to reduce blood levels of glycolated hemoglobin, which forms when sugar enters blood cells, to 6.5 percent or less.

The results overall were not impressive: The treatment goal was achieved by just 23.9 percent of those getting insulin three times a day, 17 percent of those getting insulin twice a day and 8.1 percent of those in the once-a-day group, the researchers reported.

The greater success rate in the two- and three-times-a-day regimen had a down side, the team noted, since it was also accompanied by an increased incidence of weight gain and low blood sugar levels, the report said.

Still, the results indicated that "the best thing to be done is to follow current guidelines," McMahon said. That means "using long-acting drugs and adding insulin either once, twice or three times a day," he said, depending on each patient's particular needs.

What the new data "suggests to the doctor is that if you are serious about controlling diabetes, you should be willing to use the more complex method," added Dr. Larry Deeb, clinical professor of pediatrics at the University of Florida and immediate past president of the American Diabetes Association.

Diabetes control "is hard work for doctor and patient," Deeb said, and "family doctors have got to learn to give insulin the way we endocrinologists do." Deeb is located in Tallahassee, Fla., where the ratio of endocrinologists is 1 to 75,000 inhabitants, he noted.

Family doctors can handle type 2 diabetes, McMahon said, but it is best if they do not work alone. "An endocrinologist, nutritionist and nurse-educator should cooperate," he said.

Because type 2 diabetes is a major risk factor for heart disease, attention should be paid not only to blood sugar levels but also to other coronary risk factors, such as blood pressure and cholesterol levels, McMahon said.

What lies ahead for the British study is uncertain, McMahon said. "They are going to next look at what happens when the first steps fail," he said.

More information
For more on type 2 diabetes, consult the American Diabetes Association.

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New Heart Pump Shows Promise in Trial

(HealthDay News) -- A new kind of heart pump helped patients with heart failure so severe that their only option was a transplant, cardiologists report.

"The design is completely different from existing assist devices," said Dr. Leslie W. Miller, chief of cardiology at Washington Hospital Center, referring to the Heart Mate II that was implanted in 133 people with end-stage heart failure. "They are pulsatile, stimulating the function of the left ventricle, which injects blood into the bloodstream. This is a continuous flow device."

At six months, 75 percent of those with device were still alive, with a 12-month survival rate of 68 percent.

"The results were very positive," said Miller, lead author of a report on the trial in the Aug. 30 issue of the New England Journal of Medicine. "These patients were so sick that it was hard to get more than 75 percent survival at six months."

The device performed well mechanically, Miller said. And there was no increased incidence of blood clotting or similar problems when compared to older generations of such devices.

Data from the trial is being submitted to the U.S. Food and Drug Administration by Thoratec, the California company that plans to market the device and funded the trial. An FDA expert panel will consider whether the agency will approve the device as a bridge to heart transplants.
Another study of the device as a permanent implant for people with less severe heart failure has just been completed, and that data will also be submitted to the FDA, Miller said.

The device "looks like a flashlight," he said. "It weighs about 14 grams, and is about a fifth the size of existing devices. It is also silent in operation."

That small size "will open the door for use in more patients," said Dr. Kenneth L. Baughman, a professor of medicine and cardiology at Brigham and Women's Hospital in Boston and co-author of an accompanying editorial. "It can be used for support in women and younger adults."

The continuous flow pump "offers a different kind of support," he said. "It is smaller in size with fewer moving parts."

In fact, the device has just one moving part, the rotor that transports blood, Miller said.

The new pump does not do away with the problems that have accompanied older devices, Baughman said. "There still are problems such as thromboembolisms [clots], bleeding and infection," he said. "These are not eliminated, but they do not occur at higher levels than with current devices."

The continuous flow pump does present one difficulty -- determining blood pressure, Baughman said. Because of the way the device works, it does not provide the systolic and diastolic blood pressure reading that are a constant in heart monitoring.

"And what is not known is what happens to the body over time," when a continuous flow pump is implanted, Baughman said. "We'll just have to wait and see how it works out over time."

More information
The workings of the current generation of assist devices are described by the American Heart Association.

Antioxidant Supplements May Raise Women's Skin Cancer Risk

(HealthDay News) -- Taking antioxidant supplements won't protect against skin cancer and may actually boost the risk, at least in women, according to a new French study.

"Taking into consideration our results, we are particularly concerned by the use of long-term supplementation, notably in sun-seekers and people wanting to look tanned [using beta-carotene]," said researcher Dr. Serge Hercberg, professor of nutrition at the Medical University of Paris.

The new findings come on the heels of a study, published in mid-August in the Archives of Internal Medicine, that found that antioxidants don't prevent heart disease risk in high-risk women.

In the new French study, published in the September issue of The Journal of Nutrition, Hercberg's team looked at the effects of antioxidant doses on skin cancer. The research was conducted as part of a larger study that looked at the effects of antioxidants on cancer and ischemic heart disease.

Antioxidant nutrients are thought to reduce disease risk by cutting down on the unhealthy effects of "free radical" molecules that damage cells.

The researchers assigned almost 7,900 women and more than 5,100 men to take either an oral daily capsule of antioxidant or a placebo that looked the same. The antioxidants included 120 milligrams of vitamin C, 30 milligrams of vitamin E, 6 milligrams of beta-carotene, 100 milligrams of selenium and 20 milligrams of zinc.

"They are not high doses," Hercberg said. "They are at a level below a lot of pills you can find to buy over the counter."

The men and women were followed for about 7.5 years. In that time, 157 cases of any form of skin cancers were reported, including 25 melanomas, the most deadly form.

The team found that, in women, the incidence of all types of skin cancer combined was actually higher in the antioxidant group, and so was their incidence of melanoma.

But the incidence of non-melanoma skin cancers, when evaluated separately, did not differ between the antioxidant and placebo groups in men or women. In men, there was no difference in any form of skin cancer (including melanoma) between the two groups.

In the antioxidant group, 51 women developed skin cancer, while 30 in the placebo group did. Among the men, 43 in the placebo group and 33 in the antioxidant group got skin cancers.

As for melanoma, the incidence did not differ significantly between the men's treatment group -- 6 in the placebo group and 3 in the antioxidant group got it. But 3 women on placebo and 13 on antioxidants got melanoma -- a significant difference, the researchers said.

Antioxidant studies have yielded mixed results, Hercberg stressed. For example, in previous studies, researchers saw a higher risk of lung cancer in heavy smokers who regularly took high doses of beta-carotene.

Studies have suggested that antioxidant supplements might protect against Prostate cancer incidence in men with low blood levels of prostate specific antigen (PSA), Hercberg said. But research has also suggested that the nutrients might increase prostate cancer risk in men with a high PSA. PSA levels are a marker for pre-existing prostate cancer risk.

That could also be happening in the women who got more skin cancers after taking antioxidants, he theorized. If their skin cancer had already been developing, taking an antioxidant might not help, Hercberg speculated.

While the study is interesting, further research is needed to confirm it, said Dr. Ariel Ostad, a spokesman for the Skin Cancer Foundation and a New York City dermatologist not involved in the study.

He said the study did have one serious limitation. "It does not take into account sunscreen use," he said. If the participants tended not to use sunscreen, that could have affected the results.
Meanwhile, Ostad added, taking care in the sun is important, and "sunscreens are by far the most powerful" weapon to prevent skin cancers.

More information
To learn more about preventing skin cancer with sunscreens, visit the Skin Cancer Foundation.

Sleepless Nights May Encourage Pain

(HealthDay News) -- Poor sleep can raise risks for pain in women, a new study suggests.
"This study finds that fragmented sleep profiles, akin to individuals suffering from middle of the night insomnia, health care workers on call, and parents caring for infants, alter natural systems that regulate and control pain, and can lead to spontaneous painful symptoms," researcher Michael T. Smith, of Johns Hopkins University, said in a prepared statement.

The findings are published in the April 1 issue of the journal Sleep.

The study included 32 healthy women who were studied for seven nights. For the first two nights, the women slept undisturbed for eight hours. For the next few nights, the women were then assigned to one of three groups: a control group that continued to sleep undisturbed; a forced awakening (FA) group awakened once an hour (eight times) through the night; and a restricted sleep opportunity (RSO) group subjected to partial sleep deprivation by delaying their bedtime.

On the sixth night, the women in both the FA and RSO groups underwent 36 hours of total sleep deprivation, followed by an 11-hour recovery sleep.

During the study, researchers tested the women's pain thresholds and pain inhibition. The women in the FA group showed an increase in spontaneous pain, while those in the control and RSO groups showed no changes in spontaneous pain or pain inhibition.

"Our research shows that disrupted sleep, marked by multiple prolonged awakenings, impairs natural pain control mechanisms that are thought to play a key role in the development, maintenance, and exacerbation of chronic pain," Smith said.

More information
The National Sleep Foundation has more about sleep.

Staying Trim on Turkey Day

(HealthDay News) -- With Thanksgiving tables expected to be laden with an abundance of food, overeating and weight gain are tough to avoid during the holiday.

But Kathy McManus, director of nutrition at Brigham and Women's Hospital, offers some advice for a healthier holiday feast.

For cooks:

• Ask guests ahead of time if they have any food allergies or dietary restrictions. Include a few dishes that suit multiple diets, such as steamed vegetables flavored with herbs.
• Experiment with recipe substitutions.
• Eat a satisfying meal before you start preparing the Thanksgiving meal in order to control your munching while you cook.
• Don't serve high-fat, high-calorie appetizers, such as dips or cheeses. Instead, serve fresh vegetables and sliced fruit.
• Skin the fat off refrigerated gravy or broth before you use it.
• Limit desserts to one or two choices and provide guests with a lower-fat, lower-calorie option.
• Plan a post-Thanksgiving stroll with your family and guests.

For guests:

• Exercise and eat healthy before Thanksgiving.
• If you have a special dietary need, offer to bring a health dish to share with the hosts and other guests.
• Eat a fiber-rich snack before the Thanksgiving meal to help prevent you from eating too much or too fast. Drink plenty of water to keep your body hydrated.
• Make wise choices when you're loading your plate. Take only small amounts of foods with saturated fat and high calorie content. Divide your plate into sections: half vegetables, a quarter lean protein and a quarter starch.
• Beware of "hidden" calories in alcoholic beverages and sugary mixed drinks.
• Limit yourself to a small serving of dessert.
• Eat slowly and stop before you're full. It takes about 20 minutes before your body registers that it's full.

More information
The U.S. Centers for Disease Control and Prevention has more about doing holidays the healthy way.

Heavier Young Women at Lower Breast Cancer Risk

(HealthDay News) -- Women who are heavier in young adulthood have a lower risk of developing breast cancer before they reach menopause, new research shows.

The finding, published in the Nov. 27 issue of the Archives of Internal Medicine, confirms and expands on previous research suggesting that larger body size before menopause helps fend off breast cancer.

That's not a license for women to gain weight, however, experts stressed.

"We have to remind women that obesity is pretty much bad for everything else and, as soon as you become postmenopausal, obesity is one of the strongest predictors of breast cancer," said lead researcher Karin B. Michels, an associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and Brigham and Women's Hospital in Boston.

"It's never a good idea to be obese because of other health effects," added Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "The problem is that women who are postmenopausal, which is where the largest number of breast cancers are, have a very hard time losing weight."

Recent research has shown that postmenopausal women can cut their breast cancer risk by shedding extra pounds.

However, the situation is somewhat different for younger, premenopausal females. In this group, prior studies had shown that as body-mass index (BMI) went up, breast cancer risk declined.

Some had speculated that this was because a higher BMI is associated with irregular or long menstrual cycles and the development of polycystic ovary syndrome --- all of which are associated with problems in ovulation. Ovulatory dysfunction, in turn, decreases levels of estrogen and progesterone. Lower levels of these sex hormones -- long linked to breast cancer -- could account for a lowered risk of malignancy.

For this study, Michels and her colleagues tracked outcomes for more than 113,000 premenopausal women who were part of the Nurses' Health Study II, a group of female registered nurses who have been followed by researchers since 1989. The women were followed until 2003, or until they developed breast or other cancer, died or reached menopause, whichever came first.

Women with a current BMI of 30 or higher (considered obese) had a 19 percent lower risk of breast cancer compared with those who had BMIs of 20 to 22.4 (in the normal range).
Women whose BMI at age 18 was 27.5 or higher (considered overweight) had a 43 percent lower risk of developing breast cancer, compared with women whose 18-year-old BMI was between 20 and 22.4.

"We have indeed seen this inverse association between BMI and premenopausal breast cancer, but what's new is that the earlier we go in a woman's life, the stronger that association becomes," Michels said. "BMI earlier in her life is more important than her more immediate past."

The findings held true even after adjusting for menstrual cycle patterns and infertility as a result of ovulatory disorder (usually polycystic ovary syndrome or the use of birth control pills).
"We basically figured that ovulation was not an explanation -- which had been hypothesized before, but nobody had put it to the test," Michels said.

So, the exact explanation for the weight-breast cancer link in young women remains unclear.
"We don't really know what the explanation is," Michels said.

For now, the findings may be more pertinent to researchers than to patients.

"It doesn't necessarily have clinical implications other than to say that we want to be aware of earlier life and of the importance of earlier life," Michels said. "For researchers, it is important and interesting to better understand premenopausal breast cancer, because it is not very well understood, and it's increasing. And, I think, it's particularly tragic when young women get breast cancer."

More information
Calculate your BMI at the U.S. Centers for Disease Control and Prevention.

Anemone, Shrub Compounds Battle Rheumatoid Arthritis

(HealthDay News) -- Natural compounds from a sea anemone extract and from the rue shrub plant block autoimmune disease responses in both type 1 diabetes and rheumatoid arthritis, U.S. researchers report.

Scientists at the University of California, Irvine, conducted tests on rats and on blood samples from people with type 1 diabetes and on joint fluid from rheumatoid arthritis patients. They found that these compounds worked to deter the effects of destructive T-cells.

Both SL5 (from the sea anemone) and PAP-1 (from the rue shrub) block an ion channel in the T-cells, which prevents these cells from proliferating and producing chemicals called cytokines. These cytokines can attack healthy cells in people with autoimmune diseases.

The findings were published this week in the early online edition of the journal Proceedings of the National Academy of Sciences.

The researchers say it may be possible to use the compounds to develop new autoimmune disease treatments that target the destructive T-cells but still allow other white blood cells to fight disease and infection in the body.

"Autoimmune diseases affect millions of Americans, and any new therapies that can aid them will have great significance," researcher George Chandy of the university's School of Medicine, said in a prepared statement.

"What's promising about this study is that we identified a protein target on the T-cells that promotes autoimmune activity and the compounds that can selectively block the target and shut down the destructive cells," Chandy said.

He and his colleagues are currently conducting preclinical safety studies on PAP-1 and SL5 in collaboration with AIRMID, a San Francisco-area biotech company.

More information
The U.S. National Women's Health Information Center has more about autoimmune diseases.

Hyperthermia therapy is treatment that uses heat to change or kill cancer cells.

About hyperthermia
Hyperthermia therapy is treatment that uses heat to change or kill cancer cells. Cells are altered when they encounter higher than normal temperatures, making them more susceptible to radiation therapy and chemotherapy. Extremely high temperatures are used to kill cancer cells directly.

Physicians first began to use heat to destroy tumors in the 19th century. For years, the potential cancer-fighting power of hyperthermia was limited by the difficulty in directing heat to the targeted cells without damaging other cells in the body. However, technological advances have made it easier to focus on cancer cells.

Hyperthermia uses heat between 106 to 113 degrees Fahrenheit (41 to 45 degrees Celsius) to treat cancer by one of three main methods:

Local hyperthermia. Also known as thermal ablation, this involves using great heat – up to 113 degrees Fahrenheit (45 degrees Celsius) – to destroy a small area of cancer cells. A square or round box is placed outside the body over the tumor, and forms of energy – including radio waves, microwaves and ultrasound waves – are used to raise the temperature of the target area. The most commonly used technique is radiofrequency ablation (RFA), which uses high-energy radio waves to create the heat.

Regional hyperthermia. Involves raising the temperature of the body or part of the body to a level that is higher than normal through several methods. The heat disrupts the proteins and structures within the cells. This change may allow cancer treatments, such as radiation therapy, chemotherapy or other anticancer drugs, to work more effectively. Regional therapy is used to treat cancer in organs (such as the liver or lung), limbs or body cavities.

Whole-body hyperthermia. Patient receives the heat from warm-water blankets, inductive coils or thermal chambers (similar to large incubators). Increases the effectiveness of chemotherapy in treating cancers that are spreading (metastatic).

At this time, hyperthermia remains largely an experimental procedure. Only about 30 centers in the United States offer the therapy, according to the American Cancer Society.

However, it is being studied in clinical trials to treat some cancers including:

• Breast
• Endometrial and other Women's reproductive cancers Endometrial
• Kidney
• Liver
• Lung
• Pancreatic
• Prostate
• Soft tissues (sarcomas)
• Thyroid

In many cases, clinical trials combining hyperthermia and other cancer treatments have resulted in a significant shrinkage in tumor size. Hyperthermia appears to be particularly effective when combined with radiation therapy. This combination is adept at damaging two types of cells resistant to radiation therapy alone:

Cells in the process of making DNA for replication
Cells that are acidic and poorly oxygenated. Tumors frequently contain cells that are starved for oxygen, and these cells are particularly susceptible to hyperthermia.

The treatment allows the cancer cells to be heated to higher temperatures than nearby healthy cells. Heat also prevents cells from repairing damage caused by radiation, which helps ensure that the initial destructive effect of radiation treatments have longer-lasting effect.

Researchers Explore Psychological Link to Bowel Disorder

THURSDAY, June 1 (HealthDay News) -- As many as one in five Americans suffers from the pain, bloating and embarrassment caused by irritable bowel syndrome, one of the most common disorders diagnosed by doctors.
But little is known about the disorder. In fact, doctors have been unable to pinpoint a specific cause, or find any cure.
Increasingly, research is focusing on the effect the mind may have on gut function. Many doctors believe the link between brain and body might prove the key to effective treatment of irritable bowel syndrome (IBS).

"It's really a brain-gut disorder," said Dr. Lin Chang, an associate professor at the University of California, Los Angeles' Division of Digestive Diseases and School of Medicine. "We're gaining more information from many different aspects, but I don't think we have the whole story down yet."

Abdominal pain, bloating, cramping, constipation, and diarrhea are the main symptoms of IBS, according to the National Institutes of Health (NIH).

But specific symptoms vary from person to person. Some have constipation, while others experience diarrhea. Some find their symptoms wax and wane, subsiding for a few months and then returning, while others say their symptoms get worse as time passes.

Awareness of IBS has grown over the past decade, said Chang, who is also director of the Women's Digestive Health Center at UCLA's Digestive Diseases Research Center. "

Most people may not understand what the symptoms are, but they recognize the name."
However, IBS remains a highly embarrassing and taboo disorder. Many people are ashamed of their symptoms, and find it hard to confide even in their family physician. Up to 70 percent of people suffering from IBS are not receiving medical care for their symptoms, according to federal statistics.

"The majority of patients with IBS don't seek medical treatment," Chang said. "I wouldn't say this is an easy topic to talk about at all."

Researchers have not discovered any specific cause for IBS, but several theories have gained some traction.

Chang said it appears that IBS could be initially triggered by some sort of serious physical or psychological problem, such as a runaway infection, a major surgery, or a deep depression.
The sufferer's colon grows particularly sensitive, and reacts violently to certain foods and stress.
Once IBS has been triggered, a number of mental and physical occurrences have been associated with a worsening of symptoms, according to the NIH.

These include:

• large meals,
• certain medicines,
• particular foods, including wheat, rye, barley, chocolate, milk products or alcohol,
• caffeinated beverages such as coffee, tea or soft drinks,
• stress, conflict or emotional upsets.

Antidepressants are typically used to treat flare-ups of IBS and provide some relief to patients. Fiber supplements or laxatives for constipation, medicines to decrease diarrhea, or antispasmodics drugs to control colon muscle spasms and reduce abdominal pain also are commonly prescribed.

Interestingly, doctors have found that psychological treatments like hypnosis, relaxation training or psychotherapy provide the same amount of relief -- or even more -- than drug therapy.

"Treating the patient really requires a holistic approach where you treat both the body and the mind," said Dr. Charles Gerson, co-director of the Mind-Body Digestive Center in New York City and an associate clinical professor of gastroenterology at the Mount Sinai School of Medicine. "In the short term, therapy has proven more effective than medicine. Western medicine has forgotten how much the mind and body interact."
A vicious circle can develop with IBS when the patient's body and mind interact in a way to make the disorder grow worse, Gerson said.
For example, the gut can cause discomfort that makes the patient feel depressed or anxious. That depression or anxiety can then turn around and make the discomfort even more severe, he said.

"It just keeps going around and around," Gerson said. "You have to treat both sides of the circle to see positive benefit."

Research has shown that IBS is affected by the immune system, which is affected by stress. Because of that, stress management is an important part of IBS treatment. Patients are urged to deal with stress through counseling, regular exercise and a healthy amount of sleep.

On the physical side, careful eating has been shown to reduce IBS symptoms.
With advice from a doctor or dietitian, IBS patients have been able to reduce their discomfort by removing problem foods from their diet such as dairy products, or by increasing their fiber intake.

Eating smaller meals more often, or eating smaller portions, has also been found to help IBS symptoms in some people. Another effective habit involves eating meals that are low in fat and high in carbohydrates, such as pasta, rice, whole-grain breads and cereals.

More information
To learn more, visit the National Library of Medicine.

Women's health issues - very important link!

Female imbalances: The fight with ongoing progesterone, estrogen, liver, pms, swollen breast and other monthly issues.
I am very excited because i found an incredible link.

I am once again retaining water and even though I’ve done 16 liver flushes feel the onset of pms! but the good news is I’m narrowing down my problem...it seems like a hormonal imbalance! Too much estrogen! this also playes a factor in my low thyroid symptoms, cold extremities, sluggishness, dry skin, etc.

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