Spices Could Help Fight Breast Cancer

According to new research published in the November online edition of Breast Cancer Research and Treatment, popular spices, such as, pepper and turmeric, contain compounds which could help in treating breast cancer by limiting the growth of stem cells.

Turmeric and pepper have been widely explored as potential cancer treatments, however, this is the first study that suggests the two spices could also prevent cancer by targeting stem cells. Currently cancer treatments, such as chemotherapy, are unable to eliminate cancer stem cells.

Researchers from the University of Michigan Comprehensive Cancer Centre studied curcumin (found in turmeric, an Indian spice) and piperine (a black peppercorn derivative) when administered to cell cultures reduced the number of stem cells without affecting normal cells. Both spices were used in a very high concentration - about 20-times the potency of that which would be consumed in a normal diet. More research on the role of these compounds in breast cancer treatment is needed before adding extra curcumin or piperine to our diets.

Curcumin has other well known health benefits in traditional Asian medicine for treatment of gastrointestinal disorders and arthritis. Piperine has anti-inflammatory properties and is used to improve digestion, weight loss and improves absorption of nutrients from the diet.

Reference: PubMed

Targeting breast stem cells with the cancer preventive compounds curcumin and piperine.
Kakarala M, Brenner DE, Korkaya H, Cheng C, Tazi K, Ginestier C, Liu S, Dontu G, Wicha MS.
Division of Hematology/Oncology, Department of Internal Medicine and Comprehensive Cancer Center, University of Michigan, 2150 Cancer Center, 1500 E. Medical Center Dr., Ann Arbor, MI, USA, mkakaral@umich.edu.

6 Tips for Endometriosis

From: Dr. Weil's Newsletter

Posted 12/21/09

Endometriosis, a condition where tissue resembling the lining of the uterus is found in the abdomen, is marked by severe pain, most often in the form of menstrual cramps. Its exact cause is not yet known, but it does have a strong inflammatory component and, like the lining in the uterus, is influenced by estrogen. (Endometriosis may result in powder-burn spots, ovarian cysts and pelvic scar tissue otherwise known as adhesions. At times, it can be significant enough to scar the fallopian tubes closed.) A number of dietary measures can help relieve symptoms by reducing inflammation and addressing the activity of estrogen in your system.

Start managing endometriosis nutritionally with an anti-inflammatory diet and try the following dietary changes:

1. Eliminate dairy foods (allow at least three weeks to observe any improvements).
2. Eat only hormone-free meat to avoid any additional estrogen exposure.
3. Emphasize whole soy foods in your diet. Tofu, tempeh and soymilk are rich in plant estrogens and seem to modulate the actions of other forms of estrogen.
4. Limit alcohol intake, which may influence estrogen production.
5. Choose organic foods whenever possible.
6. Drink a cup or two of red raspberry leaf tea daily to help relieve cramps.

Graphic interpretation

Endometriose = endometriosis

Schokolade-Zyste = chocolate cyst (endometrioma cyst of the ovary)

Myom = uterine fibroid

Adhasion = adhesion

Hysterosalpingogramm = hysterosalpingogram (dye-infusion test to asses for tubal patency and uterine anatomy.)

ConsumerLab Issues Statement on Probiotic Quality

Studies have shown that probiotic supplements have been found beneficial for treatment of vaginal yeast infections, irritable bowel syndrome, diarrhea caused by viral illnesses or antibiotic therapy, upper respiratory viral infections, facial acne and even high blood pressure. Probiotics are otherwise known as the “friendly” bacteria of the bowel. They can be purchased in yogurts, powders, miso, beverages or capsules.

However beneficial, not all probiotics are equal. According to a recent ConsumerLab report many brands don’t contain the bacteria cited on their label. The products may contain as little as 7 to 58 percent of the amount of viable organisms mentioned on the label. “It’s really shocking how many products really don’t have what they claim on their labels,” says Tod Copperman, the president of ConsumerLab.

What’s more, the amount of living cells (the bacteria must be alive to be effective) varied widely amongst the different probiotic products ranging from less than one hundred million to over 10 billion cells per dose. Because probiotic are not standardized, Mary Ellen Sanders, a probiotics exepert unaffiliated with ConsumerLab, states that, “The best products on the market are the ones that have been tested in human studies and have been shown to have a benefit.”

According to ConsumerLab, the highest quality probiotics they tested included Advocare Probiotic Restore, GNC Nature Brand Best Super Acidophilus and Jarrow Formulas Jarro-Dophilus.

The products with the lowest bacterial content were Nature’s Secret Ultimate Probiotics (13% viable bacteria), Swiss Natural Sources “5” Strain Dophilus (13% viable bacteria) and Dr. D Chocolate-Flavored (Pediatric) Probiotics (7% viable bacteria).

For the full ConsumerLab report, click here.

Anti-Inflammatory Diet

Q: I was just wondering if you knew of any cook books or websites specifically aimed toward correct vegetarian diets? I am trying to avoid processed foods as much as possible as well as all meats, but due to the fact that I am so picky and don't eat a wide variety of foods, I'm concerned about getting and maintaining my correct nutrition levels.

A: Thanks for the question! I think your new nutritional efforts are great! Here is the best way I know to eat healthy and add to a very healthy lifestyle: The Anti-inflammatory Diet.

A very helpful link is noted below. It is quite technical talking about ratios of different food categories to provide a nutritionally balanced diet. The basic tenets: Eat two servings of fresh or frozen vegetables and/or fruit for each meal. Try to eat more vegetables than fruit and of varying colors. Eat low-fat protein with each meal. Cook foods and eat bread with extra-virgin olive oil or canola oil. Try to eat at least 2 servings of fish per week; if not, take a fish-oil supplement or a plant-based (algae) omega-3-fatty acid supplement.

Here is the helpful link:
http://www.drweil.com/drw/u/ART02012/anti-inflammatory-diet

Hope that helps!

Processed and Fatty Foods Linked to Depression

Published on Yahoo! News: Mon Nov 2, 10:41 am ET

LONDON (AFP) – A diet heavy in processed and fatty foods increases the risk of depression, according to British research published on Monday.

Researchers at University College London also found that a diet including plenty of fresh vegetables, fruit and fish could help prevent the onset of depression.

They compared participants -- all civil servants -- who ate a diet largely based on "whole" foods with a second group who mainly ate fried food, processed meat, high-fat dairy products and sweetened desserts.

Taking into account other indicators of a healthy lifestyle such as not smoking and taking physical exercise, those who ate the whole foods had a 26 percent lower risk of depression than those who ate mainly processed foods.

People with a diet heavy in processed food had a 58 percent higher risk of depression.

The researchers put forward several explanations for the findings, which are published in the British Journal of Psychiatry.

Firstly, the high level of antioxidants in fruits and vegetables could have a protective effect, as previous studies have shown higher antioxidant levels to be associated with a lower risk of depression.

Secondly, eating lots of fish may protect against depression because it contains high levels of the sort of polyunsaturated fatty acids which stimulate brain activity.

And they said it was possible that a "whole food" diet protects against depression because of the combined effect of consuming nutrients from lots of different types of food, rather than the effect of one single nutrient.

The researchers concluded: "Our research suggests that healthy eating policies will generate additional benefits to health and well-being, and that improving people's diet should be considered as a potential target for preventing depressive disorders."

The study was carried out on 3,486 people with an average age of 55, who worked for the civil service in London.

Each participant completed a questionnaire about their eating habits, and a self-assessment for depression.

Hormones: Estrogen and Progesterone

Women and men have primarily three sex hormones: estrogen, progesterone and testosterone. Levels and ratios of these hormones differ between the sexes. Estrogen and progesterone are the dominant sex hormones in women whereas, testosterone is the predominant sex hormone in men. Understanding the interaction of estrogen, progesterone and testosterone is necessary to decipher symptoms and conditions caused by their imbalances.

"Estrogen" comes in three variations in the female body: Estrone (E1), Estradiol (E2), Estriol (E3). It is made in the ovaries, adrenal glands and fat cells. The scientific community often refers to all three forms collectively as "estrogen". However, each molecule has different actions and is present in different concentrations throughout a woman's life. Therefore, it is important to differentiate the three when referring to the "estrogen effects".

Estrone (E1) is the predominant form of estrogen in the postmenopausal period. It is manufactured in the fat cells primarily from androstenedione (a testosterone derivative). An increase in estrone correlates to increased body fat in the menopausal woman. Elevated estrone levels have been associated with increased incidence of breast tumors in animals.

Estradiol (E2) is the most active form of estrogen and is the predominant form of estrogen in women of reproductive age. Estradiol is made primarily by the ovaries and adrenals but is also made in small amounts by fat cells in the postmenopausal period.

Estriol (E3) is the weakest of the estrogens. It is primarily manufactured by the placenta during pregnancy. Estriol supplementation mainly affects the vaginal wall with little effect on the heart and bones. It also plays a role in hair, nail and skin health.

The scientific community often refers to all three forms (estrone, estradiol and estriol) collectively as "estrogen". However, each molecule has different actions. During the aging process, the ovaries cease to manufacture estradiol. The adrenal glands (small organs that sit onthe top surface of the kidneys) take over estrogen production in the form of estrone. The body transforms unused testosterone into primarily estrone and releases estrogen previously stored in fat cells.

Progesterone antagonizes the effects of estrogen, most importantly in the breast and uterus where it counteracts the stimulation of cell growth where overgrowth could lead to cancer. Progesterone is manufactured primarily by the corpus luteum on the ovary after monthly ovulation occurs and to a small degree by the adrenals. Progesterone is also manufactured by the placenta in great quantity during pregnancy. Progesterone is a precursor to most hormones making it extremely important far beyond the role it plays in the production of sex hormones.

For many reasons it is very important to maintain a healthy balance between these two sex hormones. Progesterone production diminishes significantly after menopause. Obese women who manufacture a significant amount of estrone in fat cells after menopause may not produce an adequate amount of progesterone, thereby increasing the likelihood of estrogen-related cancer, such as those of the uterus and breast.

More hormone discussion to follow...

Reference:
Schwartz ET, Holtorf K. Hormones in wellness and disease prevention: common practices, current state of the evidence, and questions of the future. Primary Care: Clinics in Office Practice 2008; 15(4)

Photomicrograph of estradiol crystals. Estradiol, the most potent of the natural estrogens, is used in its natural or semisynthetic form to treat menopausal symptoms.

Please Read New Post on MaternaCare 101

Home Birth Gone Awry.

15 Ways to Boost Your Memory in Your 30s, 40s, 50s, and Beyond - Healthy Living - Health.com

15 Ways to Boost Your Memory in Your 30s, 40s, 50s, and Beyond - Healthy Living - Health.com

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Lifestyle Changes Decrease Breast Cancer

The American Institute for Cancer Research/World Cancer Research Fund estimate that 40% of all breast cancers - over 70,000 breast cancer cases in the United States every year - could be avoided with simple lifestyle changes.

The update to the 2007 recommendations stem from review of 81 additional studies. The new AICR recommendations of lifestyle changes to decrease a woman's risk of breast cancer include:

1. Because of the link between excess body fat and cancer aiming to be as lean as possible without becoming underweight.
2. Physical activity for at least 30 minutes every day
3. If you drink alcohol at all, limit consumption to one drink per day.
4. Mothers should breastfeed exclusively for up to six months and then add other liquids and foods. Evidence is convincing that mothers who breastfeed reduce their risk for breast cancer. There is also probable evidence that children who are breastfed have a lower risk of gaining excess weight as they grow.

"This study represents the clearest picture we have ever had on how lifestyle affect's a woman's risk of breast cancer," declared Professor Martin Weisman, MD, Medical and Scientific advisor to the AICR and WCRF.

The AICR/WCRF report, Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective, was launched in November 2007 and is the most comprehensive report ever published on the link between cancer and lifestyle. For more information, visit http://www.dietandcancerreport.org/.

Bioidentical Hormones

Hormone therapy is a frequent topic of discussion with my patients. The media coverage of bioidentical hormones including Oprah, Suzanne Somers and Dr. Christiane Northrup have empowered women to seek a better quality of life and relief from menopausal symptoms such as hot flashes, night sweats, impaired sleep, vaginal dryness, decreased libido, painful intercourse, loss of memory and weight gain. This has caused quite a stir in the medical community. Why? Because women are asking questions they’ve not asked before – especially about bioidentical hormones.

What are bioidentical hormones? Bioidentical hormones are prescribed hormones that are identical to the hormones produced in a women’s body prior to the onset of menopause. The most commonly prescribed include three different types of estrogen (estrone, estradiol and estriol), progesterone, testosterone and dehydroepiandosterone (DHEA).

There are two categories of bioidentical hormones: compounded and manufactured.

Compounded bioidentical hormones are pills, creams, gels, suppositories, injectables, sublingual drops or lozenges that are prescribed by health care providers who tailor the dose to a woman’s individual symptoms and concerns. They are literally assembled in the pharmacy by a certified compounding pharmacist and are available through mail-order and some local pharmacies. Compounded bioidentical hormones are generally not covered by insurance and therefore are an out-of-pocket expense.

Manufactured bioidentical hormones are pills, creams, gels, sprays and injectable medications manufactured and marketed by large pharmaceutical companies. They come in standard doses and, therefore, are not available as tailor-made medications. There are other limitations with manufactured hormones. For instance, bioidentical estrogen is only manufactured as estradiol – the most potent of the three types manufactured in a woman’s body. Manufactured bioidentical hormones may be covered by insurance.

The alternative to bioidentical hormone therapy is synthetic hormone therapy. They include manufactured hormones that are similar to but intentionally different than the chemical structure as those hormones produced in a woman’s body. Premarin (conjugated equine estrogen) and Provera (a synthetic progestin) are the most commonly prescribed conventional hormones. They are the suspect hormones studied in the Women’s Health Initiative (WHI) Study that raised concerns about all hormone replacement therapy due to increased risks of blood clot formation, stroke, heart attack and cancer. Upon release of this information in 2002, many women abruptly stopped hormone usage and many physicians stopped or significantly limited prescribing hormone therapy.

The American College of Obstetricians and Gynecologist (ACOG) and the North American Menopause Society (NAMS) have recently issued statements supporting the use of manufactured bioidentical or conventional hormone therapy when necessary. They have also issued statements against compounded bioidentical hormones due to their unproven safety and efficacy.

The debate in the medical community continues regarding the safety and effectiveness of the bioidentical hormones as they have not been studied in large standardized controlled trials such as the WHI. However, it is difficult to undertake such studies when medications are tailor-made for individual women. Small European studies from the 1980’s suggest an improved safety profile with bioidentical hormones. However, this has yet to be proven.

A review article published in January of 2009 in the Journal of Postgraduate Medicine states that patients report greater satisfaction with bio-identical hormone therapies. Clinical outcomes and physiologic data support that bio-identical hormones are more effective than synthetic hormones and are associated with lower risks, including the risk of breast cancer, stroke and heart attack. Further randomized controlled trials are needed to further expound upon the differences.

References:

1. Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, striol and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgraduate Medicine 2009:121(1). doi: 10.3810/pgm.2009.01.1949

2. Compounded bioidentical hormones. ACOG Committee Opinion No. 322. American College of Obstricians and Gynecologists. Obstet Gynecol 2005;106:1139-40.

3. North American Menopause Society Statement on Bioidentical Hormones Therapy

Effects of the Menopause Transition and Hormone Use on Cognitive Performance in Midlife Women

Many women come to me with complaints of impaired memory or "fuzzy thinking" during the peri-menopause (the period of time prior to the cessation of menses). As it turns out, until recently very few studies have been published assessing the change in cognitive function as women go through the menopausal transition. A study was published in the journal Neurology that evaluates the change in cognitive functioning women experience throughout the menopause transition and the effect hormone therapy has on altering the deterioration.

2,362 women between the ages of 42 and 53 were monitored for four years throughout their menopausal transition in the Study of Women's Health Across the Nation. Women were categorized into groups according to the time spent in the menopause transition, hormone use prior to the last menses and hormone therapy initiated after the last menstrual flow. Assessment of three types of cognitive functioning included processing speed, verbal memory and working memory.

The results were as follows:
1. Women do experience memory impairment (demonstrated as not being able to learn as well as during the pre-menopausal period) during the menopause transition
2. Once women were through the menopausal transition their memory impairment corrected to a pre-menopausal level suggesting the cognitive changes during the menopause transition are temporary
3. Women who took hormone therapy prior to their last menses had a beneficial effect on memory retention
4. Women who started hormone therapy after their final natural menses did not experience a beneficial effect and even proved to be detrimental their cognitive performance

In brief: cognitive function declined during the peri-menopause but hormone therapy started before a woman's last menstrual flow prevented the decline in function.

Find definitions related to this article.

Study Reference: Greendale GA, Huang M-H, Wight RG, et al. Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology 2009;72:1850-7.

Photo from health.discovery.com/

Yoga Helps Reduce Hot Flashes

Some of the most life-altering symptoms of peri-menopause are hot flashes, night sweats, sleep disturbances and mental fogginess. Yoga is commonly recommended as a form of exercise for peri-menopausal women, but not necessarily for help with controlling peri-menopausal symptoms. A study recently published in the British Journal of Obstetrics and Gynecology suggests that women experiencing such symptoms could benefit from a regular integrated yoga practice.

Researchers conducted a randomized controlled study in 14 centers of yoga research in Bangalore, India to assess the effect of a regularly practiced yoga on peri-menopausal symptoms such as hot flashes, night sweats and sleep disturbance. They randomized 120 peri-menopausal women between the ages of 40 and 55 to either a yoga or control group. The women in the yoga group practiced yoga postures (asana), breathing exercises and cyclic meditation for one hour 5 days per week. The control group participated in supervised simple physical exercises for the same amount of time per week.

Results: The women in the yoga group experienced a greater reduction in hot flashes, night sweats and sleep disturbances. In addition, the women practicing yoga experienced improved cognitive functions such as concentration, memory (remote and short term) and an overall "mental balance".


Read more about developing a yoga practice


Read the abstract
Reference: Chattha R, Nagarathna R, Padmalatha V, Nagendra HR. Effect of yoga on cognitive functions in climacteric syndrome: a randomised control study. BJOG 2008;115:991-1000

To Eat Organic - Or Not?

Eating 5-9 servings of vegetables and fruits are an important aspect of healthy living. Vegetables and fruits provide nutrients and fiber that are not available from other food sources. Today, many crops are grown in massive quantities where toxic pesticides are used. Choosing organic (produce grown free of pesticides) is more important for some rather than others.


Best to Eat Organic:

1. Apples
2. Peaches
3. Bell Peppers
4. Pears
5. Celery
6. Potatoes
7. Cherries
8. Raspberries
9. Imported Grapes
10. Spinach
11. Nectarines
12. Strawberries


Not Necessary to Eat Organic:
1. Asparagus
2. Kiwi
3. Avocados
4. Mangos
5. Bananas
6. Onions
7. Broccoli
8. Papaya
9. Cauliflower
10. Pineapples
11. Corn (sweet, frozen)
12. Peas (sweet, frozen)

6 Ways to De-Stress Your Home

From Andrew Weil's Tip of the Day

Your home - whether big, small, or somewhere in between - should be your sanctuary, a place where stress is left at the door and your soul is nurtured. For a more comforting environment, gradually implement the following changes into your home:

1. Bring the outdoors in. Green plants, cut flowers and blooming bulbs, or pieces of wood, rocks and other organic elements can create a feeling of nature indoors.
2. Paint a room to suggest a mood. For instance, blue and green promote a relaxed feeling and may be good choices for the bedroom, while warm colors (maroon, coral, burgundy) suggest a cozy environment and may be inviting in a family room.
3. Surround your senses with beauty. Artwork, fragrance, smooth textures and calming sounds all provide a pleasant environment in which to relax.
4. Set aside a room or area for peace and calm. A place for spiritual reflection and meditation can provide shelter from noise and distraction.
5. Clean out clutter. A low-maintenance home is refreshing after a day of hectic meetings, errands and chores. Fewer items can mean less frustration.
6. Create an atmosphere of love. Display handmade or meaningful gifts from loved ones and photos of family and friends.

Vitamin D and Breast Cancer

Adequate serum levels of Vitamin D have been associated with decreased risk of several cancers, including breast cancer. Why? Some studies have shown vitamin D inhibits the formation of malignant breast cells. Regardless of the mechanism, KD Crew and associates recently published an abstract on line that indicates vitamin D levels are inversely related to breast cancer risk.

This population-based, case-controlled study compared vitamin D plasma levels of 1,026 women diagnosed with breast cancer between 1996 and 1997 with vitamin D plasma levels of 1,075 women who lived in the same area of Long Island, New York.

The authors found:

• Plasma vitamin D levels were inversely related to breast cancer risk


• All women with vitamin D levels greater than or equal to 40 ng/mL were 46% less likely to have breast cancer than women with vitamin D levels less than 20 ng/mL


• Postmenopausal women benefited most with a 54% reduction of breast cancer risk if their serum vitamin D level was greater than or equal to 40 ng/mL

These results add to a growing body of evidence that adequate vitamin D stores may prevent breast cancer development. It is known that circulating vitamin D levels of more than 32 ng/mL are associated with normal bone mineral metabolism; this data suggest that the optimal level for breast cancer prevention is greater than or equal to 40 ng/mL. More clinical trials are urgently needed to evaluate the role of vitamin D supplementation on breast cancer prevention.

What I tell my patients

It is unknown, as of yet, the optimal plasma level of 25-hydroxyvitamin D. Evidence continues to mount that our previous perception of "normal" levels of vitamin D falls short. Many experts now believe that a range of 40 to 80 ng/mL is an optimal range to protect us from many chronic and debilitating illness. However, many labs still report a 25-hydroxyvitamin D level as "normal" when it falls in the range of 20 - 100 ng/mL. Have your levels tested. Ask your doctor what your 25-hydroxyvitamin D level is. I recommend a level of 52 - 80 ng/mL to my patients (colon cancer risk is cut in half at 52 ng/mL).

Do self-breast exams monthly. Get annual mammograms starting at age forty; sooner if advised. Get 20 minutes of sunshine (without sun block) at least 3 days per week. Eat a diet abundant in vegetables, fruit, whole grains and omega-3's. Eat organic, when possible. Exercise regularly. Limit alcohol consumption to no more than 1 drink per day. Laugh often. Enjoy nature. Practice silence. And, be your own best health advocate.

Reference: Crew KD, et al. Association between Plasma 25-Hydroxyvitamin D and Breast Cancer Risk. Cancer Prev Res (Phila Pa). 2009 May 26. [Epub ahead of print]

Lemon Baked Halibut

Recipe from Dr. Andrew Weil's Daily Tips

Description

The mellow flavor of this low-fat fish comes from marinating it in vigorous spices. After cooking, it is topped with homemade salsa rich with the flavor of tangy onions, fiery jalapeño peppers, and cool papaya. Make the salsa first, before you start preparing the fish. It is also best to make the marinade far enough in advance so that the flavors can blend together for at least 2 hours before you actually marinate the fish in it for 30 minutes. Keep this in mind when deciding what time you want to serve this dish. I couple this entrée with a side of steamed vegetables or Roasted Root Vegetables.

Ingredients

PAPAYA SALSA 1/2 cup cilantro leaves 1 cup cubed papaya 1/4 cup cubed red bell pepper 1/4 cup diced red onion 1 small jalapeño pepper, seeded and minced 2 tablespoons freshly squeezed lime juice MARINADE 3 tablespoons freshly squeezed lemon juice 1 tablespoon grated lemon zest 1 tablespoon olive oil 1 tablespoon grated fresh ginger 3/4 teaspoon freshly ground black pepper 1/2 cup minced fresh cilantro Six 6-ounce halibut steaks, sliced in half lengthwise 3 medium bulbs fennel, trimmed and sliced 2/3 cup purified water 9 black or white peppercorns

Instructions

Make the salsa: Put the salsa ingredients in a small bowl, mixing with a spoon until everything is thoroughly melded in. Cover and refrigerate until you are ready to use. Make the marinade: Stir together the lemon juice, zest, oil, ginger, pepper, and cilantro in a bowl. Let the flavors mingle together for at least 2 hours, covered, in the refrigerator. After the 2 hours, put the fish in a baking pan, pour the marinade evenly over it, and let it sit for 20–30 minutes, covered, in the refrigerator. Preheat oven to 400°F. Meanwhile, cook the fennel in the water with the peppercorns in a large, flameproof sauté pan, covered, over high heat for about 6–8 minutes, until just tender, adding liquid if necessary. Remove from the heat. Remove the halibut steaks from the refrigerator and bake them for 5 minutes on each side. The halibut should be flaky and white. Arrange equal portions of the fennel on each of 6 plates, put the halibut on top, and spoon 1 tablespoon of Papaya Salsa on the fish. Serves 6 Per serving: Calories 322 Fat 7.1 g Saturated fat 1 g (20.2% of calories from fat) Protein 39.6 g Carbohydrate 24.4 g Cholesterol 54 mg Fiber 7.9 g This recipe is from The Healthy Kitchen - Recipes for a Better Body, Life, and Spirit (Hardcover) by Andrew Weil, M.D. and Rosie Daley (Knopf)

Mindfulness Training to Enhance Female Sexual Response

Most women are accomplished multi-taskers. However, ruminating about grocery lists or an upcoming staff meeting while engaging in sexual activity could certainly prove to be detrimental. For a rewarding sexual experience, such moments deserve to be the sole focus of attention and concentration.

Mindfulness is rooted in Eastern spiritual traditions, and is described as the means by which dispersed thoughts are gathered so that the mind can experience "living in the moment". Mindfulness is commonly used in stress reduction programs and has been shown to have many positive effects on physical, emotional and sexual health.

In general, mindfulness therapy teaches a woman to focus on the present moment without judging the experience or clouding it with feelings. Women with sexual impairment often report difficulties with intercourse because of intrusive, nonsexual thoughts and concerns about sexual performance, body image and partner-related issues. A study published in 2000 showed that a mindfulness practice can help women overcome such distractions and focus on their sexual response (Dove, 2000). Another study demonstrated improved sexual desire, arousal and satisfaction and decreased negative mood in ten women who practiced mindfulness meditation for five years (Brotto, 2008). Mindfulness has also been correlated with greater marital satisfaction (Burpee, 2005).

You can find mindfulness meditation CDs by Jon Kabat-Zinn at http://www.mindfulnesscds.com/index.html

References:
1. Dove NL, Widerman MW. Cognitive distraction and women's sexual functioning. J Sex Marital Ther. 2000;26(1):67-78
2. Brotto LA, et al. A mindfulness-based group psychoeducational intervention targeting sexual arousal disorder in women. J Sex Med. 2008;5(7):1646-59.
3. Burpee LC, Langer EJ. Mindfulness and marital satisfaction. J Adult Dev. 2005;12(1):43-51.

U.S. Faces Epidemic of Vitamin D Deficiency

According to a recent report published in the Archives of Internal Medicine, a vitamin D deficiency epidemic has hit the United States and current recommendations for vitamin D supplements are inadequate. According to the National Health and Nutrition Examination Survey vitamin D deficiency has tripled since 1994. The analysis included serum specimens from 13,369 people ages 12-60 between 2001-2004 and compared them to 18,883 specimens obtained between 1998-1994.

Authors' observations:

• Vitamin D supplementation should consist of at least 1000 IU, especially during the winter months for those living in northern latitudes (i.e. above Atlanta, Georgia)
• Current recommendations for Vitamin D supplementation (200-600 IU/d) are too low
• It is unknown what the optimal serum level is for vitamin D - most likely above 40 ng/ml
• The average vitamin D level of people ages 12-60 was 24 ng/mL
  
• Vitamin D deficiency in the African American population is the highest at 29%
• Several factors contribute to vitamin D deficiency including decreased time outdoors, obesity and the use of sunblock. (SPF 15 decreases vitamin D synthesis by 99%)

What I tell my patients:

• Vitamin D deficiency contributes to osteoporosis, depression, diabetes, many forms of cancer, cardiovascular disease, multiple sclerosis, etc.
• 25-hydroxy vitamin D levels should be checked annually (optimally between November and April when levels are likely to be lowest)
• Those most at risk for vitamin D deficiency: elderly, people of color, people who are unable to get sun exposure, and those who routinely cover their heads when walking outside
  
• You need 20 minutes of sun exposure without sunblock 3 times per week for adequate vitamin D synthesis. Care should be taken to avoid sunburn.
• Thirty minutes of sun exposure in a bathing suits results in the formation of 20,000 IU of vitamin D
  
• Our food supply does not contain adequate amounts of vitamin D supplementation - not even dairy products
  
• Everybody, with very few exceptions, should be on vitamin D supplementation 1000 IU/d
• I recommend an optimal level of 52-80 ng/mL. One study demonstrated that a level of 52 ng/mL decreases your risks of colon, breast and ovarian cancer by up to fifty percent!
• Supplements of 1000 IU can be purchased without a perscription and are relatively inexpensive.

Reference:
Ginde AA, et al. Dmographic differences and trends of vitamin D insufficiency int he US population, 1988-2004. Arch Intern Med. 2009;169(6):626-632.

Low Vitamin D Increases Risk for Metabolic Syndrome

by Stephen Daniells

According to findings published in Diabetes Care, a study with 3,262 Chinese people aged between 50 and 70 showed that deficient levels of vitamin D may increase the risk of metabolic syndrome by 52% ....

Read complete article here.

Metabolic Syndrome Risk Assessment

by Lynn Marquardt, NP

ASSESSMENT - Answer each question with "YES" or "NO"

1. Do you have a family history of early heart disease?
(Parent, brother or sister, men before age 55, women before age 65?)

2. Do you use any tobacco products?

3. Do you have elevated blood sugar?

4. Are you overweight?
(Is your BMI greater than 25.0? Calculate your BMI)

5. Is your waist size greater than 35 inches?
(Measure 2 fingers above belly button)

6. Is your blood pressure over 135/85 or are you on
high blood pressure medication?

7. Is your HDL level lower than 50 mg/dl?

8. Is your triglyceride level >149 mg/dl?

If you answered “yes” to any of these questions, you may be at greater than normal risk for metabolic syndrome. The more “yes” responses you chose, the greater your risk.

Completion of this assessment is not a substitute for contacting a healthcare provider. Discuss your risks with your healthcare provider.

What is Metabolic Syndrome?

by Lynn Marquardt, NP

People with the metabolic syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls and type 2 diabetes. Metabolic syndrome has become increasingly common in the United States. It’s estimated that over 50 million Americans have it.

The American Heart Association and the National Heart, Lung, and Blood Institute recommend that the metabolic syndrome be identified as the presence of three or more of these components:

• Elevated waist circumference:
  Men — Equal to or greater than 40 inches (102 cm)
  Women — Equal to or greater than 35 inches (88 cm)
• Elevated triglycerides:
  Equal to or greater than 150 mg/dL
• Reduced HDL (“good”) cholesterol:
  Men — Less than 40 mg/dL
  Women — Less than 50 mg/dL
• Elevated blood pressure:
  Equal to or greater than 130/85 mm Hg
• Elevated fasting glucose:
  Equal to or greater than 100 mg/dL

AHA Recommendation for Managing the Metabolic Syndrome:
The primary goal of clinical management of the metabolic syndrome is to reduce the risk for cardiovascular disease and type 2 diabetes. Therefore, the first-line therapy is to reduce the major risk factors for cardiovascular disease: stop smoking, and reduce LDL cholesterol, blood pressure and glucose levels to the recommended levels.

For managing both long- and short-term risk, lifestyle therapies are the first-line interventions to reduce the metabolic risk factors. These lifestyle interventions include:

• Weight loss to achieve a desirable weight (BMI less than 25 kg/m²)
• Increased physical activity, with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
• Healthy eating habits that include reduced intake of saturated fat, trans fat and cholesterol

a. Commit to a healthy diet. Eat plenty of fruits and vegetables. Choose lean cuts of white meat or fish over red meat. Avoid processed or deep-fried foods. Eliminate table salt and experiment with other herbs and spices.

b. Get moving. Get 30 to 60 minutes of moderately strenuous activity most days of the week.

c. Lose weight. Losing as little as 5 percent to 10 percent of your body weight can reduce insulin levels and blood pressure, and decrease your risk of diabetes.

d. Stop smoking. Smoking cigarettes increases insulin resistance and worsens the health consequences of metabolic syndrome

e. Eat fiber-rich foods. Make sure you include whole grains, beans, fruits and vegetables in your grocery cart. These items are packed with dietary fiber, which can lower your insulin levels.

Summary

The term "metabolic syndrome" is a way of identifying individuals at high risk for the development of heart disease and diabetes. Patients at risk should receive education and counseling on lifestyle modification, and all risk factors for heart disease should be treated aggressively.

http://www.americanheart.org/presenter.jhtml?identifier=534

http://www.nhlbi.nih.gov/health/dci/Diseases/ms/ms_whatis.html

Food Consumption during Labor - Why Not?

There is an ongoing international debate about food consumption during labor. The current rationale for women fasting during labor is to protect them from pulmonary aspiration should general anesthesia be needed for an emergency cesarean delivery. Other concerns include increased cesarean rate (Scheeper, 2002) or prolongation of labor (Tranmer, 2005) should women be allowed to eat while laboring.

On March 24, 2009 the British Medical Journal published a well-done randomized controlled trial (O'Sullivan, 2009) of over 2000 women suggests we should revisit current practices of not allowing women to eat while in labor. Women were randomized to water-only or a "light diet". (They were advised to consume a low fat, low residue diet at will during labor. Suggested foods included fruits and vegetables, breads, soup, low fat yogurt, fruit juices and sports drinks.)

Results:

• No difference in vaginal delivery vs. cesarean delivery rate between the two groups (30% cesarean delivery rate in both groups).
• No difference in length of labor.
• No difference in Apgar scores or admission to the neonatal ICU.
• No cases of aspiration pneumonia (However, because aspiration is so rare, a much larger study would have been needed to see one case.)
• One maternal death occurred in the water-only group due to a brain hemorrhage.

Side note:
The UK Confidential Enquiries into Maternal and Child Health reviewed 2,113, 831 deliveries between 2003-2005. Six anesthesia-related deaths occurred, none of which was associated with pulmonary aspiration. Similar findings were reported by the Australian Anesthesia Incident Monitoring Study. This supports the statement that aspiration pneumonia is exceedingly rare.

References:
1. O'Sullivan G, et al. Effect of food intake during labour on obstetric outcome: randomised controlled trial. BMJ 2009;338:b784
2. Lewis G, ed. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer—2003-2005. The seventh report on confidential enquiries into maternal deaths in the United Kingdom. London: CEMACH, 2007.

See complete MaternaCare review and references here.

PMS and Integrative Medicine (Part II): Botanicals

Chastetree, Black cohosh, Ginkgo biloba and Evening primrose are the most commonly used botanicals to treat premenstrual syndrome in the United States. Of those listed, Chastetree has been the most widely studied.

Some of the descriptions below refer to "The German Commission E". The German Commission E Monographs are a therapeutic guide to herbal medicine. There is an English translation by the American Botanical Council, with 380 monographs evaluating the safety and efficacy of herbs for licensed medical prescribing in Germany. Though the German Commission no longer exists, in Germany only those herbs with Commission E approved status are legally available.
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Chastetree Berry (Vitex agnus-castus) is the dried ripe fruit of the chaste tree. In a number of well conducted studies chastetree berry has been effective in reducing PMS symptoms, especially breast discomfort, when compared to placebo. The German Commission E has approved the use of chastetree berry for irregularities of the menstrual cycle, premenstrual symptoms and breast pain.

Chastree is considered safe. Possible side effects are mild and reversible. They include mild headache, diarrhea, abdominal cramps, decreased appetite, rash and itching. Possible drug interactions could include anti-psychotics, some antidepressants and estrogen-containing compounds. However all potential drug interactions are theoretical.

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Black Cohosh (Actaea racemosa) was used by American indigenous peoples for the treatment of respiratory complaints, muscuoskeletal pain and to aid in childbirth. It was most likely used for its anti-inflammatory and muscle relaxant properties.

Compounds in black cohosh bind to the 5-HT7 (serotonin) receptor which may explain its positive effect on depressive and anxiety symptoms in PMS. A study published by Dittmar in 1992 demonstrated a reduction of the PMS symptoms including anxiety, tension and depression. A number of studies show a benefit for various menopausal symptoms such as hot flashes, profuse sweating, sleep disturbance and depressed moods. Because these symptoms often exist in those suffering from PMS, many clinicians have recommended the use of black cohosh in this population, too. Black cohosh is approved by the German Commission E for use in women suffering from premenstrual symptoms, painful menstruation (i.e. dysmenorrhea) and menopause.

Side effects and drug interactions: Black cohosh is generally safe and well tolerated when used for 6 months; and has not been well-studied beyond 6 months duration. Caution should be exercised as there have been multiple case reports of liver damage while using black cohosh. As stated above, Black Cohosh has been studied as a therapy for menopausal symptoms, not PMS. At this time that there is insufficient evidence to support or refute the use of black cohosh for PMS.
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Ginkgo (Ginkgo biloba): Ginkgo is commonly used to sharpen mental focus and improve circulation. One well-done study suggests the ginkgo is more effective in decreasing psychological and congestive symptoms ( e.g. breast pain, breast tenderness and fluid retention) than placebo in PMS sufferers. More studies need to be conducted before strong recommendations can be made to support or refute the use of ginkgo for PMS.

Ginkgo is generally well tolerated and considered safe with similar side effect rates as placebo in several reviews. Ginkgo is thought to have a blood-thinning effect. Therefore, possible drug interactions can occur with anti-coagulants such as warfarin and aspirin.
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Evening Primrose Oil (Oenothera biennis): A systematic review of the literature published in 1996 included seven studies. Unfortunately, none of the studies found a beneficial effect of evening primrose oil for PMS symptoms; this included two well-designed, randomized, placebo-controlled trials that were adequately powered.

Potential side effects include headache, seizures among people with seizure disorder or taking anesthetics, nausea, vomiting, anorexia, diarrhea, hypersensitivity reactions, rash, inflammation and immunosuppression with long-term use. Possible drug interactions include anticoagulants, phenothiazines and other anti-seizure medication. In lite of the currently available information, EPO is not a recommended treatment for PMS.

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Other biologically based therapies: St. John’s Wort (Hypericum perforatum) is primarily used to alleviate depressive symptoms. Kava (Piper methysticum) has been proven effective for treating anxiety, though has a questionable safety profile. Valerian (Valeriana officinalis) is a common over-the-counter ingredient for sleep preparations and relaxants. Don Quai (Angelica sinensis) as a tonic for women with fatigue and low vitality. None have yet been adequately studied for the treatment of PMS.

References:
1. Daniele C, et al. Vitex agnus castus: a systematic review of adverse events. Drug Saf
2. Dittmar FW, et al. Premenstrual syndrome: treatment with a phytopharmaceutical. Therapiwoche Gynakol 1992;5:60-8.
3. Budeiri, D, Li Wan Po A, Doman JC. Is evening primrose oil of value in the treatment of premenstrual syndrome? Control Clin Trials 1996;17:60-8.
4. Tamborini A, Taurelle R. Value of standardized Ginkgo biloba extract (EGb 761) in the management of congestive symptoms of premenstrual syndrome. Rev Fr Gynecol Obstet
5. Blumental M, et al., eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine communications, 1998.
2005;28(4):319-32. 1993;88:447-57

Healthy Oils for Cooking

6 good-for-you choices that'll add health and flavor to your cooking.

Most women know they need some fat in their diet. "But moderation is key — all oils have about 120 calories and 14 grams of fat per tablespoon," says nutritionist Ellie Krieger, R.D., host of Healthy Appetite on the Food Network. She suggests sticking to about two teaspoons of added fat per meal — and cooking with a variety of oils, since they all offer different body benefits. Here are some of the best kinds, plus delicious ways to get them in your diet.

Olive Oil
Why it's healthy: Of all the oils, olive has the highest amount of heart-protective monounsaturated fats and polyphenols — antioxidants that have anti-inflammatory and anticlotting properties. It's also a staple of the Mediterranean diet, which has been shown to lower your risk of heart disease, lengthen your life, reduce your odds of cancer and diabetes, and help you lose weight. Newly pressed extra-virgin olive oil contains oleocanthal, a compound that acts similar to ibuprofen, according to a recent University of Pennsylvania study. Researchers say that a diet rich in olive oil may have pain-relieving and heart-health benefits similar to those of taking a low-dose baby aspirin every day.

What it's best for: Let extra-virgin olive oil's strong flavor shine though in salad dressings, on bread, or atop grilled meats, fish, and veggies. And (surprise!) you can fry or sauté with olive oil too! Frying isn't as unhealthy as you may think: "When you fry a food in olive oil that's heated to about 350 degrees F, a crust will form and your food will absorb less oil," says Nicki Heverling, R.D., program manager for the Mediterranean Foods Alliance. Just know that extra-virgin olive oil has a smoke point of about 385 degrees F to 420 degrees F — so keep an eye on the heat or else the oil will burn and splatter.

The skinny on olive oil: Choosing an olive oil can be confusing. Here, Heverling explains how to pick the best bottle.

Always choose extra-virgin. It's made from the first pressing of olives, so it has the most antioxidants and flavor. Look for an oil that's cold-pressed, meaning no heat was used during the processing. Think that's too pricey? Opt for an inexpensive extra-virgin olive oil for cooking, then splurge on a high-quality, unfiltered one for drizzling and dipping. "This adds amazing flavor and health to your food — it's worth every penny," says Heverling.

Go imported. Spain, Italy, and Greece are the biggest olive oil producers, and their strict quality standards mean you'll get a better product. Look for the words product of (as in "product of Italy") to guarantee that the oil comes from that country.

Buy dark-colored bottles. And keep them in a dark, cool place, since light and heat can turn oil rancid. Olive oil is best used within six months but can last for two years if stored properly.

Canola Oil
Why it's healthy: Canola oil contains the lowest levels of unhealthful saturated fats of any oil, and it's also a good source of alpha-linolenic acid, a heart-healthy omega-3 fatty acid. The FDA recently approved canola oil products to carry the health claim that it may reduce the risk of coronary heart disease. Substituting it for other vegetable oils, and canola oil — based spreads for margarine, can significantly reduce the amount of saturated fats in your diet, according to a recent study.

What it's best for: Mild-flavored canola oil is the cheapest option for sautéing and frying, and it also works well as a shortening or butter substitute in baked goods.

Peanut and Sesame Oils
Why they're healthy: Consuming a diet rich in peanuts, peanut butter, and peanut oil may be as effective in protecting against heart disease as an olive oil-rich diet, according to a Penn State study. Peanuts contain resveratrol, an antioxidant also found in wine that has been associated with a reduced risk of cancer and heart disease. Sesame oil is a good source of vitamin E, magnesium, copper, calcium, iron, and vitamin B. It also contains sesamin and sesamolin, substances that have been shown to lower cholesterol and protect the liver.

What they're best for: These oils have a high smoke point, so they work best for stir-fries. Peanut oil has a bland, nutty flavor, making it an ideal choice in dishes featuring nuts or when you want other flavors in a recipe to shine. Sesame oil has a strong, distinctive taste. "I finish Asian dishes with a splash of toasted sesame oil," says Krieger.

Walnut and Flaxseed Oils
Why they're healthy: Both oils are high in omega-3 fatty acids. In fact, flaxseed has the highest concentration of omega-3s of all non-fish foods, and it also contains lignans, chemicals that may play a role in preventing cancer.

What they're best for: Their delicate flavor makes them ideal for no-cook items such as salad dressings and fruit smoothies; walnut oil can also be used for baking. Both oils must be refrigerated and used within a few months.

Originally published WebMD 9/9/2008

by Nicole De Coursy