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