It’s difficult not to gush about green tea.

More than a decade’s worth of research about green tea’s health benefits — particularly its potential to fight cancer and heart disease — has been more than intriguing, as have limited studies about green tea’s role in lowering cholesterol, burning fat, preventing diabetes and stroke, and staving off dementia.

“I believe in green tea based on everything written about it,” says Katherine Tallmadge, RD, LD, a nutritionist and spokeswoman for the American Dietetic Association. “Green tea, white tea, black tea — I like all of them.”

Still, real-world evidence is lacking; most of the consistent findings about green tea’s health benefits have come out of the lab.

The few large-scale human studies that have focused on green tea’s impact on heart disease and cancer are promising, but many of those were conducted in the East, where green tea is a dietary mainstay. The outcomes are likely influenced by other lifestyle factors such as high consumption of fish and soy protein, says cardiologist Nieca Goldberg, MD, a spokeswoman for the American Heart Association and medical director of the New York University Women’s Heart Center.

But Goldberg agrees with other health professionals: green tea has important antioxidants and compounds that help in maintaining good health.

Green Tea’s Powerful Antioxidants

Green tea’s antioxidants, called catechins, scavenge for free radicals that can damage DNA and contribute to cancer, blood clots, and atherosclerosis. Grapes and berries, red wine, and dark chocolate also have potent antioxidants.

Because of green tea’s minimal processing — its leaves are withered and steamed, not fermented like black and oolong teas — green tea’s unique catechins, especially epigallocatechin-3-gallate (EGCG), are more concentrated.

But there’s still a question of how much green tea you need to drink to reap its health benefits. EGCG is not readily “available” to the body; in other words, EGCG is not always fully used by the body.

“We must overcome the issue of poor bioavailability [and other issues] in order to get the most out of their benefits,” says Tak-Hang Chan, PhD, professor emeritus in the department of chemistry at McGill University in Montreal. Chan has studied the use of a synthetic form of EGCG in shrinking prostate cancer tumors in mice, with success.

Green Tea vs. Cancer

Marji McCullough, ScD, RD, the American Cancer Society’s strategic director of nutritional epidemiology, says human studies haven’t yet proven what researchers like Chan have discovered in the lab: green tea’s EGCG regulates and inhibits cancer growth and kills cells that are growing inappropriately.

“Epidemiologically, one of the challenges is finding populations that drink enough green tea and have for a long time,” she says. “With cancer, it’s always difficult to find the exposure time,” or the point at which cancer cells begin to develop.

Green Tea vs. Cancer continued…

Still, it’s difficult not to be intrigued by a few human studies that have shown that drinking at least two cups of green tea daily inhibits cancer growth.

One of them, a study conducted in Japan that involved nearly 500 Japanese women with Stage I and Stage II breast cancer, found that increased green tea consumption before and after surgery was associated with lower recurrence of the cancers.

Studies in China have shown that the more green tea that participants drank, the less the risk of developing stomach cancer, esophageal cancer, prostate cancer, pancreatic cancer, and colorectal cancer.

Finally, a recent analysis of 22 studies that probed the correlation between high tea consumption and reduced risk for lung cancer concluded that by increasing your daily intake of green (not black) tea by two cups may reduce the risk of developing lung cancer by 18%.

Is Green Tea Good for Your Heart?

It seems to be, but there are conflicting results of a few epidemiological studies conducted in the East and West.

In a study that involved 500 Japanese men and women, researchers found that drinking at least four cups of green tea every day may be related to the reduced severity of coronary heart disease among the male participants.

A Dutch study of more than 3,000 men and women found that the more tea consumed, the less severe the clogging of the heart’s blood vessels, especially in women.

As Goldberg suggests, lifestyle and overall diet are critical to the outcomes of these studies.

But green tea’s antioxidants are dilators, she says, because they improve the flexibility of blood vessels and make them less vulnerable to clogging — and antioxidant-rich blueberries and pomegranates do the same.

“I think people should know these are important studies, that everyday foods that are an option may actually have health benefits,” Goldberg says. “I think green tea, because of its antioxidant value, may have heart benefits, but it’s not something we regularly prescribe to people, because there isn’t as much evidence as there is in exercise’s ability to improve heart health.”

Green Tea and Weight

Green tea and its extract have been shown to fight obesity and lower LDL “bad” cholesterol — two risk factors for heart disease and diabetes — but in very limited studies. One study in the Netherlands and a study in Japan showed that green tea did both.

In the Dutch study, participants who drank caffeinated green tea lost more weight, but even those who typically drank the decaf variety saw a decrease in their waistlines and body weight. Researchers speculated that the caffeine helps with fat oxidation.

In the Japanese study, 240 men and women were given varying amounts of green tea extract for three months. Those who got the highest amount lost fat and weight and had lower blood pressure and lower LDL “bad” cholesterol.

Green Tea Straight Up

Taking weight loss supplements that contain green tea extract probably won’t hurt, unless you have liver problems.

But the best way to get the most out of green tea — even if your main goal is losing weight — is to drink it.

“Taken altogether, the evidence certainly suggests that incorporating at least a few cups of green tea every day will positively affect your health,” says Diane McKay, PhD, a Tufts University scientist who studies antioxidants. “It’s not going to cure anything and it shouldn’t be consumed as a drug, but it can complement the rest of the diet.”

McCullough bears the same reminder: eat your fruits, vegetables, grains, seeds, and nuts — and go ahead, drink as much green tea as you want.

“I don’t think it can hurt to drink it. I’d focus on dietary sources rather than supplements because there are several compounds in green tea that might need to be consumed together. We just don’t know yet,” she says.

One of the chapters in my book “Live Well Over 100” is devoted to the health benefits of green tea. Since that book was published many studies have continued to appear about the health benefits of green tea. Remember we are talking about a cheap and safe product, compared to many other health supplements people take which are expensive and may have side effects. Besides, green tea is a pleasant drink once you develop a taste for it. Remember, you must have it without milk, as milk removes any benefit from green tea. I will be publishing more of the research and facts on green tea this week.

Why Green Tea?

Green tea has been used as a medicine for thousands of years, originating in China but widely used throughout Asia this beverage has a multitude of uses from lowering blood pressure to preventing cancer. The reason that green tea has more health benefits attached to it than black tea is (apparently) due to the processing. Black tea is processed in a way that allows for fermentation whereas green tea’s processing avoids the fermentation process. As a result, green tea retains maximum amount of antioxidants and poly-phenols the substances that give green tea its many benefits.

Here’s a list of some of its amazing benefits — benefits that you may not have been aware of. Some of these benefits are still being debated, so please do your own research if you want to use green tea for medicinal purposes.

1. Weight Loss. Green tea increases the metabolism. The polyphenol found in green tea works to intensify levels of fat oxidation and the rate at which your body turns food into calories.
2. Diabetes. Green tea apparently helps regulate glucose levels slowing the rise of blood sugar after eating. This can prevent high insulin spikes and resulting fat storage.
3. Heart Disease. Scientists think, green tea works on the lining of blood vessels, helping keep them stay relaxed and better able to withstand changes in blood pressure. It may also protect against the formation of clots, which are the primary cause of heart attacks.
4. Esophageal Cancer. It can reduce the risk of esophageal cancer, but it is also widely thought to kill cancer cells in general without damaging the healthy tissue around them.
5. Cholesterol. Green tea reduces bad cholesterol in the blood and improves the ratio of good cholesterol to bad cholesterol.
6. Alzheimer’s and Parkinson’s. It is said to delay the deterioration caused by Alzheimer’s and Parkinson’s. Studies carried out on mice showed that green tea protected brain cells from dying and restored damaged brain cells.
7. Tooth Decay. Studies suggests that the chemical antioxidant “catechin” in tea can destroy bacteria and viruses that cause throat infections, dental caries and other dental conditions
8. Blood Pressure. Regular consumption of green tea is thought to reduce the risk of high blood pressure.
9. Depression. Theanine is an amino acid naturally found in tea leaves. It is this substance that is thought to provide a relaxing and tranquilizing effect and be a great benefit to tea drinkers.
10. Anti-viral and Anti-bacterial. Tea catechins are strong antibacterial and antiviral agents which make them effective for treating everything from influenza to cancer. In some studies green tea has been shown to inhibit the spread of many diseases.
11. Skincare. Green tea can apparently also help with wrinkles and the signs of aging, This is because of their antioxidant and anti-inflammatory activities. Both animal and human studies have demonstrated that green tea applied topically can reduce sun damage.

How Much?

These are some of the many benefits but the reality is one cup of tea a day will not give you all the abundant gains. The jury is out on how many cups are necessary; some say as little as two cups a day while others five cups — and more still say you can drink up to ten cups a day. If you are thinking of going down this route, you may want to consider taking a green tea supplement instead (it would keep you out of the bathroom).

Another thing to point out is that there is caffeine in green tea — so if you are sensitive to caffeine then one cup should be your limit. Green tea also contains tannins (which can decrease the absorption of iron and folic acid), so if you are pregnant or trying to conceive then green tea may not be ideal for you. You can try mixing green tea with other healthy ingredients such as ginger.

For the rest of us with all these abundant benefits…it’s a wonder we drink anything else.

En Espanol

ANN ARBOR, Mich. — Are you good at coping when life gets tough? Do people call you a straight-shooter? Will you help others without expecting anything in return?

Those personality traits might do more than help you win a popularity contest. According to new University of Michigan-led neuroscience research, those qualities also might make you more likely to get pain relief from a placebo – a fake medicine.

And, the researchers show, it’s not just your mind telling you the sham drug is working or not. Your brain’s own natural painkiller chemicals may actually respond to the pain differently depending on your personality.

If you’re more of an angry, hostile type, they find, a placebo won’t do much for you.

For the first time, the new findings link specific, established personality traits with an individual’s susceptibility to the placebo effect from a sham medicine for pain. The researchers showed a significant link between certain personality traits and how much relief people said they felt when given the placebo – as well as the level of a specific chemical that their brains released.

The work, published online today in the journal Neuropsychopharmacology, was done by a team of U-M Medical School researchers and their colleagues at the University of North Carolina and University of Maryland.

The results build on nearly a decade’s worth of work on the placebo effect by the team led by Jon-Kar Zubieta, M.D., Ph.D., the Phil Jenkins Professor of Depression in the U-M Department of Psychiatry, a professor in the Department of Radiology and a member of the Molecular and Behavioral Neuroscience Institute.

The findings show that about one-quarter of placebo response was explained by the personality traits of resiliency, straightforwardness, altruism or anger/hostility, as measured on standardized tests. Other personality traits didn’t appear to be linked to placebo response. The new results come from a few dozen healthy volunteers, so the experiment must be repeated in larger, more diverse groups to be confirmed.

If confirmed, the findings could help researchers who study new drugs and other treatments – a field where placebo responses can really muddy the results and make it unclear whether the real therapy is working. Perhaps one day researchers will be able to adjust their results to account for the individual placebo responses of volunteers in their clinical trials.

Zubieta notes that the new findings came from a study involving pain, but that it may also apply to how personality influences a person’s response to other stress-inducing circumstances.

“We started this study not just looking at measures that might seem more obviously related to placebo responses, such as maybe impulsivity, or reward-seeking, but explored potential associations broadly without a particular hypothesis,” he explains. “We ended up finding that they greatest influence came from a series of factors related to individual resiliency, the capacity to withstand and overcome stressors and difficult situations. People with those factors had the greatest ability to take environmental information — the placebo — and convert it to a change in biology.”

He and his team, including first author, former MBNI postdoctoral fellow and now psychiatry research investigator Marta Peciña, M.D., Ph.D., hope to continue the research in people with depression, and to continue to explore how genetics as well as personality influence placebo response.

He notes that the findings may even have implications for the doctor-patient relationship – for instance, patients who have certain personality traits and placebo-response tendencies may also be more likely to partner with their doctors on their care, and discuss frankly any concerns they have about their response to treatment.

How it was done:

The researchers conducted the study among nearly 50 healthy volunteers, both male and female, between the ages of 19 and 38. They gave each person a battery of standard psychological tests that help identify the strongest personality traits an individual has, and then had them lie down in a brain scanner called a positron emission tomography or PET machine.

They told the volunteers that they were going to experience pain from salt water injected into their jaw muscle, and that a painkiller – actually, a placebo – would be injected at certain times. They asked patients to rate how much relief they expected to get before the experiment began. Then, during the 20-minute period when volunteers received salt water and/or “painkiller”, they asked them repeatedly to say how effective they though the painkiller was.

Meanwhile, the PET scanner made images of volunteers’ brains, allowing the researchers to see how much of the natural painkillers called endogenous opioids , were released in certain areas of each person’s brain under painful or “painkiller” conditions. They also drew blood from some of the patients during the experiment, and measured levels of a stress-induced chemical called cortisol.

After the tests, the researchers performed sophisticated statistical analysis to determine how personality traits influenced pain ratings, brain chemical response and cortisol levels. Although the cortisol levels did not seem to be influenced by personality traits and the placebo effect, the endogenous opioid activation elicited by the placebo, as well as patient-rated pain intensity levels, were.

In addition to Zubieta and Peciña, the team included Hamdan Azhar, M.S. and Tingting Lu, M.S., of MBNI and the U-M School of Public Health’s Biostatistics program, MBNI research investigator Tiffany M. Love, Ph.D., Barbara L. Fredrickson, Ph.D. of UNC, and Christian S. Stohler, D.M.D. of U. Maryland. The research was supported by grants from the National Institutes of Health, including AT001415, DA016423 and DA022520, and by the Phil F. Jenkins Foundation.

The team needs volunteers for other studies; visit www.umclinicalstudies.org & search for Zubieta.

Citation: Neuropsychopharmacology, DOI 10.1038/NPP.2012.227

Your daily habits and lifestyle — what you eat and drink, whether you exercise, how stressed you are, and more — affect your mental health every bit as much as your physical health. A growing body of research indicates that regular exercise and a healthful diet can help protect your memory from aging-related decline.

Exercise

Physical fitness and mental fitness go together. People who exercise regularly tend to stay mentally sharp into their 70s, 80s, and beyond. Although the precise “dose” of exercise isn’t known, research suggests that the exercise should be moderate to vigorous and regular. Examples of moderate exercise include brisk walking, stationary bicycling, water aerobics, and competitive table tennis. Vigorous activities include jogging, high impact aerobic dancing, square dancing, and tennis.

Exercise helps memory in several ways. It reduces the risk of developing several potentially memory-robbing conditions like high blood pressure, diabetes, and stroke. Exercise is good for the lungs, and people who have good lung function send more oxygen to their brains. There is some evidence that exercise helps build new connections between brain cells and improves communication between them. Finally, exercise has been linked to increased production of neurotrophins, substances that nourish brain cells and help protect them against damage from stroke and other injuries.

Here are some ways to build physical activity into your daily routine:

• Walk instead of driving when possible.
• Set aside time each day for exercise. For extra motivation, ask your spouse or a friend to join you.
• Use the stairs instead of the elevator.
• Plant a garden and tend it.
• Take an exercise class or join a health club.
• Swim regularly, if you have access to a pool or beach.
• Learn a sport that requires modest physical exertion, such as tennis.

Go Mediterranean

Mediterranean-type diets highlight whole grains, fruits and vegetables, and healthy fats from fish, nuts, and healthy oils. This eating style helps promote heart health and may also lessen the risk of memory and thinking problems later in life. In a study that followed more than 2,000 people over four years, those who most closely followed a Mediterranean-type diet had a lower risk of developing Alzheimer’s disease. A later study suggested that following a Mediterranean-type diet could slow the conversion of mild cognitive impairment into full-blown dementia.

The types of fat that predominate in the diet also seem to affect memory. As part of the national Women’s Health Initiative, 482 women ages 60 and older were observed for three years. They reported on their diets, and researchers tested their memory and thinking skills at the beginning of the study and at the end. Those who ate more unsaturated fat (which is abundant in vegetable oils and fatty fish) and less saturated fat (from red meat and full-fat dairy foods) had significantly less decline in memory than those who ate relatively little unsaturated fat.

Eating several servings of fruits and vegetables can also protect memory. Foods from plants are chock full of vitamins, minerals, and other nutrients that may protect against age-related deterioration throughout the body.

SEP 2012

Certain compounds in the brew are beneficial.

You may think of coffee as just a part of your morning routine. But it may be part of a longer, healthier life. A study published in The New England Journal of Medicine found that among older adults, those who drank coffee (caffeinated or decaf) had a lower risk of dying from diabetes, heart disease, respiratory disease, and other medical complications than non-coffee drinkers. “I think the evidence is pretty substantial now; it seems to be beneficial across the board,” says Dr. Eric Rimm, associate professor of epidemiology and nutrition at the Harvard School of Public Health.

What they found

Researchers looked at survey responses regarding the coffee habits of more than 400,000 older men and women. After adjusting for the effects of other risk factors such as alcohol consumption and smoking, scientists concluded that two or more cups of coffee per day equated to a 10% reduction in overall death for men and a 15% reduction in overall death for women, when compared with non-coffee drinkers. It’s not a cause-and-effect relationship, but researchers say there is a strong association between drinking coffee and living longer.

Brew benefits and risks

We don’t exactly know why this little bean has such big benefits, since coffee has hundreds of compounds. But we do know that one compound, chlorogenic acid, functions as an antioxidant (which helps our body fight oxidative damage). Chlorogenic acid may also turn on genes that increase insulin sensitivity and reduce the risk of developing type 2 diabetes.

But beware: Filtered coffee, no matter which kind, is associated with health benefits. Unfiltered (pressed) coffee allows the compound cafestol into your cup. “After five or six cups a day that are unfiltered, the cafestol intake may raise your cholesterol,” says Dr. Rimm. And caffeinated coffee may have risks if you’re on certain medications

Healthy brain aging: No strain, no gain

NOV 2012

To keep your mental skills and memory in tip-top shape, take on new challenges, get out of your comfort zone, and be social.

Use it or lose it: How many times have you heard that timeworn principle of healthy brain aging? Scientists say that living a mentally active life is as important as regular physical exercise. Just as your muscles grow stronger with use, mental exercise keeps your mental skills and memory in tone.

But what kind of exercise is best for the brain? As with physical exercise, are certain kinds of “brain work” more effective than others? For some insight, we spoke to Dr. Anne Fabiny, chief of geriatrics at Cambridge Health Alliance and an assistant professor of medicine at Harvard Medical School.

Any brain exercise is better than being a total mental couch potato. But the activities with the most impact are those that require you to work beyond what is easy and comfortable—just as in physical weight lifting. Playing endless rounds of solitaire and watching the latest documentary marathon on the History Channel may not be enough. “If it’s too easy,” Dr. Fabiny says, “it’s not helping you.”

Be a lifelong learner

You spent the first half of your life building what brain scientists call “cognitive reserve.” That equates with dense networks of connections between brain cells. Experience and learning build and maintain the connectivity.

“Learning new things is really important, because you are using mental skills that you would not otherwise,” Dr. Fabiny says. “When you are actually learning something, you are creating new neural pathways. That’s hugely important.”

As you get older, you want to keep what you have and maintain your neural networks in the best working order.

Strain your brain

Scientists have found that a wide variety of mental activities seem to help preserve our cognitive reserve—from playing board games to juggling. The more challenging tasks can have the most impact.

Think of all “mental activities” as a continuum from watching a TV documentary (passive; mildly challenging) to taking a class to learn how to converse in a new language (active; very challenging). Taking on a challenge like acquiring new language skills can be very difficult, but the benefits are greater, too.

“Don’t just go to the library and learn new things that way,” Dr. Fabiny says. “Be open to new experiences that cause you to see the world and do things differently.”

Get uncomfortable

Being challenged sometimes means being uncomfortable. One stereotype of aging is that young people are bold explorers but older people are timid homebodies who “know what they like.” Stereotype though it may be, it is easy to get in a rut.

“Over time, some people may become less confident, and learning new things becomes scary and intimidating,” Dr. Fabiny says. “Learning seems harder, and it takes longer than it used to. It’s just so easy to stick with what you know.”

Getting out of your comfort zone from time to time challenges your mental skills. It includes things like traveling to a city that you haven’t been to before, which forces you to navigate in unfamiliar surroundings.

“It’s allowing yourself to be open to the world and not starting to make your world smaller than it needs to be,” Dr. Fabiny explains.

Be social

While cocooned in our comfort zones, we run the risk of avoiding unfamiliar people as well as circumstances. The resulting social isolation, aging researchers have discovered, puts people at risk for mental decline. “By isolating socially and mentally, you can lose the reserve you have,” Dr. Fabiny says. “If you are not using those neural networks, they’ll just go away.”

Here’s one antidote: seek a volunteer position that’s a good fit with your skills and abilities, yet allows you to have contact with a variety of people and puts you in new settings and situations.

Aerobic exercise for the body and brain

Healthy brain aging should involve the rest of the body, too. There is abundant evidence that physical activity that gets your pulse thumping helps the mind as well as the heart.

“Aerobic exercise increases oxygen supply to the brain,” Dr. Fabiny says. “The data show that this is at least in part how exercise can potentially stave off cognitive impairment.”

And if that exercise involves mental skill and balance, like racquet sports or golf, it’s even better. As you vanquish your opponents on the court or green, you might also notice an improved ability to keep score in your head.

How to get more from your memory

SEP 2012

Don’t get frustrated by forgetfulness. Use these simple tricks and tips
to boost your ability to learn and remember.

Do you often find yourself marching around the house in a huff, searching for misplaced car keys or eyeglasses? Does the name of someone you just met at a party dangle at the tip of your tongue as you try to remember it?

Such lapses are irritating and may spark anxiety, but do not necessarily mean something is wrong. “There is some normal memory loss with aging,” says Dr. Anne Fabiny, chief of geriatrics at Cambridge Health
Alliance and an assistant professor of medicine at Harvard Medical School. “Forgetting a person’s name is an inconvenience and
an annoyance, but it doesn’t impair your ability to go to a party, navigate socially, and enjoy yourself.”

But you’re not at the mercy of forgetfulness. You can get more from your memory by acknowledging age-related changes and learning how to work around them.

Aging and forgetfulness

As we grow older, the ability to learn new information and recall it declines somewhat. Most people notice it around age 50. One reason for the change is that the rate at which the brain processes information slows down a bit starting in middle age. “You just can’t pull things out of your memory the way you used to at the same speed,” Dr. Fabiny says.

Another possible memory spoiler is medication. Though it is uncommon overall, medications can impair memory. Top offenders include anti-anxiety drugs (tranquilizers) and sedating medications.

A lack of restful sleep can also make you more forgetful. “As you get older, you can’t function cognitively the way that you used to with less sleep,” Dr. Fabiny says.

Forgetfulness can be a serious issue if it’s starting to interfere with daily tasks and routines, such as managing your healthcare, finances, or home life. If you have concerns, ask your doctor if memory testing is indicated.

But if you are well rested and functioning fine, but increasingly forgetful, try these essential tricks and tips to get more from your memory.

Follow a routine: Leave your wallet, keys, mobile phone, glasses, etc., in the same place every day. This makes it a “no brainer” to remember where your belongings are.

Take time: Slow down and pay attention when learning new things. Give the brain’s memory system the time it needs to get the job done.

Do one thing at a time: Multitasking and absentmindedness often go together. If you take on too many mental tasks at once, it overwhelms your memory.

Rehearse names: In conversation, say a person’s name at least once or twice before you part, as in, “It’s been nice talking to you, Tom.” Or silently repeat the name in your head while looking into the person’s eyes.

Learn memorization tricks: Associate a person’s name with a physical feature. For example, “Jim Brown has brown eyes.” Or link it to a vivid image: Imagine Bob bobbing out in the middle of the ocean. Or invent a funny rhyme with the name—the stranger, the better.

Be a better listener: In conversation, really focus on what you are hearing. Use active listening techniques: “So, if I hear you right, what you are saying is…”

Avoid distractions: Noisy or activity-filled environments, like busy public buildings, make it more difficult for a person to understand and take in information. Don’t have important conversations, listen to podcasts or the radio, or read in a noisy, distracting environment.

Circle back: Learning in stages works better than cramming. When learning new information, start with a leisurely skim, then circle back the next day and study the material again closely while jotting down a few notes.

Make a note of it: Write things down in a small pocket notebook instead of assuming that you will remember them later. The act of writing the information down burns the memory deeper into your brain. Pocket audio recorders are also a great way to take notes without having to fish for reading glasses.

Use a digital brain: Transfer some of the demand on your memory to a “digital brain.” The calendar and reminder tools in smartphones or tablets can take on some of the responsibility for the mundane memory tasks that forgetfulness affects.

Create memory cues: Use an object, place, or event to remind you to do something else. The classic example of this memory trick is to put your prescriptions next to your toothbrush. That will remind you to take evening drugs when you brush your teeth before bed and also your morning prescriptions when brushing in the morning.

Do statin drugs impair memory?

For several years, the FDA has received reports of people experiencing memory impairment, confusion, and “fuzzy headedness” while taking cholesterol-lowering statin drugs. In rare cases, people taking a statin have reported the inability to remember anything that happened for the last several hours to a couple of days. The symptoms occurred any time from a day to years after taking the statin, and the FDA did not find links between memory loss and any particular statin drug, the dose, the user’s age, or other medications taken.

The FDA decided in February 2012 to require drug makers to add information to statin labels about mental side effects. In doing so, the agency did not assert that statins caused the side effects—just that the 21 million Americans taking the medications ought to be aware of the reports.

How does it affect you? Research has not yet shown that taking a statin drug definitely affects the mind in harmful ways. In fact, some clinical trials for statin drugs have included checks on mental or “cognitive” function and have found no effect.

The mental symptoms also appear to be rare. “In twenty-five plus years of giving statins to patients, I can only recall two who told me that they noted a clear loss in memory performance on the drugs,” says Dr. Mason Freeman, the founding director of the lipid clinic at Massachusetts General Hospital and a professor of medicine at Harvard Medical School.

The reported memory and mental effects appear to be reversible. As the FDA noted in a “consumer update” about the label change: “In general, the symptoms were not serious and were reversible within a few weeks after the patient stopped using the statin.”

The reports have caused concern among statin users over what may actually be harmless memory slips, says Dr. William Kormos, editor in chief of Harvard Men’s Health Watch. “It’s unlikely that forgetting a name is because of a statin,” Dr. Kormos says. “The reports describe pretty dramatic memory changes.”

The uncertain mental side effects of statins must be weighed against their proven benefits. For people with established heart disease, statins save lives.

If you do notice sudden or unusual changes in your thinking or memory, tell your doctor about it. But don’t suddenly stop taking your statin without good cause. The evidence for the benefit is on a lot firmer ground than the reported cognitive side effects.

This is one of the most important posts I have done. It is an issue of importance to all women. I have been alerting women about this issue over the last few years, so am pleased to see this article  by a number of  eminent professors.   Remember there are many people with vested interests who will not take kindly to this sort of information. They would rather women went along blindly having mammograms without being fully informed about the risks and benefits. For more on this issue look under “Breast-screening – mammograms” on this website.

19 November 2012, 6.10am AEST

Is routine breast cancer screening doing more harm than good?

Public discussion about the risks of over-diagnosis of breast cancer have left some women wondering whether they should take part in the government’s breast screening program.

Let’s take a look at what the evidence says and how women might be enabled to make their own decisions about whether to participate.

Last year Sir Michael Marmot, Professor of Epidemiology and Public Health at University College London, was asked to chair an independent panel to review the benefits and harms of screening mammography in the United Kingdom. The panel focused on the findings from randomised trials, even though most of these trials were carried out a long time ago, in the 1970s and 1980s.

A report on the findings of the review and an accompanying editorial were published in the Lancet late last month. In summary, the report said that screening resulted in an estimated ratio of cases over-diagnosed, to deaths from breast cancer prevented, of 3:1. An over-diagnosed case is one where screening has identified a breast cancer that will never cause harm.

As it is not currently possible to distinguish breast cancer identified through screening which will never cause harm from cancer that will, all breast cancer identified by screening is treated – with surgery and various combinations of radiotherapy, chemotherapy, endocrine and biologic therapies.

A woman treated needlessly will have no way of knowing that her cancer was harmless and that her well-being has been sacrificed, without her knowledge or consent, for the sake of others who may have benefited from screening.

Assessing the benefits of screening

The benefits of screening appear to have been over-estimated.

Advances in treatment have changed the outlook for women with breast cancer so profoundly over the past two decades that the potential for screening to further reduce deaths from breast cancer has been considerably reduced since the original randomised trials were performed.

Furthermore, limiting the estimated benefit to reduced deaths from breast cancer is misleading because radiotherapy after surgery for breast cancer materially increases the risk of dying from heart disease.

The magnitude of overdiagnosis has also been underestimated. An estimate of overdiagnosis from Australia – adjusted for confounders and lead time and assuming 60% of invited women attend – found an over-diagnosis rate of 30% to 40% depending on the expected incidence without screening, rather than the 19% in the Lancet report.

The Nordic Cochrane Center review of screening mammography has estimated the ratio of cases over-diagnosed to deaths from breast cancer prevented at 10:1. Our estimate of the ratio in Australia, using a lower estimate of deaths prevented due to the impact of improved treatment and the higher rate of over-diagnosis, is closer to 15:1.

The clear message is that over-diagnosis exists, it happens regularly as part of the screening process and women need to understand this.

An informed decision

When an asymptomatic woman requests screening mammography through her doctor or when a doctor recommends that an asymptomatic woman be screened, the doctor has a responsibility to inform her about the potential harms and benefits so she can decide whether she will have the mammogram in the context of her situation and preferences.

But when a woman receives an invitation for screening from a government body that makes little or no reference to screening-related harm, she may reasonably expect that that there is no real likelihood of harm. It could be argued that the weight of responsibility for full and frank disclosure of risks and benefits is even greater when the invitation comes from a trusted government agency that has been historically responsible for promoting screening.

It’s time to review the routine invitation for screening to all women aged 50 to 69 years.

The proportion of women in the invited age group who currently attend for screening in Australia is between 50% and 60% so not all women currently respond to the invitation by attending.

Stopping the routine invitation for screening would not prevent women being screened. Women with a high risk of cancer – those with a family or personal history of breast cancer – should still be screened. There may be others who should consider screening because they have a combination of less powerful risk factors which might put them at above average risk.

Other women, not at above-average risk, could request screening if this is what they want.

If women elect not to be screened and only enter the medical system when a clinical problem presents itself, they can be reassured that they will have the benefit of the recent improvements in breast cancer treatment.

Next steps

Government should undertake a review of the invitation for screening. But this will take time.

For the time being, it is imperative that all women be provided with comprehensive information about the disadvantages as well as the advantages of mammographic screening. The pamphlet produced by the Nordic Cochrane Center, which presents the information in terms of the impact of screening on absolute risks and benefits, would make an excellent model.

But a pamphlet alone is insufficient. Given the risks, each woman must be given the opportunity to discuss her options and decide what is best for her, with those who are in a position to provide accurate and helpful advice.

Can exercise and weight loss help to prevent breast cancer?

Many women dread their mammograms and self exams, worrying that they may find a lump, but those women who have had breast cancer live with an even darker umbrella over their heads: their cancer could come back.  Breast cancer is a sneaky disease that comes in 50 shades of pink, black and gray! While patients are told to have chemotherapy, radiation and take a pill for 5 years, these measures are not guarantees. Many of us know women who have had their cancer come back 2 years, 5 years, 10 years or even 20 years later.  And they did everything they were told to.

But we are starting to understand how important weight loss is for keeping cancer in remission.  A recent study out of Albert Einstein College of Medicine shows that being overweight gives women — especially those with hormone-sensitive tumors — a higher risk of cancer recurrence and makes them more likely to die from cancer.
The good news is that increasing evidence shows weight loss and regular exercise can significantly decrease the risk of breast cancer coming back and the risk of dying of the disease.  Weight loss and regular exercise (or either one of them) also reduces risk for heart disease, diabetes, and other cancers as well.  The exact mechanism of how it works is still unclear. We don’t know whether weight loss decreases the amount of fat that can be converted to estrogen to stimulate a cancer or whether it is a matter of modulating insulin levels.

What’s interesting is that for years women have told me that they were instructed to eat whatever made them feel good and that it didn’t make a difference in their cancer no matter what they ate.  Others were told not to get too thin because it would make people think that they were sick and that the cancer had come back.  Instead, they were offered doughnuts and candy during their chemotherapy sessions.

Only recently have oncology programs started truly involving a nutritionist on their staff and including a diet plan for their patients. A recent study out of Italy shows that gaining weight is not an inevitable side effect of chemotherapy and that when offered cooking classes and shopping plans, women do lose weight and inches!  Physical rehabilitation programs are being mandated for many chronic diseases, including cancer.  That means more than physical therapy post-surgery; it means instruction in physical exercise.  Patients are being given pedometers with instructions to keep track of their steps or putting their readings into an app.  Some programs are including individualized nutrition programs.  Perhaps someday there will even be treadmills or elliptical machines in the waiting rooms!

As I wrote a few weeks ago, the jury is still out about what works better for weight loss — diet or exercise — but we know that in breast cancer both are important!  And weight loss can provide a double whammy:  feeling good about yourself and living longer! We have written many articles about weight loss, diet and exercise. For more information, start with our natural weight loss article.

References

Sparano, JA, et al. 2012. Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer. Cancer. URL: http://www.ncbi.nlm.nih.gov/pubmed/22926690.

Villarini, A, et al. 2012. Preventing weight gain during adjuvant chemotherapy for breast cancer: a dietary intervention study. Breast Cancer Res Treatment, 135(2), 581-9. URL: http://www.ncbi.nlm.nih.gov/pubmed/22869285.