Monthly Archives: September 2014

Age Spots Bothering You?

Dr. Weil on Women’s Health.

Age Spots Bothering You?

If you are noticing brown spots on your skin – up to an inch in diameter – you may have solar lentigos. These “age spots” are the result of years of sun exposure. Typically, they appear on the chest, face, or the back of the hands – areas of the skin that have been most exposed to the sun throughout your lifetime.

The best ways to prevent age spots are to avoid sun exposure, especially sunbathing, and use sunscreen regularly (SPF 15 or higher). However, this won’t help get rid of age spots you may already have.

To reduce the appearance of age spots over time, see your physician or dermatologist. He or she can recommend a prescription or over-the-counter skin cream containing alpha-hydroxy or retinoic acid. If you use these, be diligent about applying sunscreen, since these creams can increase your skin’s sensitivity to the sun’s rays. Laser treatment is also an option; while this approach is more costly, it does offer immediate results.Even if your age spots are not a concern, it is advisable to see a dermatologist about them. Occasionally, what appear to be age spots are identified as precancerous lesions that should be removed for medical rather than cosmetic reasons

Yoga for managing knee osteoarthritis in older women

This study showed the benefits of yoga on knee osteoarthritis in particular and most likely osteoarthritis generally. It also had a positive effect on sleep.

Yoga for managing knee osteoarthritis in older women: a pilot randomized controlled trial Full Text
BMC Complementary and Alternative Medicine, 05/19/2014  Clinical Article

Cheung C, et al. – This study’s aims were to assess the feasibility and potential efficacy of a Hatha yoga exercise program in managing osteoarthritis (OA)–related symptoms in older women with knee OA. A weekly yoga program with home practice is feasible, acceptable, and safe for older women with knee OA, and shows therapeutic benefits.

Methods

  • Eligible participants (N = 36; mean age 72 years) were randomly assigned to 8-week yoga program involving group and home-based sessions or wait-list control.
  • The yoga intervention program was developed by a group of yoga experts (N = 5).
  • The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score that measures knee OA pain, stiffness, and function at 8 weeks.
  • The secondary outcomes, physical function of the lower extremities, body mass index (BMI), quality of sleep (QOS), and quality of life (QOL), were measured using weight, height, the short physical performance battery (SPPB), the Pittsburgh Sleep Quality Index (PSQI), the Cantril Self-Anchoring Ladder, and the SF12v2 Health Survey.
  • Data were collected at baseline, 4 weeks and 8 weeks, and 20 weeks.

Results

  • The recruitment target was met, with study retention at 95%.
  • Based on ANCOVAs, participants in the treatment group exhibited significantly greater improvement in WOMAC pain (adjusted means [SE]) (8.3[.67], 5.8[.67]; p = .01), stiffness (4.7[.28], 3.4[.28]; p = .002) and SPPB (repeated chair stands) (2.0[.23], 2.8[.23]; p = .03) at 8 weeks.
  • Significant treatment and time effects were seen in WOMAC pain (7.0 [.46], 5.4[.54]; p = .03), function (24.5[1.8], 19.9[1.6]; p = .01) and total scores (35.4[2.3], 28.6[2.1]; p = .01) from 4 to 20 weeks.
  • Sleep disturbance was improved but the PSQI total score declined significantly at 20 weeks.
  • Changes in BMI and QOL were not significant.
  • No yoga related adverse events were observed.

Caffeine and menopausal symptoms: what is the association?

This is bad news for those coffee lovers out there. Caffeine makes your hot flushes worse!
Menopause. 2014 Jul 21. [Epub ahead of print]

Caffeine and menopausal symptoms: what is the association?

Abstract

OBJECTIVE:

We assessed the association between caffeine intake and menopausal symptom bother, particularly vasomotor symptoms.

METHODS:

A cross-sectional survey was conducted using the Menopause Health Questionnaire, which is a comprehensive survey of menopause-related health information. Questionnaires were completed by 2,507 consecutive women who presented with menopausal concerns at the Women’s Health Clinic at Mayo Clinic (Rochester, MN) between July 25, 2005 and July 25, 2011. Data from 1,806 women who met all inclusion criteria were analyzed. Menopausal symptom ratings were compared between women who used caffeine and women who did not use caffeine using two-sample t test and analysis of covariance, with smoking and menopause status included as covariates. In all cases, two-tailed P < 0.05 was considered statistically significant.

RESULTS:

Caffeine use was positively associated with mean (SD) vasomotor symptom scores (2.30 [0.91] vs 2.15 [0.94], P = 0.011). This finding remained significant after adjustment for menopause status and cigarette smoking (P = 0.027).

CONCLUSIONS:

Caffeine use is associated with greater vasomotor symptom bother in postmenopausal women

Love problems? There’s a pill for that, but Plato offers a wiser cure

24 May 2014, 7.38am AEST

Love problems? There’s a pill for that, but Plato offers a wiser cure

We take pills and potions for everything from a bad back to depression. Why shouldn’t we adopt the same approach to love and the miseries it may cause? Oxford ethicist Brian Earp has proposed that we should…

The ancient philosophers knew the perils of expecting other people to complete us emotionally. Candybox Images/Shutterstock

We take pills and potions for everything from a bad back to depression. Why shouldn’t we adopt the same approach to love and the miseries it may cause? Oxford ethicist Brian Earp has proposed that we should.

Is pill-popping the best way to ensure we stay in love with our long-term partner? Is it right to artificially maintain the emotions of the first flurry of love? Should we also pop a pill to try to fall out of love in order to end an abusive relationship?

In addition to these modern answers to ancient questions, there may also be some useful ancient answers. After all, Greek mythology abounds with stories of powerful emotions causing problems for gods and mortals alike.

The ancient Greek philosophers had a lot to say about the proper way to love. They generally agreed that we should attempt to control the passions, those strong emotions that disturb the tranquillity of the soul. The Ancients generally speak of passionate love as a miserable condition, a state that no-one in their right (rational) mind would wish to suffer. Such violent emotions are dangerous because they distract us from our true purpose in life which is, according to Plato, the search for wisdom.

Likewise, the Stoics refer to the tranquil Sage who cannot be harmed by any external turn of fate and finds happiness within. In common with many Eastern traditions, such as Buddhism, the Stoics argued that romantic love involves a false judgement about the worthiness of the beloved, a false judgement that can only lead to disillusionment and bitterness.

This might seem like a recipe for a bleak loveless world. In reality it merely reminds us of the perils of expecting other people to complete us emotionally. On this account, we can still love, just not to excess.

These ideas may sound strange to a culture that extols the virtues of intoxicating and transformative romantic love (just look at how popular the romcom is). Yet this is a culture in which about four in ten marriages, most of them begun in the heady excesses of romantic love, end in divorce. Maybe a little Stoicism is in order.

Advice for the lovelorn

Roman poet Ovid (c.43BC-17AD) offers a therapeutic approach for treating love. His poem Remedies for Love states that curing love can lead once more to happiness but you have to really want to change or, as he says:

Give up all tragic, sinister passions.

Ovid’s therapeutic agenda is made clear when he writes:

My aim is practical: it is to extinguish cruel flames, and from love’s fetters to free the captive heart.

Ovid does distinguish between healthy and unhealthy love. One is natural and reasonable, the other pathologically obsessive, idealised, unrealistic and destructive in its irrationality. The second kind is more interesting, so poets generally have more to say about it.

Ovid’s advice? Run! Free the heart from love’s torment. Wikimedia Commomns, CC BY

Obsessive love is insatiable. It never leads to satisfaction or contentment. Sexual fulfilment is temporary and doesn’t satisfy the love-desire itself.

From this we get the notion that love is blind – it is not the good we actually seek. We only think it is good; yet it is an imperfect copy of the form of the good – wisdom itself.

Ovid’s advice for the lovelorn includes nipping the relationship in the bud, as if someone becomes so intoxicated with the Dionysian frenzy of love, they will not hear reason. In this case you must wait until it has burnt itself out.

His other cures also sound quite modern. Ovid suggests you occupy your mind with other thoughts, work and find something else to do. Don’t think about or obsess over the beloved.

If this still isn’t working, run away! Travel! Despite the bonds that hold you back, he says:

Go on a long journey … force your reluctant feet to run.

Don’t just sit and weep in solitude, Ovid counsels. Find some good company and always avoid gossip and mud-slinging – which is always good advice. Finally, stay clear of love-sick people or romantic stories that’ll just stir up all those bothersome feelings again.

How is philosophy meant to help?

Good philosophy is therapeutic. The Ancient Greek philosophers such as Plato and the Stoics would probably claim that seeking to fulfil lack with chemical substances is delusional. Firstly, we will always need more and, secondly, that kind of lack can never be satisfied through material or sensual or chemical means.

They would suggest that it is the mind that can overcome this desperate search by finding fulfilment in a rational and pragmatic approach to relationships, or through a more universal form of love

Hormones and depression in women.

Professor John Studd DSc, MD, FRCOG was consultant gynaecologist at the Chelsea & Westminster Hospital, London and also professor of gynaecology at Imperial College.

He is now in fulltime private practice and runs the London PMS & Menopause Clinic at 46 Wimpole Street London W1G8SD. At the same address he has The Osteoporosis Screening Centre for the assessment and treatment of osteoporosis.

He is Vice-President of the National Osteoporosis Society and Chairman of the British Menopause Society.

In 2008 he was awarded the Blair Bell Gold Medal of the Royal Society of Medicine which is given every five years for the obstetrician/gynaecologist who has made the greatest lifetime contribution to the specialty.

This is someone who knows what he is talking about.

Climacteric. 2014 Jul 21:1-3. [Epub ahead of print]

Personal view: hormones and depression in women.

Abstract

Depression is more common in women, occurring at times of hormonal fluctuations as premenstrual depression, postnatal depression and perimenopausal depression. These are all related to changes in hormone levels and constitute the diagnosis of reproductive depression. There is a risk that severe premenstrual depression can be misdiagnosed as bipolar disorder and that women will be started on inappropriate antidepressants or mood-stabilizing therapy. The most effective treatment for severe premenstrual syndrome is by suppression of ovulation and suppression of the cyclical hormonal changes by transdermal estrogens or by GnRH analogs. Postnatal depression is more common in women with a history of premenstrual depression and also responds to transdermal estrogens. Transdermal testosterone gel can be also used in women who suffer loss of energy and loss of libido which may be due to the inappropriate prescription of antidepressants. There is also a role for the Mirena IUS and laparoscopic hysterectomy and oophorectomy in women who are progestogen-intolerant. The hormonal causation of certain common types of depression in women and the successful treatment by estrogens should be understood by psychiatrists and gynecologists.

Effects of testosterone on visuospatial function and verbal fluency in postmenopausal women

I have mentioned the many benefits of testosterone for older women – prevents dementia, reduces breast cancer risk, prevents osteoporosis. Oh, and it also is good for your libido.  Here is a further study revealing the benefits of testosterone for women.

 

Menopause. 2014 Apr;21(4):410-4. doi: 10.1097/GME.0b013e3182a065ed.

Effects of testosterone on visuospatial function and verbal fluency in postmenopausal women: results from a functional magnetic resonance imaging pilot study.

Abstract

OBJECTIVE:

This study aims to investigate the effects of testosterone on cognitive performance during functional magnetic resonance imaging (fMRI) in healthy estrogen-treated postmenopausal women.

METHODS:

This was an open-label study in which postmenopausal women on nonoral estrogen therapy were treated with transdermal testosterone for 26 weeks. Women performed tests of verbal fluency (number of words) and mental rotation (reaction time and accuracy) during pretreatment and posttreatment fMRI. Blood oxygen level-dependent (BOLD) signal intensity was measured during fMRI tasks.

RESULTS:

Nine women with a mean (SD) age of 55.4 (3.8) years completed the study. Twenty-six weeks of testosterone therapy was associated with significant decreases in BOLD intensity during the mental rotation task in the right superior parietal, left inferior parietal, and left precuneus regions, and during the verbal fluency task in the left inferior frontal gyrus, left lingual gyrus, and medial frontal gyrus (all P < 0.05), with no change in task performance, accuracy, or speed.

CONCLUSIONS:

Testosterone therapy is associated with reduced BOLD signal activation in key anatomical areas during fMRI verbal fluency and visuospatial tasks in healthy estrogen-treated postmenopausal women.

Our interpretation is that testosterone therapy facilitates preservation of cognitive function with less neuronal recruitment.

How gut bacteria regulate weight gain

 We keep coming back to this theme, that the bacteria in our stomachs are very important to our health. Excessive cleanliness and Hygiene actually harms our bodies.

Cork researchers further understanding of how gut bacteria regulate weight gain
Science Foundation Ireland News, 05/19/2014

Researchers at the Alimentary Pharmabiotic Centre in University College Cork have discovered how gut bacteria communicate with their host to specifically regulate weight gain and serum cholesterol levels. The research, funded by Science Foundation Ireland, has implications for the rational selection and design of probiotics for the control of obesity, high cholesterol and diabetes. The findings are published this week in the Proceedings of the National Academy of Sciences USA. The team led by Dr. Cormac Gahan and Dr. Susan Joyce has analysed a bacterial protein that modifies bile acids (a major component of bile secretions) in the gut. This protein, bile salt hydrolase, is commonly made by gut bacteria and functions to change the chemical properties of bile acids in the gut. The research team has shown that specifically increasing levels of this protein reduces serum cholesterol levels and weight gain in mice. The group are currently exploring the relevance of these findings to humans. “Recent work by other groups has shown that bile acids act as signalling molecules in the host, almost like a hormonal network, with an ability to influence host metabolism. What we have done is to show that a specific mechanism exists by which bacteria in the gut can influence this process with significant consequences for the host,” commented Dr Gahan.

Diet and breast cancer

Public Health Nutr. 2014 May;17(5):1098-106. doi: 10.1017/S1368980013001018. Epub 2013 May 7.

Dietary patterns and breast cancer risk among women.

Abstract

OBJECTIVE:

Breast cancer is the most common type of cancer in women worldwide. Several studies have examined the role of single nutrients and food groups in breast cancer pathogenesis but fewer investigations have addressed the role of dietary patterns. Our main objective was to identify the relationship between major dietary patterns and breast cancer risk among Iranian women.

DESIGN:

Hospital-based case-control study.

SETTING:

Shohada Teaching Hospital, Tehran, Iran.

SUBJECTS:

Overall, 100 female patients aged 30-65 years with breast cancer and 174 female hospital controls were included in the present study. Dietary intake was assessed using a valid and reliable semi-quantitative FFQ consisting of 168 food items.

RESULTS:

Two dietary patterns were identified explaining 24·31 % of dietary variation in the study population. The ‘healthy’ food pattern was characterized by the consumption of vegetables, fruits, low-fat dairy products, legumes, olive and vegetable oils, fish, condiments, organ meat, poultry, pickles, soya and whole grains; while the ‘unhealthy’ food pattern was characterized by the consumption of soft drinks, sugars, tea and coffee, French fries and potato chips, salt, sweets and desserts, hydrogenated fats, nuts, industrial juice, refined grains, and red and processed meat. Compared with the lowest tertile, women in the highest tertile of the ‘healthy’ dietary pattern score had 75 % decreased risk of breast cancer (OR = 0·25, 95 % CI 0·08, 0·78), whereas women in the highest tertile of the ‘unhealthy’ dietary pattern had a significantly increased breast cancer risk (OR = 7·78, 95 % CI 2·31, 26·22).

CONCLUSIONS:

A healthy dietary pattern may be negatively associated with breast cancer risk, while an unhealthy dietary pattern is likely to increase the risk among Iranian women

Stem cell timeline: The history of a medical sensation

Stem cell timeline: The history of a medical sensation

Stem cells are the cellular putty from which all tissues of the body are made. Ever since human embryonic stem cells were first grown in the lab, researchers have dreamed of using them to repair damaged tissue or create new organs, but such medical uses have also attracted controversy. Yesterday, the potential of stem cells to revolutionise medicine got a huge boost with news of an ultra-versatile kind of stem cell from adult mouse cells using a remarkably simple methodMovie Camera. This timeline takes you through the ups and downs of the stem cell rollercoaster.

1981, Mouse beginnings
Martin Evans of Cardiff University, UK, then at the University of Cambridge, is first to identify embryonic stem cells – in mice.

1997, Dolly the sheep
Ian Wilmut and his colleagues at the Roslin Institute, Edinburgh unveil Dolly the sheep, the first artificial animal clone. The process involves fusing a sheep egg with an udder cell and implanting the resulting hybrids into a surrogate mother sheep. Researchers speculate that similar hybrids made by fusing human embryonic stem cells with adult cells from a particular person could be used to create genetically matched tissue and organs.

1998, Stem cells go human
James Thomson of the University of Wisconsin in Madison and John Gearhart of Johns Hopkins University in Baltimore, respectively, isolate human embryonic stem cells and grow them in the lab.

2001, Bush controversy
US president George W. Bush limits federal funding of research on human embryonic stem cells because a human embryo is destroyed in the process. But Bush does allow continued research on human embryonic stem cells lines that were created before the restrictions were announced.

2005, Fraudulent clones
Woo Suk Hwang of Seoul National University in South Korea reports that his team has used therapeutic cloning – a technique inspired by the one used to create Dolly – to create human embryonic stem cells genetically matched to specific people. Later that year, his claims turn out to be false.

2006, Cells reprogrammed
Shinya Yamanaka of Kyoto University in Japan reveals a way of making embryonic-like cells from adult cells – avoiding the need to destroy an embryo. His team reprograms ordinary adult cells by inserting four key genes – forming “induced pluripotent stem cells”.

2007, Nobel prize
Evans shares the Nobel prize for medicine with Mario Capecchi and Oliver Smithies for work on genetics and embryonic stem cells.

2009, Obama-power
President Barack Obama lifts 2001 restrictions on federal funding for human embryonic stem cell research.

2010, Spinal injury
A person with spinal injury becomes the first to receive a medical treatment derived from human embryonic stem cells as part of a trial by Geron of Menlo Park, California, a pioneering company for human embryonic stem cell therapies.

2012, Blindness treated
Human embryonic stem cells show medical promise in a treatment that eases blindness.

2012, Another Nobel
Yamanaka wins a Nobel prize for creating induced pluripotent stem cells, which he shares with John Gurdon of the University of Cambridge.

2013, Therapeutic cloning
Shoukhrat Mitalipov at the Oregon National Primate Research Center in Beaverton and his colleagues produce human embryonic stem cells using therapeutic cloning – the breakthrough falsely claimed in 2005.

2014, Pre-embyronic state
Charles Vacanti of Harvard Medical School together with Haruko Obokata at the Riken Center for Developmental Biology in Kobe, Japan, and colleagues announced a revolutionary discovery that any cell can potentially be rewound to a pre-embryonic stateMovie Camera – using a simple, 30-minute technique.

2014, Human trials
Masayo Takahashi at the same Riken centre is due to select patients for what promises to be the world’s first trial of a therapy based on induced pluripotent stem cells, to treat a form of age-related blindness.

Effects of acupuncture and Chinese herbal medicine (Zhi Mu 14) on hot flushes and quality of life in postmenopausal women

This study shows that hormones are not the only way to treat menopause. However, if Chinese Herbal Medicine is used, it must be by someone who is skilled in this form of treatment.
Menopause. 2014 Jan;21(1):15-24. doi: 10.1097/GME.0b013e31829374e8.

Effects of acupuncture and Chinese herbal medicine (Zhi Mu 14) on hot flushes and quality of life in postmenopausal women: results of a four-arm randomized controlled pilot trial.

Abstract

OBJECTIVE:

The aim of this study was to evaluate the feasibility of a clinical trial investigating the effects of acupuncture (AP) and Chinese herbal medicine (CHM) on hot flushes and quality of life in postmenopausal women.

METHODS:

Forty postmenopausal women reporting at least 20 hot flushes per week were enrolled in a randomized controlled trial. They were randomly allocated to receive traditional Chinese medicine (TCM) AP, sham AP, verum CHM, or placebo CHM for 12 weeks. Follow-up assessment was conducted 12 weeks after intervention. Primary outcome measures included hot flush frequency and severity. As a secondary outcome measure, the severity of menopausal symptoms was assessed using the Menopause Rating Scale (MRS) II.

RESULTS:

TCM AP induced a significant decline in all outcome measures from pretreatment to posttreatment compared with sham AP (hot flush frequency, P = 0.016; hot flush severity, P = 0.013; MRS, P < 0.001). In the TCM AP group, a larger decrease in MRS scores persisted from pretreatment to follow-up (P = 0.048). No significant differences were noted between the verum CHM group and the placebo CHM group. Compared with the verum CHM group, there was a significant decrease in MRS scores (P = 0.002) and a trend toward a stronger decrease in hot flush severity (P = 0.06) in the TCM AP group from pretreatment to posttreatment.

CONCLUSIONS:

TCM AP is superior to sham AP and verum CHM in reducing menopausal symptoms, whereas verum CHM shows no significant improvements when compared with placebo CHM.