Why Kirsty Lang is going back on HRT… despite the risk of her breast cancer returning | Daily Mail Online

I had been on hormone replacement therapy for four years when I was diagnosed with breast cancer aged 53.

After the surgeon delivered this shattering news, my first question to him was: ‘Was the HRT to blame?’ I felt guilty, thinking that I had put the happiness of my entire family at risk. My maternal grandmother had died of breast cancer at a similar age, so I was already at an increased risk. I’d also read around the subject, so was aware that extra hormones in the bloodstream was linked to the growth of breast tumours. On the other hand, my mother had been on HRT for decades and is a living, breathing advert for the benefits. The surgeon paused. ‘Unlikely. There will be multiple other factors, but the HRT would have acted like a fertiliser on the tumour.’

With that, I went home and threw my oestrogen patches and progesterone pills into the bin.

But now, after chemotherapy, radiotherapy and a lumpectomy to remove the tumour, I am preparing to go back on HRT. Am I crazy? Not necessarily.

I’ve spent the past few months weighing up the risks to my health versus quality of life, based on the latest evidence and scientific facts.

Despite many doctors’ warnings against taking hormone therapies if you’ve a history of cancer, some leading oncologists say HRT should be an option for all cancer sufferers.

In fact, I’ve learned that the daily dose of progesterone and oestrogen that makes me feel ‘me’ again may even help me to live a longer, healthier life.

I shiver, I’m tired, I’m achy and stiff … gremlins have invaded my body

As my tumour was fast-growing, I was immediately put on a drug called Letrozole as I waited for surgery to remove the tumour. The drug is given to post-menopausal women with this type of early-stage breast cancer as it blocks the production of oestrogen in your body.

Ms Lang, pictured with GP Louise Newsome, right, who specialises in menopausal woman, saw her libido disappear after being thrown back into ‘an unbearable menopause nightmare’ during her breast cancer treatment 

Very soon, I was waking up several times a night drenched in sweat. My emotions were all over the place. I was anxious, tearful, fuzzy-brained, constantly tired and my joints were achy and stiff.

My libido had all but disappeared. It was like being turbo-charged back into an unbearable menopause nightmare. But I put up with it because I figured it was better than dying. Now, three years on, having been told there’s a 95 per cent chance my cancer won’t return, I’m still struggling.

Sometimes I feel like my internal thermostat has been taken over by vicious gremlins.

I alternate on an hourly basis between being so hot that my entire body is covered in sweat, to shivering with feverish cold.

I can only tolerate wearing natural fibres as artificial ones make me sweat and I’m constantly contending with the damp sticky feeling you get after a run.

I burst into tears at inappropriate moments which can be very embarrassing if it happens in a professional setting.

I’ve tried everything; acupuncture, evening primrose oil, electric fans, giving up coffee and alcohol.

My GP prescribed anti-depressants which helped a little, but they don’t make the symptoms go away.

Nothing is as powerful as HRT.

The studies to predict risk are flawed

Many British GPs won’t prescribe HRT because they are ill-informed about the risks and wary that patients may sue them if they get cancer. But according to much of the research and leading experts, including eminent American oncologist, Dr Avrum Bluming, HRT should indeed be an option for cancer sufferers. So where does this fear come from?

Being overweight is much more of a risk of developing breast cancer than taking HRT

In Dr Bluming’s book Oestrogen Matters, he argues that the design of the studies looking at the cancer risks of HRT are fundamentally flawed. One of the studies he investigates is the widely cited 2002 Women’s Health Initiative study in the US. The average age of the women taking part in this research was 63, meaning results didn’t reflect the risks for women in their 50s, when most experience menopause. Nearly 70 per cent were overweight and half were current or past smokers, two major risk factors for breast cancer.

Other studies do show that some hormone therapies can increase the risk of developing certain types of breast cancer in a cohort of post-menopausal women. However, the risk is very low, the same seen in drinkers and the overweight.

Consultant gynaecologist Charlotte Fleming is one of the leading experts on menopause in the UK. She says the way in which risks are explained to patients is ‘critical’. Fleming’s method of explanation is a visual aid; a picture with dots on.

She tells me: ‘Out of 1,000 women, 22 will get breast cancer over the course of five years. They appear as black dots on my chart. If the same 1,000 women take HRT, another five to six will develop it, so I put five green dots on the chart. It’s an increased risk but it’s quite small. If they have a glass of red wine a day, that’s another two dots. If their BMI exceeds 30, then you add another 22 dots to the chart.

‘Being overweight is much more of a risk than taking HRT’.

But what if you’ve had breast cancer?

As a breast cancer survivor, I’m in a different category altogether. No doctor can tell me exactly what my risk factors are. There may be endless reasons why I developed breast cancer, including family history, alcohol consumption, diet and exercise factors and my genetics.

Any of these factors may interact uniquely with HRT to cause a change in my cells. Or, they may have no effect whatsoever.

The problem is there are no randomised trials of breast cancer patients on HRT, the gold standard of scientific studies.

According to Ms Lang, without HRT it feels like her body’s thermostat has been taken over by vicious gremlins

A 2015 review of the available scientific literature by researchers at the MD Anderson Centre in Texas concluded: ‘Limited and conflicting evidence exists regarding the risks associated with the use of HRT in breast cancer populations.’

In fact, many specialists now agree that it is safe for women who have had early-stage breast cancer to take HRT providing they are on Tamoxifen. It is thought that this drug, which blocks oestrogen from reaching the cancer cells, interacts with the HRT in such a way that it counter-acts any potential cancer-causing affects.

taking HRT if you are on breast cancer drug Letrozole because the treatment blocks oestrogen completely.

Similarly, other studies show that topical oestrogen gels or patches – rather than tablets – can effectively alleviate the symptoms without increasing the risk of recurrence.

Last autumn, I attended a conference on breast cancer at the Royal Society in London at which Dr Bluming was speaking. I approached him after the lecture and asked if I should consider going back on HRT. He said: ‘Well, both my wife and my daughter have had breast cancer and they’re on HRT, I would suggest talking this through with your doctor.’

My doctor, consultant breast surgeon Professor Jayant Vaidya of University College London, remains equivocal. ‘It’s not black and white that taking HRT will worsen your chances [of getting cancer],’ he says, ‘but it’s not black and white that it won’t. We need more research.’ He does, however, have a ‘small cohort’ of patients on HRT. It is necessary, he says, given that their lives were hell without it.

Another role for HRT…Protection from disease

According to the current life expectancy for British breast cancer survivors, I could live one third of my life without the protection of oestrogen. This means that as I grow older, I will be at serious risk of osteoporosis (oestrogen protects the bones), cardiovascular disease and cognitive decline. Oestrogen is also important in stabilising mood, potentially warding off depression.

Studies show that women under 60 who take HRT for five years have less thickening of artery walls than those who don’t take the pills, slashing their risk of heart attack.

And a 2018 randomised, controlled trial published in the journal Neurology found that women taking combined HRT for seven years had lower accumulations of amyloid plaques – associated with the onset of dementia.

GP Dr Louise Newson, who specialises in menopausal health including HRT, has been astounded by the profound affect of HRT on her patients’ health.

Which type of HRT has the lowest risk of cancer?  

Hormone replacement therapy (HRT) replaces oestrogen, levels of which plummet at the menopause, triggering night sweats, vaginal dryness, headaches, low mood, reduced sex drive and hot flushes.

Most women take combined HRT, which contains synthetic versions of oestrogen and the hormone progesterone, because taking oestrogen alone has been seen to increase the risk of womb cancer. Combined HRT can be taken every day without a break or in cycles.

Oestrogen is taken continuously and supplemented with progesterone every few weeks. Those who have had a hysterectomy can take oestrogen-only HRT.

Tablets, skin patches, gels, implants and vaginal creams, pessaries and rings are all available. Topical treatments, such as gels, patches and creams, are associated with a lower risk of cancer.

Non-hormonal options include tibolone (livial), which is similar to combined HRT and is particularly useful for women with endometriosis.

The blood-pressure drug clonidine and some anti-depressants can also ease hot flushes and night sweats.

I made an appointment at her practice, The Newson Health Clinic, in Stratford-Upon-Avon. It offers a holistic approach to menopause including yoga classes, nutritional advice and, of course, HRT. ‘What you don’t read about in the media is the increased risk of osteoporosis, dementia, strokes and heart disease that comes from NOT having enough oestrogen,’ she warns. ‘Those women you see thriving on the golf course in their 70s and 80s are probably on HRT. My oldest patient is 93 and she takes a low dose of oestrogen gel twice a week.’

So widely accepted are the benefits that 89 per cent of women’s health experts would themselves take HRT, according to a recent survey from the Royal College of Gynaecologists and Obstetricians.

Sitting in Dr Newson’s waiting room, I was struck by the distance some women had travelled to get there. One had flown in from Inverness. There’s a large box of tissues on her desk because patients often break down in tears describing their symptoms. Many have lost jobs and partners. ‘Most women I talk to haven’t had sex for at least two years,’ she tells me. ‘Their vaginal dryness is so bad, they can’t wear trousers or even sit down.’

And Dr Fleming’s patients are so crippled by depressive symptoms that they become agoraphobic – unable to leave the house.

It’s worth noting that the suicide rate for 51- to 54-year-old menopausal women is higher than in any other age group. For some women, HRT really can be life-saving.

So, given my medical history, would Dr Newson write me a prescription? ‘In your case, I would start with a very small amount of oestrogen and see how you feel. We have to start treating women holistically, and that means not just looking at the cancer risk but their quality of life.’

I leave with a pack of oestrogen gel and progesterone tablets. I’ve decided to give it a go for three months. If my symptoms disappear, I’ll continue. If they don’t I will conclude that it’s not worth the increased risk. Statistically, my symptoms could last for up to 20 years. I don’t think I can face that.

Health check: will eating nuts make you gain weight?

February 18, 2019 1.31pm AEDT Nuts contain “good” fats. From shutterstock.com

Authors

1. Elizabeth Neale Career Development Fellow (Lecturer), University of Wollongong
2. Sze-Yen Tan Senior Lecturer in Nutrition Science, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University
3. Yasmine Probst Senior lecturer, School of Medicine, University of Wollongong

Disclosure statement

Elizabeth Neale receives funding from Nuts for Life, California Walnut Commission, International Nut and Dried Fruit Council, and the Illawarra Health and Medical Research Institute. She is affiliated with the University of Wollongong and the Illawarra Health and Medical Research Institute

Sze-Yen Tan was involved in clinical studies that were funded by the Almond Board of California and Californian Walnut Commission.

Yasmine Probst receives funding from the NSW Ministry of Health, Australian Eggs, Nuts for Life, Illawarra Health and Medical Research Institute and the University of Wollongong Health Impacts Research Cluster. She is affiliated with the University of Wollongong and the Illawarra Health and Medical Research Institute.

Partners

Victoria State Government provides funding as a strategic partner of The Conversation AU.

The Australian Dietary Guidelines recommend we eat 30g of nuts – a small handful – each day. But many of us know nuts are high in calories and fat.

So should we be eating nuts or will they make us gain weight?

In short, the answer is yes, we should eat them, and no, they won’t make us gain weight if eaten in moderate amounts. The fats in nuts are mostly the “good” fats. And aside from that, our bodies don’t actually absorb all the fat found in nuts. But we do absorb the nutrients they provide.

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Read more: Five food mistakes to avoid if you’re trying to lose weight

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Dietary fat: friend or foe?

Nuts do contain fat, and the amount of fat varies between nut types. For example, a 30g serving of raw cashews or pistachios contains around 15g of fat, whereas the same amount of raw macadamias contains around 22g of fat.

There are different kinds of fats in our diet and some are better for us than others. Nuts contain mainly monounsaturated and polyunsaturated fats. These types of fats are known as “good fats”. They can help lower cholesterol when we eat them in place of saturated fats.

The type of fats present varies between nuts. For example, walnuts are rich in polyunsaturated fats, whereas other types of nuts such as hazelnuts and macadamias have more monounsaturated fat.

What the evidence says

Even if the type of fat in nuts is good for us, they are still high in fat and calories. But this doesn’t mean we should be avoiding them to manage our weight.

Studies that looked at people’s eating habits and body weight over a long period have found people who regularly eat nuts tend to gain less weight over time than people who don’t.

We see a similar pattern in clinical studies that asked people to include nuts in their diets and then looked at the effects on body weight.

A review of more than 30 studies examined the effects of eating nuts on body weight. It did not find people who ate nuts had increased their body weight, body mass index (BMI), or waist circumference, compared to a control group of people who did not eat nuts.

In fact, one study found that when people ate a pattern of food aimed at weight loss, the group of people who ate nuts lost more body fat than those who didn’t eat nuts.

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Read more: Got high cholesterol? Here are five foods to eat and avoid

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Let’s nut this out

There are several possible explanations for why eating nuts doesn’t seem to lead to weight gain.

1. We don’t absorb all of the fat in nuts: The fat in nuts is stored in the nut’s cell walls, which don’t easily break down during digestion. As a result, when we eat nuts, we don’t absorb all of the fat. Some of the fat instead is passed out in our faeces. The amount of calories we absorb from eating nuts might be between 5% and 30% less that what we had previously thought.
2. Nuts increase the amount of calories we burn: Not only do we not absorb all the calories in nuts, but eating nuts may also increase the amount of energy and fat we burn. It’s thought this may partially be explained by the protein and unsaturated fats in nuts, although we don’t yet know exactly how this occurs. Increases in the number of calories burnt can help us maintain or lose weight.
3. Nuts help us feel full for longer: As well as fat, nuts are rich in protein and fibre. So, nuts help to keep us feeling full after we eat them, meaning we’re likely to eat less at later meals. Recent studies have also suggested providing people with nuts helps improve the overall quality of the types of foods they eat. This may be because nuts replace “junk foods” as snacks.
4. People who eat nuts have healthier lifestyles in general: We can’t rule out the idea that eating nuts is just a sign of a healthier lifestyle. However, randomised controlled trials, which can control for lifestyle factors like eating habits, still find no negative effect on body weight when people eat nuts. This means the favourable effects of nuts are not just the result of nut eaters having healthier lifestyles – the nuts themselves play a role.

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Read more: Want to improve your mood? It’s time to ditch the junk food

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Overall, the evidence suggests nuts are a healthy snack that can provide us with many of the nutrients our bodies need. We can confidently include the recommended 30g of nuts a day in a healthy diet, without worrying about the effect they will have on our waistlines.

Efficacy of intravaginal dehydroepiandrosterone (DHEA) for symptomatic women in the peri- or postmenopausal phase.

Climacteric. 2018 Nov 1:1-10. doi: 10.1080/13697137.2017.1388364. [Epub ahead of print]

Cause or prevention of breast cancer with estrogens: analysis from tumor biologic data, growth kinetic model and Women’s Health Initiative study.

Santen RJ¹, Yue W¹.

Author information

Abstract

The existing medical literature suggests that estrogens may cause breast cancer but, paradoxically, can also prevent this neoplasm under specific circumstances. Appropriate interpretation of this complex data requires an understanding of emerging concepts of tumor biology. A substantial body of data, including animal models and epidemiologic studies, suggests that estrogens contribute to the development of breast cancer. Additionally, pre-clinical experiments indicate that the responsible mechanisms include both estrogen receptor α-dependent and -independent effects (ERα-dependent and ERα-independent effects). We recently developed two models to describe the growth kinetics of occult breast tumors, one based on autopsy studies and tumor doubling time and the other, computer-based. Validation of the models involved comparison of the predicted incidence of breast cancer with the actual incidence in population-based studies.

Utilization of these models allowed us to determine that 16 years on average are required for tumors to undergo the 30 doubling times necessary for the occult tumors to reach the threshold for clinical detection.

These models suggest that menopausal hormone therapy with estrogen plus a progestogen in the Women’s Health Initiative (WHI) study accelerated the doubling time of occult, pre-existing tumors from 200 to 150 days and thus, increased the rate of tumor diagnosis. Based on estrogen-induced apoptosis data, the model accurately predicted the prevention of diagnosed breast cancer in the estrogen-alone arm of the WHI. Notably, pre-clinical studies demonstrated that conjugated equine estrogen, as used in the WHI, has unique, pro-apoptotic properties compared to the anti-apoptotic effects of estradiol, a finding providing an explanation for the reduction in breast cancer with conjugated equine estrogen

Dr Anne Nixon, a very experienced doctor in integrative medicine, and in using natural hormones, will be joining me here in April, on a part time basis.. She is available for new patients, and others who have trouble in getting appointments with myself.

Dr Anne Nixon MBBAO Bch (Ireland) FRACGP

Dr Anne Nixon has worked in general practice for 41 years having come to Australia from Ireland in 1976. She completed her medical degree with honours in University College Dublin, Ireland with a Bachelor of medicine and obstetrics. She completed her internship and registrarship at the Mackay Base hospital and became a Fellow of the Royal Australian college of General Practitioners in 1992. In 1994 she built Pioneer Medical Centre in Mackay and worked in all aspects of General and preventative medicine with six other GPS for the next 40 years.

She is experienced in children’s health, ante natal care, gynaecology, women’s health, insertion and removal of contraceptive implants and pap smears. She is also experienced in skin cancer screening performing excisions and diathermy.

Her special interest is in natural hormone balance in both women and men and has 25 years’ experience in treating menopause in both sexes. She also does Skype menopause consultations all over Australia. She is one of the few doctors in Brisbane with experience in natural HRT and compounded hormones.

She also does coal board and dive Medicals. She has worked for some time in Africa and in Papua New Guinea. Dr Anne is passionate about all aspects of patient care and treats medicine in a holistic way with emphasis on nutrition, mental health and preventative care.  In 2016 she moved to Brisbane to be close to family and grandchildren and looks forward to bringing years of experience to Family Drs Plus in a part time capacity.

Health Check: why women get PMS and why some are more affected

November 19, 2018 1.52pm AEDT Up to 80% of women experience PMS.

Author

1. Jayashri Kulkarni Professor of Psychiatry, Monash University

Disclosure statement

Jayashri Kulkarni has received grant support for research from: The Stanley Medical Research Institute (Washington,USA),The National Health and Medical Research Council of Australia, Jansen-Cilag, Neurosciences Australia, and the Department of Human Services (Victoria, Australia). She has received honoraria as a speaker for Servier, Jansen-Cilag, Lundbeck, pharmaceuticals and was a past advisory board member for Janssen-Cilag. This article received no funding or support from any source

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Monash University provides funding as a founding partner of The Conversation AU.

Victoria State Government provides funding as a strategic partner of The Conversation AU.

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Women have been menstruating throughout history. So it’s curious the earliest documented record of what we now know to be premenstrual syndrome (PMS) appeared pretty late in the game. In 1931, psychoanalyst Karen Horney described increased tension, irritability, depression and anxiety in the week preceding menstruation in one of her patients.

Now it’s generally accepted up to 80% of women in their reproductive years experience some PMS. The condition includes symptoms such as fatigue, poor coordination, feeling out of control, feeling worthless and guilty, headache, anxiety, tension, aches, irritability, mood swings, weight gain, food cravings, no interest in usual activities, cramps, feeling sad or depressed, breast tenderness, sleep problems, and difficulty concentrating.

Premenstrual syndrome is different to premenstrual dysphoric disorder (PMDD), which is rarer (only 3-5% of women of reproductive age experience it) and is listed in the diagnostic manual of mental disorders. People who experience PMDD have severe depression which is often accompanied by suicidal thoughts. Their onset and offset usually coincide with the premenstrual cycle. Unlike PMS, the severely depressed mood of PMDD usually comes on suddenly.

Reproductive hormones – oestrogen, progesterone and testosterone – are also potent brain hormones. They influence the brain chemicals responsible for our thoughts, behaviours and emotions. Their amounts fluctuate throughout the menstrual cycle, so the connection between them and mental health is clear. And we are learning more about why some women may be more affected than others.

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Read more: Chemical messengers: how hormones affect our mood

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Brain chemicals and PMS

There is no single clear theory yet to explain exactly which hormones trigger particular chemicals or why only some women experience PMDD or PMS.

But we know some women are susceptible to mood changes due to small fluctuations in reproductive hormones. In these vulnerable women, small changes in oestrogen and progesterone levels lead to shifts in central brain chemicals (GABA, serotonin and dopamine) that then affects mood and behaviour.

At the same time, many of the physical PMS symptoms such as breast tenderness, bloating, headaches and constipation are a direct effect of reproductive hormones. So both mind and body are affected.

Oestrogen appears to be a “protective” hormone, which can improve psychotic symptoms (such as those common in schizophrenia) as well as depression. Oestrogen directly influences the neurotransmitters serotonin and dopamine to achieve this positive effect.

So depression and other adverse mental symptoms can appear or worsen during phases when oestrogen is low. This happens during the four to seven days before menstruation, and during the transition into menopause.

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Read more: Menopausal mood swings can signal more serious mental illness

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Progesterones can have the opposite effect. Many women who take a progesterone-only contraceptive pill (the mini-pill) experience depression. There are certain types of progesterone in the combined oral contraceptive pill that can be very depressive.

What about the more severe symptoms?

Recent work suggests PMDD is the result of brain neurochemicals responding in unusual ways to fluctuations in brain oestrogen, progesterone and testosterone, as well as the hormones released by the pituitary gland that determine the levels and fluctuations of these reproductive hormones.

Other studies about the cause of PMDD reveal that a breakdown product of progesterone – called allopregnanolone (ALLO) – is a critical stimulator of a receptor on a part of the GABA transmitter. When stimulated, the GABA system can alleviate anxiety. Benzodiazepine drugs like diazepam (Valium) stimulate the GABA system and help to calm down agitation.

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Read more: Weekly Dose: Valium, the ‘safer choice’ that led to dependence and addiction

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In this way, ALLO works as an “anti-anxiety” hormone. Just like oestrogen, progesterone levels (and its metabolite ALLO levels) fall in the premenstrual phase.

Women who have PMDD are often agitated, anxious and depressed during the premenstrual phase. A newer theory is that their brain chemistry isn’t reacting normally to ALLO, so they become anxious. This is important to explore further and already new drugs that impact ALLO are being developed and tested.

PMDD is complex, like many mental health conditions, and there is an interplay between psychological and social issues as well as hormonal and neurochemical factors. Tertiary education, supportive relationships, fewer socioeconomic struggles and good physical health appear to be helpful, but do not mitigate PMDD completely. Overall, PMDD appears to be biologically driven.

How can we treat it?

Understanding the body-mind connections in both PMS and PMDD is critical for developing effective management strategies for the many women who suffer from significant depression and other issues every month.

Management options need to consider all aspects of the woman’s life including her work, relationships, past traumas, current physical health and daily demands. Many women experiencing PMDD require hormone treatment and other strategies such as antidepressant medication to help them improve their quality of life.

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Read more: Biology is partly to blame for high rates of mental illness in women – the rest is social

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It’s a good idea for women experiencing PMDD or PMS to keep a diary of their cycles and moods. Women can be reassured their observations connecting hormones and moods are valid. It is important women with PMS/PMDD seek help from health professionals who will explore specific targeted treatments with them. Above all, it is important to recognise the links between hormones and mental health.

Don’t have time to exercise? Here’s a regimen everyone can squeeze in

February 21, 2019 3.25pm AEDT

Author

1. Emmanuel Stamatakis Professor of Physical Activity, Lifestyle, and Population Health, University of Sydney

Disclosure statement

Emmanuel Stamatakis receives funding relevant to this article from the National Health and Medical Research Council (Australia), PAL Technologies (Scotland), and The Human Animal Bond Research Institute (US).

Partners

University of Sydney provides funding as a member of The Conversation AU.

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Have you recently carried heavy shopping bags up a few flights of stairs? Or run the last 100 metres to the station to catch your train? If you have, you may have unknowingly been doing a style of exercise called high-intensity incidental physical activity.

Our paper, published today in the British Journal of Sports Medicine, shows this type of regular, incidental activity that gets you huffing and puffing is likely to produce health benefits, even if you do it in 30-second bursts, spread over the day.

In fact, incorporating more high intensity activity into our daily routines – whether that’s by vacuuming the carpet with vigour or walking uphill to buy your lunch – could be the key to helping all of us get some high quality exercise each day. And that includes people who are overweight and unfit.

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Read more: Health Check: high-intensity micro workouts vs traditional regimes

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What is high intensity exercise?

Until recently, most health authorities prescribed activity lasting for at least ten continuous minutes, although there was no credible scientific evidence behind this.

This recommendation was recently refuted by the 2018 US Physical Activity Guidelines Advisory Report. The new guidelines state any movement matters for health, no matter how long it lasts.

This appreciation for short episodes of physical activity aligns with the core principles of high intensity interval training (HIIT). HIIT in a hugely popular regimen involving repeated short sessions, from six seconds to four minutes, with rests from 30 seconds to four minutes in-between.

Among a range of different regimens, we consistently see that any type of high intensity interval training, irrespective of the number of repetitions, boosts fitness rapidly and improves cardiovascular health and fitness.

That’s because when we regularly repeat even short bursts of strenuous exercise, we instruct our bodies to adapt (in other words, to get fitter) so we’re able to respond better to the physical demands of life (or the next time we exercise strenuously).

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Read more: Yes, your kids can run all day – they’ve got muscles like endurance athletes

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The same principle is at play with incidental physical activities. Even brief sessions of 20 seconds of stair-climbing (60 steps) repeated three times a day on three days per week over six weeks can lead to measurable improvements in cardiorespiratory fitness. This type of fitness indicates how well the lungs, heart, and circulatory systems are working, and the higher it is the lower the risk for future heart disease is.

In fact, research suggests physical activity intensity may be more important for the long-term health of middle-aged and older people than total duration.

Achievable for everyone

The main reasons people don’t do enough exercise tend to include the cost, lack of time, skills, and motivation.

Exercise regimens like high intensity interval training are safe and effective ways to boost fitness, but they’re often impractical. People with chronic conditions and most middle aged and older people, for example, will likely require supervision by a fitness professional.

Aside from the practicalities, some people may find back-to-back bouts of very high exertion overwhelming and unpleasant.

But there are plenty of free and accessible ways to incorporate incidental physical activity into our routines, including:

• replacing short car trips with fast walking, or cycling if it’s safe
• walking up the stairs at a fast pace instead of using the lift
• leaving the car at the edge of the shopping centre car park and carrying the shopping for 100m
• doing three or four “walking sprints” during longer stretches of walking by stepping up your pace for 100-200 metres (until you feel your heart rate is increasing and you find yourself out of breath to the point that you find it hard to speak)
• vigorous walking at a pace of about 130-140 steps per minute
• looking for opportunities to walk uphill
• taking your dog to an off-leash area and jogging for 30-90 seconds alongside the pup.

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Read more: Four common myths about exercise and weight loss

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This type of incidental activity can make it easier to achieve the recommended 30 minutes of physical activity a day. It can also help boost fitness and make strenuous activity feel easier – even for those of us who are the least fit.

Seven myths and truths about healthy skin

February 20, 2019 3.07am AEDT Shutterstock

Author

1. Sara J Brown Professor of Molecular & Genetic Dermatology, Wellcome Trust Senior Research Fellow, University of Dundee

Disclosure statement

Sara J Brown receives research funding from the Wellcome Trust, the Tayside Dermatological Research Charity and the British Skin Foundation and is a medical adviser for Eczema Outreach Support.

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University of Dundee provides funding as a member of The Conversation UK.

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Skin is our largest organ and something we may take for granted when it’s healthy. As an academic dermatologist I frequently hear misleading “facts” that seem to be stubbornly enduring. Here are some of the most commonly shared myths that can be cleared up immediately, and some truths you can rely on.

Skin constantly renews itself

TRUE The skin provides a dynamic barrier between your body’s internal environment and the outside world. Cells called keratinocytes in the epidermis (the outer layer of skin) are constantly dividing to produce a supply of cells that move up through this layer and are shed from its surface. Skin is a rich source of stem cells with the capacity to divide and renew themselves.

Drink two litres of water a day for healthy skin

FALSE The amount of water you drink does not directly affect your skin. Water is supplied to the skin by blood flowing through the dermis, the inner layer of skin; water is lost from the epidermis, especially in a dry environment.

Water is needed to maintain skin hydration and when you become seriously dehydrated your skin appears dull and is less elastic. In a healthy person the internal organs – kidneys, heart and blood vessels – control the amount of water reaching the skin. There is no fixed volume of water that you need to drink, it simply depends on the amounts you are using and losing.

Stress can make skin unhealthy

TRUE There are many health issues in modern life that we blame on stress, but several skin conditions have been shown in scientific studies (see below), to be worsened by life events, possibly via stress hormones including cortisol (a steroid hormone made in the adrenal glands). Notable examples are alopecia areata, an auto-immune condition where the body’s immunity begins to attack the hair follicles, causing hair to fall out; psoriasis, another auto-immune condition that causes skin thickening, scaling and inflammation; and eczema, itchy red skin inflammation often occurring alongside asthma, hay fever and other allergies. Unfortunately a flare up of these skin conditions is exactly what you don’t need when you are feeling stressed or under pressure.

Eating chocolate causes acne

FALSE Acne vulgaris, the common “teenage” acne which can actually persist into your 30s and 40s, occurs as a result of the interaction between hormonal effects on grease glands in the skin, plus the skin’s immune response to blocked pores and microbes living on the skin.

Eating a high fat diet is unhealthy for many reasons, but it doesn’t cause acne. In fact some tablets prescribed for severe acne such as oral isotretinoin are better absorbed when pills are swallowed with a fatty meal – and that could include chocolate.

Washing powder causes eczema

FALSE Eczema is a condition where the skin is dry, itchy and red. It is caused by a combination of genetic factors (how your skin is made) and environmental effects, leading to inflammation. Soap, detergents and washing powders can irritate the skin and contribute to dryness because they remove oil from the skin (just as washing-up liquid removes grease from your dishes). Biological washing powders contain enzymes – proteins that break down fats and other proteins to remove stains – and these can irritate sensitive skin, so they may worsen eczema. It is important that any washing power is thoroughly rinsed out of clothing before it is worn, to avoid skin irritation.

White marks on nails = calcium deficiency

FALSE Nails are manufactured in the nail matrix, an area under the skin at the top edge of your nail. If the matrix is traumatised, bumped or bitten, an irregularity in the developing nail occurs and air can become trapped. This appears as a white mark as the nail grows out. Calcium is important for healthy nails (as well as bones and teeth) but these white marks are not a sign of deficiency.

Sunshine is good for you

TRUE & FALSE Many people have experienced the feel-good factor of a sunny day, but there are good and bad effects of sunlight. Light from the sun includes a mixture of different wavelengths of light: some are visible to the human eye, some are shorter than the colours we can see – these are called ultraviolet (UV) – and some are longer, the infrared. Different wavelengths have different effects on skin.

UVB is used by skin to manufacture vitamin D which is essential for bone health. Without sun exposure this vitamin must be obtained from the diet. Dermatologists use specific wavelengths of UVA and UVB in carefully controlled doses to reduce skin inflammation, a valuable treatment for some skin conditions.

But when the skin is exposed to too much UV it can damage the skin cells’ DNA, leading to uncontrolled growth – the basis of cancer. As a simple rule, unless you have a disease or treatment that suppresses your immune system, sunshine is good for you in moderation, but always avoid getting sunburned.

Keep it simple

The basic principles of keeping skin healthy are mainly common sense. You should wash your skin regularly to remove dirt, but not so much that you remove the essential moisture and water-proofing substances. Use a moisturiser if your skin feels tight or dry – a greasy ointment works best unless you have acne-prone skin, in which case you should use a non-greasy water-based cream. Avoid stress if possible, eat a healthy diet and drink water when you feel thirsty. And finally, protect your skin from too much sun with a hat and clothing or sunscreen.

I have been away for the last 2 weeks celebrating 50 years of marriage. Our 4 children 4 spouses, 6 grandchildren were all there for the occasion. My son came from Tokyo to be with us, so it was wonderful to see them all and our friends and relatives. I am back to work next Monday,

BJOG Debate: HRT should be considered as first line therapy for perimenopausal depression Free Access

HRT should be considered as first line therapy for perimenopausal depression: FOR: Estrogens are the first line treatment for perimenopausal women

John Studd First published: 21 April 2016 https://doi.org/10.1111/1471-0528.13922 Cited by: 2Sections

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Perimenopausal women with depression (PMD) suffer the many symptoms of the menopausal transition before the cessation of periods, together with anxiety, poor concentration and loss of libido. These women often have a continuum of depression from an early age with a history of hormone‐related depression of premenstrual depression (PMS) and a history of postnatal depression (PND). The PND then becomes cyclical with the return of periods, becoming worse with age until the mid‐forties. These women are then denied hormone therapy because they are not post‐menopausal. This pattern of depression in women is best called reproductive depression (RD) and cannot be diagnosed or excluded by blood tests because the hormone levels will usually be in the premenopausal range (Studd & Nappi. Gynecol Endocrinol 2012;28:42–5).

Transdermal estrogens are safer than oral estrogens in that they do not carry any extra risk of thrombosis and also have been reported as more effective in the treatment of depression. This should be by patches or gels giving a reasonably high dose using estrogen patches of 100 mcg twice weekly (Soares et al. Arch Gen Psychiatry 2001;58:529–34). A similar dose of gels should be used. There is often a loss of libido and loss of energy at the same time and these women will benefit from transdermal testosterone. Although it is unlicensed in women, it can be achieved by testosterone gel, Testim or Testogel using approximately one‐tenth of the licensed male dose (Studd. Climacteric 2011;14:637–42). Those women with a uterus have to have cyclical progestogen but as these women are progesterone‐intolerant it is justifiable to use a shortened course of Norethisterone, Provera or Utrogestan for 7–10 days each month.

Not all women will have the depression removed by hormone therapy and there will be a case for the use of antidepressants in a few women, but I believe this is second line treatment for these patients who do not respond to the more logical transdermal estrogens. I have tried to arrange a lecture for years at the RCPsych but I am informed that there is no interest in this treatment among senior psychiatrists. Is it a territorial issue? Possibly. Is it a safety objection? This is unlikely as transdermal estradiol is safer than long‐term antidepressants (Smoller et al. Arch Int Med 2009;169:2128‐39). Essentially, the problem is the failure to recognise the hormonal component of perimenopausal depression. This failure leads to an interesting catalogue of explanations: treatment resistant depression (wrong treatment); borderline personality disorder (a familiar DSM V diagnosis); bipolar disorder (it is cyclical after all!); premorbid history of depression (depression also occurred before the current PMD; it was PMS or PND—usually both). Most psychiatrists are not effective when treating depression in women. I hope Michael Craig will be able to instruct them. I have failed.

Disclosures of interests

None declared. Completed disclosure of interests form available to view online as supporting information.