Adolescent use of combined hormonal contraception and peak bone mineral density accrual: A meta‐analysis of international prospective controlled studies

.Azita Goshtasebi1,2| Tatjana Subotic Brajic1| Delia Scholes3|Tamara Beres Lederer Goldberg4| Abbey Berenson5| Jerilynn C. Prior1,2,61Centre for Menstrual Cycle and Ovulation Research, Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia, Canada2British Columbia Women’s Health Research Institute, Vancouver, British Columbia, Canada3Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington4Postgraduate Program in Gynecology, Obstetrics, and Mastology, Discipline of Adolescent Medicine, Department of Pediatrics, Botucatu Medicine School, São Paulo State University (UNESP), Botucatu, São, Brazil5Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, Texas6School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, CanadaCorrespondenceJerilynn C. Prior, Centre for Menstrual Cycle and Ovulation Research, Endocrinology and Metabolism, University of British Columbia, Vancouver, BC, Canada.Email: jerilynn.prior@ubc.caFunding informationThere was no funding for this systematic review and meta‐analysis beyond donation‐based Centre for Menstrual Cycle and Ovulation/University of British Columbia infrastructure support.

Summary/Objective:

Many women use combined hormonal contraceptives (CHC) during adolescence during which they are accruing peak areal bone mineral density (BMD) that relates to lifetime fracture risk. To build BMD requires formation with which CHC‐related exogenous oestrogen may interfere. We compared peak BMD accrual in adolescents using and not using CHC.Design/Participants: We performed literature searches for prospective published peer‐reviewed articles providing 12‐ to 24‐month BMD change in adolescent (12‐ to 19‐year‐old) women using CHC vs CHC‐unexposed control women.Methods: Meta‐analyses used random‐effects models to assess BMD change rate at lumbar spine (LS) and other sites in adolescent CHC users vs CHC nonusers.

Results:

Literature searches yielded 84 publications of which nine were eligible. Adolescent‐only data were sought from cohorts with wider age inclusions. The 12‐month LS meta‐analysis with eight paired comparisons in 1535 adolescents showed a weighted mean BMD difference of −0.02 (95% confidence interval [CI]: −0.05 to 0.00) g/cm2 in CHC‐exposed adolescents (P = 0.04). The 24‐month LS meta‐analysis with five paired comparisons in 885 adolescents showed a highly significant weighted mean BMD difference of −0.02 (95% CI: −0.03 to −0.01) g/cm2 in CHC‐exposed ado‐lescents (P = 0.0006). Heterogeneities by I2 were 96% and 85%, respectively. Insufficient data for other bone sites precluded quantitative analysis.

Conclusion:

Given that adolescent exposure to CHC appears to be increasing, this evidence for potential impairment of peak spinal BMD accrual is of concern and suggests a potential public health problem. Randomized controlled trial data are needed to determine CHC effects on adolescent bone health

6 bedtime drinks that can boost weight loss overnight

John Murphy, MDLinx|February 21, 2020

For a long time, the general consensus among health experts was that we should limit what we consume in the hours before going to sleep. Eating or drinking before bedtime would add extra calories and increase the risk of cardiovascular disease and diabetes. While this may be true when you eat a smorgasbord shortly before wobbling to bed, researchers are now finding that consuming smaller amounts of specific foods (eg, protein) can have positive physiological benefits before bedtime. 

Consuming certain beverages before bedtime can improve sleep and enhance weight loss. 

Accordingly, having a soothing beverage before sleep is not only a relaxing bedtime ritual, it can also improve your sleep and even help you lose weight—depending on what you drink. Here are six bedtime beverage that may do just that: 

Greek yogurt protein shake

As noted above, having protein before bed—especially if you’ve worked out beforehand—helps stimulate the repair and rebuilding of muscle (muscle protein synthesis) while you sleep. The more muscle you have, the more calories your body burns.

Dairy is a particularly comforting source of protein, especially for children. (Do you remember your mom giving you warm milk to help you get back to sleep?) 

Milk (whether warm or cold) contains calcium and tryptophan, which have both been shown to improve sleep quality. Milk also contains two kinds of dairy protein—whey and casein. Bodybuilders are known to consume whey protein after workouts because it quickly builds muscle mass. Casein protein, however, is a slow-releasing protein better suited for building muscle over the long run. 

“Consuming casein protein (~30–40 g) prior to sleep can acutely increase muscle protein synthesis and metabolic rate throughout the night without influencing lipolysis,” the International Society of Sports Nutrition stated in a position paper. 

A good source of casein is Greek yogurt. A Greek yogurt shake before bedtime delivers a healthy dose of casein protein that supplies a steady delivery of amino acids for muscle recovery. Plus, a yogurt shake can make for a tasty, soothing bedtime beverage. SEE ALSOAvoid these 7 less-than-healthy fruits and veggies

Chamomile tea

Chamomile is a known sedative, albeit a mild one. (In fact, chamomile is listed as an official drug in the pharmacopeias of 26 countries, including Germany, Belgium, France, and the United Kingdom.) It increases the body’s levels of glycine, a neurotransmitter that relaxes your nerves and makes you feel sleepy. In addition, chamomile is good for settling an upset stomach. So, a warm mug of chamomile tea is perfect for relaxing you for bedtime.

Chamomile has also been linked to improved glucose control and weight loss. Researchers have identified four compounds in chamomile that, taken together, can modulate carbohydrate digestion and sugar absorption. 

Red wine

Resveratrol, the famed antioxidant in red wine, can turn the body’s excess white fat into the active, energy-burning beige fat. But, who wants “beige fat”

Researchers had long believed that there were only two types of fat in the body–white fat, where lipids are stored as energy, and brown fat, which burns lipids to produce heat. Scientists have since discovered beige fat, which is generated from white fat but can burn energy similar to brown fat. Resveratrol can enhance this conversion of white fat to beige fat; at high rates, it can prevent obesity.

Resveratrol is a naturally occurring compound found in red grapes, blueberries, strawberries, raspberries, and apples. Resveratrol is but one of a number of antioxidants produced in these fruits. These compounds enhance the oxidation of beige fat and burn off the excess as body heat.

One glass of red wine before turning in for the night can also help you unwind. Just don’t overdo it—the alcohol in more than two glasses can disturb your sleep. 

Kefir

Kefir is a cultured, fermented drink typically made from dairy milk. It’s rich in probiotic bacteria and it’s a good source of calcium. Kefir has a tart, tangy taste–similar to yogurt–but it has a thinner consistency than yogurt, so it’s more like a drink. 

Researchers have suggested that the probiotics in kefir can modulate gut microbiota, which inhibits lipogenesis and promotes fatty acid oxidation. This, in turn, may reduce body weight and prevent obesity. SEE ALSO5 ‘diet’ foods that can cause weight gain

Soy-based protein shake

If kefir or Greek yogurt isn’t your thing–if you’re lactose intolerant, for instance, or on a vegan diet–or if you just want to mix things up a little, a soy-based protein shake can deliver the protein punch while also promoting weight loss. Researchers have shown that soy protein is just as beneficial as other kinds of protein as part of a weight-loss program.

In addition, soy has been studied extensively for its heart-healthy benefits. Some investigators have suggested that soy imparts this cardioprotective benefit through a reduction in body fat. In one weight-loss study, researchers showed that soy foods, in place of other foods, were associated with weight loss and improvements in cardiometabolic risk, without loss of physical function or strength

Soy is also rich in amino acids, not the least of which is tryptophan, to help you drift off to sleep. 

Water

The one problem with all the drinks discussed above is that they all contain at least some calories. Water, on the other hand, contains zero calories, which gives it a leg up against any other beverage in minimizing calorie intake. 

Plus, drinking more water has been linked to more restorative sleep and less daytime sleepiness. “These results suggest that drinking more water, which is a behavior associated with a number of health benefits, may also be associated with healthy sleep,” wrote researchers in the Journal of Sleep Research, who examined the association between dietary nutrients and sleep symptoms. 

Of course, drinking any beverage before bed is a balance between risk and benefit–you may reap the health benefits but, if you drink too much, you risk waking up to have to tiptoe to the bathroom in the night

Top News in Internal Medicine

Could coffee be the secret to fighting obesity?

MedicalXpress Breaking News-and-Events | June 24, 2019

Scientists from the University of Nottingham have discovered that drinking a cup of coffee can stimulate “brown fat,” the body’s own fat-fighting defenses, which could be the key to tackling obesity and diabetes.

The pioneering study, published today in the journal Scientific Reports, is one of the first to be carried out in humans to find components which could have a direct effect on how “brown fat” functions, an important part of the human body that plays a key role in how quickly we can burn calories as energy.

Brown adipose tissue (BAT), also known as brown fat, is one of two types of fat found in humans and other mammals. Initially only attributed to babies and hibernating mammals, it was discovered in recent years that adults can have brown fat too. Its main function is to generate body heat by burning calories (as opposed to white fat, which is a result of storing excess calories). People with a lower body mass index (BMI), therefore, have a higher amount of brown fat.

Professor Michael Symonds, from the School of Medicine at the University of Nottingham, who co-directed the study said, “Brown fat works in a different way to other fat in your body and produces heat by burning sugar and fat, often in response to cold. Increasing its activity improves blood sugar control as well as improving blood lipid levels, and the extra calories burnt help with weight loss. However, until now, no one has found an acceptable way to stimulate its activity in humans.

“This is the first study in humans to show that something like a cup of coffee can have a direct effect on our brown fat functions. The potential implications of our results are pretty big, as obesity is a major health concern for society and we also have a growing diabetes epidemic, and brown fat could potentially be part of the solution in tackling them.”

The team started with a series of stem cell studies to see if caffeine would stimulate brown fat. Once they had found the right dose, they then moved on to humans to see if the results were similar.

The team used a thermal imaging technique, which they’d previously pioneered, to trace the body’s brown fat reserves. The non-invasive technique helps the team to locate brown fat and assess its capacity to produce heat.

“From our previous work, we knew that brown fat is mainly located in the neck region, so we were able to image someone straight after they had a drink to see if the brown fat got hotter,” said Symonds.

“The results were positive and we now need to ascertain that caffeine as one of the ingredients in the coffee is acting as the stimulus or if there’s another component helping with the activation of brown fat. We are currently looking at caffeine supplements to test whether the effect is similar.

Once we have confirmed which component is responsible for this, it could potentially be used as part of a weight management regime or as part of glucose regulation program to help prevent diabetes.”

It never ceases to amaze me about the benefits oestrogen has for women. Here is research showing another health benefit from oestrogen.

Review ARTICLE

Front. Endocrinol., 02 March 2018 | https://doi.org/10.3389/fendo.2018.00066

Gonadal Hormones and Retinal Disorders: A Review

Raffaele Nuzzi¹*, Simona Scalabrin¹, Alice Becco¹ and Giancarlo Panzica^2,3

• ¹Eye Clinic, Department of Surgical Sciences, University of Turin, Turin, Italy
• ²Laboratory of Neuroendocrinology, Department of Neuroscience Rita Levi-Montalcini, University of Torino, Torino, Italy
• ³Neuroscience Institute Cavalieri-Ottolenghi (NICO), Orbassano, Italy

Aim: Gonadal hormones are essential for reproductive function, but can act on neural and other organ systems, and are probably the cause of the large majority of known sex differences in function and disease. The aim of this review is to provide evidence for this hypothesis in relation to eye disorders and to retinopathies in particular.

Methods: Epidemiological studies and research articles were reviewed.

Results: Analysis of the biological basis for a relationship between eye diseases and hormones showed that estrogen, androgen, and progesterone receptors are present throughout the eye and that these steroids are locally produced in ocular tissues. Sex hormones can have a neuroprotective action on the retina and modulate ocular blood flow. There are differences between the male and the female retina; moreover, sex hormones can influence the development (or not) of certain disorders. For example, exposure to endogenous estrogens, depending on age at menarche and menopause and number of pregnancies, and exposure to exogenous estrogens, as in hormone replacement therapy and use of oral contraceptives, appear to protect against age-related macular degeneration (both drusenoid and neurovascular types), whereas exogenous testosterone therapy is a risk factor for central serous chorioretinopathy. Macular hole is more common among women than men, particularly in postmenopausal women probably owing to the sudden drop in estrogen production in later middle age. Progestin therapy appears to ameliorate the course of retinitis pigmentosa. Diabetic retinopathy, a complication of diabetes, may be more common among men than women.

Conclusion: We observed a correlation between many retinopathies and sex, probably as a result of the protective effect some gonadal hormones may exert against the development of certain disorders. This may have ramifications for the use of hormone therapy in the treatment of eye disease and of retinal disorders in particular.

Introduction

There is a growing body of evidence for the importance of gonadal hormone action in the function of the reproductive and other systems (1), including bone (2) and cardiovascular system. Sex hormones (androgenic, estrogenic, and progestinic) are produced by both sexes, though the quantity and mode differ by sex and age. Moreover, they are produced, not only by the gonads, but also by other organs (3, 4), including the central nervous system (CNS) in which estrogens are thought to exert a neuroprotective role (5, 6).

Historically, interactions between gonadal hormones and the eye have received scarce attention; however, recent research into sex-related differences has begun to reveal possible links between estrogens and eye diseases, i.e., glaucoma, age-related macular degeneration (AMD), and cataracts. This has carried over into the evaluation of the implications that postmenopausal hormone replacement therapy (HRT) and anti-estrogenic therapy in breast cancer could have for concomitant eye disorders (7).

Since, research in this area is still at its beginning, the available studies are few and often limited in sample size; this does not allow to reach a univocal and definitive answer about the relationship between sex, sex hormones, and ocular pathologies. The purpose of this review is, therefore, to summarize the results currently present in the literature.

I have returned to work after my 4 weeks holiday. It was very relaxing, mostly at home due to the virus, but was very good. The main changes for this year have been to reduce my work hours slightly, not taking on new patients (unfortunately) but otherwise will continue working as usual.

Natural ways to prevent deadly diseases

Naveed Saleh, MD, MS|January 8, 2021

Chronic diseases are defined as physical or mental health conditions that last more than one year and result in functional restrictions or ongoing treatment and monitoring. These diseases are among the most frequent and costly in the United States, with about half of Americans diagnosed with at least one chronic condition.

Studies show that walking is just one of many healthy steps you can take to prevent chronic disease.

Despite advances in healthcare and breakthroughs in medicine, the prevalence of chronic disease in the United States is on the rise, with more people developing diabetes, hypertension, stroke, heart disease, obesity, and others. Chronic disease results in death, disability, and decreased quality of life.

“Trends show an overall increase in chronic diseases,” wrote the authors of a study published in the International Journal of Environmental Research and Public Health. “The nation’s aging population, coupled with existing risk factors (tobacco use, poor nutrition, lack of physical activity) and medical advances that extend longevity (if not also improve overall health), have led to the conclusion that these problems are only going to magnify if not effectively addressed now.”ADVERTISEMENT -SCROLL TO KEEP READING

Fortunately, there are natural steps that can be taken to decrease your risk of chronic disease. Here’s a look at five natural interventions. 

Ditch ultraprocessed foods

It’s true that ultraprocessed foods make for easier food choices. But, in this case, easier is definitely not healthier. Previous cohort studies have shown that the consumption of ultraprocessed foods—including chips, white bread, cookies, and soda—is linked to higher rates of cancer, irritable bowel syndrome, hypertension, and obesity.

Results from a population-based Spanish study indicated that eating four or more servings of ultraprocessed foods each day was related to a 62% increased hazard for all-cause mortality, with each additional serving increasing hazard by 18%.

Ultraprocessed foods lead to chronic inflammation which plays a role in diabetes, heart disease, and cancer. Instead of ultraprocessed foods, eat whole grains, nuts, seeds, fruits, and vegetables. Adopting a Mediterranean diet pattern is also recommended.

Start stepping

Exercise boosts overall health, fitness, and quality of life, as well as decreases the risk of heart disease, type 2 diabetes, dementia, anxiety, depression, and various cancers.

When most people ponder exercise, they imagine the gym or a structured class. But for chronic disease prevention, all that really matters is frequency and intensity. Simply walking can be a great way to reap the health reward of physical activity.

According to the Cleveland Clinic, “Taking 10,000 steps a day is a popular goal because research has shown that when combined with other healthy behaviors, it can lead to a decrease in chronic illness like diabetes, metabolic syndromes and heart disease. Exercise does not need to be done in consecutive minutes. You can walk for 30 to 60 minutes once a day or you can do activities two to three times a day in 10- to 20-minute increments.”

Halt the salt

The WHO formulated a Non-Communicable Diseases (NCDs) Action Plan for 2013-2020, with the goal of decreasing premature death from heart disease, chronic respiratory disease, cancer, and diabetes by 25% by 2025. Among their recommendations is reducing salt intake.

The WHO calls for a 30% relative reduction in the mean population intake of salt or sodium in those aged 18 years or older. In other words, adults should consume less than 5 grams of salt or 2 grams of sodium daily.

Keep in mind that salt-laden foods don’t necessarily taste salty. High salt content lurks in canned vegetables, canned soups, fast food, cold cuts, and cheese. When in doubt, read the labels for salt and calorie content.

Limit the spirits

The WHO also calls for a 10% reduction in alcohol consumption to curb the health risks of drinking. In particular, it stresses the dangers of heavy episodic (ie, binge) drinking among adolescents and adults.

The agency notes that harmful use of alcohol “encompasses the drinking that causes detrimental health and social consequences for the drinker, the people around the drinker and society at large, as well as the patterns of drinking that are associated with increased risk of adverse health outcomes.”

For those who like to occasionally imbibe, it may be a good idea to drink smarter. Healthier alcohol choices include hard liquors—which are low in sugar and calories—as well as wine and champagne, which are full of polyphenols and antioxidants. (Champagne is essentially sparkling wine.)

Take your nutraceuticals

Nutraceuticals such as ginger, curcumin, and green tea can curb the incidence of metabolic syndrome, as well as cardiovascular disease and diabetes. 

Green tea, for example, decreased levels of body fat and drops body weight. In a study published in the Journal of Research in Medical Science, researchers found that patients with type 2 diabetes who drank 4 cups of green tea daily experienced significant decreases in average body weight (73.2 kg to 71.9 kg); BMI (27.4 to 26.9); systolic blood pressure (126.2 to 118.6); and waist circumference (95.8 cm to 91.5 cm).