As soy isoflavone intake increased, the risk of death decreased. Women at the highest levels of soy isoflavone intake (> 16.3 mg isoflavones/day) had a 54% reduction in risk of death.

Commentary: This is the third epidemiologic study to report no adverse effects of soy foods on the prognosis of breast cancer. Soy foods, which contain isoflavones, a phytoestrogen, show both antiestrogenic and estrogen-like properties. The confusion and controversy has been that many studies have shown that isoflavones may protect against an initial breast cancer but in a very few laboratory studies certain isoflavone components of soy have been able to enhance the proliferation of breast cancer cells in select doses, and have been able to both promote and inhibit mammary tumor growth in rats.

However, in 2009, some clarity began to emerge for breast cancer patients. In breast cancer survivors, one study in Asian women (the Shanghai Breast Cancer Survival Study) and the other in U.S. women (the Life after Cancer Epidemiology study), suggest that soy containing foods do not negatively affect breast cancer prognosis, do not counteract the effect of the breast cancer drug tamoxifen and may in fact provide potential benefits in decreasing risk of recurrence or death from breast cancer.

The current study has explored this issue further, by examining data from a randomized controlled trial, the WHEL study. The results of this study, and the two previous in 2009, should give practitioners and women alike, great reassurance in the safety of soy consumption for women with who have/have had a diagnosis of breast cancer. We no longer need to advise against soy consumption for breast cancer survivors. This is great news given all the potential health benefits of soy for bone health, cardiovascular health and soy as a part of a whole foods and healthy diet.

Reference

Caan B, Natarajan L, Parker B, et al. Soy food consumption and breast cancer prognosis. Cancer Epidemiol Biomarkers Prev 2011;20(5):854-858.

One the potentially big problems with this study is that the researchers did not report the actual mortality rates. Instead they compared what is called "adjusted" mortality rates between supplement users and nonusers. This was done by adjusting for a wide range of factors including weight, intake of calories, cigarette smoking, blood pressure, educational level, diabetes, use of hormone-replacement therapy, physical exercise and fruit and vegetable intake. For each of these factors, those who took supplements were in the categories that would be considered healthier– for example— less diabetes, less obesity, more physically active, less smokers and more fruits and vegetables in their diet. These healthier people would be expected to have lower death rates than those individuals who did not take vitamins. What this does statistically is that the mortality rate of the supplement users would then be adjusted upward compared to the mortality rate of non supplement users. It is very possible that the researchers “over-adjusted” the collection of data, skewing the death rate among supplement users look higher than it really was. This conclusion is supported by the fact that when the researchers adjusted the data based only on age and intake of calories, there was in fact no statistically significant difference in mortality rate between supplement users and nonusers.

Studies that are observational, as this one was, are always weaker studies than randomized controlled trials. You can never prove cause and effect with observational studies, and it would be a mistake to make meaningful conclusions from this study due to its observational nature and possible over adjustment of the data. Another issue to ponder is that the individuals taking supplements were not more likely healthy, but perhaps less healthy. In other words… we might wonder why they were taking supplements to begin with. Perhaps they had a chronic health problem or a family health history that the researchers did not use as an identifier. What if they had a family history of heart disease for example and that is why they were taking supplements. These individuals could then easily have an increased mortality rate due to their family history.

The scientific literature is robust with randomized clinical trials demonstrating the diverse range of benefits of taking vitamins and minerals. It is always important to recognize the potential benefit and risk of any intervention whether it be over the counter or prescription drugs, vitamins, minerals or herbs. For now, women should not be discouraged to take vitamins and minerals, but individual assessment and need is best determined by a licensed practitioner trained in the use of these therapies. The medical degree that offers the most training in this area of medicine is a naturopathic doctor degree. Licensed graduates from the accredited naturopathic medical schools receive extensive training in nutrition and the use of vitamins and minerals for prevention and treatment.

Reference

Mursu J, Robien K, Harnack L, et al. Dietary supplements and mortality rate in older women. The Iowa Women’s Health Study. Arch Intern Med 2011;171(18): 1625-1633.

In this trial, oral supplementation of SB oil in people with dry eyed participants for 3 months did not result in any changes in the fatty acid composition of the tears, but it did have a positive effect on osmolarity and symptoms of dry eye including burning and redness.

Commentary: The risk of dry eye is associated with older age and in hormonal changes associated with menopause. Dry eyes can be caused by a deficiency of fluid and disturbances in the tear flow or excess evaporation of the tear film. Both types are associated with increased osmolarity of the tear film and inflammation of the surface of the eye. This hyperosmolarity can activate inflammation and interference of tear film production and stability. Sea buckthorn oil is rich in several different oils and contains a high proportion of linoleic, alpha linolenic and oleic acids as well as tocols, phytosterols and carotenoids. Because the fatty acid composition of the tear film did not change when given SB oil, but yet some symptoms did improve, there must be some other mechanism at play. These potential mechanisms include the anti-inflammatory effects of fatty acids, the carotenoids and/or the tocopherols found in the SB oil.

Previous research has shown that SB oil inhibits the rise in tear film osmolarity that occurs during the winter cold and has a positive effect on dry eye symptoms. There have been only a few other oils studied for dry eye syndrome including fish oil, evening primrose oil and flax seed oil.

Reference

Jarvinen R, Larmo P, Setala N, et al. Effects of oral se buckthorn oil on tear film fatty acids in individuals with dry eye. Cornea 2011;30;9:1-13-1018.

We often talk of exercise programs, gym memberships and exercise classes of all kinds, but it starts with… we just don’t move as much as we used to. Most of us are not living on farms and ranches, not hauling hay or planting, foraging and picking our food, not hauling and chopping our firewood, and not building our shelters. Most of us aren’t even playing outside anymore. Too many of us have acquired the thought that all our needs can be met by a flip of a switch or an indoor environment. Again, too many of us press the garage door opener, put our clothes in the washing machine and our dishes in the dishwasher, watch TV and play/work on the computer, take an elevator or escalator to our destination and park right in front of the store.

In addition to this lack of physical activity in our daily life, most individuals in modern America have sedentary jobs where we sit most of the work week– talking on the telephone, typing, writing, working on the computer, talking with clients or patients or working at the check out counter.

Our bodies are made to move and actually can do it quite well, but sadly, most us do not have any kind of routine exercise and have a bevy of excuses to support our choice—not enough time, too cold, too wet, too dark, too tired, too many aches and pains, and on and on. I’ve had them myself at times.

In working with patients, I take a gentle yet tough love approach full of support and empathy and education… it is useful to ask questions, find the limitations and obstacles, try to find out what they might like, try to strategize the practicalities, set goals, motivate and inspire and never give up on the potential for change. The tough love part is trying to find ways to make them realize that moving/exercising should be considered a mandatory part of their life. I even say some times… “You have got to get religion about exercise”. Some helpful keys to the process can be: 1) Focus on the fact that you can do it– you can become someone who regularly exercises. 2) Make a schedule for when it is going to happen. Each day… I plan for when I am going to get my 60 minutes of exercise in for that day and even the next. “Oh… on my lunch hour I can walk to the hardware store, shop for light bulbs, walk back to the office (that’s 30), and then I have another 30 minute walk after work— either to the grocery store after work, or on a forest trail next to my house once I get home. 3) Maybe find an exercise partner or a personal trainer or a class or a team of some kind– even for those who are not athletically inclined— paddling on a “dragon boat” team might be just the ticket. 4) Set goals and make them a priority– and set goals that are realistic. 5) Know your limits and don’t injure yourself or make a chronic health problem worse.

According to the American Heart Association and to reduce the risk of chronic disease we need to have 30 minutes of moderately intense physical activity per day most days of the week. For those women who need to lose significant weight… it will probably take more than that to overcome the physiological forces that are now in play– insulin resistance, slowed metabolism, loss of muscle mass and aging. In my women patients who desire weight loss… our goal is 60+ minutes per day of aerobic exercise (walking, treadmill, elliptical, bicycle, running) for 6-7 days per week and ideally, some kind of strength training (yoga, weight training) 2 days per week.

With education, desire, and a plan…. You can succeed!! You can make a change! You can improve the quality of your life!

Commentary: While the percentage of women with tinnitus is less than men, women do experience unique influences that can cause or worsen their tinnitus which are not experienced by men. Hormonal influences such as puberty, the menstrual cycle, pregnancy, hormonal birth control, hormone replacement therapy and menopause are such influences. It appears that there is a link between the menstrual cycle and tinnitus and some women report that their tinnitus is worse during their premenstrual syndrome time. One survey found that 62% of women who had tinnitus before their pregnancies had it worsen during the pregnancy and 66% worsened after childbirth. Of course, hormonal changes are not the only thing going on during pregnancy and postpartum. Other changes that could influence and worsen tinnitus during these times could be lack of sleep, fatigue and stress.

Otosclerosis is a disease of bone growth where the small bones in the middle ear no longer are able to conduct signals to the inner ear, resulting in hearing loss. It affects both women and men but can become worse during pregnancy. Tinnitus is often associated with otosclerosis.

Hormone replacement therapy (HRT), specifically the synthetic progestin used in combination with estrogens can possibly exacerbate tinnitus. There have been case repots of onset of tinnitus shortly after starting HRT. Other theories postulate that side effects of HRT experienced by some women, such as fluid retention, depression, headache, dizziness, insomnia and blood pressure changes could be the cause of worsening of the tinnitus.

Tinnitus is also more common in the 40’s, 50’s and 60’s, which then may mean it is more age related than specifically perimenopause and menopause related. However, it is still possible that the fluctuations in estrogen/progesterone and/or the hot flashes and mood changes of this time of a woman’s life could affect tinnitus.

Whatever the cause, the use of melatonin 3 mg in the evening, is a reasonable and safe supplement to try for the challenging problem of tinnitus.

Reference

Hurtuk A, Dome C, Holloman C, et al. Melatonin: Can it stop the ringing? Annals of Otology, Rhinology and Laryngology 2011;120(7):433-440.

The Integrative Interview: Case Studies on Clinical Management of Successful Weight Loss in Women

Each case study illustrates a different aspect of patient care that makes the difference between success and failure in helping patients to lose weight and in maintaining weight loss. For some patients, losing weight is unusually difficult despite reasonable efforts to eat well and exercise regularly. Most patients know that the real challenge lies in preventing the return of unwanted excess weight after it has been lost. These case studies review the keys to success for each patient, including the need where appropriate to individualize the treatment protocol to match specific chronic illnesses like Type II diabetes, obstructive sleep apnea, depression, fatigue and more.

Normal transitions in a woman’s life like menopause can mean the addition of excess weight. Many women report that they experienced a healthy weight range until after they gave birth to their second or third child, and say that after that their "metabolism was never the same again". For some women, this may be an indicator of thyroid dysfunction, and for others it is a sign of metabolic decline, separate from thyroid related problems. This metabolic decline is age related and is a relentless factor in the case of steady, creeping weight gain. Many integrative and naturopathic doctors have experience with patients who upon initial presentation to their clinic were already on some type of thyroid medication, yet these patients cannot seem to lose weight effectively, even with appropriate lifestyle interventions in place. The webinar covers effective treatment protocols that can provide effective weight loss help for difficult to treat overweight and obese patients.

Some patients have trouble with thermogenesis, and this difficulty translates into excess fat gain no matter what else they do in terms of lifestyle or other therapies to lose weight safely and effectively.

During the webinar we will discuss effective ways to boost cellular metabolism, optimize cellular aging mechanisms and promote effective thermogenesis.

All treatment options presented in the protocols preserve precious muscle mass and help burn fat for calories so patients lose specifically excess fat for their weight loss and keep the muscle they need to continue to burn fat for fuel. Patient symptoms like cravings (especially for carbohydrates and simple sugars), poor sleep and altered stress response are addressed as well.

Please join us on Thursday, October 18^th, 2011 at 7:00 PM Central time.

There is no charge for this webinar.  For more information go to the link on the Events page

Tori Hudson, ND, conducts an Integrative Interview Dr. Lucille on Neuroendocrine Adaptation and Stress Management on October 25, 2011

The Integrative Interview:  Case Discussion in Neuroendocrine Adaptation and Stress Management

On Thursday, October 25, Dr. Tori Hudson will be interviewing Dr. Lucille on the deleterious effects of modern day stressors on the neuroendocrine system. Individuals dealing with these stressors often have complaints of fatigue, irritability, decreased stress resistance, insomnia, weight gain and hormone imbalances. In this interview, Dr. Lucille will share how she addresses sleep disruptions and the effects of chronic stressors by managing cortisol, so her patients can achieve greater balance and clinical outcomes, quicker.

Please join us on Thursday, October 25^th, 2011 at 7:00 PM Central time.

There is no charge for this webinar.  For more information go to the link on the Events page

This study involved more than 61,000 women between the ages of 63 and 97. During the 19 year period of follow-up on these women, almost 15,000 of them, or about one-quarter, had some type of fracture for the first time. Among those, 3,871, or 6% of them, experienced a hip fracture. Among another subcohort of 5,000 women, 20% of them met the criteria for osteoporosis.

While perhaps surprising to some, the researchers found that the rates of fracture risk were not related to dietary calcium in a linear fashion. It’s true that those women who were in the lowest calcium intake quintile (less than 751 mg/day), had the highest risk for a first time hip fracture, but the group at the next highest risk for hip fracture was the fifth quintile (greater than 1,137 mg per day). A low vitamin D intake made the rate of hip fracture in the lowest calcium quintile group even more pronounced.

Commentary: This is yet one more study that teaches us that more is not always better. In fact in this case, the most was worse. While these results are inconsistent with current U.S. guidelines, I still think it would be a good opportunity to review those guidelines. For women ages 51-70, the Recommended Dietary Allowance (RDA), the intake that meets the needs of 97.5% of the North American population is 1,200 mg per day; the Estimated Average Requirement (EAR)- a number based on the intake that meets the needs of 50% of the North American population, is 1,000 mg per day for women ages 51-70.

Reference

Warensjo E, Byberg L, Melhus H, et al. Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study. BMJ. 2011;342:d1473.

The JELIS (Japan EPA Lipid Intervention Study) trial [4] included a total of 18,645 subjects (men aged 40-75 and postmenopausal women aged > 75 and a mean age of 61 years and 31% men). Those with a serum total cholesterol level of > 250 mg/dL were eligible. About 36% were hypertensive, 15% had diabetes and 20% had coronary artery disease. Subjects were randomized to pravastatin 10mg/day or simvastatin 5mg/day or the same statin doses with 1,800 mg/day of EPA. After 5 years, those in the EPA group had a 19% reduction in major cardiac events.

These three trials indicated that omega-3 PUFAs lowered the risk of CV disease in both primary and secondary prevention. While not all studies have shown favorable results, the numbers of patients treated, the doses used, and the results of the DART, GISSI and JELIS study are strong motivations to increase dietary fish intake and especially fish oil supplementation. In order to test and remove heavy metals, pesticides, other environmental contaminants and microbes, look for products that can produce independent third part testing for each lot of supplements.

Recommended doses for primary and secondary prevention:

1,000 mg/day of combined EPA/DHA

References:

[1] Harris W, Poston W, Hadock C. Tissue n-3 and n-6 fatty acids and risk for coronary heart disease events. Atherosclerosis 2007;193:1-10.

[2] Burr M, Fehily A, Gilbert J, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet 1989;2:757-761.

[3] Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI. Lancet 2001; 357;642 and Lancet 2007;369:106 and Lancet 1999;354;447-455.

[4] Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007;369:1090-1098.

During the three months before pregnancy or the first month of pregnancy, mothers of children with autism were less likely than those of typically developing children to report having taken prenatal vitamins. In addition, there were greater risks for autism observed in some of the metabolic genetic variants, in those mothers who did not take prenatal vitamins preconception and/or in the first month. In short, the use of prenatal vitamins, taken preconception, may reduce the risk of having children with autism, especially for genetically susceptible mothers and children.

Commentary: Attention is being increasingly given to the preconception time period and the health and nutritional status of the mother in particular. This is distinct from the use of vitamins/minerals/herbs to enhance fertility in men and women. I’m encouraged to see research in this area, and to see positive results, in something as simple and affordable as prenatal vitamins is especially reassuring, and in something as daunting as autism, with the incidence increasing and as yet with an unclear cause. According to “Autism Speaks”, a leading science and advocacy organization, it is estimated that 1 in 110 children in US are diagnosed with autism. Government statistics suggest the prevalence rate of autism is increasing 10 to 17 percent annually. We clearly need to become more aggressive in understanding the potential causes and influences on autism, and be assertive in any prevention strategies that can reduce the incidence.

Reference

Schmidt R, Hansen R, Hartiala J, et al. Prenatal Vitamins, One-carbon Metabolism Gene Variants, and Risk for Autism. Epidemiology; July 2011 – Volume 22 – Issue 4 – pp 476-485

The list is long for the consequences of a magnesium deficiency. Magnesium deficiencies can result in hypokalemia (low potassium), alkalosis, hypertension, congestive heart failure, arrhythmia, myocardial infarction, angina pectoris, clotting, atherosclerosis, type 2 diabetes, preeclampsia and other electrolyte deficiencies. [2]

Magnesium deficiency can be acquired many ways. A decrease in dietary consumption of magnesium has gone from 500mg/day in 1900 to 215-283 mg/day in 1990.[3]^{, [4]} It is estimated that the typical dietary intake of magnesium today in the U.S. provides only 35-75% of the recommended daily amount.[5]

Many over the counter and prescription drugs can influence magnesium nutrient levels and depletion. The list is long, but includes loop and thiazide diuretics, digoxin, carboplatin and cisplatin, corticosteroids, estrogen and oral contraceptives, insulin, proton pump inhibitors, tetracyclines, cyclosporine, laxatives and more.1 Advanced age is also associated with decreased serum and tissue magnesium levels.

Perhaps one of the more common problems with magnesium results in the relationship of calcium and magnesium. High calcium diets or calcium supplementation without attention to magnesium supplementation has been shown to decrease tissue magnesium levels, [6] increase magnesium requirements[7] and decrease magnesium absorption.[8] In individuals with low or suboptimal magnesium status, administration of calcium without concomitant magnesium may further compromise their magnesium status, further increasing their risk of the many of the health risks associated with magnesium insufficiency/deficiency that we have mentioned earlier.

Convenient serum testing for magnesium is usually inadequate because it does not reflect magnesium stores. Less convenient but more accurate testing would include a magnesium-loading test looking at 24-hour urinary magnesium excretion after an infusion of magnesium. Magnesium can also be measured in red blood cells, white blood cells, mononuclear blood cells, and muscle. An intracellular mineral electrolyte panel using cell scrapings under the tongue with electronic photon bombardment technology is available as well.

Supplementing the body’s magnesium stores through oral supplementation takes about six weeks but may be up to six months or more. [9]^,[10] Many different magnesium salts are available as supplements. Magnesium oxide contains the largest amount of elemental magnesium. Magnesium chloride has high bioavailability. Magnesium may also be bound to aspartate, malate, succinate, fumarate, citrate, gluconate, sulfate and chloride. Some manufacturers assert that magnesium chelated to malate, succinate, fumarate or citrate are better absorbed, utilized and tolerated, but this is variable and not definitive.

Given the prevalence of hypertension, congestive heart failure, arrhythmias, ischemic heart disease, heart attacks and type 2 diabetes in the U.S., magnesium has emerged as a very critical supplement for prevention and management of these conditions. Intervention doses vary from 250 mg/day to 1,000 mg/day depending on the condition, body weight, age, and tolerability. Individuals with kidney disease or heart blocks should not take magnesium unless under a physician’s supervision. Magnesium is generally well tolerated, although there is often a dose limiting amount above which causes loose stool.

Magnesium is an essential mineral for normal body physiology. Deficiencies and insufficiencies are more common than is easily detected, and may lead to numerous cardiovascular disorders, type 2 diabetes, preeclampsia and eclampsia.

In most cases, I recommend that calcium supplementation should also include magnesium supplementation and a ration of approximate 2 parts calcium: 1 part magnesium. Current reference guidelines for daily intake for your age and gender can be obtained from the Institute of Medicine or from www.nutrition.gov. It is important to keep in mind the dietary supplement dosages are in addition to the average daily amount you are getting in your diet, to achieve the recommended daily amount.

References

[1] Dacey M. Hypomagnesemic disorders. Crit Care Clin. 2001;17:155-173.

[2] Gums J. Magnesium in cardiovascular and other disorders. Am J Health-Syst Pharm 2004;61:1569—76.

[3] Kawano Y, Matsuoka H, Takishita S, et al. Effects of magnesium supplementation of hypertensive patients: assessment by office, home, and ambulatory blood pressures. Hypertension. 1998;32:260-5.

[4] Arsenian M. Magnesium and cardiovascular disease. Prog Cardiovasc Dis. 1993; 35:271-310.

[5] Altura B, Altura B. Magnesium and cardiovascular biology: an important link between cardiovascular risk factors and atherogenesis. Cell Mol Biol Res. 1995;41:347-59.

[6] Smith K, Luhrsen K. Trace mineral interactions during elevated calcium consumption. Fed Proc 1986;45:374.

[7] O’Dell BL, Morris ER, Regan WO. Magnesium requirement of guinea pigs and rats. Effect of calcium and phosphorus and symptoms of magnesium deficiency. J Nutr 1960;70:103-111.

[8] Clarkson E, Warren L, McDonald S, de Wardener H. The effect of a high intake of calcium on magnesium metabolism in normal subjects and patients with chronic renal failure. Clin Sci 1967;32:11-18.

[9] Hollifield J. Thiazide treatment of hypertension: effects of thiazide diuretics on serum potassium, magnesium, and ventricular ectopy. AmJ Med. 1986;80 (suppl 4A): 8-12.

[10] Whang R, Ham;pton E, Whang D. Magnesium homeostasis and clinical disorders of magnesium deficiency. Ann Pharmacother. 1994;28:220-6.